OBJECTIVE
To evaluate the efficacy and safety of interactive wound dressings in the treatment of trophic ulcers following varicose veins (VV) and post-thrombotic disease (PTD).
MATERIAL AND METHODS
An open non-randomized prospective study included 40 outpatients over 18 years old with trophic ulcer de novo persisted for at least 2 previous months or recurrent venous ulcer regardless length of anamnesis. Ulcer defect area was up to 25 cm². Exclusion criteria: severe comorbidities, diabetes mellitus or lower extremity peripheral artery disease with an ankle-brachial index of 0.8, impaired movements in lower limb joints, hypersensitivity to silver. Wound dressing or combination of dressings was chosen depending on symptoms and wound healing stage. At the 1st stage, ulcer debridement and dressing were performed daily. We used a hydrogel coating with silver ions, amorphous hydrogel with silver ions, alginate fiber dressing, carboxymethylcellulose fiber dressing, coating of impregnated hydrophilic polyurethane foam, and dressing comprising laminated viscose material soaked in povidone-iodine ointment. At the 2nd or 3rd stage, we applied mesh coating impregnated with povidone-iodine ointment, mesh coating impregnated with soft paraffin and 0.5% chlorhexidine, dressing comprising polyester mesh and soft paraffin, cohesive polymers, hydrocolloid particles and silver ions, dressing of polymer mesh with soft paraffin, lipids and silver ions. Dressing was carried out every 2-3 day at the stage of granulation and epithelialization. Treatment lasted 8 weeks; follow-up examinations were carried out weekly. We analyzed symptoms of venous disease, state of the ulcer and surrounding tissues, as well as ulcer area. Adverse side effects of treatment were considered. Discomfort in everyday life was assessed according to 10-cm visual analogue scale (VAS).
RESULTS
Overall sample enrolled 40 participants including 13 (32.5%) men and 27 (67.5%) women aged 32-81 years (median 61.5, interquartile range 48.5-70.5). Thirty-eight were completely followed-up. One patient left for family reasons. Another patient required hospitalization in the department of purulent surgery. Treatment resulted ulcer healing in 19 (50%) out of 38 patients. In 14 cases, complete epithelialization occurred within the first month. By the end of treatment, ulcer area decreased by 2 times (from 298.4 to 145.4 cm2, p<0.0001). Complete cleansing of ulcer from necrotic tissues and fibrin was observed in 10 (26%) patients. Single areas of fibrinous tissue persisted on the wound surface in 9 (24%) patients. No epithelialization was observed only in 1 (3%) case. By the end of the study, VAS score of discomfort decreased or disappeared in 30 (79%) patients, remained the same in 7 (18%) patients and got worse in 1 (3%) patient. Between-group comparison of patients with healed and non-healed ulcers revealed no significant differences in gender (p=0.3), age (p=0.27), duration of venous disease (p=0.07), form of disease (VV or PTD) (p=0.4), obesity (p=0.09) and cardiopulmonary diseases (p=0.5). Baseline area and type of ulcers (primary or recurrent) were different (p=0.01 and p=0.02, respectively). In patients with healed ulcers, baseline mean (M) area of ulcers was 4.8 cm2, overall (Σ) area — 90.8 cm2. In patients with non-healed ulcers, these values were 10.9 and 207.6 cm2, respectively. Non-healed ulcers were recurrent as a rule. Dressings caused no technical difficulties for patients. There were no major adverse events. Signs of skin maceration and progressive inflammation were observed in 8 patients who used various dressings. Correction of dressing type was effective to eliminate these symptoms.
CONCLUSION
Interactive wound dressings combined with compression hosiery is ease, effective and safe approach for venous ulcers. This method contributes to fast cleansing of ulcers and stimulates regeneration processes in most patients.
