Use of a Novel Combination Dressing in the Management of Venous Leg Wounds

Background: Venous leg ulcers are notoriously heavily draining and slough-covered wounds making them a challenge to treat. Wound exudate is produced as a normal part of the healing process. During the inflammatory response, blood vessel walls dilate and become more porous, allowing leakage of protein-rich fluid into the wounded area. When this normal physiologic process is compounded with venous insufficiency found in PVD the amount of exudate can increase exponentially. Managing exudate and maintaining a wound environment that is moist but not wet is a constant challenge. This increase in drainage also contributes to the formation of a significant amount of bioburden. Bioburden on the wound is another substantial barrier to wound healing. Bioburden is comprised of devitalized tissue, proteinaceous exudates, spent white blood cells and most specifically microorganisms. Surface-associated bacteria organize into biofilms so it would appear that they are the most notable component of wound bioburden.

Methods: In this case series we used a novel dressing which combines both a superabsorber and a bacterial binding technology together to manage both excessive exudate and bioburden. The super absorbent core of fibers and gel-forming polymers absorb and retain large volumes of exudate. The dressing is coated with DACC (dialkylcarbamoyl chloride) which is a highly hydrophobic fatty acid derivative that wound bacteria find very attractive. Bacteria become irreversibly bound to the DACC coated dressing fibers and are unable to move back into the wound bed. Bacteria become inactivated, preventing toxin release and replication. By using this combination therapy in addition to gold standard multilayer compression wrap therapy we were able to facilitate healing in a difficult to treat patient population. A prospective case study was conducted in an outpatient wound care setting consisting of a sample of patients with venous leg ulcers. At clinician discretion, following appropriate wound bed preparation, the DACC coated superabsorber dressing was applied. Then a multilayer compression wrap was applied. The wounds were examined on a weekly basis. Wound size, the quality of the periwound and any adverse events were recorded.

Results: The DACC coated superabsorber dressing managed the excess drainage to help protect the periwound of venous leg ulcers under compression. The DACC coated superabsorber also decreased the incidence of infection and bioburden in the wounds thus allowing for rapid wound closure without complications.