Venous ulcers are a common chronic problem in many countries, especially in Northern Europe and the United States, with an overall prevalence reported as approximately 1% but trending to rise to 3% in the population older than 65 years.1 Venous insufficiency is a root cause for a large proportion of chronic wound cases. In many cases, the condition causes venous stasis dermatitis and ulcerations, especially in the lower extremities. Although the pathophysiology of the disease is complex and still being elucidated, the underlying venous hypertension from incompetent valves and the pro-inflammatory state of the cell wall lining of the veins seem to be the 2 main contributors to the development of stasis and ulceration.2-5
A specialized fiber-based technology, known as hydroconductive technology, has been described as being able to remove factors that negatively affect healing, such as MMPs, microbes, and necrotic debris, from the wound environment.6-14 Although it is likely that electrostatic and other physical forces are responsible for at least some of this activity, the exact mechanism of these phenomena are still subjects of research. The use of hydroconductive dressings has been shown to achieve positive clinical results in the management of venous ulcers.6
Microbial factors are of special concern in nonhealing wounds. As ulceration develops, bacterial colonization and overgrowth play a pivotal role in poor wound healing. Antimicrobial barrier products, which are formulated to form a nonadherent perforated gel upon contact with wound fluid, can help manage bioburden at the wound-dressing interface. A wound dressing known as the lipidocolloid dressing, imbued with silver ions, has been used with success.15-20 The dressing is thin, flexible, and typically used in conjunction with an overlying absorbent secondary dressing.
It is rational to imagine that these 2 novel technologies (ie, the hydroconductive and lipidocolloid technologies) may be complementary. With this in mind, the combination therapy of a silver lipidocolloid contact layer (a proprietary product from Urgo Medical North America) combined with a hydroconductive dressing (Drawtex; Beier Drawtex Healthcare) was used to treat chronic venous leg wounds with varying degrees of drainage. The rationale was based on providing an antimicrobial barrier at the wound base and additionally preventing maceration of the wound bed by controlling the fluid through the hydroconductive therapy. The expectation was that the combination therapy would address the pro-inflammatory component levels of the wound and help recalibrate the MMP imbalance while also addressing wound bioburden.