Super-absorbent dressings: how do they perform in vitro?

The free swell and absorption capacity under compression of six wound dressings that are indicated for moderately to highly exuding wounds was investigated. Measuring in vitro the absorptive capacity and retention under compression is important in terms of clinical efficacy and efficiency. This in vitro comparative study demonstrated that sorbion sachet EXTRA had the highest free swell capacity of the six test dressings and absorbed more than twice the volume (126%) of the test solution than its nearest competitor. When measuring capacity under compression, sorbion sachet EXTRA absorbed 88% more fluid than the nearest competitor

The conundrum of wound infection

Abstract not available

Wound infection, dressings and pain, is there a relationship in the chronic wound?

The focus on quality of life issues in wound care has justly taken a far greater importance. With the acceptance that pain can be a major factor to the patient, and in particular, pain at dressing change comes the opportunity for avoidance and/or reduction strategies. Whilst pain has been associated with wound infection for millennia, it is only much more recently that this has received due attention from research and clinical practice. In this study, the nature of pain, changes in pain and pain associated with infection are the focal points. A Delphi approach, now a frequently used tool in wound care research, has been used to obtain expert opinion on these aspects of management

Biofilms: possible strategies for suppression in chronic wounds

The aim of this paper is to provide a brief overview of strategies that could be applied to chronic wounds harbouring biofilms. The importance of biofilms in chronic wounds is highlighted in respect of them preventing the normal wound healing processes and with regards to their resistance to removal by conventional antimicrobial agents. An array of anti-biofilm agents is provided, and the mode of action of these agents together with their efficacy in suppressing biofilms is discussed. It is hoped this article will provide foresight into wound management and promote consideration of future anti-biofilm strategies

Collagen matrix wound dressings and the treatment of DFUs

Objective: To obtain clinical evidence on the use of a collagen wound dressing in patients with diabetic foot ulcers (DFus).   Method: A convenience sample of patients managed in the podiatry outpatient clinic over an 8-month period were included in the evaluation, if their DFus were not progressing. All participants received traditional adjunctive wound care as part of their treatment. Wound surface-area measurements and imaging of patients was carried out on a regular basis to allow the tracking of wound healing. Results: Six patients, with seven wounds were included in this study. There was an overall decrease in wound surface area over time. Three patients showed a relatively swift reduction in wound area, while one patient showed a slight increase in wound area. The percentage decrease in wound area levelled out quite quickly in three patients, with a mean wound duration of 14 months compared with 7.3 months in the remaining four wounds. one patient died of an unrelated cause. Conclusion: This case series evaluation provides a snapshot of experience at one clinical centre and the treatment of DFus, and suggests that an active biological collagen dressing may support progression to healing by modulating the wound environment. l declaration of interest: S. Haycocks and P. Chadwick received supplies of ProHeal from MedSkin Solutions Dr Suwelack for use on patients in this evaluation. K.F. Cutting is a consultant to MedSkin Solutions Dr Suwelack and received a honorarium for his participation. MedSkin Solutions Dr Suwelack did not have any editorial control over the production of this manuscript

Topical silver-impregnated dressings and the importance of the dressing technology

A wide variety of silver-impregnated wound dressings has become available in recent years. This has given the practitioner choice but little evidence by which an appropriate dressing may be selected. In many instances, the ancillary function(s) of the dressing will become differentiating factors that influence choice. For example, the dressing capacity to manage exudate, maintain an optimum moist environment, reduce or avoid maceration, maintain an intimate contact with the wound bed, promote autolytic debridement, sequester bacteria and bind matrix metallo proteases (MMPs) are some of those functions that are of clinical significance and may dictate choice. In this article we present the evidence for these functions, thereby enabling practitioners to evaluate comparative dressing attributes, and so make an informed choice of which silver dressing best suits the needs of the wound under differing circumstances

Clinical and cost-effectiveness of absorbent dressings in the treatment of highly exuding VLUs

l Objective: To estimate the clinical effectiveness and cost effectiveness of using a sodium carboxymethylcellulose dressing (CMC [Aquacel]) and four superabsorbent dressings (DryMax Extra [DM], Flivasorb [F], Kerramax [K] and sachet S [S]) in the treatment of highly exuding chronic venous leg ulcers (VLUs) in the UK, from the perspective of the National Health Service (NHS). l Method:A decision model was constructed depicting the patient pathways and associated management of a cohort of 439 patients with highly exuding chronic VLUs of ≥3 months of age. The model was based on the case records of a cohort of matched patients from The Health Improvement Network (THIN) database (a nationally representative database of patients registered with general practitioners (GPs) in the UK) who were treated with one of the five dressings. The model estimated the costs and outcomes of patient management over 6 months and the relative cost-effectiveness of using each dressing. l Results: Patients’ mean age was 73.1 years, and 46% were female. Between 39% and 56% of VLUs healed by 6 months. CMC-treated wounds that remained unhealed increased in size by 43% over the study period, whereas unhealed wounds treated with the other dressings decreased in size by a mean 34%. Consequently, CMC was excluded from the cost-effectiveness analysis. The 6-monthly NHS cost of managing a VLU with S was £3700 per patient, which was 15–28% lower than the cost of managing patients with the other three superabsorbents. Additonally, use of S improved patients’ health status to a greater extent than the other three superabsorbents, since S-treated patients accrued 0.3–3% more QALYs. Starting treatment with S was the preferred strategy followed by DM, K and F in that order. l Conclusion: Within the limitations of the data set, S affords the NHS a cost-effective treatment for managing highly exuding chronic VLUs of ≥3 months of age, compared with DM, F, K and CMC. l Declaration of interest: This study was funded with an unrestricted research grant from Sorbion GmbH & Co. KG, Senden, Germany, manufacturers of sachet S. However, Sorbion did not have any control of the methodology, conduct, results or conclusion of this study, or editorial involvement in this manuscript. The authors have no other conflicts of interest that are directly relevant to the content of this manuscript, which remains their sole responsibilit

Bacterial Growth Kinetics under a Novel Flexible Methacrylate Dressing Serving as a Drug Delivery Vehicle for Antiseptics

A flexible methacrylate powder dressing (Altrazeal®) transforms into a wound contour conforming matrix once in contact with wound exudate. We hypothesised that it may also serve as a drug delivery vehicle for antiseptics. The antimicrobial efficacy and influence on bacterial growth kinetics in combination with three antiseptics was investigated in an in vitro porcine wound model. Standardized in vitro wounds were contaminated with Staphylococcus aureus (MRSA; ATCC 33591) and divided into six groups: no dressing (negative control), methacrylate dressing alone, and combinations with application of 0.02% Polyhexamethylene Biguanide (PHMB), 0.4% PHMB, 0.1% PHMB + 0.1% betaine, 7.7 mg/mL Povidone-iodine (PVP-iodine), and 0.1% Octenidine-dihydrochloride (OCT) + 2% phenoxyethanol. Bacterial load per gram tissue was measured over five days. The highest reduction was observed with PVP-iodine at 24 h to log10 1.43 cfu/g, followed by OCT at 48 h to log10 2.41 cfu/g. Whilst 0.02% PHMB resulted in a stable bacterial load over 120 h to log10 4.00 cfu/g over 120 h, 0.1% PHMB + 0.1% betaine inhibited growth during the first 48 h, with slightly increasing bacterial numbers up to log10 5.38 cfu/g at 120 h. These results indicate that this flexible methacrylate dressing can be loaded with various antiseptics serving as drug delivery system. Depending on the selected combination, an individually shaped and controlled antibacterial effect may be achieved using the same type of wound dressing

Towards the ontology-based consolidation of production-centric standards

Production-­centric international standards are intended to serve as an important route towards information sharing across manufacturing decision support systems. As a consequence of textual-­based definitions of concepts acknowledged within these standards, their inability to fully interoperate becomes an issue especially since a multitude of standards are required to cover the needs of extensive domains such as manufacturing industries. To help reinforce the current understanding to support the consolidation of production-­centric standards for improved information sharing, this article explores the specification of well-defined core concepts which can be used as a basis for capturing tailored semantic definitions. The potentials of two heavyweight ontological approaches, notably Common Logic (CL) and the Web Ontology Language (OWL) as candidates for the task, are also exposed. An important finding regarding these two methods is that while an OWL-­based approach shows capabilities towards applications which may require flexible hierarchies of concepts, a CL-­based method represents a favoured contender for scoped and facts-­driven manufacturing applications