Assessment of Acceptability and Ease of Use of Haemoglobin Spray (Granulox®) in the Management of Chronic Wounds

Abstract

: Wound healing is a complex and orchestrated process. Oxygen is one of the molecules that is required throughout the wound healing continuum for various underlying processes from innate immune response at the in fl ammatory phase to building of collagen type III at the remodel-ling phase. Therefore, it is not surprising that, due to primary diseases like venous insuf fi ciency and diabetes mellitus, hypoxia caused by sustained lack of oxygen is common in chronic wounds. Adjunct to systemic therapies of the primary disease aimed at revascularizing the tissue, recently developed technologies are now available that provide topical oxygen-enhanced wound healing. Several devices are designed to provide pure oxygen directly to the wound either with or without pressure. Another approach to the provision of additional topical oxygen is to use haemoglobin to facilitate oxygen diffusion. This phenomenon was fi rst shown more than 50 years ago, but it has only recently been discovered as a means of improving wound healing. In vitro and in vivo studies have shown that haemoglobin is capable of transporting oxygen outside of erythrocytes. Furthermore, several clinical studies have shown a bene fi cial effect on wound healing in different wound types. In this review, we summarise publicly available in vitro and in vivo clinical data and discuss the acceptability and ease of use of haemoglobin spray (Granulox ® ) in the management of chronic wounds. In conclusion, currently available data are promising, demonstrating that puri fi ed haemoglobin in an aqueous solution is able to serve as an oxygen shuttle by facilitating diffusion. No severe side effects have been reported in the literature, implying that it is a safe product. In clinical studies, it has been observed to improve the speed of healing of different types of chronic wounds. As a simple spray, it can be used as adjunct treatment in many standard-of-care settings with only a few limitations.