Evidence for Polymeric Membrane Dressings as a Unique Dressing Subcategory, Using Pressure Ulcers as an Example

Abstract

Objective: Wound management recommendations usually group dressings by base substrate material or reimbursement codes, even when functional differences are vast (e.g., honey-containing alginates, super-absorbent hydrogels). Polymeric membrane dressings (PMDs) diverge dramatically from conventional foam dressings in functional attributes, indications, and patient results, providing an opportunity to demonstrate the evidence for categorizing dressings based upon functional differences. Approach: A search of ALL published literature describing the use of PMDs, with no date or language limits, was conducted. Documents simply listing a PMD brand name (e.g., PolyMem) as one of many "foam" dressings were eliminated. The subset of evidence evaluating PMDs for tissue damage resulting from pressure (pressure ulcers, pressure injuries, henceforth: PUs) was summarized. Results: Studies of PMDs, primarily from independent clinician-researchers, have accumulated into a significant evidence base over the past 30 years. PMDs actively cleanse and debride wounds, balance moisture, relieve pain, and limit inflammation: all functions not shared by conventional foams. Innovation: This article supports a paradigm shift for wound management guidance materials to embrace a more evidence-based, patient-centered method of classifying products. The results presented here, using PMDs for PUs as an example, show that functional attributes, indications, and patient results are not always dictated by dressing substrates. Rather than being comparable with conventional foam dressings, PMDs have substantially enhanced functions and results. Conclusion: These results strongly support the author's assertion that evidence-based wound management requires guidelines and recommendations that categorize advanced dressings based upon how they function in real-life settings, rather than upon their base substrate.

Keywords: debridement/methods; occlusive dressings/standards; pain management; pressure ulcer; wound healing; wounds and injuries.

Linda L. Benskin, PhD, RN, SRN (Ghana), CWCN, CWS, DAPWCA

Figure 1.

Structural account of heterogeneity. Each wound (X) has its own success parameter (p) arising from a common distribution with random parameters (a, b).

Figure 2.

Polymeric membrane pressure ulcer case study and case series wound data analysis. Up to 12 aspects of wound management (x axis) were coded as dichotomous variables for each wound; wound counts for each aspect (left, y axis) are indicated by the columns. For each aspect of wound management, the 95% credibility intervals (p0.275–p0.975) are indicated by the blue bars (right, y axis), with red triangles marking p0.50. PU, pressure ulcer.