Combined approach of advanced dressing and treatment modality promotes complete healing

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Robert Klein
Robert J Klein

Results of a retrospective cohort study, published online in Wounds, have demonstrated that a combination of advanced treatment modalities—such as negative pressure wound therapy (NPWT)—and the use of oxidised regenerated cellulose (ORC), collagen or silver-ORC dressings, contributes to an improved rate of complete wound healing.

“Chronic or senescent wounds are difficult to heal,” explains lead author Robert J Klein (PRISMA Health, Greenville, USA), “and often require a multimodal treatment plan.” According to the author, NPWT or advanced wound dressings can help to promote the development of granulation tissue and the healing of complex wounds, especially for patients with “comorbid medical problems that can impair or delay wound healing”.

Klein adds: “In wounds requiring further treatment, the use of skin substitutes or epidermal grafting may be necessary to promote re-epithelialisation, especially in large chronic wounds.”

In order to determine the possible benefits of ORC, collagen or silver-ORC dressings—either used alone or subsequent to advanced wound therapies—a retrospective cohort of 24 patients (average age 66.8±12.7 years) was studied. Each of the wounds that were examined as part of the investigation underwent sharp debridement before therapy, while oral or intravenous antibiotics were administered if necessary. Klein also details that one wound received topical phenytoin and lidocaine for promotion of wound bed granulation, “which is an atypical use with limited evidence reported in the literature.”

Patients involved in the study received either an ORC, collagen, or silver-ORC dressing (with a secondary dressing) alone, or following the application of NPWT. “In the case of a non-exudating or low-exudating wound, the dressings were hydrated with a sterile saline solution prior to application,” says Klein. He stated further that “dressings were reapplied every two to three days, depending on the amount of wound exudate, because highly exudating wounds required reapplication sooner than wounds with minimal to moderate exudate levels.” In 12 patients, epidermal grafting was also utilised.

Among the 24 patients who were investigated, there were 27 wounds (average duration 70.4±61.6 days), including diabetic foot ulcers (DFUs), surgical wounds, a traumatic wound, an ulcer and thermal burns. However, it was noted by the author that “patients who only received ORC/collagen/silver-ORC dressings had an average wound age of 33.3±33.6 days”. Furthermore, the most prevalent comorbidities in this cohort were hypertension, diabetes, obesity, peripheral neuropathy, hyperlipidaemia, coronary heart disease, and tobacco use.

On the results of the study, Klein says: “All 27 wounds fully closed, with an average time to heal of 65.5±41.5 days. For wounds that only received ORC/collagen/silver-ORC dressings, the average time to heal was 31.5±19.4 days. Of the 24 patients, three were treated following recommendations for limb or toe amputation by a previous clinician due to prior treatment failure.” In these patients, it was found that the ORC/collagen/silver-ORC dressings alone or subsequent to NPWT treatment plan promoted wound closure and enabled limb or toe salvage.

Regarding some of the study’s limitations, Klein underlines the lack of a control cohort, as well as the inherent selection bias of the retrospective cohort examined. “In addition, no comparison with a standard of care control group was performed,” he emphasises.

Klein concludes: “All of the complex and/or chronic wounds treated with NPWT, epidermal grafting, and ORC/collagen/silver-ORC dressings in these patients healed without complications. Further study utilising large patient cohorts with a standard of care control cohort, to examine potential clinical and health economic benefits of multimodal treatment plans, is needed.”

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