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New wound care products offer edge
"Pressure ulcers are the No. 1 thing we see, closely followed here in the South by neuropathic ulcers," Loehne said. "We have such a high population of people with diabetes, we’ve seen an awful lot of that." She said PTs also treat many patients with arterial or venous vascular ulcers in the lower leg. In an acute care setting, Loehne said PTs often see complicated surgical wounds.
"Diabetes is one of the most difficult comorbidities," Loehne said. "And a big majority of the people who have diabetes are obese ... and those are terrific problems for healing wounds."
Even without diabetes, nutrition is a big player in wound healing, Loehne said. Secondhand smoke and tobacco use also slows healing because nicotine takes oxygen out of the bloodstream, she said.
She said wound care PTs use different modalities in their practices, depending on what they find successful, such as pulsed lavage and suction for irrigation and debridement, negative pressure wound therapy and e-stim.
Negative pressure wound therapy was one of the most important developments in wound care in her lifetime, Loehne said. "It pulls all that fluid, drainage, exudate and swelling out," she said. "It also pulls growth factors up through the wound, so the wound contracts, gets smaller. It stimulates the granulation, stimulates the new tissue."
Loehne said while NPWT isn’t new, there are many new aspects. "Different companies are developing [units] that are portable and some that are disposable that allow for a lot of uses that we didn’t have before," she said. "[They] allow patients to go back to work, to be more mobile."
Early this year, Smith & Nephew’s single-use NPWT system, Pico, gained Food and Drug Administration clearance for use in home care and hospital settings, according to a company news release. "A lot of the patients come out of some sort of surgery, especially orthopedic surgery," said Janine McCargo, assistant vice president of EVC Group Inc., a public relations firm. "The last thing they want is to have an infection."
McCargo said the machine allows patients to wear their regular clothes and walk around without having to deal with an external pump. The Pico is indicated for traumatic, acute and chronic wounds, ulcers, burns, flaps and grafts, and closed surgical incisions, according to the company. It can be used for up to seven days.
Several companies also have come out with NPWT units that can be used to treat more than one wound on the same person, Loehne said. "It used to be that you had to have one for each wound, and that gets very expensive," she said. "So therapists really quickly figured out that you could put foam in each wound, and if you put a strip of foam between the two that you could use the same pump if there wasn’t too much drainage, and it would collapse both wounds."
Loehne said companies including Smith & Nephew and Kinetic Concepts Inc. have developed premade, user-friendly dressings. "There are special ones for large, abdominal wounds now, where we used to sort of piecemeal them together," she said, adding some dressings also include silver for antimicrobal properties.
SurgiClear from Covalon Technologies Ltd. combines silver and chlorhexidine in an antimicrobal silicone dressing designed to protect surgical wound sites and wound closures, according to John Hands, director of global marketing for Covalon. Silver and chlorhexidine are effective at killing bacteria and yeasts including multiple-resistant Staphylococcus aureus, Enterococcus faecalis, Klebsiella pneumoniae, Enterobacter cloacae and Candida albicans. "To get FDA clearance it needed to show a 4-log reduction of microorganisms," Hands said. "It reduces the bacteria at a rate greater than a 4-log reduction." Company scientists were able to embed the two antimicrobial agents in a soft silicone adhesive, he said.
"Many film dressings use an acrylic adhesive," Hands said. "They have the potential to irritate a person’s skin and are a very aggressive adhesive."
A study published in the journal Wounds UK in 2008 showed soft silicone adhesives minimize pain during dressing changes, and cause less erythema than acrylic adhesives. The research showed removing the two adhesives required a similar amount of force, but those who received silicone adhesives reported less pain. As PTs work with patients, range of motion is important, Hands said. The silicone dressing moves with the body and doesn’t pull or tug on the skin while the person is moving, he said.
The dressings can remain in place for as long as seven days and are transparent, allowing clinicians to monitor the wound without disturbing the site. "Clinicians will be able to observe for things that aren’t going right," he said. "In the case of infection, you’re looking for redness, swelling, exudate."
Gradient compression wraps are critical for patients who have venous insufficiencies, especially those with venous wounds and edemas, Loehne said. "Usually the valves have become incompetent in the lower extremity veins," she said. "If you don’t get that swelling out, it opens up into big wounds."
Loehne said two-layer wraps and four-layer wraps are available. She often uses the Profore four-layer wrap made by Smith & Nephew, and said ConvaTec, 3M and other companies also make very good compression wraps. •