Creating Wound Care
Technology
Chip Bettle
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Four Products
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Key Clinical Factors
• Perfusion
• Biofilm
• Off-loading
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Key Clinical Factors
• Perfusion
– Anti-inflammatory Fish Oil
• Vasodilator
• Biofilm
– Oil creates Acid Mantle in Wound Bed
• Binds calcium needed for biofilm structure building
• Off-loading
– Clinician Time Saving
• Creates time for proper off-loading
4

Model Development
TEACH FORMULATE CLINICAL OBSERVATIONS
MODEL REVISION
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Invention Focus
US PTO MENTIONS (2001 to 2009)
Chronic Wound 364
Periwound 61
Chronic Wound + Periwound 6
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Evidence-Based Practice
• Current Paradigm
– Optimize the Variable
• Single-Variable Significant Difference
• Proposed Paradigm
– Optimize the System
• Wound Bed
• Wound Margin
• Lower Leg
• Patient Compliance
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Fish Oil Collagen Paste +
Collagen Matrix
• Anhydrous
• Slow-release oil
– Fish Oil
• EPA C20:5n3
• DHA C22:6n3
– Red Palm Oil
• Antioxidants
• Vitamins
– All 8 moieties of Vit. E
• Wound bed moisture
control
• Wound margin protection
Red Palm Oil Salmon Oil
• Control leakage
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Omega 3 Fatty Acid
• Count from the tail
• EPA C20:5n3
• DHA C22:6n3
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Collagen Added
• Fish oil + collagen increased the rate of
healing
• Anhydrous
• Messiness resolved by covering with
collagen matrix
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Mrs. Bell’s Crème
• Improves skin texture on lower leg
• Cosmetic elegance increases compliance
• Increases lower leg circulation
– Omega 3 oil is a vasodilator
• Lymph and venous systems drain faster
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After Three Weeks of Crème
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Protocol
1. Debride once
2. Fill wound with Fish Oil Paste
1. Coat the Margin
3. Press collagen matrix into paste
4. Rub entire lower leg with Crème
5. Cover wound with Adaptic
6. Wrap & off-load pressure
7. Repeat weekly
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Wound Ready for Treatment
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Beginning to Apply Collagen Paste
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Paste Applied in Wound Bed
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Fibracol Covers Paste
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Adaptic Over Fibracol
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Fully Wrapped
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Consistent Clinical Findings
• Less debriding
• No wound bed disruption
• No infection
• No periwound debriding
• Moist, never wet
• Rapid epithelialization
• Little swelling
• Lower leg: Pink & Warm
• No dermatitis
• Happy Patients
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Start
(2.9cm x 1.8cm = 5.22cm2)
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After Two Weeks
(2.0cm x 1.7cm = 3.4cm2)
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After Three Weeks
(1.7cm x 1.4cm = 2.38cm2 )
(54% reduction)
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Beneficial Synergy
• Simultaneously Treat:
– Wound bed
– Wound margin
– Lower leg
• It’s a system, not a single variable
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Acknowledgment
• Dr. Randy Wolcott
– It’s the acid mantle, Stupid
• Dr. Marcia Ryder
– Chelating compounds kill biofilms
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Proposed Technical Model
• Virgin oils have free fatty acids (FFA)
– FFA creates wound bed acid mantle
– FFA binds calcium needed to grow biofilm
• Biofilm is disrupted and disperses
• Wound stays uninfected
• Nutrients feed granulation buds
• Collagen builds structure & absorbs
exudate
• Unabsorbed fats coat wound margin
– Internal moisture retained
– External moisture rejected 26

Technical Model
fish oilh
collagen collagen/water gel
& EXUDATE & OIL @ pH = 5.5
oil is adsorbed by collagen collagen swells with water & releases oil
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Wound Bed Model
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Margin/Wound Bed Interface
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Apparent Circulation Increase
• Short chain fats are converted into fatty
acids and esters.
• The acids cause a pH drop similar to the
lactic acid pH drop in muscle activity.
• Bohr-Effect oxygen is dropped locally and
gives the appearance of better circulation
• The omega 3 fats are vasodilators
– The existing lymph and venous systems drain
better.
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Wound Bed Chemistry
FISH OIL ORIGIN
C22:6 Shortening Enzyme
Anti-inflammatory C20 Compounds
VEGETABLE OIL ORIGIN
C18:3 Elongating Enzyme
Inflammatory C20 Compounds
(kinetically preferred)
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Fatty Acid Packing Density
• C16 & C18 nest
together
• Packing Density =
1+sin 60°=1.707
Wound Bed
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Calcium Sequestration
+Ca+ +Ca+ +Ca+ +Ca+ • Divalent cations
¯ ¯ ¯ ¯ preferentially bind
¯- ¯- ¯- ¯- to free fatty acid
and are no longer
available for biofilm
stabilization
Wound Bed
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Apparent Increased Circulation
Figurative Leg
Topical Nutrients
Wound
Omega 3 Vasodilators
Oil-to-Fatty Acid lowers local blood pH,
increasing local oxygen availability
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Steps to Success
1. Find a willing doctor
2. Listen to patients
3. Photographic evidence
4. Lower natural defense mechanisms
5. Reformulate on anecdotal data
6. Construct technical models
7. Modify model to explain new findings
8. If model is stable, you are close
9. Test product/protocol with others
10. Find a path through the regulatory maze 35