Clinical Trial 2

Atherton Chemspunge® Wound Dressings Trial: November 1997
Atherton District Hospital,  Atherton,  Queensland Australia.

Background:
Chemspunge® is a non interactive granular dressing.  It consists of a sterile permeable sachet that contains a Patented formula. This formula was first developed and tested in South Africa.  It is reported to be a non-interactive dressing that facilities blood flow to the area, debrides the wound by it's adsorptive potential, reduces wound oedema and inhibits bacterial growth in the wound environment.  Although the dressing was designed in the modern context of wound dressings, the manufacturers claim that the action of wound healing of Chemspunge® is unique and dramatic.

Case study no 1:
Mr. S. was admitted to the Atherton Hospital with a two year history of a chronic ulcer anterior to the lateral mallcolus of his right foot.  He had been treated over the preceding two years with various kinds of dressings. Despite these attempts, the ulcer was extending.

General:
Mr. S. was a heavy tobacco smoker.  He also had asthma and COAD for which he was treated with Becoloforte (no systematic steroids).  He was of average weight.  He used Lisinopril for hypertension and Lasix & Digoxin for his cor pulmunale.  Significant peripheral vascular disease was evident, with no pulses palpable in his feet.  He was taking Aspirin at a dosage of 150 mg per a day.

Day 1: (Figure 1.1)
A deep central ulcer of 16 x 5.8 cm was present on the dorso lateral aspect of his right foot and ankle.  The inferior margin of the wound was lined with more superficial ulcers.  A thick layer of slough covered the wounds.




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Figure 1.1
Procedure:
The wounds were soaked in a sodium chloride solution for 30 minutes.  The ulcers were then packed with Chemspunge® sachets.  The dressings were changed every 3-5 days.
During the first two days the patient experienced mild pain in the wound areas which was easy to tolerate. 






Day 8:
The central ulcer was dry and clean.  It measured 14.5 x 4.5 cm and was noticeable shallower.  The surrounding tissue was less oedernatous and the satellite ulcers were healing

Figure 1.2
Day 14 (figure 1.2)
The central ulcer was shallower and good out crops of granulation tissue were visible.  The ulcer surface further contracted to 14 x 4.5 cm.  This represented a reduction of 32% of the surface area over the two-week period.  It was attempted to continue with the treatment for a while longer, but due to poor compliance (Mr. S. being from another town and experiencing domestic problems) the wound treatment was terminated.

Case Study no 2:

Mrs. I. was a 58 year old lady that was admitted to hospital with suspected pyoderrma gangrenosum.  Despite treatment with various other topical wound formulas,  the ulcers were getting bigger and more extensive.  She was experiencing discomfort and pain in the wound areas from time to time.  It was decided to start her on a trail of Chemspunge® for a period of time.  She was also given a course of prednisone.

Day 1
There was a reasonable clean, small ulcer in the supra umbilical area.  This was a very deep ulcer with undermined edges.  In the right groin area there was a large deep ulcer present,  with thick firmly embedded sough.  It extended into a wide area around it,  where the skin was eroded away into shallow ulcers with varying amounts of slough.  On the inside of the left thigh was a large,  shallow elongated ulcer with some haemorrhagic changes in the base of the ulcer.
 
Procedure:
The wounds were soaked in a Sodium Chloride solution for thirty minutes and the ulcers packed with Chemspunge® sachets.  The dressings were changed every three to five days.

Mrs. I. still experienced some ongoing discomfort and pain in the wounds.

Day 30
The supra ulcer was of the same surface dimensions.  The ulcer however diminished in depth from more than 2 cm, to 0.5 cm.  The base of the ulcer was clean with good granulation tissue present.  The margin of the wound was also undermined.  In the right groin area most of the satellite ulcers were healed.  The main ulcer was shallower and smaller.  Although the base of the ulcer was much cleaner,  there was still a significant area of dead tissue firmly attached to one side of the ulcer.

The wound on the left thigh was about 40% smaller than on day one.  It had a clean, smooth, shallower ulcer base,  with good granulation tissue.

Discussion

In both instances the ulcers were unresponsive to typical modern wound management.  In both the cases, a very beneficial effect of the Chemspunge® Wound Dressings was visible in a relative short period of time.  At least initially some discomfort/pain were experienced in the wound area.

Wound debridement and eradication of superficial wound infection was visible in the first case.  There was an area of stubborn eschar in the second case that warranted surgical debridement.
Dr. A. G. Green M B B S (Qld) F R A C S

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