A prospective, randomized, controlled, crossover study comparing three multilayered foam dressings for the management of chronic wounds

Alves

Beeckman

et al. 2024

Advances in Wound Care

Significance: Wounds of all types remain one of the most important, expensive and common medical problems, e.g., 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.* e.g., in the TIME model -a widely used practical guide to wound management developed by a global team of wound care experts, which relates clinical observations and interventions to the underlying wound pathology in several aspects, including moisture imbalance. 15

Section: Summary and Concluding Remarksmentioning

confidence: 99%

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

Alves

Beeckman

et al. 2024

Advances in Wound Care

Section: Discussionmentioning

confidence: 99%

“…Poorly performing wound dressings or dressing pairs may cause suboptimal moisture balance, sharp tissue temperature gradients, mechanical damage to tissues, foreign body reaction or a combination of these unwarranted events. 70 It is therefore surprising that existing laboratory tests for evaluating the fluid management performance and mechanical durability of wound dressings, e.g., the commonly used European EN 13726 family of standards for wound dressings, 52 typically neglect the fundamental physiological and clinical aspects that determine the environment in which dressings function. Among the major topics that are ignored in the abovementioned and similar testing standards are: (a) the anatomical configuration relevant to the wound aetiology, (b) exposure to physiological mechanical forces that may influence the performance of dressings, (c) the directionality of the exudate flow from the wound into the applied dressings, (d) the forces and clinical technique of removal of the dressings and (e) the biophysical behaviour of the exudate, particularly the range of possible exudate viscosities.…”

Section: Discussionmentioning

confidence: 99%

The performance of gelling fibre wound dressings under clinically relevant robotic laboratory tests

Lustig

International Wound Journal

2022

The effectiveness of wound dressing performance in exudate management is commonly gauged in simple, non‐realistic laboratory setups, typically, where dressing specimens are submersed in vessels containing aqueous solutions, rather than by means of clinically relevant test configurations. Specifically, two key fluid–structure interaction concepts: sorptivity—the ability of wound dressings to transfer exudate, including viscous fluids, away from the wound bed by capillary action and durability—the capacity of dressings to maintain their structural integrity over time and particularly, at removal events, have not been properly addressed in existing test protocols. The present article reviews our recent published research concerning the development of clinically relevant testing methods for wound dressings, focussing on the clinical relevance of the tests as well as on the standardisation and automation of laboratory measurements of dressing performance. A second objective of this work was to compile the experimental results characterising the performance of gelling fibre dressings, which were acquired using advanced testing methods, to demonstrate differences across products that apparently belong to the same “gelling fibre” family but differ remarkably in materials, structure and composition and, thereby, in performance.

“…Poorly performing dressings or dressing pairs may cause suboptimal moisture balance, excessive tissue temperature changes, mechanical damage to tissues, foreign body reaction to debris from disintegrated dressings or a combination of these unwarranted events 23 . Any and all these factors have potential consequences on patient safety and wellbeing, progression of healing (or the lack of), the quality of care and the treatment costs.…”

Section: Discussionmentioning

confidence: 99%

“…Made from tightly packed fibres of blended superabsorbent materials, gelling fibre dressings absorb excess exudate, causing the dressing material to swell and take the form of a gel which closely conforms to the wound cavity shape. After inserting a gelling fibre dressing into the wound cavity, the common clinical practice is to cover the wound with a secondary, ‘bordered’ foam dressing (ie, a dressing having a wound contact foam pad surrounded by an adhesive border) 23 . The secondary dressing provides an additional reservoir for the exudate absorption and retention; supports the maintenance of a moist environment by preventing dehydration of the wound; prevents excessive heat loss from the wound bed; and protects the wound from further mechanical trauma and pathogens.…”

Section: Introductionmentioning

confidence: 99%

Fluid management and strength postsimulated use of primary and secondary dressings for treating diabetic foot ulcers: Robotic phantom studies

Lustig

International Wound Journal

2021

Non‐offloaded diabetic heel ulcers and the wound dressings used to treat them may be subjected to considerable bodyweight forces. A novel robotic foot phantom with a diabetic heel ulcer was designed and constructed to test the combined performances of applied primary and secondary dressings, in simulated non‐offloaded (standing) and offloaded (supine) postures. We specifically compared the performances of the primary Exufiber dressing (Mölnlycke Health Care) combined with the secondary Mepilex Border Flex dressing (Mölnlycke) against a corresponding pair from an alternative manufacturer. Fluid retention and distribution between the primary and secondary dressings of each pair were determined using weight tests, and mechanical strength of the primary dressings was further measured postsimulated use through tensile testing. The Exufiber and Mepilex Border Flex pair performed similarly in the two simulated postures (retention = ~97%), whereas the comparator pair exhibited a 13%‐decrease in retention for a supine to standing transition. Furthermore, the Exufiber dressing delivered up to 2‐times more fluid to its paired secondary dressing and endured 1.7‐times greater strain energy than the corresponding primary dressing before failure occurred. The present robotic foot phantom and associated methods are versatile and suitable for testing any dressing, in consideration of the relevant clinical factors and practice.