References

Schultz GS, Sibbald RG, Falanga V Wound bed preparation: a systematic approach to wound management. Wound Repair Regen. 2003; 11:S1-S28 https://doi.org/10.1046/j.1524-475X.11.s2.1.x

Schultz GS, Barillo DJ, Mozingo DW, Chin GA Wound bed preparation and a brief history of TIME. Int Wound J. 2004; 1:(1)19-32 https://doi.org/10.1111/j.1742-481x.2004.00008.x

Atkin L, Bucko Z, Conde Montero E Implementing TIMERS: the race against hard-to-heal wounds. J Wound Care. 2019; 23:S1-S50 https://doi.org/10.12968/jowc.2019.28.Sup3a.S1

Moore Z, Dowsett C, Smith G TIME CDST: an updated tool to address the current challenges in wound care. J Wound Care. 2019; 28:(3)154-161 https://doi.org/10.12968/jowc.2019.28.3.154

Dissemond J, Chadwick P, Weir D M.O.I.S.T. Concept for the local therapy of chronic wounds: an international update. Int J Low Extrem Wounds. 2024; https://doi.org/10.1177/15347346241245159

Wound exudate: effective assessment and management. 2019. WUWHS consensus document. https://tinyurl.com/55h7kht4 (accessed 13 August 2024)

Rippon MG, Rogers AA, Ousey K The importance of periwound skin in wound healing: an overview of the evidence. J Wound Care. 2022; 31:(8)648-659 https://doi.org/10.12968/jowc.2022.31.8.648

Kandhwal M, Behl T, Singh S Role of matrix metalloproteinase in wound healing. Am J Transl Res. 2022; 14:(7)4391-4405

Tardáguila-García A, García-Morales E, García-Alamino JM Metalloproteinases in chronic and acute wounds: a systematic review and meta-analysis. Wound Repair Regen. 2019; 27:(4)415-420 https://doi.org/10.1111/wrr.12717

MMPs made easy. 2009. https://tinyurl.com/2s3pfk5f (accessed 13 August 2024)

Swanson T, Ousey K, Haesler E IWII wound infection in clinical practice consensus document: 2022 update. J Wound Care. 2022; 31:S10-S21 https://doi.org/10.12968/jowc.2022.31.Sup12.S10

Edwards R, Harding KG Bacteria and wound healing. Curr Opin Infect Dis. 2004; 17:(2)91-96 https://doi.org/10.1097/00001432-200404000-00004

Jones SG, Edwards R, Thomas DW Inflammation and wound healing: the role of bacteria in the immuno-regulation of wound healing. Int J Low Extrem Wounds. 2004; 3:(4)201-208 https://doi.org/10.1177/1534734604271810

Hampton J, Sharpe A, McCluskey P Diagnosis and treatment of infected wounds: a multi-centre audit of current clinical practice across the UK, Ireland and Scandinavia. J Clin Nurs. 2023; 32:(15-16)4730-4740 https://doi.org/10.1111/jocn.16527

Lipsky BA, Dryden M, Gottrup F Antimicrobial stewardship in wound care: a position paper from the British Society for Antimicrobial Chemotherapy and European Wound Management Association. J Antimicrob Chemother. 2016; 71:(11)3026-3035 https://doi.org/10.1093/jac/dkw287

Antimicrobial stewardship strategies for wound management. Best practice statement. https://tinyurl.com/26wn9mfn (accessed 13 August 2024)

Tiscar-González V, Menor-Rodríguez MJ, Rabadán-Sainz C Clinical and economic impact of wound care using a polyurethane foam multilayer dressing. Adv Skin Wound Care. 2021; 34:(1)23-30 https://doi.org/10.1097/01.ASW.0000722744.20511.71

Scalise A, Arizmendi M, Vicente H Evaluation of a five-layer hydrocellular polyurethane foam dressing across wound care settings in southern Europe. J Wound Care. 2023; 32:(2)68-73 https://doi.org/10.12968/jowc.2023.32.2.68

Berg L, Lazaro-Martinez JL, Serena TE Promoting wound healing by optimising dressing change frequency. Wounds International. 2019; 10:(3)68-75

Rippon M, Davies P, White R Taking the trauma out of wound care: the importance of undisturbed healing. J Wound Care. 2012; 21:(8)359-368 https://doi.org/10.12968/jowc.2012.21.8.359

Undisturbed wound healing: a narrative review of the literature and clinical considerations. 2019. https://tinyurl.com/77w79b84 (accessed 13 August 2024)

Gefen A, Alves P, Beeckman D How should clinical wound care and management translate to effective engineering standard testing requirements from foam dressings? Mapping the existing gaps and needs. Adv Wound Care. 2024; 13:(1)34-52 https://doi.org/10.1089/wound.2021.0173

Percival SL, Slone W, Linton S Use of flow cytometry to compare the antimicrobial efficacy of silver-containing wound dressings against planktonic Staphylococcus aureus and Pseudomonas aeruginosa. Wound Repair Regen. 2011; 19:(3)436-441 https://doi.org/10.1111/j.1524-475X.2011.00685.x

Edwards-Jones V Microbiology and malodorous wounds. Wounds UK. 2018; 14:(4)72-75

Rossington A, Drysdale K, Winter R Clinical performance and positive impact on patient wellbeing of ALLEVYN Life. Wounds UK. 2013; 9:(4)91-95

Hurd T, Murdoch J Integrated care bundle for the management of chronic wounds. J Community Nurs. 2023; 37:(2)38-44

Joy H, Bielby A, Searle R A collaborative project to enhance efficiency through dressing change practice. J Wound Care. 2015; 24:(7)312-317 https://doi.org/10.12968/jowc.2015.24.7.312

Gutwein LG, Panigrahi M, Schultz GS, Mast BA Microbial barriers. Clin Plast Surg. 2012; 39:(3)229-238 https://doi.org/10.1016/j.cps.2012.04.002

Schultz GS, Woo K, Weir D, Yang Q Effectiveness of a monofilament wound debridement pad at removing biofilm and slough: ex vivo and clinical performance. J Wound Care. 2018; 27:(2)80-90 https://doi.org/10.12968/jowc.2018.27.2.80

Singh G, Byrne C, Thomason H, McBain AJ Investigating the microbial and metalloprotease sequestration properties of superabsorbent wound dressings. Sci Rep. 2022; 12:(1) https://doi.org/10.1038/s41598-022-08361-3

Wolcott RD, Rumbaugh KP, James G Biofilm maturity studies indicate sharp debridement opens a time-dependent therapeutic window. J Wound Care. 2010; 19:(8)320-328 https://doi.org/10.12968/jowc.2010.19.8.77709

Malone M, Nygren E, Hamberg T In vitro and in vivo evaluation of the antimicrobial effectiveness of non-medicated hydrophobic wound dressings. Int Wound J. 2024; 21:(2) https://doi.org/10.1111/iwj.14416

Braunwarth H, Brill FH Antimicrobial efficacy of modern wound dressings: oligodynamic bactericidal versus hydrophobic adsorption effect. Wound Medicine. 2014; 5:16-20 https://doi.org/10.1016/j.wndm.2014.04.003

Dowsett C, Bellingeri A, Carville K A route to more effective infection management: The Infection Management Pathway. Wounds International. 2020; 11:(3)50-57

Gethin G, Grocott P, Probst S, Clarke E Current practice in the management of wound odour: an international survey. Int J Nurs Stud. 2014; 51:(6)865-874 https://doi.org/10.1016/j.ijnurstu.2013.10.013

Ousey K, Roberts D, Gefen A Early identification of wound infection: understanding wound odour. J Wound Care. 2017; 26:(10)577-582 https://doi.org/10.12968/jowc.2017.26.10.577

Bowler PG, Davies BJ, Jones SA Microbial involvement in chronic wound malodour. J Wound Care. 1999; 8:(5)216-218 https://doi.org/10.12968/jowc.1999.8.5.25875

Baskovich B, Sampson EM, Schultz GS, Parnell LK Wound dressing components degrade proteins detrimental to wound healing. Int Wound J. 2008; 5:(4)543-551 https://doi.org/10.1111/j.1742-481X.2007.00422.x

Matsumura H, Imai R, Ahmatjan N Removal of adhesive wound dressing and its effects on the stratum corneum of the skin: comparison of eight different adhesive wound dressings. Int Wound J. 2014; 11:(1)50-54 https://doi.org/10.1111/j.1742-481X.2012.01061.x

Enhanced exploration of the mode of action of a five-layer foam dressing: critical properties to support wound healing

02 September 2024
Volume 8 · Issue 2

Abstract

Objective:

The aim of this in vitro experimental series was to explore the mode of action of a hydrocellular polyurethane foam dressing (HPFD) and how its advanced features support beneficial interactions with the wound bed to address common barriers to wound healing, thus supporting improved clinical outcomes.

Method:

Multiple in vitro microbiological tests were performed, assessing prevention of bacterial ingress, surface removal of bacteria, bacterial sequestration and retention into the dressing in a clinically relevant environment. Odour molecule concentrations were measured using gas chromatography and further assays explored matrix metalloproteinase (MMP)-9 retention in the dressing using enzyme linked immunosorbent assay.

Results:

The HPFD demonstrated marked reductions in bioburden levels across multiple tests. These included prevention of bacterial ingress for seven days, removal of surface bacteria and absorption into the dressing. Further tests identified that most bacteria were sequestered into the hyperabsorbent layer (90.5% for Pseudomonas aeruginosa and 89.6% for meticillin-resistant Staphylococcus aureus). Moreover, the majority of bacteria (99.99% for both test organisms) were retained within the dressing, even upon compression. Additional tests demonstrated a marked reduction of odour molecules following incubation with HPFD and total retention of protease MMP-9 within the dressing.

Conclusions:

Proactive management of the wound environment with an appropriate advanced wound dressing, such as the HPFD examined in these in vitro investigations, can not only help to minimise the barriers to healing, as observed across this test series by direct interaction with the wound bed, but may, as a result, provide an ideal environment for wound progression with minimal disturbance.

Optimising the wound bed to facilitate improved healing in hard-to-heal (chronic) wounds is well known, and has been the focus of wound education and practice since the concept was conceived over 20 years ago.1,2 Recent updates to these principles of wound bed preparation reiterate the importance of balancing removal of necrotic tissue, infection and inflammation, and moisture balance in the wound.35 While important new technologies and adjuncts are continually added to the armamentarium of health professionals (HPs), many interventions require removal of these known barriers to wound healing in order to function optimally.3,5

Moisture balance is critical for wound healing; excessive levels of moisture can lead to tissue maceration and too little may restrict autolytic debridement, cellular migration and delivery of growth factors.1,6 The presence of maceration or dry, excoriated skin also plays an important role in disturbance of the periwound area, further adversely effecting wound healing.7 Furthermore, wound exudate can be an important carrier of proteases. Matrix metalloproteinases (MMPs) play an important role in the wound healing process; however, elevated MMPs, such as MMP-2 and MMP-9 specifically, have been associated with delayed wound healing and are found in 54.5% of wounds;8,9 thus protease management is important in optimally balancing wound parameters.10

Register now to continue reading

Thank you for visiting Wound Central and reading some of our peer-reviewed resources for wound care professionals. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Access to clinical or professional articles

  • New content and clinical updates each month