8/12/2019 Using Antimicrobial Foam Dressings

1/1

Wounds International Vol 3 | Issue 2 | Wounds International 201252

Technology and product reviews

K endall AMD antimicrobial foam dressingsare highly absorbent foam dressings thatcontain polyhexamethylene biguanide(PHMB also known as polihexanide) aneffective antimicrobial agent that has very lowcytotoxicity. These dressings are particularlysuited to the management of acute or chronicwounds with moderate to high levels of exudatewhere there is an increased risk or evidence ofwound infection. The following article describesthe use of this dressing in paediatrics in a hospitalin Italy.

Antimicrobial foam dressings inpaediatrics The skin of paediatric patients is more prone tobreakdown and the development of pressureulcers than adult skin [1]. There are a numberof important differences between the skin ofchildren and adults that may contribute to this

problem. For example, the skin of children has a:

thinner stratum corneum the skin is lesswell protected against mechanical damage

lower lipid content the skin is moreprone to becoming dry

higher pH the low acidic pH of adultand adolescent skin has a protective effectagainst microorganisms [2,3].

The differences between the skin of adultsand children are more pronounced in thevery young. In addition, in pre-term babiesand neonates the lack of cohesion betweenthe epidermis and dermis makes the skinvulnerable to mechanical damage [2].

Kendall AMD antimicrobial foam dressingscan be used in the treatment of complexwounds in paediatric patients. The high levelof exudation and high rate of polymicrobialismthat may be responsible for the wounddeterioration seen in these patients can bemanaged by the combination of the open cell

foam dressing and PHMB.

Evidence in paediatricsIn a series of 25 consecutive bed-ridden patients(mean age 4.6 years), 90% of wounds that weretreated with Kendall AMD antimicrobial foamdressing were healed within two weeks and amean of 6.5 dressing changes [4]. The woundsoccurred at a range of sites, including occiput,ear, heel, back and sacrum. The dressing was welltolerated and no adverse effects, allergic reactionsor periwound skin complications were observed. [4]

Practicalities in paediatricsIn children, the Kendall AMD antimicrobialfoam dressing should be applied so that a1.5cm border extends beyond the wound ontonormal skin. This helps to prevent the dressingfrom being dislodged and to ensure a moistwound environment beneath the dressing. Thedressing should be changed initially every twodays and then every four days. The dressingcan be cut into any shape and be easily moldedto cover wounds on body prominences.

Author DetailsGuido Ciprandi , Chief Pressure Ulcer Project,Plastic and Maxillofacial Surgery Unit, BambinoGesu Childrens Hospital, IRCCS, Rome, Italy

Using antimicrobial foam dressings inpaediatric wounds

References1. Afsar FS. Skin care for preterm and

term neonates. Clin Exp Dermatol2009; 34(8): 85558.

2. Fluhr JW, Darlenski R, Taieb A, etal. Functional skin adaptation in

infancy - almost complete but notfully competent. Exp Dermatol 2010;

19(6): 48392.

3. Fernandes JD, de Oliveira ZNP.Children and newborn skin care and

prevention. An Bras Dermatol2011;86(1): 10210

4. Ciprandi G. Palliative wound care in

pediatric patients. 21st Conference ofthe European Wound ManagementAssociation, EWMA 2527 May 2011.

T E C H N O L O G Y U P D A T E :

AG is a 26-month-old girl presented to the Bambino Gesu Childrens Hospital in Rome withlarge Stage/Category III infected occipital pressure ulcer which had developed during

reatment for bacterial meningitis. The wound was covered with a dark brown eschar that wasrmly adherent to the tissues below (Figure 1). Microbiological analysis revealed high levels ofPseudomonas aeruginosa and Acinetobacter baumannii.

Treatment

A Kendall AMD antimicrobial foam dressing was applied to the wound (Figure 2). The centref the dressing was removed to allow for application of a gel for enzymatic debridement.

After three days, the eschar was reduced in size and debridement was completed surgically.Treatment was continued with an intact Kendall AMD antimicrobial foam dressing. Afterwo weeks of treatment the wound had reduced in size, the redness had disappeared and the

wound was no longer infected (Figure 3). Two months later hair growth was visible and only amall area remained to heal.

Kendall AMD antimicrobial foam dressing paediatriccase report

1: Occipital pressure ulcer onsentation

Fig 2: Kendall AMD antimicrobialfoam dressing in situ

Fig 3: After two weeks oftreatment