Advanced Wound Care Interventions for Non-Healing Wounds

Chronic and non-healing wounds are those that do not progress through the healing process in a timely or predicted manner. They are a global problem and are becoming harder to treat. Medicare estimates that over 8 million Americans have chronic wounds that cost the national health care system between $18.1 and $96.8 billion dollars annually.1
Most wound care protocols recommend standard wound care treatments, including debridement when indicated, the application of dressings, and periodic reassessment. However, non-healing wounds often require advanced treatment to enable these wounds to progress through the stages of healing.

Management of the Wound Bed

During normal wound-healing, a balance of healthy proteins and enzymes promotes healing in the wound bed. Disruption to this balance can cause the wound to become chronic. Such disruption can take many forms, although a common type of disruption is elevated protease activity, which contributes to chronic inflammation. In addition, intrinsic factors, such as age and comorbidities, and extrinsic factors, such as lifestyle and polypharmacy, can impact the delicate chemical balance in the wound bed.2
The first step for moving a chronic wound to an acute status is adequate wound bed preparation, which can be achieved with various strategies, including debridement, maintaining a proper moisture balance, and reducing the bacterial bioburden and inflammation.3 For non-healing diabetic foot and pressure injuries, offloading is also a crucial strategy. For venous ulcers, compression can be beneficial.2
The road to healing for many wounds starts with management of the wound bed. Moreover, the effectiveness of many advanced therapies relies on proper wound bed preparation that promotes healing.2 Even with the introduction of advanced wound therapies, including dressings, negative pressure wound therapy (NPWT), and cellular and/or tissue-based products, less than half of wounds heal after 12 weeks of treatment. However, the combination of proper wound bed preparation and advanced therapy can lead to greater success in helping these wounds achieve healing.3

Advanced Therapies for Non-Healing Wounds

Cellular and Tissue-Based Therapies

This type of advanced therapy consists of several therapies based on cells, including3:

  • Stem cells, including bone marrow stem cells, keratinocytes, and fibroblasts
  • Scaffolds, including carrier systems
  • Skin substitutes
  • Tissue-based therapies, including autologous blood derivatives for wound care and advanced cell therapy
  • Epidermal substitutes, dermal substitutes, and dermoepidermal substitutes
  • Melanocytes, vessels, and genetic manipulation

Stem cells derived from a variety of sources induce immunomodulation in the wound bed and facilitate healing by resolving inflammation, thus making them attractive cell therapeutic agents to treat chronic wounds.4
Negative Pressure Wound Therapy
NPWT has been described as an effective treatment for wounds of many etiologies, including complex non-healing wounds.5 With NPWT, subatmospheric pressure is applied to the surface of a wound sealed off by a film dressing and connected to a suction pump and drainage collection system with a tube. The use of NPWT is becoming increasingly popular because it can reduce the number of dressing changes required. It can be readily applied at the bedside,6 and it can result in improved healing and better patient outcomes.7
Antimicrobial Dressings
There are numerous innovative wound care dressings specifically developed to treat chronic wounds. These dressings contain a variety of antimicrobial agents, such as silver,2 polyhexamethylene biguanide, medical-grade honey, povidone-iodine, dialkylcarbamoyl chloride, and chlorhexidine gluconate.8 These dressings can work to manage bioburden levels in the wound and inhibit protease activity.2

Conclusion

Chronic wounds remain a significant challenge in clinical practice and can have a detrimental impact on patients’ quality of life. Understanding the biological processes occurring in the wound bed can help clinicians optimize these conditions and select compatible advanced therapies to overcome the challenges that delay healing of complex and chronic wounds.
References
1.Nussbaum SR, Carter MJ, Fife CE, et al. (2018). An economic evaluation of the impact, cost, and Medicare policy implications of chronic on-healing wounds. Value Health. 2018;21:27-32.
2.Chamanga ET. Clinical management of non-healing wounds. Nurs Stand. 2017;32(29):48-62.
3.Armstrong DG, Bauer K, Bohn G, et al. Principles of best diagnostic practice in tissue repair and wound healing; an expert consensus. Diagnostics (Basel). 2020;11(1):50. https://doi.org/10.3390/diagnostics11010050. Accessed February 15, 2021.
4.Nuschke A. Activity of mesenchymal stem cells in therapies for chronic skin wound healing. Organogenesis.2014;10(1):29-37.
5.Apelqvist J, Willy C, Fagerdahl A, et al. EWMA document: negative pressure wound therapy. J Wound Care.2017;26(Suppl 3):S1-S154.
6.Robert N. Negative pressure wound therapy in orthopaedic surgery. Orthop Traumatol Surg Res. 2017;103(1 Suppl):S99-S104.
7.El-Sabbagh AH. Negative pressure wound therapy: an update. Chin J Traumatol. 2017;20(2):103-107.
8.Mana TSC, Donskey C, Carty N, Perry L, Leaper D, Edmiston CD Jr. Preliminary analysis of the antimicrobial activity of a postoperative wound dressing containing chlorhexidine gluconate against methicillin-resistant Staphylococcus aureus in an in vivo porcine incision wound model. Am J Infect Control. 2019;47:1048-1052.

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What Is the Wound Telling You?

Wound healing can stall for a number of reasons. Wounds that have not healed or significantly reduced in size after four to six weeks are considered chronic. They are characterized by a multitude of impeding factors including biofilm, excess matrix metalloproteinases (MMPs) and extracellular matrix degradation, inflammation, fibrosis, unresponsive keratinocytes and fibroblasts, and atypical growth factor signaling.
The vast majority of chronic wounds contain biofilm, which delays or stalls progression in the inflammatory phase of wound healing.1 Molecular and cellular abnormalities in chronic and hard-to-heal wounds lock in chronic inflammation, which plays a major role in suspending the normal healing process. The ultimate aim is to transform chronic wounds back into acute wounds to enable them to heal.2,3
Monitoring healing progress by checking wound status every two to four weeks can help determine what the stalling factors are, as can knowing what signs to look for within the wound — specifically, biofilm, granulation tissue and wound pain.

Biofilm in Chronic Wounds

If the wound is not smaller after four to six weeks, biofilm may be present in the wound, signaling that the clinician should review the treatment plan. Identifying biofilms early on and adjusting the plan of care as necessary are both essential in optimizing wound healing outcomes.4
Clinicians should know how to effectively identify devitalized wound tissue types and the signs of bacterial imbalance. Devitalized tissue (slough, eschar) impairs wound healing and should be removed as appropriate. Biofilm formation triggers a chronic inflammatory response in the wound that results in a high number of neutrophils and macrophages, which in turn leads to higher levels of reactive oxygen species and proteases ([MMPs] and elastase) that will then damage normal healing tissues, proteins and immune cells.
Biofilm formation follows a common pattern of bacterial cell attachment, microcolony formation, maturation and dispersion. During the initial attachment, biofilm is reversible; if not reversed, the attachment becomes stronger, and cells begin to multiply rapidly. They also begin to mutate so that they can compete in this now intensely crowded environment. At this point, the bacteria begin using quorum sensing, a communication process that enables the bacteria to regulate what genes they express as the cell population density increases.4-6
There is no fix-all solution or gold standard test for identifying or treating biofilm in a wound.5Evidence suggests that physical removal (debridement) and continuous, vigorous cleansing are the best ways to reduce biofilm colonies.6 These strategies not only help prevent and manage biofilm, but also reduce antibiotic usage, thereby supporting antimicrobial stewardship.
Using a combination of debridement methods is one way to battle biofilm in chronic wounds and accelerate healing.7 Sharp debridement is the most aggressive approach. The clinician uses a scalpel, forceps, scissors and other surgical instruments to remove biofilm and devitalized tissue, stimulating platelets to release growth factors key to tissue repair and move chronic wounds into an acute state.
Wound cleansers and solutions used in chronic wounds help decontaminate the wound, disrupt biofilm and promote healing. Cleansing the wound bed surface, periwound and surrounding skin with non-cytotoxic solutions is essential. Various delivery methods make them user-friendly for both the patient and clinician.
Advanced wound care dressings can be used in chronic wounds to prevent and manage biofilm. The wide array of impregnated dressing technologies includes antimicrobial formats in collagens, alginates, foams, hydrogels, gauzes and topical agents. Antimicrobial or bacteriostatic dressings may be impregnated with silver, cadexomer iodine, copper, methylene blue, gentian violet, polyhexamethylene biguanide (PHMB), etc. Used appropriately, these dressings and products have been found to be effective in chronic wound management.
Once biofilm and infection have been resolved, clinicians should look for methods of encouraging wound closure. Cellular and/or tissue-based products (CTP) can be one method of encouraging closure. CTPs come in a variety of formats, and may include collagens or antimicrobials such as silver or PHMB. They encourage wound closure by providing elements such as extracellular matrices, collagen, and other vital components that act as a scaffold for the healing wound. Encouraging rapid wound closure can ensure better outcomes for the patient, such as reduced costs, reduced pain, and better quality of life. CTPs that contain an antimicrobial component can provide a barrier against bioburden.

Granulation Tissue in Chronic Wounds

Irregular or unhealthy granulation tissue indicates poor healing and/or infection and requires a wound culture and appropriate treatment based on the culture results. Absent infection, chemical cauterization with silver nitrate or a topical steroid can be used to facilitate healing.8

Wound Pain

Numerous factors can cause wound pain, including underlying pathology/etiology, skin damage, nerve damage, blood vessel injury, infection and ischemia. Psychological and emotional factors can also trigger wound pain. Clinicians need to listen to their patients to help identify the type of pain, its cause(s) and the best treatment options. Because chronic pain impacts patients’ quality of life, appropriately managing the pain is paramount to achieving the best possible outcomes for patients.9
Practical knowledge of prognostic indicators and risk factors in chronic and hard-to-heal wounds — including biofilm, granulation tissue and wound pain — is essential to early identification, treatment and successful healing outcomes.

References

1. Murphy C, Atkin L, Swanson T, et al. International consensus document. Defying hard-to-heal wounds with an early antibiofilm intervention strategy: wound hygiene. J Wound Care. 2020;29(Suppl 3b):S1-S28.
2. Hayes, Skin Substitutes for Chronic Foot Ulcers in Adults with Diabetes Mellitus: A Review of Reviews, November 2018; Nicholas et al., 2016.
3. Liu Y, Panayi AC, Bayer LR, Orgill DP. Current Available Cellular and Tissue-Based Products for Treatment of Skin Defects. Adv Skin Wound Care. 2019 Jan;32(1):19-25.
4. Vowden P. Hard-to-Heal Wounds Made Easy. Wounds International. 2011;2(4):1-6. Available from: www.woundsinternational.com
5. Wolcott RD, Kennedy JP, Dowd SE. Regular debridement is the main tool for maintaining a healthy wound bed in most chronic wounds. J Wound Care. 2009;18(2):54-56.
6. World Union of Wound Healing Societies (WUWHS), Florence Congress, Position Document. Management of Biofilm. London: Wounds International 2016.
7. Ayello EA, Cuddigan JE. Debridement: controlling the necrotic/cellular burden. Adv Skin Wound Care. 2004;17(2):66-75.
8. Alhajj M, Bansal P, Goyal A. Physiology, Granulation Tissue. [Updated 2020 Nov 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan. Available from: www.ncbi.nlm.nih.gov/books/NBK554402/
9. Frescos N. What causes wound pain?. J Foot Ankle Res. 2011;4(Suppl 1):22.
10. Wolcott RD, Kennedy JP, Dowd SE. Regular debridement is the main tool for maintaining a healthy wound bed in most chronic wounds. J Wound Care. 2009;18(2):54-56.
11. World Union of Wound Healing Societies (WUWHS), Florence Congress, Position Document. Management of Biofilm. London: Wounds International 2016.

Recommended for You

Dermlin series are developed by Jiangsu Yenssen Biotech Co., Ltd. as the advanced functional dressing in the world, containing inorganic formula with nano pores granule which has significant effects of neutralizing acidic exudation of the wound, preventing secondary infection, accelerating a proliferation of the human epithelial cells, resulting in fast healing and less scar formation.

Contact us for more details: [email protected]

Refractory Wounds: Etiologic Factors and Management

Refractory wounds comprise a significant worldwide health problem. Wounds that fail to heal not only impact quality of life but also impose a significant physical, psychosocial, and financial burden. Additionally, individuals with refractory wounds often experience significant morbidity and sometimes mortality. Wound infections and amputations are common in this population, and chronic conditions often exist as well.

Definition of Refractory Wounds

By definition, refractory wounds are chronic wounds that do not respond normally to treatment. A wound is considered refractory if there is no improvement within two to four weeks of implementing an evidence-based plan of care. Wound size and duration are predicative factors for wound healing. Ninety percent of all non-healing wounds have been identified as diabetic or neuropathic wounds, pressure injuries, or wounds of venous etiology, and they are often multifactorial.
Identifying Wound Etiology and Causative Factors
We’ve all seen and cared for wounds that just won’t heal. When developing an evidence-based plan of care for wound management, it is important first to determine wound etiology. We cannot effectively heal something if we don’t know the cause. Wound etiology guides treatment, and determining the cause of a wound is an important first step in putting together an evidence-based plan of care for treatment and prevention of wound recurrence.
Once wound etiology is determined, we must try to correct the identified causative factor. If it cannot be fully corrected, the plan of care will need to be adjusted. Supportive, evidence-based topical treatment with an individualized plan of care is key to successful wound management. An inability to correct etiologic factors will lead to impaired healing. A bedbound patient with an inconsistent turning schedule and a diabetic patient with inconsistent offloading of the plantar surface are examples of patients in whom healing would be impaired and the etiologic factor is not fully corrected. It is important to remember that a biopsy should be considered whenever a wound is non-healing and the reason for failure to heal is unclear.
Systemic factors affecting repair are commonly categorized into four parts: intrinsic, extrinsic, iatrogenic, and adherence. In this blog, we will focus on intrinsic factors affecting repair and thereby contributing to a refractory wound.

Intrinsic Factors in Wound Healing

Intrinsic factors are those belonging to the patient, and they include both modifiable and non-modifiable factors. The patient’s comorbidities and physical and physiologic conditions that impact wound healing are classified as intrinsic factors. Some examples include age, the presence of chronic illness, tissue perfusion and oxygenation (also related to chronic disease), immunosuppression (autoimmune diseases and medications that can suppress the immune system), and neurologic impairment (spinal cord injuries are common here).
As discussed in prior blogs, older adults are at risk for a multitude of skin issues, skin breakdown, and impaired healing related to aging changes both internally and specifically within the different layers of the skin (thinning epidermis, dermal atrophy, dryness, and reduced elasticity). Additionally, the increased prevalence of chronic illness among older adults contributes to recognizing age as an intrinsic factor affecting wound healing.
Chronic illnesses also contribute to refractory wounds as an intrinsic factor. Diabetes, heart disease, cancer, vascular disease, and neuropathic diseases are all examples of chronic illnesses that may cause a delay in healing for a multitude of reasons. Blood flow and tissue perfusion, sensory perception, and adequate oxygenation are all important factors to consider when looking at the healing process.
Perfusion and oxygenation are significant factors in the healing process as well; inadequacies in either will likely result in a failure to heal or delay in the healing process. Chronic illnesses can often lead to impairments in perfusion and oxygenation.
Immunosuppressive conditions (cancer, diabetes) and treatments (chemotherapy, whether for cancer or autoimmune reasons, and corticosteroid therapy leading to immunosuppression) cause impairment of the initial inflammatory response required for healing to occur and therefore usually result in delayed wound healing.
Finally, neurologic conditions often result in refractory wounds as well. Spinal cord injury (SCI) patients are known to have delayed healing below the level of injury for many reasons: persistent inflammation, edema, and changes in perfusion and oxygenation.1 Additionally, SCI patients are at a high risk for pressure injury development given their impaired sensory perception, impaired mobility, and often altered weight-bearing status. SCI patients are often identified as at risk for pressure injuries according to the Braden Scale.

Conclusion

It is important to piece together all of the systemic factors impacting healing when looking at reasons that a wound is not improving within two to four weeks of evidenced-based topical therapy and a comprehensive plan of care. Additionally, it is always important to remember to treat the WHOLE patient, not just the HOLE in the patient—a common theme among many of my prior blogs.
In future blogs, we will be exploring and defining the remaining three common factors affecting tissue repair: extrinsic factors, iatrogenic factors, and adherence.

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Contact us for more details: [email protected]

How Inflammation Affects Wound Healing

An injury to the human body initiates a wound healing chain reaction that occurs in four sequential but overlapping phases: hemostasis, inflammatory, proliferative and maturation. This post focuses on the second (inflammatory) phase, which begins after blood flow stops (i.e., hemostasis) and defender white blood cells, or leukocytes, migrate to the site of the injury — a process known as chemotaxis.1

Understanding the Inflammatory Stage of Wound Healing

The inflammatory stage typically lasts several days, but it can go on for much longer, making the wound chronic. Many cells and chemical reactions or signals keep the wound progressing in the inflammatory phase. Understanding these processes can jump-start a chronically stalled wound so that healing resumes.
The clinician’s goals in the inflammatory phase are to limit further damage, close the wound, remove cellular debris and bacteria, and encourage cellular migration.1 Following hemostasis and chemotaxis, white blood cells and thrombocytes release more mediators and signaling cytokines, which accelerates the inflammatory process. Several growth factors work in concert to promote collagen degradation, transform fibroblasts, grow new blood vessels and work toward re-epithelialization. Platelets release mediators, including serotonin and histamine, to increase cellular permeability.1 Fibroblasts are recruited and multiplied by platelet-derived growth factors. Once the fibroblasts are in place, they produce collagen, a crucial protein the body needs for building and remodeling.
During this process, a fibrin scaffold forms through platelet activation.1 The scaffold gives the inflammatory cells a place to stick. Some of the inflammatory cells attracted to the scaffold are neutrophils, monocytes and endothelial cells.1
Neutrophils digest cellular debris and bacteria through a process called phagocytosis, which helps cleanse the wound. Monocytes fight infections and help remove dead or damaged tissues.2 Endothelial cells send signals to organize the growth of connective tissue cells that eventually form the surrounding layers of blood vessel walls.3All these cells working in concert keep the wound moving to the next healing phase, known as the proliferative or granulation phase.
Matrix metalloproteinases, or MMPs, are required for the migration of inflammatory cells. MMPs also break down proteins to allow new tissue to form. However, if MMP levels get too high or if MMPs are present for too long, they can break down proteins and growth factors and stall wound healing.4

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References
1. Basehore, B. M., Zito, P. M., & Wallace, H. A. (2020). Wound Healing Phases. Treasure Island, FL: StatPearls Publishing.
2. Territo, M. (2020, January). Monocyte Disorders. Retrieved from Merck Manuals.
3. Alberts, B., Johnson, A., Lewis, J., Raff, M., Roberts, K. & Walter, P. (2002). Molecular Biology of the Cell. New York: Garland Science.
4. Cullen, B., Gibson, D., Harding, K., Legerstee, R. & Shultz, G. (2009). MMPs Made Easy. Wounds International, 1(1), 1-6.

Delayed Care During the COVID-19 Pandemic: Effects on Chronic Wound Therapy

Chronic wound care is challenging for the entire healthcare ecosystem, from clinicians to patients, and COVID-19 has only exacerbated those challenges. Patients are delaying primary care provider and wound clinician visits for ongoing guidance and therapy to reduce possible exposure to the virus. This is understandable, as many chronic wound patients are in the high-risk category if they become ill with COVID-19.1They are also putting off elective surgeries, annual physicals, and basic preventive care, which can negatively affect long-term outcomes. A survey of wound care clinicians in March 2021 reported a decrease in patient visits from pre-pandemic numbers, and 57% of respondents stated that “wound severity has either increased or significantly increased since the start of the pandemic.”2 At the same time, the pandemic has accelerated patient-driven care and increased usage of interactive devices for care administered at home, rapidly increasing the use of telemedicine across demographics. In fact, one report by the research firm Frost & Sullivan says the demand for telemedicine services in the United States grew by over 60% in 2020 due to the pandemic.3 As the pandemic continues, it’s important to look at how reduced access to care might affect wound care in the future and how patient-driven and more value-based care options will come into play in daily practice.

The Trickledown Effect on Patient Outcomes and Their Wounds

While there have been improvements, access to care has not fully recovered, and continued COVID-19 surge rates suggest that delayed preventive and emergent wound care could continue to trend.4 This is a negative outcome from a public health perspective, which could prove catastrophic for wound patients as they leave themselves vulnerable to infection, sepsis, amputation, and possibly death. These problems are especially concerning in our growing senior population, whose chronic wounds are complicated by vascular disease, diabetes mellitus, and unrelieved pressure. A reduction of traditional weekly or biweekly wound care visits could increase hospitalization by a factor of 20 in the United States,5 exposing the scale and often unknown prevalence of chronic wounds and their impact on the healthcare system.
The increase in the rate of untreated wounds over the last year has led some researchers to describe the situation as a “pandemic within a pandemic.” A trauma center study in Ohio found that diabetic patients were “10.8 times more likely to undergo any level of amputation and 12.5 times more likely to undergo a major amputation during the COVID-19 pandemic.” Another study reported in the same AJMC article showed that “during COVID-19 lockdowns, patients with diabetes admitted to a tertiary care center for DFU had a more than threefold risk of amputation compared with those in 2019.”6 None of this is surprising, considering how delayed care has swept across the U.S. healthcare system, especially during the stage of rising Delta variant rates. And it’s impossible to imagine how neglected wound care rates could increase when a new variant emerges. COVID-19 has had a sustained, ongoing impact on how patients receive wound care. Or even if they will be able to receive care, because patients may remain uncomfortable visiting clinics as the pandemic lingers. Widespread staffing shortages are also a concern, and wound care treatment must adapt to meet patients where they are and where they feel comfortable receiving care.

Leading Through Patient-Centered Solutions

As the healthcare industry examines existing challenges, its leaders are finding new ways to transform outcomes. One notable shift is the acceleration of telemedicine. It is already a viable choice for healthcare professionals regarding preventive care like consultations, prescriptions, wellness checks, counseling, and more. Access is an essential reason telehealth—or telemedicine—is playing such an important role. In 2019, more than half of U.S. households used the internet for health-related activities.7 And the pandemic has escalated this shift.8 During the first quarter of 2020, the number of telehealth visits increased by 50% compared with the same period in 2019.8
Solutions

Dermlin series are developed by Jiangsu Yenssen Biotech Co., Ltd. as the advanced functional dressing in the world, containing inorganic formula with nano pores granule which has significant effects of neutralizing acidic exudation of the wound, preventing secondary infection, accelerating a proliferation of the human epithelial cells, resulting in fast healing and less scar formation.

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References

1.Oropallo A. COVID-19: issues related to wound care and telehealth management. UpToDate. September 2021. Accessed October 27, 2021. https://www.uptodate.com/contents/covid-19-issues-related-to-wound-care-…
2.Armstrong DG. Managing the surge: delayed chronic wound care during COVID-19. AJMC. September 21, 2021. Accessed October 27, 2021. https://www.ajmc.com/view/managing-the-surge-delayed-chronic-wound-care-…
3.Frost & Sullivan. Telehealth to experience massive growth with COVID-19 pandemic, says Frost & Sullivan. May 13, 2020. Accessed October 27, 2021. https://www.frost.com/news/press-releases/telehealth-to-experience-massi…
4.National Center for Healthcare Statistics. Reduced access to care: RANDS during COVID-19. CDC.gov. Updated August 6, 2021. Accessed October 27, 2021. https://www.cdc.gov/nchs/covid19/rands/reduced-access-to-care.htm
5.Sen CK. Human wound and its burden: updated 2020 compendium of estimates. Adv Wound Care (New Rochelle). 2021;10(5):281-292. Accessed October 27, 2021. https://doi.org/10.1089/wound.2021.0026
6.Armstrong DG. Managing the surge: delayed chronic wound care during COVID-19. AJMC. September 21, 2021. Accessed October 27, 2021. https://www.ajmc.com/view/managing-the-surge-delayed-chronic-wound-care-…
7.Johnson J. Internet usage in the United States: statistics & facts. Statista. August 4, 2021. Accessed October 27, 2021. https://www.statista.com/topics/2237/internet-usage-in-the-united-states
8.Koonin LM, Hoots B, Tsang CA, et al. Trends in the use of telehealth during the emergence of the COVID-19 pandemic — United States, January–March 2020. MMWR Morb Mortal Wkly Rep. 2020;69:1595-1599. Accessed October 27, 2021. https://doi.org/10.15585/mmwr.mm6943a3

Wound Dressing Options for Achieving Moisture Balance

Selection of a wound dressing requires a multifaceted approach. Currently, no dressing can meet all needs of a wound (infection prevention, promotion of re-epithelialization, moisture balance, etc.). Clinicians must weigh the benefits and drawbacks of the dressing or dressings chosen, to optimize wound healing. However, one aspect that is common to most wound dressings is the need for moisture balance to promote wound healing. To achieve this balance, an appropriate dressing must be chosen.
To aid in the clinical reasoning process, this discussion contains a breakdown of the dressings that research indicates are most effective for maintaining a wound’s moisture balance.

Alginate Wound Dressings

Alginates are non-adhesive pads and ribbons composed of natural polysaccharide fibers or xerogel.
Benefits. After absorption of exudate, alginates form a moist environment. Alginates are easy to pack, can be applied over irregularly shaped wounds, and are generally comfortable for the patient.
Indications. Alginates are indicated for wounds with large amounts of exudate. These wounds may include:
Pressure injuries
Diabetic foot ulcers
Cavity wounds
Venous leg ulcers
Post-operative wounds
Traumatic wounds
Partial-thickness burns
Contraindications. Alginates must have exudate to absorb to promote proper moisture balance. They should not be used on dry wounds, over eschar, on third-degrees burns, or on surgical wounds. They are also contraindicated for wounds with anaerobic infections.
Other Factors to Consider. Alginates often require a secondary dressing because they do not have adhesive properties. To optimize moisture balance, the secondary dressing may also act as a barrier to absorb excess fluid that the alginate cannot absorb.

Collagen Wound Dressings

Collagen wound dressings come in a variety of forms and contain collagen derived from animal sources. Collagen dressings encourage the deposition of new collagen fibers, support granulation tissue formation and new tissue growth, and ultimately support a moist wound healing environment.
Benefits. Collagen dressings encourage the deposition of new collagen fibers and support granulation tissue formation and new tissue growth. As collagen absorbs exudate, it helps create and maintain a moist environment directly on the surface of the wound bed, and it helps to maintain the hemodynamic stability of the wound bed. Collagen is biodegradable and fully utilized in the wound bed; therefore, there is no need for its removal from the wound surface during dressing changes.
Indications. Collagen wound dressings are indicated for the following wound types:
Abrasions
Full-thickness and partial-thickness wounds
Dehisced surgical wounds
Donor sites and other bleeding surface wounds
Pressure injuries
Diabetic foot ulcers
Ulcers caused by mixed vascular etiologies
Traumatic wounds healing by secondary intention
Contraindications. Collagen wound dressings should not be used on the following wound types:
Third-degree burns with dry eschar
Wounds with dry eschar
Wounds with active vasculitis
Wounds with sensitivity to collagen or silver
Other Factors to Consider. Collagen wound dressings require a secondary dressing and are a cost-effective means of promoting moist wound healing in wound management.

Foam Wound Dressings

Foam dressings are made of semipermeable, small, open cell polyurethane. They contain foamed polymer solutions and are capable of holding fluids. The level of absorption depends on the material and the thickness, as well as the number of layers and the types of materials making up those layers.
Benefits. The primary functions of foam dressings include:
Absorption of wound exudate
Maintenance of a moist wound healing environment
Insulation of the wound to maintain a constant temperature to facilitate cell division and migration
Control of biofilm development (foams with antimicrobial properties)
Use in infected or non-infected wounds
Use as a primary dressing on shallow wounds and as a secondary dressing on deeper wounds
Skin protection on top of bony prominences or high-friction areas on the skin
Indications. Foam dressings may be indicated for any wound with excessive exudate. These wounds may include:
Diabetic foot ulcers
Venous leg ulcers
Pressure injuries
Chronic wounds
Surgically dehisced wounds
Foam dressings may also be indicated for:
Skin tears
Skin grafts and donor sites
Venous ulcers (in combination with compression therapy)
Contraindications. Foam dressings are contraindicated on third-degree burns, necrotic tissue, or wounds without drainage. Non-silicone foam dressings should be used carefully on or near fragile skin.
Other Factors to Consider. Foam dressings do not need to be changed frequently because they are highly absorbent and can remain in place up to seven days. Of note, foam dressings with silver or other antimicrobials may reduce the overall cost of wound care.

Gelling Fiber Wound Dressings

Gelling fiber dressings control exudate levels to reduce the risk of periwound maceration while maintaining a moist wound healing environment.
Benefits. Gelling fibers aid in moisture balance by managing drainage. They also promote a slow level of autolysis7 by helping remove necrotic, damaged, or infected tissue from a wound. This promotes a slow level of autolysis.7 As exudate is absorbed into the dressing, it forms a soft gel, while encapsulating the wound in a healthier, moist environment promoting the formation of granulation tissue. Although gelling fiber dressings conform to the terrain of various wound shapes, they can also be removed in one piece without damaging new granulation tissue.
Indications. Gelling fiber dressings are indicated for wounds with moderate to excessive exudate, as well as aiding in the removal of dead, damaged, or infected tissue from the wound. They are also available with antimicrobial properties, most often silver, to aid in addressing biofilm control and for use with infected wounds.
Contraindications. Gelling fiber dressings should not be used on dry wounds. If used with lower levels of exudate, gelling fiber dressings should be saturated with saline before application, and if needed they must be soaked with a saline solution before removal to reduce the risk of wound damage.
Other Factors to Consider. Gelling fiber dressings have been found to be the most cost-effective for post-operative wounds after total hip or knee arthroplasty.

Hydrocolloid Wound Dressings

Hydrocolloid wound dressings are advanced wound care dressings composed of gelatin, pectin, or carboxymethylcellulose. They are available in the form of wafers, powders, or pastes. The wafer forms are waterproof and self-adhering, and this makes them easy to use, while they are maintaining a moist wound healing environment conducive to granulation tissue formation.
Benefits. Hydrocolloid dressings facilitate granulation tissue formation, inhibit bacterial growth through an acidic environment, and promote autolytic debridement.
Indications. Hydrocolloids are indicated for the following wound types:
Wounds with light to moderate exudate
Partial- and full-thickness wounds
Pressure injuries
Minor burns and abrasions
Leg ulcers
Burns
Donor sites
They can also be indicated as a protective measure against shearing forces and pressure injury development on bony prominences.
Contraindications. Hydrocolloids should be avoided in wounds with high levels of exudate, dry wounds, infected wounds, and diabetic foot ulcers because of growth of anaerobic bacteria.They also should not be used after hypergranulation has occurred.
Other Factors to Consider. Hydrocolloid dressings have been found to be the most cost-effective type of dressing for pressure injuries. They can be used in high-friction areas because they adhere well to intact tissue. Additionally, hydrocolloid dressings can help to reduce pain. Hydrocolloid dressings should not be removed with a vertical pull; instead, loosen the edge and pull horizontally, and the dressing will release easily from the skin. This technique helps to reduce the risk of skin tears with the dressing’s removal in patients with fragile skin.

Hydrogel Wound Dressings

Hydrogels are designed to provide moisture and rehydrate a dry wound bed. Hydrogels come in three main forms: amorphous, impregnated, and sheets.
Amorphous hydrogel: viscous form. It comes in tubes, foil packages, or spray bottles.
Impregnated hydrogel: hydrogel-saturated gauze pad, nonwoven spongy ropes or strips.
Sheet hydrogel: hydrogel that is held together by a thin fiber mesh. This type of hydrogel wound dressing is available with and without the adhesive borders.
Also, all are available in antimicrobial versions, with silver being the most widely used antimicrobial additive.
Hydrogel dressings are 90% water- or glycerin-based, and the other 0% consists of three-dimensional networks of hydrophilic polymers. These dressings are designed to maintain optimum moisture level in he wound bed (some have the ability to absorb small amounts of exudate). This provides an ideal environment for proper and easier wound cleaning and pain management. As a result, the formation of necrotic tissues can be decreased, so that the healing process may progress in timely fashion to closure.
Benefits. Hydrogels offer moisture to a dry wound. This high moisture content is beneficial in:
Providing a barrier to potentially infectious microorganisms
Providing antibacterial enzymes in some versions
Having a soothing or cooling effect on the wound bed
1)Especially in patients with severe wounds or if the patient has other health issues, such as diabetes
2)Cooling effect can last up to six hours
Facilitating autolytic debridement
Promoting ease of removal and less pain with dressing changes because they do not adhere to the wound bed
Wounds that are very dry or necrotic wounds, such as superficial abrasions, severe scrapes, and scratches. Hydrogel helps improve this type of wound because it provides sufficient hydration that helps with skin moisture retention and effective healing. If the wound site is overdrying, it is possible for scabs to form excessively, delaying the entire healing.
Partial or full-thickness lesions. Because hydrogel dressing does not stick or allow the necrotic tissue to slough off during the healing process, it promotes faster healing process.
Minor burns. Although minor, burns almost always cause excruciating pain and tenderness to the skin. Hydrogels are helpful for minor burns in that they have a soothing effect on the wound site.
Wounds that create cavities or depressions in the skin. Hydrogels are fibrous and contain glycerin, which promotes faster cell regeneration. Applying the gel for depressed wounds is likely to improve tissue growth and minimize the risk of a dented healed wound site.
Indications. Hydrogels can be indicated for the following wound types:
Wounds with minimal exudate or necrotic tissue
1)Help improve healing by providing adequate hydration and moisture retention
2)Do not allow scabs to form, which could delay healing
Dehydrated wounds
Partial- or full-thickness wounds (superficial abrasions, scrapes, scratches)
1)Do not stick or allow the formation of necrotic tissue or slough during the healing process
Lacerations
Exposed tendon or bone
Minor burns (including those from radiation therapy), by supporting faster healing as well as having a cooling soothing effect on the burn
Wounds resulting in cavities or depressions in the skin
1)Along with the polymers, hydrogels also contain glycerin and both promote faster granulation tissue formation and epithelialization
Chickenpox lesions, by softening the scab and soothing the area
Donor sites
Pressure injuries
Contraindications. Hydrogel dressings should not be used on wounds with heavy exudate or in sinus tracts. Also important is that hydrogel dressings may cause an allergic reaction. In areas at high risk for cross contamination or infection, such as sacral or coccygeal wounds, hydrogels do not provide an adequate bacterial barrier for the wound that other dressings may offer.
Other Factors to Consider. Hydrogel dressings require changing every three days. Therefore, proper follow up care must be available. Hydrogels can be easily removed by irrigating with a saline solution before removal.

Choosing the Best Dressing

The literature has shown that no single wound dressing type will meet the needs of every wound. However, each dressing has unique properties that can help create an optimal moisture balance and promote healing. Using this guide, clinicians can decide on a case-by-case basis which wound dressing is best, following best practices while also being cost-effective.

Recommended for You

Dermlin series are developed by Jiangsu Yenssen Biotech Co., Ltd. as the advanced functional dressing in the world, containing inorganic formula with nano pores granule which has significant effects of neutralizing acidic exudation of the wound, preventing secondary infection, accelerating a proliferation of the human epithelial cells, resulting in fast healing and less scar formation.

Contact us for more details: [email protected]

How to Choose an Antimicrobial Wound Dressing: Questions to Ask and Factors to Consider

It is well known that chronic and hard-to-heal wounds have created a global crisis. Delayed healing in these wounds is often associated with biofilm, and antimicrobial dressings can be effective in managing bioburden in chronic wounds. For the use of antimicrobial advanced wound care dressings to be successful in chronic wound care, however, clinicians must have practical knowledge of dressing formats and options, dressing indications and applications, the principles of antimicrobial stewardship, and care planning for specific wound types.
There are many antimicrobial wound care dressings on the market, and making a selection can be a challenge, even for licensed health care professionals. Antimicrobial dressings are available in a variety of formats, including foams, alginates, gauzes, and more, and selecting the format most appropriate for your patient and their wound can make all the difference in wound healing.
Goals in choosing an antimicrobial dressing should include preventing, addressing, and managing biofilm and bioburden. Evaluating different antimicrobial formats, including the antimicrobial agent incorporated, mode of delivery to the wounds, and dressing material, is essential for optimal overall healing outcomes in chronic and hard-to-heal wounds.

Solutions

Dermlin series are developed by Jiangsu Yenssen Biotech Co., Ltd. as the advanced functional dressing in the world, containing inorganic formula with nano pores granule which has significant effects of neutralizing acidic exudation of the wound, preventing secondary infection, accelerating a proliferation of the human epithelial cells, resulting in fast healing and less scar formation.

See a clinical care solving chronic wounds by Dermlin on Youtube: https://youtu.be/RrQsktcYmlk

Contact us for more details: [email protected].

Is oral cavity ulcer old bad?May be these 3 reasons, often eat 3 kinds of food, to help relieve ulcers

https://www.yenssenbiotech.com/oral-ulcer-13.html

It is believed that everyone has experienced mouth sores, and in severe cases, even unable to eat.In the life besides accidentally bite cut lip, ate too excitant food outside, what reason still causes often oral cavity ulcer?

I. problems in immune function

If the body is immune dysfunction, the body will be attacked by external bacteria, may cause oral ulcers.In addition, most patients with oral ulcers also have varying degrees of diarrhea and constipation due to problems with the immune system.Common immune system diseases that can easily cause oral ulcer include behcet’s disease, systemic lupus erythematosus, etc.

Want oneself to do not have oral ulcer, want to enhance oneself immunity above all, want immunity to become good only, oral ulcer just won’t relapse.

2. Sleep environment

The body detoxifies during sleep, and if you don’t sleep well, your liver’s ability to detoxify is disrupted, which can lead to an increase in toxins in your body.Once the person sleeps badly, the spirit of the next day won’t be very good, appear immunity drops thereby circumstance.So people who don’t sleep well often get canker sores.In fact, as long as not stay up late, to ensure a quiet and comfortable sleeping environment, oral ulcer will soon be good.

Lack of necessary vitamins

Lack of vitamins, especially B vitamins, can affect body growth and can easily lead to mouth ulcers.Most canker sores are caused by vitamin B deficiency.Suggest the friend of oral cavity ulcer, notice at ordinary times compensatory vitamin, eat fruit and vegetable more.Such as the body does not lack these vitamins, oral ulcer natural good.

Although oral ulcer is not a serious disease, but our daily diet, communication caused discomfort.Many oral ulcers are recurrent and difficult to treat.In fact, oral ulcer and our diet have a lot of work and rest, in order to prevent oral ulcer, we can pay more attention to diet.

Usually, patients with oral ulcers can eat more of the following foods to relieve ulcers

1. Tomatoes

Eating more tomatoes can relieve canker sores.Tomato contains rich vitamin and nutrient composition, can squeeze tomato juice into juice, tomato juice is contained in the affected place in oral cavity, food can clean oral cavity for many times, antiseptic disinfection, promote wound to heal quickly.Have the friend of oral cavity ulcer, might as well try!

Second, the watermelon

Watermelon has clear heat detoxification, diuresis reduces the effect of heat.Long-term edible watermelon can prevent oral cavity ulcer effectively not only, still can compensatory vitamin and moisture, promote metabolism, enhance immunity.To the oral cavity ulcer that causes fire, watermelon juice has very tall remedial effect.Watermelon juice contained in the wound, several times a day, can alleviate pain, promote the rapid healing of oral ulcers.

Green bean and egg soup

Mung bean can clear heat detoxify, egg is rich in protein, mix both make mung bean egg flower soup, nutrition is more rich, facilitate human body to absorb.For people who often stay up late to eat spicy, oral ulcer is often appear, at this time if the consumption of mung bean egg soup, morning and evening, not only can clear the heat and go away, but also can timely relieve the pain of oral ulcer, help wound healing.

Tips: do not lick mouth ulcers, to adhere to the daily mouthwash, keep the mouth clean, prevent infection.

Everything you need to know about mouth ulcers is here!

Oral cavity ulcer had experienced surely everybody, indescribable had so one in the mouth, that aches!A reason for the oral ulcer, but usually because: smoking, stress and anxiety, high acidity of the fruit, oral internal friction, malnutrition and other causes.
You need to know: most oral sores are benign nuisances that recur repeatedly. For most people, oral sores heal within two weeks. Acid and spicy substances can aggravate oral sores.
A standard oral ulcer usually appears in the inner cheek, lasts about a week, and can heal itself without any treatment.Oral ulcers are classified into three types: large ulcers, small ulcers, and herpetic ulcers.
Herpetic ulcer: herpetic ulcer is a subtype of oral ulcer.Small ulcer: this ulcer is about 2-8 mm and will heal in about two weeks with mild pain.Large ulcers: large ulcers are slightly larger, irregularly shaped, and more easily infiltrate into the tissue than smaller ulcers. When they are well, they are likely to leave scars.Symptoms of large or small ulcers are usually one or more sores on the cheeks, upper jaw, tongue, and gums.It is usually a red or white round wound with an irregular shape.
Will someone ask, is canker of oral cavity ulcer the precursor that oral cavity cancerization changes?Of course not!Oral ulcer and oral cancer are two different things!
Oral ulcer will have obvious pain, and oral cancer is not;Oral ulcers usually heal within two weeks. Oral cancer does not.The plaque of oral cancer is rougher and harder;Oral cancer usually forms large red and white sores on the tongue, gums, and canker sores that are not so large.When you have several ulcers in your mouth, or sores that tend to spread over three weeks.This is the best time to go to the hospital to find a doctor for diagnosis.
Oral ulcer has no effective treatment, we can keep the mouth clean, eat more fruits and vegetables, to reduce the extent of ulcer, avoid its aggravation!https://www.yenssenbiotech.com/oral-ulcer-13.html

Common wound treatment strategy, look prepared, when necessary, very useful!

Health first line video network

Post date: 18-06-1411:26 Beijing xinma interactive media technology co., LTD

I. shallow abrasion:

If it is a very shallow scratch, the wound should be repeatedly washed with tap water or warm water, and then use iodine volt to disinfect the scratch area.Then apply the disinfectant 2-3 times a day.

2. Blunt impact:

If the skin is not broken by blunt force blow or punching, but there are local bluish and purple mass, namely subcutaneous small hematoma;Light generally do not deal with, if it is the intestines, abdomen, waist, joints or brain and other places to be more severe contusion, it is best to immediately go to the hospital for treatment.

Three, sharp tool cut:

If the skin is cut by a knife, scissors, glass, etc., you can use iodine-volt to disinfect the wound to prevent infection.If the finger is cut, should raise the hand high, pinch the root of both sides of the finger, can stop bleeding, with iodine or iodine and alcohol disinfection cut wounds, then with clean gauze wrapped.

Iv. Scalp damage:

If the wound is small, press on the skin around the wound to stop the bleeding.Then shave off or cut off the hair, thoroughly remove visible booties and foreign bodies, in the wound and around the application of disinfection liquid dressing;If the wound is large, you must go to the hospital debridement suture treatment.

Minor burns and scalds

For mild burns and scalds, immediately rinse the injured area under running water or soak it in cold water to reduce local temperature and wound pain. The duration of this cold treatment is subject to the reduction of pain.If it is a large area of serious burns or burns must be immediately to the hospital treatment.

Mild frostbite

If the limb is slightly frostbitten, warm it quickly in warm water, generally no more than 40℃, to avoid scald has lost consciousness of the tissue.If it has been frozen for too long, it is best not to defrost immediately. It should be kept dry after cleaning and protected by a bandage or other material to allow it to thaw warm.You can also apply frostbite cream to frostbite areas.If frostbite is serious, you’d better go to the dermatology department of the hospital.

In addition, if there is open trauma, especially deep wound, serious pollution, there is a risk of tetanus infection, the best to go to the hospital to inject tetanus antitoxin prevention.

Finally, I would like to remind families with young children to prevent trauma.The knife in the family, cut, thermos bottle must be put in the place that the child cannot reach, also should teach the child not to play sharp thing at ordinary times, do not use mouth to contain chopsticks, Popsicle stick, candy stick to wait to play and run, lest accident falls, occurrence trauma.wound