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

Cadexomer iodine (CI) was evaluated as palliative would 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 amputationa 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 woulds 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.