The efficient application of instilling negative pressure wound therapy with a hypochlorous acid-preserved wound cleanser: a case series and practical advice.

BACKGROUND: The use of negative pressure wound therapy with instillation and dwell time (NPWTi-d) has been shown to be effective in removing nonviable tissue, reducing bioburden, and promoting granulation tissue formation in acute and chronic infected wounds. OBJECTIVE: To illustrate the clinical efficacy of the use of pure hypochlorous acid (pHA) antimicrobially preserved wound cleansing solution as the instillation fluid for NPWTi-d (NPWTi-d/pHA) in wound bed preparation in patients with complex wounds. CASE REPORT: The treatment protocol for use of NPWTi-d/pHA in preparing wound beds for final closure is demonstrated in 3 illustrative cases of patients with complex wounds resulting from necrotizing infection and trauma with heavy contamination. All 3 patients developed a healthy-appearing wound bed deemed suitable for primary closure an average of approximately 1 month following initial surgical debridement. CONCLUSION: The cases presented demonstrate the ability of a pHA antimicrobially preserved wound cleansing solution used as the instillation fluid with NPWTi-d to aid in bacterial reduction, mechanical debridement, and promotion of wound healing. Use of NPWTi-d/pHA in these cases of extensive necrotizing infection and posttraumatic injury with heavy contamination allowed for final closure an average of 1 month after initial surgical debridement.

A debriding gel in the treatment of post-trauma, non-healing lesions.

BACKGROUND: Topical desiccation agent (TDA) is an acidic species in a gel with a potent hygroscopic action. When in contact with (water in) biofilm and necrosis, rapid desiccation occurs, with the dehydrated tissues typically sloughing off in 1-3 days. This allows for quick granulation tissue formation which is an essential step for healing by secondary intention or as wound bed preparation for grafting. METHODS: A series of nine non-healing, post-trauma lesions on the lower leg were treated with TDA, followed by treatment of the lesion with vaseline gauze. RESULTS: The average age of the patients was 77.0 years and the lesions had been in existence for 5.6 months on average. The average size of the lesion was 15.9 cm2. Complete granulation of all lesions was reached in an average of 34.1 days while the time to complete reepithelialization averaged, 69.8 days (data from one outlier removed). There were no adverse events. CONCLUSION: These data suggest TDA treatment is an effective and efficient way to debride lesions, and to prepare them for healing by secondary intention or for grafting.

A desiccation compound as a biofilm- and necrosis-removing agent: a case series.

OBJECTIVE: A new compound, Debrichem (DEBx Medical BV, the Netherlands), a topical desiccation agent (TDA), is an active gel that contains an acidic species with a potent hygroscopic action. When in contact with microorganisms and necrosis, rapid desiccation and carbonisation of the proteins in these microorganisms, as well as of the extracellular matrix of biofilms and necrosis, occurs. The resulting 'precipitate' rapidly dislodges from the wound bed, resulting in a clean wound which granulates, which is a prerequisite for healing by secondary intention. METHOD: In a retrospective study, a series of mostly large and hard-to-heal lesions of different aetiologies were treated with a one-time application of the TDA, followed by weekly dressing changes. RESULTS: Of the total of 54 lesions included in this case series, 22 were diagnosed as venous leg ulcers (VLUs), 20 as diabetic foot ulcers (DFUs), nine as post-traumatic, hard-to-heal lesions, two as vascular ulcers and one as an ischaemic ulcer. All of the VLUs, 75% of the DFUs and all of the other lesions reached complete granulation. CONCLUSION: The use of a TDA may contribute to the consistent, fast and easy removal of both biofilms and necrosis, and hence to wound healing.

A review of iodine-based compounds, with a focus on biofilms: results of an expert panel.

Biofilms play a central role in the chronicity of non-healing lesions such as venous leg ulcers and diabetic foot ulcers. Therefore, biofilm management and treatment is now considered an essential part of wound care. Many antimicrobial treatments, whether topical or systemic, have been shown to have limited efficacy in the treatment of biofilm phenotypes. The antimicrobial properties of iodine compounds rely on multiple and diverse interactions to exert their effects on microorganisms. An expert panel, held in Las Vegas during the autumn Symposium on Advanced Wound Care meeting in 2018, discussed these properties, with the focus on iodine and iodophors and their effects on biofilm prevention and treatment.

The treatment of paediatric burns with concentrated surfactant gel technology: a case series.

OBJECTIVE: To assess the safety and efficacy of a surfactant-based technology for the management of burns. METHOD: In a retrospective review, paediatric patients with different types of burns were treated with the gel technology. In some patients, the treatment was combined with a topical antimicrobial agent. Primary objectives of the review were the assessment of healing, healing times and ease of use of the material. RESULTS: The wounds of 15 paediatric patients with different types of burns, particularly with regard to depth and anatomical location, were evaluated using a retrospective chart review. It was found that the surfactant gel technology, with or without the topical antimicrobial agent, assisted in autolytic debridement, and that time to re-epithelialisation was short and within the range of those obtained with other established treatments. CONCLUSION: The number of patients and wounds in this evaluation is small but the study indicates that the gel technology provides a safe and effective way to treat smaller burns in paediatric patients.

Report on Three Porcine Proof-of-concept Studies: Comparison of a Dermatome With a Rotating Excision Ring With Conventional Dermatomes for the Harvesting of Split Skin Grafts and Excision of Necrosis.

INTRODUCTION: A new pneumatic dermatome with a circular excision blade was designed to improve a number of disadvantages of regular dermatomes. OBJECTIVE: This study analyzes the safety and efficacy of a new dermatome (test device) for the tangential excision of necrosis and harvesting of split-thickness skin grafts (STSGs). MATERIALS AND METHODS: Three porcine proof-of-concept studies were conducted to compare the test dermatome with conventional dermatomes (control devices) for both excision of necrosis (one study) and the harvesting of a STSG (2 studies). For the harvesting studies, donor sites and grafts were analyzed for viability, healing rate, and scar outcomes. Biomechanical tests also were performed on the donor sites. For the necrotectomy study, healing of the excised area and thickness of the excised tissues were studied. RESULTS: The test device was similar to the control devices in viability of collected tissues, speed of healing, and donor site biomechanics. In 1 graft harvesting study, as well as in the excision study, uniformity of the thickness of the harvested tissues was better for the test device than for the control devices. The test device performed better than the controls on maneuverability, control of the consistency of the relationship between depth setting and actual graft thickness, device assembly, overall ease of use, depth of the debridement as intended, consistency of the debridement thickness, device accuracy, and size. CONCLUSIONS: The studies showed the test device, when compared with the control devices, was equal on safety. On efficacy, consistency of the excised tissues was superior for the test device, which may result in better grafts and outcomes. Several aspects related to the ease of use, particularly maneuverability, were superior as well.