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Choosing the Ideal Dressing
Pornthep Sirimahachaiyakul, M.D.
Division of Plastic Surgery, Department of Surgery,
Faculty of Medicine Vajira Hospital, Navamindradriraj University
• I have no financial or other conflicts of interest to report
Disclosure
• Introduction
•Tips for wound dressing selection
• Ideal wound dressing
•Wound dressing categories and clinical applications
•Conclusion
Outline
Introduction
http://www.medical-supplies-equipment-company.com/homehealth/product/gauze-sponges-woven_537.htm
The Principles of Wound Bed Preparation
T
I
M
E
Schultz GS, et al. Wound bed preparation and a brief history of TIME. Int Wound J 2004;1(1):19-32.
The TIME Concept
Leaper DJ, et al. Extending the TIME concept: what have we learned in the past 10 years? Int Wound J 2012;9(Suppl 2):1-19.
Tips for Wound Dressing Selection
http://operson.en.made-in-china.com/product-group/JqsmprgPTnWY/Wound-dressing-catalog-1.html
Tips for Wound Dressing Selection
1.Etiology
2. Location
3. Size
4. Tissue types
5. Exudate
6. Periwound condition
7. Bacterial burden
8. Support needs
Weir D. Wounds Int 2012;3(4):18-22.
Tips for Wound Dressing Selection
1. Etiology
2.Location
3. Size
4. Tissue types
5. Exudate
6. Periwound condition
7. Bacterial burden
8. Support needs
Weir D. Wounds Int 2012;3(4):18-22.
Tips for Wound Dressing Selection
1. Etiology
2. Location
3.Size
4. Tissue types
5. Exudate
6. Periwound condition
7. Bacterial burden
8. Support needs
Weir D. Wounds Int 2012;3(4):18-22.
Tips for Wound Dressing Selection
1. Etiology
2. Location
3. Size
4.Tissue types
5. Exudate
6. Periwound condition
7. Bacterial burden
8. Support needs
Weir D. Wounds Int 2012;3(4):18-22.
Tips for Wound Dressing Selection
1. Etiology
2. Location
3. Size
4. Tissue types
5. Exudate
6. Periwound condition
7. Bacterial burden
8. Support needs
Weir D. Wounds Int 2012;3(4):18-22.
Tips for Wound Dressing Selection
1. Etiology
2. Location
3. Size
4. Tissue types
5. Exudate
6. Periwoundcondition
7. Bacterial burden
8. Support needs
Weir D. Wounds Int 2012;3(4):18-22.
Tips for Wound Dressing Selection
1. Etiology
2. Location
3. Size
4. Tissue types
5. Exudate
6. Periwound condition
7. Bacterial burden
8. Support needs
Weir D. Wounds Int 2012;3(4):18-22.
Tips for Wound Dressing Selection
1. Etiology
2. Location
3. Size
4. Tissue types
5. Exudate
6. Periwound condition
7. Bacterial burden
8. Support needs
Weir D. Wounds Int 2012;3(4):18-22.
Ideal Wound Dressing
http://www.cccme.org.cn/products/detail-3048804.aspx
Ideal Wound Dressing
•General characteristicsEasy to apply and maintain
Aesthetically pleasing
Cost permissive
Easily stored
Non-allergenic
Broussard KC, et al. Am J Clin Dermatol 2013;14(6):449-59.
•Facilitate healingMaintain moist environment
Minimize trauma or maceration to wound edges
Retention of heat
Facilitates gas exchange
Ideal Wound Dressing (Cont.)
Broussard KC, et al. Am J Clin Dermatol 2013;14(6):449-59.
•Minimize risk of infectionDebride necrotic tissue
Absorb exudate
Minimize external contamination
Ideal Wound Dressing (Cont.)
Broussard KC, et al. Am J Clin Dermatol 2013;14(6):449-59.
Wound Dressing Categories & Clinical Applications
http://taxstudents.co.za/just-anything-deal-cuts/
1. Inert or Passive wound dressings
2. Interactive wound dressings
Wound Dressing Categories
Broussard KC, et al. Am J Clin Dermatol 2013;14(6):449-59.
1. Inert or Passive Wound Dressings
http://www.publicdomainpictures.net/view-image.php?image=139458&picture=stack-of-gauzehttp://www.globalsources.com/si/AS/Wuhan-Mei/6008848541606/pdtl/Vaseline-gauze/1085071020.htm
1. Inert or Passive Wound Dressings
http://www.publicdomainpictures.net/view-image.php?image=139458&picture=stack-of-gauzehttp://www.globalsources.com/si/AS/Wuhan-Mei/6008848541606/pdtl/Vaseline-gauze/1085071020.htm
Protection of wound bed
and Covering
A. Moisture-retentive dressings
B. Silver dressings and antimicrobials
C. Miscellaneous dressings
2. Interactive Wound Dressings
A.Moisture-retentive dressings
B. Silver dressings and antimicrobials
C. Miscellaneous dressings
2. Interactive Wound Dressings
a) Films
b) Hydrogels
c) Hydrocolloids, Hydrofibers
d) Alginates
e) Foams
Moisture-retentive Dressings
Films
http://solutions.3mchile.cl/wps/portal/3M/es_CL/Littmann/stethoscope/products/product-catalog-
australia/?PC_Z7_RJH9U5230GE3E02LECIE20KF96000000_nid=5N9BC8XZ8NbeSXJDGZDK2Lglhttp://www.progress.com.sg/product/opsite-flexifix-transparent-film-roll/
Films
Visualization of wound bed
and Wound protection
http://solutions.3mchile.cl/wps/portal/3M/es_CL/Littmann/stethoscope/products/product-catalog-
australia/?PC_Z7_RJH9U5230GE3E02LECIE20KF96000000_nid=5N9BC8XZ8NbeSXJDGZDK2Lglhttp://www.progress.com.sg/product/opsite-flexifix-transparent-film-roll/
Hydrogels
https://www.medicaldepartmentstore.com/Hydrogel-Dressings-s/295.htm
https://www.bbraun.com/en/products/b/askina-gel.htmlhttp://www.kpmmedical.com.vn/blugel.html
Hydrogels
https://www.medicaldepartmentstore.com/Hydrogel-Dressings-s/295.htm
https://www.bbraun.com/en/products/b/askina-gel.htmlhttp://www.kpmmedical.com.vn/blugel.html
Hydrate dry wound bed
and Facilitate autolytic debridement
Clinical Application of Hydrogels in Diabetic Foot Ulcers (DFU)
Dumville JC, et al. Cochrane Database Syst Rev 2013;(7):CD009101.
Clinical Application of Hydrogels in Diabetic Foot Ulcers (DFU)
Dumville JC, et al. Cochrane Database Syst Rev 2013;(7):CD009101.
Hydrocolloids, Hydrofibers
http://www.hightidehealth.com/duoderm-signal.htmlhttps://www.convatec.ca/products/pc-wound-aquacel-extra-dressing/21603750-5757-4a85-a075-465347dbfccb
Hydrocolloids, Hydrofibers
http://www.hightidehealth.com/duoderm-signal.htmlhttps://www.convatec.ca/products/pc-wound-aquacel-extra-dressing/21603750-5757-4a85-a075-465347dbfccb
Absorb minimal to moderate exudate,
Maintain moist environment and Facilitate autolytic debridement
Clinical Application of Hydrocolloids/Hydrofibers in DFU
Dumville JC, et al. Cochrane Database Syst Rev 2013;(8):CD009099.
Clinical Application of Hydrocolloids/Hydrofibers in DFU
Dumville JC, et al. Cochrane Database Syst Rev 2013;(8):CD009099.
Alginates
http://woundcaresociety.org/alginate-dressing-complete-guidehttps://www.convatec.com/products/pc-wound-burns/kaltostat-calcium-sodium-alginate-dressing
Alginates
http://woundcaresociety.org/alginate-dressing-complete-guidehttps://www.convatec.com/products/pc-wound-burns/kaltostat-calcium-sodium-alginate-dressing
Absorb large amounts of fluid,
Provide moist environment and
Stimulate platelet activation & blood coagulation
Clinical Application of Alginates in DFU
Dumville JC, et al. Cochrane Database Syst Rev 2013;(6):CD009110.
Clinical Application of Alginates in DFU
Dumville JC, et al. Cochrane Database Syst Rev 2013;(6):CD009110.
Foams
http://www.smith-nephew.com/canada/products/advanced-wound-management/allevyn-gentle/http://uk.live.nodeb.convatemp.dk/wound-skin/aquacel-foam-dressing/key-features-and-benefits
Foams
http://www.smith-nephew.com/canada/products/advanced-wound-management/allevyn-gentle/http://uk.live.nodeb.convatemp.dk/wound-skin/aquacel-foam-dressing/key-features-and-benefits
Absorb heavy amounts of exudate,
Maintain moist environment and Protect skin against mechanical trauma
Clinical Application of Foams in DFU
Dumville JC, et al. Cochrane Database Syst Rev 2013;(6):CD009111.
Clinical Application of Foams in DFU
Dumville JC, et al. Cochrane Database Syst Rev 2013;(6):CD009111.
Clinical Application of Foams in DFU
Dumville JC, et al. Cochrane Database Syst Rev 2013;(6):CD009111.
Clinical Application of Foams in DFU
Dumville JC, et al. Cochrane Database Syst Rev 2013;(6):CD009111.
A. Moisture-retentive dressings
B.Silver dressings and antimicrobials
C. Miscellaneous dressings
2. Interactive Wound Dressings
a) Silver
b) Iodine
c) Honey
Silver Dressings and Antimicrobials
Silver
http://www.rch.org.au/burns/clinical_information/
https://www.amazon.com/ConvaTec-Aquacel-extra-AG-2x2/dp/B00HJCI68K
http://www.bbraun.co.id/cps/rde/xchg/cw-bbraun-id-id/hs.xsl/products.html?prid=PRID00002996
http://www.kpmmedical.com.vn/blugel.html
https://www.exmed.net/p-1987-molnlycke-mepilex-ag-antimicrobial-soft-silicone-foam-dressing.aspxhttp://www.urgomedical.nl/products/urgotul-ssd/
Silver
http://www.rch.org.au/burns/clinical_information/
https://www.amazon.com/ConvaTec-Aquacel-extra-AG-2x2/dp/B00HJCI68K
http://www.bbraun.co.id/cps/rde/xchg/cw-bbraun-id-id/hs.xsl/products.html?prid=PRID00002996
http://www.kpmmedical.com.vn/blugel.html
https://www.exmed.net/p-1987-molnlycke-mepilex-ag-antimicrobial-soft-silicone-foam-dressing.aspxhttp://www.urgomedical.nl/products/urgotul-ssd/
Broad spectrum antimicrobial agent,
Easy to use and Reducing inflammation
Clinical Application of Silver in DFU
Jude EB, et al. Diabet Med 2007;24(3):280-8.
Clinical Application of Silver in DFU
Jude EB, et al. Diabet Med 2007;24(3):280-8.
Clinical Application of Silver in DFU
Jude EB, et al. Diabet Med 2007;24(3):280-8.
Clinical Application of Silver in DFU
Jude EB, et al. Diabet Med 2007;24(3):280-8.
Clinical Application of Silver in DFU
Jude EB, et al. Diabet Med 2007;24(3):280-8.
Iodine
http://www.hightidehealth.com/iodoflex-cadexomer-iodine-pad-dressings.html
http://www.deforcemedical.be/nl/iodosorb-cadexomeer-zalf-met-iodine-tube-2-x-20g-nieuwhttps://www.fishpond.com.hk/c/Health/q/Iodine+Dressing
Iodine
http://www.hightidehealth.com/iodoflex-cadexomer-iodine-pad-dressings.html
http://www.deforcemedical.be/nl/iodosorb-cadexomeer-zalf-met-iodine-tube-2-x-20g-nieuwhttps://www.fishpond.com.hk/c/Health/q/Iodine+Dressing
Broad spectrum antimicrobial agent,
and
Penetration of biofilm
Clinical Application of Iodine in DFU
Apelqvist J, et al. Acta Derm Venereol 1996;76(3):231-5.
Clinical Application of Iodine in DFU
Apelqvist J, et al. Acta Derm Venereol 1996;76(3):231-5.
Honey
http://jazzmed.com/product-technology.html
https://www.exmed.net/p-4085-derma-sciences-medihoney-1-12-oz-wound-and-burn-dressing-gel.aspxhttp://commonsensehome.com/honey-as-medicine/
Honey
http://jazzmed.com/product-technology.html
https://www.exmed.net/p-4085-derma-sciences-medihoney-1-12-oz-wound-and-burn-dressing-gel.aspxhttp://commonsensehome.com/honey-as-medicine/
Broad spectrum antimicrobial agent,
Enhancing autolytic debridement and
Anti-inflammatory response
Clinical Application of Honey in DFU
Kamaratos AV, et al. Int Wound J 2014;11(3):259-63.
Clinical Application of Honey in DFU
Kamaratos AV, et al. Int Wound J 2014;11(3):259-63.
31 days43 days
P < 0.05
A. Moisture-retentive dressings
B. Silver dressings and antimicrobials
C.Miscellaneous dressings
2. Interactive Wound Dressings
a) Negative pressure wound therapy(NPWT)
b) Bioengineered skin/ Skin subsitutes
c) Collagen dressings
d) Growth factors
e) Gold dust
f) Drawtex hydroconductive dressing
Miscellaneous Dressings
Negative Pressure Wound Therapy (NPWT)
http://www.kci-medical.ie/cs/Satellite?c=Page&cid=1229637734560&p=1229637734560&pagename=IE-ENG%2FKCILayout
Negative Pressure Wound Therapy (NPWT)
http://www.kci-medical.ie/cs/Satellite?c=Page&cid=1229637734560&p=1229637734560&pagename=IE-ENG%2FKCILayout
Reduction of edema,
Wound edge contraction,
Granulation tissue formation and
Reduction of bacterial load
Clinical Application of NPWT in DFU
Armstrong DG, et al. Lancet 2005;366(9498):1704-10.
Clinical Application of NPWT in DFU
Armstrong DG, et al. Lancet 2005;366(9498):1704-10.
Clinical Application of NPWT in DFU
Blume PA, et al. Diabetes Care 2008;31(4):631-6.
Clinical Application of NPWT in DFU
Blume PA, et al. Diabetes Care 2008;31(4):631-6.
Clinical Application of NPWT in DFU
Sajid MT, et al. J Coll Physicians Surg 2015;25(11):789-93.
Clinical Application of NPWT in DFU
Sajid MT, et al. J Coll Physicians Surg 2015;25(11):789-93.
Skin Substitutes
http://www.woundcarenurses.org/uploads/7/6/6/7/7667574/6082877.jpg
http://personalpages.manchester.ac.uk/staff/j.gough/lectures/te/13_skin/dermagraft3.GIF
http://www.rileyanimation.com/wp-content/uploads/2014/03/GraftJacket_BIG21.jpghttp://www.ilstraining.com/bmwd/images/bmwd_chronic_app_02.jpg
Skin Substitutes
http://www.woundcarenurses.org/uploads/7/6/6/7/7667574/6082877.jpg
http://personalpages.manchester.ac.uk/staff/j.gough/lectures/te/13_skin/dermagraft3.GIF
http://www.rileyanimation.com/wp-content/uploads/2014/03/GraftJacket_BIG21.jpghttp://www.ilstraining.com/bmwd/images/bmwd_chronic_app_02.jpg
Promote wound healing by
cytokines and growth factors
Clinical Application of Skin Substitutes (Graftskin) in DFU
Veves A, et al. Diabetes Care 2001;24(2):290-5.
Clinical Application of Skin Substitutes (Graftskin) in DFU
Veves A, et al. Diabetes Care 2001;24(2):290-5.
56%
38%
Graftskin
Control
P = 0.0042
Marston WA, et al. Diabetes Care 2003;26(6):1701-5.
Clinical Application of Skin Substitutes (Dermagraft) in DFU
Clinical Application of Skin Substitutes (Dermagraft) in DFU
Marston WA, et al. Diabetes Care 2003;26(6):1701-5.
Clinical Application of Skin Substitutes (Graftjacket) in DFU
Reyzelman A, et al. Int Wound J 2009;6(3):196-208.
Clinical Application of Skin Substitutes (Graftjacket) in DFU
Reyzelman A, et al. Int Wound J 2009;6(3):196-208.
69.6% 46.2% P = 0.0289
Clinical Application of Skin Substitutes (Integra) in DFU
Driver VR, et al. Wound Repair Regen 2015;23(6):891-900.
Clinical Application of Skin Substitutes (Integra) in DFU
Driver VR, et al. Wound Repair Regen 2015;23(6):891-900.
51%
32%
P = 0.001
Collagen Dressings
http://www.elastogel.com/product-catalog/wound-care/stimulen-collagen-wound-care
http://www.blowoutmedical.com/johnson-and-johnson-promogran-prisma-matrix.htmlhttp://www.midtownhealthonline.com/fibracolall.html
Collagen Dressings
http://www.elastogel.com/product-catalog/wound-care/stimulen-collagen-wound-care
http://www.blowoutmedical.com/johnson-and-johnson-promogran-prisma-matrix.htmlhttp://www.midtownhealthonline.com/fibracolall.html
Bind MMPs,
Providing temporary scaffolding,
Attracting cells to wound site and
Create moist environment
Clinical Application of Collagen Dressings in DFU
Veves A, et al. Arch Surg 2002;137(7):822-7.
Clinical Application of Collagen Dressings in DFU
Veves A, et al. Arch Surg 2002;137(7):822-7.
P = 0.12
28%
37%
Growth Factors
http://www.webmd.com/drugs/2/drug-5550/regranex-topical/details
http://www.cgbio.co.kr/en/product/wound/easyef-ointment/
http://www.daewoong.com/Sub06/Sub06_0101.asp?MODE=V&SRNO=60752
http://www.bharatbiotech.com/products/bio-therapeutic/regen-d/
Growth Factors
http://www.webmd.com/drugs/2/drug-5550/regranex-topical/details
http://www.cgbio.co.kr/en/product/wound/easyef-ointment/
http://www.daewoong.com/Sub06/Sub06_0101.asp?MODE=V&SRNO=60752
http://www.bharatbiotech.com/products/bio-therapeutic/regen-d/
Stimulate migration &
proliferation of cells and
Promote new tissue formation
Clinical Application of Growth Factors (Becaplermin) in DFU
Wieman TJ, et al. Diabetes Care 1998;21(5):822-7.
Clinical Application of Growth Factors (Becaplermin) in DFU
Wieman TJ, et al. Diabetes Care 1998;21(5):822-7.
43%35%
35%
36%
50%
P = 0.007
Clinical Application of Growth Factors (EGF) in DFU
Hong JP, et al. Ann Plast Surg 2006;56:394-8.
Clinical Application of Growth Factors (EGF) in DFU
Hong JP, et al. Ann Plast Surg 2006;56:394-8.
52/68
46 days
Clinical Application of Growth Factors (EGF) in DFU
Mohan VK. Diabetes Res Clin Pract 2007;78(3):405-11.
Clinical Application of Growth Factors (EGF) in DFU
Mohan VK. Diabetes Res Clin Pract 2007;78(3):405-11.
Gold Dust
http://www.soza.com.my/products-gold-dust.asphttps://www.youtube.com/watch?v=OrITniCtHbo
Gold Dust
http://www.soza.com.my/products-gold-dust.asphttps://www.youtube.com/watch?v=OrITniCtHbo
Absorb heavy amounts of exudate
and
Maintain moist wound environment
Drawtex HydroconductiveDressing
https://hmpusers.com/cas/login?service=http%3A%2F%2Fwww.o-wm.com%2Fcontent%2Fdiscovering-hydroconductive-dressings&gateway=truehttp://www.wounds-uk.com/news/martindale-pharma-enters-wound-care-market-with-an-intelligent-new-option-for-rapid-wound-bed-preparation
Drawtex HydroconductiveDressing
https://hmpusers.com/cas/login?service=http%3A%2F%2Fwww.o-wm.com%2Fcontent%2Fdiscovering-hydroconductive-dressings&gateway=truehttp://www.wounds-uk.com/news/martindale-pharma-enters-wound-care-market-with-an-intelligent-new-option-for-rapid-wound-bed-preparation
Absorb moderate to heavy exudate
and
Lift and draw exudate, wound
debris, bacteria and harmful MMPs
Conclusion
http://www.smith-nephew.com/key-products/advanced-wound-management/dressing-types/
•Understanding wound healing
•Strong evidence of effectiveness and cost-effectiveness
•Adequate wound debridement, appropriate systemic antibiotics, dressing changes and wound inspection
•Prevention of DFU
Conclusion
Questions???
Thank Youfor Your Attention
http://jmlevinemd.com/wound-odor-philoctetes/
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