Securing cellular and tissue-based products using a soft silicone wound contact layer
Abstract
Cellular and tissue-based products (CTBPs) provide many benefits to the well-prepared wound bed. CTBPs are traditionally secured with sutures, staples or wound closure strips and covered with a secondary dressing. These dressings are often changed in between clinical evaluations of wound response to the CTBP. The secondary dressing changes are usually done by the provider's clinic or office staff but are also frequently performed by nursing staff at skilled nursing facilities (SNFs) or home health agencies (HHAs) that have little familiarity with CTBPs, risking loss of CTBP adherence. Wound closure strips, sutures and staples have known complications but using silicone wound contact layers for securement have not been reported. This case series evaluated the use of this product type to assure adherence of CTBPs to the wound bed.
After application of a CTBP, a soft silicone wound contact layer was applied over the CTBP in 15 patients for a total of 64 CTBP applications. A secondary dressing of provider choice was placed over the soft silicone wound contact layer. Secondary dressings were changed by staff in HHAs/SNFs in 13/15 patients between office visits.
Soft silicone wound contact layer applications were rated ‘very easy’ by providers. Large fenestrations in the dressing allowed free flow of drainage with loss of one soft silicone contact layer integrity noted at one week after CTBP application. Of the 15 patients, four were able to remove the secondary dressing and shower. Pain scores on soft silicone dressing removal was consistently two or less (mean: 0.5). No adverse events were seen.
The use of cellular or tissue-based products (CTBPs) have become more commonplace to treat recalcitrant wounds. CTBPs can be either non-viable animal or human cells or viable human cells. Viable human cells are usually cultured in vitro on an animal or synthetic substrate, while non-cultured cellular products are available as intact tissue.1,2
Successful outcomes are partly dependent on good wound bed preparation, management of bioburden and adequate treatment of the underlying comorbidities associated with poor wound healing. Effective use also requires meticulous application and aftercare.2 As the CTBPs vary in each class, using them requires intimate knowledge of the specific product. Providers should read the product insert for application instructions to assure optimal outcomes.
There are common interventions that can be generalised for all CTBPs. These include assuring complete contact with the wound bed by preventing air bubbles or crumpling; providing fenestration to prevent wound exudate from ‘floating’ the CTBP off the surface of the wound; preventing desiccation of CTBPs by using a cover dressing to provide moisture balance; and using a ‘bolster’ or ‘pressure dressing’ to keep the CTBP intact for a prolonged period, usually five to seven days. Non-adherent dressings are preferred to prevent premature dislodgement of the CTBP. Using a topical antimicrobial agent over the CTBP has also been reported.2 Reported adherence mechanisms used include skin closure strips (e.g. Steri-Strip), staples, skin adhesives, sutures, negative pressure wound therapy, or ‘clinician choice of fixation’.2
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