Manufacturers market wide variety of dressings

By Liza Ovington, PhD, CWS
President, Ovington & Associates
Fort Lauderdale, FL

Judging by a recent tour of the exhibit floor at a large wound care symposium, the proliferation of advanced wound care dressings is at an all-time high. New and different dressings continue to be introduced into the marketplace every year. A review of the different brands of various categories of dressings listed in three consecutive annual buyer’s guides shows that while numbers have decreased slightly in a few individual categories, the overall numbers have increased every year.

Many of the new dressings are copycats of something already on the market, with the primary difference being a reduced price. Some new dressings claim to offer better performance such as increased absorption, better conformability, better adhesion and wear time, or specialized shapes. Others claim to be specialized, with singular performance parameters such as special ingredients that facilitate a particular phase or cell of the healing process. Promotional materials and reports describing clinical use accompany most of the new dressings as well as the returning brands. These reports may be as simple as a descriptive case study or a case series or a comparative study vs. a logical competitor. More and more, the wound care decision makers are demanding randomized controlled trials to evaluate wound care products, and this type of study may be available as well.

The more specialized a product becomes in terms of its function or performance parameters, the less widely applicable it may be for different wound types or for one wound over the entire course of its healing process. Everyone would agree that the use of an enzymatic debriding agent in a wound with slough or eschar should be discontinued once the devitalized tissue is cleared.

Most clinicians also would agree that as a wound evolves in its healing, it has different requirements in terms of the topical dressing used for management. A wound that presents as a deep crater with copious exudate may need a conformable, absorbent dressing such as an alginate until it begins to granulate in and drain less. At that point, the alginate may be too absorbent and topical management might be switched to another type of dressing such as a hydrocolloid. As the same wound begins to epithelialize, the hydrocolloid may become too adhesive for the nascent epithelium, and topical treatment may again evolve to a less adhesive dressing. As the wound evolves, so should the dressing or topical management.

However, this logical evolution of dressing type with wound healing progress is rarely employed in the course of a comparative, randomized clinical trial. Usually, the control and test dressings are used from the time of patient enrollment until the day of complete wound closure. So, while the design of a randomized controlled trial minimizes bias between the two modalities being compared, does it represent the reality of clinical practice as it relates to product utilization? If the same dressing is used from the time of wounding until the time of healing, might it not be inappropriate or at least not the best choice at some time point or status of wound healing? Might the randomized controlled trial that employs one dressing throughout the course of healing actually be dampening the benefit of the dressing?

These thoughts lead to questions about study designs that may best evaluate and compare the efficacy of the wide variety of dressings available on the market today.