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CC BY-NC-ND 4.0 · Indian J Plast Surg 2012; 45(02): 379-387
DOI: 10.4103/0970-0358.101321
Review Article
Association of Plastic Surgeons of India

Recent advances in topical wound care

Sujata Sarabahi
Department of Burns and Plastic Surgery, VMMC and Safdarjung Hospital, New Delhi, India
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Publication History

Publication Date:
27 November 2019 (online)

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ABSTRACT

There are a wide variety of dressing techniques and materials available for management of both acute wounds and chronic non-healing wounds. The primary objective in both the cases is to achieve a healed closed wound. However, in a chronic wound the dressing may be required for preparing the wound bed for further operative procedures such as skin grafting. An ideal dressing material should not only accelerate wound healing but also reduce loss of protein, electrolytes and fluid from the wound, and help to minimize pain and infection. The present dictum is to promote the concept of moist wound healing. This is in sharp contrast to the earlier practice of exposure method of wound management wherein the wound was allowed to dry. It can be quite a challenge for any physician to choose an appropriate dressing material when faced with a wound. Since wound care is undergoing a constant change and new products are being introduced into the market frequently, one needs to keep abreast of their effect on wound healing. This article emphasizes on the importance of assessment of the wound bed, the amount of drainage, depth of damage, presence of infection and location of wound. These characteristics will help any clinician decide on which product to use and where,in order to get optimal wound healing. However, there are no ′magical dressings′. Dressings are one important aspect that promotes wound healing apart from treating the underlying cause and other supportive measures like nutrition and systemic antibiotics need to be given equal attention.

KEY WORDS

Moist healing - topical wound care - wet dressings
 
  • 1 Winter GD.Formation of scab and rate of epithelialization of superficial wounds in the skin of the young domestic pig. Nature 1962;193:293-4.
  • 2 Cho CY, Lo JS.Excision and repair: Dressing the part. DermatolClin1998;16:25-47.
  • 3 Moon CH, Crabtree TG.New wound dressing techniques to accelerate healing. Curr Treat Options Infect Dis 2003;5:251-60.
  • 4 Varghese MC, Balin AK, Carter DM, Caldwell D. Local environment of chronic wounds under synthetic dressings. Arch Dermatol 1986;122:52-7.
  • 5 Alvarez OM, Mertz PM, Eaglstein WH.The effect of occlusive dressings on collagen synthesis and re-epithelialization in superficial wounds. J Surg Res 1983;35:142-8.
  • 6 Rubio PA.Use of semiocclusive, transparent film dressings for surgical wound protection: An experience in 3637 cases. Int Surg 1991;76:253-4.
  • 7 Jones AM, San Miguel L. Are modern wound dressings a clinical and cost effective alternative to the use of gauze? J Wound Care 2006;15:65-9.
  • 8 Robson MC, Smith PD.Topical use of growth factors to enhance healing. In:Falanga V, editor.Cutaneous wound healing. London: Martin Dunitz, Ltd; 2001. p. 379-98.
  • 9 Scales JT. Development and evaluation of a porous surgical dressing. Br Med J 1956;2:962-81.
  • 10 Hinman CD, Maibach H. Effect of air exposure and occlusion on experimental human skin wounds. Nature 1963; 200:377-8.
  • 11 Field FK, Kerstein MD. Overview of wound healing in a moist environment. Am J Surg 1994;167:2S-6S.
  • 12 Bolton LL, Monte K, Pirone LA. Moisture and healing: Beyond the jargon.Ostomy Wound Manage2000;46(1A Suppl):51S-62S;quiz 63S-64S.
  • 13 Lineaweaver W, Howard R, Soucy D, Mc Morris S, Freeman J, Crain C, et al. Topical antimicrobial toxicity. Arch Surg 1985;120:267-70.
  • 14 White RJ, Cutting K, Kingsley A.Topical antimicrobials in the control of wound bioburden. Ostomy Wound Manage 2006;52:26-58.
  • 15 Lawrence JC.The use of iodine as an antiseptic agent. J Wound Care 1998;7:421-5.
  • 16 Schultz GS, Sibbald GR, Falangna V, Ayello E, Dowsett C, Harding K, et al. Wound bed preparation: A systematic approach to wound managment. Wound Repair Regen 2003;11:1-28.
  • 17 Lio PA, Raye ET. Topical antibacterial agents.Infect Dis Clin North Am 2009;23:945-63.
  • 18 Lansdown AB. Silver in health care:Antimicrobial effects and safety in use.Curr Probl Dermatol 2006;33:17-34.
  • 19 Lansdown AB.Metallothioneins:Potential therapeutic aids for wound healing in the skin. Wound Repair Regen 2002;10:130-2.
  • 20 Demling RH, Leslie De Santi MD. The rate of re-epithelialization across meshed skin grafts is increased with exposure to silver. Burns 2002:28;264-6.
  • 21 Bradley M, Cullum N, Nelson EA, Petticrew M, Sheldon T, Torgerson D. Systematic reviews of wound care management (2) dressings and topical agents used in healing of chronic wounds. Health Technol Assess 1999;3:1-35.
  • 22 Rubin JR, Alexander J, Plecha EJ, Arman C. Unna′s boot Vs polyurethane foam dressings for the treatment of venous ulceration: A randomized prospective study. Arch Surg 1990;125:489-90.
  • 23 Kannon GA, Garrett AB. Moist wound healing with occlusive dressings: A clinical review.Dermatol Surg 1995;21:583-90.
  • 24 Argar MS. Four alginate dressings in the treatment of partial thickness wounds: A comparative experimental study.Br J Plast Surg 1996;49:129-34.
  • 25 Suzuki Y, Tanihara M, Nishimura Y, Suzuki K, Yamawaki ;Y, Kudo ;H, et ;al. In vivo evaluation of a novel alginate dressing. J Biomed Mater Res 1999;48:522-7.
  • 26 Doyle JW, Roth TP, Smith RM, LI YQ, Dunn RM. Effects of calcium alginate on cellular wound healing processes modelledinvitro. J Biomed Mater Res 1996;32:561-8.
  • 27 Suzuki Y, Nishimura Y, Tamihara M, Suzuki K, Nakamura ;T, Shimizu Y, et al. Evaluation of a novel alginate gel dressing: Cytotoxicity to fibroblasts invitro and foreign body reactions in pig skin in vivo. J Biomed Mater Res 1998;39:317-22.
  • 28 Sprung P, Hon Z, Ladin DA. Hydrogels and Hydrocolloids: An objective product comparison. Ostomy Wound Manage 1998;44:36-46.
  • 29 Banks V, Hagelstein S, Thomas N, Bale S, Harding KG.Comparing hydrocolloid dressings in management of exuding wounds. Br J Nurs 1999;8:640-6.
  • 30 Jones V, Milton T. When, how to use Hydro gels.Nurs Times 2000;96(14 Suppl):3-4.
  • 31 Lay-Flurrie K. The properties of Hydrogel dressings and their impact on wound healing. Prof Nurse 2004;19:269-73.
  • 32 Moffatt CJ, Franks PJ,Hollinworth H. 33. Falanga V. Wound bed preparation and the role of enzymesa case for multiple actions of therapeutic agents. Wounds 2002;14:47-74.
  • 33 Burgess AR, Poka A,Brumback RJ, Flagle CL, Loeb PE, Ebraheim NA. Pedestrian tibial injuries.J Trauma 1987;27:596-604.
  • 34 Klein MB, Hunter S, Heimbach DM, Engrav LH, Honari ;S, Gallery ;E, et al. The versajet water dissection: A new tool for tangential excision. J Burn Care Rehabil 2007;26:483-7.
  • 35 Courtenay M. The use of larval therapy in wound management in the UK. J Wound Care 1999;8:177-9.
  • 36 Bonn D. Maggot therapy: An alternative for wound infection. Lancet 2000;356:1174.
  • 37 Thomas S, Andrews A, Jones M. The use of larval therapy in wound management.J Wound Care1998;7:521-4.
  • 38 Morykwas MJ, Argenta LC, Shelton-Brown EL, McGuist W. VAC: A new method for wound control and treatment: Animal studies and basic foundation. Ann Plast Surg 1997;38:553-62.
  • 39 Shirakawa M, Isseroff RR. Topical negative pressure devices: Use for enhancement of healing chronic wounds. Arch Dermatol 2005;141:1449-53.
  • 40 Venturi ML, Attinger CE, Mesabahi AN, Hess CL,Grawk S. Mechanisms and clinical application of VAC device: A review. Am J Clin Dermatol 2005;6:185-94.
  • 41 Higley HR,Ksander GA, Gerhardt CO,Falanga V. Extravasation of macromolecules and possible trapping of transforming growth factors -beta in venous ulcerations. Br J Dermatol 1995;132:79-85.
  • 42 Trengone NJ, Stacey MC, MacAuley S. Analysis of acute and chronic wound environment: The role of proteases and their inhibitors. Wound Repair Regen 1999;7:442-52.
  • 43 Trengone NJ, Bielefeldt -Ohmann H, Stacey MC. Miogenic activity and cytokine levels in nonhealing and healing chronic leg ulcers. Wound Repair Regen 2000;8:13-25.
  • 44 Greenhalgh DG. The role of growth factors in wound healing. J Trauma 1996;41:159-67.
  • 45 Hardinge KG, Morris HL, Patrl GK. Science, medicine and the future: Healing chronic wound s. BMJ 2002;324:160-3.
  • 46 Robson MC, Mustoe TA, Hunt TK. The future of recombinant growth factors in wound healing. Am J Surg 1998;176 (suppl 2A):80S-82S.
  • 47 Brem H, Balledux J, Bloom T, Kerstein MD, Hollier L. Healing of diabetic foot ulcers and pressure ulces with human skin equivalent: a new paradigm in wound healing. Arch Surg 2000;135:627-34.
  • 48 Margolis DJ, Bartus C, Hoffstad O, Malay S, Berlin JA. Effectiveness of recombinant human PDGF for treatment of diabetic neuropathic foot ulcers. Wound Repair Regen 2005;13:531-6.
  • 49 Mian M, Beghe F, Mian E. Collagen as a pharmacological approach in wound healing. Int J Tissue React 1992;14:S1-9.
  • 50 Hess CT. Wound care. 5 th ed. Baltimor MD: Lippincott Williams and Wilkins; 2005.
  • 51 Wilson JM, Baines R, Babu ED, Kelley CJ. A role of topical insulin in the management of problematic surgical wounds. Ann R Coll Surg Engl 2008;90:160.
  • 52 Zhang X, Wu X, Wolf SE, Hawkins HK, Chinkes DL, Wolfe RR. et ;al. Local insulin zinc injection accelerated skin closure donor site wound healing. J Surg Res 2007;142:90-6.
  • 53 Greenway SE, Filler LE, Greenway FL. Topical insulin in wound healing: A randomized double -blind, placebo controlled trial. J Wound Care 1999;8:526-8.
  • 54 Rezvani O, Shabbak E, Aslam A, Bidar R, Jafari M, Safanezhad ;S. A randomized double blind placebo controlled trial to determine the effects of topical insulin on wound healing. Ostomy Wound Manage 2009;55:22-28.
  • 55 Chen X, Liu Y, Zhang X. Topical insulin application improves healing by regulating the wound inflammatory response. Wound Repair Regen 2010;20:425-34.
  • 56 Baumann LS, Spencer J. The effects of topical vitamin E on the cosmetic appearance of scars.Dermatol Surg 1999;25:311-5.
  • 57 Pinnel SR. Regarding d-alpha -Tocopherol. Dermatol Surg 1999;25:827.
  • 58 Mackay D, Miller AL. Nutritional support for wound healing.Altern Med Rev 2003:8:359-77.
  • 59 Schreml S, Szeimes RM, Prantl L, Karrer S, Landthaler M, Babilas ;P. Oxygen in acute and chronic wound healing. Br J Dermatol 2010;163:257-68.
  • 60 Kallianien LK, Gordillo GM, Schlanger R, Sen CK. Topical oxygen as an adjunct to wound healing:A clinical case series. Pathophysiology 2003;9:81-7.
  • 61 Hanson SE, Bentz ML, Hematti P. Mesenchymal stem cell therapy for nonhealing cutaneous wounds.Plast Reconstr Surg 2010;125:510-16.
  • 62 Cha J, Falanga V. Stem cells in cutaneous wound healing.Clin Dermatol 2007;25:73-8.
  • 63 Stoff A, Riviera AA, Banerjee NS, Moore ST, Numnum TM, Monteros A, et al. Promotion of incisional wound repair by human mesenchymal stem cell transplantation. Exp Dermatol 2009;18: 362-9.
  • 64 Yoshikama T, Mitsumo H, Nonaka I, Sen Y, Kawanishi K, Inada Y, et al. Wound therapy by marrow mesenchymal cell transplantation.Plast Reconstr Surg 2008;121:860-77.
  • 65 Ko SH, Nauta A, Wong V, Glotzbach J, Gurtner GC, Longaker MT. The role of stem cells in cutaneous wound healing: What do we really know? Plast Reconstr Surg 2011;127(Suppl 1);10S-20S.
  • 66 Cherubino M, Rubin JP, Miljkovic N, Kelmendi-Doko A,Marra KG. Adipose derived stem cells for wound healing applications. Ann Plast Surg 2011;66:210-15.
  • 67 Lau K, Paus R, Tiede S, Day P, Bayat A. Exploring the role of stem cells in cutaneous wound healing. Exp Dermatol 2009;18:921-33.
  • 68 Gauglitz GG, Jeschke MG. Combined gene and stem cell therapy for cutaneous wound healing.Mol Pharma 2011;8:1471-9.
  • 69 Branski LK, Gauglitz GG, Herndon DN, Jeschke MG. A review of gene and stem cell therapy in cutaneous wound healing. Burns 2009;35:171-80.
  • 70 langer R. Biomaterials in drug delivery and tissue engineering: onelaboratory′s experience. Acc Chem Res 2000;33;94-101.
  • 71 Korbling M, EstronZ. Adult stem cells for tissue repair -a new therapeutic concept? N Eng J Med 2003;349:570-82.
  • 72 Eming SA,Kreig T, Davidson JM. Gene therapy and wound healing.Clin Dermatol 2007;25:79-92.