title: Case series of lower-extremity chronic wounds managed with an antibacterial foam dressing bound with gentian violet and methylene blue.
abstract: OBJECTIVE
  To evaluate an antibacterial dressing for the management of lower-extremity chronic wounds with critical colonization.
  
  
  METHODS
  A case series of n = 15 patients with lower-extremity chronic wounds were treated with an antibacterial foam dressing consisting of polyvinyl alcohol (PVA) foam bound with gentian violet and methylene blue (Hydrofera Blue; Hydrofera, LLC, Willimantic, Connecticut).
  
  
  METHODS
  An outpatient clinic in Ontario, Canada.
  
  
  METHODS
  The dressing was applied to diabetic foot ulcers (n = 8) and other venous/leg wound etiologies (n = 7). The study population was clinically challenging due to high mean body weight, extended wound durations, and high diabetes prevalence.
  
  
  METHODS
  Wounds were assessed for clinical signs of superficial and deep/surrounding bacterial burden using the validated NERDS and STONEES mnemonic and with semiquantitative bacterial swabs. Changes in wound size, pain, and other clinical parameters were also recorded.
  
  
  RESULTS
  Improvements in surface critical colonization and pain score at the end of the study period were noted in some patients, especially in patients with diabetic foot ulcers. A decreasing wound size was observed in 8 of the 14 patients (57%) at week 4. One patient was excluded from wound size change analysis.
  
  
  CONCLUSIONS
  An antibacterial foam dressing consisting of PVA foam bound with gentian violet and methylene blue showed encouraging results in a clinically challenging study population. This dressing may be a suitable option for lower-extremity chronic wounds demonstrating an increased superficial bacterial burden. Further investigation focused on identifying the characteristics of patients who are most responsive to the dressing is warranted.
authors: Patricia M. Coutts, RN, IIWCC (Toronto), is a Wound and Clinical Trials Coordinator, and Judy Ryan, RN, is a Nurse, both at Toronto Regional Wound Healing Clinic, Mississauga, Ontario, Canada. R. Gary Sibbald, BSc, MD, MEd, FRCPC(Med Derm), MACP, FAAD, MAPWCA, is Professor of Public Health and Medicine, University of Toronto, Toronto, Ontario, Canada; Director, International Interprofessional Wound Care Course & Masters of Science in Community Health (Prevention & Wound Care), Dalla Lana School of Public Health, University of Toronto; Past President, World Union of Wound Healing Societies; and Clinical Editor, Advances in Skin & Wound Care, Philadelphia, Pennsylvania. Ms Coutts has disclosed that she is a consultant to and member of the speakers' bureau for Hollister Limited. Ms Ryan has disclosed that she has no financial relationships related to this article. Dr Sibbald has disclosed that his employer, the University of Toronto, is the recipient of an unconditional educational grant from Hollister Inc, research grants from Healthpoint Biotherapeutics, Systagenix, and Exiton, and was the recipient of research grants from the Government of Ontario, 3M, BSN, CIDA, Coloplast,Covidien, Gaymar, KCI, Johnson & Johnson, Registered Nurses Association of Ontario, Mölnlycke, Hollister Limited, Valeant, Shire, Galderma, Leo, Stiefel, Abbott, and Mississauga Halton Community Care Access Center; he is a board member of 3M, BSN, Coloplast, Covidien, Gaymar, KCI, Systagenix, Mölnlycke, Registered Nurses Association of Ontario, Hollister Limited, Healthpoint Biotherapeutics, Valeant, and Shire Regenerative Medicine; and he is a member of the speakers' bureau for 3M, BSN, Coloplast, Gaymar, KCI, Systagenix, Mölnlycke, Hollister, Valeant, Shire Regenerative Medicine, Galderma, Leo, and Stiefel Laboratories, Inc. This study was sponsored by an unrestricted educational grant from Hollister Limited, distributors of Hydrofera Blue. Submitted November 26, 2013; accepted in revised for
authors: Patricia M
authors: PM
authors: Coutts
authors: Judy
authors: J
authors: Ryan
authors: R Gary
authors: RG
authors: Sibbald
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000379:methods; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002908:Chronic Disease; D015331:Cohort Studies; D003131:Combined Modality Therapy; D017719:Diabetic Foot / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D005840:Gentian Violet / Q000494:pharmacology; D006801:Humans; D007871:Leg Ulcer / Q000175:diagnosis* / Q000628:therapy*; D008297:Male; D008751:Methylene Blue / Q000494:pharmacology; D008875:Middle Aged; D009779:Occlusive Dressings; D009864:Ontario; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D005840:Gentian Violet; D008751:Methylene Blue