Future dressings will test the limits of functionality
Using liquid materials to prevent trauma
What will wound dressings of the future look like? How will they enhance wound care or decrease costs of treatment? Will they be significant improvements over currently available options?
Ben Peirce, RN, CCN, clinical manager of the wound program at Columbia Homecare Resource Center in Ft. Lauderdale, FL, offered Wound Care a few historical perspectives and some predictions about the future of wound dressings.
Until the 1950s, researchers had not figured out that the micro-environment of a wound — or what you put on it or in it — measurably affected healing rates, Peirce says. Prior to that period, wound dressings were little more than adaptations of natural materials used to absorb fluid and to protect the wound from contaminants.
In a landmark 1962 article in the journal Nature, researchers found that if the micro-environment of a wound was controlled (e.g., kept moist), the healing rate increased. This finding led to what turned out to be an explosion in the types and formulation of dressings that are designed to control local environmental factors of a wound. These dressings now make up the bulk of "standard" wound dressings.
For the future, Peirce predicts several trends and directions that dressings for chronic wounds will take. Some are truly cutting-edge developments, while others are just combinations of existing materials that result in an improved product.
• There will be an increasing number of sophisticated composite dressings that combine properties of films, colloids, hydrogels, and alginates.
"The common thread is functionality: extending wear time and allowing for simpler dressing application," says Peirce. "Manufacturers are attempting to use these combinations, and many are coming up with combination dressings that defy categorization, but the bottom line is to increase ease of use and to extend wear time, thus cutting down on the frequency of dressing changes." The attractiveness of those qualities is, of course, to reduce personnel cost associated with dressing changes.
• Peirce predicts that the wound care community will see more utilization of liquid materials that dry into the top layers of skin, such as liquid polymers applied to intact skin to prevent trauma caused by adhesives. Other liquid applications will protect skin from chemical exposure from wound drainage, urine, and feces.
"I think [liquids] will become more and more effective. Often, they’ll be used around stage I wounds and on intact skin where the surface has suffered some injury," Peirce says. "The idea is to stop the problem before it begins or to stop a wound’s progress early."
Clinicians also should expect such liquids to become available more often in the form of sprays and wipes, which are easy to apply and whose application is easy to teach to students.
Do growth factors accelerate healing?
• One trend headed for expansion is dressings that are able to deliver chemicals, such as silver or iodine, to wounds. Even more advanced will be delivery of growth factors or cytokines via wound dressings to stimulate the healing process in wounds, Peirce says. Curative Inc., which runs a nationwide system of wound care clinics, already uses autologous growth factors aggressively for its chronic wound patients.
"We’ll see more of these kinds of products," says Peirce. Products such as Regranax (an altered form of yeast that produces platelet-derived growth factor and is applied topically) grew out of oncology research in the 1980s in which neo-angiogenesis was found in some tumors that stimulated the formation of new blood vessels.
Some clinicians say there is a normal healing rate that cannot be exceeded, regardless of what chemical aids are used. But others claim growth factors do accelerate healing. "This is a very controversial area," Peirce says.
• Skin equivalents will play an ever-more important role in wound care. These compounds are grown on matrices or lattices and seeded with fibroblasts and other cells found to be important in wound healing. Some could be thought of as "growth factor factories."
Because skin equivalents are grown in sheets, surgeons who are adept at using skin grafts already are technically prepared to apply them. Skin equivalents often can be applied in an outpatient setting without the need to harvest skin grafts.
• Other types of dressings to keep an eye out for are "smart dressings" that are designed to adjust the amount of fluid they allow to pass through them to accommodate a wound’s tendency to change the amount of exudate it produces.
• From a marketing perspective, wound care dressings are entering an "adult" phase, with more consolidation not only of dressing types but of dressing manufacturers as well. "The big motivating factor is the change in reimbursement, so you have to choose wound dressings based on clinical trials that show them to be more cost-effective," says Peirce. Effectiveness may mean ease, minimal staff time required, or superior outcome, and may not be based solely on cost. An expensive dressing may be the best choice from a clinical and economic standpoint if it doesn’t require much attention from skilled health care professionals to apply, maintain, or change.
"The least expensive dressing may not be the most cost-effective," says Peirce. "We’re trying to de-skill’ the use of these dressings, and I think that’s going to be good for society."