title: Silver-Collagen Dressing and High-voltage, Pulsed-current Therapy for the Treatment of Chronic Full-thickness Wounds: A Case Series.
abstract: Research suggests high-voltage, pulsed-current electric therapy (HVPC) is safe and effective for treating chronic wounds, and some data suggest silver- and collagen-based dressings may facilitate healing. A combination therapy utilizing both HVPC and silver-collagen dressing may present clinical advantages. To explore the effect of the combined therapy for chronic full-thickness wounds, a prospective, consecutive case series study was conducted. All participants were adults with wounds of at least 6 weeks' duration. After obtaining informed consent, patient and wound characteristics were obtained, wounds were assessed and measured, and patients received 2 to 3 HVPC treatments per week followed by application of the silver- and collagen-based dressing for a period of 2 weeks. Data were analyzed descriptively, and changes in wound size and volume from baseline were analyzed using Wilcoxon Signed Rank Test. The dressings were saturated with normal saline, used simultaneously during the 45-minute HVPC treatment, and left on top of the wound after treatment. The HVPC electro pads (stainless steel electrodes with a sponge interface) also were moistened with normal saline and the cathode placed on top of the wound. If the patient had more than 1 wound on the same leg, the anode was placed on the additional wound (otherwise over the intact skin nearby). Secondary dressings (eg, foam and/ or gauze) were used as clinically appropriate, and a 4-layer compression wrap was used, if indicated, for patients with venous ulcers. Ten (10) patients (3 women, 7 men, 57.30 ± 9.70 years old with 14 wounds of 273.10 ± 292.03 days' duration before study) completed the study and were included in the final analyses. Average wound surface area decreased from 13.78 ± 21.35 cm(2) to 9.07 ± 16.81 cm(2) (42.52% ± 34.16% decrease, P = 0.002) and wound volume decreased from 3.39 ± 4.31 cm(3) to 1.28 ± 2.25 cm(3) (66.84% ± 25.07% decrease, P = 0.001). One (1) patient was discharged with complete wound closure. No serious adverse events were noted, but a diagnosis of osteomyelitis in 1 patient and increased pain in a patient with significant Reynaud's syndrome suggest clinicians should be cautious using HVPC in these instances. The combined intervention utilizing both HVPC and silver-collagen dressing was effective in the treatment of chronic fullthickness wounds in this patient population. Controlled clinical studies of longer duration are needed to further explore the safety, effectiveness, and efficacy of this treatment.
authors.affiliation: Daemen College Physical Therapy Wound Care Clinic and Department of Health Care Studies, Daemen College, Amherst, NY.
authors.forename: Kehua
authors.initials: K
authors.lastname: Zhou
authors.affiliation: Daemen College Physical Therapy Wound Care Clinic, Daemen College, Amherst, NY.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Krug
authors.affiliation: Department of Physical Therapy, Daemen College, Amherst, NY.
authors.forename: John
authors.initials: J
authors.lastname: Stachura
authors.affiliation: Department of Health Care Studies, Daemen College, Amherst, NY.
authors.forename: Paulette
authors.initials: P
authors.lastname: Niewczyk
authors.affiliation: Department of Physical Therapy, Daemen College, Amherst, NY.
authors.forename: Michael
authors.initials: M
authors.lastname: Ross
authors.affiliation: Department of Health Care Studies, Daemen College, Amherst, NY.
authors.forename: Justine
authors.initials: J
authors.lastname: Tutuska
authors.affiliation: Department of Physical Therapy, Daemen College, Amherst, NY.
authors.forename: Gregory
authors.initials: G
authors.lastname: Ford
mesh_terms: D000328:Adult; D000368:Aged; D001458:Bandages; D002908:Chronic Disease; D003094:Collagen; D004599:Electric Stimulation Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018030:Silver Compounds / Q000627:therapeutic use*; D012883:Skin Ulcer / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D018030:Silver Compounds; D003094:Collagen