Achieving Adjunctive Success With Wound Dressings

By Alan J. Cantor, DPM, CWS

The wound care industry has produced and marketed a flurry of new options for clinicians in a very short period of time. Indeed, some experts wonder whether this has created confusion among clinicians, further widening the gap between academic clinicians and those who are in everyday community or office settings.1 As Professor Terence Ryan pointed out, “There is a difference between the ‘gold standards’ of the elite and the logistics of providing care in the environments of those with limited access to expertise.”2 A February 2002 survey of podiatrists in the United States offered some critical insights into wound care.3 Regranex and Silvadene Cream were commonly used by approximately 20 percent of the survey respondents yet some of the more recent wound care products were in the low single digits for common usage in practice. Another intriguing finding was the fact that 17 percent of those polled cited saline wet-dry dressings as their most common wound agent. Why are wet-dry dressings so prevalent? Studies have clearly identified how these dressings increase trauma to the wound; increase pain; increase the rate of infection; lower skin temperature on the site, enhancing wound chronicity; and are far more expensive than newer moist wound environment options.1 That said, let’s take a closer look at some of the more impressive wound care dressings that have emerged and how one can apply these technological advances in a clinical setting. Silver Dressings: Why You Should Consider Aquacel Ag And Acticoat Silver has long been known to be an effective antimicrobial agent with a broad spectrum of activity against bacteria, fungi and viral organisms. The silver ions in the dressings replace the sodium ions in the wound fluids, resulting in the antimicrobial activity of the dressings. However, not all dressings are designed the same so it’s important to be aware of key distinctions. Aquacel Ag (ConvaTec) is a silver impregnated dressing that is based upon the hydrofiber technology of Aquacel hydrofiber. The silver concentration is continuously available to the wound and delivers silver in an “as needed” fashion. Wound exudate activates the delivery of silver in a sustained manner. The backbone of this dressing is a carboxymethylcellulose base with 1.2% silver, which has been demonstrated to be an optimal concentration for antimicrobial activity without causing toxicity to the tissues.4 Aquacel Ag has impressed our team. When we have used this dressing, it has facilitated superb management of exudate, reduced pain at dressing changes and enhanced wound bed appearance with decreased slough and non-viable tissue.5 We use Aquacel Ag on wounds of various etiologies and we now cover donor graft sites with the dressing. One should change these dressings based on the amount of exudate, with 72 hours being the maximum time period you should leave the dressing over a wound. Acticoat (Smith and Nephew) is another silver dressing that we use in our center. This is a silver impregnated sheet that incorporates silver nanocrystals onto the layered dressing.6 With Acticoat, the silver is delivered into the wound based upon exudate interaction, with the nanocrystals being deposited into the wound in a rapid fashion. Our team presently uses Acticoat barrier dressings on burn injuries and burn and skin graft sites. One difference between the two dressings is that we have noted staining of the skin with the crystalline dressings that is similar to silver nitrate. Both dressings have shown broad spectrum of activity against pathogens, including MRSA, Pseudomonas and VRE. Assessing The Potential Of Oasis Oasis xenograft (Healthpoint), a naturally occurring extracellular matrix derived from porcine small intestinal mucosa (SIS), stimulates the extracellular matrix foundation. With meticulous wound management (debridement of necrotic tissue), the Oasis graft can help develop a scaffold upon which the cellular repair and response can formulate. This graft does not need special storage needs and is produced in a fenestrated and non-fenestrated format. Presently, I use the graft on various wounds and prefer to cover the graft with a hyrocolloid or silver impregnated dressing. Based upon graft/wound inspection, I will repeat the graft application until I see healthy granulation tissue at weekly or biweekly intervals.

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