Wound care benefits from ongoing advances

National report - The wound care market continues to expand with new innovations, and as wound management has relevance to the practice of almost all dermatologists, it is important for clinicians to stay abreast of product introductions, new techniques and recent research, Eliot N. Mostow, M.D., M.P.H., says.

"There are a number of good wound care meetings held throughout the year that provide a good venue for keeping current with recent developments, and I would also encourage others to seek expanded sessions on wound care and wound care vendor attendance at the annual AAD (American Academy of Dermatology) meeting," notes Dr. Mostow, head of the dermatology section, Northeastern Ohio Universities College of Medicine, Rootstown, Ohio.

Newer modalities

However, he notes there are some newer modalities dermatologists should be aware of that can be helpful in the office setting.

Wound care researchers Professors Patricia M. Mertz and Stephen C. Davis also reviewed some recent developments in investigational and marketed products for promoting wound healing.

Venous stasis disease

For the management of patients with venous stasis disease, a new type of knee-high compression hose manufactured with silver ion-releasing threads appears anecdotally to be a worthwhile product for reducing the risk of infection and ulcer recurrence, says Dr. Mostow.

"We are just starting to collect data from our own case series and there are no good studies to conclusively demonstrate the benefit of these compression hose," he says. "However, our clinical observations are favorable as several patients with extensive stasis dermatitis and crusting have done very well with them."

Silver dressings

A variety of silver dressings is also on the market to take advantage of the fast-acting, broad-spectrum antimicrobial properties of silver ions.

These products differ with respect to the type of silver they contain and their release characteristics, and there are no good head-to-head studies comparing the various dressings. Nevertheless, Dr. Mostow indicates he often uses silver dressings and selects between the various products depending on the features of a particular wound and the surrounding skin.

Within this category, a unique new dressing became available earlier this year that combines collagen, oxidized regenerated (ORC) cellulose, and silver-ORC. Intended for care of exudative wounds and able to be used under compression therapy, it has been shown to reduce bacterial counts and remove matrix metalloproteinases that may interfere with wound healing, notes Professor Mertz, who is currently a private consultant with Miami Dermatology Research Institute and formerly research professor, department of dermatology and cutaneous surgery, University of Miami.

Dr. Mostow says he has been pleased with responses achieved using the biomaterial derived from porcine small intestinal submucosa as a wound matrix replacement. With its intact extracellular matrix, it provides a scaffold for stimulating and enhancing keratinocyte migration across the wound. Since it is a less expensive than human tissue engineered skin replacements, Dr. Mostow notes he often uses it as a stepping stone, trying it first before resorting to the latter products.

"This biomaterial is not the answer for every patient, but results of randomized trials and our own clinical experience indicates that Oasis (Healthpoint) can often be helpful for hastening and achieving wound closure," he says.

Reimbursement concerns

Despite the high direct cost of tissue engineered skin replacements, various pharmacoeconomic analyses indicate those products are cost-effective as treatment for chronic wounds in appropriately selected patients, Professor Mertz notes.

"Patients may be referred to a wound care clinic to receive the tissue engineered skin replacement, and then return for follow-up care to their own dermatologist," Dr. Mostow explains.

Of relevance to the use of skin substitutes, a recent in vitro study undertaken by Professor Davis and colleagues showed topically applied mupirocin penetrated bilayered cellular construct therapy and reduced colonization by methicillin-resistant Staphylococcus aureus (MRSA).