Expert Insights On Wound Care Products
Dr. Grossman says randomized controlled prospective studies have supported using growth factors for diabetic neuropathic ulcerations. While Dr. Karlock has used growth factors with success on vasculitic ulcers, he wasn’t that impressed with the clinical outcomes in the Regranex study, which he says showed “only a small increase in the percentage of healing with a growth factor versus the control group.”
Drs. Hanft and Rosenblum have used Regranex (becaplermin) and have found it helpful in facilitating increased granulation tissue in wounds. However, acknowledging the author Steed, Dr. Rosenblum cautions that using becaplermin isn’t a substitute for performing good wound debridement.
Dr. Blitch adds that he has had “several success stories” using Regranex, including some off-label use on patients with sickle cell disease.
Q: What other wound care products do you use and why?
A: Dr. Karlock says he uses topical agents such as Bactroban and IntraSite gel. Dr. Hanft notes that he uses the topical Acticoat not only to eliminate bacteria, but also to decrease bacterial burden in wounds that are not frankly infected.
Dr. Karlock occasionally uses Kaltostat for a highly draining wound, as well as Aquacel. Drs. Grossman and Rosenblum note that alginate products can be effective for highly exudative wounds, and Dr. Rosenblum adds that they’re also good for filling or packing voids.
When it comes to larger, deeper wounds, Drs. Grossman and Rosenblum are fans of using VAC therapy. Dr. Grossman has used the VAC after performing extensive debridements and/or after performing open amputations for severe diabetic foot infections. He praises the device for its constant suction of exudate, dressing changes every 48 hours and the ease of use for patients.
Drs. Grossman, Hanft and Rosenblum all have experience in using living skin equivalents for chronic wounds. Dr. Grossman has used Oasis to treat neuropathic ulcers. Dr. Rosenblum has employed Apligraf and Dermagraft in specific cases and found that “each of these can be helpful in stimulating a wound that has been slow to heal.”
He adds that hydrogels can be useful when a moist environment is favored or when wet-to-dry dressings have been too drying.
Q: Do you have any use for wet-to-dry dressings?
A: Each of the panelists has had experience in using wet-to-dry dressings. “Wet-to-dry dressings are certainly useful in the proper patient population,” says Dr. Blitch. “The problem with wet-to-dry dressings is that many physicians improperly use them as a panacea for wound care.”
Dr. Blitch will use wet-to-dry dressings in patients with deep necrotic wounds that exhibit evidence of a high microbial load. He prefers to use a dilute Dakin’s solution to moisten the dressing and then have the patient remove the materials when they are nearly dry. According to Dr. Blitch, the solution has an antimicrobial effect and the dressing change mechanically removes necrotic tissue that has adhered to materials.
Dr. Rosenblum uses the dressings but says he is less likely to use them with a larger void and hesitates to use them in cases of exposed tendons or cartilage. “In these cases, I may use a hydrogel product,” he says. “I will occasionally use dilute Betadine, especially when there is a relatively superficial wound with a moderate amount of exudates.”
Dr. Hanft does not use the standard wet-to-dry dressing, although he does frequently employ the wet to moist sterile water dressing or sterile saline dressing. When he uses the wet-to-moist dressing (frequently on wounds that require maintaining a moist environment and do not require autolytic debridement or elimination of bacterial burden), he does so in conjunction with Acticoat.
“In the last eight to 10 years, my utilization of wet dressings has decreased significantly with the invention and use of topical hydrogels and dressings that have a semi-permeable barrier,” notes Dr. Hanft.
At this point, Dr. Karlock says his only indication for wet-to-dry dressings is for a postoperative surgical wound. In that case, he would use it twice a day after an incision and drainage of an abscess, etc. He does not use the dressing otherwise as a standard treatment for outpatient wound care.