Enhancement of Wound StO<2 Using a Novel Borate-based Bioactive Glass Matrix: a Pilot Case Series

Introduction: Introduction  A novel borate-based bioactive glass fiber matrix (BBBGM) has recently been introduced for adjunctive management of difficult-to-heal chronic ulcerations. The borate glass fibers provide scaffolding simulating a natural matrix and constituent ions, shown to enhance angiogenesis, stimulate cellular proliferation and complement antimicrobial protection. We performed a pilot study to investigate healing outcomes and corresponding changes in wound base tissue oxygen saturation (StO2) rates following use of BBBGM in a series of complex ulcers.  Methods: Methods  Five patients with 5 wounds were treated with BBBGM*. Wounds were cleansed with hypochlorous acid solution and debrided once prior to initial application of BBBGM. Wounds were not debrided or scrubbed during subsequent use of BBBGM. BBBGM was shaped to fit the wound bed, and placed directly in contact with the wound, including undermining and tunneling. A moisture barrier cream was applied to the periwound, and BBBGM was secured with a non-contact layer and appropriate secondary dressing, plus compression as needed. The matrix was reapplied every 1-2 weeks, at which time wounds were gently cleansed using hypochlorous-soaked gauze set in the wound bed for 5 minutes and lightly removed to lift off any residual crust. Near-infrared spectroscopy (NIRS)†, a noninvasive imaging device that measures oxygenated and deoxygenated hemoglobin in wound and periwound tissues, was utilized to calculate StO2 at each reapplication. BBBGM dressings were discontinued when wound was 100% reepithelialized, or at 10 weeks.  Results: Results  Wound types treated were: traumatic (n=1), venous insufficiency (n=2), pressure (n=1), and abdominal wall ulceration (n=1). Wounds were present an average of 3.7 years (range: 0.1-16.0 years) prior to initial BBBGM application and mean wound volume at start of BBBGM was 10.6 cm3 (range: 0.03-25.0 cm3). Limb salvage was achieved for all patients and wounds were 96%-100% closed in an average of 8.0 weeks (range: 6.0-10.0 weeks) during BBBGM use. For all wounds, NIRS images showed progressively improved wound bed StO2 which correlated positively with wound size reduction.  Discussion: Discussion  All BBBGM-treated wounds in this pilot series exhibited a positive healing trajectory with increased granulation tissue formation and enhanced wound bed StO2, despite absence of wound bed debridement.   References: 1. Armstrong DG, Orgill DP, Galiano RD, et al. A multi-centre, single blinded randomised controlled clinical trial evaluating the effect of resorbable glass fibre matrix in the treatment of diabetic foot ulcers. Int Wound J. 2022;19(4):791-801. 2. Jung S, Day T, Boone T, Buziak B, Omar A. Anti-biofilm activity of two novel, borate based, bioactive glass wound dressings. Biomed. Glasses 2019;5:67-75. 3. Pizzorno L. Nothing Boring About Boron. Integr Med (Encinitas).2015;14(4):35-48. 4. Rahaman MN, Day DE, Bal BS, et al. Bioactive glass in tissue engineering. Acta Biomater. 2011; 7(6): 2355-2373.