Combined Sequential Effect of a Purified Collagen Matrix with Polyhexamethylene Biguanide, Followed by a Complete Placental Allograft, on a Diverse Group of Chronic Wounds of Various Etiologies: A Case Series

Introduction: Chronic wounds frequently stall in the inflammatory phase, and are characterized by elevated pro-inflammatory molecules and proteases. The presence of biofilm is suspected to be a main reason wounds stall and become chronic.  
We are reporting retrospectively, our initial experience with the sequential use of (1) a purified Collagen Matrix containing antimicrobial Polyhexamethylene Biguanide (PHMB)*, followed by applications of a complete Placental Allograft ** in 13 patients.

Objective: With standard wound care and the product combination of the collagen matrix with antimicrobial then a complete amniotic allograft wound healing results increase. First quenching proteases, eradicating bacteria, preventing biofilm re-formation post debridement transfers the wound  through the inflammatory phase. Followed by applying a complete amniotic allograft that is abundant in Growth Factors and Regulatory Proteins accelerating the wound’s proliferating phase.

Methods: Thirteen patients (6m/7f, average age 76.4 years) with extensive co-morbidities were retrospectively included. These included upper and lower extremity wounds of multiple etiologies, such as trauma, arterial, pressure, diabetic and venous ulcers, excised skin malignancies and complicated insect bites. (Average size 18.42 cm², and 3.37-month duration prior to initiation of treatment. The wounds received weekly debridements, followed by the application of Purified Collagen Matrix with antimicrobial(*), then transitioned to debridement and weekly application of a Placental allograft(**) until healed. 

Results: 84% of wounds (11/13) healed before 12 weeks, (mean closure time 8.48 weeks), the remaining 16% (2/13) by week 17. Mean number of weekly applications was 8.34, with 5.18 purified collagen applications, followed by 3.16 amniotic product applications to closure.

Conclusion: These results, support the strategy of a multimodal approach involving good wound care practices, biofilm based wound management, followed by growth factor delivery as a means of complete closure in this chronic wound patient cohort, with multiple co-morbidities.