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Mepilex ag by Dr. Sunil Keswani, National Burns Centre, Airoli
- 1. The use of Mepilex-Ag in BURNS Dr Sunil Keswani National Burns Centre, Airoli, Navi Mumbai. Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com
- 2. The problem • All wounds are contaminated. • One reason for impaired healing • Infected wounds are more painful* *Delphi round 1 Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com Wound Care Division
- 3. ”Patients with a wound infection generally suffer from more pain than those with non-infected wounds.” 85% Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com Wound Care Division
- 4. Identifying the problem Subtle signs of infection some odour, pain or exudate Healing progressing normally Increasing signs - increasing odour pain and/ or exudate Healing no longer progressing normally Overt signs of local infection; pus, swelling, erythema odour, pain, local warmth Surrounding tissue involvement Overt signs of local and systemic infection; pyrexia, raised blood cell count Ref: EWMA position document : Management of wound infection. London: MEP Ltd,2006 Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com
- 5. Managing the problem Subtle signs of infection some odour, pain or exudate Healing progressing normally Standard care review and assess Increasing signs - increasing odour pain and/ or exudate Healing no longer progressing normally Start local antimicrobial for 14 days then reassess Overt signs of local infection; pus, swelling, erythema odour, pain, local warmth Surrounding tissue involvement Overt signs of local and systemic infection; pyrexia, raised blood cell count Systemic antibiotics and possibly local AM Systemic antibiotics and possibly local AM Ref: EWMA position document : Management of wound infection. London: MEP Ltd,2006 Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com Wound Care Division
- 6. When to use anti-microbial dressings? Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com Wound Care Division
- 7. Why would you use a dressing with Safetac®? • Safetac prevents pain and trauma - hurts less at dressing changes and during wear - prevents maceration • Absorption and retention • With or without border • Reliable antimicrobial action - onset within 30 minutes - effect for 7 days - broad effect; MRSA, VRE 85% Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com
- 8. Safetac technology – how it works Safetac adhesive technology Traditional adhesives The Safetac layer is extremely soft and moulds to the uneven surface of the skin to create a large effective contact area. On dressing removal, Safetac distributes the peel force over a large area of the skin under the dressing. The benefit of this is that skin stripping is minimized, the skin barrier preserved and pain minimized at removal. Traditional adhesives are relatively inflexible and only make contact with few points on the top of the skin. Traditional adhesives therefore require an aggressive adhesion in order to stay in place. On removal the skin cells at the contact points will be stripped and the skin barrier compromised. This will cause pain. Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com
- 9. Non-adherent to moist wound bed • Less painful dressing removal • Minimised risk of wound disturbance • Easier dressing changes for clinicians Leaves no residues • Easier to clean the wound and surrounding skin. • No residues left in the wound Will adhere gently to dry skin • Protects the surrounding skin from maceration • No skin prep needed to protect the skin Non-sensitizing • No skin allergies • Potentially longer wear time No stripping of epidermal cells • Less painful dressing removal • Less damage to surrounding skin Can be repositioned • Easy to dress wounds, saves time • Less waste, cost effective Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com
- 10. Flexible, effective and less painful Mepilex® Ag 4 sizes for chronic and acute wounds 2 sizes for heel wounds Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com
- 11. Safetac® layer Less pain and trauma Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com
- 12. Unique patented silver foam absorption and antimicrobial action Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com
- 13. Mepilex Ag Exudate Safetac® layer Burn / Wound bed Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com
- 14. Areas of use Low to moderate exuding wounds where an antimicrobial effect is wanted. Leg and foot ulcers, pressure ulcers, partial thickness burns - also for prevention. Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com
- 15. Wound examples Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com
- 16. How to use Debride and cleanse the wound according to local protocol Choose a dressing where the wound pad exceeds the wound margins with at least 2 cm Change according to wound status; exudation, level of contamination etc. Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com
- 17. What Mepilex® Ag offers Less pain for the patient will increase quality of life and most probably also be beneficial for the wound healing Soft and conformable for highest comfort and full range of motion Substantial and significant benefits in cost effectiveness in the treatment of partial thickness burns* *Puma 415 Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com
- 18. Burn Case Studies Burn Case Study 1 CASE 1 – Arm Burn 36 HRS POST-BURN Previously treated with Silver Sulfadiazine Application of Mepilex Ag Antimicrobial soft silicone foam dressing Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com
- 19. Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com
- 20. Case Study 1 – Day 1 CASE 1 – Arm Burn 36 HRS POST-BURN Previously treated with Silver Sulfadiazine Application of Mepilex Ag Antimicrobial soft silicone foam dressing
- 21. Case Study 1 – Day 1 Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com
- 22. Case Study 1 – Day 1 Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com
- 23. Case Study 1 - Day 5 Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com
- 24. Case Study 1 - Day 5 Range of Motion Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com
- 25. No staining & no tissue damage Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com Case Study 1 - Day 5
- 26. Case Study 1 - Day 5 Application of the dressings Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com
- 27. Secondary dressings Case Study 1 - Day 5 Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com
- 28. Removal of Mepilex Ag Case Study 1 - Day 9 Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com
- 29. Removal of Mepilex Ag Case Study 1 - Day 9 Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com
- 30. Removal of Mepilex Ag Case Study 1 - Day 9 Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com
- 31. Removal of Mepilex Ag Case Study 1 - Day 9 Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com
- 32. Case Study 1 - Conclusion Powerful Antimicrobial Action • Absence of Wound Bed Staining • Reduces bacterial colonization • Begins to inactivate common wound pathogens within 30 min. • Kills a broad range of pathogens, including MRSA • Sustained antimicrobial effect for up to 7 days Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com
- 33. Case Study 2 – Hand burn Burn Case Study 2
- 34. Case Study 2 - Day 1 Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com
- 35. Case Study 2 - Day 1 Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com
- 36. Case Study 2 - Day 1 Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com
- 37. Case Study 2 - Day 6 Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com
- 38. Case Study 2 - Day 6 Improved comfort for the patient • Maintains it’s flexible nature • Does not inhibit range of motion exercising • Conforms easily to body contours Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com
- 39. Case Study 3 Burn Case Study 3 Hot Soup Burn Initial Consult Post Burn Day 3 Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com
- 40. Case Study 3 – Hot soup burn Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com
- 41. Case Study 3 – Hot soup burn Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com
- 42. Case Study 3 – Day 9 Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com
- 43. Case Study 3 – Day 9 Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com
- 44. Case Study 3 – Day 9 Minimizes trauma and pain at dressing application and removal • Gentle Removal • Eliminates stripping of epidermal cells Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com
- 45. ® Safetac technology and silver a perfect combination!
Editor's Notes
- New unique product- with important benefits – Safetac benefits, absorption, retention and a less painful way of target bacteria. What do customer use today? What could be netter with the product used today? Do they use Mx Ag?
- The contamination does usually not affect the wound healing •All wounds are contaminated. •One reason for impaired healing may be increasing number of bacteria, critical colonization • Infected wounds are more painful*
- Delphi panel results: 85% of the Delphi panel members agreed that patients with infected chronic wounds suffer more wound pain than those with other chronic wounds. A Delphi evaluation has been conducted to to investigate if there is a relationship in the chronic wound between pain and and infection and choice of dressings. The Delphi Method is based on a structured process for collecting and distilling knowledge from a group of experts by means of a series of questionnaires interspersed with controlled opinion feedback. The results from this Delphi panel were clear: infected wounds are more painful than other wounds and dressings have a clear role to play inmanaging this pain. References: 1. Data on file. 2. White R. A Multinational survey of the assessment of pain when removing dressings. Wounds UK 2008; Vol 4, No 1. 3. White R. Evidence for atraumatic soft silicone wound dressing use. Wounds UK 2005;1(3):104-9. 4. Dykes PJ et al. Effect of adhesive dressings on the stratum corneum of the skin. Journal of Wound Care 2001;10(2):7-10. 5. Meaume S et al. A study to compare a new self adherent soft silicone dressing with a self adherent polymer dressing in stage II pressure ulcers. Ostomy Wound Management 2003;49(9):44ﾐ51. 6. Wiberg AM et al. Preventing maceration with a soft silicone dressing: in-vitro evaluations. Poster publication. World Union of Wound Healing Societies congress, Toronto, Canada 2008. 7. Taherinejad and Hamberg. Antimicrobial effect of a silver-containing foam dressing on a broad range of common wound pathogens. Poster publication. World Union Congress, Toronto, Canada 2008. 8. External lab report: NAMSA 09C 29253 01/09C 29253 02. 9. Data on file. 10.Silverstein et al. An open, parallel, randomized, comparative, multi-center investigation in the US evaluating the cost-effectiveness, efficacy, safety and tolerance of Mepilexｨ Ag versus Silvadeneｨ in the treatment of partial thickness burns. Oral Presentation. The JAB Burn and Wound Care Symposium. Maui, Hawaii, USA, Feb 2010. 11. External lab report: NAMSA 06C 21924 01/06C 21923 01. 12. Data on file.
- Ref: EWMA position document : management of wound infection. London: MEP Ltd,2006. Stage 3-4: possibly local antimicrobial treatment if the wound is open and the wound bed needs therapeutic intervention
- Ref: Model modified from Falanga 2003. Suggested treatment: Gray, White et al This model shows when it is appropriate to use an antimicrobial dressing. This is still theory and not scientifically proved. The green area represents an increase in bacterial count and the stages in the wound infection continuum. The ‘Yes’ and ‘No’ on the top states if you should use an antimicrobial dressing. In general, an antimicrobial dressing should not be used in a colonised wound. However, prophylaxis may be considered in vulnerable wound groups such as diabetic foot ulcers, or vulnerable immuno-suppressed patients or if the patient has a recurrent history of infection in this wound. The optimal solution in this state is a dressing with Safetac. Critical colonisation: Suggested treatment – antimicrobial dressings suitable for wet wound. Local infection: Systemic antibiotics – oral + antimicrobial dressings. Spreading infection: Systemic antibiotics – oral if red zone around the wound is static. Intravenous- if red zone is spreading. Consider antimicrobial dressing in diabetic foot ulcers, critically ischemic wounds, burns and the severely immuno-compromised patient.
- Let me show you why I call this an ingenious product: First we have a Safetac layer – And now the million dollar question: WHY IS SAFTEC IMPORTANT….????????????? Wound contact layer so called HSF Acrylic adhesive Polyurethane film Safetac layer
- We have a patented foam with silver on top of the Safetac layer. Polyurethane silver foam It is the same foam as in Mepilex Ag but our R&D group developed it for better spreading of exudate and also for better retention as the foam will be better utilized And why do we want to spread the exudate? For one very simple reason: if the exudate is not spread out and to be absorbed into the foam and up and away from the surface but into the superabosorbent pad and then we would perhaps have had problems with silver release. We really want the moist to solve the silver so that it is released into the wound. It is 1,2 mg silver in the foam as in Mepilex Ag. The silver compound is silver sulphate and the active part of the silver sulphate e.g. silver is 67% of the total and that makes 1,2 mg/cm2 and that’s why it says 1,2mg/cm2 in the IFU and on the packages.
- Mode of action – back up slides for surgeon if needed
- Potential wounds for Mepilex Ag Ag Leg ulcer mixed with signs of high bio burden. Partial thickness burn where some want to prevent infection and use MxAg on the fresh burn.
- May be left in place for 7 days. Note; follow local protocol. When used for prevention for example on burns.
- May be left in place for 7 days. Note; follow local protocol. When used for prevention for example on burns.
- This one of the first burns that was treated with the Mepilex Ag
- The application of Mepilex Ag to the hand. You will see the evolution of finger application after fixation.
- A secondary of roll gauze and a tubular fixation dressing Note: Tubifast can also be used
- The appearance of the secondary dressings and the Mepilex Ag
- The patient exhibiting their range of motion Other products may limit the patient’s range of motion which may affect the desired clinical outcome for the patient.
- And the appearance of the wound. Notice there is no staining to the wound bed. There is also no damage /to the re-epithielization.
- Application of the dressings
- The secondary dressings
- The appearance of the secondary dressings
- The Mepilex Ag
- And his healed burn
- The outer edges are the remnants of deeper 1st degree burns. This is not staining.
- There is no reported staining of the wound bed with Mepilex AG
- Appearance of the left hand after the burn. Grey color is staining from oil explosion
- Here you see the application to the fingers in a more evolved manner. Note the first two digits have stapled edges and the remaining digits the Mepilex Ag were just folded.
- These are the same secondary dressings. You see here the patient has full range of motion.
- Here you see the patient demonstrate his range of motion at day 6
- The Mepilex Ag does not become stiff and rigid
- Healed on the 9:th day.
- As you can see very gentle removal from a 4 day old donor site.