COMPARISON BETWEEN TWO TYPES OF COMPLEX DRESSINGS IN THE APPROACH TO DIFFICULT WOUNDS: RANDOMIZED CLINICAL TRIAL IN SINGLE BLIND TO EVALUATE THE “WOUND ADVANCEMENT PROTOCOL”

Background: Venous leg ulcers are a common chronic disorder that tends to be complicated by excessive exudate, infection and by impaired healing: the more conventional dressings tend to fall short in addressing the complex underlying pathology and the more recent advances in wound care are starting to highlight absorbent gelling fiber dressings that are able to integrate moisture control with antimicrobial activity in order to support and accelerate the healing process. Objectives: This study aimed to evaluate the clinical efficacy, biological effects, and patient- centered outcomes of Exufiber Ag+®—a novel antimicrobial gelling fiber dressing— in the management of VLUs over 45 days. A multidimensional approach was employed, incorporating morphometric, cellular, microbiological, and subjective assessments. Methods: A prospective, single-center cohort study enrolled 23 patients with venous ulcers, treated with Exufiber Ag+ or control dressings (Acquacel Ag). Data collected included wound measurements via standardized photography, biopsies for cytofluorimetric analysis of endothelial progenitor cells (EPCs), microbiological cultures, and patient- reported outcomes using the WOUND-Q questionnaire. Statistical analyses assessed wound size reduction, cellular responses, microbial clearance, and subjective perceptions. Results: Significant wound size reduction was observed in both groups, with a greater delta (mean 24 cm2) in the experimental group (p<0.05). Morphometric parameters such as area and diameters decreased markedly over time. Cellular analysis demonstrated a significant increase in EPCs post-treatment (41%), correlating with wound contraction; this increase was higher in the Exufiber Ag+ group (p<0.01). Microbiological cultures revealed a significant reduction in bacterial colonization (p<0.05). Patients reported improved quality of life, particularly in drainage, odor, and overall wellbeing, with scores significantly better in the Exufiber Ag+ group (p<0.05). Discussion: The findings reinforce the hypothesis that absorbent gelling fiber dressings with antimicrobial properties not only provide effective exudate and infection control but also stimulate microvascular regeneration through EPC recruitment; the broad spectrum of benefits that spanned from measurable wound reduction, favorable cellular activity, microbiological clearance and improved patient satisfaction, 83 underscores their promise as active contributors to contemporary wound care, nonetheless, limitations such as the relatively small sample size and brief follow‐up period should be acknowledged. Conclusions: Exufiber Ag+ showed encouraging clinical effectiveness and biological activity in the management of venous leg ulcers going on to offer various benefits in accelerating healing and in the enhancement of patient quality of life; looking ahead, the researches of the future should underline larger, multicenter cohorts with longer follow‐up in order to incorporate detailed cellular and molecular investigations while exploring personalized therapeutic strategies that can be guided by wound‐specific biomarkers.