Case Closed: A Dressing for Chronic and Acute Wounds

  The prevalence of chronic wounds increases with patient age and compounding medical conditions. An estimated 6 million patients in the United States have chronic wounds, representing an estimated annual $20 billion burden on the health care system¹; therefore, it is important to effectively address wound concerns early and help prevent nonhealing chronic wounds.

  A wound is considered chronic when it does not heal in an orderly set of phases and in a predictable amount of time. Wounds that do not heal within 3 months often are considered chronic.² The more difficult it is for chronic wounds to heal, the greater the potential burden to patients, their families, and the healthcare system.

  The RTD® Wound Dressing is a highly absorbent, ready-to-use polyurethane foam dressing. It is the only dressing on the market that contains known organic active ingredients integrated into the polymer matrix: methylene blue (0.25 mg/g) and gentian violet (0.25 mg/g) plus a silver compound (silver zirconium phosphate (7 mg/g). This dressing provides sustained antimicrobial protection and is effective against a broad spectrum of Gram-negative and Gram-positive bacteria, yeast, and fungi. It is a more effective antimicrobial than dressings that contain organic pigments (methylene blue and gentian violet) alone.³

  The 3 active ingredients, including silver, provide combined antimicrobial properties that have demonstrated benefits to improving wound healing.⁴ In addition, this dressing is hydrophilic and possesses absorptive properties that create an optimal environment for wound healing. The silver compound in this dressing is noncytotoxic; it can be used to address wounds throughout the continuum of healing.⁵

  The RTD® Wound Dressing represents an effective option for chronic, hard-to-heal wounds, as well as acute wounds of most etiologies. When used as part of a first-line treatment protocol, RTD may help mitigate the risk of wounds not progressing to closure and becoming chronic. Ultimately, a quicker healing time could help save a healthcare facility staff time and money spent on costly wound care products and interventions.

  A retrospective review was conducted to demonstrate the effectiveness of RTD to close both chronic and acute wounds in a timely fashion. Wound care treatment outcomes for 18 patients treated with RTD Wound Care Dressing were analyzed retrospectively. Patients included in the study received RTD Wound Dressing throughout the duration of the treatment period. Patients were excluded if there was interruption of the RTD dressing application or if the treatment regimen was changed for any reason. Patients were assessed by clinic staff weekly. The RTD dressing was changed 3 times per week by the clinic staff, patient, family member, or home health nurse. RTD was cut to fit the wound then packed or layered into the wound bed. The dressing was covered with a semiocclusive or adhesive dressing and left in place for up to 3 days. Some patients received other wound treatments before RTD use; in these cases, wound closure rates and time to heal measures were calculated for the RTD usage period only. Wound measurements were recorded at 2-week intervals. Time to close (in days) was calculated. Patients ranged from 40–93 years old (median 76 years). All patients had associated comorbidities: 50% had diabetes mellitus and 56% had venous insufficiency. Other comorbidities included, infection, cancer, congestive heart failure, peripheral arterial disease, sickle cell anemia, and obesity. Of the 18 wounds treated, 11 (61%) were chronic (see Table 1). The average initial wound surface area measurement was 10.5 cm². Wound duration ranged from 0.5 to 14 months (median 4.0 months). All wounds treated and analyzed came to full closure using RTD dressing. Time to wound closure ranged from 3 to 151 days (median = 40 days).

Examples of cases.
  Case 1. A 72-year-old white woman presented with skin flap compromise following a below-the-knee amputation performed on July 17, 2014. Her history included peripheral artery disease with attempted lower extremity stent placement that failed. Her wound was present for approximately 4 months. The wound measured 8.5 cm x 5 cm x 0.2 cm and was likely related to postsurgical complications. The wound base contained pink granulation with slough and was covered with necrotic eschar. The base of the wound had 60% granulation tissue. The wound bed had exposed subcutaneous and adipose tissue. The skin around the wound was denuded. Wound treatment with RTD was initiated on December 10, 2014. Approximately 4 weeks (27 days) later, 100% closure was achieved (see Figure 1).

  Case 2. An 89-year-old white man was seen for a nonhealing, postoperative wound on the right lower leg following basal cell carcinoma removal performed on January 24, 2014. On initial assessment, the wound had been present for approximately 1 month and measured 3.2 cm x 3.0 cm x 0.3 cm. A moderate amount of serosanguinous exudate was draining from the wound. The wound bed had exposed subcutaneous tissue, and periwound skin was erythematous. The patient was treated for approximately 4 weeks with several other wound dressings with no success in healing. RTD treatment commenced February 25, 2014. The wound achieved full closure within 7 weeks of initiation of RTD Wound Dressing (see Figure 2).

  Case 3. An 82-year-old white man was diagnosed with nonhealing ulcers related to atherosclerosis on December 13, 2013. He reported the ulcer on the anterior right leg had been present for at least 1 month. He had been followed by cardiology and dermatology with little improvement. Past medical and surgical history was significant for multiple comorbidities including coronary artery bypass grafting, hypertension, venous (peripheral) insufficiency, cellulitis, diabetes, chronic renal failure, congestive heart failure, and prostate cancer. On initial examination, the ulcer measured 3.3 cm x 1 cm x 0.1 cm. The patient had received treatment with several other wound dressings for approximately 5 months without successful closure of the wound. Following the initiation of RTD on June 6, 2014, the wound came to full closure in 14 weeks (approximately 3.5 months) (see Figure 3).

Conclusion

  The RTD® wound care dressing was found to be effective at closing a number of wounds treated at our wound care center. Several of these wounds were nonhealing despite multiple wound care interventions other than RTD. Using RTD Wound Dressing as the first choice for treatment may help prevent wounds from becoming chronic and requiring more invasive, higher risk interventions, such as systemic antibiotics and surgical debridement. Further analysis is recommended to compare the wound healing outcomes for wounds treated before the introduction of RTD versus wounds treated after in order to better quantify the full impact of the use of RTD on both wound closure rates and cost to treat chronic wounds at our facility.

Case Closed is made possible through the support of Keneric Healthcare, Irving, TX. The opinions and statements provided in Case Closed are specific to the respective authors and not necessarily those of Ostomy Wound Management or HMP Communications. This article was not subject to the Ostomy Wound Management peer-review process.