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• Acetic acid (AA): It is another antiseptic solution that has been applied as a topical antimicrobial agent to wounds, including burns.
• A few heterogeneous studies involving a limited number of grossly contaminated or
infected wounds suggest that 1–5% AA solutions have been effective; however, pain, itching, and burning of the skin have been reported
when this concentration range has been
applied. There are no clinical studies of AA
use in burn patients. One invitro study found
that 3% AA was bactericidal against a broad
range of burn wound pathogens [35].
• Povidone-iodine and chlorhexidine solutions
have been used as topical antiseptic agents on
burn wounds. Both agents are effective against
a wide range of bacteria and fungi.
• Presently, both agents are commonly used as
soap solutions to clean wounds, especially as
a “prep” of the skin, and burn wounds prior to
surgery.
• Chlorhexidine diphosphanilate cream: It has
been tested in burn patients, and the agent is
though difcult to apply and painful at concentrations above 0.5% [36].
10.6 Chemical Burns
Chemical burn injuries represent only 3% of all
burns; many compounds have the potential to
induce chemical burns due to exposure to industrial or household cleaning substances or pesticides. Most commonly affected body areas are
face, eyes, and extremities. All burn wounds,
whether due to chemical or thermal sources, have
in common protein denaturation, as changes in
pH or dissolution of surrounding lipids may stabilize a protein and disrupt its function.
Severity of a chemical burn injury is deter-
mined by several factors:
• Concentration of chemical agent.
• Quantity of chemical agent.
• Manner and duration of skin contact.
• Extent of penetration.
• Mechanism of action.
• Phase of agent (liquid, solid, and gas).
Within these groups, there are different categories of compounds. Chemical burns are often
described as acidic or alkaline [37, 38]. Acids act
as proton donors in the biological system, and
strong acids have a pH<2. Alkali, or basic material, capable of producing injury, typically has a
pH > 11.5 [39]. In general, alkaline materials
cause more injury than acidic compounds. Acids
cause coagulation necrosis with protein precipitation, whereas the reaction to alkali is “liquefaction” necrosis, allowing the substance to penetrate
deeper into the injured tissue [40].
Most important aspects of rst aid for chemical burns involve agent removal from contact
with the patient. This requires the removal of all
potentially contaminated clothing and copious
irrigation.
Irrigation of chemical burns requires the protection of healthcare providers, in order to prevent additional injuries. Immediate copious
irrigation has been shown to reduce the extent
and depth of injury, especially to eyes [41]. Thirty
minutes to 2h of lavage may be necessary.
The use of neutralizing agents is discouraged.
The practical problems encountered with their
use are exothermic reactions causing further thermal damage. Regional poison control centers for
household chemicals or unidentied agents can
be valuable resources for potential systemic toxicity and side effects of a particular agent.
References
1. Institute of Medicine. Clinical practice guidelines we
can trust. Washington, DC: The National Academies
Press; 2011. p.16.
2. Leon-Villapalos J, Barret JP. Surgical Repair of the
Acute Burn Wound: Who, When, What Techniques?
What Is the Future?. J Burn Care Res. 2023:44.
3. ISBI “Practice Guidelines for Burn Care” ISBI Practice
Guidelines Committee; Steering Subcommittee;
Advisory Subcommittee.
4. Sarkar A, Rakshit P, Majumdar BK, et al. Use of
cadaveric skin allograft in management of deep burn
wounds: our experience. Int J Basic Appl Med Sci.
2013;3:186–8.
5. Obeng MK, McCauley RL, Barnett JR. Cadaveric
allograft discards as a result of positive skin cultures.
Burns. 2001;27:267–71.
6. Kua EH, Goh CQ, Ting Y, Chua A, Song C.Comparing
the use of glycerol preserved and cryopreserved allo-
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genic skin for the treatment of severe burns: differences in clinical outcomes and invitro tissue viability.
Cell Tissue Bank. 2012;13:269–79.
7. Böttcher-Haberzeth S, Biedermann T, Reichmann
E.Tissue engineering of skin. Burns. 2010;36:450–60.
8. van Zuijlen P, etal. Tissue engineering in burn scar
reconstruction. Burns Trauma. 2015;3:18.
9. Tang B, Zhu B, Liang Y-Y, Bi L-K, Chen B, Hu Z-C,
Zhu J-Y.Early escharectomy and concurrent composite skin grafting over human acellular dermal matrix
scaffold for covering deep facial burns. Plast Reconstr
Surg. 2011;127(4):1533–8.
10. Stephen L, David H, Maureen H, Yvelle A, Abhijit
N. Transplanted acellular allograft dermal matrix:
potential as a template for the reconstruction of viable
dermis. Transplantation. 1995;60(1):1–9.
11. The Cochrane Collaboration. Published by John
Wiley & Sons, Ltd. “Dressings for supercial and
partial thickness burns (Review)” 2013.
12. Whitaker IS, Worthington S, Jivan S, Phipps A.The
use of biobrane by burn units in the United Kingdom:
a national study. Burns. 2007;33:1015–20.
13. Vana LPM, Battlehner CN, Ferreira MA, Caldini
EG, Gemperli R, Alonso N.Comparative long-term
study between two dermal regeneration templates
for the reconstruction of burn scar contractures in
humans: clinical and histological results. Burns.
2020;46(3):596–608.
14. Whitaker IS, Prowse S, Potokar TS.A critical evaluation of the use of Biobrane as a biologic skin substitute: a versatile tool for the plastic and reconstructive
surgeon. Ann Plast Surg. 2008;60:333–7.
15. Busche MN, et al. Der Biobrane®-Handschuh bei
Verbrennungen der Hand. Handchir Mikrochir Plast
Chir. 2009;41:348–54.
16. Gravante G, Delogu D, Giordan N, Morano G,
Montone A, Esposito G.The use of Hyalomatrix PA
in the treatment of deep partial-thickness burns. J
Burn Care Res. 2007;28(2):269–74.
17. Auxenfans C, Shipkov H, Bach C, Catherine Z,
Lacroix P, Bertin-Maghit M, Braye F.Cultured allogenic keratinocytes for extensive burns: a retrospective study over 15 years. Burns. 2014;40(1):82–8.
18. Kesting MR, Wolf K-D, Hohlweg-Majert B,
Steinstraesser L. The role of allogenic amniotic
membrane in burn treatment. J Burn Care Res.
2008;29(6):907–16.
19. Ang ES, Lee ST, Gan CS, See P, Chan YH, Ng LH,
Machin D.The role of alternative therapy in the management of partial thickness burns of the face--experience with the use of moist exposed burn ointment
(MEBO) compared with silver sulphadiazine. Ann
Acad Med Singap. 2000;29(1):7–10.
20. Berry MG, Goodwin TI, Misra RR, Dunn
KW.Digitisation of the total burn surface area. Burns.
2006;32:684–8.
21. Zhang W, et al. Catechol-functionalized hydrogels:
biomimetic design, adhesion mechanism, and biomedical applications. Chem Soc Rev. 2020;49:433–64.
22. Kopecki Z. Development of next-generation antimicrobial hydrogel dressing to combat burn wound
infection. Biosci Rep. 2021;41:2.
23. Alven S, Aderibigbe BA. Chitosan and cellulosebased hydrogels for wound management. Int J Mol
Sci. 2020;21(24):9656.
24. Richetta AG, Cantisani C, Li WV, Mattozz C,
Melis L, De Gado F, et al. Hydrober dressing and
wound repair: review of the literature and new patents. Recent Patents Inamm Allergy Drug Discov.
2011;5(2):150–4.
25. Dinah F, Adhikari A.Gauze packing of open surgical
wounds: empirical or evidence-based practice? Ann R
Coll Surg Engl. 2006;88:33–6.
26. Jones V, Grey JE, Harding KG. Wound dressings.
BMJ. 2006;332:777–80.
27. Giudice G, Filoni A, Maggio G, Bonamonte D, Vestita
M, etal. Cost analysis of a novel enzymatic debriding
agent for management of burn wounds. Biomed Res
Int. 2017;2017:9567498.
28. Kern MA, Depka N, Schackert C, Henkel W,
Hirche CR. Enzymatic burn wound debridement
with NexoBrid1: cost simulations and investigations on cost efciency. Gesundheitsökonomie und
Qualitätsmanagement. 2018;23:21–8.
29. Russo R, Carrizzo A, Barbato A, Rasile BR,
Pentangelo P, Ceccaroni A, Marra C, Alfano C, Losco
L. Clinical evaluation of the efcacy and tolerability of Rigenase® and polyhexanide (Fitostimoline®
Plus) vs. hyaluronic acid and silver sulfadiazine
(Connettivina® Bio Plus) for the treatment of
acute skin wounds: a randomized trial. J Clin Med.
2022;11(9):2518.
30. Hoogewerf CJ, Hop MJ, Nieuwenhuis MK, Oen
IM, Middelkoop E, Van Baar ME. Topical treatment for facial burns. Cochrane Database Syst Rev.
2020;7(7):CD008058.
31. Hirsch T, Ashkar W, Schumacher O, Steinstraesser L,
Ingianni G, Cedidi CC.Moist exposed burn ointment
(MEBO) in partial thickness burns—a randomized,
comparative open mono-center study on the efcacy of dermaheal (MEBO) ointment on thermal 2nd
degree burns compared to conventional therapy. Eur
J Med Res. 2008;13(11):505–10. PMID: 19073386.
32. Isak V, Beerli T, Cozzio A, Flatz L. A rare case of
localized argyria on the face. Case Rep Dermatol.
2019;11(1):23–7.
33. Fernandez R, Green HL, Grifths R, Atkinson RA,
Ellwood LJ. Water for wound cleansing. Cochrane
Database Syst Rev. 2022;9(9):CD003861.
34. Cooper DD, Seupaul RA.Is water effective for wound
cleansing? Ann Emerg Med. 2012;60:626–7.
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35. Ryssel H, Kloeters O, Germann G, Schäfer T,
Wiedemann G, Oehlbauer M.The antimicrobial effect
of acetic acid- an alternative to common local antiseptics? Burns. 2009;35:695–700.
36. Miller LM, Loder JS, Hansbrough JF, Peterson HD,
Monafo WW, Jordan MH.Patient tolerance of topical
chlorhexidine diphosphanilate: a new topical agent
for burns. Burns. 1990;16:217–20.
37. Moriarty R. Corrosive chemicals: acids and alkali.
Drug Ther. 1979;1:3.
38. Leonard LG, Scheulen JJ, Munster AM. Chemical
burns: effect of prompt rst aid. J Trauma.
1982;22(5):420–3.
39. Yano K, Hata Y, Matsuka K, etal. Effects of washing
with a neutralizing agent on alkaline skin injuries in
an experimental model. Burns. 1994;20(1):36–9.
40. Palao R, Monge I, Ruiz M, et al. Chemical
burns: pathophysiology and treatment. Burns.
2010;36(3):295–304.
41. Kuckelkorn R, Schrage N, Keller G, etal. Emergency
treatment of chemical and thermal eye burns. Acta
Ophthalmol Scand. 2002;80(1):4–10.
Innovative Dressings
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EvelinMakuc
11
As the modern world’s population has become an
increasingly aging one, chronic conditions
including skin healing disorders have become
more and more common, bringing about a huge
economic and sanitary burden. Statistics report
that, among chronic limb wounds, for example,
diabetic foot ulcers are the most common, being
responsible for up to 70% of lower limb amputations, and, as a consequence, for increased mortality [1].
This and other signicant reasons, which
include psychological and social implications of
having to deal with poorly healing lesions, have
led to the need to develop smart materials that
can optimize the management of said
conditions.
Progression in knowledge of wound etiology
and healing processes has led to the introduction
of more technological, advanced dressing materials that target specic aspects of the wound, thus
optimizing the healing process.
While traditional dressings are still widely
used both for their low cost and simple manufacturing process, these are, however, considered
inert dressings, because of the lack of interaction
with the wound bed, and inability to create the
optimal conditions for an accelerated healing
process, unlike advanced dressings [2].
E. Makuc (*)
RN and Wound Care Expert at Cattinara Hospital,
ASUGI, Trieste, Italy
e-mail: evelin.makuc@asugi.sanita.fvg.it
Nowadays, dressings are considered optimal
and efcient when they are both cost-effective
and deliver specic benecial effects. These
include antibacterial properties, pain relief, epithelialization acceleration, mechanical protection
and exibility, exudate absorption, and dissolving of necrotic tissue and brin [3].
Innovative dressings, besides providing better
biocompatibility, moisture retention, and degradability [4], nowadays provide innovative technology with the use of nanotechnology, micelle
matrixes, and antimicrobial agents. They not only
function as a protective layer, but also operate as
diagnostic sensors in wound monitoring and
wound healing promotion.
Wound care dressings can be summarized into
three macro-groups: passive, interactive, and bioactive products [5]. While passive dressings are
suitable for dry wounds and not for moderately to
highly exuding ones, interactive and bioactive
ones perform brilliantly: the rst by creating an
hypoxic environment that has proven to be highly
stimulating re-epithelialization and granulation
[6], the second, by delivering bioactive compounds to the wound bed.
More in detail, dressings can be further
divided into four categories, according to the
Italian Association of Chronic Wounds position
paper of 2014: [7].
© The Author(s), under exclusive license to Springer Nature Switzerland AG 2023
M. Maruccia et al. (eds.), Pearls and Pitfalls in Skin Ulcer Management,
https://doi.org/10.1007/978-3-031-45453-0_11
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• Autolysis and debridement promoting
dressings.
• Granulation-stimulating dressings.
• Antimicrobial dressings.
• Re-epithelialization promoting dressings.
Some innovative dressing technologies are
listed as follows and will be thoroughly analyzed
in this chapter:
• TLC-NOSF Technology-based dressings.
• Gelling hydrober dressings.
• Microbe-trapping dressings.
11.1 TLC-NOSF Technology-Based
Dressings
Technology lipidocolloid with nano-oligosaccharide factor (TCL-NOSF) is a lipidocolloid
matrix containing sucrose octasulfate potassium
salt: This salt has proven to actively inhibit matrix
metalloproteases (MMPs) and to interact with
different growth factors. Lipidocolloid
Technology-silver matrix (TLC-Ag)-based dressings have been in use since 2006, supported by
high-quality medical evidence, for the management of wounds at high risk or with ongoing
infection [8]. This technology can be applied to
contact layers, adhesive and non-adhesive foams,
and gelifying bers and has lately been used as
coating of polyacrylate polyabsorbent bers.
Results from a randomized controlled trial on
chronic leg ulcer treatment [9] and an observational study on 227 patients [10] suggest an
increased efcacy of wound healing and reduction in complications following the use of silverbased dressings, as opposed to dressings without
silver: TCL-Ag technology has a broad-spectrum
antimicrobial effect along with anti-biolm
action thanks to the synergic if not enhanced
action of the matrix and the polyabsorbent bers
that mechanically break down biolm of also
methicillin-resistant Staphylococcus aureus
(MRSA) and pseudomonas aeruginosa, remaining active for up to 7days [11].
Furthermore, it reduces up to 32.5% of the
wound surface after a 4-week treatment and up to
62.5% of slough [12], resulting in an effective,
safe dressing in the management of wounds
regardless of their level of exudate or healing
stage, with superior capacity when compared to
commonly used hydrobers [13].
This technology can be applied and combined
with different materials, or can be preceded by
preparation treatments with dressings containing
polyacrylate and hydro-desloughing bers (as in
UrgoClean Ag dressing), which are highly absorbent and trap slough, bacteria, and biolm residues, keeping the wound deterged. Biolm is a
structured colony of bacteria enclosed in a polysaccharide extracellular matrix that takes only 2
to 4days to form and is present in over 80% of
infections [14, 15], hindering healing by promoting inammation, exudate production, and
slough; it also acts as barrier against antimicrobial molecules, antibodies, and macrophages
[16].
Most silver-based dressings have the ion
impregnated into the absorbent bers or foam,
whereas the silver contained in some advanced
dressings like UrgoClean Ag® comes directly in
contact with the wound bed because of its incorporation in the lipidocolloid layer, maximizing
its antimicrobial efcacy [11].
Change in these types of dressings may vary
according to the clinical conditions and the exudate level of the wound, approximately every
other day.
They are mostly indicated for acute and
chronic lesions with and without local infection
and are contraindicated in patients with allergies
to any of the components.
Another type of polyabsorbent ber dressing
containing a protease inhibitor (TLC-NOSF healing matrix that inhibits excess metalloproteinase)
and polyabsorbent bers that bind, trap, and
retain exudate is UrgoStart Plus®. This is particularly indicated for diabetic foot ulcers: Lower
limb wounds, diabetic foot, and pressure wounds
generally require an average of 210days to heal
completely [17, 18].
Along with the underlying causes, three other
factors greatly affect the healing: process: excess
MMP damages the extracellular matrix and is
systematically higher in chronic wounds as
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opposed to acute ones [19]. Vascular alterations
limit oxygen supply [20] and slough recurrence
perpetuates inammation.
When addressing these issues, physicians
must prioritize quality of life, avoidance of further complications, and reduction of healthcare
costs.
That being stated, innovative dressings such
as UrgoStart Plus® have proven to reduce that
median healing time by 100days on average [21]
thanks to its polyabsorbent bers that absorb
excess exudate and bind slough and debris
through electrostatic mechanism and thanks to its
TCL-NOSF matrix technology (Lipidocolloid
Technology-Nano-Oligosaccharide Factor). This
patented matrix technology, once in contact with
the wound bed, hydrates and turns into a gel that
creates a favorable healing environment by inhibiting excess matrix metalloproteinase (MMP)
and by promoting angiogenesis through endothelial cell migration.
These properties combined make the dressing
highly cohesive and provide atraumatic, painless
removal [22, 23].
Following adequate treatment of the underlying causes (compression, revascularization, etc.),
advanced dressing must be changed every other
day at the beginning of treatment and subsequently every 7days considering the level of exudate and clinical conditions of the wound.
If infection of the wound bed coexists, it is
recommended to rst apply a silver-based dressing (such as UrgoClean Ag®) before starting a
TLC-based treatment.
In light of new scientic evidence proving that
TLC-NOSF technology reduces healing time of
diabetic foot ulcers by approximately 60 days
and heals 60% more patients affected by DFU
compared to wounds treated with non-interactive
dressings [24], 2019 International Working
Group on the Diabetic Foot (IWGDF) guidelines
and NICE [25] strongly recommend the use of
TLC-NOSF based dressings like UrgoStart for
local treatment of neuro-ischemic diabetic foot
wounds [26]. It is mainly indicated on lower limb
lesions, diabetic foot lesions, and pressure
wounds, while contraindications include heavy
bleeding wounds, cancerous wounds, and
abscesses.
Polyester bers like those used for UrgoStart
Contact® dressing are also efciently combined
with lipidocolloidal matrix rich in saccharide factors (TLC-NOSF Technology), which creates a
humid environment that stimulates tissue regeneration, inhibits metalloprotease, excess and promotes neoangiogenesis [27].
This polyester weave allows exudate to be
transferred to the secondary dressing, preventing
internal growth of granulation tissue, while the
composition of the bers does not leave dressing
fragments that could have pro-inammatory
properties.
Because of its exibility and atraumatic painless removal, UrgoStart is indicated in the treatment of cavitated, hardly accessible, or deep
wounds. Ideal dressing change may vary from 2
to 7days according to healing stage and level of
exudate, for a total recommended treatment time
of at least 8weeks.
Contraindications to the use of this type of
dressing include tumor lesions, stulas, and
abscess.
11.2 Hydroactive Dressings,
Gelling Fiber Dressings,
and3D FIT Technology
Dressings
Hydroactive dressings are multilayered, highly
absorbent polymer dressings. Some even have a
waterproof outer layer, and although hydroactive
dressings are similar to foams, they have a different action for absorbing exudate because they
draw uid into the structure of the polymer and
trap the exudate to maintain a moist environment,
whereas foams absorb exudate by a siphon effect.
The main advantages of the hydroactive dressing are that they (1) absorb exudate quickly and
effectively, reducing the risk of maceration, and
they provide moisture to dry wounds, facilitating
faster healing; they do not stick to the wound bed,
making removal atraumatic for the patient; they
also soothe painful wounds, providing greater
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patient comfort and tolerability, and nally
protect the wound from bacteria, reducing the
risk of infection. Hydroactive dressings are indicated for highly exuding wound surface and cavity wounds, including pressure injuries, venous
leg ulcers, and minor burns. Due to the ability to
contract and expand without causing constriction, they are particularly useful over joints.
Because of their absorbing abilities, these
dressings are not indicated for lightly exuding
and dry wounds [28].
Gelling ber dressings are absorbent wound
dressings that contain synthetic bers made from
sodium carboxymethyl cellulose, strengthening
cellulose bers, and other absorbent materials.
As wound uid is absorbed into the dressing, a
gel forms, which assists in maintaining a moist
environment for optimal wound healing and the
formation of granulation tissue.
Biatain Fiber® with HexaLock technology is
an example of a new gelling ber in the form of
rope or sheet dressing with characteristic heatsealed hexagonal unities that block exudate and
maintain their original shape thanks to the innovative HexaLock technology [29].
This new dressing can be applied to exuding
wounds, especially undermined and cavitary
wounds, with the advantage of creating a stronger, quicker gelling substance when in contact
with the wound bed, as well as better managing
the exudate level through absorption, retention,
and resistance to shrinkage, when compared with
traditional alginate dressings [30].
Like other gelling bers, Biatain Fiber® can
also be combined with other super-absorbent
dressings, which, however, must conform to the
wound edges: Contact with exuding wound bed
creates a cohesive gel through vertical absorption, which prevents the surrounding skin from
macerating.
In addition to its absorbing properties, Biatain
ber greatly supports autolytic debridement and
de-sloughing, promoting faster wound healing
[29].
3D FIT technology dressings include dressings with the ability to perfectly adapt and conform to the wound bed: These can consist of
multilayer, polyurethane adhesive, and non-
adhesive absorbent foams (e.g., Biatain Ag®)
with continuously released silver ions that provide antimicrobial properties up to 7 days. The
non-adhesive area is in direct contact with the
wound bed, while the external hydrophobic
sheath protects from external agents.
Thanks to its patented 3D FIT technology, the
dressing absorbs all excess exudate, when in contact with the wound bed, and molds itself to the
wound bed’s shape for up to 2cm of depth.
The adhesive border is delicate on the surrounding skin and allows atraumatic removal,
leaving no residues. Indicated on acute and
chronic wounds with high bacterial presence,
with medium to high exudation level. The dressing can also have prophylactic use, and dressing
change can occur in 5 to 7days. Contraindications:
Silver Hypersensitivity [31].
11.3 Dressings withHydrober
andMore Than Silver
Technology
“Hydrober” and “more than silver” technology
dressings are antimicrobial absorbent dressings
developed to counteract biolm on the wound
bed.
To accelerate healing, biolm and excess exudate must be managed.
By placing the dressing on the wound bed,
hydrober technology begins to absorb the exudate and form a cohesive gel ensuring full contact
with the wound bed.
“Hydrober” technology is composed of carboxyl methyl cellulose bers and physically
removes and pulls debris and bacteria away from
the wound by trapping them inside the dressing.
The “more than silver” technology consists of
three components: BEC, EDTA, and Ag+that act
synergistically to disrupt and destroy biolm.
Benzethonium chloride (BEC) is a surfactant
that reduces surface tension within the biolm
and its action helps antibiolm agents reach bacteria more effectively and faster.
Ethylenediaminetetraacetic acid or disodium
salt (EDTA) is a metal chelating agent that selectively binds and removes metal ions that hold the
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EPS matrix of the biolm together, exposing the
microorganisms within it.
Ag+− Once defenses are down, the ionic silver can reach and kill exposed microorganisms.
The concentration of silver is 1.2%, and the
dressing provides safe, broad-spectrum antimicrobial action. Silver ions become available only
when the dressing gels, and this modulated action
ensures a constant silver level to destroy and prevent biolm reproduction.
Strengthening the bers of the dressing allows
for increased tensile strength and safe removal in
a compact manner without leaving residue
[32–40].
11.3.1 PluroGel® Burn andWound
Dressing
This is a 100% water-soluble, biocompatible surfactant gel utilizing micelle matrix technology.
This dressing as well comes with or without silver ions and shows autolytic and pro-healing
properties.
Slough, bacteria, and debris are effectively
trapped and softened by the concentrated surfactant that also helps maintain an optimal moist
environment.
Its painless removal increases patient compliance, while the unique micelle matrix allows the
dressing to maintain thickness [41].
PluroGel® Burn and Wound Dressing are indicated for use on chronic vascular ulcers, venous
ulcers, diabetic ulcers, draining wounds, partialand full-thickness wounds, pressure injuries,
second-degree burns, surgical wounds, trauma
wounds (abrasions, lacerations, skin tears), and
tunneling/undermining wounds.
It can be applied directly onto secondary
dressing using a sterile applicator (foam for a
shallow wound, packing strips for a deeper
wound). Thickness of 3mm (slightly more than
nickel) is ideal for minimal drainage and 5mm (2
nickels thick) for moderate drainage or dressing
change every 3days.
Where applicable, the gel can be covered with
absorbent dressing and kept for up to 3 days:
PluroGel® is 100% water-soluble and can be eas-
ily irrigated from the wound at dressing change
using normal dressing change solutions.
Contraindications include use on third- and
fourth-degree burns.
11.3.2 PluroGel® Burn andWound
Dressing withPSSD
It consists of a comfortable gel containing
PluroGel surfactant concentrate with the addition
of antimicrobial silver sulfadiazine: can manage
the same lesions listed for PluroGel Burn; however, should not be used in case of known sensitivity to sulfadiazine, silver, or sulfonamides.
11.3.3 Issue-Targeting Dressings
Innovative dressings have been developed for the
treatment and management of specic skin
issues. One of these issues is Intertrigo.
Intertrigo is a form of moisture-associated
skin damage and is commonly found in skin-fold
areas such as armpits, under the breasts, abdomen, toes, and groin. It occurs as a result of prolonged exposure to perspiration and skin-to-skin
contact.
Obese individuals are at higher risk of developing intertrigo, and it is exacerbated by factors
such as immobility and poor hygiene. Patients
may experience itching, and burning sensation,
often combined with unpleasant odor, with great
affection of quality of life and risk of secondary
infection [42].
InterDry® is a product for the management of
skin-fold complicated conditions, such as
Intertrigo, which targets all three factors associated with skin-fold damage simultaneously: skin
moisture, friction, and microbial proliferation,
thanks to its antimicrobial silver complex.
The fabric can be shaped and applied in a single layer after assessing and drying the affected
area, making sure to leave at least 5cm of excess
fabric to be exposed outside the skin fold to promote evaporation. Each application must not
exceed 5 days, after which the fabric must be
replaced with a new one.
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E. Makuc
InterDry has been demonstrated to provide
relief and reduction in symptoms such as erythema, denudement, maceration, itching, and
pain within 5days from application [43, 44].
11.3.4 Activated Carbon-Based
Dressings
Zorex® wound contact dressings accelerate the
wound healing process 1 [45–47] across a diverse
range of wound types. Activated carbon cloth
(ACC) has been used for many years as an antiodor component in wound dressings. The key
innovation behind Zorex® activated carbon
cloth is the recent discovery that, when in direct
contact with the wound bed, helps signicantly
accelerate wound healing – attracting and trapping the microbes from the wound bed into the
activated carbon cloth through electrostatic force.
It has proven effective against MRSA and as a
protease modulator [47], providing an effective
antimicrobial barrier for up to 7days.
Besides reducing pain and exudate, it reduces
and controls odor through its highly absorbent
properties.
This dressing is indicated for full- and partialthickness wounds such as traumatic wounds, surgical sites, fumigating carcinomas, pressure
ulcers, venous leg ulcers, diabetic foot ulcers,
and recipient graft sites.
11.4 Copper Antimicrobial
Dressings
Dressings impregnated with copper oxide microparticles are indicated for acute, post-surgical,
and chronic wounds such as
• Diabetic wounds.
• Lower extremity ulcers.
• Pressure injuries.
• Supercial epidermal and dermal burns.
• Surgical wounds.
Copper is an essential nutrient mineral with
potent broad-spectrum antimicrobial efcacy; it
is safe, biocompatible, nonsensitizing, and nonirritating to the skin.
The dressings are disposable with an inner
absorbent layer and one or two outer nonwoven,
nonadherent layers. All layers are impregnated
with copper oxide particles and can be left in
place for up to 7days.
11.4.1 Dialkylcarbamoyl Chloride
(DACC) Technology
Dialkylcarbamoyl chloride (DACC) is a synthetic
fatty acid that is highly hydrophobic: Since most
microorganisms responsible for chronic wounds
have hydrophobic surfaces, invitro data suggest
that bacteria and endotoxins naturally bind irreversibly to the unique DACC-coated dressing
and, therefore, unlike other dressings that kill
bacteria and the microbes, when these dressings
are removed, a great quantity of bacteria and
microbes is also removed [48].
This technology can be applied to different
materials, coating diverse types of dressings
according to the kind of wound and main issue to
address.
Cutimed Siltec Sorbact®, for example, consists of a super-absorbent foam with a silicone
part that comes in contact with the wound bed,
while the top part is made of a highly breathable
lm. This dressing is designed to greatly manage
exudate but also traps bacteria and maintains
wound moisture. It can be used for all shallow,
contaminated, and colonized or infected wounds
with moderate to high exudate level (traumatic
wounds, chronic leg ulcers, diabetic and pressure
wounds, and fungal infections).
Bacteria-binding properties may be altered if
used in combination with creams and ointments,
so these are generally not recommended when
using Cutimed Siltec Sorbact. Cutimed Sorbact
dressing pad, instead, is an exudate absorbing
and bacteria-binding dressing that is coated with
DACC technology. It best works in a moist environment and can be used for all traumatic and
nontraumatic chronic wounds with low levels of
exudate. As with Cutimed Siltec Sorbact, ointments and creams are not recommended in
11 Innovative Dressings
https://t.me/medicina_free
119
combination with this dressing to not alter its
bacteria-binding properties.
Gels and hydrogels, like Cutimed Sorbact
Gel®, can be also used for the management of low
levels of exudate and to bind bacteria in sloughy
wounds. Combination with hydropolymer gel
sheets for Cutimed Sorbact Hydroactive® is
designed to reduce wound bioburden, as well as
absorb and lock in exudate while maintaining a
moist environment. Moreover, its non-adhesive
borders make its removal atraumatic for the
patient.
11.5 Primary Wound Dressing
Spray
Medicament based on natural extracts derived
from two plants, Hypericum perforatum or St.
John’s Wort and Azadirachta indica, A. Juss or
Neem tree that are found to have antiinammatory, healing, antibacterial properties
against Gram-negative and Gram-positive microorganisms as well as biocidal and repellent effects
against harmful dipterans.
The commercial product 1—Primary wound
dressing (1PWD®) derived from the ENEA patent is a plant-based, non-single-molecule, truly
effective (evidence-based) preparation with “allin- one” characteristics as primary dressing,
applicable at any stage of the wound, i.e., from
the moment of injury and until complete healing,
which allows the resolution of all wounds both
acute and chronic, unlike the countless treatment
protocols, which involve the simultaneous or successive use of different products.
The medicament exerts a powerful attractive
ability to macrophages responsible for infection
control in the wound bed, which disappear during
the granulation phase. The initial phase of the
scarring process is dominated by the inammatory phase, which is characterized by local activation of the innate immune system, resulting in
an immediate inux of polymorphonuclear leukocytes (neutrophils) followed by subsequent
invasion of blood monocytes that differentiate
into tissue macrophages, which are essential for
the regulation of immune responses and proper
course of inammation.
The medicament promotes re-epithelialization by controlling the proliferation of keratinocytes along the wound margins already in the
inammatory phase, which will then serve to
re- epithelialize the granulation tissue in
preparation.
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