BB&T Contributing Editor
GRAPEVINE, Texas – The Symposium on Advanced Wound Care featured 189 podium presentations and 334 poster presentations, along with more than 180 exhibitors.
The range of materials, technologies, dressing designs and devices used for treating wounds continues to expand as was evident in the wide assortment of therapies promoted by exhibiting companies.
Antimicrobial and Foam Dressings.
Milliken (Spartanburg, South Carolina) uses AFM (Active Fluid Management) technology to pump fluid in one direction, either away from the wound or toward the wound. Its AFM Ag dressing delivers broad spectrum antimicrobial protection over seven days and can be used to promote a moist wound healing environment. AFM Ultra was recently launched recently.
It is an advanced wound dressing that helps reduce maceration and has a foam layer for cushioning comfort. One side of the dressing is hydrophilic and the other side is hydrophobic. Depending on which side is in contact with the wound, it either retains moisture or moves fluid aside. AFM Ultra is especially suited for use on graft and donor sites.
Coloplast (Humlebaek, Denmark/Minneapolis) introduced its InterDry AG, which uses a knitted polyester woven textile. It provides a lubricious and friction reducing surface with a proprietary polyurethane coating for moisture translocation It is impregnated with ionic silver to provide antimicrobial protection and odor control. The product is designed for managing moisture, odor and inflammation in skin folds.
Covidien (Mansfield, Massachusetts) introduced its new Kendall AMD antimicrobial foam dressings. They are comprised of open cell polyurethane foam that is impregnated with 0.5% polyhexamethylene biguanide, a low toxicity antiseptic, and supports a moist and bactericidal environment.
The dressings are effective against gram-positive and gram-negative bacteria and also work against fungi and yeast.
INOS Technologies (Ann Arbor, Michigan), a joint venture between Nanosystems (Ann Arbor) and INOAC (Nagoya, Japan), supplies hydrophilic polyurethane foams for wound dressings and for use in ear plugs and as cosmetic applicators. Its SAQ foam assists in moisture management and is non-swelling when saturated.
First Water (Wilshire, UK) manufactures advanced wound dressings and skin adhesives. It introduced this year a range of new products including Pro-ionic Matrix, a biomimetic wound dressing comprising a partially hydrated superabsorbent polymer that serves as both a hydrating and absorbing dressing. It is formulated to closely mimic the water activity of healthy skin and is intended for use on chronic wounds.
Foam Plus is a gel-foam product which contains a Pro-ionic gel positioned at the back of the foam to absorb excess fluid. Its superabsorbent layer binds fluid and prevents it from leaking back into the foam. Pro-ionic Hydrocolloid is a patented composition of carboxymethylcellulose particles trapped in a superabsorbent hydrophilic matrix. FW Sheet Gels are based on an ionic copolymer system.
They are designed to enhance the interactions of the dressing with chronic wound fluid. Several of First Water's dressings are being sold in the U.S. The company is seeking partnerships for the distribution of its products and for development programs using its proprietary dressing designs as a platform for incorporating partner-specific technologies.
Vomaris Innovations (Chandler, Arizona) introduced its Procellera bioelectric antimicrobial dressing for use on partial and full thickness wounds and acute and chronic wounds. It is a conformable, cut-to-fit, electrically active wound dressing and is designed to mimic the body's natural electric current. It is a single layer polyester fabric dressing. The antimicrobial agent is a blend of silver and zinc.
Procellera utilizes the company's Prosit technology which activates and generates one voltage of electricity at the surface when moistened which prevents microbial penetration. The product remains active for seven days. The company had five posters on this product that reviewed data from clinical research and case studies.
Derma Science (Princeton, New Jersey) has licensed from Quick-Med Technologies (Gainesville, Florida) the Bioguard Barrier non-leaching antimicrobial gauze roll that incorporates Quick-Med's Nimbus cationic biocide technology.
Quick-Med recently reported that it has entered into a joint development and exclusive option agreement with Avery Dennison (Pasadena, California) to collaborate in applying Quick-Med's Nimbus technology to adhesives for medical device and industrial applications. Quick-Med presented abstracts at the conference on three of its antimicrobial technologies
Derma Science recently introduced Xtrasorb, a superabsorbent wound dressing that binds fluids for use as a primary dressing for partial thickness wounds and as a secondary dressing for full thickness wounds.
Matrix Dressings and Fillers.
3M Company (St. Paul, Minnesota) featured its Tegaderm Matrix dressing to restore balance in delayed healing wounds. It employs PHI (polyhydrated ionogen) technology which functions by inhibiting matrix metalloproteinases (MMPs). The product consists of a blend of cations found naturally in the body (potassium.zinc, calcium and rubidium) which help promote the natural moisture balance needed for chronic wound healing.
Integra's (Plainsboro, New Jersey) Flowable Wound Matrix is designed for use in filling deep soft tissue or tunneling wounds, such as ulcers. It is comprised of granulated crosslinked bovine tendon Type I collagen and glycosaminoglycan.
It is hydrated with saline and administered to the wound side via a syringe with a flexible injector. When a wound has an irregular geometry, grafting with a sheet form is not adequate. Flowable Wound Matrix is indicated for use in partial and full thickness wounds, ulcers, surgical wounds, trauma wounds and draining wounds.
Integra recently launched the Meshed Bilayer Wound Matrix that is designed for use in conjunction with NPWT. It is comprised of a porous matrix of crosslinked bovine tendon collagen and glycosaminoglycan and a semi-permeable silicone layer. The meshed bilayer matrix allows drainage of wound exudate and provides a flexible adherent covering for the wound surface. The collagen-glycosaminopglycan beiodegradable matrix provides a scaffold for cellular invasion and capillary growth. Its indications are the same as for the Flowable Wound Matrix.
Hemostats.
HemCon Medical Technologies (Portland, Oregon) markets hemostatic bandages based on chitosan. The bandages were originally developed for treating arterial bleeding caused by battlefield injuries. HemCon recently announced a co-promotion agreement with ConvaTec (Skillman, New Jersey) for marketing ConvaTec's advanced wound and critical care products to the U.S. Armed Forces.
HemCon has entered into the general medical and dental markets with its ChitoFlex dressings and has expanded into Europe with its acquisition in May 2008 of Alltracel Pharmaceuticals (Dublin, Ireland), marketer of m-doc, a micro-dispersed oxidized cellulose hemostat. Synpart (London) is HemCon's consumer products division and markets sports support and oral care products
MedTrade Products (Crewe, UK) sells Celox Pro, a chitosan-based hemostat for stopping severe arterial bleeding that was initially developed for battlefield use. In February, it launched Celox Gauze for sale to the U.S. military and to emergency medical professionals in conjunction with Sam Medical Products (Tualatin, Oregon)
TraumaCure (Berthesda, Maryland) markets WoundStat, a hemostat that stops bleeding of traumatic wounds in seconds. It is comprised of a granular mineral blend.
Biologic Dressings and Skin Substitutes.
TEI Biosciences (Boston) sells PriMatrix Dermal Repair Scaffold, an acellular collagen matrix derived from fetal bovine dermis that is rich in Type III collagen.. It provides an environment that supports cell repopulation and revascularization processes needed for wound healing and stimulates rapid tissue granulation in foot ulcers.
SurgiMend Collagen Matrix is used for soft-tissue reconstruction. It is implanted and acts as a scaffold to reinforce weak or damaged tissue. It is indicated for use in plastic surgery, muscle flap reinforcement and for hernia repair. SurgiMend conforms to the surgical site and is easily sutured. The product's microporosity facilitates rapid cell penetration and revascularization.
Pegasus Biologics (Irvine, California) markets Unite Biomatrix, a crosslinked collagen scaffold for the treatment of chronic wounds. It conforms to a debrided wound bed is pre-fenestrated to manage wound exudate. OrthoADAPT Bioimplant is a collagen tissue scaffold used for orthopedic soft tissue repair
Stratatech (Madison, Wisconsin) is using tissue engineering of cells from infant circumcision tissue to develop its StrataGraft skin graft. When placed on a wound, it causes the sustained delivery of natural growth factors, cytokines and other beneficial substances to promote tissue regeneration and wound healing. A Phase I/II trial was recently completed at the Arizona Burn Center (Phoenix)
ExpressGraft is a next-generation product which consists of skin tissues that are genetically engineered to express and secrete factors to fight bacterial infections, promote blood flow or reduce scarring during healing. It is the first time that human keratinocyte progenitors have been genetically engineered with non-viral vectors. It aims to address the underlying pathophysiology of non-healing chronic wounds.
The company reviewed its ExpressGraft program in a pre-IND meeting held with the FDA in February. The technology was featured in six posters at the conference. The company initiated sales in March of StrataTest skin tissue, a miniaturized version of StrataGraft, to major consumer product companies for testing ingredients used in their products.
Gels, Emulsions and Powders.
Wake Pharm US (Bellwood, Illinois) markets Wound-be-Gone, a topical hydrophilic gel for accelerating wound healing and reducing scarring. It maintains a moist wound environment and contains an active ingredient that removes free oxygen radicals from the wound site. An elastic layer is created that protects the wound from the external environment, preventing contamination.
OrthoNeutrogena, a subsidiary of Johnson & Johnson (New Brunswick, New Jersey), markets Biafine, a water-based emulsion used for treating dermal ulcers, full thickness wounds, donor sites, 1st and 2nd degree burns and minor abrasions. It is contraindicated for use on bleeding wounds. It is applied three times per day over a period of a week.
Uluru (Addison, Texas) displayed Altrazeal, a nanoparticle powder comprised of hydroxyethylmethacrylate and hydroxypropylmethacrylate (HEMA and HPMA in a 85/15 ratio). It is poured onto a wound surface and is transformed into a flexible skin-like dressing that fills and seals the wound. It is recommended for use on exuding wounds such as partial thickness burns, donor sites, surgical and chronic wounds. In March, Uluru reported clinical evidence on the use of Altrazeal to treat diabetic foot ulcers.
Altrazeal is sold by Bio Med Sciences (Allentown, Pennsylvania), which also markets thin silicone sheeting for use on burns, in plastic surgery and for scar management. It uses Silon-IPN technology that combines silicone with Teflon
Negative Pressure Wound Therapy Devices Proliferate.
The enormous success of KCI's (San Antonio) V.A.C. NPWT system has attracted a growing number of competitors. The company is still locked in litigation with Smith & Nephew Wound Therapy (Hull, UK), which entered the NPWT market with its acquisition of Blue Sky Medical (Carlsbad, California).
Other NPWT products are Invia Liberty from Medela Healthcare (McHenry, Illinois), Genadyne A4 from Genadyne Biotechnologies (Great Neck, New York), PRO-II and Pro-III from Prospera (Forth Worth, Texas), NPD 1000 from Kalypto Medical (Mendota Heights, Minnesota), and Compact NPWT system from Talley Medical (Lansing, Michigan), a division of the Talley Group (Ramsey, UK).
Ultrasound-Aided Wound Care.
Söring (Quickborn, Germany) markets Sonoca-180 Ultrasonic Assisted Wound Treatment (UAW). It is non-invasive and uses ultrasonic energy in combination with an irrigation solution to clean and debride wounds. The microprocessor-controlled unit operates at a frequency of 25 kHz. The ultrasonic vibration is transmitted to the handpiece (Sonotrode) and converted to mechanical vibration. It allows for deep tissue penetration of the irrigating solution with associated microcavitations that cause bacterial destruction.
Arobella Medical (Minnetonka, Minnesota) recently received CE-mark approval of its Qoustic Wound Therapy System, an ultrasound aided system for treating chronic wounds. It uses a unique, dome-shaped curette tip to apply low-frequency, cavitational ultrasound to wounds. The combination of physical design and ultrasonic energy gently removes dead and diseased tissue cells, kills harmful bacteria and biofilm, and leaves healthy and pre-healing granulation tissue
Misonix (Farmingdale, New York) markets the SonicOne ultrasonic wound care system that provides tissue specific debridement and cleansing for removing devitalized tissue and fibrin deposits while sparing viable tissue. The ultrasonic probe oscillates at a frequency of 22.5 kHz and makes direct wound contact that allows for deep tissue penetration. Continuous irrigation provides cavitation and flushes the wound of fibrin deposits and bacterial growth.
Celleration's (Eden Prairie, Minnesota).MIST acoustic pressure wound therapy uses low frequency ultrasound waves to produce and propel a gentle mist of sterile saline into the wound bed to cleanse and debride the wound. This non-contact approach promotes painless and accelerated healing through cellular stimulation while reducing the bioburden.
Oxygen Therapy.
Pro2med (Temecula, California) is a distributor of a topical wound oxygen therapy system from Advanced Oxygen Therapy (Galway, Ireland) used for healing venous, diabetic, arterial and pressure ulcers. Cyclical pressurized oxygen has been shown to stimulate collagen synthesis and to enhance fibroblasts and angiogenesis. Its two2 therapy is effective as an adjunctive treatment modality for closing chronic wounds.
Irrigation Device.
PuriCore (Malvern, Pennsylvania) exhibited Vashe irrigating equipment that is used for wound cleansing, lubricating and reducing the growth of infectious pathogens. It combines a proprietary electrolysis cell and control system in a countertop dispenser and delivers a precisely pH-controlled hypochlorous acid solution.
Hypochlorous acid is effective against a broad range of microorganisms including MRSA, VRE and other bacteria, viruses and fungal spores. Vashe wound therapy is used to treat ulcerated and post-surgical, and 1st and 2nd degree burns.
Compression Device.
Derma Science markets Mobility 1 which is claimed to be the only fully sequential and gradient pneumatic compression device for complete patient mobility. It is used to assist patients suffering from lymphatic or venous disorders. A small pump in the boot is placed under the sole of the foot directly under the heel.
As the patient walks, the pump is compressed and a small amount of air flows through a tube and into a set of compression segments. As air flows through the tube, a set of magnetically driven valves allow air to move into the next compression segment when the targeted pressure against the patient's leg is reached in the prior segment.
The device has many applications, including preventing deep vein thrombosis, enhancing blood circulation, reducing post-op pain and edema, and for treating various types of wound ulcers.