Fibrin cuff lysis in chronic venous ulcers treated with a hydrocolloid dressing.

Abstract

Pericapillary fibrin cuffs (PFC) are a recognized part of the pathology of venous stasis ulcers. A hydrocolloid dressing capable of lysing wound surface fibrin was tested in venous ulcers for its capacity to lyse pericapillary fibrin below the wound surface. Tissue biopsies from the rims of 19 venous ulcers were evaluated for thickness of shallow and deep dermal PFCs before and after treatment with DuoDERM covered by Unna's boot and a compression bandage (DD+UB; n = 9) versus the same treatment without the hydrocolloid dressing (UB; n = 10). Frozen sections of all biopsies were stained with an immunofluorescent antibody to fibrin for rating of PFC thickness. Separate sections were stained with hematoxylin and eosin to assess capillary frequency, histopathology, and inflammation. All ratings and pathology assessments were performed blinded to treatment conditions. Both deep and shallow PFCs were reduced in 89% of ulcers treated with DD+UB versus 40% of ulcers treated with UB (alpha < 0.04). No other significant differences in inflammation, histopathology, or capillary frequency were observed. Treatment with DD+UB reduced PCFs in twice the number of ulcers than UB alone in 1 week. This is the first scientific documentation that a topical wound dressing could reduce the pathophysiology associated with venous ulcers, beyond the known beneficial effect of graduated compression. Not all hydrocolloid dressing are fibrinolytic, so this effect may not generalize to other dressings.