Polyhexamethylene Biguanide-Betaine Dressing Combined with Silver Sulfadiazine for Biofilm Control in an Advanced Cancer Wound: A Case Report

Abstract

Biofilm in a wound base can cause chronic infection and a persistent immune response in the host, inhibiting wound healing. Antibiotics and antiseptics may not be effective because the protective layers of biofilms are difficult to penetrate. Polyhexamethylene biguanide-betaine (PHMB-B) has been known as an effective antiseptic agent for biofilm treatment. Here, we present a case of chronic wound biofilm management using PHMB-B combined with silver sulfadiazine in a patient with advanced breast cancer, which enabled successful flap coverage without infection. A 46-year-old female had left breast cancer with chronic wounds that had not been treated for 2 years. After chemotherapy and radiotherapy, the chronic wounds were aggravated with biofilms. Following palliative total mastectomy, surgical debridement and povidone-iodine dressings were performed. However, the wound did not display significant improvement and also caused severe pain. The povidone-iodine dressings were changed to silver sulfadiazine ointment, however this was also ineffective for controlling the biofilm. Eventually, we additionally applied PHMB-B before silver sulfadiazine which led to wound improvement with no identifiable microorganisms. Subsequently, a pedicled transverse rectus abdominis myocutaneous flap was performed without complications. Consequently, PHMB-B combined with silver sulfadiazine could effectively eradicate biofilms in a patient with advanced breast cancer.