Does A New Cellulose Dressing Have Potential In Chronic Wounds?

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By Barbara J. Aung, DPM
Researchers found the dressing also helped promote autolytic debridement and provided a moist wound environment to maintain a healthy granulation tissue base. The wound dressing also aids in cleansing wound margins to help epidermal migration, which leads to wound size reduction and the healing of various chronic wounds. Case Study: How XCell Can Aid Ulcer Healing A 66-year-old Hispanic female presents to our office with a non-healing ulcer to the plantar aspect of the left hallux. She has been treated by a general surgeon since 1996 for this condition. The patient has undergone several debridements and hospitalizations with IV antibiotic therapy. She has also used orthotics to reduce pressure to this area. A biopsy of the ulceration showed squamous epithelial hyperplasia, parakeratosis and marked inflammation. Her past medical history includes IDDM for 16 years, HTN, hyperlipidemia and depression. The patient underwent a left breast mastectomy and is currently undergoing chemotherapy. She also experienced renal failure and is undergoing renal dialysis with the fistula in the left upper arm. Her current medications include insulin and a HTN medication. The patient does not know the name of the HTN medication. She denies using tobacco and alcohol. The patient was scheduled for X-rays, lab work with CBC w/diff, A1c and noninvasive vascular studies. She reports a random blood sugar of 120 to 140. The physical exam reveals a frail woman, who is cooperative and oriented. She is concerned that her toe will need to be amputated, which is adding to her stress and depression. The exam of the lower extremity shows nonpalpable pulses. Her skin temperature is warm proximal to distal with equal and adequate hair distribution to bilateral limbs and toes. There are no foot deformities other than the ulceration to the left plantar hallux and edema to the entire left hallux. There is no cellulitis. We did note mild erythema distal to the first metatarsophalangeal joint. The wound itself is 3 cm in diameter with a thick callus rim and 2 mm deep. The base of the wound appears macerated with white and yellow fibrotic tissue with bleeding within the hyperkeratosis layer. The wound did not bleed with debridement. There was a foul odor during the debridement but no drainage. Proceeding With Treatment We emphasized an initial home care regimen, having the patient apply enzymatic debridement ointment daily with saline moistened gauze and Kling wrap. We ordered a wheelchair for the patient to faciliate offloading. The X-ray findings do not show evidence of acute or chronic osteomyelitis. They did reveal diffuse osteopenia. Her labs were normal and, as expected, the noninvasive vascular study is abnormal with moderately severe occlusive disease, femoral-popliteal disease. The left ABI is 0.41 mmHg. The patient lives one hour from the clinic and has missed several appointments, but I maintained phone contact weekly to stress to the patient the need for follow-up and to remind her of the signs of worsening of the condition. Two months later, the wound was unchanged. I obtained a wound biopsy and requested quantitative analysis. At this point, I initiated the antimicrobial XCell wound dressing along with continued sharp debridement. The patient began performing dressing changes herself with the XCell dressing, followed by normal saline moistened gauze and Kling every other day. Results of quantitative analysis was 2.2 x 10^6 bacteria, gram positive cocci. I did not initiate an oral antibiotic based on the clinical exam and my clinical experience. A month later, the exam showed resolution of the ulceration so I discontinued the wound care regimen and fit the patient for multi-density insoles and extra depth shoes. I encouraged the patient to continue nonweightbearing to prevent reoccurrence until she receives her new insoles and shoes. In Conclusion This biosynthesized cellulose wound dressing, which has a dual moisture handling capability to donate moisture to dry surfaces and absorb fluid from a highly hydrated environment, shows promise in caring for diverse wounds. The ease of application and the ability to leave the dressing in place for up to seven days allows the private practice clinician to offer wound care services within his or her own practice, and schedule follow up care that is more manageable on a weekly basis. Does this mean we only need to have one type of wound care dressing available in our clinics? That remains to be seen.

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