Using a Multimodal Hygiene Protocol to Manage a Recurrent Inflammatory VLU With a Novel Bioresorbable Antimicrobial Nanoparticle Matrix

The topic of wound hygiene is beginning to resurface as a term to describe a Holistic or Multimodal approach to wound management. The term was coined by an international panel of wound healing experts convened by a prominent wound care corporation that wanted to expand Biofilm –based Wound Care and the Step-up Step-down approach made popular by Dr. Randy Wolcott and Dr. Greg Schultz. 1-3 The panel wanted to improve the current standard of care for management of biofilm in hard-to-heal wounds by encouraging four core principles: (1) cleanse, (2) debride, (3) refashion the wound edges, and (4) dress the wound. At the Temple University School of Podiatric Medicine, we have used biofilm-based wound care principles since 2010 when Dr. Wolcott introduced us to the concept. We also recently developed a new pneumonic for wound care called ABCESS that focused us on the above 4 principles and more. 4 Our holistic approach has included careful assessment of the patient’s comorbidities, wound bed characteristics and interventions that include the 4 principles, complete vascular status, exudate, periwound skin and regional protection, and social/spiritual factors that may have significant impact on wound environment. Our primary cleanser has been hypochlorous acid due to its strong antimicrobial profile and almost complete lack of tissue toxicity. That has been coupled with dressings that allow for intimate contact with cells on the wound bed to both inhibit biofilm development and stimulate cell growth. The recent addition of the nanoparticle matrix has accomplished both goals better than any previously used contact layers. A case of a chronic VLU complicated by vasculitis and our hygiene protocol exemplifying the utility of this dressing are presented.