Achieving Adjunctive Success With Wound Dressings

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A Few Thoughts About The Impact Of VAC Therapy

VAC therapy (KCI) is a major modality that we utilize in treating critical wounds. Based upon the production of negative pressure, this system has been shown to reduce bacterial count and increase granulation tissue.9 One theory behind the enhanced granulation tissue is that VAC therapy stimulates an increased expression of angiogenic growth factors in the chronic wound.10

Our team regularly utilizes VAC for diabetic foot wounds, burns, pressure ulcers, traumatic and surgically dehisced wounds. Our clinical experience has consistently revealed that the negative pressure greatly assists in reducing edema, removing infected tissue, and facilitates and expedites total wound closure, either with grafting, flapping or with some of the human skin equivalent products.

Using the VAC has not only enabled us to achieve faster wound healing and reduced costs, it has given our team additional time to survey a wound in order to formulate a better treatment plan. We are currently using VAC synergistically over topical agents, grafts and dressings with no adverse effects.

While we do not commonly see seepage of fluid from an improper seal, we’ve been able to address this by placing zinc paste around wound margins or cutting Aquacel into a border of strips that surround the wound. Doing so has helped control peri-wound maceration.

Do keep in mind that VAC is not intended to be used as a primary treatment for underlying osteomyelitis so systemic infection management is mandated while using VAC therapy.

This 53-year-old male with insulin-dependent diabetes initially presented with a chronic ulcer on his right plantar first MPJ. As you can see, the clinical exam noted a grossly infected right first MPJ with an exposed metatarsal joint.
The team was able to create a clean wound with no devitalized tissue. The condition of the patient’s open wound as seen here is conducive to a healthy wound bed.
This picture shows the application of the split thickness skin graft (STSG), which was applied 10 days after surgery. The team stapled the graft in place and covered it with Acticoat.
 A 14-year-old female patient suffered gross gangrene on both feet and one hand due to meningococcal toxemia (as shown above). The initial exam revealed dry gangrene of the left forefoot and necrotic ulcers on the left and right heel.
Three digits on the 14-year-old girl’s left foot were amputated due to the extent of the gangrene. Surgeons decided to leave as much of the hallux and second digit intact as possible.
The patient experienced rapid healing of wounds on her feet and hands. Following the girl’s surgery, practitioners used Aquacel Ag to dress the wounds as well as a silver-impregnated hydrofiber dressing and a Hyalofill dressing.
This 5-year-old male’s left heel sustained a full-thickness thermal burn when his foot froze to an oxygen tank leaking liquid oxygen. As seen here, his left heel had necrosis encompassing the majority of plantar skin.
In treating the 5-year-old boy, the author applied an Oasis xenograft (as shown above) to an optimally prepared wound and proceeded to apply VAC therapy over it to enhance wound bed status.
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.

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