Enabling Aggressive Surgical Debridement and Healing in a 10 year old Decubitus Ulcer with a Novel Self-Assembling Peptide-based Advanced Wound Dressing

Frequent debridement and surface management are the most important techniques for achieving better outcomes in chronic wounds, which are chronic infections caused by surface-associated bacteria (biofilm).[1] Unfortunately, bleeding is among the greatest barriers to aggressive debridement, exacerbated by the paucity of available effective advanced wound dressings and other tools that could enable better debridement, especially in the low acuity clinic setting. Therefore, a novel and proprietary self-assembling peptide-based advanced wound dressing[2] was assessed during the debridement and care of chronic wounds.
A 47 year old patient presented with a history of paraplegia and an ischial decubitus ulcer that would not heal during the prior decade of standard care. The patient was then treated every two weeks over 42 days with aggressive surgical debridement, until a bleeding wound bed was visible, and concomitant application of the self-assembling peptide-based advanced wound dressing. Debridement depth below the necrotic biofilm containing tissue was initially 0.5 cm and subsequently 0.1 cm. In our experience, this level of debridement typically requires an operating room plus thrombin, sutures and/or other interventions to manage bleeding.
This novel advanced wound dressing self-assembles locally on the wound bed into a nanofiber network. We noted that its concomitant use allowed for more aggressive debridement and with bleeding control, avoiding back ups to the clinic schedule. Furthermore, the dressing permits migration of host healing cells and noteably during the six weeks, wound volume decreased 50% from 4x3x7 cm3 to 3x3x4.5 cm3 (length x width x depth).[3] Importantly, the patient expressed excitement to keep his appointments, noting a significant reduction in drainage and easier self-care of the wound.
In conclusion, this novel self-assembling peptide-based advanced wound dressing enabled aggressive surgical debridement in the clinic and was associated with evidence of healing and hemostasis in a previously stalled 10 year old ischial decubitus ulcer.  
[1] European Society of Clinical Microbiology and Infectious Diseases guideline for the diagnosis and treatment of biofilm infections 2014, Clin Microbiol Infect 2015; 21: S1–S25
[2] AC5® Advanced Wound System, Arch Therapeutics, Inc., Framingham, MA
[3] Wounds were measured with comparably applied tension at each point in time.

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