Presentation for different modern wound dressings and their optimal use

1. Recent Advances In
Wound Dressings
Prof. Ayman Samir

2. Introduction
• Tried and True treatments
• Updated and improved variations of previous
treatments
• Entirely new fields of study

3. SIMPLE WOUND those wounds which are
readily managed by local wound care /contraction,
direct closure, skin grafting, local tissure rearrangment.
COMPLEX WOUND these are large wounds
requiring tissue distant from wound site i.e. regional,
distal transposition or microvascular composite tissue
transfer
PROBLEM WOUND Those wounds which fails
to achieve closure with the above methods or recurres
due to local or systemic causes.

4. Location, size,
depth, exposed
structures, level of
contamination,
necrosis, level of
exudation,
granulation,

5. 1.Sloughy wound 2.Necrotic wound
• Dead cells accumulated in exudate
Aim:
to liquefy slough and aid its removal
•Aims:
• to debride and remove eschar

6. 3. Infected wound
Aims: support granulation,
protect new tissue, keep moist
4.Granulating
wound
•Aims: reduce exudate,
odour and promote
healing

7. VisitrakGrid Visitrak Grid

8. Standardized serial digital photography

9. Portable Digitizer for Wound Monitoring

10. Full blood count,
serum albumen,
blood glucose
level and HbA1c,
CRP and ESR,
ABPI,

11. Transcutaneous
oxygen pressure (tcPO2)

12. PROBLEM
WOUND
Bacterial
Infection
Ischemia
Age

13. Accelerated senescence, diminished
production of growth factors, collagen,
matrix, decreased ability to survive
hypoxic stress,
Aging is irreversible: optimization of the systemic
parameters & supplementation is the solution
AGE

15. Offloading: Reduction of
pressure reduces
ischemia.
ISCHEMIA

17. Bacterial inoculum & virality, presence
of foreign bodies, determines the
severity of the wound
Bacteria: Set up free radicles
environment, secrets toxins &
proteases----bystander damage
BACTERIA

18. Indications for antibiotics: Venous
stasis ulcers, lymphangitis, cellulitis,
critical colonization of the wound,
infection (straw color oozing, pain),
BACTERIA
Never forget to use topical antibiotics
‘cuase peri-wound fibrosis restricts
the the delivery of systemic
antibiotics

19. Management (debridement)….?

20. Debridement : without debridement wound is
exposed to cytotoxic stressors & competes with the
bacteria for scarce oxygen & nutrition resources,
debridement reduces the bioburden and help
ensure healing

21. Post-debridement

24. Autolytic debridement: through
the action of the leukocytes i.e.
hydrocollides

25. JETFORCE
•Comprehensive innovation for cleansing and
Debridement
• Compressed oxygen combined with a minimal
amount of saline solution
•fast and virtually painless debridement compared
to
other mechanical debridement methods.

26. Pressurized water jet
machamical debrider
(VersaJet)

31. Advances in wound healing
 Silver
 Negative Pressure Therapy
 Advanced Dressings
 Skin Substitutes
 Growth Factors and Biologic wound products
 Hyperbaric Oxygen Therapy

32. NEGATIVE PRESSURE WOUND THERAPY
Tremendous adjuvent for wound closure
Mechanism: relieves
edema, removes
deletrious enzymes,
exudates, bacterial load,
cyclical compression &
relaxation stimulates
mechanotransductive
pathway of growth
factors.
Precautions: the
sponge should not be
placed on normal skin,
use of optimal negative
pressure of 125mmHg

33. Indications: lymphatic leak,
venous stasis ulcers, diabetic
wounds, sternal wounds,
orthopedic wounds,
abdominal wounds
Contraindications: malignancy, ischemic wounds,
inadequately debrided & badly infected wounds,
exposed vessels, patients on anticoagulants

38. Hyperbaric oxygen therapy
100% oxygen at 2-3 ATA raises
the dissolved oxygen level from
0.3% to 7% in plasma which
increases 4-5 times oxygen
delivery to the wound

41. DRESSINGS
Goals: to clean the wound, creat moist healing
environment to facilitate cell migration & prevent
dessication
Paradigm shift: from moist to dry dressing to
moist dressing.

42. Hydrogel/films/composite dressings: ;used for
light exudating wounds
Hydrocollides are used for moderate quantities of
exudation.
Alginates/foams/NPWT: usefull for heavy
exudation.
CHOICE OF DRESSING IS BASED
ON QUANTITY OF EXUDATE

43. Recent Dressings
 Antimicrobial
 Hydrocolloids
 Alginates
 Foams
 Hydrogels
 Hydrofibers

44. Pyodine iodine & Chlorhexadine
damages the normal cells,
fibroblasts and growth factors as
well, so newer antimicrobial
agents containing dressings are
favoured i.e. silver and
cadexomer iodine

46. • Highly reactive charged silver ion (Ag+) negatively
charged particles such as proteins, DNA, RNA, and
chloride ions.
• Bactericidal material-kills on contact
• Inhibiting the respiratory chain at the cytochrome level
• Interfering with electron transport
• Denaturing nucleic acids
• Inhibiting DNA replication
• Altering cell membrane permeability

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zinc activity
• Inhibitory effect on release of proinflammatory
cytokines and tumour necrosis factor–
alpha

48. Ideal Delivery System
• Adequate concentration of silver
• Long enough residual activity.

49. • Gauze
• Hydrocolloids,
• Alginates
• Foams
• Creams
• Gels but each of them differ in the way in which
silver ions are released

50. Antimicrobial dressings
Most benefical agent is Silver, broad spectrum
antimicrobial agent including VRE, MRSA.

51. Cadexomer iodine
Slow release iodine for cosistent
bactericidal levels without the
wound cell damaging effects seen
with pyodine-iodine products

52. Semiocclusive Dressings
Unpermeable to fluids to keep moist
environment, permit of gas molecules.
To cover freshly closed incisions, skin
graft donor site. Should not be used for
contaminated wounds .

53. Hydrocolloids

54. Hydrocolloids
• Gelatin, pectin and or carboxymethylcellulose
• Serve as occlusive or semi-occlusive dressings
• Impermeable to water, bacteria and other
contaminants but permeable to water vapour
• Absorb wound exudates to form a hydrophilic gel.
• Most important advantage is their long wear time,
which decreases the cost, inconvenience and local
trauma associated with dressing changes.

55. • Promote fibrinolysis
• Angiogenesis
• Wound healing
• Without causing softening and breaking down of
tissue.

57. • Not indicated
• Arterial/neuropathic ulcers
• Infected or heavily exuding wounds because of risk of
periwound maceration.
• Malodorous exudates, which can be mistaken for
infection

58. Foam

59. Foam
• Highly absorbent polyurethane dressings, available as
pads, sheets and cavity dressings
• Moist environment and provide thermal insulation to
the wound
• Nonadherent, easy to apply and remove and are
meant for highly exuding wounds
• Layered in combination with other materials with
overlying compression bandages.

60. Alginates

61. Alginates useful in
wounds with significant
exudated fluids, they can
absorb fluids 20 times their
dry weight, not to be used on
nonexudative wounds as they
will dry up the wound. If used
for dry wound they should be
hydrated with saline prior to
application

62. Alginates
• Soft, non-woven fibres, which contain calcium and
sodium salts of alginic acid.
• Ion exchange reaction occurs between calcium in the
alginate and sodium in the wound fluid producing
soluble calcium–sodium alginate -- a gelatinous
mass maintains moist environment and facilitates
autolytic debridement

63. Collagen

64. • Important constituent of connective tissue
• Type I is mostly seen in healing tissues
• Chronic wounds -laying down a matrix which favours
deposition of new tissue and attracts cells necessary
for healing
• Chemotactic for fibroblasts and macrophages and
also provide a temporary scaffold to allow in growth
of tissue

65. • Human , porcine or bovine origin and are available as
particle or sheet form
• Absorb wound exudates to form a soft
biodegradable gel over the wound surface, which
maintains wound moisture

66. Hydrogels

67. Hydrogel dressing:
Autolytic debridement by rehydrating
the wound and facilitat healing. Used
in wound with small amount of
eschar and predisposed to
dessication, infected wounds, require
secondary dressing on top of it.

68. Hydrogel
• Polymers, glycerine or water-based gels, impregnated
gauzes or sheet dressings
• High water content does not allow them to absorb
large amount of exudates heavy exuding wounds.
• Gentle yet effective debriding and desloughing
action
• rehydrating necrotic tissue
• removing without damaging healthy tissue

69. Hydrofibers

70. Hydrofibers
• Sterile sodium carboxymethyl cellulose fibres
• Conform to the wound surface, highly absorbent
and interact with wound exudates to form a gel.
• Maintain a moist environment and allow autolytic
debridement

71. Uses
• Pressure ulcers
• Lower limb ulcers
• Surgical wounds

72. Skin Substitutes
• Biosynthetic skin substitutes and cultured autologous
engineered skin, are available to provide temporary or
permanent coverage, with the advantages of
availability in large quantities and negligible risk of
infection or immunologic issues.

73. Biobrane
• Temporary dressing composed of knitted nylon
mesh bonded to a thin silicone membrane and coated
with porcine polypeptides
• Clean superficial and middermal
depth burns or as coverage for
donor sites in split-thickness
skin grafting

74. Transcyte
•Biosynthetic dressing of a semi-
permeable silicone membrane on a
nylon mesh coated with porcine
collagen and newborn human
fibroblast cells
•Superficial burns that do not require
skin grafting, or as a temporary cover
for excised burns prior to grafting

75. Dermagraft
• Dermagraft contains neonatal fibroblasts on a
bioabsorbable polyglactin mesh
• Dermal collagen, glycosaminoglycans, growth factors,
and fibronectin to support wound healing
• Temporary or permanent cover used for excised burn
wounds as well as venous ulcers and pressure ulcers

76. Apligraf
• Apligraf is composed of an epidermal layer of
allogeneic neonatal keratinocytes and fibroblasts
from neonatal foreskin on bilayered type I bovine
collagen
• adjunct covering to autograft, providing accelerated
healing times

77. Integra
• Semibiologic bilayered dressing
composed of a matrix of type I bovine collagen,
chondroitin-6-sulfate, a glycosaminoglycan from
shark cartilage, under a temporary silicone epidermal
sheet
• Pore size (70–200 μm) is designed to allow migration
of the patient’s own endothelial cells and fibroblasts.
• Silicone sheet removed & a thin autograft is grafted
onto the neodermis to complete the wound coverage.

78. • Indicated for excised
deep partial- and full-
thickness burn wounds
• Complex traumatic soft
tissue reconstruction over
exposed tendons, joints,
and bone, as well as
wounds from vascular
and pressure ulcers

79. Growth Factors and Biologic
Wound Products
• Biologic wound products aims to accelerate healing
by augmenting or modulating inflammatory
mediators
• Prostaglandin E1
• Cytokines-Chemokines , lymphokines, monokines,
interleukins, colony-stimulating factors, and
interferons.
• Becaplermin(Regranex)rhPDGF & EGF-FDA-
approved products in the growth factor family

80. Top Closure System
• An innovative new technology created for skin
stretching and secure wound closure
• Post traumatic
• Surgical
• Acute and chronic skin wounds, which do not
respond to conventional wound care.

82. 6
Notable emerging
wound care
management technologies
Wound Care Management–Innovation Capability
Wound closure devices
providing non-invasive
wound healing
Pressure relief devices
that enable tissue
perfusion
Usage of silver and
combination dressings
Nanotechnology-enabled
drug delivery to wounds
Therapeutic
ultrasound
Recombinant growth
factors and tissue
scaffolds for wound
closure
Many of technological advancements in wound care management sector are concentrated across innovations in
advanced wound management, wound closure devices, and pressure-relief devices. Advances in wound
management products are noted to be an expanding sector with opportunities designed for treatment of both acute
and chronic wounds.
Other Emerging Wound Management Technologies
Source : Frost & Sullivan
D4BE-TI

83. 7
Cost Effective Wound
Management
Wound Care Drugs and
Biologics
Increase of Home and
Extended-care Wound
Treatments
Source : Frost & Sullivan
Wound Management Technologies–Noteworthy Trends
D4BE-TI
These days advanced biological materials are available in the form of enzyme
preparations and mechanical debridement tissue scaffolds that help remove dead
cells. Potential benefits to patients by utilizing such advanced biological materials
includes fewer reapplication of dressings, lesser discomfort and pain, much faster
healing, and reduced risk of complications that includes infection and amputations.
This enables cost-effective treatment to be achieved.
With product innovation spurs in drug delivery approaches for wound care
management, more and more patients will leave the hospital sooner without post-
surgical wounds and traumatic wounds that are not healed. This shift will ensure an
increase of at-home and extended care wound healing initiatives to be provided
outside of a sterile environment.
Wound care companies that are most successful in advanced wound management
sector are those that find ways to innovate around wound care and healing. These
firms are engaged towards development of products that enable rapid wound healing
within home settings and at the same time decrease the risk of hospital-acquired
infections significantly.

85. 11
D4BE-TI
Sector Level of Attractiveness Probability of Success
Therapeutic ultrasound-
enhanced wound
management
• The demand for wound care platforms that
provide a greater therapeutic versatility in
treating wounds serves as the key factor for
this technology's higher level of attractiveness.
• Ultrasound technology uniquely utilizes surface acoustic
waves that are implemented within a thin transducer to
allow for effective ultrasound therapy to be delivered
around the application site (wounds). Low-frequency
sonophoresis has been well documented to enhance
the permeability of skin to drugs and patches.
• The potential behind surface acoustic waves technology
is huge in terms of facilitating the delivery of oxygenated
saline at an appropriate depth in wound bed and
physiologically effective in promoting angiogenesis and
collagen formation.
Nanocomposites and
silver-based advanced
wound dressings
• Wound care standards have constantly evolved
from surgical drapes and conventional wound
dressings to present-day advances in terms of
nanocomposites and silver-based dressings.
• Wound dressing platforms have evolved from
hydrocolloid platform to more advanced
polymer and biomaterials-based dressings that
impart antimicrobial or analgesic properties to
wound area. Silver and nanocomposites-based
dressings have been integrated as part of
modern wound management due to efficient
control of bacterial load and local infection
combating properties.
• The rising number in elderly patient population and their
impact on healthcare expenditure suggest a higher
adoption potential of nanocomposites and silver-based
wound dressings.
• The strategy going forward would be identification and
delivery of best available wound care while at the same
time limiting complications and associated treatment
costs.
Potential Technologies—Opportunity Analysis
Source: Frost & Sullivan.
Misonix Sonic One ultrasonic wound care system
Picture credits: Misonix Inc. (Farmingdale, New York)
Antimicrobial silver-based wound dressing
Picture credits: B. Braun AG (Germany)

86. Take Home Message
• Recent trends indicate that materials used to maximize wound
healing in the future will utilize a wide range of nanotechnologies
as smart dressings that respond to the wound environment, with
dressings capable of releasing biomolecules or producing a signal
currently being developed

87. Take Home Message
• Another expanding field is the investigation of natural agents
such as plant- and animal-derived polymers for use in scaffolds
and gels as well as a return to natural antimicrobial agents that
were known to ancient cultures such as silver, honey and iodine.

88. Take Home Message
Ultimately, clinicians will be able to select from a suite of
sophisticated, smart dressings in order to best maximize outcomes
for each unique wound, and, subsequently, the patient.