2021 General Surgery Presentations

Phillip M Kemp Bohan; Anne E O'Shea; Pamela Collins; Jackie Polson; Jason S Radowsky; Remealle A How; Valerige G Sams; Brooke Army Medical Center

Objectives: Antibiotic-resistant infections are increasingly prevalent and represent a major concern for both civilian and military health systems. Products selectively disruptive to biofilm and biofilm-producing microorganisms while simultaneously biocompatible with human tissue can mitigate wound colonization and infection. In this study, we compared a novel polyhexamethylene biguanide-based wound cleanser, BIAKOS™ Antimicrobial Skin and Wound Cleanser (BIAKOS), to a standard-of-care hypochlorous acid wound cleanser, Vashe® Wound Solution (Vashe), and measured wound healing-related outcomes.

Methods: We conducted a retrospective chart review of patients who underwent wound care with either BIAKOS or Vashe in our outpatient wound clinic. Wounds were assessed at treatment initiation and at regular intervals using physical exam and MolecuLight imaging. Patient age, gender, comorbidities, type of wound, time from wound onset to treatment, wound size, Bates-Jensen Score (with higher scores representing worse wound bed conditions), and MolecuLight photos at treatment initiation and conclusion were collected. Groups were compared with Chi-square and Kruskal-Wallis tests, with significance set at p<0.05.

Results: 28 patients were included, with 14 patients in each treatment group. Compared to the Vashe group, the BIAKOS group was older (median age 71 years vs 58 years; p=0.77), more frequently female (64% vs 21%, p=0.02), and contained a higher proportion of patients with diabetes (43% vs 7%, p= 0.03). The two most common wound types treated in each group were surgical and venous stasis wounds (BIAKOS: 71% and 21%, respectively; Vashe: 50% and 36%, respectively; p=0.26). Pressure injuries accounted for the remainder of the wounds in each group. Median wound duration at treatment initiation was longer in the Vashe group compared to the BIAKOS group, though this difference did not reach significance (2.0 months vs 0.9 months, p=0.09). Over the course of treatment, we observed a median wound size reduction of 69% in the BIAKOS group versus 31% in the Vashe group (p=0.67) and a median Bates-Jensen score reduction of 27% in the BIAKOS group versus 6% in the Vashe group (p=0.008). Analysis of MolecuLight photos also suggest a reduction in biofilm luminescence in the BIAKOS group.

Conclusions: Application of BIAKOS improved overall wound bed condition and wound size when compared to a standard-of-care cleanser. A trend towards reduced wound biofilm burden was noted. The results of this study support the need for future clinical research that utilizes BIAKOS in the setting of acute traumatic injuries similar to those encountered in a deployed or austere setting.