(DLS-003) The use of ultrasonic-assisted wound debridement and novel antimicrobial foam dressing for effective management of venous leg ulceration

Alexis Lai, Bsc Podiatry – Podiatrist, National university Hospital; Thasvhinni Nasendran, Bsc Podiatry – Podiatrist, National university Hospital

Introduction: The concept of biofilms has remained a contentious issue in wound care management. Being characteristically polymicrobial and found predominately in chronic wounds, they are able to evade both the host's immune response and antibiotics leading to persistent inflammation and degradation of essential extracellular matrix proteins necessary for wound healing. The key to the management of biofilm rest on aggressive wound debridement and effective bactericidal killing. Ultrasonic-assisted wound debridement has shown to be an effective yet gentle form of debridement to achieve disruption of biofilms by inducing cavitation effects. The use of polyhexamethylene biguanide (PHMB) has shown to exhibit bactericidal effect, including planktonic and biofilm bacteria.

Methods: In this case report, we presented a case of chronic venous ulcerations over the bi-malleoli of the left lower limb for many about 18 months which has been recalcitrant to standard of care, including antimicrobial wound dressing (Alginate silver) and compression bandage. In view of debridement-associated pain, we perform UAW using PHMB-based wound irrigation solution to bi-malleoli wounds. Secondly, we examine the usefulness of a novel PHMB-based foam that was used over the medial malleolar wound. We then compared with the clinical progression of the lateral malleolar wound which was managed by alginate silver and gauze. A 2-layered compression bandage was applied to both wounds as standard management of VLU.

Results: UAW was well-tolerated and debridement-associated pain was negligible. As a result, the wound bed preparation was optimized. Secondly, the PHMB-based foam dressing shown to promote faster wound healing in terms of wound size (more than 50% reduction) and wound appearance than the alginate silver.

Discussion: From this case report, we showed that effective wound debridement is essential in disrupting biofilm. UAW allows clinician a more thorough debridement within a shorter duration. Furthermore, PHMB-based foam dressing maintains adequate moisture balance and exerting antimicrobial effect, both of which is ideal for the promoting faster wound healing.