Combination therapy of oxidised regenerated cellulose/collagen/silver dressings with negative pressure wound therapy for coverage of exposed critical structures in complex lower‐extremity wounds

Abstract

Complex wounds with exposed critical structures such as tendon and bone are a conundrum in wound management, especially in the setting where the patient is not a suitable candidate for flap surgery. While the individual use of negative pressure wound therapy (NPWT) and oxidised regenerated cellulose (ORC)/collagen/silver (PROMOGRAN PRISMA) dressing has been described in the literature, there are little data on the efficacy of their combined use. In this study, we describe a novel technique of combining the use of NPWT and ORC/collagen/silver dressings to manage complex wound beds as an alternative management option for patients not suitable for reconstructive flap surgery. This technique was performed in a series of 37 patients with complex lower‐extremity wounds that were not healing with conventional NPWT alone. All patients had open wounds with exposed critical structures that were difficult to manage, such as exposed tendon, bone, deep crevices, and joint. Successful coverage of exposed critical structures was achieved in 89% of patients, and coverage was achieved within 28 days of combination therapy in 82% of these patients, without any complications. The novel technique of combining ORC/collagen/silver dressing and NPWT provides a useful option in the armamentarium of a reconstructive surgeon dealing with difficult complex lower‐extremity wounds.

Bioactive Dressing: A New Algorithm in Wound Healing

“…ORC/CG Matrix: it is a sterile lyophilized pad composed of 55% CG and 45% ORC. This device reduces the activity of elastase, MMPs (particularly CGase and gelatinase), and oxygen-free radicals [105]. Interacting with the wound, it hinders tissue degradation and promotes granulation tissue synthesis through mechanisms such as reducing proteolytic activity and free radical damage, binding and stabilizing growth factors like PDGF, increasing the recruitment of macrophages and fibroblasts, and fostering fibroblast proliferation [106]; 2.…”

Use of oxidised regenerated cellulose/collagen dressings versus standard of care over multiple wound types: A systematic review and meta‐analysis

“…One such dressing family, oxidised regenerated cellulose (ORC)/collagen dressings, has a growing body of published literature to support its use. Increased wound healing rates and reduced protease activity in the wound bed have been reported in a wide variety of patients receiving ORC/collagen dressings 4‐9 …”