(CS-140) A synthetic bioresorbable polymeric matrix* to treat chronically infected wounds: A clinical case series

Nour El Ghazal, BSc – Medical Student, St George's University of London; Rania Mansour, MPH – Medical Student, St George's University of London

Introduction:

Chronically stalled wounds that have failed standard local wound care, serial debridement, systemic and topical antimicrobials represent a difficult clinical problem. These wounds have entered a nonhealing phase due to altered wound milieu, persistent inflammatory state, and biofilm formation. We hypothesize that these wounds are often chronically infected with bioburden and may respond well to a novel synthetic bioresorbable polymeric matrix that provides a sustained release of antimicrobial silver ions.* Studies investigating the efficacy of this polymeric matrix remain scarce. We aim to delineate the type of wounds that respond well to this matrix and report a case series of difficult nonhealing wounds treated with this polymeric matrix.

Methods:

Retrospective review of five patients treated at a community teaching hospital in Chicago, Illinois. All patients were felt to have chronic wound bioburden. Patients underwent standard local wound care including debridement, compression therapy, and antibiotics when indicated. Polymeric matrix was applied serially to the nonhealing wounds. Wound dimension, clinical events, culture results, and antibiotics administered were collected and tracked over time.

Results:

Patient 1: 91 year-old female with a recalcitrant chronic venous ulcer of over 11 years who underwent multiple venous ablation procedures as well as arterial revascularization without healing. Patient 2: 69 year-old female with history of venous insufficiency, diabetes, and smoking with chronic recurrent ankle ulcers for 13 years. She presented with a stalled ulcer of 7 months duration. Patient 3: 80 year-old female with venous insufficiency who presented with an ulcer of 6 years duration. Her course was complicated by hospital admission for neutropenia secondary to chemotherapy for breast cancer. Patient 4: 74 year-old female, former smoker, with history of brown recluse spider bite resulting in an ankle ulcer that had previously healed after skin grafting. She presented with recurrent ankle wounds after minor trauma. The wounds were stalled for 6 months despite aggressive local wound care. Patient 5: 91 year-old female, former smoker who presented with a chronic wound of 2 months duration after a fall while on anticoagulation resulting in a hematoma with overlying skin necrosis. All wounds began to respond after serial matrix application. All 5 patients healed completely.

Discussion:

This novel bioresorbable polymeric matrix shows promise in treating chronic wounds with bioburden that have failed antibiotics and standard silver-based dressings. Larger multicenter trials are needed to delineate the ideal wound population and to optimize treatment technique.