Choosing the Ideal Dressing

Pornthep Sirimahachaiyakul, M.D.

Division of Plastic Surgery, Department of Surgery,

Faculty of Medicine Vajira Hospital, Navamindradriraj University

• I have no financial or other conflicts of interest to report

Disclosure

• Introduction

•Tips for wound dressing selection

• Ideal wound dressing

•Wound dressing categories and clinical applications

•Conclusion

Outline

Introduction

http://www.medical-supplies-equipment-company.com/homehealth/product/gauze-sponges-woven_537.htm

The Principles of Wound Bed Preparation

T

I

M

E

Schultz GS, et al. Wound bed preparation and a brief history of TIME. Int Wound J 2004;1(1):19-32.

The TIME Concept

Leaper DJ, et al. Extending the TIME concept: what have we learned in the past 10 years? Int Wound J 2012;9(Suppl 2):1-19.

Tips for Wound Dressing Selection

http://operson.en.made-in-china.com/product-group/JqsmprgPTnWY/Wound-dressing-catalog-1.html

Tips for Wound Dressing Selection

1.Etiology

2. Location

3. Size

4. Tissue types

5. Exudate

6. Periwound condition

7. Bacterial burden

8. Support needs

Weir D. Wounds Int 2012;3(4):18-22.

Tips for Wound Dressing Selection

1. Etiology

2.Location

3. Size

4. Tissue types

5. Exudate

6. Periwound condition

7. Bacterial burden

8. Support needs

Weir D. Wounds Int 2012;3(4):18-22.

Tips for Wound Dressing Selection

1. Etiology

2. Location

3.Size

4. Tissue types

5. Exudate

6. Periwound condition

7. Bacterial burden

8. Support needs

Weir D. Wounds Int 2012;3(4):18-22.

Tips for Wound Dressing Selection

1. Etiology

2. Location

3. Size

4.Tissue types

5. Exudate

6. Periwound condition

7. Bacterial burden

8. Support needs

Weir D. Wounds Int 2012;3(4):18-22.

Tips for Wound Dressing Selection

1. Etiology

2. Location

3. Size

4. Tissue types

5. Exudate

6. Periwound condition

7. Bacterial burden

8. Support needs

Weir D. Wounds Int 2012;3(4):18-22.

Tips for Wound Dressing Selection

1. Etiology

2. Location

3. Size

4. Tissue types

5. Exudate

6. Periwoundcondition

7. Bacterial burden

8. Support needs

Weir D. Wounds Int 2012;3(4):18-22.

Tips for Wound Dressing Selection

1. Etiology

2. Location

3. Size

4. Tissue types

5. Exudate

6. Periwound condition

7. Bacterial burden

8. Support needs

Weir D. Wounds Int 2012;3(4):18-22.

Tips for Wound Dressing Selection

1. Etiology

2. Location

3. Size

4. Tissue types

5. Exudate

6. Periwound condition

7. Bacterial burden

8. Support needs

Weir D. Wounds Int 2012;3(4):18-22.

Ideal Wound Dressing

http://www.cccme.org.cn/products/detail-3048804.aspx

Ideal Wound Dressing

•General characteristicsEasy to apply and maintain

Aesthetically pleasing

Cost permissive

Easily stored

Non-allergenic

Broussard KC, et al. Am J Clin Dermatol 2013;14(6):449-59.

•Facilitate healingMaintain moist environment

Minimize trauma or maceration to wound edges

Retention of heat

Facilitates gas exchange

Ideal Wound Dressing (Cont.)

Broussard KC, et al. Am J Clin Dermatol 2013;14(6):449-59.

•Minimize risk of infectionDebride necrotic tissue

Absorb exudate

Minimize external contamination

Ideal Wound Dressing (Cont.)

Broussard KC, et al. Am J Clin Dermatol 2013;14(6):449-59.

Wound Dressing Categories & Clinical Applications

http://taxstudents.co.za/just-anything-deal-cuts/

1. Inert or Passive wound dressings

2. Interactive wound dressings

Wound Dressing Categories

Broussard KC, et al. Am J Clin Dermatol 2013;14(6):449-59.

1. Inert or Passive Wound Dressings

http://www.publicdomainpictures.net/view-image.php?image=139458&picture=stack-of-gauzehttp://www.globalsources.com/si/AS/Wuhan-Mei/6008848541606/pdtl/Vaseline-gauze/1085071020.htm

1. Inert or Passive Wound Dressings

http://www.publicdomainpictures.net/view-image.php?image=139458&picture=stack-of-gauzehttp://www.globalsources.com/si/AS/Wuhan-Mei/6008848541606/pdtl/Vaseline-gauze/1085071020.htm

Protection of wound bed

and Covering

A. Moisture-retentive dressings

B. Silver dressings and antimicrobials

C. Miscellaneous dressings

2. Interactive Wound Dressings

A.Moisture-retentive dressings

B. Silver dressings and antimicrobials

C. Miscellaneous dressings

2. Interactive Wound Dressings

a) Films

b) Hydrogels

c) Hydrocolloids, Hydrofibers

d) Alginates

e) Foams

Moisture-retentive Dressings

Films

http://solutions.3mchile.cl/wps/portal/3M/es_CL/Littmann/stethoscope/products/product-catalog-

australia/?PC_Z7_RJH9U5230GE3E02LECIE20KF96000000_nid=5N9BC8XZ8NbeSXJDGZDK2Lglhttp://www.progress.com.sg/product/opsite-flexifix-transparent-film-roll/

Films

Visualization of wound bed

and Wound protection

http://solutions.3mchile.cl/wps/portal/3M/es_CL/Littmann/stethoscope/products/product-catalog-

australia/?PC_Z7_RJH9U5230GE3E02LECIE20KF96000000_nid=5N9BC8XZ8NbeSXJDGZDK2Lglhttp://www.progress.com.sg/product/opsite-flexifix-transparent-film-roll/

Hydrogels

https://www.medicaldepartmentstore.com/Hydrogel-Dressings-s/295.htm

https://www.bbraun.com/en/products/b/askina-gel.htmlhttp://www.kpmmedical.com.vn/blugel.html

Hydrogels

https://www.medicaldepartmentstore.com/Hydrogel-Dressings-s/295.htm

https://www.bbraun.com/en/products/b/askina-gel.htmlhttp://www.kpmmedical.com.vn/blugel.html

Hydrate dry wound bed

and Facilitate autolytic debridement

Clinical Application of Hydrogels in Diabetic Foot Ulcers (DFU)

Dumville JC, et al. Cochrane Database Syst Rev 2013;(7):CD009101.

Clinical Application of Hydrogels in Diabetic Foot Ulcers (DFU)

Dumville JC, et al. Cochrane Database Syst Rev 2013;(7):CD009101.

Hydrocolloids, Hydrofibers

http://www.hightidehealth.com/duoderm-signal.htmlhttps://www.convatec.ca/products/pc-wound-aquacel-extra-dressing/21603750-5757-4a85-a075-465347dbfccb

Hydrocolloids, Hydrofibers

http://www.hightidehealth.com/duoderm-signal.htmlhttps://www.convatec.ca/products/pc-wound-aquacel-extra-dressing/21603750-5757-4a85-a075-465347dbfccb

Absorb minimal to moderate exudate,

Maintain moist environment and Facilitate autolytic debridement

Clinical Application of Hydrocolloids/Hydrofibers in DFU

Dumville JC, et al. Cochrane Database Syst Rev 2013;(8):CD009099.

Clinical Application of Hydrocolloids/Hydrofibers in DFU

Dumville JC, et al. Cochrane Database Syst Rev 2013;(8):CD009099.

Alginates

http://woundcaresociety.org/alginate-dressing-complete-guidehttps://www.convatec.com/products/pc-wound-burns/kaltostat-calcium-sodium-alginate-dressing

Alginates

http://woundcaresociety.org/alginate-dressing-complete-guidehttps://www.convatec.com/products/pc-wound-burns/kaltostat-calcium-sodium-alginate-dressing

Absorb large amounts of fluid,

Provide moist environment and

Stimulate platelet activation & blood coagulation

Clinical Application of Alginates in DFU

Dumville JC, et al. Cochrane Database Syst Rev 2013;(6):CD009110.

Clinical Application of Alginates in DFU

Dumville JC, et al. Cochrane Database Syst Rev 2013;(6):CD009110.

Foams

http://www.smith-nephew.com/canada/products/advanced-wound-management/allevyn-gentle/http://uk.live.nodeb.convatemp.dk/wound-skin/aquacel-foam-dressing/key-features-and-benefits

Foams

http://www.smith-nephew.com/canada/products/advanced-wound-management/allevyn-gentle/http://uk.live.nodeb.convatemp.dk/wound-skin/aquacel-foam-dressing/key-features-and-benefits

Absorb heavy amounts of exudate,

Maintain moist environment and Protect skin against mechanical trauma

Clinical Application of Foams in DFU

Dumville JC, et al. Cochrane Database Syst Rev 2013;(6):CD009111.

Clinical Application of Foams in DFU

Dumville JC, et al. Cochrane Database Syst Rev 2013;(6):CD009111.

Clinical Application of Foams in DFU

Dumville JC, et al. Cochrane Database Syst Rev 2013;(6):CD009111.

Clinical Application of Foams in DFU

Dumville JC, et al. Cochrane Database Syst Rev 2013;(6):CD009111.

A. Moisture-retentive dressings

B.Silver dressings and antimicrobials

C. Miscellaneous dressings

2. Interactive Wound Dressings

a) Silver

b) Iodine

c) Honey

Silver Dressings and Antimicrobials

Silver

http://www.rch.org.au/burns/clinical_information/

https://www.amazon.com/ConvaTec-Aquacel-extra-AG-2x2/dp/B00HJCI68K

http://www.bbraun.co.id/cps/rde/xchg/cw-bbraun-id-id/hs.xsl/products.html?prid=PRID00002996

http://www.kpmmedical.com.vn/blugel.html

https://www.exmed.net/p-1987-molnlycke-mepilex-ag-antimicrobial-soft-silicone-foam-dressing.aspxhttp://www.urgomedical.nl/products/urgotul-ssd/

Silver

http://www.rch.org.au/burns/clinical_information/

https://www.amazon.com/ConvaTec-Aquacel-extra-AG-2x2/dp/B00HJCI68K

http://www.bbraun.co.id/cps/rde/xchg/cw-bbraun-id-id/hs.xsl/products.html?prid=PRID00002996

http://www.kpmmedical.com.vn/blugel.html

https://www.exmed.net/p-1987-molnlycke-mepilex-ag-antimicrobial-soft-silicone-foam-dressing.aspxhttp://www.urgomedical.nl/products/urgotul-ssd/

Broad spectrum antimicrobial agent,

Easy to use and Reducing inflammation

Clinical Application of Silver in DFU

Jude EB, et al. Diabet Med 2007;24(3):280-8.

Clinical Application of Silver in DFU

Jude EB, et al. Diabet Med 2007;24(3):280-8.

Clinical Application of Silver in DFU

Jude EB, et al. Diabet Med 2007;24(3):280-8.

Clinical Application of Silver in DFU

Jude EB, et al. Diabet Med 2007;24(3):280-8.

Clinical Application of Silver in DFU

Jude EB, et al. Diabet Med 2007;24(3):280-8.

Iodine

http://www.hightidehealth.com/iodoflex-cadexomer-iodine-pad-dressings.html

http://www.deforcemedical.be/nl/iodosorb-cadexomeer-zalf-met-iodine-tube-2-x-20g-nieuwhttps://www.fishpond.com.hk/c/Health/q/Iodine+Dressing

Iodine

http://www.hightidehealth.com/iodoflex-cadexomer-iodine-pad-dressings.html

http://www.deforcemedical.be/nl/iodosorb-cadexomeer-zalf-met-iodine-tube-2-x-20g-nieuwhttps://www.fishpond.com.hk/c/Health/q/Iodine+Dressing

Broad spectrum antimicrobial agent,

and

Penetration of biofilm

Clinical Application of Iodine in DFU

Apelqvist J, et al. Acta Derm Venereol 1996;76(3):231-5.

Clinical Application of Iodine in DFU

Apelqvist J, et al. Acta Derm Venereol 1996;76(3):231-5.

Honey

http://jazzmed.com/product-technology.html

https://www.exmed.net/p-4085-derma-sciences-medihoney-1-12-oz-wound-and-burn-dressing-gel.aspxhttp://commonsensehome.com/honey-as-medicine/

Honey

http://jazzmed.com/product-technology.html

https://www.exmed.net/p-4085-derma-sciences-medihoney-1-12-oz-wound-and-burn-dressing-gel.aspxhttp://commonsensehome.com/honey-as-medicine/

Broad spectrum antimicrobial agent,

Enhancing autolytic debridement and

Anti-inflammatory response

Clinical Application of Honey in DFU

Kamaratos AV, et al. Int Wound J 2014;11(3):259-63.

Clinical Application of Honey in DFU

Kamaratos AV, et al. Int Wound J 2014;11(3):259-63.

31 days43 days

P < 0.05

A. Moisture-retentive dressings

B. Silver dressings and antimicrobials

C.Miscellaneous dressings

2. Interactive Wound Dressings

a) Negative pressure wound therapy(NPWT)

b) Bioengineered skin/ Skin subsitutes

c) Collagen dressings

d) Growth factors

e) Gold dust

f) Drawtex hydroconductive dressing

Miscellaneous Dressings

Negative Pressure Wound Therapy (NPWT)

http://www.kci-medical.ie/cs/Satellite?c=Page&cid=1229637734560&p=1229637734560&pagename=IE-ENG%2FKCILayout

Negative Pressure Wound Therapy (NPWT)

http://www.kci-medical.ie/cs/Satellite?c=Page&cid=1229637734560&p=1229637734560&pagename=IE-ENG%2FKCILayout

Reduction of edema,

Wound edge contraction,

Granulation tissue formation and

Reduction of bacterial load

Clinical Application of NPWT in DFU

Armstrong DG, et al. Lancet 2005;366(9498):1704-10.

Clinical Application of NPWT in DFU

Armstrong DG, et al. Lancet 2005;366(9498):1704-10.

Clinical Application of NPWT in DFU

Blume PA, et al. Diabetes Care 2008;31(4):631-6.

Clinical Application of NPWT in DFU

Blume PA, et al. Diabetes Care 2008;31(4):631-6.

Clinical Application of NPWT in DFU

Sajid MT, et al. J Coll Physicians Surg 2015;25(11):789-93.

Clinical Application of NPWT in DFU

Sajid MT, et al. J Coll Physicians Surg 2015;25(11):789-93.

Skin Substitutes

http://www.woundcarenurses.org/uploads/7/6/6/7/7667574/6082877.jpg

http://personalpages.manchester.ac.uk/staff/j.gough/lectures/te/13_skin/dermagraft3.GIF

http://www.rileyanimation.com/wp-content/uploads/2014/03/GraftJacket_BIG21.jpghttp://www.ilstraining.com/bmwd/images/bmwd_chronic_app_02.jpg

Skin Substitutes

http://www.woundcarenurses.org/uploads/7/6/6/7/7667574/6082877.jpg

http://personalpages.manchester.ac.uk/staff/j.gough/lectures/te/13_skin/dermagraft3.GIF

http://www.rileyanimation.com/wp-content/uploads/2014/03/GraftJacket_BIG21.jpghttp://www.ilstraining.com/bmwd/images/bmwd_chronic_app_02.jpg

Promote wound healing by

cytokines and growth factors

Clinical Application of Skin Substitutes (Graftskin) in DFU

Veves A, et al. Diabetes Care 2001;24(2):290-5.

Clinical Application of Skin Substitutes (Graftskin) in DFU

Veves A, et al. Diabetes Care 2001;24(2):290-5.

56%

38%

Graftskin

Control

P = 0.0042

Marston WA, et al. Diabetes Care 2003;26(6):1701-5.

Clinical Application of Skin Substitutes (Dermagraft) in DFU

Clinical Application of Skin Substitutes (Dermagraft) in DFU

Marston WA, et al. Diabetes Care 2003;26(6):1701-5.

Clinical Application of Skin Substitutes (Graftjacket) in DFU

Reyzelman A, et al. Int Wound J 2009;6(3):196-208.

Clinical Application of Skin Substitutes (Graftjacket) in DFU

Reyzelman A, et al. Int Wound J 2009;6(3):196-208.

69.6% 46.2% P = 0.0289

Clinical Application of Skin Substitutes (Integra) in DFU

Driver VR, et al. Wound Repair Regen 2015;23(6):891-900.

Clinical Application of Skin Substitutes (Integra) in DFU

Driver VR, et al. Wound Repair Regen 2015;23(6):891-900.

51%

32%

P = 0.001

Collagen Dressings

http://www.elastogel.com/product-catalog/wound-care/stimulen-collagen-wound-care

http://www.blowoutmedical.com/johnson-and-johnson-promogran-prisma-matrix.htmlhttp://www.midtownhealthonline.com/fibracolall.html

Collagen Dressings

http://www.elastogel.com/product-catalog/wound-care/stimulen-collagen-wound-care

http://www.blowoutmedical.com/johnson-and-johnson-promogran-prisma-matrix.htmlhttp://www.midtownhealthonline.com/fibracolall.html

Bind MMPs,

Providing temporary scaffolding,

Attracting cells to wound site and

Create moist environment

Clinical Application of Collagen Dressings in DFU

Veves A, et al. Arch Surg 2002;137(7):822-7.

Clinical Application of Collagen Dressings in DFU

Veves A, et al. Arch Surg 2002;137(7):822-7.

P = 0.12

28%

37%

Growth Factors

http://www.webmd.com/drugs/2/drug-5550/regranex-topical/details

http://www.cgbio.co.kr/en/product/wound/easyef-ointment/

http://www.daewoong.com/Sub06/Sub06_0101.asp?MODE=V&SRNO=60752

http://www.bharatbiotech.com/products/bio-therapeutic/regen-d/

Growth Factors

http://www.webmd.com/drugs/2/drug-5550/regranex-topical/details

http://www.cgbio.co.kr/en/product/wound/easyef-ointment/

http://www.daewoong.com/Sub06/Sub06_0101.asp?MODE=V&SRNO=60752

http://www.bharatbiotech.com/products/bio-therapeutic/regen-d/

Stimulate migration &

proliferation of cells and

Promote new tissue formation

Clinical Application of Growth Factors (Becaplermin) in DFU

Wieman TJ, et al. Diabetes Care 1998;21(5):822-7.

Clinical Application of Growth Factors (Becaplermin) in DFU

Wieman TJ, et al. Diabetes Care 1998;21(5):822-7.

43%35%

35%

36%

50%

P = 0.007

Clinical Application of Growth Factors (EGF) in DFU

Hong JP, et al. Ann Plast Surg 2006;56:394-8.

Clinical Application of Growth Factors (EGF) in DFU

Hong JP, et al. Ann Plast Surg 2006;56:394-8.

52/68

46 days

Clinical Application of Growth Factors (EGF) in DFU

Mohan VK. Diabetes Res Clin Pract 2007;78(3):405-11.

Clinical Application of Growth Factors (EGF) in DFU

Mohan VK. Diabetes Res Clin Pract 2007;78(3):405-11.

Gold Dust

http://www.soza.com.my/products-gold-dust.asphttps://www.youtube.com/watch?v=OrITniCtHbo

Gold Dust

http://www.soza.com.my/products-gold-dust.asphttps://www.youtube.com/watch?v=OrITniCtHbo

Absorb heavy amounts of exudate

and

Maintain moist wound environment

Drawtex HydroconductiveDressing

https://hmpusers.com/cas/login?service=http%3A%2F%2Fwww.o-wm.com%2Fcontent%2Fdiscovering-hydroconductive-dressings&gateway=truehttp://www.wounds-uk.com/news/martindale-pharma-enters-wound-care-market-with-an-intelligent-new-option-for-rapid-wound-bed-preparation

Drawtex HydroconductiveDressing

https://hmpusers.com/cas/login?service=http%3A%2F%2Fwww.o-wm.com%2Fcontent%2Fdiscovering-hydroconductive-dressings&gateway=truehttp://www.wounds-uk.com/news/martindale-pharma-enters-wound-care-market-with-an-intelligent-new-option-for-rapid-wound-bed-preparation

Absorb moderate to heavy exudate

and

Lift and draw exudate, wound

debris, bacteria and harmful MMPs

Conclusion

http://www.smith-nephew.com/key-products/advanced-wound-management/dressing-types/

•Understanding wound healing

•Strong evidence of effectiveness and cost-effectiveness

•Adequate wound debridement, appropriate systemic antibiotics, dressing changes and wound inspection

•Prevention of DFU

Conclusion

Questions???

Thank Youfor Your Attention

http://jmlevinemd.com/wound-odor-philoctetes/