Synopsis: Hospitals and clinics often have to stock a huge variety of bandages and dressings to address the moisture needs of different kinds of wounds. Now a high-tech “smart dressing” can replace them. It absorbs moisture when necessary but can also supply the right amount of moisture in places where it’s needed.

Host: Nancy Benson. Guests: Dr. Alexander Reyzelman, Associate Professor of Medicine, California School of Podiatric Medicine and Co-Director, Limb Preservation Center, University of California San Francisco; Vicki Fischenich, geriatric nurse-practitioner and Director, Clinical Affairs, Osnovative Systems

Smart Bandages

Nancy Benson: There may be nothing more frustrating than a medical problem that painfully drags on and on. About seven million Americans suffer exactly that–a chronic wound that won’t heal. Chronic foot ulcers, for example, are extremely common in people with diabetes… And they can be deadly serious. More than half of foot ulcers become infected and require hospitalization. About 20 percent of them require an amputation. Chronic wounds are also expensive. We spend about $20 billion a year to manage them. And it can be incredibly complicated.

Alexander Reyzelman: Every wound behaves differently some wounds drain a lot more some wounds drain a lot less some wounds are located on the bottom of the foot some on the top of the foot or on the leg or anklet region. Some wounds are deeper some wounds are more superficial and all of these characteristics require a different kind of dressing.

Nancy Benson: That’s dr. Alexander Reyzelman Associate Professor of Medicine at the California School of Podiatric Medicine and co-director of the Limb Preservation Center at the University of California San Francisco.

Alexander Reyzelman: Some wounds require dressings to absorb more of the fluid some wounds require more moisture there’s always this different balance we have to create with every wound and that’s why we have so many dressings. We have thousands of dressings on the market for every different style of wound a different stage of the wound so to speak.

Vicki Fishenich: One may be good or two items may be good at the beginning of the wound but then they have to be removed. That makes a lot of decisions making throughout the course of the wound healing when I order different types of wound care for a patient I would use these two at the beginning. Two weeks later I would have a call from the home health nurse or the family caregiver saying you know it doesn’t look right I think it’s too dry now we need something that’s going to work for this stage.

Nancy Benson: Vicki Fischenick is a geriatric nurse practitioner and director of clinical affairs for Osnovative systems, a maker of wound dressings. She says moisture control is most important in getting a wound to heal.

Vicki Fishenich: You need to have a moist healing environment in that wound you can’t have it too wet, not too dry. So it needs a certain amount of moisture if it’s too dry they call it a dedicated too dry for it to close so that also can hinder the wound healing.

Nancy Benson: But a wound that’s too wet can also be disastrous.

Alexander Reyzelman: The drainage from the wound in excess amounts causes problems because the fluid from the wound carries a lot of inflammatory factors and these inflammatory factors and enzymes if their in abundant amounts they will actually cause wounds to delay healing it will cause wounds to get bigger in size and the wound will grow and destroy the healthy tissue rather than improve. So in small amounts drainage is normal but once the drainage increases then that’s problematic.

Nancy Benson: However, many chronic wounds have an area that’s too wet… And another that’s too dry, all in the same wound. How can you bandage a wound like that?

Vicki Fishenich: There’s a lot of products out there that you can use on a wet wound but you can’t use it on a dry wound and you’ve got products that you can use on a dry wound but you know I normally had to use a combination of dressings either a foam dressing and add a sea weed dressings for added absorbency and then maybe some skin preps to make sure that the skin doesn’t get macerated and sometimes if it was heavy what we’d do is we’d have to add the moisture barriers there was times we’d have to add different types of topicals and the pharmaceutical topicals get really pricey and it’s hard for patients to afford that particular types I mean some of the topicals we were using were $400. Early on that was kind of where I practiced we used this, this, this and we added this and this.

Nancy Benson: That’s why doctors have long sought a dressing that would work on just about any wound, either wet or dry. Now they’re available–so called “smart dressings.”

Vicki Fishenich: The smart dressing Enluxtra is able to adapt for those changes in a wound. It’s able to go from a wet wound or start from a dry wound it’s able to sense the wounds needs it’s got a technology that allows it to absorb and lock in that drainage. So even if the patient is sitting on the dressing stepping on the dressing or under some pressure it doesn’t allow your wound drainage to seep back in your wound bed, which then resupplies that bacteria.

Nancy Benson: Smart dressings even know how much moisture to absorb. However, on a wound that’s too dry, smart dressings work the opposite way. They sense the lack of moisture… And supply some of their own. Reyzelman says smart dressings can be used for almost any wound from beginning to end… But they’re especially good for some patients.

Alexander Reyzelman: Patients that have chronic wounds that they can’t handle daily dressings or frequency of the dressings to be done every day or every other day these are the patients that could definitely benefit from the smart dressing because you can leave the dressing anywhere from 1 to seven days without disturbing it. All of that depends on the type of drainage and monitoring as that occurs. But once the drainage is controlled the smart dressing can be left on there for a week without a problem.

Nancy Benson: And when the dressing needs to be changed, Reyzelman says it can often be done with a lot less pain.

Alexander Reyzelman: For the most part the smart dressing does not produce pain. Although occasionally we have patients that no matter what you put on, no matter what you take off they are still going to complain of pain. But because this wound dressing keeps moisture there’s an interface between the wound dressing and the wound itself when you remove the dressing it’s not painful it doesn’t tear off or damage the underlying tissue that’s been built. If the dressing became too dry then when you remove it, it would actually cause pain by tearing and damaging the surface.

Vicki Fishenich: We’ve been asked is this dressing embedded with some type of pain relieving chemical and it’s not it’s just that Enluxtra has the ability and as a clinician I always try to explain that it brings down the inflammatory cycle which then of course decreases the pain. The inflammatory cycles in a wound is what causes the pain and enluxtra addresses that really well and it corrects for the breakdown of skin around the wound, which can be irritating or painful. So that’s how it addresses the pain it provides that perfect environment for a wound to heal and it doesn’t allow it to get too wet or too dry. When your wound is wet it’s painful and uncomfortable when it’s too dry it’s also painful and uncomfortable.

Nancy Benson: In the future, smart dressings may be able to do even more– for example, sense when medication is needed in a wound and dispense it. To some doctors, it all sounds like a dream come true. In fact, Fischenick says some doctors think it’s too good to be true.

Vicki Fishenich: Where I have won most of my physician friends over and are kind of a little skeptical of that like “Really? I’m gonna use this dressing?” I’m like “ I understand I was you four years ago feeling the same way.” But this product has allowed us to heal up some very long-term wounds you know 8 years, 3 years, 14 years. Because physicians have been like “You know what I’m not sure if I feel comfortable just using the dressing. And I’ll always tell them “Listen. Give me your worst wound give me the wound you have done all your other treatment choices and you still have that. Those are the wounds were healing at and that’s when I finally get them to understand.

Nancy Benson: You can find out more about smart dressings and all of our guests through links on our website… You can always find all of our shows on iTunes and stitcher. Our production director is Sean Waldron. I’m Nancy Benson

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