Use of Silver Collagen Oxidized Regenerated Cellulose Dressings in Conjunction With Negative Pressure Wound Therapy: Expert Panel Consensus Recommendations

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Goals for wound care often include exudate management, promotion of granulation tissue, and reduction of inflammation. Other considerations include cost of care, length of treatment, and patient comfort, with the ideal wound care plan resulting in lower costs with high rates of healing. While a number of wound care options exist, advanced wound dressings and NPWT are some of the more commonly utilized products. One available advanced wound dressing, silver collagen ORC dressing (3M Promogran Prisma Collagen Matrix with ORC and Silver; Solventum Corporation), helps maintain a physiologically moist environment at the wound surface, which is conducive to granulation tissue formation, epithelialization, and optimal wound healing.^1,2 Additionally, in the presence of exudate, silver collagen ORC dressings transform into a soft, conformable, biodegradable gel, allowing for contact with all areas of the wound.³ When used alone, silver collagen ORC dressings also contain ionically bound silver to provide an effective antimicrobial barrier.⁴ RCTs of silver collagen ORC dressing use have reported a safety profile similar to that of standard of care dressings, with improved rates of wound healing in patients with DFUs and VLUs.^5,6 A comparative study utilizing US Wound Registry data noted that silver collagen ORC dressing use was associated with a significantly higher rate of DFU healing or improvement compared with ovine collagen dressings.⁷ Similarly, a meta-analysis reported significant increases in wound closure and percent wound area reduction in a mix of chronic wound types.⁸

NPWT acts by drawing wound edges together, removing exudate and infectious material, maintaining a moist wound environment, and promoting granulation tissue development and angiogenesis.⁹ Previously published RCTs have reported increased wound size reduction, improved granulation tissue, and both increased rates of wound closure and reduced time to closure across DFUs, VLUs, and pressure injuries/ulcers compared with standard of care dressings.^10-13 Meta-analyses published between 2011 and 2021 have reported similar results with NPWT use across DFUs, VLUs, pressure injuries/ulcers, and mixed chronic wounds.^14-17

A new indication for the use of silver collagen ORC dressing in conjunction with NPWT (3M ActiV.A.C. Therapy System; Solventum Corporation) with ROCF dressings (3M V.A.C. Granufoam Dressing; Solventum Corporation, or 3M V.A.C. Simplace Dressing; Solventum Corporation), along with a drape (3M V.A.C. Drape; Solventum Corporation, or 3M Dermatac Drape; Solventum Corporation) has become available. The use of both NPWT with ROCF dressings and silver collagen ORC dressings may combine the effects of NPWT with the benefits of silver collagen ORC dressings; however, there is limited published literature available to guide use. An expert panel was convened to identify clinical care settings and conditions for appropriate use of silver collagen ORC dressings in conjunction with NPWT and ROCF dressings.

Panelist selection and meeting

A panel was convened of 7 experts who were identified based on experience using silver collagen ORC dressings and NPWT in their practice, previous presentations or publications on NPWT and/or silver collagen ORC dressings, as well as the ability to understand and participate in the formation of consensus statements. Panel selection criteria were created by industry (Solventum Corporation) personnel. Two podiatrists, 1 plastic surgeon, 2 nurse practitioners, and 2 registered nurses from the US attended the panel meeting. Panel member specialties included plastic surgery, nursing, wound care, and podiatric surgery. The in-person meeting was held on April 29, 2023, in National Harbor, Maryland. The meeting schedule included a presentation on the use of silver collagen ORC dressings in conjunction with NPWT and ROCF dressing, along with a discussion and development of consensus statements.

Literature search

A brief literature search was conducted using PubMed, Science Direct, and Cochrane Reviews for peer-reviewed articles published between January 2000 and March 2023. Keywords included "ORC/collagen/silver-ORC dressing", "NPWT", "negative pressure wound therapy", "vacuum assisted closure", "topical negative pressure", and "negative pressure therapy". Abstracts, posters, and off-topic publications were excluded.

Prior to the meeting, panel members received a meeting agenda and literature on the management of chronic wounds, treatment recommendations, and silver collagen ORC dressings. Recently published consensus documents that used the modified Delphi method were also included in the reading list.

Consensus statement formation

Consensus methodology was based on the modified Delphi technique.¹⁸ Three rounds of input were used to gather feedback and identify topics with potential for agreement. Discussion subjects included sites of care for the use of silver collagen ORC dressings in conjunction with NPWT, wound types and wound bed conditions for product use, contraindications to use, amount of negative pressure applied, dressing change frequency, and when to discontinue product use. Open-ended feedback was used during the in-person panel meeting. The 7 panel members were then provided with the consolidated potential consensus statements to provide a second round of open-ended input to refine wording and content. Panel members recommended additional HCPs to participate in the consensus statement survey. The additional 25 participants were invited based on their experience with silver collagen ORC dressings and NPWT within their own practice. The 32 total survey participants included podiatrists, surgeons (general, orthopedic, plastic, trauma, and vascular), physician assistants, registered nurses, and nurse practitioners across the US. HCP specialties included general surgery, plastic surgery, podiatric surgery, nursing, and wound care. Lastly, panel members and the 25 invited HCPs received the final consensus statements in a survey format, which allowed each survey participant to anonymously agree or disagree with the consensus statements. Consensus was defined as greater than or equal to 80% agreement among survey respondents.

Instructions for use of silver collagen ORC dressing with NPWT and ROCF dressing

The silver collagen ORC dressing when used with NPWT and ROCF dressings is intended for the management of exuding wounds. This therapy combination may be used only for management of VLUs, pressure injury/ulcer, diabetic ulcers, partial-thickness burns, traumatic wounds healing by secondary intention, and dehisced surgical wounds. Per the instructions for use, silver collagen ORC dressing use in conjunction with NPWT is contraindicated for use with compression therapy.¹⁹ However, further testing of therapy use with compression should be evaluated. Use is not recommended for wounds with mixed vascular etiologies, donor sites or other bleeding surface wounds, or abrasions.

HCPs must ensure adequate hemostasis has been achieved prior to use of this dressing and therapy combination. Patients with weakened or friable blood vessels or organs in or around the wound, patients without adequate wound hemostasis, patients receiving anticoagulants or platelet aggregation inhibitors, and patients without adequate tissue coverage over vascular structures are at increased risk of bleeding with use. This dressing and therapy combination is only indicated for use for 30 days. Additionally, silver collagen ORC dressings must be fenestrated prior to application to the wound bed to ensure the free passage of exudate and delivery of the selected pressure at the wound bed (Figure 1, Figure 2).

Consensus statement 1: Silver collagen ORC dressings use in conjunction with NPWT and ROCF dressings is recommended for use in (a) outpatient care settings (ie, wound care clinics), (b) HCP office settings, (c) home health care settings, (d) acute care settings, and (e) skilled nursing facilities

Wound care is increasingly being performed in clinical settings outside the traditional hospital-based wound care clinic. For example, a single-center retrospective review reported increased wound care consultations in the post-acute and long-term care settings between 2017 and 2018.²⁰ In 2019, office visits and home health Medicare expenditures for wound care were found to be higher than those of skilled nursing facilities and hospital-based outpatient centers, indicating a shift away from the traditional hospital-based outpatient setting.²¹ Additionally, a growing number of stand-alone outpatient wound care centers have been opening.²² The increases in wound care appointments for HCP office visits, home health, and stand-alone outpatient wound care centers indicate a shift toward increased wound care in these settings. Panel members recommended use of silver collagen ORC dressing in conjunction with NPWT and ROCF dressings in outpatient, HCP office, home health, acute care, and skilled nursing facility settings (Table 1).

Consensus statement 2: Along with appropriate wound care, use of silver collagen ORC dressings in conjunction with NPWT and ROCF dressings may be utilized as an adjunct therapy in (a) traumatic wounds, (b) surgical wounds, including dehisced wounds, wounds healing by secondary intention, or wounds being prepared for surgical closure, (c) diabetic ulcers, (d) venous leg ulcers, and (e) pressure injuries/ulcers

Use of silver collagen ORC dressings in traumatic wounds, surgical wounds, diabetic ulcers, VLUs, pressure injuries/ulcers has been previously reported. When compared with standard of care dressings, use of silver collagen ORC dressings resulted in increased rates of wound healing, wound closure, and percent wound area reduction across VLUs, DFUs, pressure injuries/ulcers, trauma wounds, and surgical wounds.^8,23,24 Additionally, silver collagen ORC dressings were reported to have a safety profile similar to that of standard of care dressings.^8,23,24 Similarly, use of NPWT in traumatic wounds, surgical wounds, diabetic ulcers, VLUs, and pressure injuries/ulcers has also been associated with increased wound closure rates as well as reduced time to closure, length of hospital stay, and rate of infection compared with standard of care dressings.^10,15,25,26

A study by Loh et al²⁷ published in 2020 detailed the use of silver collagen ORC dressings with NPWT. Those authors reported granulation tissue development over exposed structures in 89% of the patients with complex lower extremity wounds, including those for whom NPWT had previously been unsuccessful. In 82% of patients, granulation tissue coverage was observed within 28 days. No complications were reported with the combined use of silver collagen ORC dressing with NPWT and ROCF dressings.²⁷

Use of silver collagen ORC dressings with NPWT and ROCF dressings may provide patients the combined benefits of a moist wound environment, removal of exudate and infectious materials, and promotion of granulation tissue. As such, panel members recommended silver collagen ORC dressing with NPWT and ROCF dressing use in traumatic wounds, surgical wounds, diabetic ulcers, VLUs, and pressure injuries/ulcers along with appropriate wound care (Table 2). Example images of a surgical wound are shown in Figure 3.

Consensus statement 3: Silver collagen ORC dressing use in conjunction with NPWT and ROCF dressings is NOT recommended in wounds or in patients with contraindication to NPWT and/or silver collagen ORC dressings with (a) presence of exposed unprotected organs or exposed unprotected vessels, (b) inadequate or potential for inadequate wound hemostasis, (c) acutely ischemic wounds, or (d) surgically closed incisions

NPWT use is contraindicated over unprotected organs, over unprotected and exposed vessels, in wounds without adequate hemostasis, and in ischemic wounds.²⁸ Use of negative pressure under these circumstances can result in organ and vessel damage, increased potential for fistula formation, and blood loss.²⁸ Additionally, use of negative pressure in ischemic wounds has been shown to increase the risk of necrosis due to the potential for negative pressure to cause occlusion within local capillaries, leading to reduced tissue perfusion.²⁹

With these considerations in mind, the panel members did not recommend the use of silver collagen ORC dressings in conjunction with NPWT and ROCF dressings in the presence of exposed unprotected organs or exposed unprotected vessels, in wounds with inadequate or potential for inadequate wound hemostasis, in acutely ischemic wounds, or over surgically closed incisions (Table 3).

Consensus statement 4: Silver collagen ORC dressing use in conjunction with NPWT and ROCF dressings is contraindicated in patients with known hypersensitivity to foam, drape components, ORC, collagen, or silver

In patients with known hypersensitivity to dressing and drape components, a potential allergic reaction to foam, drape, silver, ORC, or bovine collagen can occur, resulting in nonhealing or a worsening wound condition. In some patients, hypersensitivity responses can damage the periwound skin. Thus, the panel members did not recommend use of silver collagen ORC dressings with NPWT and ROCF dressings in patients with hypersensitivity to therapy and dressing components (Table 3).

Consensus statement 5: Silver collagen ORC dressing use in conjunction with NPWT and ROCF dressings is NOT recommended in patients with (a) untreated osteomyelitis, (b) untreated malignancy at the wound site, (c) unexplored fistula(s), or (d) third-degree burns

Use of negative pressure in the presence of untreated osteomyelitis, malignancy, unexplored fistula, and third-degree burns can be detrimental to the patient. With untreated osteomyelitis there is an increased potential for spread of infection. If untreated malignancy exists at the wound site, the use of NPWT may promote unwanted tissue growth along with an increased risk of blood loss, because malignant tissue is often prone to bleeding.²⁸ There is also a potential for fistula eruption or negative pressure in the body cavity, which can damage organs and/or vessels, when NPWT is used in unexplored fistulas. Finally, NPWT may cause further skin damage due to drape adhesion to vulnerable skin in patients with third-degree burns. Thus, panel members did not recommend use of silver collagen ORC dressings with NPWT and ROCF dressings in patients with these conditions as use could exacerbate the underlying conditions or result in loss of hemostasis or damage to organs or vessels (Table 3).

Consensus statement 6: Silver collagen ORC dressing use in conjunction with NPWT and ROCF dressings may be used with caution in wounds that contain (a) appropriately protected vessels and/or organs, (b) appropriately protected tendons, ligaments, bones, and nerves, (c) explored tunnels, and (d) explored areas of undermining

Use of NPWT in wounds with appropriately protected vessels and/or organs, tendons, ligaments, bones, nerves, explored tunnels, and areas of undermining minimizes the potential risk of tissue/organ damage, fistula formation, and blood loss. Protection of these delicate structures refers to the use of nonadherent dressings to prevent direct contact with the NPWT and the system components. Panel members recommended use of silver collagen ORC dressings with NPWT and ROCF dressings when delicate structures are protected and tunneling and undermining areas have been explored. This allows patients to receive the benefit of this combination therapy while minimizing risk of damage and blood loss (Table 4).

Consensus statement 7: Patients should be made aware that silver collagen ORC dressing components contain biological material of animal origin

Silver collagen ORC dressing components contain animal products. Panel members believe clinicians should be considerate of potential cultural or religious objections to the use of this product and discuss its use with the patient prior to application (Table 5).

Consensus statement 8: Along with appropriate wound care, silver collagen ORC dressings in conjunction with NPWT and ROCF dressings may be considered for use in (a) adequately cleansed and debrided wounds, (b) contaminated or infected wounds, (c) inflamed wounds, (d) stalled and/or hard-to-heal wounds, and (e) wounds that are slow to granulation with traditional NPWT alone

Delays in wound healing can occur if wounds are contaminated/infected, inflamed, and slow to granulate. Different stages of wound contamination/infection exist, although not all produce a host response. Contamination is the presence of nonproliferating microbes without host response.²⁹ Limited microbe proliferation with host response is colonization. Microbe proliferation deeper in the wound with host response defines local infection, whereas microbe invasion of surrounding tissue with signs and symptoms outside of the wound border is considered a spreading infection. Systemic infection is more serious, affecting the whole body.³⁰ Delays in wound healing are often observed when local infection, spreading infection, or systemic infection is present.³⁰

Inflamed wounds are in a state of a prolonged inflammatory phase of healing.³⁰ Inflammatory products and enzymes build up and degrade growth factors and extracellular matrix proteins, resulting in swelling, redness, and exudate production.³⁰ It can be difficult to distinguish wound infection from inflammation because they often have overlapping symptoms. However, inflammation unrelated to infection has swelling and redness that decreases over time along with thin, watery exudate that is clear or pinkish in color.³⁰

Wounds that are slow to granulate do not progress through healing in a timely manner. This can be due to poor nutrition, patient-centric challenges/comorbidities (eg, tobacco use, obesity, uncontrolled diabetes, use of certain medications), blood flow issues, and barriers to healing (ie, high levels of exudate, high levels of matrix metalloproteinases, presence of infection).

Panel members recommended use of silver collagen ORC dressings in conjunction with NPWT and ROCF dressings as this combination may help remove barriers to healing, balance the wound environment, and promote granulation tissue development (Table 5). In wounds with infection present, appropriate infection control measures should be performed. An example of a wound managed with infection control measures and silver collagen ORC dressing combination with NPWT and ROCF dressings is shown in Figure 4.

Consensus statement 9: It is recommended that silver collagen ORC dressing use in conjunction with NPWT and ROCF dressings should be considered at the earliest opportunity once deemed clinically appropriate

In 2017, a multidisciplinary panel recommended the use of silver collagen ORC dressings throughout the treatment plan, including in early stages of wound care after debridement.³¹ Several studies have examined the potential clinical benefits of early use of NPWT. Kaplan et al³² reported reduced hospital inpatient and treatment days along with reduced total and variable costs per patient discharge in patients with trauma wounds who received NPWT within the first 2 days of care compared with patients who received NPWT after day 3. Similarly, Driver and De Leon³³ reported reduced total length of stay, reduced wound care costs, and an increase in percent of wound area reduction in patients with DFU who received NPWT within 14 days of admission. Similar results have been observed in the home health setting, with reduced length of stay observed in patients with pressure injury/ulcer who received NPWT within 30 days and in patients with surgical wounds who received NPWT within 7 days.³⁴ Baharestani et al³⁴ indicated that for each day NPWT was delayed, almost 1 day was added to the patient’s total length of stay regardless of wound type.

Panel members recommended silver collagen ORC dressing use with NPWT and ROCF dressings as early as possible in the wound care plan (Table 5). While no current data on early vs late use of this therapy combination exist, panel members believe the potential benefits of silver collagen ORC dressings and NPWT could help remove barriers to healing. Earlier use of silver collagen ORC dressings with NPWT and ROCF dressings may result in reduced time to healing; however, future studies are needed to examine potential differences in clinical outcomes between early and late use of this therapy combination.

Consensus statement 10: The recommended minimum negative pressure setting for NPWT with ROCF dressings in conjunction with silver collagen ORC dressing use is continuous negative pressure at −125 mm Hg or higher at the clinician’s discretion

In 1997, Morykwas et al³⁵ examined the effect of negative pressure on the wound and surrounding tissues in a porcine model. In that study, a reported 4-fold increase in blood flow with use of −125 mm Hg was observed compared with baseline. Increased rate of granulation tissue development with −125 mm Hg was also observed. More recently, several studies have reported conflicting results, with some reporting −125 mm Hg as the optimal negative pressure, which may vary depending on wound type.³⁶ Other studies reported no difference between negative pressure settings, with the caveat that negative pressure should be selected to provide the required pressure based on the goals of therapy.^37,38 Because patients and wounds may require different negative pressure settings based on goals of therapy, panel members recommended a −125 mm Hg pressure setting or higher, depending on the clinician’s discretion, for silver collagen ORC dressing use in conjunction with NPWT and ROCF dressings (Table 5).

Consensus statement 11: When used in conjunction with NPWT and ROCF dressings, silver collagen ORC dressings are recommended to be reapplied every 48 to 72 hours, or more frequently, at the clinician’s discretion

Following hydration or contact with wound exudate, silver collagen ORC dressings turn to soft, biodegradable gel to cover the wound bed. During dressing changes, the wound and periwound skin can be cleaned; however, the residual dressing does not necessarily need to be removed from the wound bed prior to reapplication. Depending on the wound environment, silver collagen ORC dressings should be reapplied every 72 hours for non- and low-exudating wounds and reapplied more frequently when used in moderately exudating wounds.³¹

During use of NPWT, tissue ingrowth into the ROCF dressing was observed in 48 hours for some wounds in a porcine model of wound healing.³⁵ A similar finding was observed with NPWT use in 300 wounds at a single institution.³⁹ In that clinical study, excessive tissue ingrowth was observed in some wounds when the ROCF dressings were left in place for longer than 48 hours.

The panel members recommended ROCF dressing changes at 48 to 72 hours with reapplication of silver collagen ORC dressings, or more frequently at the clinician’s discretion (Table 5). This dressing change and reapplication frequency was selected to mitigate the potential for tissue ingrowth into the foam dressings while reducing potential time needed for silver collagen ORC dressing application by performing them at the same time.

Consensus statement 12: Silver collagen ORC dressing use in conjunction with NPWT and ROCF dressings should be discontinued (a) when clinical goals are met or (b) if the wound has deteriorated

Typical clinical goals for wound management include reducing bioburden, managing exudate, promoting a moist wound healing environment and granulation tissue development, and removing exudate and infectious materials. When the individual advanced wound care products were assessed, reduction in wound surface area and increased rates of wound closure were reported with silver collagen ORC dressing use.^1,6,8,24,40 Similarly, an increase in granulation tissue development, wound area reduction, removal of exudate and infectious materials, and reduced time to wound healing have been associated with NPWT use.^9,41,42 Panel members recommended the discontinuation of silver collagen ORC dressings in conjunction with NPWT and ROCF dressings once clinical goals have been met in order to transition the patient to wound closure methods (Table 5).

In some patients, despite the use of advanced wound care methods, some wounds do not respond to treatment or, worse, deteriorate. When a wound deteriorates, wound healing is impaired and the wound does not respond to treatment. In some cases, the wound size and depth increases along with changes in the wound bed environment toward too moist or too dry.

In line with updated wound healing algorithms,⁴³ the panel recommended discontinuing treatment, reevaluating the wound, and changing the wound care plan when wound deterioration or nonresponse is observed (Table 5).

Chronic nonhealing wounds affect an estimated 2.5% of the total US population.⁴⁴ A new option for wound management includes the use of silver collagen ORC dressings in combination with NPWT and ROCF dressings. However, limited evidence exists regarding use of this therapy combination.

A large body of evidence supports the individual use of silver collagen ORC dressings or NPWT for wound care.^5-8,10-17 Currently, only 2 published studies exist describing the use of silver collagen ORC dressings with NPWT. Loh et al²⁷ assessed the use of this therapy combination in 37 patients with complex lower extremity wounds, 27 of whom had previously undergone unsuccessful management with NPWT alone. The silver collagen ORC dressings were placed over exposed structures, with NPWT and ROCF dressings applied over the dressing to provide negative pressure therapy to promote granulation tissue development. The combination of silver collagen ORC dressing with NPWT resulted in granulation tissue covering exposed structures in 89% of patients. In 82% of patients, granulation tissue coverage occurred within 28 days. None of the patients developed complications.²⁷ A retrospective comparative analysis of 485 matched cohort cases from deidentified records in the US Wound Registry showed that combining silver collagen ORC dressing with NPWT significantly improved healing outcomes compared to NPWT alone.⁴⁵ The observed wound area reduction was greater (40%) for wounds managed with the combination of silver collagen ORC dressing and NPWT compared to NPWT alone (9%).⁴⁵ Additionally, the median time to achieve 75% to 100% granulation with no measurable wound depth was 8 days shorter across all wound types and 14 days shorter for surgical wounds when NPWT was applied with silver collagen ORC dressings.⁴⁵

While no other published literature assessing the use of silver collagen ORC dressings in combination with NPWT and ROCF dressings exists, conference abstracts have been presented at recent wound care conferences.^46-50 These 5 conference presentations reported no complications with use, as well as successful wound bed preparation, reduced time to healing, reduced time to granulation tissue coverage, and decreased wound area and volume in a variety of acute and chronic wound types.^46-50

The quantity of published evidence on the new indication for use of silver collagen ORC dressing in conjunction with NPWT and ROCF is limited, as the combination use has only recently become available. This limitation was addressed by relying on HCPs’ experience to create the consensus statements and by using peer-reviewed literature to support these statements where possible. As more published clinical data become available, these consensus statements should be further refined.

The small number of panel members and the role of the manufacturer in panel member selection may be considered limitations. To minimize bias, panel members were selected based on their diverse experience with the use of silver collagen dressings and NPWT. The resulting panel was a mix of podiatrists, surgeons, nurse practitioners, and nurses, all with extensive experience managing wounds. Furthermore, to include more key stakeholders in the consensus process, an anonymous survey was sent out to 25 HCPs to obtain their input on the consensus statements developed by the panel. These HCPs were an expanded mix of surgeons, nurses, nurse practitioners, physician assistants, and podiatrists with experience in wound care. Additionally, a modified Delphi method with an anonymous survey was used to minimize the potential for social interaction bias between the panel members and the survey respondents.

A new indication for use of silver collagen ORC dressings in combination with NPWT and ROCF dressings exists. However, limited published evidence exists to guide use of this therapy combination. An expert panel met to develop guidelines for use of silver collagen ORC dressings with NPWT and ROCF dressings. An anonymous survey was developed and sent to the panel members and 25 other invited HCPs across the United States. Panel members recommended the use of silver collagen ORC dressings with NPWT and ROCF dressing in both inpatient and outpatient health care settings, and for acute and chronic wounds, and further recommended their use at the earliest point possible in the wound care plan. The therapy combination was not recommended in the presence of exposed unprotected organs or exposed unprotected vessels, when the potential for inadequate wound hemostasis exists, acutely ischemic wounds, third-degree burn wounds, surgically closed incisions, or in patients with hypersensitivity to the therapy components. While the early clinical results following the use of silver collagen ORC dressing in combination with NPWT and ROCF dressings has been promising, more robust, large-scale studies are warranted to fully understand the benefits of this therapy combination. 

Authors: Robert Klein, DPM, CWS¹; Michael N. Desvigne, MD, CWS²; Emily Greenstein, APRN, CNP, CWON³; Ralph J. Napolitano, Jr, DPM, CWSP^4,5; Catherine Milne, APRN, MSN, ANP, CWOCN-AP⁶; Marcus S. Speyrer, RN, CWS, DAPWCA⁷; and Dot Weir, RN, CWON, CWS⁸

Acknowledgments: The authors thank Christopher Barrett, DPM; Saeed Chowdhry, MD; H. John Cooper, MD; Anthony Dardano, DO, FACS; Marcus Duda, MD; Amanda Estapa, NP; Elizabeth Faust, CRNP, CWOCN, CWS; Regina Fearmonti, MD; Luis Fernández, MD, FACS, FASAS, FCCP, FCCM, FICS; Allen Gabriel, MD, FACS; Janis Harrison, RN, BSN, CWOCN; Daphne Hodges, RN, BSN; Luther H. Holton, MD; Ravi Karia, MD; Martha Kelso, RN, HBOT; Paul Kim, DPM, MS; Mary Anne Obst, RN, BSN, CCRN, CWON; Todd Shaffett, DNP, FNP, CWS, FACCWS, DAPWCA; Olivia Snodgrass, PA; Kerry Thibodeaux, MD, FACS; Casey Thomas, DO, FACOS, FACS; Colin Traynor, DPM, CWSP; Terry Treadwell, MD; Julie West, PA; and Phil Wrotslavsky, DPM, for their participation in the consensus statement survey. The authors also thank Ricardo Martinez, Julissa Ramos, and Julie M. Robertson (Solventum) for assistance with manuscript preparation and editing.

Affiliations: ¹University of South Carolina School of Medicine Greenville, Greenville, SC, and Prisma Health, Greenville, SC; ²Abrazo Arrowhead Hospital and Wound Clinic, Glendale, AZ; ₃Essentia Health-Fargo, Fargo, ND; ⁴OrthoNeuro, Columbus, OH; ⁵Heritage College of Osteopathic Medicine, Ohio University, Athens, OH; ⁶Connecticut Clinical Nursing Associates, LLC, Bristol, CT; ⁷The Wound Treatment Center, Opelousas, LA; ⁸Saratoga Hospital Center for Wound Healing and Hyperbaric Medicine, Saratoga Springs, NY

Disclosure: All authors serve as consultants for Solventum.

Correspondence: Robert Klein, DPM; Clinical Associate Professor of Surgery, University of South Carolina School of Medicine, 200C Patewood Drive, Suite 300, Greenville, SC 29615; robklein63@gmail.com

Manuscript Accepted: June 4, 2024