Types of modern wound dressings
Hydrocolloid dressings
Hydrocolloid dressings are made of colloidal particles that form a gel when encounter wound exudate. While absorbing wound exudate, maintain a moisturizing environment, accelerate cell proliferation and migration, and thus promote wound healing.
They are suitable for wounds with low to moderate exudate secretion, wounds, abdominal incisions, mild to moderate burns, pressure trauma, venous insufficiency ulcers, and other types of wounds.
In addition, the gel layer can protect the wound from external influences, thereby reducing infection. For large amount of wound exudate, it is easy to lead to poor absorption of exudate and infection of wound maceration.
Hydrogel dressings
Hydrogel dressings are composed of a highly absorbent three-dimensional multilayer of polymers (polymer materials), which be able to keep wounds moist, easy to remove, shape, and promoting healing.
Due to its easy removability, the hydrogel is not sticky enough and it is difficult to stay on the wound for a long time. There are also hydrogel dressings based on self-healing, antibacterial, drug release, adhesion,
injectability and others. It is mainly suitable for chronic ulcers, burns and diabetic feet, etc., and is not suitable for wounds with a lot of exudate and high infection.
Alginate dressings
Alginate dressings can be divided into two categories: surface wound dressings and wound fillers. Alginate dressings convert insoluble calcium alginate into soluble sodium alginate through ion exchange,
which can absorb exudate equivalent to twice its own weight, which is 5 to 7 times that of ordinary gauze. While absorbing exudate, it also accelerates wound healing. Alginate wound fillers are designed for deep or irregularly shaped wounds.
They are highly plastic and fill various types of wounds. Effectively absorb deep exudate and very suitable for deep pressure injuries, perforated wounds, fractures or open wounds after surgery.
Drug dressings
The biggest feature of drug dressings is that they can release drugs locally at the wound. Not only can they keep the wound moist and absorb exudate, but also release drugs to control wound infection and reduce inflammatory response.
Studies have shown that a dressing containing shikonin can inhibit bacteria and promote wound healing. It is usually made of biodegradable polymers and can be loaded with various drugs such as antibiotics and growth factors.
Studies have shown that drug-loaded functional dressings regulate cell responses (migration, proliferation and differentiation) during wound healing through endogenous signal molecules such as growth factors (GFs) and cytokines (CFs),
and play a key role in accelerating wound repair. A wound dressing with polyacrylonitrile/purslane extract has a strong inhibitory effect on Staphylococcus aureus and Escherichia coli.
Purslane extract can destroy bacterial cell membranes, thereby achieving a bactericidal effect. Combining purslane extract with dressings is expected to be used in the prevention and treatment of wound infections in the future.
Smart dressings
Based on the booming development of artificial intelligence technology, a variety of smart dressings have emerged, namely stimulus-responsive wound dressings. Dressings that can regulate the release of wound active substances according to changes
in the in vitro environment (ultraviolet, near-infrared, field and ultrasound) or the wound microenvironment [pH, enzyme reactive oxygen species (ROS) and temperature]. A single-blind, randomized controlled study showed that the new antioxidant dressing has
a regulatory effect on the ROS level of the wound bed and is effective for the healing of both acute and chronic wounds. For example, Pang et al.1 introduced a flexible smart wound dressing with oxygen sensing capability for the treatment of foot ulcers.
It can generate oxygen through the dressing patch covering the wound bed, regulate the wound microenvironment, and monitor the wound healing. In addition, the development of a full-function smart dressing that integrates sensors, drug delivery systems
and wireless communications! It can also adjust the treatment plan according to the real-time wound status, optimize the healing process, and contribute to the development of modern new dressings for remote wound management.
The role of modern wound dressings
Wound therapeutic and protective properties.
First of all, wound dressings should have good tissue compatibility and conform to the "wet wound healing concept". In the proliferation stage of wound healing, in addition, to keeping the wound environment moist,
wound dressings should also promote the growth of granulation epithelial tissue at the edge of the wound and control the excessive fibrosis of fibroblasts, thereby reducing the formation of scars. Studies have shown that biosynthetic cellulose wound dressings
can significantly improve the condition of the skin around the wound and promote rapid wound healing compared with standard care foam dressings. A randomized clinical trial observing the effect of multi-layer silicone foam dressings in preventing high-risk
pressure trauma patients showed that multi-layer silicone foam dressings can prevent sacral and coccyx pressure trauma in patients with persistent severe diarrhea and fragile skin. It protects the skin through simple and effective dressings, reduces the incidence
of pressure trauma and dermatitis, and improves the quality of life of patients.
Design rationality and comfort The ideal new dressing should have mechanical properties similar to human skin, maintain its integrity under dry and wet conditions, and effectively absorb exudate.
Tests show that dressings of different materials perform differently in dealing with patient exudate, which requires wound dressing manufacturers and medical clinical decision makers to ensure that dressing products are accurately
applicable to specific clinical scenarios when conducting product-specific performance evaluations, and develop more targeted dressings to improve patient comfort.
Significance of economic benefits and practicality New dressings should be easily available and low-cost, shorten treatment time, reduce complications and overall treatment costs, etc.
In an open-label clinical trial, the economic effects of polyurethane film dressings and gauze dressings in the care of postoperative wounds were compared, showing that the incremental
procurement cost is easily offset by the treatment costs of wound complications associated with the use of gauze dressings, and can reduce the postoperative infection rate.
A randomized controlled trial on the cost-effectiveness of silver ion dressings for the treatment of second-degree burns in children showed that silver ion dressings have more obvious wound healing
effects and economic benefits, and can reduce the formation of scars during or after healing. Another study found that the use of ulcer patches is more effective in promoting wound healing than conventional dressings,
although the cost is similar, but ulcer patches are more cost-effective, indicating that the economic benefits and costs should also be considered when using dressings.
Modern wound dressings combined with new technologies for wound treatment
Removal of wound bed biofilm Clinical practice of wound infection: Biofilm is a microbial community that cannot be observed with the naked eye, especially in deep tissues, and can only be discovered through corresponding
diagnostic techniques. Debridement is a necessary operation to reduce the production of wound biofilm, and the production of biofilm can be reduced through systematic wound assessment, wound bed preparation and the
application of antibacterial dressings. The application of probiotics on the wound surface can change the microbial environment on the wound surface, regulate its flora balance, and promote the healing of chronic wounds.
Laser can effectively destroy bacterial biofilms in wounds, providing opportunities for subsequent antibacterial treatment and wound growth, but most of the existing studies only involve the one-time removal rate of biofilms.
There are still controversies in the antibacterial effect of biofilms in the wound window period and the management of dressings. There is no clear conclusion on the concentration of antimicrobial drugs in dressings and whether
antimicrobial drugs will cause wound biofilms to develop drug resistance.
Negative pressure wound therapy (NPWT) combined with topical oxygen therapy (TOT) NPWT combined with TOT is referred to as NPWTO2
It has a significant effect in treating anaerobic bacteria.
Studies have shown that the combination of negative pressure drainage and the application of new dressings can help protect the wound surface, absorb exudate, control infection, and promote wound healing.
At the same time, the combination of dressings and negative pressure drainage can increase the fit between the wound and the dressing, reduce exudate, and reduce the incidence of infection.
Stem cell exosomes promote wound repair
In recent years, stem cell-based wound healing methods have attracted much attention due to their ability to be easily isolated, self-renewal, use specific growth factors to induce physiological functions,
and the ability to regenerate and differentiate skin tissue into various cell types, and have great application prospects.
Summary
There are many types of wound dressings, but each dressing has its limitations and lacks clear boundaries in application, which leads to medical staff relying more on experience to judge treatment, affecting timeliness. In the challenge,
the future development direction of dressings includes intelligent dressings that integrate sensors and remote technology to achieve dynamic monitoring and real-time evaluation of wound status, and then adjust the treatment plan.
It not only helps to improve the accuracy of diagnosis and personalize treatment, but also has the potential to promote the transformation of dressings to wearable technology, increase portability and comfort, reduce the risk of infection,
and improve the quality of life of patients. In general, modern dressings combined with new technologies play a key role in promoting the development of wound care towards specialization and refinement. At the same time, the gradual
promotion of smart medical care also indicates that modern wound dressings will better meet the needs of chronic wound care in the future.
