Porcine Derived 3-Dimensional Extracellular Matrix Simultaneously with Silver Impregnated Polymer Film on Lower Extremity Wounds with Bacterial Impediment to Heal

Background: For some patients with venous leg ulcers, compression therapy is not enough and requires that some adjunctive therapy be used to aid in wound healing. Despite using additional products, patient’s wounds may still fail to heal. Some of these wounds’ healing abilities are impeded by bacteria, causing prolonged healing time and necessitating meticulous wound care. These difficult to heal wounds can lead to decreased quality of life, increased healthcare costs, and other morbidity. Silver-impregnated polymer film has been shown to support cell growth and vascularization and thus improving wound healing. Porcine derived 3-dimensional extracellular matrix allows for host cell migration. The use of both products simultaneously could potentially provide more favorable would healing results in these types of wounds. Methods: 4 patients with venous leg ulcers characterized as having bacterial impediment to healing were chosen to participate in this study.  Patients had silver impregnated polymer film and porcine derived 3D extracellular matrix applied to wound weekly for 8 weeks followed by an additional 4 weeks of observation without product application to observe for synergistic effects on wound healing. Wound cultures were obtained at weeks 1,3, and 7. Primary endpoints were overall wound area reduction and treatment tolerance at 12 weeks. Secondary endpoints were: percentage of wound closure at 12 weeks, change in wound characteristics, number of patients with closed wounds, and presence of bacteria. Results: Patients tolerated both products well without any adverse effects reported. Wound area reduction was observed in 4/4 patients. On average, there was a 37.5% decrease in wound area at 8 weeks. The greatest wound area percent reduction observed was 54%. There was also a decrease in bacteria present in the wound in 2/4 patients, as reflected in wound culture data. Conclusion: Despite this patient group having wounds with a bacterial impediment to heal, patients experienced a reduction in wound size due to the use of the products. While not many patients were able to achieve complete wound closure, the products were effective in decreasing the bacterial burden of some of the wounds and improving overall wound healing.