Wound Care Tool Kit: ORC Collagen

Many wound care clinicians over the years have used Promogran and Prisma (ORC Collagen) as their treatment of choice for chronic wounds.  What I first noticed with the use of ORC collagen (Prisma and Promogran) was that chronic wounds would often undergo a new wave of contraction and granulation.  It was a product that I would  pull out of my wound care tool kit for any long- standing wound.

As the years have rolled by many of the other wound care companies have jumped into the space seeking to capitalize on the chronic wound / collagen market. But is collagen the same as ORC collagen (Prisma & Promogran)? I learned first-hand that switching (from ORC collagen) to plain collagen can lead to disappointing results when different collagen products were added to our hospital formulary.  In time I realized that plain collagen wasn’t providing the wound contraction and granulation formation that I would see with the ORC Collagen (To the point that I stopped using collagen altogether).

My question is has any one else observed this difference in quality?

Disclosure: The author of this article declares that he receives no financial reward for this posting from Systagenix (the manufacturer of ORC Collagen).

Wound Care Toolkit: Proteasemarker

Take a look at Systagenix’s new educational offering www.proteasemarker.com .  This site shows their commitment to sharing information with clinicians regarding chronic wounds (There are lots of resources at this site). Systagenix is also bringing a product to the US market at the beginning of the next year that should revolutionize how we assess our patients. Essentually, this product (after a swab of the wound) will  quickly identify out of balance chemicals that lead to chronic wound states. Needless to say this will be a huge advantage over what has pretty much been guess-work.

Wound Care Tool Kit – Drawtex

Drawtex (SteadMed) is a new find as a hydroconductive debridement agent. I was able to see an average reduction in slough of up to 75% in the eight patients I have tried it on so far. The assumed mode of action is through the dressings ability to forcefully remove drainage (up to 150cc/hr) and content from the wound into the dressing. The force of the fluid transferred into the hydroconductive dressing is able to cleave the denuded collagen that bonds the necrotic tissue from the healthy tissue. The advantage of hydroconductive debridement is that it is a top down debridement tool that can debride over a large surface area (versus the peripherial wound area such as side down debridement agents i.e. Santyl Collagenase).

Indications:

Drawtex works well with wounds with moderate to large drainage, Reoccurring slough, Adherent slough, Consolidated slough with is difficult to remove with curettage and as an alternative for patients who have pain with sharps debridement.

Author notes:

Drawtex is also useful for controlling Biofilm as noted in the  (Randy Wilcott Poster which won first place at the SAWC Spring, 2011 Conference).

The dressing will not degrade in the wound and will continue to pull fluid from high draining cavities, so it is very useful with deep narrow or wide tunnels (Were alginates fail).

Hydroconductive Debridement a new Perspective in Wound Debridement

I have long been looking for what to do once we lost Panafil and Accuzyme.  Currently, many clinicians have been using Santyl as the default wound debridement agent.  We know that Santyl  has a place in the scope of debridement, but it in itself has limitations. Needless to say, I have found what we may have been looking for as a wound debridement agent. I recently had the opportunity to finish a case study with a product that provides what I have been looking for as a debridement agent.  I will be submitted a poster on a Hydroconductive Debridement dressing called Drawtex  (SteadMed)  at the Spring 2011 SAWC . The numbers (in terms of reduction of avascular tissue) were very promising. This case study series included a average (with 8 cases) percentage reduction in the total slough and necrosis of  36% at week one, 52% at week two, and 72% at week three. Please note that no other types of debridement were utilized during this study. The study also noted an average percentage reduction in wound area of 15% at week one, 35% at week two, and 47% at week three.

Disclosure: the author receives no financial incentives from SteadMed.

Wound Care Tool Kit (Stoma Paste)

Stoma Paste is a very useful tool when trying to provide a uniform surface for the placement of wound VAC drape over uneven surfaces. Uneven surfaces include skin folds, incision line deformations, or anatomical irregularities related to surgery or trauma. There are many brands of stoma paste available, but I have had good luck with Convatec and Hollister Brands. I recommend using the following process to prevent the paste from doing what it does best – sticking to everything.

1. Prewarm the past in a tray of warm water for a few minutes to make the paste less thick

2. Squeeze a little paste out on the clean side of the opened VAC kit package (let it sit for about a minute).

3. Pour a little water or normal saline into an appropriate container.

4. Dip into the water with a wood depressor or the back of the 10 blade scalpel (that you are using to cut the VAC foam)

5. Take up the stoma paste with the moist utensil surface and place it into the uneven surface. Leaving the top of the stoma paste even with the corresponding topside tissue. If you need to add more paste remember to re-moisten the utensil or else it will stick fast to the applicator.

6. Smooth out the paste between the inserted stoma paste with the corresponding topsided tissue by re-wetting the utensil and gently moving across it surface.

7. Wait a few minutes for the paste to firm and then apply the VAC drape over it. If you don’t wait for the stoma paste to firm up the VAC suction could pull it in, which could loose the seal.

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