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Clinical Research
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Changing the healing trajectory of HIV + venous stasis wound with combination PDGF* and collagen/cellulose/silver** dressings John Lantis, MD, Cindy Gendics, RN, George Todd, MD Introduction: The patients with the chronic venous wound, with non-reconstructable venous obstructive disease, and HIV+ status represent a very difficult to treat subset of venous stasis disease. Therefore, there is a need for a novel and effective treatment for these patients Methods: A longitudinal single center case series is reported, where the patients represent their own longitudianl wound healing trajectory controls. Twenty three patients with twenty three venous stasis ulcers were under care for greater than 4 years. All the patients were HIV+,Hep C+ and all had obstructive venous outflow disease by ultrasound criteria. All patients had ankle brachial indices of 1.0, 4 diabetics had HGBA1C < 9.0. Eleven had had previous skin grafts, six had previous trilayered skin substitute, three had treatment with other skin sustitutes. The average size of the venous leg ulcer upon initiation of treatment at our center was 42cm2 (+/- 32cm2). Eighteen patients were treated with zinc oxide, glycerin paste with elastic compression. Five patients were treated with sustained release silver dressings and multilayer compression dressings for an average of 13 months (+/- 9mo). Over this time the average change is size of the wound was 4 cm2 (0-14 cm2) At a single point in time all patients were started on Platelet derived growth factor (PDGF) in combination with a Bovine Collagen/Cellulose/Silver (CCS) dressing two to three times a week under a zinc oxide, glycerin paste and elastic compression dressing. Results: During the six months of novel treatment the average decrease in the size of the wound has been 38 cm2 (+/- 16 cm2). There have been eight complete closures, a 35% complete closure rate compared to a 0% previous closure rate for the same cohort Discussion: We believe that this radical improvement in the healing rate of this difficult to heal group can only be attributed to the properties of the novel dressing combination; addressing presumed growth factor deficiency in the immunocompromised host and the matrix metalloprotienase over productions seen in chronic vneous stasis ulcers. * Regranex, Johnson & Johnson, Somerville NJ.** Prisma, Johnson & Johnson, Somerville NJ Davis PA, Wastell C; A Comparison of biomechanical properties of excised scars from HIV positive patients and non-HIV controls. Am J Surg. 2000;180(3):217Ð222 Burns J, Pieper B. HIV/AIDS: impact on healing. Ostomy Wound Manage. 2000;46(3):30Ð40 Mastroianni A, Cancellieri C. Local treatment of a chronic leg ulcer with GM-CSF in a patient with HIV infection. Sex Transm Infect. 1999;75(3):203Ð204 DeLaney AR, Damato RA, Ikeda CJ; Delayed autograft loss in HIV positive patients: two cases. J Burn Care Rehabil. 1990;11(1):67Ð70. |
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