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Self-Adaptive Wound Dressings: A "Bandaid" That Does A Doctor's Work

by — Last updated: 2015-12-14 in Skin & Hair problems

One of the challenges of taking care of wounds that refuse to heal is that it may be necessary to remove old tissue, as often as every day, so new tissue can form. A new "self-adaptive" wound dressing does this without daily wound care.

I have a condition known as venous insufficency. It's not the sort of thing you might ordinarily pay a lot of attention to. As I have gotten older, the veins in my legs just don't conduct blood "uphill" as well as they used to. I don't have the bulging varicose veins that are more common with venous insufficiency syndromes, but I go have chronic redness and dryness on my feet an lower legs and my skin tends get dry and flake. Also, the skin on my feet and my toenails are unusually thick and tough. My toenails are so hard I can't trim them without the clippers flying up toward the ceiling, and calluses on my feet grow as much as 1/3 of an inch (8 mm) thick if I don't have a podiatrist debride them every two or three months.

The effects of venous sufficiency are certainly noticeable, but I didn't really think they were such a big deal until just a few months ago. I ordinarily use a moisturizer called Eucerin on my feet, but I had run out and I hadn't had a chance to go to the pharmacy to buy more. My feet got really dry. The skin was cracked, although I couldn't see it. I was living with some people who didn't have a concept of hygiene, and on top of that, we were having flooding rains. My shoes got soaked just going from the driveway to my door. Any kind of bacteria or fungus that go trapped in my shoes had ideal conditions for growth.

I didn't really see the cut, but apparently a tiny cut in my foot was enough to let a profusion of bacteria grow in abundance. 

At first my big toe was red. I didn't think a lot of it. Then my whole foot was red. I noticed. Then the lower half of my leg became red, tender, and feverish, and my heart started racing (not because I was upset, but because I had an infection) 200 beats a minute even with medication to slow it down. A tiny cut in my foot, which turned out to be a less than 0.5 mm (1/50 inch) cut had let bacteria in that weren't just infecting my foot, but threatening my life. Four hospitalizations, 50 adminstrations of IV antibiotics, $250 thousand in hospital bills, and four months later, I am essentially over the infection. However, the reason I didn't get better faster had to do with wound care.

Wound care isn't just about big, ugly, obvious wounds. It can also be needed for tiny wounds. 

READ Maggots Help Heal Diabetic Wounds

Chronic ulcers on the feet and legs typically just won't heal when the skin is thick, dry, and tough. It's necessary to remove dead and dying skin through a process called debridement over and over again to keep a thick callus from cutting off circulation. It's major chore to have a wound care specialist (in the US, a nurse with an MSN, usually, or a physical therapist with a doctor's degree) come in to your hospital room every day to remove tiny flecks of dead skin, or to get a similar service from home health care. That's why it's the new self-debriding bandages are such a major innovation.

What's So Special About A Self-Debriding Bandage

Stubborn wounds on the feet and legs can take years to heal. While the wound is open, bacteria such as Pseudomonas aeruginosa, Staphylococcus aureus, Proteus mirabilis, or Enterococcus faecalis can grow and, as in my case, infect nearby tissues and even affect the entire body. It's necessary both to cover the wound and to make sure that dead tissue doesn't interfere with circulation and bacteria don't get a chance to grow. That's the purpose of debridement, which is performed before a wound is covered with a dressing.
The tricky thing about bandaging a chronic wound is that the healthy tissue at the edge of the wound has to be left undisturbed, while the dead tissue over the center of the wound has to be removed. Also, the skin needs to be moist, so it remains flexible, but not wet, which would encourage the growth of bacteria. Most wound dressings can accomplish one of these objectives, but not all of them. 
 
A self-adaptive wound dressing such as Enluxtra, made by OSNovative Systems, Inc, in Santa Clara, California is an inovation in wound care designed to meet all of these objectives in a single product. 
 
It has multiple layers that protect the wound from reinfection, wick excess moisture away from the skin, and also removes the icky exudate that accumulates over the surface of a wound. These bandages can be changed every other day by the patient at home, without the need for a visit from a wound care nurse or physical therapist.
 
How can patients tell if the bandage is working?
  • There may be a change in odor. Infected wounds are rotting flesh, and they smell like it. Effective wound care results in cessation of odor. This may take two or three weeks.
  • There may be a change in color. Necrotic (dead or dying tissue) tends to be black. If the bandage is working, there won't be as much black tissue around the wound. This may occur in just two or three days.
Products like this are recommended for "larger" wound care. A large chronic wound isn't as large as you might think. Just 20 square centimeters (less than 2 inches by 2 inches) is considered a "large" wound. Many troublesome wounds are just a centimeter (4/10 inch) across.
 
The tremendous advantage of these products is that they produce results in just two or three weeks, instead of two or three years. An added advantage is that they are products you can use on your own. It isn't necessary to fight your insurance company to get home visits from a wound care specialist. It isn't necessary to go in to see your podiatrist every other day. They are vastly less expensive than podiatrist visits. Don't quit seeing your podiatrist or wound care specialist just because you find a wound dressing that works for you, but be sure to ask about autolytic debridement products if you haven't tried them on your own.
Read full article

  • Alexander M. Reyzelman, DPM
  • Mher Vartivarian, DPM. Evidence of Intensive Autolytic Debridement With a Self-adaptive Wound Dressing. Wounds. 2015.27(8):229-235.
  • Photo courtesy of stephanie_in_love: https://www.flickr.com/photos/stephanie_in_love/5434424913/
  • Photo courtesy of opensourceway: www.flickr.com/photos/opensourceway/5754766455/

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