| 303 |
Case Study/Series
|
Combination Therapy using Silver Dressing and Bioengineered Skin Substitute in Recalcitrant Venous Stasis Ulcers First Author: Maria Guidry Authors: Maria T. Guidry, MD, CWS INTRODUCTION: This three-patient case series is part of a prospective study comparing healing rates of recalcitrant venous stasis ulcers when a silver-impregnated foam (SIF) is combined with a bioengineered skin equivalent (BSE) graft, compared to BSE alone. It is hypothesized that SIF can reduce the bacterial bioburden and infection rate of grafts, facilitating graft survival and re-epithelialization. Six subjects with recalcitrant chronic venous stasis ulcers present for over six months were studied. Three of the six are presented as case studies. All ulcers were full-thickness venous ulcers that failed to heal with conventional wound care, debridement, and four-layer compression. These patients showed no evidence of diabetes, arterial insufficiency, neoplastic transformation, or other co-morbidities that may impair healing. Each patient had two or more venous stasis ulcers. One ulcer was treated with BSE alone, and any other was treated with both BSE and SIF. Four-layer compression wrap was applied, and wound progress was monitored weekly. In patients treated with BSE plus SIF, five ulcers out of six were 80-90% epithelialized by week four; ulcers treated with Apligraf alone were 50-70% epithelialized by week four. CONCLUSION: This case series suggests improved healing when SIF is used with BSE instead of BSE alone. This may be attributed to enhanced bioburden and infection control and possible anti-inflammatory effects, enhancing the graft "take". Randomized controlled trials would help determine any evidence of improved healing rates, which would support the combined use of silver dressings over skin grafts and bioengineered skin substitutes. *Acticoat Moisture Controlª, Smith and Nephew, Inc., Largo, FL **Apligraf¨, Organogenesis, Inc., Canton, MA |
|