AmeriGel: An Alternative To Soaking?
Why aren’t more DPMs using the AmeriGel Wound Dressing for post-matrixectomies? After all, it is a product that reportedly promotes faster healing and, as a no-soak alternative, facilitates higher patient compliance. Well, it turns out that people are catching on to the benefits of the AmeriGel Wound Dressing. According to the manufacturer AmerX Health Care, over 1,000 podiatrists are using the product to treat their patients. “AmeriGel has worked well for most of my patients,” says Gerald Travers, DPM. “AmeriGel seems to speed the post-op recovery and reduce the tenderness involved with the post-op process.” As far as the pharmacology goes, AmeriGel is antimicrobial (biostatic), antifungal, antiinflammatory and is an autolytic debriding agent. AmerX Health Care says the primary ingredient of AmeriGel is oakin, an oak extract (tannins) which acts locally by proliferating proteins to the wound site and decreases cell membrane permeability. “For post-op matrixectomies, (AmeriGel) works extremely well,” notes Mark Johnson, DPM, who has used it on post-op nails for the last few years. Dr. Johnson has tried other products such as Silvadene and collagen, but he says AmeriGel gives him the best results. “AmeriGel is the best of everything I’ve worked with in terms of healing,” claims Dr. Johnson, who also cites the product’s cost-effectiveness, ease in handling and its once-a-day application. The combination of quicker healing and better patient compliance appears to be big factor in the emergence of the AmeriGel Wound Dressing. “The advantages seem to be faster healing without the drudgery of soaking the toe(s) twice a day,” explains Dr. Travers. AmerX Health Care claims what once took four to six weeks to heal now takes two to three weeks when DPMs use the AmeriGel Wound Dressing. While he believes the cost of AmeriGel is a disadvantage, Dr. Travers says the no-soak convenience is a big plus. He says most patients prefer applying a medication and bandage once a day as opposed to soaking 15-20 minutes a day and applying topical medication and a bandage. George Merritt, DPM, agrees that a big advantage to using AmeriGel is its lack of a soaking requirement. Other Key Considerations Also be aware that occasionally, patients may experience allergic reactions to the product. Dr. Johnson has found that 1 to 2 percent of his patients have hypersensitivity reactions to it, possibly due to an allergy to oakin, the main ingredient in AmeriGel. Dr. Travers adds that one of his patients was allergic to one of AmeriGel’s components and he had to revert back to the soaks. He also notes that another patient became infected so he had to stop using AmeriGel and initiate soaks and oral antibiotics before the problem resolved. How Does AmeriGel Stack Up To Silvadene? Overall, however, some podiatrists seem to think AmeriGel is a better alternative than Silvadene, a sulfa-based, broad-range antimicrobial (bactericidal) and antifungal indicated for use on burns and skin infections. Silvadene is more expensive than AmeriGel and causes maceration and extra moisture in the wound area, according to Dr. Johnson. Dr. Merritt agrees, emphasizing that AmeriGel is a cheaper, OTC product that works “a lot better” than Silvadene. Yet AmerX Health Care notes that a recent survey found that 45 percent of podiatrists use Silvadene to dress their matrixectomies and instruct their patients to soak frequently. The remaining 55 percent use various antibiotic topicals which help prevent infection but still require soaking. According to AmerX, the survey also found that an average of 30 percent of patients are noncompliant with post-operative instructions, specifically with soaking. AmeriGel notes that in a comparison case study, Silvadene and AmeriGel were used as topical medications on a patient who was undergoing a total bilateral matrixectomy. The patient was a healthy, 49-year-old male, non-compromised, non-diabetic with controlled hypertension. After the total bilateral matrixectomy was completed, a DPM applied Silvadene to the left toe and AmeriGel to the right toe, and then applied appropriate bandages. The DPM instructed the patient to keep the dressings dry and intact, and to return for a follow-up visit in 48 hours. Immediately after the dressings were removed, the left toe showed maceration and a need for debridement wheras the right toe had a clean, debris-free nail bed that only needed to be redressed. The patient later reported the left toe was sore and tender while the right toe was asymptomatic. Upon the patient’s request, the DPM discontinued Silvadene and applied AmeriGel bilaterally thereafter.