Chronic Wound Management with the Innovative Ovine Extracellular Matrix Technology: The Honduran Experience

Abstract Body:       The triad of local wound management includes debridement, control of infection/inflammation, and moisture balance (Bohn, Schultz et al. 2017). Complex wounds present a major challenge due to the degree of damaged/missing tissue, where the void requires re-epithelialization. This lengthy process leaves the exposed wound and underlying tissues susceptible to infection. This further exacerbates the underlying inflammatory processes thus delaying wound healing. Prolonged inflammation can lead to wound chronicity, where inflammatory cells release high levels of matrix metalloproteinases that breakdown collagen, interrupting tissue re-building and wound closure (Schultz, Sibbald et al. 2003). The aim of this study was to describe the use of an extracellular matrix (ECM) technology-based treatment in the treatment of chronic wounds. The ECM technology is available both with (ECM/Ag†) and without (ECM#) ionic silver enabling intervention to the tailored to a wound. The ECM technology functions as a structural and biological mimic of tissue ECM (Lun, Irvine et al. 2010, Dempsey, Miller et al. 2019). The ionic silver variant protects from microbial colonization and biofilm formation  (Karnik, Dempsey et al. 2019). Chronic wounds (n=4) from spontaneous and traumatic causes were included in the study. The average wound size was 28 cm2 (range 10 to 40 cm2), and average wound age was 264 months (range 24 to 528). All wounds received debridement and appropriate wound care followed by ECM/Ag† application for the first five weeks. At this point, treatment was switched to ECM. One wound became infected at week 6, so was switched back to ECM/Ag. All wounds responded well and the average percentage wound area reduction at 4 weeks was 19%. This represents the first Honduran evaluation of this ECM-based product for the management of chronic wounds. The availability of this advanced technology provides another tool for the management of these complex wound pathologies, even in one of the most challenging healthcare settings, such as in the Honduras.