Jet Lavage Irrigation and Dialkylcarbamoyl Chloride Wound Dressing in Stage 4 Pressure Injury Chronic Wounds: Pre-hypothesis Study

Introduction:Dialkylcarbmoyl (DACC) chloride-coated wound dressing is a non-cytotoxic system for reducing bio-burden by hydrophobic binding of the microorganisms. This pre-hypothesis study assessed a DACC dressing in three patients with failed chronic pressure injuries to determine the suitability for an intention to treat protocol. Methods:Three patients participating in an investigational review board study (#6066, Sterling IRB, Atlanta, Ga) were selected for testing using a protocol of daily jet lavage irrigation using a pulsatile irrigator. A 71-year old male had been treated for a severe chronic wound that initially measured 260 cm2. Treatment was performed 5 days per week, and the wound has not moved out of the inflammation stage. A 70-year old female, disabled by a severe Covid infection, developed a 270 sq cm2 pelvic pressure injury that had stalled with negative pressure wound therapy. A 42-year old female with extreme obesity(BMI of 52), chronic diabetes and lymphedema had a stage 4 chronic posterior distal calf wound measuring 21 cm2 that had not healed in four years. On a Friday, each wound was treated with a 3-liter normal saline jet lavage protocol. Autoflourescence imaging (MolecuLight) revealed complete removal of all imageable bacteria (Sensitivity:log 4 CFU/gram tissue)with bright red imaging (bacterial porphyrin autofluorescence). DACC offered no measurable effect. The second and third patient had a negative autofluorescence image after treatment and the wound surface showed excellent red granulating wound surface. A second assessment repeated using the same protocol after another 48 hours interval revealed the same findings. Discussion:The first patient requires an intensive protocol of wound antiseptics, such as sodium hypochlorite, with daily jet lavage irrigation, and treatment is palliative. In the other two patients, autofluorescence imaging was negative at 48 and 72 hours. Based on autofluorescence, progressive healing is likely with jet lavage irrigation and use of the DACC rope warranting further study.