Wound Dressings and Comparative Effectiveness Data

Abstract

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. 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. 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. 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.

Fluorinated methacrylamide chitosan hydrogels enhance collagen synthesis in wound healing through increased oxygen availability

“…Unfortunately, this strategy has a number of shortcomings including the possibility of systemic side-effects from the locally applied reactive chemicals or enzymes [13], local pH changes, and heating via exothermic reactions. Specific biomaterial strategies have been developed to blunt these potentially negative effects [9, 12, 14, 15], or avoid their need altogether including work using methacrylamide chitosan modified with perfluorocarbons (MACF) [16, 17]. …”

“…PFCs are often combined with excipients and formed into short-lived colloidal suspensions [21]. To overcome these PFC limitations, MACF can form the basis of aqueous hydrogels that can sustain the benefit of PFCs and be used to enhance local oxygenation [17]. Chitosan is the base biopolymer of choice, because it is naturally abundant, biodegradable, and acceptable for use in many biomedical applications [22].…”

“…A plethora of FDA-approved clinical wound dressings focus on maintaining wound hydration, antimicrobial properties, and supportive ECM structure for new granulation tissue [17, 27]. Many wound dressings used in standard wound care are synthetic such as polyester pads, polyurethane foams, and various synthetic blends [17].…”

Evaluation of genipin-crosslinked chitosan hydrogels as a potential carrier for silver sulfadiazine nanocrystals

“…Several reviews had summarized and analyzed the merits of polymer hydrogels applied for wound care [18][19][20][21]. In our previous work CHI hydrogels were prepared by using natural genipin as crosslinking agent.…”

First Middle East Experience with Novel Foam Dressing Together with Negative Pressure Wound Therapy and Instillation

“…These epidemics result in significant morbidity and increased health care costs. In the United States chronic wound affects 6.5 million people with an estimated cost of 6–15 billion dollars annually [1]. Many research studies are designed to innovate advanced wound dressings, shorten the duration of wound healing and avoid the cost of hospitalization with recurrent visits to the operating rooms (OR).…”