Use of Advanced Elastomeric Skin Protectant on Venous Leg Ulcer Periwound Skin

VLUs affect 2.2 million Americans annually and account for 70% to 80% of all lower extremity ulcers, with recurrence rates as high as 70% at 6 months.^1-3 VLUs have commonly been associated with prolonged wound healing, with the underlying causes leading to fragile periwound skin prone to breakdown.⁴  Traditional management of VLUs includes wound bed debridement, periwound skin protection (such as pastes and creams), use of highly absorbent wound dressings, and multilayer compression therapy.^1,5,6

The management of VLU periwound skin can be challenging. The already fragile periwound skin can be further irritated by heavy VLU exudate or injured with the application and removal of thick creams and pastes. Additionally, creams and pastes can obscure the periwound skin from viewing, making skin condition monitoring difficult.⁷ However, barrier films, such as advanced elastomeric skin protectant (Cavilon Advanced Skin Protectant; 3M Company), are available and may provide easier application and allow for better periwound skin monitoring due to the product’s transparent quality. As a lack of published evidence reporting on the use of the advanced elastomeric skin protectant in patients with VLUs exists, this retrospective study assessed the use of skin protectants with topical dressings and multilayer compression wrap in 5 patients with VLUs.

Deidentified retrospective data from patients with medial ankle VLUs were assessed. As the study assessed retrospective data from a small number of patients, IRB approval was not needed. Full patient and wound assessments were performed. All patients underwent endovenous ablation to correct venous insufficiency. Zinc barrier cream was applied to the periwound skin followed by application of silver hydrofiber dressings, super absorbent dressings (KerraMax Care Super-Absorbent Dressing; 3M Company), and multilayer compression wraps (Coban 2 Two-Layer Compression System; 3M Company). Dressings were changed and the zinc barrier cream removed and reapplied every 7 days. Wound healing and periwound skin condition were monitored.

After 3 weeks, use of zinc barrier cream was discontinued and use of the advanced elastomeric skin protectant was initiated. As before, silver hydrofiber dressings, super absorbent dressings, and multilayer compression wraps were applied, after the advanced elastomeric skin protectant had dried completely. Dressings were changed and the advanced elastomeric skin protectant reapplied every 7 days. Wound healing and periwound skin condition monitoring was continued.

Five patients presented for care with medial ankle VLUs. Mean patient age was 72.6 years (Table). Common patient comorbidities included hypertension, obesity, venous insufficiency, and varicose veins. During the first 3 weeks of treatment, zinc barrier cream was utilized. However, unwanted product buildup was noted during application, and removal of the barrier cream at dressing changes often led to periwound epidermal skin stripping.

After 3 weeks, advanced elastomeric skin protectant became available at the author’s institution, and its use was initiated due to periwound skin injury during removal of the zinc barrier cream. The advanced elastomeric skin protectant was easy to apply using the applicator, and unwanted product buildup was not reported. Epidermal stripping was not observed with the advanced elastomeric skin protectant as it does not require removal. Periwound skin improvement, wound size reduction, and development of healthy granulation tissue were noted in all patients after advanced elastomeric skin protectant use was initiated (Figures 1-3).

VLU periwound skin was examined in 5 patients following the use of periwound skin protectant with topical dressings and multilayer compression wrap. Routine current practice consisted of zinc barrier cream use for periwound skin protection. However, in these 5 patients, periwound skin protection transitioned to the advanced elastomeric skin protectant after 3 weeks due to skin injury during removal of the zinc barrier cream. Additionally, unwanted product buildup was observed with the zinc barrier cream use. Following the use of the advanced elastomeric skin protectant, the periwound skin condition improved, and erythema was reduced in all 5 patients. Product buildup and epidermal stripping were not observed with advanced elastomeric skin protectant usage as it was reapplied once every 7 days and did not require removal.

Limited evidence exists for the use of advanced elastomeric skin protectant, and currently all published studies focus on the management of IAD. One article reported reduced patient-reported pain scores and resolution or reduction of IAD with advanced elastomeric skin protectant use in 18 patients.⁸ An article by Brennan et al indicated that use of the advanced elastomeric skin protectant led to a reduction in the IAD score, improved or complete re-epithelialization of damaged skin, and reduction in patient-reported pain in 16 patients with IAD.⁹ However, an 84-patient randomized, open-label trial in Singapore reported similar rates of IAD healing in patients who received skin cleansers and advanced elastomeric skin protectant or zinc barrier cream when compared with patients who received zinc barrier cream alone.¹⁰

The limited evidence means that a direct comparison to the published literature cannot be made; however, the available literature does provide evidence that use of the advanced elastomeric skin protectant may help protect skin from further irritation and breakdown while allowing for skin healing. In this population of patients with VLUs, the application of advanced elastomeric skin protectant resulted in reduction or resolution of periwound skin erythema in all patients, similar to the improved skin condition reported in the published IAD literature. Additionally, the use of the advanced elastomeric skin protectant allowed for an unobstructed view of the periwound skin, enabling the clinician to repeatedly check healing progress without the need for removal and reapplication.

Limitations for this study include the small number of patients, retrospective study design, and lack of evidence reporting on the use of the advanced elastomeric skin protectant in VLU management. While the study results are promising and show how the use of an advanced elastomeric skin protectant can help manage and protect periwound skin, there is a need for larger, randomized, controlled studies to fully assess the patient outcomes.

In these 5 patients, advanced elastomeric skin protectant use along with wound dressings and multilayer compression wraps led to improved periwound skin and reduced erythema compared to zinc barrier cream use. Additionally, the use of the advanced elastomeric skin protectant in patients with periwound skin irritation
has become routine in the author’s institution due to the ease of application compared with zinc barrier cream, as well as the positive clinical benefits observed following its use.