Wound Dressings and Comparative Effectiveness Data

Abstract

Significance: Injury to the skin provides a unique challenge, as wound healing is a complex and intricate process. Acute wounds have the potential to move from the acute wound to chronic wounds, requiring the physician to have a thorough understanding of outside interventions to bring these wounds back into the healing cascade. Recent Advances: The development of new and effective interventions in wound care remains an area of intense research. Negative pressure wound therapy has undoubtedly changed wound care from this point forward and has proven beneficial for a variety of wounds. Hydroconductive dressings are another category that is emerging with studies underway. Other modalities such as hyperbaric oxygen, growth factors, biologic dressings, skin substitutes, and regenerative materials have also proven efficacious in advancing the wound-healing process through a variety of mechanisms. Critical Issues: There is an overwhelming amount of wound dressings available in the market. This implies the lack of full understanding of wound care and management. The point of using advanced dressings is to improve upon specific wound characteristics to bring it as close to "ideal" as possible. It is only after properly assessing the wound characteristics and obtaining knowledge about available products that the "ideal" dressing may be chosen. Future Directions: The future of wound healing at this point remains unknown. Few high-quality, randomized controlled trials evaluating wound dressings exist and do not clearly demonstrate superiority of many materials or categories. Comparative effectiveness research can be used as a tool to evaluate topical therapy for wound care moving into the future. Until further data emerge, education on the available products and logical clinical thought must prevail.

Aditya Sood, MD, MBA

Figure 1.

Gauze used as packing in an infected and irregularly shaped wound of the lower extremity. To see this illustration in color, the reader is referred to the web version of this article at www.liebertpub.com/wound

Figure 2.

(A) Adaptic Gauze^® (Johnson and Johnson, New Brunswick, NJ) used as a contact layer on a granulating wound bed of the lower leg combined with a compressive dressing. Removal shows nonadherent nature of dressing and facilitation of intrinsic healing. (B) Xeroform Gauze^® (Coviden) used as the primary dressing over a split-thickness skin graft donor site on the lateral thigh. (C) Xeroform Gauze used as a contact layer on second- and third-degree burns of the chest and arm. To see this illustration in color, the reader is referred to the web version of this article at www.liebertpub.com/wound

Figure 3.

Tegaderm^® (3M, St. Paul, MN) used as a primary dressing over a split-thickness skin graft donor site of the lateral thigh. To see this illustration in color, the reader is referred to the web version of this article at www.liebertpub.com/wound

Figure 4.

(A) Regranex^® (Healthpoint Biotherapeutics, Arlington, TX), a platelet-derived growth factor therapy that utilizes an amorphous hydrogel as a vehicle for its active ingredient, being applied to a sacral decubitus ulcer. (B) Flexigel (Smith and Nephew) hydrogel flexible sheet dressing applied to a nonhealing wound of the lower breast. To see this illustration in color, the reader is referred to the web version of this article at www.liebertpub.com/wound

Figure 5.

(A) A chronic nonhealing wound of the posterior upper thigh. (B) Same wound covered with Aquacel prior to placement of a secondary compressive dressing. To see this illustration in color, the reader is referred to the web version of this article at www.liebertpub.com/wound

Figure 6.

(A) A hypertrophic scar extending from the lower border of the mandible to the neck. (B) Cica-Care (Smith and Nephew) silicone sheet applied to this wound. To see this illustration in color, the reader is referred to the web version of this article at www.liebertpub.com/wound

Figure 7.

A silver-impregnated dressing used to cover a chronic lower extremity wound. To see this illustration in color, the reader is referred to the web version of this article at www.liebertpub.com/wound

Figure 8.

(A) A chronic lower extremity wound after sharp debridement. (B) The same wound closed with a black, sterile, polyurethane foam and negative pressure wound therapy. To see this illustration in color, the reader is referred to the web version of this article at www.liebertpub.com/wound

Figure 9.

(A) Open chest wound after coronary artery bypass graft covered with Biobrane^® (UDL Laboratories), a biocomposite dressing composed of nylon fibers embedded in silicone and collagen. (B) After removal of Biobrane 2 weeks later, showing abundant granulation tissue present at base. (C) After coverage with a split-thickness skin graft. To see this illustration in color, the reader is referred to the web version of this article at www.liebertpub.com/wound