Iodophor Foam Dressing Used in Combination with an Esterified Hyaluronic Acid Matrix to Reduce the Risk of Infections and Benefit Wound Healing in Lower Extremity Wounds

Introduction: Infections of lower extremity wounds (LEWs) can often result in sepsis or loss of a limb.1, 2 A multicenter study of elderly patients with chronic LEWs including “hard-to-heal” ulcers showed improved re-epithelization following esterified hyaluronic acid matrix (eHAM) application.3 Iodine is a proven broad spectrum antimicrobial. Iodine ointment has been shown to reduce wound size and promote complete wound healing in chronic recalcitrant ulcers,4 However, iodine ointments can be messy and difficult to handle making it not an ideal treatment option.

Objective: Evaluate a controlled release iodine containing iodophor foam dressing (IFD) in combination with eHAM in order to reduce the risk of infection and benefit wound healing in diabetic patients with LEWs. Compare the combination of IFD with eHAM to IFD alone.Method: Seven patients (63-84 y/o) with a total of 10 diabetes-related LEWs (5 per group) were evaluated. Three patients (Group 1) received IFD alone along with 2-4 layer compression dressings applied weekly or biweekly. Four patients (Group 2) received IFD with eHAM applied weekly. The initial wound area, weeks to wound healing, and rate of wound healing was determined per patient.

Results: The average initial wound area for Group 1 and 2 was 6.5±4.9 cm2 and 13.0±15.7 cm2, respectively. The average number of weeks for wound healing for Group 1 and 2 was 5.4±2.3 weeks and 10.2±1.8 weeks, respectively. The average rate of wound healing for all wounds in Group 1 and 2 was similar at 1.0±0.7 cm2/week and 1.3±1.6 cm2/week, respectively. However, larger area wounds (8.1 to 33.6 cm2) had a significantly faster rate of healing for Group 2 (3.0±1.1 cm2/week) compared to Group 1 (1.4±0.3 cm2/week) (p< 0.05). There was no incidence of infection observed in either group of patients.

Conclusion: We conclude from this case study of seven patients, that IFD used in combination with eHAM has a beneficial effect on wound healing in patients with diabetic-related LEWs, especially in larger area wounds. This unique “delivery method” when used in combination can also reduce the risk of recurrent infections in diabetic-related LEWs.