Annals of Case Reports

Introduction

Today, a large variety of wound dressings exists to support a good wound healing process.

The novel treatment studied in this article involves the application of a plant-derived wound spray based on St John’s wort oil and Neem oil [1]. This spray acts as a primary wound dressing and is applied from a distance of 5-10 cm directly onto the wound surface and peri-wound skin, after which it creates a thin layer of oil covering the wound bed and the surrounding skin. The spray thereby creates a non-adherent wound coverage, which facilitates wound healing since damage of the granulation tissue and regenerating epithelium during dressing change is prevented. The oily spray creates a sustaining moist wound environment due to reduced water evaporation from the wound. A moist environment is known to support wound healing. In addition, the spray exerts an antimicrobial effect based on a physical mode of action due to its high content of unsaturated fatty acids [2,3]. Finally, the spray protects also the skin area around the wound and supports a healthy skin barrier function [4].

The spray can be used for acute and chronic wounds and in all health care settings including the patients’ home [5].

This short case series describes 3 diabetic foot ulcer (DFU) cases of patients from Vietnam in which this innovative wound spray was applied to treat their wounds. Special attention was paid to the effect of the spray on wound healing, its feasibility for use in daily wound care practice and the patients’ and professionals’ satisfaction with the product.

Methods

Design: case study following a uniform structured approach.

Inclusion: adult patients (> 18 y) with a confirmed diagnosis of DFU. An informed consent procedure was followed.

Intervention: the studied wound spray based on St John’s wort oil and Neem oil was applied as a primary wound dressing following informed instructions. Prior to the application of the wound spray, all wounds were thoroughly cleaned, surgically sharp debrided and rinsed with normal saline 0,9%. The wound spray was evenly applied to cover the entire wound surface area (WSA) and protected with a layer of sterile non-woven gauze. 

Data collection:

A structured Wound Case Study Form was used to gather all relevant study data.

General and patient related data involved: demographic data and patient related data (age, gender, main diagnosis, comorbidity, wound healing affecting medication, ADL (care dependent or not) and activity level (Braden score: bedfast, chairfast, walks occasionally, walks frequently); treatment setting (patient’s home, hospital, nursing home, assisted living) and type of caregiver (professional, non-professional, self-administering, informal caregiver).

DFU data involved: location, duration of existence and severity (Wagner classification: grade I, II, III, IV, V) [6], wound bed preparation (WBP) [7,8], cleansing, primary and secondary dressings prior to the application of the wound dressing spray.

Outcome data (at start of application of the wound spray and weekly during maximum 6 weeks treatment period until complete healing or partial healing had occurred): WSA (maximum length x maximum width in cm²), type of secondary dressing, and a photo of the wound (including a measurement strip), always made in the same way (from the same distance) and with preferably the same background.

Data at stop of application of the wound spray: extent of healing process (partial of complete healing), WSA, WSA decrease and total amount of wound spray application days.

Additional data: wound spray related adverse events (AE), if any, were documented. Feasibility of applying the wound spray was assessed via a scale ranging from 0 = hard to use to 10 = very easy to use, and patient’s and caregiver’s appreciation of the wound spray were measured via a 5-item scale (bad-moderate-good-very good-excellent). 

Results

The 3 included longitudinally studied cases were conducted in different care settings. One patient was treated at home, one in hospital, and one started treatment in hospital and continued it at home.

All participants were female, on average 73,6 years old and suffering from type II diabetes treated with medication. They were all more or less care dependent and regarding mobility, 2 were chairfast and 1 walked occasionally.

Their wounds were respectively located in the medial foot (N=1, toe 1) and lateral foot (N=2, toe 4 and 5). The 3 wounds existed between 4 and 12 weeks. In all cases wound care was executed by a professional.

The demographic and patient related data of the participants are presented in Table1.

The WSAs varied between 1 and 21 cm². After applying the wound spray, a secondary dressing was used in all patients (a nonwoven gauze). One wound completely healed in 42 days. Two wounds partially healed in 42 and 28 days with a WSA decrease of 93% and 75% respectively. The induction of granulation tissue formation was impressive, resulting in progressive filling up of the wounds and finally in re-epithelialization. The results with the wound spray are depicted in Table 2.

In all 3 cases no wound spray related adverse events were reported. The feasibility of application of the wound spray was rated as high in all cases. The patients’ appreciation of the wound spray was rated “very good”, the caregivers’ appreciation was rated “excellent and very good”. These results are shown in Table 3.

*Braden scale                    °Wagner classification

Table 1: Demographics of participants.

°Antimicrobial foam bandage.

Table 2: Treatment with the wound spray.

*The reported primary wound dressing is a spray based on St John’s wort oil and Neem oil, currently available as WOUND. (https:// www.bap-medical.com/brands/wound/)

Table 3: Adverse events, feasibility of applying the wound spray and appreciation of the wound spray.