Case Series/Study

(CS-051) The use of an acidic debridement agent in combination with Negative Pressure Wound Therapy for the development of granulation tissue in skin ulcers

Co-Author(s):

Introduction: <span style="font-size: 12.0pt; line-height: 150%; font-family: 'Arial',sans-serif; mso-fareast-font-family: 'Times New Roman'; color: black; mso-themecolor: text1; mso-ansi-language: EN-US; mso-fareast-language: NL;">Most skin ulcers heal by secondary intention1 but progress is hampered by the presence of necrosis and biofilm. Therefore, debridement is necessary to remove these detrimental factors. 
<span style="font-size: 12.0pt; line-height: 150%; font-family: 'Arial',sans-serif; mso-fareast-font-family: 'Times New Roman'; color: black; mso-themecolor: text1; mso-ansi-language: EN-US; mso-fareast-language: NL;">A new debriding agent (TDA) contains <a name="_Hlk49852584"></a>an acidic species in a gel. The agent has a potent hygroscopic action<span style="font-size: 12.0pt; line-height: 150%; font-family: 'Arial',sans-serif; mso-fareast-font-family: 'Times New Roman'; color: black; mso-themecolor: text1; border: none windowtext 1.0pt; mso-border-alt: none windowtext 0cm; padding: 0cm; mso-ansi-language: EN-US; mso-fareast-language: NL;">2<span style="font-size: 12.0pt; line-height: 150%; font-family: 'Arial',sans-serif; mso-fareast-font-family: 'Times New Roman'; color: black; mso-themecolor: text1; border: none windowtext 1.0pt; mso-border-alt: none windowtext 0cm; padding: 0cm; mso-ansi-language: EN-US; mso-fareast-language: NL;"> and causes swift desiccation, oxidation and denaturation of microorganisms and tissues: in earlier publications it was shown that the use of TDA leads to rapid formation of granulation tissue, necessary for healing by secondary intention. 
Negative pressure wound therapy (NPWT) has also been shown to support the development of granulation. Methods: A clinical evaluation was conducted to assess whether the combination of TDA with NPWT would be beneficial. Results: Twelve patients (10 female, average age 77.9 years) with lesions on the lower leg participated. Five ulcers were venous in origin, two were arterial, one was of mixed venous/arterial origin, and one was post-trauma (unknown: N=3). The average size was 308 cm2 (60-1750). The lesion’s average age was 13,2 months (4-48). All patients suffered from one or more significant comorbidities. 
TDA was applied once, and NPWT (at -125 mmHg) was used immediately after the procedure, for a period of one week. 
All patients reached complete granulation in, on average, 13,2 weeks (7-21). There were no side effects of either treatment. Discussion: The combination of TDA-NPWT was shown to support the rapid development of granulation tissue in a series of serious ulcers (given their size and age) and, thus, supports healing by secondary attention. Trademarked Items: References: 1. Zitelli J. Wound healing for the clinician. Adv Dermatol 1987;2:243-67. [published Online First: 1987/01/01]
2. Bignozzi AC, Cogo A, Carinci F. Compositions for removing necrotic or infected tissues from body lesions and from oral cavity. . Patent Cooperation Treaty Nr PCT/IB2019/051146 2020;Patent Pending