WO2008079036A1 - Atraumatic wound-cleansing long acting polymer hydrogel dressing - Google Patents

Abstract

The inventive atraumatic wound-cleansing long acting polymer hydrogel dressing is used for treating necrotic septic wounds of various etiology and consists of thee layers. The first healing layer applicable to a wound is embodied in the form of a dialdehyde cellulose provided with trypsin and lysozyme ferments co-immobilised thereon. The second layer is embodied in the form of a hydrogel plate which is based on acrylic polymers, for example, polyacrylamide dried to residual moisture of 6%. The third protective-and-absdorbingis layer is embodied in the form of a non-woven material which is based on ultrathin fibres and is covered on both sides with a perforated polyethylene film, wherein the surface area of the pores of the lower polyethylene layer is by three times greater than the thickness of the top layer. The dry dressing is packed in two-layer polyethylene packages is sterilised by means of gamma-radiation the dose of which is of 25 kGy. Prior to application, the dressing is humidified, thereby providing the healing layer with a high specific activity. The inventive dressing is characterised in that it can be applied to a wound for four days. Said dressing removes detritus from the wound and also accelerates reparative processes. The healing and hydrogel layers are constantly humid, thereby making the dressing highly atraumatic.

Description

 Atraumatic cleansing wound dressing of prolonged action with polymeric

HYDROGEL

FIELD OF THE INVENTION

The present invention relates to medicine, specifically to a medical material for closing wounds, which is capable of lysing necrotic proteins for a long time and removing them from the surface of the wound, having high sorption ability against wound exudate. The multilayer combined construction of the material allows you to create the optimal microenvironment for wound healing, prevent the ingress of microorganisms, has a permeability to water vapor and prevents drying of the wound. In the presence of the above properties, the material or bandage from it is easily removed from the surface of the skin even after a long stay on the wound.

Medical material and products from it are intended for the treatment of purulent necrotic wounds, trophic ulcers, burns, frostbite and other similar diseases.

State of the art

Currently known materials and methods for their preparation, which are successfully used to treat purulent necrotic wounds, trophic ulcers, burns and other similar disorders.

This is the nameplate “Kompigel” (manufacturer: “Paul Hartmapp AB” (HARTMANN product catalog for the clinic “page 10 combined sorption dressings”, 2004). This is an atraumatic gel dressing with a sorption pad made of non-woven material that has high absorbency, with a non-woven coating; the side facing the wound is covered with a gel layer that does not adhere to the wound, it is secret and airtight, the wound can be easily penetrated into the sorption pad; the dressing is well drained and, thanks to its light weight, CB gel adhesive action, easily applitsiruetsya. The product is used for the general treatment of wounds of various etiologies, but the ability to cleanse the wound dressing "Koppigel" does not possess.

Compress “TandepBet 24” (manufacturer: “HARTMANN”, see ibid., P. 2, p. 16) is a suction sorption compress on the wound, which in within 24 hours it is activated by Ringer's solution, which moisturizes the wound and absorbs the discharge, while accelerating the cleaning of the wound. Compress is used for complex wet therapy, especially for continuous wound cleansing, for example, for wounds with a poor tendency to heal in chronic wounds of various origins, such as pressure sores, trophic and diabetic ulcers.

The dressing Gidropocop is also known (manufacturer: HARTMANN, see p. 16, see p. 2). This is an absorbent hydrogenic dressing with a semi-permeable top layer that prevents the penetration of microorganisms. The dressing creates a uniform moist environment in the wound; promotes rapid rejection of necrotic masses, stimulates the processes of granulation and epithelization. The dressing is used to treat wounds in a humid environment, especially when treating chronic, poorly healing wounds and treating burns, but the dressing does not have a cleaning ability.

The products listed above, as already noted, do not contain in their molecular or compositional structure proteins, enzymes or drugs that contribute to wound cleansing.

However, materials and methods for their preparation are known on the basis of a textile carrier made from dialdehyde cellulose (DAC) or polycaproamide, containing drugs of a protein nature immobilized on them, which are quite successfully used in the treatment of purulent-necrotic wounds, trophic ulcers and other similar diseases.

So known is a method of obtaining material (see DE 197 47 832 Al) in the form of a wound cover for use in the treatment of purulent-necrotic wounds and similar injuries. The method consists in the fact that cotton fabric in the form of medical gauze is pre-oxidized with a sodium periodate solution to a DAC with an aldehyde group content of 0.04-0.06 mEq per 1 g of carrier. Then, the material is treated with a mixture of trypsin and insulin solutions with a bath module 2.5. (The bath module is the ratio of the weight of the solution to the weight of the processed material.) In this case, the aldehyde groups of the carrier material interact with the free amino groups of trypsin and insulin with the formation of the azomethine bond and, as a result, these proteins are immobilized on the material. The referenced link states that when a polycaproamide knit fabric is used as a carrier, aldehyde groups are introduced by treating the polycaproamide knit fabric with glutaraldehyde. The final product contains trypsin, trypsin and insulin as the active ingredient. As an advantage of this technical solution, a significant (20%) reduction in the time for cleansing of detritus of purulent necrotic wounds compared to the closest analogue is mentioned, for which patents RU 2 062 1 13 and RU 2 131 268 are named.

There is also known a method of producing material (see US 6,500,799 B2) in the form of a wound dressing, which provides for the preliminary activation of the carrier material as a result of its oxidation, as a result of which the material contains 0.026-0.06 mEq aldehyde groups per 1 g of carrier. After that, at least one enzyme is immobilized on it in an effective amount for the functioning of the material for at least 3 days. The same link discloses material with the above properties obtained by the disclosed method. The material contains trypsin, trypsin and insulin, trypsin and lysozyme, trypsin and mexidol as the active ingredient. It is also reported that the terms of wound cleansing are 2.4 days compared with 7.5 days during which a similar effect is achieved using conventional methods and means.

A known method of obtaining a material containing lysoamidase immobilized on dialdehyde cellulose (an enzyme having both proteolytic and bacteriolytic activity (see RU 2 127 609).

RU 2 142 818 discloses a method for producing dressings, comprising treating an activated textile carrier material with a protein preparation solution, followed by maintaining the treated carrier material; in air and drying. In the method, dialdehyde dellulose or polycaproamide with an aldehyde group content of 0.04-0.06 mEq per 1 g of support is used as the activated textile material, and processing is performed by adding the activated textile material in a protein solution. The material contains, as immobilized proteins, trypsin or trypsin and insulin, or trypsin and lysozyme. In cases of a large number of wound discharge, the manufacture of dressings is provided, in which the therapeutic layer adjacent to the wound is connected by a sewing method to an absorbent layer having a large moisture absorption. The link states that the use of material obtained by the disclosed method allows you to clean the wound within 2.3-2.6 days.

From the application Na PCT / RU 2005/000133, a material (system) having biological activity, a method for its preparation and a therapeutic agent for it are known basis. To obtain such material, known carriers are used: cotton fabric made from dialdehyde cellulose or a polycaproamide knitted fabric activated with glutaraldehyde containing aldehyde groups of 0.08-0.10 mEq per 1 g of carrier. Three proteins are immobilized on these carriers: trypsin, lysozyme and insulin in a weight ratio of 1: 1.33: 1.67, respectively, per 1 g of carrier. Known materials can be used to treat purulent-necrotic wounds of various etiologies in the form of applications, lint (cotton wool) or powder. The dispersed form can be used independently or introduced into the composition of gels, ointments, suppositories, etc. on a hydrophilic basis. In addition to the treatment layer of the therapeutic material, a hydrophilic drainage layer absorbing wound exudate can be placed on top of it.

The above materials (systems) are not without drawbacks. One of the serious drawbacks is that the treatment layer, and especially the system consisting of treatment and absorbent layers, actively absorbs wound exudate and promotes the evaporation of moisture. And with insufficient moisture, the treatment layer dries to the wound surface and injures it during dressings. In addition, these proteins have a therapeutic effect only in a humid environment, in the dry state they are inactive.

A hydrogel composition is known in which the water-swellable polymer comprises from about 2 to 15% by weight of the composition (see RU 2,276,998). This composition is used to produce dressings for a wound. The dressing contains bacteriostatic and bactericidal compounds, antibiotics, amino acids, proteins, proteolytic enzymes, cytokines and other drugs. This patent also has several disadvantages. This dressing can not be sterilized by known methods: with steam sterilization, the thermal inactivation of drugs occurs; in radiation sterilization - inactivation due to radiolysis in a humid environment. Non-sterile material is not allowed on the wound. It can be assumed that, probably for this reason, the said patent does not contain data on the properties of the dressings themselves, which they showed, for example, during treatment. Therefore, it is impossible to judge the applicability of the proposed technical solution, its advantages over solutions known in the prior art.

And finally, despite the fact that in paragraphs 55 and 56 of the claims of the patent it is provided that an active agent suitable for application to the wound, for example, proteolytic enzymes, the characteristics of such a composition are completely absent in the description, for example, the concentration of enzymes, the rate of protein diffusion into wound exudate, etc. are not known.

The aim of the present invention is to remedy these disadvantages and create a material that provides the maximum therapeutic effect, high non-invasiveness and a high degree of wound cleansing.

SUMMARY OF THE INVENTION

The aforementioned goal is achieved by using the atraumatic wound cleansing wound dressing of the present invention. Thus, the present invention, in one of its aspects, relates to a sustained-release atraumatic wound dressing containing a polymeric macroporous hydrogel, in which the healing layer adjacent to the wound is dialdehyde cellulose with trypsin and lysozyme enzymes co-mobilized on it. The specified dressing contains a plate of dried hydrophilic gel, which is located on the treatment layer, and also contains a protective and absorbent layer, which is located on top of the hydrogel plate, while the entire structure is bonded in the usual way.

Preferably, in the dressing according to the invention, the degree of oxidation of cellulose to dialdehyde cellulose is 1.1 ± 0.1%, and the content of trypsin and lysozyme co-immobilized on it is 3 mg per 1 g of carrier for each of the enzymes. To obtain a treatment layer with such an enzyme content, 3 g of solution are dissolved in 3 l of distilled water, 3 g of lysozyme are dissolved in 3 l of distilled water, the solutions are poured together and dipped in 6 l of the resulting mixture 1 kg of dialdehyde cellulose with an oxidation state of 1.1% by 4 hours.

When proteins are immobilized under given conditions, three fractions of trypsin and lysozyme are formed on the treatment layer:

- a fraction consisting of sorbed proteins, which, when applied to a wound, quickly pass into the volume of exudate, providing a short-term therapeutic effect;

- a stabilized fraction located on the fragments of the carrier and representing proteins immobilized on them, which go into the volume of exudate in a given mode, providing a prolonged therapeutic effect;

- therapeutic fraction chemically associated with sections of the polymer chain with low content of aldehyde groups and therefore stable in water, which has a uniform therapeutic effect on the wound surface during the functioning of the dressing.

Preferably, a polymer based on acrylic acid derivatives is used in the dressing of the invention in the form of a structured film with a moisture content of not more than 6%, obtained by drying a 20% aqueous polymer solution at a temperature not exceeding 37 ° C. Upon contact with an aqueous medium, the structured polymer film swells and turns into a structured macroporous hydrophilic gel that maintains the moisture of the treatment layer for the entire time the dressing is on the wound, which ensures high enzymatic activity, and after Consequently, the high therapeutic effect of the layer adjacent to the wound, as well as its high non-invasiveness.

Most preferably, Temposcrin (from the manufacturer, the scientific and technical company Atombiotex) or a polyacrylamide gel is used as the indicated acrylic derivatives.

Preferably, in the bandage according to the invention, a three-layer structure is used as said protective absorbent layer, the upper and lower layers of which are perforated polyethylene film and the inner layer is a non-woven material with high absorbency, while the total area of the holes on the lower adjacent to the gel plate layer, 3 times the area of the upper layer.

A further aspect of the present invention is a method for treating purulent necrotic wounds using the dressing of the invention described above. The method includes the step of wetting the dressing according to the invention before applying it to the wound surface for up to 4 days.

Another aspect of the invention is a method for producing a dressing. The method includes the steps of: a) oxidizing the cellulose web to dialdehyde cellulose (DAC) with an oxidation state of 1.1%; b) processing 1 kg of DAC for 4 hours with a solution of a mixture of trypsin and lysozyme containing 3 g of each enzyme in 6 l of distilled water, spinning and drying the sheet to a residual moisture content of not more than 6%; c) obtaining a structured polymer film with a moisture content of not more than 6% by drying a 20% aqueous polymer solution based on derivatives acrylic acids at a temperature not exceeding 37 ⁰ C; d) the manufacture of a dressing consisting of a lower layer adjacent to the wound with immobilized enzymes, a middle layer, which is a structured polymer film based on derivatives of acrylic acids, characterized by a high value of water absorption and a protective-absorbent layer, which is a non-woven material with high absorbency, concluded on both sides in a perforated plastic film, while the entire structure is fastened in a known manner; e) packaging the dressing in double plastic bags and sterilization with gamma radiation at a dose of 25 kGy.

The implementation of the invention

The present invention provides a new medical dressing that can improve and accelerate the time of wound cleansing and healing, sorb the wound discharge and not injure the wound surface during dressing, create an optimal microenvironment for wound healing, prevent microorganisms from entering the wound and prevent drying of the wound.

The dressing of the present invention is a multilayer combination composition. The product consists of three layers: therapeutic, dried hydrogel and protective and absorbent layers. The healing layer adjacent to the wound consists of dialdehyde cellulose-based tissue with the trypsin proteolytic enzyme and the lysozyme bacteriolytic enzyme immobilized on it. In the process of co-immobilization of these proteins on the tissue, three therapeutic fractions of the drug are formed, two of which, in the mode set by the developers, switch from tissue to wound exudate evenly distributed in its volume and thus have a therapeutic effect on the wound.

The presence of three fractions provides an effective mechanism for the therapeutic effect of the treatment layer. The properties of modified cellulose are very different from the original cellulose. Cellulose is a chemically inert, water-insoluble substance. Modified cellulose is a chemically active compound capable of partial dissolution in water (hydrolytic destruction).

During the oxidation of cellulose, aldehyde groups are distributed unevenly along the polymer chain. The higher the local concentration of aldehyde groups, the higher the rate of hydrolytic destruction of such sites.

Protein immobilization does not fundamentally change the patterns of hydrolytic destruction. It must be emphasized that due to the uneven distribution of aldehyde groups in the macromolecule of dialdehyde cellulose, some proteins are not chemically attached to the carrier (tissue), but are bound to it by sorption forces. When applied to the wound, this part of unmodified proteins is easily washed out by wound exudate and provides a short-term shock proteolytic and bacteriolytic effect of enzymes (hereinafter - the loading dose). The second, most effective fraction of proteins is stabilized (hereinafter - the maintenance dose). It is located on fragments of the carrier in the form of a chemically immobilized fraction. These fragments are formed as a result of hydrolytic destruction and in a given mode enter the volume of exudate, providing a prolonged therapeutic effect. Sections of the polymer chain with a low content of aldehyde groups and the third fraction of proteins attached to them are stable in water. These areas, here called the therapeutic dose, provide throughout the entire time the wipes are in the wound (up to 4 days) a uniform therapeutic effect on the surface of the wound.

The higher the rate of hydrolytic destruction, the greater the proportion of stabilized fraction.

At an oxidation state of 2%, the loading dose is small, the fraction of the stabilized fraction is hypertrophied, and the fraction of the non-hydrolyzable fraction quickly falls below the minimum therapeutic dose, which is not permissible.

With an oxidation state of 0.4%, most of the proteins are not chemically bound to the carrier, are quickly washed out in the form of a loading dose, and both the maintenance and the minimum therapeutic doses are practically absent.

One of the most important distinguishing features of this invention is a certain combination of the oxidation state of the carrier and the amount of immobilized proteins, which ensures the formation of three therapeutic fractions at the optimal ratio. The immobilization of 0.6 mg of protein per 1 g of modified cellulose with an oxidation state of 1.1% provides the following optimal ratio of fractions: shock dose -15% maintenance dose -70% therapeutic dose -15% Known hydrophilic polymer gels are predominantly isotropic gels, the moisture content of which reaches 95-97% of the total weight, however, a significant drawback of such systems is their low gas permeability and low mechanical strength while achieving high degrees of swelling. Another significant drawback of the majority of polymeric isotropic hydrogels is a change in their equilibrium swelling with a slight change in ionic strength and the pH of the environment. In addition, in such systems, most of the water is in a bound state in the nodes of the polymer network, which makes it difficult to isolate it from the hydrogel volume, thereby reducing the value of these polymer systems from the standpoint of their possible use as a component of the moisturizing layer.

The polymer macroporous hydrogels according to the invention (i.e., hydrogels containing a developed system of interconnected pores with a size of tens of micrometers) are mainly devoid of most of the above disadvantages, due to the fact that the bulk of the liquid bound by such polymer systems is in a free state in the pore volume, and the contribution to the total swelling of the polymer part itself is relatively small. Such systems are characterized by a high value of water absorption (up to 40 g of liquid / g of dry hydrogel), slightly varying over the entire range of physiological pH values and ionic strength, high permeability, considerable mechanical and thermal stability. The high specific surface of macroporous polymer hydrogels and the easy availability of their functional groups provide ample opportunity for their modification with various biologically active ligands.

The macroporous hydrophilic gels according to the invention can be obtained on the basis of polymers and copolymers of acrylic and methacrylic acids, methyl acrylate and methyl methacrylate, ethyl acrylate and ethyl methacrylate, the Tempoccrin reagent (from the manufacturer Scientific and Technical Company Atombiotex) and polyacrylamide.

A method of producing polyacrylamide is known (see "Encyclopedia of Polymers, vol. 1, pp. 30-31, ed." Soviet Encyclopedia)), 1972). Polyacrylamide is obtained by polymerization of acrylamide according to the radical mechanism in the presence of conventional initiators. Typically, the polymerization is carried out in an aqueous solution (8 - 10% - nom) with the participation of a redox system (for example, ammonium persulfate - potassium metabisulfite). The polymer is isolated from the aqueous solution by evaporation at low temperature (under vacuum). To obtain a dried hydrophilic gel, useful for the purposes of the invention, a 20% solution of polyacrylamide or Tempoccrin reagent in water is prepared, poured into 12x12 cm baths and dried at a temperature not exceeding 37 ⁰ C to a residual moisture content of not more than 6%.

The protective-absorbent layer of the dressing according to the invention is multicomponent. A nonwoven fabric made from ultrafine polyester fibers is placed between two layers of a polyethylene film having openings. This material is designed to absorb exudate, necrotic tissue and pathogens lysed by immobilized proteins from the wound. The specified multicomponent complex, in addition to removing exudate, is intended to protect the wound from microorganisms.

To make a dressing, the healing layer adjacent to the wound, the dried hydrogel and protective-absorbing layers are combined in a known manner, sealed in double plastic bags and sterilized with gamma radiation at a dose of 25 kGy.

Before applying to the wound, the dressing is moistened. When applied to the wound, the polymer macroporous gel swells. The shock (sorption) and stabilized (supporting) fractions of proteins (trypsin and lysozyme) in a humid environment begin to work, lysing the proteins of necrotic tissue and destroying pathogenic microflora. The absorbent layer absorbs the exudate, and the therapeutic dose provides a stable "work" of the medical dressing for up to 4 days.

Confirmation that the quantitative characteristics of the dressing proposed in this application are optimal from the point of view of the therapeutic effect are the data shown in table I.

Table 1

As can be seen from table 1, the time of wound cleansing, and, consequently, the enzymatic activity of the dressing, depends on the degree of binding of the enzymes to the carrier - the number of enzymes per mg per 1 elementary unit of dialdehyde cellulose. In patent RU 2131268, this value is 0.125. The degree of binding is large, the fraction of the adsorbed fraction is small, the stabilized fraction is hypertrophied, and the therapeutic fraction is small. The period of wound cleansing is three days. In the patent RU 2142818 the degree of binding is small (1 elementary unit of dialdehyde cellulose cannot chemically bind 320 mg of enzymes), the fractions of the stabilized and therapeutic fractions are small, sorbed are large. The terms of wound cleansing are 2.4 days. The optimal degree of binding characteristic of the claimed invention was 87.2. In the claimed invention, in terms of wound cleansing efficiency, fractions complement each other. The term for wound cleansing is 2 days.

The prior art does not disclose a bandage with similar characteristics, which indicates its novelty. The obtained experimental optimal value of the degree of binding is not obvious, does not follow from the prior art or fundamental theoretical knowledge. There is a practical value of the proposed technical solution, which provides a reduction in the time (1.5 times) for cleansing wounds from detritus compared with, for example, patent RU 2131268, as the closest analogue.

The use of a hydrophilic gel as the second layer of the dressing allows you to maintain high therapeutic activity of the product for 4 days (according to the patent US b 500 799B2 - 3 days).

Currently, the dressing according to the invention has undergone clinical trials, developed and approved specifications and technological regulations for the production of dressings.

Table 2 shows data demonstrating the non-invasiveness of the products disclosed in patents and applications DE 19747832 Al, US 6 500 799B2 and JMa PCT / RU 2005/000113, as well as the dressing according to the invention.

Table 2 Comparative non-invasiveness of various products when changing on the second day

A method for determining the non-invasiveness of medical dressings is described in the USSR Copyright Certificate 1522928, 1987.

It can be seen that the proposed medical dressings have an advantage over the well-known not only in terms of cleansing and healing of wounds, but also in terms of noninvasiveness. The force of separation from the surface of the wound of the therapeutic system manufactured according to the invention is 100 times less than medical gauze, 50 times less than trypsin - insulin or trypsin - lysozyme systems and 2.5 times lower than trypsin - lysozyme - insulin systems on dialdehyde dellulose (see table 2) .

Industrial applicability

One of the serious problems that the medical staff of purulent departments of clinical hospitals faces is the drying of dressings to the surface of the wound. With dressings, the wound is injured, secondary bleeding occurs, the patient experiences pain.

In order to avoid the drying of dressings to the wound, the medical staff spends considerable time and effort on periodic irrigation of the dressing. For this reason, treatment of wounds with dressings with biological activity is carried out in the first half of the week so as not to leave such dressings on the wound on weekends, when only the medical staff on duty who cannot carry out additional wound irrigation procedures remains in hospitals.

It is assumed that the mechanism of therapeutic action of the proposed dressings is two-stage. In the first two days, due to desorption and hydrolytic destruction, 67.5% of 85% of the fractions capable of passing into a soluble form pass into the wound exudate. Usually during this time the wound is completely cleansed of purulent-necrotic masses and pathogenic microflora. In addition to cleansing the wound from detritus, trypsin and lysozyme have a powerful reparative effect, accelerate cell proliferation, the growth of granulations and thus contribute to the restoration of lost soft tissues.

Thus, the proposed dressing, applied to the wound for 4 days, the first 2 days cleanses the wound from devitalized tissues, the second two days - promotes reparative processes. Removal of the dressing occurs with minimal effort, not injuring the wound.

Claims

CLAIM 1. Atraumatic wound cleansing dressing of prolonged action with a polymer macroporous hydrogel, in which the healing layer adjacent to the wound is dialdehyde cellulose with trypsin and lysozyme enzymes co-mobilized on it, characterized in that the dressing contains a structured polymer film characterized by a high water absorption treatment layer, and also contains a protective absorbent layer, which is located on top of the structured polymer film, with this whole structure is fastened in a known manner. 2. The dressing according to claim 1, characterized in that the degree of oxidation of cellulose to dialdehyde cellulose is 1.1 ± 0.1%. 3. The dressing according to claim 1, characterized in that the content of trypsin and lysozyme co-immobilized on it is 3 mg per 1 g of carrier for each of the enzymes. 4. The dressing according to claim 1, characterized in that upon immobilization of proteins under specified conditions, three fractions of trypsin and lysozyme are formed on the treatment layer: a fraction consisting of unmodified sorbed proteins, which, when applied to the wound, quickly pass into the exudate volume, providing a short-term shock therapeutic effect; the stabilized fraction located on fragments of the carrier and representing proteins immobilized on them, which pass into the volume of exudate in a given mode, providing a prolonged therapeutic effect; the therapeutic fraction chemically bound to sections of the polymer chain with a low content of aldehyde groups and therefore stable in water, which has a uniform therapeutic effect on the surface of the wound during the entire operation of the dressing. 5. The dressing according to claim 1, characterized in that a polymer based on acrylic acid derivatives is used as a structured polymer film with a moisture content of at least 6%. 6. The dressing according to claim 5, characterized in that Temposcrin or polyacrylamide gel is used as acrylic acid derivative. 7. The dressing according to claim 1, characterized in that a three-layer structure is used as the protective-absorbent layer, the upper and lower layers of which are perforated plastic film, and the inner layer is non-woven material with high absorbency, while the total area of the holes in the lower layer adjacent to the structured polymer film is 3 times the area of the upper layer. 8. A method for treating purulent necrotic wounds, characterized in that the dressing described in any one of paragraphs 1-7 is moistened and applied to the wound surface for up to 4 days before application to the wound. 9. A method of obtaining a dressing described in paragraph 1-7 comprising the steps of: a) oxidizing the cellulose web to dialdehyde cellulose (DAC) with an oxidation state of 1.1%; b) processing 1 kg of DAC for 4 hours with a solution of a mixture of trypsin and lysozyme containing 3 g of each enzyme in 6 l of distilled water, spinning and drying the canvas to a residual moisture content of not more than 6%; c) obtaining a structured polymer film with a moisture content of not more than 6% by drying a 20% aqueous polymer solution based on derivatives of acrylic acids at a temperature not exceeding 37 ⁰ C; d) the manufacture of a dressing consisting of a lower layer adjacent to the wound with immobilized enzymes, a middle layer, which is a structured polymer film based on derivatives of acrylic acids, characterized by a high value of water absorption and a protective-absorbent layer, which is a non-woven material with high absorbency, concluded on both sides in a perforated plastic film, while the entire structure is fastened in a known manner; e) packaging the dressing in double plastic bags and sterilization with gamma radiation at a dose of 25 kGy.