When one thinks of wound closure products, the image of a suture or staple is usually foremost in mind, and while these closures by primary intention devices are a vital part of the surgical toolkit, it is the secondary dressing, often in the form of a semi-occlusive film, where much of the recent innovation has occurred. It is a well-established fact that an infected wound is not only slow to heal, but can lead to deep tissue infections, resulting in an increase in severity for the patient, and an increase in costs to the system. Think of a failed hip replacement, or a breast implant due to infection – the enormous cost of treating infections and the attention now on Healthcare-Associated Infections (HAI) has brought post-surgical wound management under increased scrutiny. Surgeons therefore should consider a number of factors when choosing a closure product for their wound site:
- Does the dressing possess antimicrobial capabilities and if so, to what degree is it using the most advanced technology available. For example, does the dressing contain the appropriate antimicrobial(s) to provide as wide a spectrum of activity as possible and are the antimicrobial agents dispersed uniformly throughout the dressing to provide protection not just at the immediate wound site, but also at the peri-wound area to prevent potential migration of opportunistic pathogens to the wound.
- How is the antimicrobial activated? Most antimicrobials need moisture to be activated. If the dressing is a dry dressing and does not promote a moist wound healing environment the antimicrobials will not be effective, so a dressing that maintains a moist environment to ensure the optimal conditions, while still maintaining breathability to avoid any potential for maceration of the wound site should be considered.
- Does the dressing have good contact with the wound bed? If the dressing has dead spaces there will be no antimicrobial coverage under the dead space and the risk of infection increases.
- Dressing transparency is a factor. The clinician should be able to visualize the wound in order to rapidly and easily assess the current state of the healing process. Useful for determining if an infection is present as might be suggested by the presence of excessive exudate, edema, or erythrema.
- Comfort considerations, especially if the patient has fragile skin. Some dressings contain acrylic adhesives that can damage sensitive skin upon removal, while others are more skin-friendly (e.g. those with silicone-based adhesives).
- Last but not least is the minimization of hypertrophic and keloid scarring. A valuable ancillary strategy for reducing excessive scar formation includes the use of semi-occlusive dressings for maintaining a moist wound environment, especially when combined with a wound contact area containing silicone, which is known play a role in scar management.
Keeping aware of new technologies that address many or all of these considerations can ultimately lead to optimal patient outcomes.
John Hands is director of marketing for Covalon Technologies Ltd. For more information about Covalon, visit www.covalon.com.