Abstract and Introduction
Introduction: Topical antimicrobial treatment of wounds in pediatric, and especially neonatal, patients can be challenging due to increased systemic absorption, damaging inflammatory cytokines, and oxygen radicals released by bacterial death. A product combining all wound bed preparation principles is desired. Methylene blue and gentian violet (MB/GV) foam dressings can keep wound beds moist, decrease ongoing inflammation, provide antibacterial coverage, and promote healthy wound edges.
Objective: This article examines the use of MB/GV antibacterial foams in pediatric patients. Cases included infants with giant omphalocele epidermal stripping, dehisced abdominal wounds, peristomal dermatitis, and peripheral intravenous extravasations and adolescents with stage 4 pressure injuries. The treatment goals were to optimize the wound bed through debridement, elimination of bioburden, providing moisture balance, and enhancement of granulation tissue growth.
Materials and Methods: Eight patients (6 infants and 2 adolescents) received MB/GV foam dressings every 2 to 3 days along with standard of care (SOC) management.
Results: Effective debridement, bioburden elimination, moisture balance, and edge enhancement were achieved in all wounds. All wound beds were well-prepared to receive other SOC products as needed. Three cases were considered for negative pressure wound therapy (NPWT), but NPWT was not used because of challenging clinical characteristics and wound locations. Instead, MB/GV polyvinyl alcohol foam provided capillary wicking action that enhanced wound closure without NPWT. No side effects were observed.
Conclusions: Methylene blue and gentian violet foam dressings appear to be a safe clinical option for antibacterial coverage, moisture management, and debridement in neonatal and pediatric patients.
Pediatric wound management has traditionally involved administering systemic antibiotics and topical antibiotic agents. Unfortunately, these approaches often prove unsuccessful for biofilm prevention, slough removal, and optimal wound bed preparation. Topical antimicrobial application in pediatric, and especially neonatal, patients is challenging. Factors complicating antimicrobial application include increased systemic absorption, damaging inflammatory cytokines, and oxygen radicals released during bacterial death.
Neonatal preterm skin is uniquely challenging. Preterm skin is extremely fragile compared with full-term and pediatric skin. Preterm skin has fewer layers of stratum corneum, resulting in increased transcutaneous epidermal water loss and topical product absorption. In addition, the skin mantle is less acidic, which increases the likelihood of microbial organism colonization. There are also fewer anchoring fibrils at the dermal/epidermal junction, resulting in elevated risk of epidermal stripping with adhesive devices. The dermis and subcutaneous tissue are less robust, which increases the risk of pressure injuries.
Despite these unique challenges, neonatal wounds follow the same 4 stages of wound healing as other wounds: hemostasis, inflammation, proliferation, and remodeling. Wound healing must be supported through this cascade. When selecting wound care products, it is important to consider the specific characteristics of neonatal skin, particularly the deficiency of systemic oxygen radical scavengers and the need to decrease the inflammatory milieu. The ideal product should address all wound bed preparation principles, including keeping the wound moist, decreasing ongoing inflammation, providing antibacterial coverage, and promoting a healthy tissue edge. A product with a painless, infrequent application and atraumatic removal is preferred to minimize epidermal stripping/skin tears and pain. Although negative pressure wound therapy (NPWT) can benefit certain wounds, NPWT in small neonates can be challenging owing to hemodynamic instability, pain, and skin tolerance concerns. Furthermore, NPWT placement can be difficult owing to the small and curvy wound area. In older children, concern for wound infection, osteomyelitis, or challenging anatomic areas may also preclude NPWT.
This case series describes the author's experiences with methylene blue and gentian violet (MB/GV)-impregnated foam technology—both polyvinyl alcohol (PVA) and polyurethane (PU) foams—in pediatric patients with wounds. This case series included infants with giant omphalocele epidermal stripping, dehisced abdominal wounds, peristomal dermatitis, and peripheral intravenous extravasations and adolescents with stage 4 pressure injuries.
Wounds. 2021;33(10):253-259. © 2021 HMP Communications, LLC