Wound Dressings Update

Abstract

The availability of different types of wound dressings has increased in the last decade. Wound care practitioners have at their disposal an extensive range of dressings. Emerging dressing types include interactive/bioactive dressings and tissue-engineered skin substitutes. There is no one dressing that is suitable for the management of all types of chronic wounds and few are suited for the treatment of a single wound during all stages of the healing cycle. Successful wound management depends on an understanding of the healing process combined with knowledge of the properties of the various dressings available. Without such knowledge and careful assessment of all the factors that effect healing, dressing selection is likely to be arbitrary and ineffective, wasteful both in terms of time and physical resources. This article is an overview of some of the first-line and second-line interactive/bioactive dressings available. A synopsis of wound assessment and wound bed preparation will aid in choosing the appropriate dressings. It will also touch on advanced technologies including tissue-engineered skin substitutes. INTRODUCTIONNormal wound healing processes require restoration of epithelialisation and collagen formation. The first occurs by migration and proliferation of keratinocytes from the wound edges and by differentiation of stem cells from remaining hair follicle bulbs. The second occurs by influx of growth factors secreted by macrophages, platelets and fibroblasts, by fibroblast proliferation and subsequent synthesis and remodelling of collagenous dermal matrix. However, in the case of full-thickness burn injuries and chronic wounds such as pressure ulcers, venous ulcers and diabetic foot ulcers these processes are damaged and new technologies have been developed to improve the healing in these conditions. 1 The time it takes for a chronic wound to heal varies due to the idiosyncratic nature of each wound and inherent complex factors, which may impede healing. Infection, poor blood supply, immobility, diabetes, medicines, inadequate hydration and nutrition, trauma and poor wound management are causative or contributory factors. Tissue repair research and advances in moist wound healing pharmaceuticals have been pivotal in improving wound dressing technology. 2 Clinical experience suggests that wound healing is often impaired in the elderly. The elderly have a high prevalence of chronic leg and pressure ulcers and are vulnerable to skin tears that can be slow to heal due to decreased dermal thickness and the loss of proliferative capacity of the ageing dermis. 3 Chronic wounds represent a significant burden in human and economic costs. 4

Recent advances on the development of wound dressings for diabetic foot ulcer treatment—A review

“…Their capacity to absorb wound fluids is in general dependent on the specific polymeric material employed and on the foam thickness [73]. These dressings are highly absorbent, cushioning, protective and conformable to body surfaces [83]. Moreover, they are easy to manipulate and can be adapted to the required wound size [74,77].…”

Incorporation and Release Kinetics of Alpha-Bisabolol From PCL and Chitosan/Guar Gum Membranes

“…Wound dressings are used to protect the lesion from mechanical damage and contamination by microorganisms, as well as to provide an appropriate environment for the healing process, which includes the restoration of the epithelium and the formation of collagen (Weller and Sussman, 2006;Mulder et al, 2002). They can be classified according to the role they play in the lesion (barrier, debridement, antibacterial, occlusive, absorbent, adherent), the type of material used in its production (hydrocolloid, alginate, collagen, etc.…”

“…According to this classification, the materials used as wound dressings are divided into inert or passive, interactive and bioactive (Agrawal et al, 2014). Bioactive dressings are capable of interacting with the injured tissue, helping to reduce or eliminate pain and inflammatory processes, stimulating and accelerating the healing process (Weller and Sussman, 2006).…”

Clinical and Antibiofilm Efficacy of Antimicrobial Hydrogels

“…7 Since these gels are used in all wound types, their rheological profile is such that they stay in place after application to the wound and can remain in situ for relatively long periods of time. 8 …”