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Aim: Diabetic foot ulcers, particularly those with high Wagner scores, are difficult to heal. They are, per definition, infected and patients in this category typically also suffer from serious comorbidities. TDA* is an innovative debriding agent that works via topical desiccation of necrosis and biofilm through a hygroscopic action. This results in the denaturing of their proteins and, typically, a rapid sloughing off. Efficacy of TDA was evaluated in patients with Wagner III and IV diabetic foot ulcers with culture-confirmed colonization of multidrug-resistant Pseudomonas Aeruginosa. Method: TDA was applied for 60 second and rinsed of, followed by the application of standard dressings. Study participation was limited to 40 days. Results / Discussion: The average age of patients was 74+12.2 years. Average ulcer (N=20) size was 9.1+7.6 cm2. 16 of 20 patients (75%) were revascularized prior to the initiation of TDA. Five patients (25%) were on hemodialysis, and all were on anticoagulant or antiplatelet therapy. Within the maximum observation period of 40 days, improvement of the wound occurred in 17 of 20 (85%) cases. Size reduction was noted in 16 of 20 patients (80%) and six of the 20 ulcers (30%) healed completely. Two ulcers (10%) were unchanged at 40 days and one ulcer (5%) worsened, probably due to poor compliance. Conclusion: Wagner III and IV diabetic ulcers were treated with TDA as the primary debridement agent. In spite of the complexity and seriousness of the lesions, all but three showed considerable improvement or complete healing within the study period of 49 days. * Debrichem, DEBx, the Netherlands [ABSTRACT FROM AUTHOR]

Aim: An acid-based debriding gel (TDA*) works through a strong hygroscopic action. When applied onto biofilm and/or necrosis, rapid desiccation and denaturation of microorganisms and tissues occurs. Typically, quick sloughing follows. In a previous study, TDA was shown to assist in the rapid development of granulation tissue, a necessary step in healing by secondary intention. Negative pressure wound therapy (NPWT) also supports the development of granulation tissue. The aim of our study was to assess the combination of TDA and NPWT on efficacy of the development of granulation tissue. Method: TDA was applied for 60 seconds and rinsed off, after which NPWT (at -125 mmHg) was applied for up to one week. The percentage of granulation was assessed on a 3-daily basis. Results / Discussion: 12 ulcers (in 12 patients) of the lower leg participated. Ulcers were venous (N=5), arterial (N=2), and mixed venous/arterial (N=1). One lesion was post-trauma (etiology unknown: N=3). Average size was 308 cm2 and average wound-age was 13 months. Each patient had at least one serious comorbidity. Average time to complete granulation was 13,2 days (range: 7-21). There were no side effects to NPWT or TDA treatment. Conclusion: In this study, combining TDA therapy with NPWT was shown to assist in the rapid development of granulation tissue. This indicates that healing by secondary intention is supported by this treatment routine. The use of TDA was also shown to be cost-effective in a separate study. * Debrichem, DEBx, the Netherlands [ABSTRACT FROM AUTHOR]