Topical Application of Cadomer Powder versus Silver Nitrate in the Management of Non-Healing Chronic Ulcers: A Prospective Randomized Comparative Clinical Trial

Abstract

Background: Non-healing chronic ulcers constitute a significant health burden globally and in the Indian subcontinent. Effective topical wound management remains a cornerstone of therapy. Cadomer powder, a novel polysaccharide-based super-absorbent dressing agent, and silver nitrate (AgNO₃), a long-established antimicrobial cauterizing agent, represent two distinct topical strategies. Head-to-head comparative data between these agents in chronic non-healing ulcers remain limited. Objective: To compare the clinical efficacy, safety, wound healing rates, and patient-reported outcomes of topical cadomer powder versus topical silver nitrate application in patients with non-healing chronic ulcers over a 12-week period. Methods: A prospective, randomized, open-label clinical trial was conducted at the Department of General Surgery, Kota, Rajasthan. Seventy patients with chronic non-healing ulcers (duration ≥6 weeks) were randomized 1:1 to receive topical cadomer powder (n=35) or topical 10% silver nitrate solution (n=35) at weekly clinical visits. The primary outcome was percentage reduction in wound surface area at 4, 8, and 12 weeks. Secondary outcomes included wound bed preparation quality (TIME framework), exudate control, pain scores (NRS 0-10), complete healing rates, adverse events, and patient satisfaction (PSWCS 1-5). Results: At 12 weeks, the cadomer powder group demonstrated significantly greater mean wound surface area reduction (72.4±14.6%) compared to the silver nitrate group (54.1±18.3%) (p<0.001). Complete healing was achieved in 17 (48.6%) cadomer-treated patients versus 11 (31.4%) in the silver nitrate group (p=0.048). Pain scores were significantly lower in the cadomer group (NRS 2.1±1.4 vs 4.8±1.9, p<0.001). Patient satisfaction was higher in the cadomer group (PSWCS 4.3±0.7 vs 3.1±0.9, p<0.001). Adverse events were significantly more frequent in the silver nitrate arm (11/35, 31.4% vs 3/35, 8.6%, p=0.015). Conclusion: Topical cadomer powder is superior to silver nitrate in promoting wound healing, reducing pain, and minimizing adverse effects in non-healing chronic ulcers. These findings support the preferential use of cadomer powder as a first-line topical agent in this patient population.

Keywords: chronic wound; non-healing ulcer; cadomer powder; silver nitrate; wound healing; topical therapy; randomized controlled trial; wound bed preparation