Dressings for chronic wounds

Abstract

Covering wounds, acute and chronic, is one of the most fundamental activities of any medical practitioner. Although wound dressings primarily serve to contain the "good" and keep out the "bad," research has characterized more specifically the sophisticated interaction between the human wound bed and its dressing counterpart. Wound dressings for today's chronic wounds come in many flavors, ranging from the classic types of moisture-retentive dressings to silver-coated varieties to biologic dressings serving as skin substitutes. Moisture-retentive dressing types include foams, films, hydrogels, hydrocolloids, and alginates. Appropriate use of these dressings can help to keep the wound bed moist, which allows for epithelial migration, angiogenesis, retention of growth factors, autolytic debridement, and maintenance of electrical gradients.

Wound bed preparation: A novel approach using HydroTherapy

“…HydroTac provides a continuum of hydration that aids wound healing.  Faster wound healing (Winter, 1962;Dyson et al, 1988;Beam et al, 2008)  Promote epithelialisation rate (Winter, 1962;Eaglstein, 2001;Ågren et al, 2001;Varghese et al, 1986;Rubio, 1991;Madden et al, 1989;Wigger-Alberti et al, 2009)  Promote dermal/wound bed healing responses, e.g., cell proliferation, ECM synthesis (Svensjö et al, 2000;Dyson et al, 1992;Mosti, 2013;Korting et al, 2010;Chen et al, 1992;Leung et al, 2010;Field & Kerstein, 1994;Dowsett & Ayello, 2004;Katz et al, 1991)  ReducI can't es scarring (Atiyeh et al, 2003(Atiyeh et al, ,2004O'Shaughnessy et al, 2009;Mustoe & Gurjala, 2011;Tandara et al, 2007;Hoeksema et al, 2013)  Retention of growth factors at wound site (Svensjö et al, 2000;Hackl et al, 2014;Powers et al, 2013;Chen et al, 1992;Attinger et al, 2006;Vogt et al, 1995)  Lower wound infection rates (Kannon & Garret, 1995;Hutchinson & Lawrence, 1991;Lawrence, 1994)  Reduces pain perception (Wiechula, 2003;Metzger, 2004;Leaper et al, 2012;Coutts et al, 2008;Feldman, 1991;...…”

Clinical efficacy of dressings for treatment of heavily exuding chronic wounds

“…27 Hydrocolloids are best used in low to moderately exuding wounds because large amounts of exudate may cause peri-wound maceration and off-floating of the dressing. An offensive odor, skin stripping, 4,32 and allergic reactions 12,33,34 have also been reported. Whenever the wound is generating moderate to high levels of exudate, an absorbent dressing is required.…”

“…Films are excellent for superficial lacerations and wounds producing small amounts of exudate like thin burn wounds, venous catheter sites, or split-thickness skin graft donor sites. 32 However, fluid will accumulate underneath the film, and skin stripping could occur due to tight adherence and exertion of shearing forces.…”

“…32 Therefore, hydrogels are able to rehydrate a dry desiccated wound, promoting healing by creating a moist wound environment. 5 These dressings are very comfortable to wear and provide a cool and soothing feeling to the patient accompanied by a certain amount of pain relief.…”

“…5 These dressings are very comfortable to wear and provide a cool and soothing feeling to the patient accompanied by a certain amount of pain relief. 4,32 However, although being slightly absorbent, use of hydrogels on wounds that are already highly moist may result in overhydration and cause maceration of the surrounding skin.…”