Successful Management of Complex Pediatric and Neonatal Wounds with Methylene Blue and Gentian Violet Foam Dressings

Abstract

Background
Topical antimicrobial application in pediatric and neonatal patients can be challenging due to increased systemic absorption, damaging inflammatory cytokines and oxygen radicals release during bacterial death. A product combining all wound bed preparation principles is desired. Methylene blue/gentian violet (MB/GV) foam dressings can keep wound beds moist, decrease ongoing inflammation, provide non-cytotoxic antibacterial coverage and promote healthy wound edges. There are two foam types of the MB/GV foams that were used: Polyvinyl Alcohol(PVA) and Polyurethane(PU).

Cases
We share the use of MB/GV antimicrobial foam technology in pediatric patients, including neonates with injuries such as giant omphaloceles epidermal stripping, dehisced abdominal wound, peristomal dermatitis, extravasations and adolescents with stage 4 pressure injury. Eight patients (6 infants and 2 adolescents) received MB/GV foam dressings every 2-3 days depending on the wound, in addition to standard of care management (SOC).

Results
Effective debridement, bioburden elimination, moisture balance and edge enhancement were achieved in all wounds. Every wound bed was well prepared to receive other SOC products, as necessary. Three cases were determined to benefit from negative pressure wound therapy (NPWT), yet clinical characteristics and wound location were challenging. The MB/GV polyvinyl alcohol (PVA) foam provided capillary wicking action that enhanced closure without the need for NPWT. No side effects were noted.

MB/GV Technology
*MB/GV foams-- microporous structure enhances absorption and creates a capillary action that resembles the NPWT pulling action. Bacteria in the exudate is drawn into the foam where it comes into contact with MB and GV, organic dyes. The dyes work via interference with the oxidation-reduction (redox) potentials in the electron chain transport steps of oxidative metabolism.

*Effective absorption of exudate, including inflammatory mediators likely contributes to decrease inflammation.

*The PVA foam supports wound edges. It activates edge keratinocytes and enhances migration across the wound. It flattens epibole minimizing the need for aggressive sharp debridement.

Conclusion
Our positive outcomes support MB/GV foam dressings as a safe alternative for anti-bacterial, moisture and debridement management in neonatal and pediatric patients.

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