Cadexomer Iodine: An Effective Palliative Dressing in Chronic Critical Limb Ischemia

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Author(s): 
Robert L. Williams, MD; From the Southeast Texas Center for Wound Care and Hyperbaric Medicine, Austin, Texas

Abstract: Cadexomer iodine (CI) was evaluated as a palliative wound care dressing for foot ulcers in chronic critical limb ischemia (CCLI) given its ability to prevent infection and absorb moisture. Methods. A retrospective study of 11 patients with CCLI and wounds on distal lower extremities that were treated with cadexomer iodine. The product was applied topically on a daily basis. Wounds were debrided cautiously to minimize blood loss. Patients were monitored in the clinic on a weekly to biweekly basis. Results. Seven patients in this cohort had all or some wounds on their feet close, at least temporarily. Two patients ultimately underwent proximal amputations, but the procedures were delayed 9 months in one patient, and 3 years in the other. Ischemic wounds of 3 patients were stabilized with CI allowing time for invasive revascularization followed by successful distal amputations resulting in ongoing limb salvage of 5 months to almost 4 years. Four patients currently being treated with CI have avoided proximal amputations for 4–18 months. Conclusion. Cadexomer iodine is an effective palliative dressing for wounds in CCLI. The antimicrobial effect of iodine prevents wet gangrene. The absorptive capacity of cadexomer beads dries necrotic tissue facilitating dry gangrene and auto-amputation without desiccating viable tissue. Cadexomer iodine enhances autolytic debridement, mitigates inflammation beyond the antimicrobial effects of iodine, and encourages granulation and epithelialization even in severely hypoperfused wounds. Cadexomer iodine delays proximal limb amputation in CCLI and may facilitate healing in some ischemic wounds.


Address correspondence to:
Robert L. Williams, MD
Southeast Texas Center for Wound Care and Hyperbaric Medicine
3817 Summer Ln.
Huntsville, TX 77340
Phone: 936-295-2668
E-mail: robkarin@suddenlink.net



     Chronic critical limb ischemia (CCLI) refers to a condition manifested by rest pain, ulceration, or gangrene that is objectively demonstrated to be related to arterial occlusive disease.1 Ulcers in patients with CCLI may arise spontaneously due to inadequate perfusion to support basal tissue metabolism or when factors such as trauma or infection elevate tissue perfusion requirements that exceed the distal circulatory system’s capacity. Patients with CCLI, regardless if wounds are present or not, have a 40% incidence of a major amputation (above or below the knee) within 6 months if their disease is not amenable to revascularization. 1 The likelihood of major amputation is most likely greater if these individuals already have a wound. When tissue perfusion is demonstrably inadequate to support wound healing, conservative surgical interventions such as distal amputations (toe, transmetatarsal, or Chopart’s) or even local sharp debridement typically result in extension of tissue necrosis, infection, and a larger, still nonhealing wound.

     The decision to amputate is usually prompted by physical manifestations (eg, gangrene, osteomyelitis, or systemic symptoms of infection), or quality of life issues such as intractable pain or negative body image. Although a major amputation can potentially “cure” a nonhealing wound associated with CCLI, the decision to amputate has many profound implications. Major amputations in the face of CCLI have a 20%–37% risk for complications such as myocardial infarction (MI), stroke, or infection, and a mortality rate as high as 30%.2–5 Quality of life can be severely and irreparably disturbed. Major amputations, especially in the elderly, too frequently mark the end of a patient’s ambulatory existence. 6

     Limb salvage is presently thought to be dependent on re-establishing distal tissue perfusion.

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