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EUROPEAN JOURNAL OF CARDIOVASCULAR MEDICINE Volume:13 Issue:4
46
European Journal of Cardiovascular Medicine
Print ISSN: 2042-4884 | E-ISSN: 2042-4892
Language: Multilingual
Origin: United Kingdom
Website: https://www.healthcare-bulletin.co.uk/ Volume 13 Issue: 4 - 2023
A New Classification for Wound Dressings
Amit Kumar C Jain
INTRODUCTION
Wounds remain a challenging condition to health care professionals and millions of people are known to suffer from
different wounds annually [1, 2]. It was noticed that nearly one billion people suffered from wounds around the globe [3].
The wounds are either acute or chronic in nature [3, 4]. It is well known that healing process in acute wounds can be
estimated whereas in chronic wounds, healing cannot be predicted [5]. Some of the common chronic wounds are venous
ulcers, diabetic foot ulcers and pressure ulcers [6].
Dressing is one of the most used modalities in treatment of wounds [7]. There are many factors that determine dressing
selection and they include nature of wounds, its location, cost, and ranges of dressing materials available [8].
For years, traditional dressings (also known as passive dressings) like sterile gauges have been in use at many places
even today as primary dressing [9, 10]. Distinct modern dressings have evolved recently and they are either interactive or
bioactive categories [4]. Commonly used modern dressing include hydrogels, hydrocolloids, alginates, etc [4, 9].
The traditional dressings are dry dressing which does not create moist environment whereas modern dressing maintains
moist environment [9].
Abstract: Wounds are extremely common in clinical practice and they include diabetic foot
wounds, venous ulcers, burns, traumatic wounds, etc. These wounds occur frequently in
daily life and needs to be managed appropriately otherwise they can lead to complications.
Numerous wound dressings/products are available in Industry with each having merits
and demerits. Often, it is also difficult to understand their usage and mechanisms of action.
The primary author extended his ‘SCC’ classification series to wound dressings wherein
one can categorize them into 3 type’s namely simple, complex, and complicated wound
dressings. This article aims to discuss this new classification of wound dressings.
Keywords: Wounds, Diabetic Foot, Dressings, Types, Healing
AFFILIATIONS
Consultant and Head, Amit Jain’s
Diabetic Foot and Wound
Research Unit, Amit Jain’s
Institute of Diabetic Foot and
Wound Care, Brindhavvan Areion
Hospital, Bengaluru, India.
CORRESPONDING AUTHOR
Amit Kumar C Jain
Open Access
Article Title: A New Classification for Wound Dressings
EUROPEAN JOURNAL OF CARDIOVASCULAR MEDICINE Volume:13 Issue:4
47
The author proposes a new, easy to remember descriptive classification for wound dressings/products which is an
expansion and extension of his ‘SCC’ classification in diabetic foot that was used for ulcers, footwears, offloading,
deformities, etc [11, 12, 13].
Based on distinct factors like ease of application, cost of dressing, mechanism of action and its understanding, etc, the
author divided the wound dressings into 3 distinct classes namely Class 1, Class 2, and Class 3 wound dressings (Figure
1).
Figure 1 showing the new Amit Jain’s Classification for Wound Dressings
The Class 1 dressings are simple dressings and they include sterile gauge dressings, hydrogels, hydrocolloids, foams
(Figure 2), polysaccharides like alginates, chitosan, etc. Most of these dressings are nowadays affordable and they aim at
providing moist environment for effective wound healing.
Figure 2 showing foam dressing. This is Amit Jain’s Type 1 wound dressing
Article Title: A New Classification for Wound Dressings
EUROPEAN JOURNAL OF CARDIOVASCULAR MEDICINE Volume:13 Issue:4
48
The Class 2 dressings are complex dressings and they include collagen-based dressing, Technology Lipido Colloid
(TLC), Growth factors, etc. The TLC dressings are newer dressings that comprises of matrix containing hydrocolloid and
lipophilic substances and it consists of neutral TLC, Silver combines TLC or with a protease inhibitor (TLC- NOSF) [14,
15]. Many of the complex dressings are costly.
The Class 3 dressings are complicated dressings and the best example in this class is the Skin Substitutes. The skin
substitutes are either acellular, cellular or dermo-epidermal types [16]. These are currently very expensive.
Just like other SCC classification in diabetic foot, this wound dressing classification can also have a triangle (Figure 3).
Figure 3 showing the Amit Jain’s triangle of wound dressings
One needs to be aware that although we mentioned some of the commonly available dressing used in practice, there are
more than 500 dressing available with each having different composition and properties [17]. In centres like ours, which is
an expert diabetic foot and wound care centre, on an average in a year, around 5 to 10 types of dressings are usually
available in the pharmacy. This means out of 500 available dressing in the industry, only 1-2% (max 10x100/500 =2%)
are used in clinical practice.
Many times, the dressings are available or used in combination in clinical practice. No single dressing today can be
suitable for all the types of wounds [8]. Further, one needs to understand that many dressings, especially the newer modern
dressings lack evidences with many being poorly designed studies, which in many are industry funded or they use saline
gauge dressing as control [16].
CONCLUSION
Wound dressings are essential in clinical management to achieve appropriate healing. There is no one ideal dressing
that fulfils all the criteria’s or is universally applicable. Hence, one needs to have a flexibility in using wound dressing
depending upon the type of wound, location, and patients’ affordability. The new Amit Jain’s classification for wound
dressing, based on SCC classification system, is an easy to remember descriptive classification and it can serve as a good
teaching tool especially its triangle, that provides the available options of dressings.
REFERENCES
1. Velnar T, Bailey T, Smrkolj V. The wound healing process: an overview of the cellular and molecular mechanisms.
The Journal of International Medical Research 2009;37:1528-1542.
2. Gushiken LFS, Beserra FP, Bastos JK, Jackson CJ, Pellizzon CH. Cutaneous wound healing: An update from
physiopathology to current therapies. Life 2021:11:665.
3. Raziyeva K, Kim Y, Zharkinbekov Z, Kassymbek K, Jimi S, Saparov A. Immunology of Acute and Chronic Wound
Healing. Biomolecules 2021;11(5):700.
Article Title: A New Classification for Wound Dressings
EUROPEAN JOURNAL OF CARDIOVASCULAR MEDICINE Volume:13 Issue:4
49
4. Brumberg V, Astrelina T, Malivanova T, Samoilov A. Modern wound dressings: Hydrogel dressings. Biomedicines
2021;9:1235.
5. Mahyudin F, Edward M, Basuki MH, Basrewan Y, Rahman A. Modern and classic wound healing comparison in
wound healing, comfort and cost. Jurnal Ners 2020;15(1):31-36.
6. Frykberg RG, Banks J. Challenges in the treatment of chronic wounds. Adv Wound Care (New Rochelle)
2015;4(9):560-582.
7. Smaniotto PHD, Ferreira MC, Issac C, Galli R. Systematization of dressing for clinical treatment of wounds. Rev Bras
Cir Plast 2012;27(4):623-6.
8. Rahman GA, Adigun IA, Yusuf IF, Ofoegbu CKP. Wound dressing where there is limitation of choice. Nigerian J Surg
Research 2006;8(3):151-154.
9. Sundaresan S, Sasikala L. Developments in wound dressings. Curr Trends Fashion Technol Textile Eng
2018;2(1):555578.
10. Aderibigbe BA, Buyana B. Alginate in wound dressings. Pharmaceutics 2018;10:42.
11. Jain AKC. A new classification for diabetic foot surgery. Int J Surg & Surgical Res 2020;2:6-8.
12. Jain AKC. Extended application of Amit Jain’s ‘SCC’ classification concept for diabetic foot. Int J Surg Sci
2019;3:188-91.
13. Jain AKC. Super modern diabetic foot surgery. Medicine Science 2021;10(3):1081-4.
14. McGrath A, Newton H, Trudgian J, Greenwood M. TLC dressings made easy. Wounds UK 2014;10(3)-1-4.
15. Galea E, Shankar U. The Use of a non-adherent Lipido-colloid dressings with silver in the management of wounds.
Wounds Middle East 2019;6(2):28-32.
16. Davide Vincenzo Verdolino, Helen A. Thomason, Andrea Fotticchia, Sarah Cartmell; Wound dressings: curbing
inflammation in chronic wound healing. Emerg Top Life Sci 2021;5(4):523–537.
17. Andryukov BG, Besednova NN, Kuznetsova TAet al. Sulfated polysaccharides from marine algae as a basis of modern
biotechnologies for creating wound dressings: Current achievements and future prospects. Biomedicines 2020;8:301.

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New Classification for Wound Dressings

  • 1. EUROPEAN JOURNAL OF CARDIOVASCULAR MEDICINE Volume:13 Issue:4 46 European Journal of Cardiovascular Medicine Print ISSN: 2042-4884 | E-ISSN: 2042-4892 Language: Multilingual Origin: United Kingdom Website: https://www.healthcare-bulletin.co.uk/ Volume 13 Issue: 4 - 2023 A New Classification for Wound Dressings Amit Kumar C Jain INTRODUCTION Wounds remain a challenging condition to health care professionals and millions of people are known to suffer from different wounds annually [1, 2]. It was noticed that nearly one billion people suffered from wounds around the globe [3]. The wounds are either acute or chronic in nature [3, 4]. It is well known that healing process in acute wounds can be estimated whereas in chronic wounds, healing cannot be predicted [5]. Some of the common chronic wounds are venous ulcers, diabetic foot ulcers and pressure ulcers [6]. Dressing is one of the most used modalities in treatment of wounds [7]. There are many factors that determine dressing selection and they include nature of wounds, its location, cost, and ranges of dressing materials available [8]. For years, traditional dressings (also known as passive dressings) like sterile gauges have been in use at many places even today as primary dressing [9, 10]. Distinct modern dressings have evolved recently and they are either interactive or bioactive categories [4]. Commonly used modern dressing include hydrogels, hydrocolloids, alginates, etc [4, 9]. The traditional dressings are dry dressing which does not create moist environment whereas modern dressing maintains moist environment [9]. Abstract: Wounds are extremely common in clinical practice and they include diabetic foot wounds, venous ulcers, burns, traumatic wounds, etc. These wounds occur frequently in daily life and needs to be managed appropriately otherwise they can lead to complications. Numerous wound dressings/products are available in Industry with each having merits and demerits. Often, it is also difficult to understand their usage and mechanisms of action. The primary author extended his ‘SCC’ classification series to wound dressings wherein one can categorize them into 3 type’s namely simple, complex, and complicated wound dressings. This article aims to discuss this new classification of wound dressings. Keywords: Wounds, Diabetic Foot, Dressings, Types, Healing AFFILIATIONS Consultant and Head, Amit Jain’s Diabetic Foot and Wound Research Unit, Amit Jain’s Institute of Diabetic Foot and Wound Care, Brindhavvan Areion Hospital, Bengaluru, India. CORRESPONDING AUTHOR Amit Kumar C Jain Open Access
  • 2. Article Title: A New Classification for Wound Dressings EUROPEAN JOURNAL OF CARDIOVASCULAR MEDICINE Volume:13 Issue:4 47 The author proposes a new, easy to remember descriptive classification for wound dressings/products which is an expansion and extension of his ‘SCC’ classification in diabetic foot that was used for ulcers, footwears, offloading, deformities, etc [11, 12, 13]. Based on distinct factors like ease of application, cost of dressing, mechanism of action and its understanding, etc, the author divided the wound dressings into 3 distinct classes namely Class 1, Class 2, and Class 3 wound dressings (Figure 1). Figure 1 showing the new Amit Jain’s Classification for Wound Dressings The Class 1 dressings are simple dressings and they include sterile gauge dressings, hydrogels, hydrocolloids, foams (Figure 2), polysaccharides like alginates, chitosan, etc. Most of these dressings are nowadays affordable and they aim at providing moist environment for effective wound healing. Figure 2 showing foam dressing. This is Amit Jain’s Type 1 wound dressing
  • 3. Article Title: A New Classification for Wound Dressings EUROPEAN JOURNAL OF CARDIOVASCULAR MEDICINE Volume:13 Issue:4 48 The Class 2 dressings are complex dressings and they include collagen-based dressing, Technology Lipido Colloid (TLC), Growth factors, etc. The TLC dressings are newer dressings that comprises of matrix containing hydrocolloid and lipophilic substances and it consists of neutral TLC, Silver combines TLC or with a protease inhibitor (TLC- NOSF) [14, 15]. Many of the complex dressings are costly. The Class 3 dressings are complicated dressings and the best example in this class is the Skin Substitutes. The skin substitutes are either acellular, cellular or dermo-epidermal types [16]. These are currently very expensive. Just like other SCC classification in diabetic foot, this wound dressing classification can also have a triangle (Figure 3). Figure 3 showing the Amit Jain’s triangle of wound dressings One needs to be aware that although we mentioned some of the commonly available dressing used in practice, there are more than 500 dressing available with each having different composition and properties [17]. In centres like ours, which is an expert diabetic foot and wound care centre, on an average in a year, around 5 to 10 types of dressings are usually available in the pharmacy. This means out of 500 available dressing in the industry, only 1-2% (max 10x100/500 =2%) are used in clinical practice. Many times, the dressings are available or used in combination in clinical practice. No single dressing today can be suitable for all the types of wounds [8]. Further, one needs to understand that many dressings, especially the newer modern dressings lack evidences with many being poorly designed studies, which in many are industry funded or they use saline gauge dressing as control [16]. CONCLUSION Wound dressings are essential in clinical management to achieve appropriate healing. There is no one ideal dressing that fulfils all the criteria’s or is universally applicable. Hence, one needs to have a flexibility in using wound dressing depending upon the type of wound, location, and patients’ affordability. The new Amit Jain’s classification for wound dressing, based on SCC classification system, is an easy to remember descriptive classification and it can serve as a good teaching tool especially its triangle, that provides the available options of dressings. REFERENCES 1. Velnar T, Bailey T, Smrkolj V. The wound healing process: an overview of the cellular and molecular mechanisms. The Journal of International Medical Research 2009;37:1528-1542. 2. Gushiken LFS, Beserra FP, Bastos JK, Jackson CJ, Pellizzon CH. Cutaneous wound healing: An update from physiopathology to current therapies. Life 2021:11:665. 3. Raziyeva K, Kim Y, Zharkinbekov Z, Kassymbek K, Jimi S, Saparov A. Immunology of Acute and Chronic Wound Healing. Biomolecules 2021;11(5):700.
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