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Burn Dressings
19-12-05
Zohaib Hussain
1
Burn Wounds
Trends in biotechnology, 36(9), 907-922. 2
Ideal Burn Wound Dressing
3
Dressing based upon Wound Depth
and Exudates
4
Types of Polymeric Dressings
5
a. sodium alginate b. Chitosan c. Dextran d. N-O-carboxymethyl chitosan
e. Hydroxyethyl starch f. Glucan g. Hyaluronic acid h. Poly-N-acetylglucosamine
i. Silk j. Gelatin
Natural Polymers
6
a. polyvinyl alcohol
b. poly (N-isopropylacrylamide)
c. poly (N-vinylpyrrolidone)
d. polyethylene glycol
e. polyurethane)
Synthetic Polymers
7
Hydrocolloid Dressings
• The gel forming agents are combined with elastomers and adhesives
and applied to a carrier
• A variety of constituents including gelatin, pectin and sodium
carboxymethylcellulose in an adhesive polymer matrix.
• Forms a gel when their inner layer comes into contact with exudate
• Examples of a hydrocolloid dressing include Comfeel (Coloplast) and
DuoDerm (ConvaTec).
8
SMARTPORE Technology®
9
Comfeel® Plus
It consists of a semipermeable polyurethane film coated with a
flexible, cross-linked adhesive mass containing sodium
carboxymethylcellulose and calcium alginate
DuoDERM® Dressings
First to incorporate hydrocolloid technology
BETAplast®
It consists of polyurethane foam dressing impregnated with 3%
PVP-I, which has powerful antimicrobial properties
Medifoam®
A korea leading company in biomaterials especially wound
dressings 10
BETAplast®
11
Commercial Products
12
Polyurethane Films Based Dressings
• Polyurethane films are transparent, adhesive-coated sheets
• Permeable to water vapour, oxygen and carbon dioxide but
not to liquid water or bacteria.
• Film dressings are suitable for lightly exuding wounds
• OpSite (Smith & Nephew) or Tegaderm(3M Company),
Finesse PU Film,
13
Polyurethanes
• Composed of urethane linkages in their main chains.
• Properties can be tuned-chemical structure, the molecular
weight of polyol, contents of hard and soft segment, or a
synthetic method.
• Fibers, elastomers, adhesives, coatings, synthetic leathers and
construction materials.
• Hydrophilic (PEG)
14
Hydrogel Dressings
• High water content gels containing insoluble polymers d by crosslinking of
polymers (PVA, PEO)
• Modified carboxymethylcellulose, hemicellulose, agar, glycerol and pectin.
• More capacity to absorb fluid-higher levels of wound exudate-Autolytic
debridement
• Amorphous form (a loose gel)
• such as IntraSite (Smith & Nephew) and Solugel,
• Sheet form where the gel is presented with a fixed three-dimensional macro
structure.
• Aqua clear and Nu-gel (Johnson & Johnson) 15
INTRASITE Gel
• Amorphous hydrogel-contains propylene glycol
• SOLUGEL™
Wound Care Gel is a clear hydrogel
• Purilon® gel
Consists of purified water, sodium carboxymethylcellulose, and
calcium alginate. Natural ingredients-No additives
16
Commercial Products
17
Alginate Dressings
• Calcium or sodium/calcium salts of alginate acid-seaweed
• Sodium salts present in the wound exchange with the calcium in the alginate
to form sodium alginate, a hydrophilic gel
• Ability to absorb exudate into itself while maintaining a moist environment.
• Highly absorbent, form gel with exudates, provide a moist interface, are
easily removed-Rinsed away with saline irrigation
• (Algisite M™, Sorbsan™, Algosteril (Johnson & Johnson), Comfeel Alginate
Dressing (Coloplast), Carrasorb H (Carrington Laboratories), Kaltostat
(ConvaTec), quacel®, Aquacel Extra® and Aquacel Foam®.
18
Commercial Products
19
Silk Fibroin
• Poor mechanical strength of collagen that restricts its applications
for wound dressings
• SF is a flexible polymer with excellent mechanical properties,
including tensile strength (0.5 GPa), breaking elongation (15%), and
elasticity (<35%)
• Cross-linked structure of elastin hinders its processability and
decreases its solubility. Additionally, available supplies of elastin are
more limited
• SF has high solubility in aqueous salt solutions
• nanofibers, sponges, films, and hydrogels.
• Synthetic polymers, such as soft silicon are not biodegradable,
Polyurethanes-toxicity of the degradation products
• SF is categorized as a non-degradable material based on the US
Pharmacopeia’s definition 20
Chouhan, D., Lohe, T. U., Samudrala, P. K., & Mandal, B. B. (2018). In situ forming injectable silk
fibroin hydrogel promotes skin regeneration in full thickness burn wounds. Advanced healthcare
materials, 7(24), 1801092.
Silk Fibroin
21
Foam Dressings
• Soft, open-celled hydrophobic/hydrophilic non-adherent dressings that may
be single or multiple layered and meet many of the properties of an ideal
dressing
• Exudry™ Zetuvit™ and Mesorb® are examples of products with a highly
absorbent pad and a non-stick, non-shear surface.
• As a secondary dressing over moderate to highly exudating wounds and over
hydrocolloid paste, cadexomer iodine, alginate and other primary dressings.
• Zetuvit E is a non-irritant absorbent dressing pad. The covering layer consists
of hydrophobic, non-woven polypropelene material.
22
Nanofiber-based Wound Dressings
An electrospun-nanofibrous layer is applied to a basic support
fabric material
• Haemostasis
• High filtration & liquid absorption efficiency
• Semi-permeability: Facilitate cell respiration due to their porosity
• Conformability
• Functional ability
• Scar free
23
Commercial Products
24
Hydroactive Dressings
• Hydroactive dressings are multi-layered highly absorbent polymer
dressings with a surface adhesive and a waterproof outer layer are
similar to hydrocolloids, however, instead of forming a gel in
contact with exudate, the fluid is trapped within the product itself,
to maintain a moist environment.
• highly absorbent polymer dressings
• waterproof
• non-residual
• semi-permeable
Cutinova Hydro™, Tielle™, Biatain™Cavity dressing, PolyMem® 25
Conclusion
A wound dressing thus approaching ideal characteristics should
conform to the site of the wound, offer alleviation of pain
symptoms, promote faster wound-healing time and attempt to
restore the patients’ normal daily activities
The need for a more holistic approach towards wound healing and
management so that while selecting the appropriate dressing for a
wound, the physiological and biochemical requirement of the
wound and the patient are also taken into account.
26

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Burn Dressings

  • 2. Burn Wounds Trends in biotechnology, 36(9), 907-922. 2
  • 3. Ideal Burn Wound Dressing 3
  • 4. Dressing based upon Wound Depth and Exudates 4
  • 5. Types of Polymeric Dressings 5
  • 6. a. sodium alginate b. Chitosan c. Dextran d. N-O-carboxymethyl chitosan e. Hydroxyethyl starch f. Glucan g. Hyaluronic acid h. Poly-N-acetylglucosamine i. Silk j. Gelatin Natural Polymers 6
  • 7. a. polyvinyl alcohol b. poly (N-isopropylacrylamide) c. poly (N-vinylpyrrolidone) d. polyethylene glycol e. polyurethane) Synthetic Polymers 7
  • 8. Hydrocolloid Dressings • The gel forming agents are combined with elastomers and adhesives and applied to a carrier • A variety of constituents including gelatin, pectin and sodium carboxymethylcellulose in an adhesive polymer matrix. • Forms a gel when their inner layer comes into contact with exudate • Examples of a hydrocolloid dressing include Comfeel (Coloplast) and DuoDerm (ConvaTec). 8
  • 10. Comfeel® Plus It consists of a semipermeable polyurethane film coated with a flexible, cross-linked adhesive mass containing sodium carboxymethylcellulose and calcium alginate DuoDERM® Dressings First to incorporate hydrocolloid technology BETAplast® It consists of polyurethane foam dressing impregnated with 3% PVP-I, which has powerful antimicrobial properties Medifoam® A korea leading company in biomaterials especially wound dressings 10
  • 13. Polyurethane Films Based Dressings • Polyurethane films are transparent, adhesive-coated sheets • Permeable to water vapour, oxygen and carbon dioxide but not to liquid water or bacteria. • Film dressings are suitable for lightly exuding wounds • OpSite (Smith & Nephew) or Tegaderm(3M Company), Finesse PU Film, 13
  • 14. Polyurethanes • Composed of urethane linkages in their main chains. • Properties can be tuned-chemical structure, the molecular weight of polyol, contents of hard and soft segment, or a synthetic method. • Fibers, elastomers, adhesives, coatings, synthetic leathers and construction materials. • Hydrophilic (PEG) 14
  • 15. Hydrogel Dressings • High water content gels containing insoluble polymers d by crosslinking of polymers (PVA, PEO) • Modified carboxymethylcellulose, hemicellulose, agar, glycerol and pectin. • More capacity to absorb fluid-higher levels of wound exudate-Autolytic debridement • Amorphous form (a loose gel) • such as IntraSite (Smith & Nephew) and Solugel, • Sheet form where the gel is presented with a fixed three-dimensional macro structure. • Aqua clear and Nu-gel (Johnson & Johnson) 15
  • 16. INTRASITE Gel • Amorphous hydrogel-contains propylene glycol • SOLUGEL™ Wound Care Gel is a clear hydrogel • Purilon® gel Consists of purified water, sodium carboxymethylcellulose, and calcium alginate. Natural ingredients-No additives 16
  • 18. Alginate Dressings • Calcium or sodium/calcium salts of alginate acid-seaweed • Sodium salts present in the wound exchange with the calcium in the alginate to form sodium alginate, a hydrophilic gel • Ability to absorb exudate into itself while maintaining a moist environment. • Highly absorbent, form gel with exudates, provide a moist interface, are easily removed-Rinsed away with saline irrigation • (Algisite M™, Sorbsan™, Algosteril (Johnson & Johnson), Comfeel Alginate Dressing (Coloplast), Carrasorb H (Carrington Laboratories), Kaltostat (ConvaTec), quacel®, Aquacel Extra® and Aquacel Foam®. 18
  • 20. Silk Fibroin • Poor mechanical strength of collagen that restricts its applications for wound dressings • SF is a flexible polymer with excellent mechanical properties, including tensile strength (0.5 GPa), breaking elongation (15%), and elasticity (<35%) • Cross-linked structure of elastin hinders its processability and decreases its solubility. Additionally, available supplies of elastin are more limited • SF has high solubility in aqueous salt solutions • nanofibers, sponges, films, and hydrogels. • Synthetic polymers, such as soft silicon are not biodegradable, Polyurethanes-toxicity of the degradation products • SF is categorized as a non-degradable material based on the US Pharmacopeia’s definition 20
  • 21. Chouhan, D., Lohe, T. U., Samudrala, P. K., & Mandal, B. B. (2018). In situ forming injectable silk fibroin hydrogel promotes skin regeneration in full thickness burn wounds. Advanced healthcare materials, 7(24), 1801092. Silk Fibroin 21
  • 22. Foam Dressings • Soft, open-celled hydrophobic/hydrophilic non-adherent dressings that may be single or multiple layered and meet many of the properties of an ideal dressing • Exudry™ Zetuvit™ and Mesorb® are examples of products with a highly absorbent pad and a non-stick, non-shear surface. • As a secondary dressing over moderate to highly exudating wounds and over hydrocolloid paste, cadexomer iodine, alginate and other primary dressings. • Zetuvit E is a non-irritant absorbent dressing pad. The covering layer consists of hydrophobic, non-woven polypropelene material. 22
  • 23. Nanofiber-based Wound Dressings An electrospun-nanofibrous layer is applied to a basic support fabric material • Haemostasis • High filtration & liquid absorption efficiency • Semi-permeability: Facilitate cell respiration due to their porosity • Conformability • Functional ability • Scar free 23
  • 25. Hydroactive Dressings • Hydroactive dressings are multi-layered highly absorbent polymer dressings with a surface adhesive and a waterproof outer layer are similar to hydrocolloids, however, instead of forming a gel in contact with exudate, the fluid is trapped within the product itself, to maintain a moist environment. • highly absorbent polymer dressings • waterproof • non-residual • semi-permeable Cutinova Hydro™, Tielle™, Biatain™Cavity dressing, PolyMem® 25
  • 26. Conclusion A wound dressing thus approaching ideal characteristics should conform to the site of the wound, offer alleviation of pain symptoms, promote faster wound-healing time and attempt to restore the patients’ normal daily activities The need for a more holistic approach towards wound healing and management so that while selecting the appropriate dressing for a wound, the physiological and biochemical requirement of the wound and the patient are also taken into account. 26

Editor's Notes

  1. A review on polymeric hydrogel membranes for wound dressing applications: PVA-based hydrogel dressings
  2. A review on polymeric hydrogel membranes for wound dressing applications: PVA-based hydrogel dressings
  3. Chemical structures of synthetic polymers which were employed formerly as hydrogel membranes for wound dressings or skin substitutes, (a. polyvinyl alcohol, b. poly (N-isopropylacrylamide), c. poly (N-vinylpyrrolidone), d. polyethylene glycol, e. polyurethane).
  4. the term hydrocolloid will therefore be applied to the adhesive sheet formulation in which, typically, the gel forming agents are combined with elastomers and adhesives and applied to a carrier – commonly consisting of a sheet of polyurethane foam or film, to form an absorbent, self adhesive, waterproof dressing. hydrogels are in fact true colloidal dispersions and that the CMC fibres form a colloidal dispersion in the presence of liquid https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD002106.pub4/epdf/full
  5. consists of a semipermeable polyurethane film coated with a flexible, cross-linked adhesive mass containing sodium carboxymethylcellulose and calcium alginate as the principal absorbent and gel forming agents. The dressing is permeable to water vapour but impermeable to exudate and microorganisms. In the presence of exudate, the absorbent components absorb liquid and swell to form a cohesive gel.  Managing burn wounds with SMARTPORE Technology polyurethane foam: two case reports
  6. Hydrocolloid dressings for moist wound healing An ‘in-vitro’ comparison of the physical characteristics of hydrocolloids, hydrogels, foams, and alginate/cmc fibrous dressings. https://www.convatec.com/wound-skin/duoderm-dressings/ http://medifoam.co.kr/ http://www.dressings.org/Dressings/comfeel-plus.html http://www.genewel.com/en/
  7. Retrospective case studies evaluation: BETAplast‰ PRO-N dressing
  8. https://www.finessemedical.com/assets/21/2121B3A0-981D-407D-0F74D3464A1853D8_document/Polyurethane_film.pdf
  9. Evaluation of AgHAP-containing polyurethane foam dressing for wound healing: synthesis, characterization, in vitro and in vivo studies†
  10. Autolytic debridement uses the body's own processes (enzymes and moisture) to break down tough eschar and slough. It does not damage healthy skin, but breaks down dead and devitalized tissue over time quite effectively.  Biocompatible Hydrogel Film of Polyethylene Oxide-Polyethylene Glycol Dimetacrylate for Wound Dressing Application
  11. https://www.smith-nephew.com/professional/products/advanced-wound-management/intrasite-gel/
  12. Overview of Silk Fibroin Use in Wound Dressings
  13. Full‐thickness skin wounds, associated with deep burns or chronic wounds pose a major clinical problem. Herein, the development of in situ forming hydrogel using a natural silk fibroin (SF) biomaterial for treating burn wounds is reported. Blends of SF solutions isolated from Bombyx mori and Antheraea assama show inherent self‐assembly between silk proteins and lead to irreversible gelation at body temperature. Investigation of the gelation mechanism reveals crosslinking due to formation of β‐sheet structures as examined by X‐ray diffraction and Fourier transform infrared spectroscopy. The SF hydrogel supports proliferation of primary human dermal fibroblasts and migration of keratinocytes comparable to collagen gel (Col) as examined under in vitro conditions. The SF hydrogel also provides an instructive and supportive matrix to the full‐thickness third‐degree burn wounds in vivo. A 3‐week comparative study with Col indicates that SF hydrogel not only promotes wound healing but also shows transitions from inflammation to proliferation stage as observed through the expression of TNF‐α and CD163 genes. Further, deposition and remodeling of collagen type I and III fibers suggests an enhanced overall tissue regeneration. Comparable results with Col demonstrate the SF hydrogel as an effective and inexpensive formulation toward a potential therapeutic approach for burn wound treatment.
  14. https://www.nanowerk.com/spotlight/spotid=25577.php
  15. https://www.nanowerk.com/spotlight/spotid=25577.php