Improving Lives and Limbs with Advances in Wound Dressings

It has been estimated that every 30 seconds, somewhere in the world a person is losing a limb to diabetes. Frequently, it starts with what seems like a minor wound. But for the more than 25 million people in the U.S. with diabetes¹ there is no such thing as a "minor wound" when any wound that is not treated adequately can lead to amputation.

It's clear that the old ways of dressing wounds have not always been adequate. Weeping wounds presented a problem, as most absorbent foam dressings just held the weeping fluid (exudate) in place and the healthy skin at the wound's edge became soggy (macerated) and broke down, causing the wound to enlarge.

Other old absorbing dressings were the calcium alginates that got packed into the wound like rope fibers or in the shape of a pad, which often left residue behind in the wound. Gels that may have been used would leave too much moisture at the wound and once again, cause maceration.

While we learned of the importance of moisture for a wound to heal, we also learned that it had to be just the right amount. The scab that Mother Nature provides is not acceptable for anyone who might have a problem with healing. A scab is formed when the wound surface is too dry and the material that oozes from the wound is not removed.

Not allowing a scab to form also prevents the need to remove it, which might destroy some good tissue during the process. Dressings need to allow for some moisture at the wound surface to facilitate moving of cells across it to close the open areas of the wound. This cellular movement is a critical aspect of the healing process.

The problem for people with diabetes is that this condition causes defects in the response to bacteria that might invade the body through breaks in the skin. The bacteria grow to amounts that cause infection before the person with diabetes shows any signs. Once signs of infection—e.g., redness, fever, pus—show up, it might be too late to get control with antibiotic treatment.

Those with diabetes have several strikes against them. They often don't feel their feet, so this increases the risk of developing an ulcer at pressure points. As a result of poorly fitted shoes, long-distance walking, or or even sitting with pressure on the heels for a long period, an ulcer might develop. This ulcer might go undetected until it becomes infected and a compromised immune system may make it difficult to fight off infection.

This means at the first sign of an ulcer the response needs to be very aggressive. There are several crucial aspects of this response: fighting off contaminating bacteria, removing any dead tissue and maintaining a clean, moist environment.

One dressing, known as sorbion sachet S, has a covering on it that will gently pull off necrotic tissue without affecting the healthy tissue and cells that help to heal the wound. It uses what is called "hydration response technology" to pull off the bacteria and excess fluid from the wound, and then hold it within the dressing without making the surface or tissue around the wound soggy.

It leaves just the right amount of moisture using a combination of fibers and gels without allowing the bacteria absorbed into it to re-enter the wound. The sorbion dressing also comes in several shapes that can fit around almost any region of the body.

Innovations of this sort represent the next generation of wound care and could offer improved outcomes for those with diabetic ulcers.

¹American Diabetes Association

Janice M. Smiell, M.D. is Chief Medical Officer of Alliqua BioMedical Inc., a biomedical company focused on the development, manufacturing, and distribution of proprietary wound management technologies.