Wound Care Products

DEPARTMENT OF PODIATRIC SURGERY

 Wound Management
Science & Technology Clinical Practice

QUALITY OF LIFE
 Revolutions
• 1960’s Moist wound healing

• 1990’s Advanced technological products

• 1999’s Wound Bed Preparation

»Tissue engineered products
 Wound Healing Cascade
• Coagulation: 0-2 hours

• Inflammation: 0-3 days

• Cell migration and proliferation: 3-21 days

• Angiogenesis

• Remodeling: 21 days -1.5 years

 Systemic Assessment

Age Medications

Body Build Tissue Oxygenation

Stress Immunity

Nutrition Concomitant
Disease
 What’s Available?
• Traditional Treatment Modalities

– Hydrogels: Normlgel, Hypergel, Clearsite, etc

– Hydrocolloids: Duoderm, Comfeel, Restore, Tegasorb, Replicare

– Transparent films: Opsite, Tegaderm, bioclusive, epiview

– Wet to dry dressing

– Foam dressings: Allevyn, Biatain, Hydrasorb, etc.

– Calcium alginates: Sorbsan, AlgiSite, Curasorb, Kaltostat

– Enzymatic: Santyl, Panafil, Accuzyme, Gladase,

– Biological: Maggot therapy

– Antibacterial: Acticoat, Iodosorb, Prisma

 Hydrogels
Normlgel, Hypergel, Clearsite, Curasol gel, Solosite,
Intrasite, Hydrogel, Nu-Gel, Skintegrity, Clearsite, etc
 Hydrogels
• Hydrophillic / glycerin based gels

• High water content, viscosity varies by manufacturer

• Limited absorptive capacity

• Autolytic debridement of necrotic / slough tissues

• Partial or full thickness wounds

• Hydrogels help maintain a moist wound healing environment for

granulation, epithelialization, and facilitation of autolytic
debridement.
 Hydrogel Sheet Dressing
Flexderm, Vigilon, Flexigel, Curasol Gel, Restore, CarraGauze, etc

• Higher rate of
absorption

• Cooling, soothing effect

on superficial wounds
Hydrogel Sheet
Xeroform
 Hydrocolloids
Duoderm, Comfeel, Restore, Tegasorb, Replicare, Nu-
Derm, Dermatell, Curaderm, Hydrocol
 Hydrocolloids
• Components of gelatin, pectin or cellulose

• More occlusive compare to other dressings

• Waterproof

• Partial thickness wounds with low - moderate exudate

• Contraindicated for clinical infected wounds

• Conformable

• Adhesive, may damage fragile periwound skin

Hydrocolloid Application
 Promogran
• Advanced wound care device comprised of a sterile
freeze dried composite of 45% oxidized regenerated
cellulose (ORC) and 55% collagen.

– Maintains moist microenvironment at the wound surface

– Enhances granulation tissue formation, epithelization and
rapid wound healing.

• PRISMA: Anti-Bacterial property

 Transparent Films
Opsite, Tegaderm, Bioclusive, Epiview
 Transparent Films
• Polyurethane or co-polyester composition

• Waterproof and gas permeable

• Superficial wounds with no / minimal exudate

• Promote autolysis of necrotic / slough tissue

• Permit evaluation of wound progress

• Can tear healthy skin if improperly removed

• Occlusion may reduce pain

Transparent Film
Autolytic Debridement
Transparent Films
 Alginates
Sorbsan, AlgiSite, Curasorb, Kaltostat, Gentell, Restore, SeaSorb, Maxorb,
Curasorb, AlgiDerm
 Alginates
• Non-woven fibers derived
from brown seaweed
• Useful for filling moderate exudate wounds
• Interact with fluid to form a gel-like
• Safe to use with clinical infected wounds
• Will not debride hard eschar
Alginate Application
 Aquacel
Hydrofiber Dressing
 Nanocrystalline Silver
• Centuries of proven antimicrobial activity
• Cytotoxicity concerns associated with carriers not silver - ex.
Silver nitrate, Silver sulfadiazine15
• Traditional delivery required repeated applications due to
binding with chlorine and proteins
• Contemporary silver dressings allow for continued release up
to 7 days
• Broad spectrum - inactivates almost all know bacteria
including MRSA and VRE15
• No documented cases of bacterial resistance15
• Ex: Silver Cel, Acticaot
15
Demling and DeSanti (2001)
 Common Silver Compounds
Sulfadiazine Silver Cream
• Commonly used in variety of
wounds
• Effective against broad range
of resistant organisms
• Painless upon application
• Difficult to remove
• May form pseudoeschar
Silver Nitrate Solution 0.5%
• Used in 1943 in treatment of burns
• Wide spectrum of activity
• No known bacterial resistance
• Staining of skin
• Frequent dressing changes
• Not effective with eschar
 What’s Available?
Enzymatic
Panafil, Accuzyme, Gladase, Kovia ointment, Ziox ointment, Ethezyme
 Skin Substitutes/Tissue Engineered

• Tissue engineered xenografts

– Oasis, MediSkin, EZ Derm

• Tissue engineered allografts

– Apligraf, Dermagraft, GammaGraft, Alloderm

• Tissue engineered acellular dermal replacements:

– GraftJacket, GammaGraft, Integra, Primatrix
• Oasis: Freeze dried porcine xenograft, stored at
room temperature, long shelf life.

• EZ Derm: Porcine xenografts, long shelf live,

stored at room temperature

• Mediskin: frozen epidermal/dermal porcine

modified xenograft; must be kept frozen at less
than 32 degrees Fahrenheit, thawed at room
temperature 1-2 hours prior to application.
 Oasis
• Small Intestine Submucosa
– Derived from porcine small intestine
– Complex matrix of collagen, growth factors
and other proteins
• Apligraf: Bi-layered laminate of epidermis and
dermis and grown from neonatal foreskin; shelf
life up to 10 days when stored in its own
shipping container.

• Dermagraft: human fibroblast derived dermal

skin substitutes

• GraftJacket: Contains dermal elements and no

epidermis, allow rapid revascularization and cell
re-popularization, can use on tendons, capsule,
exposed bone
 Apligraf
• Bilayered living skin substitute
– Epidermal layer of human keratinocytes
– Dermal layer of human fibroblasts
– Bovine type I collagen lattice

• Mechanism of Action
– Provide a collagen scaffolding
– Provide cellular structures
– Release growth factors from cell
 Indications for the Use of
Dermagraft®
DERMAGRAFT is indicated for use in the treatment in full-
thickness diabetic foot ulcers greater than six weeks
duration which extend through the dermis, but without
tendon, muscle, joint capsule, or bone exposure.
DERMAGRAFT should be used in conjunction with
standard wound care regimens and in patients that have
adequate blood supply to the involved foot.
Case Study 2

Week 0 Week 9 Week 5

• Alloderm: Freeze dried de-cellularized human product.
Defined as human allogeneic skin; acellular tissue; allograft.

• GammaGraft: Irradiated human skin allograft from human

cadaveric donors. Stored in a foil pouch at room
temperature for up to 2 years.

• Integra: Bilayer Matrix (Integra Bilayer Matrix Wound

Dressing—Intergra BMWD and Single layer Wound
Dressing)

• Primatrix: acellular dermal matrix from fetal bovine skin,

stored at room temperature up to 2 years.
 What’s Available?
• Fibrin Glue: Combination of fibrinogen, calcium and
thrombin

• Fibrin Gel: Combination of calcium and thrombin and

autologous plasma.

• Platelet Gel: Autologous blood is collected and

centrifuged to isolate platelet rich plasma and then
combined with thrombin.
 Regranex: Becaplermin
• PDGF-BB: Recombinant Human Platelet-
Derived Growth Factor 1997
• Stimulates mesenchymal cells
 Mist U/S Transport Technology
(MUST)
• Increases mast cell degranulation
– Vascular permeability
– Realease of mitogenic growth factors
– Migration of macrophages and fibroblasts
– Capillary density
– Calcium up take in fibroblasts
– Collagen synthesis
– Tensile strength and elasticity of collagen
• 40 KHz
• Effective in reducing bacterial load, stimulate
debridement, induce granulation buds.
 Superoxidized Water
• Superoxidized Water (Dermacyn; Oculus
Innovative Sciences, Petaluma, Calif)

– Flush wounds under 8 pounds per square

inch of pressure (twice weekly) AND/OR
– Sock wounds with superoxidized water for 30
minutes AND/OR
– Use as wet dressing to the wound daily
 Negative Pressure Wound
Therapy: Vacuum Assisted Closure
(VAC)
• 48 hour dressing changes
• Aggressive reduction in interstitial fluids
• Can be used for any size of wound
• Can be used on infected wound (12 hour
change)
• Can treat more than one wound at a time.
 VAC: KCI-Kinetic Concepts, Inc,
The Versatile 1 (Blue Sky Medical)
• Contraindications:
– Fistulas to organs or body cavities ???
– Necrotic tissue with eschar present: Need
debridement
– Untreated Osteomyelitis
– Malignancy in the wound
– Application of dressing over exposed arteries
or veins.