Case series using a silver contact layer (UrgoTulAG) combined with a hydro-conductive dressing (Drawtex) for management of chronic lower extremity wounds.

 Venous insufficiency accounts for a large proportion of cases, with an estimated prevalence of 17% (men) and 40% (women).  PVD may cause venous stasis dermatitis and ulcerations. On a molecular level, studies of veins under increased pressure have shown physical changes, including both thickening and thinning of the vessel wall, dilation of the valve annulus, stretching of the leaflets, and complete destruction of the valves. The imbalance of the matrix metalloproteases (MMPs) including MMP-2 and MMP-9 and their tissue inhibitors (TIMPs), along with upregulation of pro-inflammatory cytokines and growth factors, favor the alteration in the cell membrane of the vessel walls. These changes result in alterations in fibroblastic activity, vascular remodeling, and hydrostatic tensions across the vessel wall, all of which lead to the leaking of the vessels, pooling of blood and the development of ulcers.  As ulcerations develop, bacterial colonization and overgrowth play a pivotal role in poor wound healing. With this in mind, we utilized a combination therapy of silver contact layer (UrgoTulAG) and a hydro-conductive dressing (Drawtex) to treat chronic venous leg wounds. Our purpose for this case series was to assess the effectiveness of these dressings in combating the chronic drainage of venous stasis wounds. This, in turn, addresses the pro-inflammatory components of the wound and recalibrates the MMP imbalance.

A series of patients with underlying lower extremity venous insufficiency wounds were treated with dressing combination therapy and compression wraps during weekly wound care therapy.  

Our results thus far show a promise in providing a non-adherent, absorbent therapy that optimizes the wound beds for better healing.

Trademarked Items (if applicable): Drawtex
UrgoTulAG

References (if applicable): 1. Akase S, Pascarella L, Bergan JJ, Schmid-Schönbein GW. “Hypertension-Induced Venous Valve Remodeling.”  J Vasc Surg, 2004 Jun; 39 (6): 1329-34.
 2. Dortmund DN. ”Chronic Venous Insufficiency – A Review of Pathophysiology, Diagnosis, and Treatment.” J Germ Soc Derm, 2017 May ; vol 15 (5): 538-56.
 3. Durham KC, Herbert AA. “Chronic Venous Insufficiency: Pathophysiology and Treatment.” Todays Wound Clinic. 2012 Dec;vol 6 (9) – online.
 4. Fan CM. “Venous Pathophysiology.” Semin Intervent Radiol. 2005; 22 (3): 157–61.