Utilizing Transforming Powder Dressing on Chronic Venous Leg Ulcers Refractory to Standard of Care Management: Outcomes of Three Patients

Introduction: Venous leg ulcers (VLU), account for 70% of all leg ulcers, occurring in 1-2% of the general population and in 4% of people 65 years of age and older.1. The average healing rate for VLU is only 60% after 12 weeks of treatment,1 and these wounds are associated with significant financial burden,2 decreased quality of life,2,3,4 and pain.3,4. This case series describes the outcomes of 3 patients with chronic VLUs and multiple comorbidities who were transitioned to a novel transforming powder dressing (TPD) after no significant improvements with commonly used standard of care (SOC) wound dressings for several months. TPD is an extended wear powder dressing comprised primarily of polymers similar to those used in contact lenses, that when hydrated, aggregate to form a moist oxygen-permeable barrier that covers and protects the wound.Methods:Three patients with wounds refractory to SOC treatments (various modalities including hydrogels and other dressings with broad spectrum antimicrobial properties in conjunction with compression therapy) were transitioned to TPD. TPD was applied to the wound and “topped off” (additional powder sprinkled on existing TPD matrix) or reapplied weekly, followed by compression, in an outpatient wound clinic. The type of compression utilized for each patient before and after implementing TPD was not changed.Results:Three patients [mean age 68.3 years (range 60-74), 33% female] with chronic VLUs refractory to SOC were followed. Duration of VLU ranged from 4 to 9 months prior to initiation of TPD. Average wound area was 2.6 cm2 (range: 1 -4.6 cm2) when TPD was first applied. All wounds epithelialized within 6 weeks of first TPD application [Patient 1: 6 weeks (3 TPD applications, 1 top off); Patient 2: 5 weeks (4 applications, 1 top off); Patient 3: 6 weeks (3 applications, 3 top offs).Discussion: Despite quality SOC for VLU for several months, there was no significant improvement for these 3 patients. Once converted to TPD, all wounds epithelialized within 6 weeks with reduced frequency of dressing changes versus SOC. TPD was well tolerated under compression, and no complications were observed. TPD should be considered for treatment of VLUs in addition to standard compression.References:1. Kyung Bok Lee. Ann Phleboloby 2023; 21 (1): 5-13. Published online June 30, 2023. 2. Kolluri R, Lugli M, Villalba L et al. An estimate of the economic burden of venous leg ulcers associated with deep venous disease. Vasc Med. 2022 Feb;27(1):63-72. doi: 10.1177/1358863X211028298. Epub 2021 Aug 16. Erratum in: Vasc Med. 2021 Sep 22;:1358863X211048020. PMID: 34392750; PMCID: PMC8808361. 3. Guarnera G, Tinelli G, Abeni Det al. S. Pain and quality of life in patients with vascular leg ulcers: an Italian multicentre study. J Wound Care. 2007 Sep;16(8):347-51. doi: 10.12968/jowc.2007.16.8.27856. PMID: 17927081. 4. Mahmood BA, ElSayed EH, Abd Elghany SM, et al. A New Powder Dressing for Management of Chronic Venous Ulcers. Dermatol Surg 2023;00:1-5. www.dermatologicsurgery.org.