Choosing the right dressing: Options are plentiful in 'Wild West' of woundcare

Key Points

Akron, Ohio - Just as chronic wounds take a wide variety of shapes and forms, the broad array of wound dressings is also expansive, presenting challenges to physicians in choosing just the right dressing for just the right wound.

"The woundcare world is a little like the 'Wild West' right now in that there are a lot of products out there and a lot of claims, but there is really not very much in the way of good clinical trials to prove that anything works better than any other product - or even better than placebo, for that matter," Dr. Mostow tells Dermatology Times.

Products that do have some of the strongest research behind them include dermal substitute Apligraf (Novartis/Organogenesis), shown to be useful in the healing of diabetic foot ulcers, or the growth factor-containing Regranex (0.01 percent becaplermin, Ortho-McNeil), also indicated for diabetic or neuropathic ulcers.

"Those are two products with excellent clinical trials, but most products don't have evidence to that extent," Dr. Mostow says.

In the absence of few, if any, groundbreaking new wound-dressing products, the latest approaches have involved the modification of what is already available.

Silver ions

"What's in vogue right now is the addition of silver ions to a given dressing in order to provide additional bacterial benefit, and this is relatively new in dressings," Dr. Mostow explains.

Silver-infused dressings have gained favor due to their exceptional efficacy as antibacterial agents, but the treatments have one significant shortcoming - the inability to tackle biofilms.

"A lot of treatments that may be effective for regular bacterial colonization or infection don't work as well with biofilms," Dr. Mostow says.

"Likewise," he says, "silver is not especially effective if the bacteria in the wound is in a biofilm formation."

ECM dressings

Extracellular matrix dressings that are being used more often include Oasis (Healthpoint), a product that is derived from porcine intestinal mucosa. Oasis acts to support cell adherence.

"Oasis is an advanced option, because it is a minimally processed collagen that you apply to a wound, and it acts as a scaffold with molecular activity," he says.

Cousins to Oasis include Prisma and Promogran (Johnson & Johnson), which combine collagen with oxidized regenerated cellulose.