Nooshin Zolfaghari

Issue: Volume 64 - Issue 10 - October 2018 ISSN 1943-2720

Index: Ostomy Wound Manage. 2018;64(10):12,14.

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Introduction

In the August 2018 column,1 we shared our early experience with the newly introduced product Endoform Antimicrobial (manufactured by Aroa Biosurgery Limited, Auckland, New Zealand, and distributed by Appulse;www.appulsemed.com). This month’s column updates our use of Endoform Antimicrobial for early intervention and describes a change to the nonantimicrobial variant, Endoform Natural.

Control of bioburden via debridement and use of advanced extracellular matrix (ECM) technologies is gaining recognition as a proactive early wound care intervention.2 This strategy is important not only for existing chronic wounds, but also because it decreases the risk of acute wounds becoming chronic. Facilitating this approach has been the development of advanced wound care technologies, most notably Endoform. The ECM technology of the Endoform product family augments the wound healing phases (ie, hemostasis, inflammation, proliferation, and remodeling [see Figure 1]) by stabilizing the wound bed, rebalancing wound proteases to correct inflammation, scaffolding cell infiltration to build new tissue, and organizing the deposition of new healing tissue; it also includes secondary molecules important to healing (eg, fibronectin and hyaluronic acid). In short, Endoform Natural and Endoform Antimicrobial (a 0.3% silver variant) have been shown to complement all phases of wound healing from early stabilization of the wound bed through resolution of inflammation and finally to scaffolding cell infiltration and closure of the tissue deficit (see Figure 1). 

The launch of Endoform Antimicrobial has provided a new opportunity for our wound care clinic to intervene early using an antimicrobial then advance to a neutral ECM once we are satisfied the wound is stabilized. In 2012, an Expert Working Group3 proposed the “14-day challenge” that describes conservative use of silver-based dressings in wound care. The consensus paper recommends use of silver-based products for 14 days, after which time either the silver dressing is discontinued based on positive changes in the wound bed or silver is continued and the wound reassessed on a weekly basis. This guidance has become one of the gold standards in wound care and addresses growing concerns related to the potential overuse of silver in the wound care sector, the potential for silver resistance, and the known detrimental effects of silver on cell viability. 

We have implemented the proactive use of Endoform Antimicrobial from day 1 using a 14-day challenge during which time the wound is assessed for wound bed and bioburden stabilization; essential wound care, including wound bed preparation through debridement and maintaining a moist wound environment, also is implemented.4 After the initial 14-day challenge period, the wound is provided Endoform Natural and managed using this ECM until closure. Because not all wounds or patients are the same and wound treatment can be unpredictable, we have found having 2 Endoform products allows great flexibility so we can individualize our interventions. 

Case Study

Case Study

A 57-year-old woman with diabetes presented with a chronic ulcer measuring 2.0 cm x 2.0 cm x 0.4 cm, with exposed capsule and approximately 4 weeks old. The wound was debrided and management with Endoform Antimicrobial was initiated (see Figure 2). Endoform Antimicrobial was applied every 2 to 7 days and the wound assessed weekly for infection and progression of the granulation tissue. 

After 3 weeks, the wound had reduced in size to 2.0 cm x 1.5 cm x 0.4 cm as the epithelial margins were migrating inward (see Figure 3). At this point, management with Endoform Natural was initiated. The wound continued to improve with weekly applications of Endoform Natural and without visible signs of infection. 

Disclosure

Wound Care in the First Person is made possible through the support of Appulse (www.appulsemed.com). The opinions and statements of the clinicians providing Wound Care in the First Person are specific to the respective authors and not necessarily those of Appulse, OWM, or HMP. This article was not subject to the Ostomy Wound Management peer-review process.