Scientific paper| Volume 129, ISSUE 5, P537-544, May 1975

Download started.


Proteolytic enzymes as adjuncts to antimicrobial prophylaxis of contaminated wounds

      This paper is only available as a PDF. To read, Please Download here.


      When a tissue is injured, its vessels exhibit a marked increase in vascular permeability. Blood proteins, including fibrinogen, traverse the vessel walls and lead to the development of a surface coagulum. This inflammatory response continues until primary closure of the wound edges is accomplished. The thickness of the surface coagulum is roughly proportional to the time interval between wounding and closure. This coagulum encompasses the surface contaminants, preventing contact with either topical or systemic antibiotics. The presence of this surface coagulum limits the time in which antibiotic prophylaxis is effective. At three hours after injury, antimicrobial prophylaxis of contaminated wounds has no therapeutic value.
      Hydrolysis of the protein coagulum by proteolytic enzymes enhances the activity of the antibiotic in experimental wounds. The success of proteolytic enzymes as adjuncts to delayed antibiotic treatment can be correlated with the clot lysis activity of the enzymes in vitro. Travase, the most potent fibrinolytic enzyme, is the most effective adjunct to delayed antibiotic therapy of contaminated wounds. In contrast, the active enzymes found in Elase, which exhibit no significant clot lysis activity in vitro, do not potentiate the activity of antibiotics in wounds subjected to a delay in treatment.
      Travase prolongs the period of effective topical antibiotic action for at least eight hours in experimental contaminated wounds. The therapeutic merit of Travase is also apparent when the antibiotic is administered systemically. Travase shows promise as an adjunct to a variety of antibiotics that are effective against both gram-positive and gram-negative organisms.
      The results of these experimental studies support our belief that clinical studies should now be initiated to test the therapeutic value of Travase as an adjunct to antibiotics in heavily contaminated wounds subjected to an unavoidable delay in treatment.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Burke JF
        The effective period of preventive antibiotic action in experimental incisions and dermal lesions.
        Surgery. 1961; 50: 161
        • Fullen WD
        • Hunt J
        • Altemeier WA
        Prophylactic antibiotics in penetrating wounds of the abdomen.
        J Trauma. 1972; 12: 282
        • Edlich RF
        • Smith QT
        • Edgerton MT
        Resistance of the surgical wound to antimicrobial prophylaxis and its mechanisms of development.
        Am J Surg. 1973; 126: 583
        • Rodeheaver GT
        • Edgerton MT
        • Elliott MB
        • Kurtz LD
        • Edlich RF
        Proteolytic enzymes as adjuncts to antibiotic prophylaxis of surgical wounds.
        Am J Surg. 1974; 127: 564
        • vonKaulla KN
        A simple test tube arrangement for screening fibrinolytic activity of synthetic organic compounds.
        J Med Chem. 1965; 8: 164
        • Grannis G
        Plasma fibrinogen: determination, normal values, physicopathologic shifts, and fluctuations.
        Clin Chem. 1970; 16: 494
        • McConn JD
        • Tsuru D
        • Yasunobu KT
        Bacillus subtilis neutral proteinase. I. A zinc enzyme of high specific activity.
        J Biol Chem. 1964; 239: 3706
        • Prytz B
        • Connell Jr, JF
        • Rousselot LM
        Bacillus subtilis protease in the digestion of burn eschar.
        Clin Pharmacol Ther. 1966; 7: 347
        • Silverstein P
        • Ruzicka FJ
        • Helmkamp Jr, GM
        • Lincoln Jr, RA
        • Mason AD
        In vitro evaluation of enzymatic debridement of burn wound eschar.
        Surgery. 1973; 73: 15
        • Grossman AR
        Sutilains ointment as a topical debriding agent in burns.
        Int Surg. 1973; 58: 93
        • Pennisi VR
        • Capozzi A
        • Friedman G
        Travase, an effective enzyme for burn debridement.
        Plast Reconstr Surg. 1973; 51: 371
        • Fishman LS
        • Hewitt WL
        The natural penicillins.
        Med Clin North Am. 1970; 54: 1081
        • Robson MC
        • Edstrom LE
        • Krizek TJ
        • Groskin MG
        The efficacy of systemic antibiotics in the treatment of granulating wounds.
        J Surg Res. 1974; 16: 299