Gerit D. Mulder, DPM, MS; Joseph P. Cavorsi, MD; Daniel K. Lee, DPM

Disclosures

Wounds. 2007;19(7):173-182. 

In This Article

Case Reports

Case 1

A 58-year old woman presented with a full-thickness draining wound over the dorsal foot secondary to an incision (Figure 2). The patient's wound extended to the level of tendon and was recalcitrant to topical gels, ointments, foam dressings, silver dressings, and moist saline gauze. Past medical history was significant for Hodgkin's disease, heart valve replacement, pacemaker, hemolytic anemia, and chemo and radiation therapy for breast cancer, which was on-going at the time of presentation. After 3 weeks of treatment with a papain-urea ointment (PanafilAE, Healthpoint, Fort Worth, Tex), the majority of fibrotic tissue was removed although the wound did not decrease in size. The patient was then placed exclusively on BWD-PHMB for approximately 4 weeks with the dressing being changed once a week. The wound rapidly improved and progressed to complete closure during this time period.

Figure 2.

As presented, prior to BWD-PHMB (left) and after 4 weeks of use of BWD-PHMB (right).

Case 2

A 78-year-old woman presented with a large wound secondary to a hematoma occurring after trauma (Figure 3). The patient was not on anticoagulants and had a medical history significant for hypertension. The wound had been present for 1 week prior to presentation. Following extensive debridement, the patient was started exclusively on BWD-PHMB dressing changes every 4 days. The wound closed completely in approximately 2 months. The patient had a history of similar lesions that required up to 6 months of treatment.

Figure 3.

Prior to BWD-PHMB (left) and after 2 months of BWD-PHMB (right).

Case 3

An 89-year-old woman with diabetes presented with venous disease and psoriasis (Figure 4). She had 2 wounds, one each on her right and left lower extremities (RLE and LLE) that were treated separately over a period of 209 days.

Figure 4.

Prior to BWD-PHMB (left) and after initial use of BWD-PHMB (right).

Upon presentation, the RLE wound was 17.5 cm x 7.0 cm x 0.3 cm. It was treated for 167 days using various products including Acticoat99 (46 applications, [Smith & Nephew, Largo, Fla]), SantylAE (7 applications, [Healthpoint, Fort Worth, Tex]), ApligrafAE (6 applications, [Organogenesis, Canton, Mass]), and Xeroform99 (7 applications, [Tyco-Kendall HealthCare Group, Mansfield, Mass]). After these treatments the wound measured 9.0 cm x 4.4 cm x 0.1 cm. Following an initial decrease in size, the wound became unresponsive to these treatments. At that time, BWD-PHMB was substituted as the exclusive primary dressing. Over the next 42 days, a total of 10 BWD-PHMB dressings were applied. The patient subsequently went on to heal 1 week after her final treatment (49 days total) using this protocol.

Upon presentation, the LLE wound was 1.0 cm x 0.9 cm x 0.3 cm. It was treated for 156 days using various products including Acticoat (2 applications), XCell (2 applications), Santyl/Panafil (70 applications), Apligraf (4 applications), Sulfamylon (26 applications), AquacelAE (3 applications, [ConvaTec, Skillman, NJ]), OpSite99 (8 applications, [Smith & Nephew, Largo, Fla]), and Xeroform (7 applications). The wound remained unhealed after these treatments. The wound was recalcitrant to care; therefore, BWD-PHMB was substituted as the exclusive primary dressing. Over the next 53 days, a total of 12 BWD-PHMB dressings were applied as the exclusive treatment. The wound healed at approximately 60 days.

Case 4

A 79-year-old woman presented with venous leg ulcer on her lower extremity (Figure 5). She was treated over a period of 104 days. The wound was 15.0 cm x 9.0 cm x 0.1 cm. The wound was initially treated for 34 days using Panafil (13 applications) and Iodosorb (22 applications). After these treatments the wound measured 10.0 cm x 9.0 cm x 0.3 cm. The wound was determined to be recalcitrant after an initial decrease in size (15.0 cm x 9.0 cm to 10.0 cm x 9.0 cm, [B2 35%]) and BWD-PHMB was substituted as the exclusive primary dressing. Over the next 70 days, a total of 10 BWD-PHMB dressings were applied.

Figure 5.

Prior to BWD-PHMB (left) and after use of BWD-PHMB (right).

Effect on wound bioburden and pain. By evaluating the bacterial load pre- and post-BWD-PHMB, it was demonstrated that the dressing resulted in elimination of Pseudomonas aeruginosa, Diptheroid gram-positive rods, beta hemolytic streptococcus, and Enterobacter aerogenes in some patients. In other patients, decreased levels of Staphylococcus aureus, Pseudomonas aeruginosa, and Proteus mirabilis were observed.

A reduction in pain has been noted with BWD44 as was observed in the present study.

Economics of BWD-PHMB

The estimated cost for the treatment of chronic wounds including services and associated products is close to $40,000 or in some cases even more.[45] Any delay to heal a wound can increase that cost. Mulder[46] described an economic model for determining the cost of 2 different treatments for removing necrotic tissue. The analysis demonstrated that a hydrogel/polyurethane combination was slightly more expensive than wet-to-dry gauze but was more cost effective when time to reach 8E 50% debridement was included.

The cost of BWD-PHMB is similar to other advanced wound dressings. An economic analysis was performed in this study to determine the cost of BWD-PHMB use over time. An economic analysis of the use of BWD-PHMB dressings demonstrates the low cost of using BWD-PHMB on recalcitrant wounds. The average cost of material was calculated to be $5.99 to $9.01 per day with the wounds demonstrating improvement or healing. No attempt was made to quantify the remaining cost of treatment (clinic visit, staff time, etc.).

Data were gathered retrospectively for 2 patients that presented at the UCSD Healthcare System in San Diego, Calif. These patients had a total of 3 wounds that were initially treated with an array of advanced wound care products prior to exclusive use of a BWD-PHMB dressing. The costs associated with the products used in Cases 3 and 4 appear in Table 3 and Table 4 , respectively. Table 5 illustrates the cost of the use of BWD-PHMB including the use of saline and gauze to clean the wound.

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