Antimicrobial alternatives among new woundcare therapies in development

Key Points

Miami - There is a gold standard in woundcare systems based on the concept of negative pressure wound therapy (NPWT), but making refinements to the gold standard is driving innovation that is seeing the emergence of alternative woundcare systems.

"All the systems work through negative pressure to the wound," says Robert Kirsner, M.D., Ph.D., dermatologist, Stiefel Laboratories professor and vice chairman, department of dermatology and cutaneous surgery, University of Miami Miller School of Medicine, Miami. "What is not known is the amount of negative pressure that needs to be applied and the optimal interface to use."

Negative pressure therapy

The V.A.C. Therapy uses a foam that is integrated into the wound bed, but a side effect is that granulation tissue formation is so brisk that it integrates into the wound and there can be some bleeding, Dr. Kirsner says.

"It can cause bleeding and trauma to the wound bed," he says.

Another aspect to other woundcare systems is using a different interface.

"The thought is that an interface that is more gentle or easily removed can be used," Dr. Kirsner says. "Plain gauze has been used as an interface, or others have envisioned various interfaces be used that are biodegradable or dissolve."

It remains to be seen whether altering the amount of negative pressure, altering how it is administered, and altering the interface will affect the efficacy of a woundcare system, Dr. Kirsner says.

Bacterial defense

Controlling bacterial burden and preventing infection are important to those caring for wounds. Dr. Kirsner suggests potential future therapies.

"We can look at our own innate immunity," Dr. Kirsner says. "We have peptides or chemicals that defend against bacteria and are part of our skin. They are turned on when we cut our skin. We could envision using these peptides or chemicals as topical creams or dressings in the future. That could possibly be another antimicrobial agent."

In terms of antimicrobial agents, silver is leading the pack as an agent that is used in woundcare.

"There are many companies that make silver products, often altering silver content and delivery as a way to distinguish themselves, as well as using dressings that differ based on absorption and dressings," Dr. Kirsner says.