Interesting and Consistent Results Utilizing a Microporous Pigmented Antibacterial Polyvinyl Alcohol (PVA) Foam to Augment Wound Bed Preparation

Introduction:Chronic open wounds, particularly venous leg ulcers, frequently accumulate a stubborn gelatinous material that is not easily removed with routine cleansing without significant force being applied to the wound bed which is often painful for the patient. Often described as slough, this leads one to think of it as necrotic tissue, yet in an uninfected, well perfused ulcer, continuous necrosis does not make sense. This coagulum, however, often requires removal by a sharp instrument due to its tenacious attachment, and is often not impacted by topically applied collagenase, presumably because of the absence of devitalized collagen.Methods:Our clinic was re-introduced to a pigmented, pre-moistened wide-cell polyvinyl alcohol (PVA) foam with large open pores* which would be conducive for use with negative pressure wound therapy. We decided to try it as a primary dressing, predominately on venous ulcers or other types of lower extremity wounds under compression, as these often present with the previously described material. The dressings were applied directly to the wound bed, and 100% of the time were covered with a 5-layer superabsorbent foam† to assure intimate contact with and transfer of exudate from the wound bed, followed by a 2, 3- or 4-layer compression wrap.Results:We consistently found at the subsequent dressing changes, 3 to 7 days later, the wound beds were curiously and consistently cleaner with the adherent material captured into the PVA foam and other exudates, if present, absorbed into the secondary foam. Once the surface of the wound improved, we then resumed use of alternate dressings based upon the other assessed environmental needs of the wound. Conclusions:As illustrated in multiple before and after photos, the explanation for the now predictable outcomes is still elusive, however our previous experience with PVA materials, specifically a more classic, closed cell foam with the same pigments as well as a PVA gelling fiber has been remarkable for movement of exudates and detritus from wound surfaces. We will continue to employ the utilization of the dressing in this fashion with the expectation of continued consistent outcomes.