Evidence of Intensive Autolytic Debridement With a Self-Adaptive Wound Dressing.
BACKGROUND
Chronic venous leg ulcers (VLUs) can be challenging to manage and heal. Despite the observed efficacy of surgical debridement, many patients with VLUs refuse the procedure due to the associated pain. Autolytic debridement induces no pain, but is slow or disrupted in chronic VLUs. Elucidation of the wound dressing functions that are sufficient to support autolytic debridement is needed.


METHODS
The authors report 2 challenging cases with large, nonresponsive VLUs. A 52-year-old female patient, Case 1, presented with a VLU of 91.4 cm(2) (10.5 cm x 8.7 cm); and a 58-year-old female patient, Case 2, presented with bilateral VLUs, the larger of which was 50 cm(2) (10 cm x 5 cm). Both VLU cases were covered with yellow slough, and case 1 had a small area of black necrotic tissue. The patients had received standard care for more than 16 months, but their VLUs were worsening. A self-adaptive wound dressing (SAWD) with a compression wrap was applied 2 to 3 times a week.


RESULTS
Within 21 days, the VLUs of both cases had shed the yellow slough, and healthy granulation tissue was visible.


CONCLUSIONS
In summary, the SAWD removed excess exudate with liquefied components of slough and nonvital tissue; provided sufficient moisture for preventing wound desiccation; sequestered microorganisms, thereby blocking their multiplication; and supported efficient autolytic debridement, clearing most of the slough and all crusted necrotic tissue within 3 weeks. The effect of SAWD on autolytic debridement is a promising mechanism for promoting healing of VLUs and warrants further study.
Department of Medicine, California School of Podiatric Medicine, Samuel Merritt University, San Francisco, CA.
Alexander M
AM
Reyzelman
Department of Medicine, California School of Podiatric Medicine, Samuel Merritt University, San Francisco, CA.
Mher
M
Vartivarian
D001329:Autolysis; D047070:Bandages, Hydrocolloid; D058128:Compression Bandages; D003646:Debridement / Q000295:instrumentation / Q000379:methods; D005260:Female; D006801:Humans; D008875:Middle Aged; D016896:Treatment Outcome; D014647:Varicose Ulcer / Q000628:therapy*; D014945:Wound Healing / Q000502:physiology*