Polymeric Membrane Dressings for Topical Wound Management of Patients With Infected Wounds in a Challenging Environment: A Protocol With 3 Case Examples

Abstract

Patients with acute wounds often delay seeking medical assistance until an incapacitating infection has developed. When such patients come for help at a remote Christian clinic in northern Ghana, West Africa, the goals of care are to resolve and prevent a return of infection, decrease pain, enable an immediate return to normal activities, and facilitate healing. Because the local protocol of care, Edinburgh University Solution of Lime (EUSOL)-soaked gauze, did not meet these goals, the author tried using a variety of donated wound dressing regimens. Ultimately, polymeric membrane dressings (PMDs) were observed to meet patient care needs while also reducing clinic staff time and resources, and a PMD protocol of care was developed. Three (3) representative patients who presented with acute wounds and infection are described: a 20-year-old man with a hand abscess, a 16-year-old boy with a malleolus wound, and an approximately 20-year-old woman with an injection abscess, all otherwise relatively healthy, albeit undernourished. All 3 patients received oral antibiotics, their wounds were initially cleansed and debrided, and an appropriate configuration of either regular or silver-containing PMDs was applied to all exposed wound surfaces. Dressing changes were scheduled based upon the personalized plan of care. In all 3 patients, the pain-relieving properties of PMDs allowed resumption of activities within 1 day of initiating treatment, the dressings' continuous wound cleansing system kept the wounds clean and free of infection despite the challenging environment, and the wounds healed steadily. Managing infected acute wounds with PMDs through complete wound closure was time efficient for clinic staff and met all 4 major patient goals of care. Randomized, controlled studies to compare wound and quality of life outcomes in patients whose infected wounds are managed with PMDs compared with those whose wounds are managed with other advanced dressings are warranted.

Methods used in the study,Evaluation of a polyurethane foam dressing impregnated with 3% povidone-iodine (Betafoam) in a rat wound model, led to unreliable results

“…Basic knowledge of PMDs is needed to understand why the study design was not suitable for this dressing type. PMDs release a nontoxic surfactant cleanser [ 5 ] to break the chemical bonds between the wound bed and substances that impair healing [ 3 6 7 8 9 10 11 12 ]. Glycerol pulls nutrient-filled, enzymerich fluid from the body into the wound bed, enhancing both healing and autolytic debridement [ 6 8 9 10 13 14 15 ].…”

“…PMDs release a nontoxic surfactant cleanser [ 5 ] to break the chemical bonds between the wound bed and substances that impair healing [ 3 6 7 8 9 10 11 12 ]. Glycerol pulls nutrient-filled, enzymerich fluid from the body into the wound bed, enhancing both healing and autolytic debridement [ 6 8 9 10 13 14 15 ]. The nowloosened and floating undesirable substances are drawn by the superabsorbent into the PMD substrate [ 4 6 10 16 ].…”

“…Glycerol pulls nutrient-filled, enzymerich fluid from the body into the wound bed, enhancing both healing and autolytic debridement [ 6 8 9 10 13 14 15 ]. The nowloosened and floating undesirable substances are drawn by the superabsorbent into the PMD substrate [ 4 6 10 16 ]. This continuous wound cleansing system is so powerful that routine rinsing is not recommended at dressing changes [ 6 15 16 17 ].…”

“…The nowloosened and floating undesirable substances are drawn by the superabsorbent into the PMD substrate [ 4 6 10 16 ]. This continuous wound cleansing system is so powerful that routine rinsing is not recommended at dressing changes [ 6 15 16 17 ].…”

“…PMDs balance moisture using several simultaneous mechanisms [ 6 , 8 9 15 20 25 ]. The one that is important to this research study design is that the “intelligent” backing adjusts the moisture vapor transmission rate to allow excess fluid to evaporate while retaining the fluid needed to keep dry wounds moist [ 8 ].…”