If regeneration is a direct consequence of the loss of tissue and initiated by an internal factor, the cicatrization of a wound protected against all external irritation must take place normally. What treatment devices are we using in practice?

1. COMPARATIVE TREATMENTS CICATRIZATION OF DIABETIC
FOOT ULCERS
If regeneration is a direct consequence of the loss of tissue and
initiated by an internal factor, the cicatrization of a wound protected
against all external irritation must take place normally.
What treatment devices are we using in practice?
Compiled and reviewed by:
I. Dr Mahfuz Ashraf, Member, World Health Organisation (WHO) Collaborative eHealth Centre, School of
Public Health & Community Medicine, UNSW Sydney. (md.ashraf@unsw.edu.au)
II. Atharva Gajendragadkar, Graduate Student, Advanced Medical Engineering, Monash University.
III. Numa Sarkar, Graduate Student, Faculty of Science, School of Optometry & Vision Science, UNSW
Sydney

2. Composition or Base and Presentation: Thin
film or plastic film of adhesive polyurethane.
Dressings, generally transparent, semioclusive
(permeable to gases and vapors but not to
liquids). They create a moist environment in
the wound that stimulates tissue regeneration
and accelerates healing. They are flexible,
washable and impervious to bacteria, but DO
NOT ABSORB THE EXUDED. Because of their
flexibility, they adapt well to the most difficult
edges, allowing the patient to be better
mobilized. They can be cut to the desired size
without reducing their effectiveness.
Indications: Wounds or superficial ulcers in the
epithelization phase. Protection of areas at risk
of developing ulcers
POLYURETHANS

3. Composition or Basis: Fundamentally water plus
microcrystalline systems of polysaccharides and highly
absorbent synthetic polymers. Also sodium
carboxymethyl cellulose and alginates
Hydrogels are designed for the debridement of necrotic
tissue and slough, thereby improving the conditions for
effective healing of wounds. It is also intended for
wounds in the granulation and epithelization phase.
Indications: Lesions of any etiology and pressure or
vascular ulcers at any stage or stage. As a self-polluting
debridement. It favors the granulation and
epithelization of wounds. Exudate control (those
containing alginates)
In liquid version or in granules for filling cavitated ulcers
at any stage.
HIDROGEL APOSITES

4. The hydrocolloids exert an absorption and retention of the
exudate, controlling the amount thereof between the
dressing and the lesion. The hydrocolloid substances
together with the exudate of the lesion create a gel that
maintains a moist environment that favors healing and
protects against infection.
Indications:
Pressure or vascular ulcers in phases or stages I - II or III
without signs of infection. They are also used as autolytic
debridents and in general for granulation and
epithelization of wounds
The extrafine or transparent ones allow the visual control
of the healing, for superficial ulcers of any etiology with
mild exudate, as protection of zones of risk of
development of ulcers, on clean sutured surgical wounds
or in dermabrasion.
HYDROCOLOID APOSITES

5. The hydrophobic nature of the silicone cover and its softness
provides it with selective microadherence, this soft adhesion to
dry skin prevents it from sticking to the wound, that is, it
adheres gently to the skin around the wound (which is dry) but
not to the humid bed of the same, given its hydrophobic
nature.
The silicone cover adheres gently to the skin surrounding the
wound. The cover extends across the surface of the skin
creating a very effective contact area. This feature is called
microadherence.
They reduce the pain. It reduces the risk of maceration. It
leaves no residue. It prevents the detachment of the epidermal
cells.
The silicone cover does not lose its adhesive properties after
the dressing change. This happens because the dressings do not
tear off the epidermal cells, thus preventing them from sticking
to the adhesive, thus reducing their effectiveness. The same
sheet can remain in the wound for 5 days.
Indications: Any wound in the granulation phase. Painful ulcers
Fragile skin, Fixation of grafts.
SILICONE APOSITES

6. The alginates absorb exudate or serous fluid and react
chemically with it to form a hydrophilic gel, with rheological
and ion exchange properties that depend on a number of
factors. These include the relative percentage of mannuronic
and guluronic acid residues and the method of sterilization of
the final dressing.
Alginate dressings vary in their absorption capacity, but
generally absorb 15 to 20 times their own weight of exudate
through three systems of action: passive diffusion, capillary
action and hydrophilic properties.
Indicated in moderate-high exudation wounds, some authors
also report their usefulness in infected wounds and wounds
with bad odor. Due to its high absorption capacity some
hydrocolloid dressings and some hydrogel in amorphous
structure incorporate this product to complement its
properties.
Indications: Wounds and pressure ulcers and vascular exudative
and even infected. Debriding ability
ALGINATE APOSITES ASSOCIATED WITH HYDROCOLLOIDS

7. Silver on carbon mesh, Hydrofiber plus silver,
Polyethylene mesh covered with nanocrystalline silver,
Silver on hydrocolloid or hydropolymer base,
Hydrocellular dressing with alginate and silver ions,
Lipido-colloidal dressing plus silver sulfadiazine,
Polyamide weft impregnated with fatty acids and silver
metallic The cure mask in wet environment of one of
them is provided by the secondary dressing used.
Although with different ways of acting all have in
common their antimicrobial or bactericidal effect on
wounds. They can be used against wounds of torpid
evolution, with suspicion of infection or with evidence of
it. Its effectiveness to prepare the ulceral bed, control
the exudate and the bad smell of the lesion is also
demonstrated. According to his presentation some will
require a secondary dressing and others will not
Indications: Prophylaxis and treatment of infection in
wounds.
TOPICAL AGENTS WITH SILVER AND ACTIVATED CARBON

8. Iodinated cadexomer releases iodine in a sustained manner for
the control and elimination of microorganisms present in the
bed of the lesion.
Indications: For the treatment of wounds with slough and / or
necrotic tissue with signs of infection (the infection should be
treated and controlled based on the local protocol of local
infection approach).
It is available in powder, ointment and foil format.
Main features
Absorbs exudate in a controlled manner, favoring the generation
of a moist environment in the lesion that favors the healing
process.
It cleanses the lesion of slough and / or necrotic tissue,
performing an effective debridement of it.
Absorbs exudate and devitalized tissue.
High absorption capacity
Broad spectrum antibacterial.
Sustained release in the time of iodine.
Maintains bactericidal concentrations on the surface of the
wound. Accelerates healing Easy to apply and remove without
damaging the newly formed tissue. Needs secondary dressing
IODATE CADEXOMER

9. Acts as a driver in tissue repair processes.
Provides structural support. It controls the differentiation,
migration and synthesis of numerous cellular proteins.
It favors the formation of fibroblasts, granulation tissue and
native collagen. It facilitates hemostasis and stimulates
angiogenesis,
According to the presentation:
- It forms a gel layer in the wound bed that is slowly reabsorbed
by the underlying tissue and allows to maintain a constant humid
environment on the wound bed.
-Once exposed to exudate or blood, the formulation of native
collagen and calcium alginate is transformed into a wet gel sheet
that covers the surface of the wound intimately and creates
optimal conditions for healing.
Indications:
Stimulator of the physiological healing process. Hemostatic
properties Suitable for the treatment of all wounds that heal by
second intention, which are free of necrotic tissues such as: •
diabetic ulcers • venous ulcers • pressure ulcers • ulcers caused
by arterial or venous circulatory disorders • traumatic and
surgical wounds
COLLAGEN APOSITES

10. IMPREGNATED APOSITES WITH DACC
(Dialquilcarbamoyl Chloride)
Presentation: The surface of the dressing is impregnated
with DACC (dialkylcarbamoyl chloride), a derivative of
highly hydrophobic fatty acids. In humid environments, the
bacteria and fungi present in the wound are attracted by
the surface of the dressing following the natural law of the
hydrophobic interaction.
They are captured irreversibly by fibers impregnated with
DACC, unable to return to the wound bed. Adhered
pathogens are eliminated with each change of dressing,
helping to clean contaminated, colonized and infected
wounds, by reducing the total bacterial load.
Indications: When the bacterial load deteriorates or
prevents the healing process in wounds of any etiology: •
chronic wounds (such as venous, arterial, diabetic or
pressure ulcers) • dehiscence of postsurgical wounds •
traumatic wounds • after excision of fistulas and abscesses
• fungal skin infections

11. Composition or Base and Presentation:
Attiva® Plus is a patented dressing ( Microbe-
binding hydrophobic dressing ) made from
plant extracts and a sterile medical device for
topical treatments, consisting of an open-
weave hydrophilic cotton gauze, uniformly
impregnated with polyethylene-glycol based
ointment containing plant extracts. It’s a
ready-to-use disposable device, which does
not adhere to skin lesions and supports its free
drainage, allowing the passage of exudate
toward a secondary adsorbent dressing.
Indications: For topical use, indicated for the
treatment of alterations of the dermo-
epidermal tissue by allowing an acceleration of
the natural healing process.
ATTIVA PLUS

12. COMPARATIVE TREATMENTS CICATRIZATION OF DIABETIC FOOT ULCERS
Low
Medium
High
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ATTIVA PLUS
CHARACTERISTICS / PRODUCT
HIDROGEL
APOSITES
ALGINATE /
HYDROCOLOID
APOSITES
HYDROCOLOID
APOSITES
POLYURETHANE
APOSITES
SILICONE
APOSITES
IMPREGNATED
APOSITES WITH DACC
(Dialquilcarbamoyl
Chloride)
IODATE
CADEXOMER
COLLAGEN
APOSITES
TOPICAL AGENTS
WITH SILVER
AND ACTIVATED
CARBON
CLINICAL EVIDENCE ** ** ** * * * * ** ** *****
EFFECTIVENESS IN ALL DEGREES ** * ** * * * * ** * ***
ACCELERATION OF TISSUE
REGENERATION PROCESSES ** ** * ** ** * * ** ** **
NATURAL AND SECURE ACTIVE
PRINCIPLES
PROMOTES THE MIGRATION OF
THE CELLS RESPONSIBLE FOR THE
TISSUE TRAINING
* * * ** * * * ** * ***
CREATE A BARRIER EFFECT THAT
ALLOWS THE RECOVERY OF
OPTIMAL CONDITIONS FOR THE
HEALING PROCESS
** ** * ** ** * * ** ** ***
REDUCTION AND / OR
ELIMINATION OF FACTORS THAT
PREVENT TISSUE REPAIR
PROCESSES
* ** * ** ** ** * * ** ***
PROMOTES THE CREATION OF A
CLEAN MICROENTERNO IN THE
WOUND
** ** ** ** ** ** *** * *** ***
ISOLATES OF EXTERNAL AGENTS,
SUCH AS BACTERIA AND HEAT * * * ** ** ** *** * *** ***
ACTIVITY OF ELIMINATION OF
LOCAL BARRIERS IN THE PROCESS
OF HEALING
** ** * * ** ** ** * ** ***
ACCELERATING THE HEALING
PROCESS ** ** * ** ** * * ** ** ***
DOES NOT ADHERE TO SKIN
INJURIES ** ** ** ** *** * * ** ** ***
SUPPORT A FREE DRAINAGE ** *** ** * ** * * * ** ***
ALLOWS THE PASSAGE OF EXUDED
TOWARDS A SECONDARY
ADSORBIENT APRESS
* *** * * * ** * * ** ***
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