Compression Is Key: Silver, Elastic Compression Stockinet, and Hyper-Absorbent Felt in Direct Contact with VLU Granulation Tissue Reverses Comorbid Inflammation, Pain, and Exudate That Delays Effective Compression Therapy

Problem: The triad, bacterial inflammation, painful dermatitis, and exudate with skin maceration, can delay effective wound clinic compression for months resulting in venous leg ulcer (VLU) outliers. At the first visit, we employ three wound contact dressings to tame the terrible triad, enabling robust compression therapy: antimicrobial ionic and metallic silver re-sorbable matrix, compressive force delivered by fuzzy wales that form furrows in moist granulation tissue, and negative hydrostatic pressure from highly absorbent polymer fiber scrim backed felt dressings in contact with wet granulation tissue protruding between fuzzy wales.

Methods: Six refractory VLU outliers in aggregate suffered from pain, exudate, malodor, and depression, which prevented effective treatment in the wound clinic. Ulcers were treated with debridement, antimicrobial silver, fuzzy wale elastic compression stockinet from metatarsals to patella, absorbent felt on top of the stockinet to cover ulcers and areas of inflamed, painful or wet dermatitis, short stretch wraps, and instructions for leg exercises and elevation.  

Results: Topical silver, elastic compression stockinet, and absorbent felt in direct contact with ulcer granulation control co-morbid pain, exudate, and maceration to enable the delivery of effective compression therapy. Ulcer epiboly, peri-wound dermatitis, wound drainage, and pain resolved rapidly. Photos document ulcer presentation, treatment, complications, and wound closure.

Conclusion: Three therapeutic modalities intimately sharing the granulating ulcer surface appear to deliver effective antimicrobial silver, elastic compression force, and negative hydrostatic pressure to control the triad of inflammation, exudate, and pain. This therapeutic triad enables rigorous compression therapy at the first visit to heal six refractory VLU outliers with co-morbidities that were difficult to control with standard of care elastic VLU layer dressing kits.