Using patient-reported experiences to inform the use of foam dressings for hard-to-heal wounds: perspectives from a wound care expert panel

Caring for patients with hard-to-heal (chronic) wounds requires a multifaceted approach that addresses their diverse needs, which can contribute to the complexity of care. Wound care providers must have a comprehensive understanding of the patient's comorbid conditions and psychosocial issues to provide personalised and effective treatment. Key quality indicators for effective wound care involves not only selecting appropriate local wound care products, such as foam dressings, but also addressing individual patient experiences of wound-related pain, odour, itch, excessive wound drainage, and self-care needs. The purpose of this review is to inculcate the wound care practice community, research scientists and healthcare industry with a sense of accountability in order to work collaboratively in addressing these unmet care needs.

Comparison of Medical Tape Performance Using Skin Response Quantitative Measurements on Healthy Volunteers

BACKGROUND

Medical tapes can lead to skin damage upon removal in susceptible patients with fragile skin and at higher risk of developing tissue injury.

PURPOSE

We compared the effect of medical tapes with silicone-based versus acrylate-based adhesives on the back or volar forearm stratum corneum using analytical techniques to assess skin condition and potential damage post product removal on 88 healthy volunteers.

METHODS

Two studies were conducted in separate facilities (Study 1: 3M In-house Clinical Facility, St. Paul, Minnesota; Study 2: DermiCo, LLC, Broomall, Pennsylvania). Four commercially available tapes were the same in both studies, two for each type of adhesive. We evaluated adhesion to the skin, total proteins and corneocytes removed by the tapes, changes in transepidermal water loss (TEWL), and induction of the inflammatory cytokine interleukin-1 alpha (IL-1a).

RESULTS

One of the silicone tapes displayed the strongest adhesion at 24 hours, and one of the acrylate tapes had the lowest adhesion, showing differences in performance within adhesive categories. The adhesion forces did not correlate with the amount of total protein or corneocytes removed. Silicone adhesives removed less total protein and corneocytes than acrylate adhesives. Silicone adhesives did not alter TEWL, whereas acrylate adhesives significantly raised TEWL. There were no differences in interleukin-1alpha induction.

CONCLUSION

The silicone adhesive tapes were less disruptive to the skin barrier than the acrylate adhesive tapes, even in healthy volunteers whose skin is not as fragile as what is observed in typical patients. This type of data could guide clinical product usage decisions.

How Should Clinical Wound Care and Management Translate to Effective Engineering Standard Testing Requirements from Foam Dressings? Mapping the Existing Gaps and Needs

Significance: Wounds of all types remain one of the most important, expensive, and common medical problems, for example, up to approximately two-thirds of the work time of community nurses is spent on wound management. Many wounds are treated by means of dressings. The materials used in a dressing, their microarchitecture, and how they are composed and constructed form the basis for the laboratory and clinical performances of any advanced dressing. Recent Advances: The established structure/function principle in material science is reviewed and analyzed in this article in the context of wound dressings. This principle states that the microstructure determines the physical, mechanical, and fluid transport and handling properties, all of which are critically important for, and relevant to the, adequate performances of wound dressings. Critical Issues: According to the above principle, once the clinical requirements for wound care and management are defined for a given wound type and etiology, it should be theoretically possible to translate clinically relevant characteristics of dressings into physical test designs resulting specific metrics of materials, mechanical, and fluid transport and handling properties, all of which should be determined to meet the clinical objectives and be measurable through standardized bench testing. Future Directions: This multidisciplinary review article, written by an International Wound Dressing Technology Expert Panel, discusses the translation of clinical wound care and management into effective, basic engineering standard testing requirements from wound dressings with respect to material types, microarchitecture, and properties, to achieve the desirable performance in supporting healing and improving the quality of life of patients.

Adhesives for medical application - Peel strength testing and evaluation of biophysical skin response

BACKGROUND

Medical adhesives are commonly used for securing wound dressings and medical devices used for diagnostic or therapeutic purposes. Mechanical irritation of skin due to adhesive stripping and repeated application can lead to discomfort and device removal. This study aims to examine the peel strength and skin response to different medical adhesives in a cohort of healthy volunteers.

METHOD

Twelve healthy participants were recruited for peel strength testing of three candidate adhesive tapes, and evaluation of the skin response after adhesive removal. A modified ASTM D903 peel strength testing was performed at 180° peeling angle and a rate of 300 mm/min on the forehead, upper back and forearm skin. A longitudinal study was conducted on the forearm and back, with the adhesive samples left in-situ for up to 60 h for analysis of repeat application. The effects of two skin preparation approaches (water and alcohol cleaning) prior to adhesive application were also assessed. Skin biophysical properties were assessed at baseline and at various timepoints following adhesive removal using transepidermal water loss (TEWL), erythema and hydration.

RESULTS

Peel strength reduced uniformly with repeat application over prolonged periods for all the adhesive samples tested. Skin preparation with water and alcohol cleansing prior to adhesive application increased peel strength at both the back (1.1% and 2.9%), and forearm (21.3% and 20%) sites. There was statistically significant increase from baseline to post-tape application for TEWL, skin redness and hydration (p < 0.001). However, there were no statistically significant differences between adhesive types (TEWL: p = 0.38, SR: p = 0.53, HY: p = 0.46). TEWL increased the most post-adhesion across all test sites and adhesive samples with repeat application (p < 0.05). Two-way ANOVA tests revealed no statistically significant interactions between the effects of application duration and adhesive on skin redness or TEWL for both the back and forearm sites (p > 0.05), though a significant interaction was indicted for hydration at the back site (p = 0.01).

CONCLUSION

This study revealed that site and duration of adhesive application effected peel strength. The corresponding changes in skin properties identified that skin barrier function was disrupted with long-term application of adhesives. The back site was identified to be most reliable for adhesion testing and skin response assessment for future work.

Effectiveness of wound contact layers in enabling undisturbed wound management: a case series

OBJECTIVE

Wound contact layers (WCLs) are intended to protect and support wounds during the healing process. An open, non comparative, case series clinical evaluation was undertaken to assess the impact of these dressings on establishing an undisturbed wound environment that supports effective wound management, and to allow the establishment of limits of duration of the wear time for the experimental WCLs.

METHOD

The primary objectives of this clinical evaluation were to assess the ability of the WCLs to prevent tissue disturbance to the wound and surrounding skin and for the clinicians to have confidence to extend the wear time of the WCL dressings. For them to have confidence in leaving the dressings in place for extended periods, the assessment of the wound and periwound skin condition and an assessment of patient comfort was performed: assessment of wound and periwound condition in relation to tissue adherence of the dressing to the wound resulting in tissue damage/bleeding (to wound and/or periwound skin) and cellular infiltration into the WCL; assessment of patient wearing comfort and satisfaction; assessment of WCL wear time, relating to times between dressing changes as judged by the clinician.

RESULTS

Based upon five parameters used to assess the extent to which the WCLs Atrauman, Atrauman Silicone and Atrauman Ag (HARTMANN, Germany) disturbed the underlying tissues-bleeding, wound tissue damage, periwound skin damage, tissue ingrowth and dressing adherence-the majority (>95%) of assessments indicated low or no disturbance of tissue. Over the 14 days of study assessment, the mean (±standard deviation) wear time was 7.3±1.2 days for the Atrauman group, 9.9±2.8 days for the Atrauman Silicone group, and 5.8±1.0 days for the Atrauman Ag group. All dressings were well tolerated by patients and rated highly in terms of in-use dressing performance.

CONCLUSION

The results indicate that Atrauman WCLs are suitable for the management of a variety of wounds as they promote an undisturbed wound environment, including extended wear time.

[Treatment of 52 patients with a self-adhesive siliconised superabsorbent dressing: a multicentre observational study]

OBJECTIVE

To provide 'in use' clinical data to support exudate management in patients with moderately to highly exuding wounds with bordered superabsorbent wound dressing with a silicone adhesive interface Zetuvit Plus Silicone Border (Paul Hartmann Ltd., Germany).

MATERIALS AND METHODS

This study was an open-labelled non-comparative study. Patients included in the study were selected by the clinical investigator(s) according to whether the patient required a dressing for the management of moderately to highly exuding wounds such as pressure ulcers, diabetic foot ulcers, venous leg ulcer and arterial ulcers The patients were treated with A superabsorbent sterile wound dressing with bordered superabsorbent wound dressing with a silicone adhesive interface Zetuvit Plus Silicone Border (Paul Hartmann Ltd., Germany).

RESULTS

The Zetuvit Plus Silicone Border dressing had met the clinical objectives relating to exudate management, affirmed by the health professionals with a yes response in 94% of cases. Additionally, the health professionals rated the handling of exudate as excellent/good (78%) and most (80%) reported that they would use the superabsorbent wound dressing with a silicone adhesive interface again. Allied to this was the fact that the dressing improved the wound edge and periwound skin conditions (29% and 36% of patients, respectively). The dressing retained its position in 72% of patients. For wear time, the largest proportion of dressing changes, both pre-study and during the evaluation period, was every third day (45% and 44%, respectively). But there was a shift to extended wear time with use of the superabsorbent wound dressing with a silicone adhesive interface with 72% of patients' dressing changes being every third day or longer.

CONCLUSION

The superabsorbent silicone border dressing was successful in managing wound exudate in moderately to highly exuding wounds and consequently this had a beneficial impact on the wound edge and periwound skin. Overall, there was a positive effect on wound bed preparation and in turn the healing response was progressive.

The importance of periwound skin in wound healing: an overview of the evidence

DECLARATION OF INTEREST

The authors have no conflicts of interest.

Fit testing and comfort evaluation of prophylactic dressing use for healthcare workers under N95/P2 respirators in one health service district in Australia

BACKGROUND

This study evaluated the use of prophylactic dressings (silicone foam, silicone tape, hydrocolloid) under N95/P2 respirators to determine which dressings fit successfully.

AIM

The aim was to develop a health service protocol for one state in Australia.

METHODS

Data were collected during August and September 2021 as part of the Respiratory Protection Program on 600 health workers using three types of prophylactic dressings. Five different types of respirators were used. Participant healthcare workers rated comfort on a four-point Likert scale.

RESULTS

Successful fit was achieved by 63.6% of the respirator-dressing combinations. The best-performing respirator-dressing combination was the Trident® respirator with dressing Mepilex® Lite silicone foam (90.2% pass rate). High pass rates were found in the Trident® respirator with Mepilex® Border Lite with SofSicure silicone tape (79.1%); the 3M™ 1860 respirator with Mepilex® Border Lite with SofSicure silicone tape (74%); and the BSN orange duckbill respirator with Mepilex® Lite silicone foam (69.8%). The poorest-performing combination was the BYD^TM respirator with Mepilex® Border Lite with SofSicure silicone tape (25.9% pass rate). Uncorrected chi-squared tests for association revealed significant associations between dressing type and outcome (p=0.004) and respirator type and outcome (p<0.001). Most respondents (82%) found the dressing combination markedly comfortable.

CONCLUSIONS

When using prophylactic dressings under N95/P2 respirators, it is necessary to perform a fit test. In this study Trident® respirators had the highest probability of successful fit, while BYD^TM respirators had the lowest. Combining Trident® respirators with Mepilex® Lite dressing was optimal. Most participants reported greater comfort with the dressings under the respirators.

Biodegradable, Tissue Adhesive Polyester Blends for Safe, Complete Wound Healing

Pressure-sensitive adhesives typically used for bandages are nonbiodegradable, inhibiting healing, and may cause an allergic reaction. Here, we investigated the effect of biodegradable copolymers with promising thermomechanical properties on wound healing for their eventual use as biodegradable, biocompatible adhesives. Blends of low molecular weight (LMW) and high molecular weight (HMW) poly(lactide-co-caprolactone) (PLCL) are investigated as tissue adhesives in comparison to a clinical control. Wounds treated with PLCL blend adhesives heal completely with similar vascularization, scarring, and inflammation indicators, yet require fewer dressing changes due to integration of the PLCL adhesive into the wound. A blend of LMW and HMW PLCL produces an adhesive material with significantly higher adhesive strength than either neat polymer. Wound adhesion is comparable to a polyurethane bandage, utilizing conventional nonbiodegradable adhesives designed for extremely strong adhesion.

Different therapeutic effects between diabetic and non-diabetic adipose stem cells in diabetic wound healing

OBJECTIVE

This study aimed to investigate how adipose tissue-derived stem cells (ASCs) from diabetic and from non-diabetic rats affect wound healing in different microenvironments.

METHOD

The two types of ASC-rich cells were distinguished by characteristic surface antigen detection. The ASC-rich cells were transplanted into the wounds of diabetic and non-diabetic rats. Wound healing rates were compared and the healing process in the wound margin sections was used to determine how ASC-rich cells affect wound healing in different microenvironments.

RESULTS

ASC density was decreased in diabetic rats. The generation time of ASC-rich cells from diabetic rats (d-ASC-rich cells) was longer than that of ASC-rich cells from non-diabetic rats. The number of pre-apoptotic cells in the third generation (passage 3) of d-ASC-rich cells was higher than that among the ASC-rich cells from non-diabetic rats. CD31 and CD34 expression was higher in d-ASC-rich cells than in ASC-rich cells from non-diabetic rats, whereas CD44 and CD105 expression was lower than that in ASC-rich cells from non-diabetic rats. Transplantation of ASC-rich cells from non-diabetic rats promoted wound healing in both non-diabetic and diabetic rats. In contrast, d-ASC-rich cells and enriched nuclear cells only promoted wound healing in non-diabetic rats. ASC-rich cell transplantation promoted greater tissue regeneration than d-ASC-rich cell transplantation.

CONCLUSION

ASC-rich cells promoted wound healing in diabetic and non-diabetic rats. ASC density was lower in the adipose tissue of diabetic rats compared with non-diabetic rats. d-ASC-rich cells did not promote wound healing in diabetic rats, suggesting that caution is warranted regarding the clinical use of diabetic adipose stem cell transplantation for the treatment of diabetic wounds.

Impact on quantitative fit-test results after application of prophylactic hydrocolloid dressing under N95 respirators

Objective:

Discomfort and device-related pressure injury (DRPI) caused by N95 filtering facepiece respirators (FFRs) are common. The use of prophylactic hydrocolloid dressings is one of the strategies that may improve comfort and reduce DRPI. In this study, we investigated the impact of these dressings on N95 respirator fit.

Methods:

We performed a repeat quantitative fit testing through the Respiratory Protection Program on 134 healthcare workers (HCWs), who applied hydrocolloid dressings on the bridge of their nose under the N95 FFRs that they passed the initial fit test with, but reported discomfort with the FFR.

Results:

With the hydrocolloid dressings in place, the fit-test pass rate for the semirigid cup style (3M 1860) was 94% (108 of 115); for the the vertical flat-fold style (BYD), the pass rate was 85% (44 of 52); for the duckbill style (BSN medical ProShield and Halyard Fluidshield), the pass rate was 81% (87 of 108); and for the 3-panel flat-fold style (3M Aura) N95 FFRs, the pass rate was 100% (3 of 3). There was a statistically significant reduction in the overall fit factors for both the vertical flat-fold and duckbill type N95 respirators after the application of hydrocolloid dressings.

Conclusions:

Hydrocolloid dressings are likely to disturb the mask seal for nonrigid-style N95 FFRs, particularly the vertical flat-fold style and the duckbill style N95 FFRs. Given the risk of mask seal disturbance of N95 respirators as shown in this study, we advocate that any HCW requiring the use of prophylactic dressings should undergo repeat quantitative fit testing with the dressing in place prior to using the dressing and mask in combination.

Synthesis and evaluation of an alginate-methacrylate xerogel for insulin delivery towards wound healing applications

Background: Alginate is one of the most widely used biopolymer for wound healing. But poor mechanical strength and degradability limits its application especially as a drug-delivery matrix. The aim of this study was to develop stable alginate based scaffold for insulin delivery toward wound care. Materials & methods: The xerogel alginate-g-poly (methacrylic acid; AGM2S) was characterized by various analytical techniques. Results: AGM2S xerogel showed improved physical stability, low degradation, good swelling and water vapour transmission rate (WVTR). About 70% of insulin was released from loaded xerogel over a period of 48 h and favorably modulated the healing response in in vitro scratch wound assay. Conclusion: Grafting improved the strength and stability of alginate xerogel and the results suggest the application of insulin loaded AGM2S xerogels as a potential wound healing material.

Epidermal Barrier Function and Skin Homeostasis in Skin with Permanent and Adhesive Tattoos: A Cross-Sectional Study

Tattoos are a current trend, but their impact on skin homeostasis and epidermal barrier function is not well known. So, the aims of this study are (1) to investigate epidermal barrier function and skin homeostasis in skin with permanent tattoos, adhesive temporary tattoos and non-tattooed skin, and (2) to analyze the effect of petrolatum on skin with permanent and adhesive tattoos. In total, 67 tattoos were enrolled (34 permanent tattoos and 33 adhesive tattoos). Temperature, transepidermal water loss (TEWL), stratum corneum hydration (SCH), erythema and total antioxidant capacity (TAC) were measured in skin with permanent tattoos, adhesive tattoos and non-tattooed skin before and after petrolatum application. The temperature was lower (30.47 °C vs. 31.01 °C; p = 0.001) on skin with permanent tattoos than non-tattooed skin, while SCH (48.24 Arbitrary Units (AU) vs. 44.15 AU; p = 0.008) was higher. Skin with adhesive tattoos showed lower temperature, SCH (21.19 AU vs. 41.31 AU; p < 0.001) and TAC (1.27 microcoulombs (uC) vs. 3.48 uC; p < 0.001), and higher TEWL (8.65 g/h/m² vs. 6.99 g/h/m²; p = 0.003), than non-tattooed skin. After petrolatum application, the temperature decreased on skin with permanent tattoos, and TEWL and SCH decreased on skin with adhesive tattoos. Adhesive tattoos may affect skin barrier function, while permanent tattoos may have a lower impact. Tattooed and non-tattooed skin responds in different ways to moisturizers.

The Management of Burn Pain in a Pediatric Burns-Specialist Hospital

Appropriate pain management for children who have experienced an acute burn injury is critical to improve patient outcomes and reduce potential morbidities. With 60% of our patients being under the age of 4 years, pain management is crucial in reducing pain and anxiety in both patients and parents. It is imperative that appropriate pain relief is commenced from initial contact with healthcare workers as this will affect the success or failure of future wound procedures. Uncontrolled pain can negatively affect a patient, both short and long term. It may cause anticipatory anxiety for future medical procedures, increased pain and anxiety can decrease wound re-epithelialization which can lead to long-term consequences for growth and mobility, and increased pain can also influence the possibility of patients and families displaying signs of post-traumatic stress disorder. Pain management in the form of pharmaceuticals is imperative during burn wound treatment and should incorporate pain relief targeted at both background and procedural pain. It also requires a multimodal, individualized, and targeted approach combining both pharmaceutical and nonpharmaceutical techniques, including cold running water, multimodal distraction devices, hypnotherapy, and bubbles. We discuss the research and knowledge that our center has gained through treating pediatric patients with burns over the last 20 years.

Wound, pressure ulcer and burn guidelines - 1: Guidelines for wounds in general, second edition

The Japanese Dermatological Association prepared the clinical guidelines for the "Wound, pressure ulcer and burn guidelines", second edition, focusing on treatments. Among them, "Guidelines for wounds in general" is intended to provide the knowledge necessary to heal wounds, without focusing on particular disorders. It informs the basic principles of wound treatment, before explanations are provided in individual chapters of the guidelines. We updated all sections by collecting references published since the publication of the first edition. In particular, we included new wound dressings and topical medications. Additionally, we added "Question 6: How should wound-related pain be considered, and what should be done to control it?" as a new section addressing wound pain, which was not included in the first edition.

Treatment of 52 patients with a self-adhesive siliconised superabsorbent dressing: a multicentre observational study

Objective:

To provide ‘in use’ clinical data to support exudate management in patients with moderately to highly exuding wounds with bordered superabsorbent wound dressing with a silicone adhesive interface.

Method:

This study was an open-labelled non-comparative study. Patients included in the study were selected by the clinical investigator(s) according to whether the patient required a dressing for the management of moderately to highly exuding wounds.

Results:

The primary aim of this study was to evaluate the clinical objective in relation to exudate handling (moderate to high) with a superabsorbent silicone border dressing (Zetuvit Plus Silicone Border; SAP silicone border dressing; designated RespoSorb Silicone Border in some countries). The SAP border dressing had met the clinical objectives relating to exudate management, affirmed by the health professionals with a yes response in 94% of cases. Additionally, the health professionals rated the handling of exudate as excellent/good (78%) and most (80%) reported that they would use the SAP silicone border dressing again. Allied to this was the fact that the SAP silicone border dressing improved the wound edge and periwound skin conditions (29% and 36% of patients, respectively). Regarding dressing retention, the SAP silicone border dressing retained its position in 72% of patients. For wear time, the largest proportion of dressing changes, both pre-study and during the evaluation period, was every third day (45% and 44%, respectively). But there was a shift to extended wear time with use of the SAP silicone border dressing with 72% of patients' dressing changes being every third day or longer.

Conclusion:

The SAP silicone border dressing was successful in managing wound exudate in moderately to highly exuding wounds and consequently this had a beneficial impact on the wound edge and periwound skin. Overall, there was a positive effect on wound bed preparation and in turn the healing response was progressive. This study has shown that the SAP silicone border dressing successfully controlled exudate and provided positive benefits when used in the treatment of patients with moderately to highly exuding wounds.

Does the application of Opsite⋄ Flexigrid⋄ occlude the oxygen saturation readings in healthy individuals using the moorVMS-OXY machine?

Background

A proportion of people who have been diagnosed with peripheral arterial disease and diabetes mellitus will be susceptible to chronic wounds. Oxygen is vital for wound healing, so oxygen measurements should to be taken as predictive values for wound healing in patients. When measuring oxygen at the wound bed, there is potentially a risk of cross-infection if no protective barrier is used; and skin stripping if an adhesive barrier is used on the wound bed. This cross sectional within subject repeated measures pilot study, aims to determine if the application of opsite film, as an infection control measure, in one or two layers, impacts on tissue oxygenation readings obtained when using the MoorVMS-OXY.

Methods

Mean oxygen saturation percentages were measured from 29 limbs of 18 healthy participants. Oxygen saturation was measured for 20 s and analysed at the first metatarsophalangeal joint using no film, one and two layers using the MoorVMS-OXY. A one-way repeated ANOVA with a Bonferroni post hoc test was performed to test for statistically significant differences between the values of the three parameters and multiple pairwise comparisons was completed.

Results

Amongst the three layers, there was a statistically significant difference in oxygen saturation between the two layers of Opsite Flexigrid and none; and also between the two layers of Flexigrid and single layer (p < 0.05). It was also established that there was no statistically significant difference between the single layer of Opsite Flexigrid and no Flexigrid layer (p > 0.05).

Conclusions

The results imply that one layer of Opsite Flexigrid is a suitable protective barrier to use when establishing capillary bed oxygen perfusion with the MoorVMS-OXY. However, the application of two Opsite Flexigrid layers, to prevent skin stripping, decreases the recorded values of oxygen saturation percentages significantly, therefore providing inaccurate results. Indicating that a double layer cannot be used over ulceration sites if measuring oxygen levels at the wound bed.

Pressure-Sensitive Tissue Adhesion and Biodegradation of Viscoelastic Polymer Blends

Viscoelastic blends of biodegradable polyesters with low and high molecular weight distributions have remarkably strong adhesion (significantly greater than 1 N/cm2) to soft, wet tissue. Those that transition from viscous flow to elastic, solidlike behavior at approximately 1 Hz demonstrate pressure-sensitivity yet also have sufficient elasticity for durable bonding to soft, wet tissue. The pressure-sensitive tissue adhesive (PSTA) blends produce increasingly stronger pull-apart adhesion in response to compressive pressure application, from 10 to 300 s. By incorporating a stiffer high molecular weight component, the PSTA exhibits dramatically improved burst pressure (greater than 100 kPa) when used as a tissue sealant. The PSTA's biodegradation mechanism can be switched from erosion (occurring primarily over the first 10 days) to bulk chemical degradation (and minimal erosion) depending on the chemistry of the high molecular weight component. Interestingly, fibrosis toward the PSTA is reduced when fast-occurring erosion is the dominant biodegradation mechanism.

Evaluation of a superabsorbent wound dressing, patient and clinician perspective: a case series

Objective:

The primary objective of this study was to evaluate the fluid management capabilities of a superabsorbent wound dressing (Zetuvit Plus Silicone), with secondary objectives related to parameters that support whether the dressing enables undisturbed healing.

Method:

This study was an open labelled non-comparative study. Patients included in the study were selected by the clinical investigator(s) according to whether the patient required a dressing for the management of moderately to highly exuding wounds.

Results:

A total of 50 patients were included in the study. Results related to the primary objective demonstrated that the superabsorbent wound dressing was able to absorb all levels of exudate across the range (low to high). At each assessment time point these results show that in 98% of assessments the superabsorbent dressing was rated as ‘very good’ (91%) or ‘good’ (7%) at exudate management. Secondary objectives relating to wound bed preparation, healing and management of pain were also positive. Additionally, at the end of each patient treatment, the dressing's fluid management capabilities were rated overall as ‘excellent’ (100% of cases). There was little pain associated with the wound or at dressing change throughout the study and its flexibility/conformability allowed for comfort and patient satisfaction aligned with increased quality of life. Additionally, inclusion of a silicone adhesive layer allowed painless and atraumatic removal of the dressing, increasing patient comfort, both during wear and at dressing removal, and supported the description of enabling undisturbed wound healing.

Conclusion:

The superabsorbent wound dressing achieved the primary objective relating to wound exudate management in all the assessments undertaken in this study. In addition, the silicone interface allowed for undisturbed healing as evidenced by little or no adherence of the dressing to underlying tissue, preventing damage to periwound skin. Overall, the superabsorbent wound dressing with the addition of the silicone interface could offer advantages over other superabsorbent polymer dressings (that might adhere to the wound surface) or silicone wound dressings (that might not have the absorbent properties of this type of dressing).

Polyhexamethylene Biguanide:Polyurethane Blend Nanofibrous Membranes for Wound Infection Control

Polyhexamethylene biguanide (PHMB) is a broad-spectrum antiseptic which avoids many efficacy and toxicity problems associated with antimicrobials, in particular, it has a low risk of loss of susceptibility due to acquired antimicrobial resistance. Despite such advantages, PHMB is not widely used in wound care, suggesting more research is required to take full advantage of PHMB’s properties. We hypothesised that a nanofibre morphology would provide a gradual release of PHMB, prolonging the antimicrobial effects within the therapeutic window. PHMB:polyurethane (PU) electrospun nanofibre membranes were prepared with increasing PHMB concentrations, and the effects on antimicrobial activities, mechanical properties and host cell toxicity were compared. Overall, PHMB:PU membranes displayed a burst release of PHMB during the first hour following PBS immersion (50.5–95.9% of total released), followed by a gradual release over 120 h (≤25 wt % PHMB). The membranes were hydrophilic (83.7–53.3°), gradually gaining hydrophobicity as PHMB was released. They displayed superior antimicrobial activity, which extended past the initial release period, retained PU hyperelasticity regardless of PHMB concentration (collective tensile modulus of 5–35% PHMB:PU membranes, 3.56 ± 0.97 MPa; ultimate strain, >200%) and displayed minimal human cell toxicity (<25 wt % PHMB). With further development, PHMB:PU electrospun membranes may provide improved wound dressings.

Predictive factors for the formation of tape blisters: An observational, prognostic prospective study

BACKGROUND

Tape blisters are common complications in the peri-lesional area of the surgical incision, forming below the layer of dressing adhesive applied and causing numerous complications for patients.

OBJECTIVES

The purpose of this study was to investigate the incidence of the phenomenon, and to identify and quantify the main prognostic factors associated.

DESIGN

Multicentric, prognostic prospective cohort study.

SETTING

Shoulder Orthopaedic surgery, General surgery, Advanced Oncology therapies, Gastro-entero mininvasive surgery and Endocrine surgery.

PARTICIPANTS

One thousand and two patients who underwent chest, abdominal, upper limb and joint laparotomic surgery consecutively admitted to the surgical units involved, were included.

METHODS

Data regarding individual and patient care variables, such as intrinsic (e.g. age and gender) and extrinsic (e.g. surgery type and time) data were collected. A multivariate logistic regression model was used to identify the variables which independently influenced the onset of the tape blister.

RESULTS

In the multivariate analysis, patients who underwent chest (Odds Ratio = 8.99, 95% CI 5.33-15.13), and upper limb and joint surgery (Odds Ratio = 2.09, 95% CI 1.22-3.58) were more likely to develop tape blisters in the postoperative period, At the same time, having drainage (Odds Ratio = 1.98, 95% CI 1.11-3.53), being female (Odds Ratio = 1.56, 95% CI 1.01-2.44) and having a high Body Mass Index (BMI) score (Odds Ratio: 1.06, 95% CI 1.02-1.11) were also predictors of tape blister formation.

CONCLUSIONS

A higher BMI score, chest, upper limb and joint surgery, female gender and the presence of drainage were predictive factors of the tape blister event while, in contrast with the literature, the type of dressing used in this study was not significantly associated with the event.

Developing Antibacterial Nanocrystalline Cellulose Using Natural Antibacterial Agents

We used hairy nanocrystalline cellulose functionalized with aldehyde groups, otherwise known as sterically stabilized nanocrystalline cellulose (SNCC), to facilitate the attachment of the antibacterial agents lysozyme and nisin. Immobilization was achieved using a simple, green process that does not require any linker or activator. X-ray photoelectron spectroscopy and Fourier transform infrared spectroscopy analyses showed successful attachment of both nisin and lysozyme onto the SNCC. The efficacy of the conjugated nanocellulose against the model bacteria Bacillus subtilis and Staphylococcus aureus was tested in terms of bacterial growth, cell viability, and biofilm formation/removal. The results show that the minimum inhibitory concentration of the conjugated nanocellulose is higher than that of lysozyme and nisin in free form, which was expected given that immobilization reduces the possible spatial orientations of these proteins. We observed that free nisin is not active against S. aureus after 24 h of exposure due to either deactivation of free nisin or development of resistance in S. aureus against free nisin. Interestingly, we did not observe this phenomenon when the bacteria were exposed to antibacterials immobilized on nanocellulose, suggesting that immobilization of antibacterial agents onto SNCC effectively retains their activity over long time periods. We suggest that antibacterial SNCC is a promising candidate for the development of antibacterial wound dressings.

A randomised, controlled, non-inferiority trial comparing the performance of a soft silicone-coated wound contact layer (Mepitel One) with a lipidocolloid wound contact layer (UrgoTul) in the treatment of acute wounds

Wound contact layer (WCL) dressings are intended to protect tissue during the healing process. A randomised controlled trial was undertaken to compare 2 such dressings. Outpatients with acute wounds were randomly allocated to treatment with either a soft silicone-coated WCL (intervention group, n = 59) or a lipidocolloid-impregnated WCL (control group, n = 62). At the first dressing removal (day 3), 89.8% of patients in the intervention group experienced non-painful dressing removal (defined as a pain rating <30 mm on a 100 mm visual analogue scale), compared with 73.6% of patients in the control group (P = .017) (per protocol population). At day 21, wounds were considered as healed in 66.1% of patients in the intervention group compared with 43.5% in the control group (P = .012) (intention-to-treat population). Both dressings were well tolerated and rated highly in terms of in-use characteristics, although the soft silicone-coated WCL was rated significantly higher than the lipidocolloid-impregnated WCL in terms of its ability to remain in place (P= .016). The results indicate that the soft silicone-coated WCL is suitable for the management of acute wounds as it can minimise dressing-associated pain and support healing.

The use of prophylactic dressings in the prevention of pressure ulcers: a literature review

Pressure ulcers pose a significant burden to both patients and health care resources. There are an increasing number of studies that have examined the use of prophylactic dressings, and their ability to redistribute pressure and protect the skin from shear and friction damage. This literature review examines six studies conducted on this controversial subject. Brindle and Wegelin ( 2012 ; Chaiken, 2012 ; Cubit et al, 2012 ; Santamaria et al, 2012) all examined the role of dressings to prevent pressure ulcers, and Call et al (2013a ; 2013b ), conducted in vitro research into the mode of dressings. Current research suggests that while further research is required, the use of prophylactic dressings have a place alongside standard measures, in helping to prevent pressure, shear and friction damage.

Models of wound healing: an emphasis on clinical studies

BACKGROUND

The healing of wounds has always provided challenges for the medical community whether chronic or acute. Understanding the processes which enable wounds to heal is primarily carried out by the use of models, in vitro, animal and human. It is generally accepted that the use of human models offers the best opportunity to understand the factors that influence wound healing as well as to evaluate efficacy of treatments applied to wounds.

OBJECTIVES

The objective of this article is to provide an overview of the different methodologies that are currently used to experimentally induce wounds of various depths in human volunteers and examines the information that may be gained from them.

METHODS

There is a number of human volunteer healing models available varying in their invasiveness to reflect the different possible depth levels of wounds.

RESULTS

Currently available wound healing models include sequential tape stripping, suction blister, abrasion, laser, dermatome, and biopsy techniques. The various techniques can be utilized to induce wounds of variable depth, from removing solely the stratum corneum barrier, the epidermis to even split-thickness or full thickness wounds.

CONCLUSION

Depending on the study objective, a number of models exist to study wound healing in humans. These models provide efficient and reliable results to evaluate treatment modalities.

Comparison of Medical Adhesive Tapes in Patients at Risk of Facial Skin Trauma under Anesthesia

Introduction. Adhesive tapes are used for taping eyelids closed and securing endotracheal tubes during general anesthesia. These tapes can cause facial skin injury. We compared the incidence of facial skin injury and patient satisfaction with different tapes used. Methods. A total of 60 adult patients at risk of skin trauma were randomized to use 3M™ Kind Removal Silicone Tape or standard acrylate tapes: 3M Durapore (endotracheal tube) and Medipore (eyelids). Patients were blinded to tape used. Postoperatively, a blinded recovery nurse assessed erythema, edema, and denudation of skin. Anesthesiologist in charge also assessed skin injury. On postoperative day 1, patients rated satisfaction with the condition of their skin over the eyelids and face on a 5-point Likert scale. Results. More patients had denudation of skin with standard tapes, 4 (13.3%) versus 0 with silicone tape (p = 0.026) and in anesthesiologist-evaluated skin injury 11 (37%) with standard versus 1 (3%) with silicone (p = 0.002). No significant differences were found in erythema and edema. Patient satisfaction score was higher with silicone tape: over eyelids: mean 3.83 (standard) versus 4.53 (silicone), Mann-Whitney U test, p < 0.001; over face: mean 3.87 (standard) versus 4.57 (silicone) (p < 0.001). Conclusion. Silicone tape use had less skin injury and greater patient satisfaction than standard acrylate tapes.

Measurement of morphological and physiological skin properties in aged care residents: a test-retest reliability pilot study

This test-retest pilot study investigated the intra-rater reliability and reproducibility of non-invasive technologies to objectively quantify morphological (colour, thickness and elasticity) and physiological (transepidermal water loss (TEWL), hydration, sebum and pH) skin properties in an aged care population. Three consecutive measurements were taken from five anatomical skin sites, with the mean of each measurement calculated. The intra-class correlation coefficient (ICC) and the standard error of measurement (SEM) were used to examine the intra-rater reliability and reproducibility of measurements. Non-invasive technologies in this study showed almost perfect reliability for ultrasound measurements of the subepidermal low echogenicity band (SLEB) (ρ = 0·95-0·99) and skin thickness (ρ = 0·95-0·99) across all sites. The ICC was substantial to almost perfect for pH (ρ = 0·76-0·88) and viscoelasticity (ρ = 0·67-0·91) across all sites. Hydration (ρ = 0·53-0·85) and skin retraction (ρ = 0·57-0·99) measurements ranged from moderate to almost perfect across all sites. TEWL and elasticity were substantial to almost perfect across four sites. Casual sebum levels and most colour parameters showed poor ICC. The use of non-invasive technologies in this study provided an objective and reliable means for quantifying ageing skin and may offer future studies a valuable option for assessing skin tear risk.

The effect of concentration of tackifying agent on adhesive and skin-protective properties of ceramide 2-containing hydrocolloid dressings

OBJECTIVE

In the treatment of pressure ulcers and leg ulcers it is necessary to achieve an effective balance between adhesive and skin-protective properties. We speculated that addition of a tackifying agent (TA) to ceramide 2-containing hydrocolloid dressings would increase their adhesiveness under dry conditions and reduce their adhesiveness under wet conditions because dry tack converts to wet tack after water absorption.

METHOD

We prepared ceramide 2-containing hydrocolloid dressings with varying amounts of TA. Basic characteristics of the test ceraminde dressings, such as initial tack force and peeling force, were evaluated using standard methods. Peeling force and stratum corneum (SC) removal on healthy human skin were also evaluated at 20 minutes, 7 hours, and 72 hours. In addition, the effect of 10 repeated applications on transepidermal water loss (TEWL) was investigated on the skin of hairless mice under dry and wet conditions. Statistical analyses were performed using one-way analysis of variance followed by Dunnett's multiple comparison test. A p-value of <0.05 was considered statistically significant.

RESULTS

On a stainless steel substrate, initial tack force and 180° peeling force increased as TA content increased. Twenty minutes after application on human skin, peeling force and SC removal increased with increasing TA content. When TA contents were over 10%, significant differences in peeling force and SC removal were obtained compared with ceramide 2-containing hydrocolloid dressings without TA (p<0.05). However, a TA content-dependent increase in peeling force was not evident 7 hours and 72 hours after application. Under dry conditions, TEWL increased with repeated application and peeling. Conversely, no significant increases in TEWL were evident under wet conditions after 10 repeated applications and peelings.

CONCLUSION

Our data demonstrate that the initial attachment of ceramide 2-containing hydrocolloid dressings to the skin increases with addition of TA. Skin damage can be avoided by conversion of the adhesive system to wet tack with water absorption.

DECLARATION OF INTEREST

Masushi Kohta and Tetsuji IwasakI are employees of ALCARE Co., Ltd., Japan. This project was supported by an unrestricted grant from ALCARE.

Using a silicone-based dressing as a primary wound contact layer

The use of silicone-based dressings as a primary contact layer for wound care can prevent epithelial stripping, pain and sensitivity and have been widely available for nearly 20 years. Cuticell Contact from BSN medical is the latest silicone-based dressing to add to the armoury of the wound care clinician. Using documented case studies the author explores the reasoning behind why clinicians should consider re-examining the use of silicone dressings.

Health economic benefits of cyanoacrylate skin protectants in the management of superficial skin lesions

Superficial skin damages, including stage II pressure ulcer, skin tears and moisture-associated skin damages (MASDs) are common and constitute a significant disease burden to the health care system. A cost analysis was conducted by comparing a cyanoacrylate barrier film with routine care in the treatment of superficial skin damages in a chronic care facility. The analysis included 12 patients: four patients with stage II pressure ulcers, six with MASD and two with skin tears. Cost analysis was conducted comparing the cost of care 7 days before and 7 days after the acrylate barrier was used. The total cost took into consideration the time, products and supplies required to manage the skin problem.

Dressings and Products in Pediatric Wound Care

Significance: The increasing complexity of medical and surgical care provided to pediatric patients has resulted in a population at significant risk for complications such as pressure ulcers, nonhealing surgical wounds, and moisture-associated skin damage. Wound care practices for neonatal and pediatric patients, including the choice of specific dressings or other wound care products, are currently based on a combination of provider experience and preference and a small number of published clinical guidelines based on expert opinion; rigorous evidence-based clinical guidelines for wound management in these populations is lacking. Recent Advances: Advances in the understanding of the pathophysiology of wound healing have contributed to an ever-increasing number of specialized wound care products, most of which are predominantly marketed to adult patients and that have not been evaluated for safety and efficacy in the neonatal and pediatric populations. This review aims to discuss the available data on the use of both more traditional wound care products and newer wound care technologies in these populations, including medical-grade honey, nanocrystalline silver, and soft silicone-based adhesive technology. Critical Issues: Evidence-based wound care practices and demonstration of the safety, efficacy, and appropriate utilization of available wound care dressings and products in the neonatal and pediatric populations should be established to address specific concerns regarding wound management in these populations. Future Directions: The creation and implementation of evidence-based guidelines for the treatment of common wounds in the neonatal and pediatric populations is essential. In addition to an evaluation of currently marketed wound care dressings and products used in the adult population, newer wound care technologies should also be evaluated for use in neonates and children. In addition, further investigation of the specific pathophysiology of wound healing in neonates and children is indicated to promote the development of wound care dressings and products with specific applications in these populations.

Dressings as an adjunct to pressure ulcer prevention: consensus panel recommendations

The formulation of recommendations on the use of wound dressings in pressure ulcer prevention was undertaken by a group of experts in pressure ulcer prevention and treatment from Australia, Portugal, UK and USA. After review of literature, they concluded that there is adequate evidence to recommend the use of five-layer silicone bordered dressings (Mepilex Border Sacrum(®) and 3 layer Mepilex Heel(®) dressings by Mölnlycke Health Care, Gothenburg, Sweden) for pressure ulcer prevention in the sacrum, buttocks and heels in high-risk patients, those in Emergency Department (ED), intensive care unit (ICU) and operating room (OR). Literature on which this recommendation is based includes one prospective randomised control trial, three cohort studies and two case series. Recommendations for dressing use in patients at high risk for pressure injury and shear injury were also provided.

A closer examination of atraumatic dressings for optimal healing

The concept that undisturbed wound healing, optimised by dressing choice, improves wound outcomes has become a focal point of consideration when evaluating wound management regimens in recent years. However, little evidence exists related to wound contact layers and the potential detrimental effects of the intimate contact with the wound bed. The aim of this study was to evaluate the effects of atraumatic wound contact dressings on the healing of partial-thickness wounds in comparison to untreated air-exposed wounds. Using an in vivo porcine wound model the handling properties of each dressing in terms of adhesion were analysed. Methods of wound characterisation included histological analysis of granulation tissue formation and epithelialisation and this was correlated with various clinical observations. Differences were found between dressings in terms of adherence to the wound bed and surrounding skin, capacity to retain wound exudates and enhancement of healing.

Mepitel One: a wound contact layer with Safetac technology

This article examines the use of Mepitel One, a wound contact layer that promotes wound healing by using the clinical benefits of Safetac technology. A wide range of clinical evidence shows that dressings with Safetac prevent trauma, minimise wound pain and associated psychological stress, while facilitating undisturbed wound healing. Mepitel One has been developed as a highly transparent wound contact layer with Safetac on the wound contact surface alone; this makes it easy to apply without sticking to gloves, and allows it to be used with a choice of secondary dressings. The dressing can stay in place for up to 14 days and allows examination of the wound without removal. The clinical evidence reviewed here shows that Mepitel One is a versatile option for use on a wide range of wound types to promote undisturbed healing and minimise pain at dressing changes.

Removal of adhesive wound dressing and its effects on the stratum corneum of the skin: comparison of eight different adhesive wound dressings

In recent years, adhesive wound dressings have been increasingly applied postoperatively because of their ease of use as they can be kept in place without having to cut and apply surgical tapes and they can cover a wound securely. However, if a wound dressing strongly adheres to the wound, a large amount of stratum corneum is removed from the newly formed epithelium or healthy periwound skin. Various types of adhesives are used on adhesive wound dressings and the extent of skin damage depends on how much an adhesive sticks to the wound or skin surface. We quantitatively determined and compared the amount of stratum corneum removed by eight different wound dressings including polyurethane foam using acrylic adhesive, silicone-based adhesive dressing, composite hydrocolloid and self-adhesive polyurethane foam in healthy volunteers. The results showed that wound dressings with silicone adhesive and self-adhesive polyurethane foam removed less stratum corneum, whereas composite hydrocolloid and polyurethane foam using acrylic adhesive removed more stratum corneum.

Taking the pressure off in the Emergency Department: evaluation of the prophylactic application of a low shear, soft silicon sacral dressing on high risk medical patients

Pressure injuries are key clinical indicators of care standard. In Australia, pressure injuries increase length of hospital stay by 4.31 and cost $285 million annually. This pilot study examined the effectiveness of sacral dressing in reducing the prevalence of pressure injuries in older, high-risk patients. A non randomised one-sample experimental design was used in this study comprising of four phases. Of the 51 patients recruited to the study, one patient developed a sacral pressure injury compared to six patients identified in a known group with similar demographics who were not approached to participate in the study. The results indicated that patients in the known group were 5.4 times more likely to develop a pressure injury than the intervention group. Findings suggest that applying a protective sacral dressing with a low shear backing as part of a simple standardised prevention injury prevention regime commencing in the Emergency Department was beneficial in the prevention of pressure injury in older 'at high risk' medical patients.

A model for quantitative evaluation of skin damage at adhesive wound dressing removal

The removal of adhesive wound dressings from the wound surface involves a risk of damaging the intact stratum corneum and regenerating epithelium. Pain associated with the removal of wound dressings is a major issue for patients and medical personnel. Recently, wound dressings coated with a silicone adhesive have been developed to reduce such skin damage and pain on removal and they have received good evaluation in various clinical settings. However, there is neither a standard method to quantify whether or not the integrity of the stratum corneum and regenerating epithelium is retained or if both structures are damaged by the removal of wound dressings, nor are there standardised values with which to assess skin damage. We applied six different types of adhesive wound dressing on plain copy paper printed with black ink by a laser printer, removed the dressings, examined the adhesive-coated surface of the wound dressings using a high-power videoscope, and examined the stripped areas. Wound dressings coated with a silicone adhesive showed significantly less detachment of the stratum corneum and regenerating epithelium, followed by those coated with polyurethane, hydrocolloid, and acrylic adhesives. The assessment method utilised in this study revealed distinct differences between wound dressing types, but less variation in the evaluation outcome of each type. This assessment method may be useful for the evaluation of adhesive wound dressings, particularly during product development. However, further studies will be needed to examine the effectiveness of this assessment method in the clinical setting because the adherent properties of polyurethane and hydrocolloid adhesives may be altered by the absorption of water from the skin.