The Use of a Silver Contact Layer Combined With a Hydroconductive Dressing for the Management of Chronic Lower Extremity Wounds Related to Venous Insufficiency

Venous ulcers are a common chronic problem in many countries, especially in Northern Europe and the United States, with an overall prevalence reported as approximately 1% but trending to rise to 3% in the population older than 65 years.¹ Venous insufficiency is a root cause for a large proportion of chronic wound cases. In many cases, the condition causes venous stasis dermatitis and ulcerations, especially in the lower extremities. Although the pathophysiology of the disease is complex and still being elucidated, the underlying venous hypertension from incompetent valves and the pro-inflammatory state of the cell wall lining of the veins seem to be the 2 main contributors to the development of stasis and ulceration.^2-5

A specialized fiber-based technology, known as hydroconductive technology, has been described as being able to remove factors that negatively affect healing, such as MMPs, microbes, and necrotic debris, from the wound environment.^6-14 Although it is likely that electrostatic and other physical forces are responsible for at least some of this activity, the exact mechanism of these phenomena are still subjects of research. The use of hydroconductive dressings has been shown to achieve positive clinical results in the management of venous ulcers.⁶

Microbial factors are of special concern in nonhealing wounds. As ulceration develops, bacterial colonization and overgrowth play a pivotal role in poor wound healing. Antimicrobial barrier products, which are formulated to form a nonadherent perforated gel upon contact with wound fluid, can help manage bioburden at the wound-dressing interface. A wound dressing known as the lipidocolloid dressing, imbued with silver ions, has been used with success.^15-20 The dressing is thin, flexible, and typically used in conjunction with an overlying absorbent secondary dressing.

It is rational to imagine that these 2 novel technologies (ie, the hydroconductive and lipidocolloid technologies) may be complementary. With this in mind, the combination therapy of a silver lipidocolloid contact layer (a proprietary product from Urgo Medical North America) combined with a hydroconductive dressing (Drawtex; Beier Drawtex Healthcare) was used to treat chronic venous leg wounds with varying degrees of drainage. The rationale was based on providing an antimicrobial barrier at the wound base and additionally preventing maceration of the wound bed by controlling the fluid through the hydroconductive therapy. The expectation was that the combination therapy would address the pro-inflammatory component levels of the wound and help recalibrate the MMP imbalance while also addressing wound bioburden.

METHODS

Patients with wounds related to lower extremity venous insufficiency were treated with a weekly combination therapy of lipidocolloid and hydroconductive dressings. Wound sizes were measured over time, and images of the healing wounds were taken. Additionally, compression bandages were used on all patients to optimize healing results.

Case 1 (Figure 1). A 61-year-old man with a history of venous stasis, diabetes mellitus, and hypertension presented with a wound of 1 month’s duration on his left inferior limb. The patient was admitted to the hospital and underwent surgical debridement. Antibiotics were prescribed prophylactically or empirically prior to discharge from the acute care unit. During a follow-up visit on November 11, 2019, the wound measured 9 cm × 6.9 cm × 0.3 cm. Treatment was switched to UrgoTul Ag (Urgo Medical), Drawtex, and continued compression. On March 6, 2020, the wound was almost healed as it measured 1.3 cm × 1.3 cm × 0.1 cm.

Case 2 (Figure 2). A 77-year-old woman presented with a history of venous stasis, coronary artery disease, hypertension, chronic lymphedema, and a 4-year history of a wound on the right lateral leg. Previous treatment included silver alginate and compression. Minimal improvement had been achieved, but the wound persisted for over 3 years. The patient was seen in the clinic on March 2, 2020, and the wound measured 6.8 cm × 9.9 cm × 0.1 cm. A regimen of UrgoTul Ag and Drawtex with continuation of compression was initiated. On March 23, 2020, after only 3 weeks of this combined treatment, the wound measured 5.4 cm × 5.5 cm × 0.1 cm.

Case 3 (Figure 3). A 65-year-old man with venous stasis, diabetes mellitus, coronary artery disease, hypertension, end-stage renal disease, Charcot foot, and congestive heart failure presented to the emergency department with a 1-month history of a wound over the left medial ankle. A course of antibiotics was prescribed, prophylactically or empirically at the acute care unit, and the patient was discharged to the wound care clinic. The patient was seen in the clinic about 1 week later, on December 30, 2019, and treatment with UrgoTul Ag and Drawtex with continued compression was begun. At that time, the wound measured 4.5 cm × 3.7 cm × 0.1 cm. On February 24, 2020, closure of the wound was nearly achieved (it measured 0.4 cm × 0.3 cm × 0.1 cm.)

RESULTS AND DISCUSSION

The author postulates that the combination of a silver contact layer with a hydroconductive dressing can allow for better control of moisture in the wound bed without using traditional products such as a calcium alginate. Commonly used alginate dressings shed fibers, and these fibers can contribute to shearing off the fragile developing epithelium in the face of mechanical stress induced by ambulation. In addition, the alginate can adhere to the underlying tissue, particularly in dry wounds.²¹ Finally, alginates also do not possess the documented hydroconductive properties of the absorbent dressing, such as the ability to draw away MMPs and other deleterious matter from the wound,¹⁴ used in the current study.  Hydroconductive properties have been well described in the literature and consist of an ability of a dressing via physical chemistry action to remove to a significant distance, and in significant amounts, deleterious components from the wound bed.

The wounds in the current study either healed or had a remarkable reduction in volume over a few weeks or months. In each case, the hydroconductive dressing did not adhere to the wound bed, and there was no trauma observed during dressing removal. The wound bed appeared healthy, granulating, and non-inflamed. The observed, positive, general health of the wound could reasonably be attributed to the modulation of MMP levels characteristic of hydroconductive dressings and the additional control of inflammatory bioburden at the dressing-wound interface due to the antimicrobial silver property of the lipidocolloid dressing. Results thus far show promise in providing a nonadherent, absorbent therapy that optimizes the wound bed for optimal healing without the use of more expensive therapies such as skin substitutes or collagen dressing.

Pearls for Practice is made possible through the support of Urgo Medical, Fort Worth, TX (www.urgomedical.com). The opinions and statements of the clinicians providing Pearls for Practice are specific to the respective authors and not necessarily those of Urgo Medical, Wound Management & Prevention, or HMP Global. This article was not subject to the Wound Management & Prevention peer-review process.

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Pearls for Practice is made possible through the support of Urgo Medical, Fort Worth, TX (www.urgomedical.com). The opinions and statements of the clinicians providing Pearls for Practice are specific to the respective authors and not necessarily those of Urgo Medical, Wound Management & Prevention, or HMP Global. This article was not subject to the Wound Management & Prevention peer-review process.