Key Insights On Selecting Wound Care Modalities

Clinical Editor: Lawrence Karlock, DPM

   While there is quite an array of choices when it comes to choosing appropriate wound care modalities for lower-extremity wounds, there is not, as one panelist points out, a lot of published evidence for guidance. With this in mind, our expert panelists discuss a variety of wound care scenarios and how their clinical experience guides their decision-making on dressings and debriding agents.    Q: Given the multitude of wound care dressings available, how do you narrow down your choice of wound dressings?    A: Eric Espensen, DPM, and Lawrence G. Karlock, DPM, says it often comes down to clinical experience. Dr. Karlock says he has experimented with 20 to 30 different wound products over the last few years and has narrowed his choices based on his experience. He says he prefers one or two products for draining wounds, and one or two products when dealing with wounds that have a thick eschar.    William Jeffcoate, MD, FRCP, who practices in the United Kingdom (U.K.), says published evidence is “woefully thin” in regard to wound care products and their effect on lower-extremity ulcers in patients with diabetes. In light of this, Dr. Jeffcoate points to the adage that healing is promoted not so much by a wound care product per se as by the wound care process. Therefore, he tends to rely on simple principles of wound healing until there is more published literature to direct him otherwise.    Speaking from his clinical experience, Dr. Jeffcoate says he does not like occlusive or semi-occlusive dressings because they can cause maceration of the wound edge when they are left on too long. When debridement fails to remove surface debris, Dr. Jeffcoate employs an alginate- or an iodine-containing preparation.    However, he maintains there is a “desperate need for a robust comparison of outcomes” between different specialist clinics as well as more reliable measures of what constitute acceptable rates of healing. To that end, Dr. Jeffcoate says he is currently involved in a large, government-funded, multicenter study in the U.K. that is looking at three dressings (a simple non-adherent dressing, iodine impreganted gauze and a hydrofiber dressing) in diabetic foot ulcers. He hopes the study will yield valuable data by the anticipated completion in December 2006.    Q: Do you still utilize the traditional saline wet to dry dressing for foot wounds?    A: Dr. Jeffcoate says he has never used this dressing for diabetic foot wounds. Dr. Karlock notes he usually employs the dressing only within the first three to four days after performing an incision and drainage of infections. Otherwise, he says he has no use for the traditional dressing.    However, Dr. Espensen maintains that wet to dry dressings are inexpensive, easy and readily available. He typically utilizes them for inpatients who have large wounds that need moderate debridement and frequent dressing changes (up to four times a day). Dr. Espensen adds that wet to dry dressings are still the standard of care to which newer dressings are compared in clinical research trials.    Q: What is your preference for a wound that has a red, beefy and clean granular base?    A: Dr. Jeffcoate prefers a simple, non-adherent dressing while Dr. Espensen typically uses a moisture-retentive dressing such as a hydrogel. Dr. Karlock prefers to use Bactroban 2% Cream. He concedes that some may question whether he is “overtreating” the wound with a topical antibiotic initially designed for MRSA infections. However, Dr. Karlock doesn’t think this is much of an issue. He says the Bactroban Cream allows moist wound healing and doesn’t tend to macerate the skin like some of the other products including hydrogels.    Q: What is your preference for a wound that has fibrous

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