The Management of Wounds with Exposed Tendon and Bone with Innovative and Complementary Technologies: Ovine Extracellular Matrix and Gentian Violet/Methylene Blue Antibacterial Foams

The three main components of local wound management include debridement, control of infection/inflammation, and moisture balance (Bohn, Schultz et al., 2017). This is also true in the resolution of complex wounds where tendon and bone is exposed. These wounds can also present a major challenge due to the degree of damaged/missing tissue, where the void requires reconstruction and reepithelialization. The lengthy process leaves the exposed wound susceptible to infection. Tendon and bone may be exposed in trauma wounds, stage IV pressure wounds, diabetic wounds, and infected surgical wounds. Infection of tendon and bone exposed wounds causes a state of inflammation, delaying the healing process.

Prolonged inflammation can lead to wound chronicity, where inflammatory cells release high levels of matrix metalloproteinases that break down collagen, interrupting rebuilding and wound closure (Schultz, Sibbald et al., 2003). The objective of this study was to describe the use of a treatment bundle that includes extracellular martrix (ECM) technology and gentian violet/methylene blue (GV/MB) antibacterial foam dressings. The ECM technology is protected from microbial contamination, as well as being able to modulate wound proteases and build tissue (Karnik, Dempsey et al., 2019). GV/MB polyvinyl alcohol (PVA) foam dressing is a complementary technology which is non-cytotoxic and does not inhibit growth factors. Wounds (n=10), including VLU, DFU, PI, surgical, and traumatic, were included in this study. The average wound size was 5 cm and wound age was eight weeks.

All wounds received debridement followed by ovine ECM/Ag application covered with either GV/MB antibacterial polyvinyl alcohol (PVA) foam or GV/MB polyurethane foam (PU) dressing. Wound management was switched to non-antimicrobial ECM in some cases. All wounds responded well with 60% achieving a >50% reduction in wound area by four weeks. The average percentage wound area at four weeks was 35% of the starting wound size.