Wound Care

The basic function of the wound care materials is providing protection against an infection, blood and exudates absorption, to promote healing and possibly apply a medication to the wound [1]. The today available materials range from simple cotton gauzes and lint to sophisticated multifunctional systems made from natural or synthetic materials [2]. In the history, the development of wound dressings was managed in accordance to personal experience or historical knowledge. Recently, the development is guided by clinical studies and evidence based medicine. There have been recognized two wound care systems, these being traditional and advanced dressing. Their classification includes 10 dressing classes [3]. Gauzes Antiseptics Proteolytic Enzymes Absorbents Granulation Promoters Bio-dressing Skin derivates Semipermeable Dressings Occlusive Dressing Hydrogels

The materials and designs of wound dressings are derived from the application condition. These are for the traditional and advanced dressing summarized in Table 1 [3]. It was already known in the Arabian period that the healing conditions are critical for successful healing process. The moist wound healing philosophy was scientifically explained in 1960s in magazine Nature by George Winter. On the basis of this theory, a new wound care treatment methods have been developed promoting and respecting the physiological healing process. Table 1: The functionality of traditional and advanced wound dressings.
Traditional dressing Exudate absorption and drying of the wound Haemostatis Antisepsis Protection from infection Wound covering Advanced dressing Keep a moist environment Remove exudates and necrotic tissue Keep temperature constant Oxygen permeable Protection from exogeous infection Easy to handle Non-traumatic at the dressing change

The wound dressing materials belonging to the traditional and advanced wound dressings are designed according to their functionality. They are presented in Table 2 [3]. Table 2: The categories of traditional and advanced wound dressings according to their design or a material.
Traditional dressing Gauze Lint Wadding Plasters Advanced dressing Alginates Hydrogel Hydrocolloids Foam dressing Film dressing

The Figure 1 shows the different classes of products; we can highlight that alginates are positioned in the middle of the two wound care philosophies, because they keep the microenvironment moist and do not occlude the wound and promote granulation. We can now analyse the conditions, which advanced dressings produce in comparison to traditional dressings [3].

Figure 1: Different categories of wound dressings according to use. Epithelial Cells Migration Under Advanced And Traditional Dressing The ability to keep a moist microenvironment is important because human cells can only live in water. The only tissue that can live in the air is that of the skin (keratinised dead cells). The wound has a superficial loss of tissue and so the structures that need water to live are exposed. It is obvious then, we need to promote a moist environment to support the healing process. The second most important condition is that of the length of healing time. Epithelialization starts from the edge of the wound due to cell migration: keratinocytes need a moist microenvironment. In a dry wound they will migrate under the dry dermis, but in a moist

wound they will migrate on the surface, as shown in Figure 2. We can easily understand that a water mass movement is quicker than that of the removal of dry tissues [3].

Figure 2: Cell migration in a dry and moist wound environment.

Mitosis stops at 32/33C and this is the temperature on the wound surface when it is exposed to air. Dressings made from a fabric cannot isolate the wound but this can be achieved by using synthetic films because they have a lower thermal conductivity and can be worn over a longer period of time. This helps to restore the thermal stability lost by the skin.

Prevention of Infection - Comparison Between Traditional & Advanced Dressings (Hutchinson, mod.) Its commonly believed that a moist wound is frequently infected. Hutchinson demonstrated in a very large number of studies that advanced dressings can reduce the incidence of infection by more than 50% in comparison with traditional dressings. The advanced dressings do not adhere to the lesion and so avoid further damage to the wound or its surrounding tissues. The comfort during dressing changes is immediately noticeable and the creation of a moist, warm environment can reduce pain. Everyone knows that dressings represent 5% of the management costs of a chronic wound, whilst 70% of the cost is absorbed by nursing time. It is evident that if dressings worn over a longer period are used, nursing time can be reduced. This represents a gain, both economically and in clinical resources [3].

Traditional Wound Dressings Examples of available wound dressings according to their origin, functions and applications are presented in Table 3 [2]. Table 3: Traditional wound dressings.
Types Traditional dressings Low adherent dressing Examples Cotton wool gauze & lint Cutilin Melolin Release Setoprime Function Form of Application Allow strike through, shed fibres and Used on clean, dry wound or as adhere to the wound + dehydrate the secondary dressing wound Suitable for dry wounds or lightly Need to be secured with bandage or exuding wounds. adhesive tape.

Some structures of gauze and lint materials are shown in Figure 3. A gauze material is an open weave, absorbent fabric. When coated with parafin wax, it is used for burns and scalds treatment.

Figure 3: Examples of gauze and lint structures: A structure of plain weave, B real gauze plain weave, C structure of leno weave, D real fabric of leno weave. A gauze serves as an absorbent material in a pad form (swab) in surgical applications. If yarns are barium sulphate coated and incorporated into a swab, the material is X-ray detectable [1]. Lint is a plain weave cotton fabric that is used as a protective dressing for first aid and mild burn applications [1]. 4

Wadding materials are also used for wound care applications. They are a high absorbent materials sometimes covered with a nonwoven fabric to prevent wound adhesion or fibre loss as shown in Figure 4 [1]. The absorbent layer can be made of cellulose pulp, wood pulp, wet laid cotton or viscose fabrics, etc. Recently the absorbent core can also obtain superabsorbent polymer powder.

Figure 4: Structure of a wadding material. More complex wound dressings are composite materials consisting of an absorbent layer placed between a wound contact layer and a flexible base material, as shown in Figure 5 [1]. The wound contact layer should prevent the adherence of the dressing to a wound and be easily removed without disturbing the tissue growth. The function of absorbent layer is to absorb blood or other exudate liquids and provide cushioning effect to protect a wound.

Figure 5: A wound dressing functionality. The basic textile structures of a wound contact layer are the same as gauze and lint materials shown in Figure 3. They can be also made of a soft nonwoven spunlaced fabric shown in Figure 6 [4]. All the fabrics are mostly made of the natural fibres. The recent use of a collagen, alginate or chitin fibres contribute to the healing process [4]. Some of these articles can be coated by pressure sensitive adhesives which contribute to wound dressing performance by being stick to the skin around the wound and preventing the abrasion of wound by the material, therefore damaging of new grown tissue [2].

Figure 6: E structure of spunlaced fabric, F spunlaced fabric. The absorbent layers are much more the same as those described for wadding materials shown in Figure 4.. The flexible base materials should protect the surrounding of a wound from leaking of blood or other exudates leaking. It can be made from a polymer film or porous membranes permeable to air but not to a liquid. Examples of a commercially available gauze, lint and wadding pads ES gauze swabs are the classic swabs made of absorbent cotton threads [5]. They are highly absorbent, soft, conformable and permeable to air. They are also available with interwoven Telatrast X-ray detectable thread under the brand name of "Telacomp ". They are used for general wound treatment, especially in primary treatment of dirty, infected or highly exudative wounds, as swabs and sponges in minor surgery actions. ES umbilical pads are elastic pads made of absorbent cotton threads. They are soft and absorbent, used for sterile care of the cord stump in new born babies [5]. PehaSlit Dressing is gauze dressing with the Y slit made of absorbent cotton threads. A pre-cut, so-called Y slit makes them suitable for use around rains, in tracheotomies and extensions [5].

Mulpa is a general purpose gauze swab made of absorbent cotton specially designed to meet criteria for generally treatment, especially for larger wounds. They are high absorbent, air permeable, soft and conformable [5].

Medicomp is a non-woven swab used as an alternative to the traditional gauze in the ward and in outpatient treatment [5]. It is made of 70% viscose and 30% polyester fibres. It has an open gauze-like structure. They are very absorbent, soft and permeable to air. The non-woven fabric is bonded mechanically and does not contain binding agents or optical brighteners. Medicomp Drain is a non-woven, gauze-structured slit dressings made of 70% viscose and 30% polyester fibres; free of binding agents and optical brightening agents, two additional layers for extra high absorbency, with Y slit [5]. Medicomp Drain nonwoven swabs with Y slits are recommended for use around drains, in tracheotomies and extensions as well as to offer protection when cannulae und probes are employed. It is used for the general treatment of wounds; as swabs and sponges during outpatient and inpatients interventions.

Examples of commercially available wadding pads and wound dressing composites Eycopad is and eye pad made of absorbent cotton wool with pure cotton gauze covering. The use of high-quality absorbent cotton wool and absorbent gauze made of pure cotton makes the Eycopad eye pad particularly soft and absorbent [5]. The gauze covering is closed at the narrow sides of the dressing, which considerably improves cohesion. Eycopad is lint-free and has a long-lasting, good cushioning effect. Comprigel is an impregnated, non-adhering gel dressing with an integrated absorbent core made of a non-woven fabric [5]. This favourable combination of materials allows both simple and

effective management of many different kinds of wounds. The wound side of the dressing is layered with a gel of natural polysaccarides, which is well tolerated by the skin and permeable to air and secretions. Wound secretions can freely pass through into the absorbent core. The highly absorbent core is made of a non-woven fabric and possesses a high retention capacity. Comprigel does not adhere to the wound surface and it keeps wound edges supple. The gelatinous mass is firmly bonded to the supporting layer made of open-weave cotton tulle, ensuring that the wound remains clean and the risks of drying out or sticking are reduced. Comprigel can therefore also be removed painlessly even if the dressing is left in place for long periods of time. The cooling effect of the gel when applied eases patient discomfort. The gel layer gives Comprigel slight adhesive properties. It remains in place without any additional fixation, making its application considerably easier. Comprigel is used for the general treatment of wounds of diverse origins, on the ward, in general practice and in first aid. Fil-Zellin is non-iritant universal dressing for particularly economical use. It consists a wound compatable nonwoven layer applied directly to the wound, and several layers of highly bleached cellulose as the absorbent layer. The dressings are quilted several times over the entire width to connect the two material layers [5]. The soft, nonwowen wound-contact layer rapidly guides secretions into the absorbent core. The absorbent core made of highly bleached, creped cellulose layers provides Fil-Zellin its good absorption capacity. The quilting gives both materials good cohesion, which guarantees a constantly smooth surface at the wound dressing with no creases. It may be used universally for wound-compatible treatment of dry or secreting wounds or as carrier material for ointment and moist dressings. Zetuvit was specially developed for the treatment of highly exudative wounds. It consists of four layers of different materials, which complement each other perfectly to give the dressing pad its outstanding properties [5]. The covering layer consists of a two-ply non-woven material: The surface in contact with the wound is made of hydrophobic polyamide fibres and does not absorb any liquids, thus preventing it from sticking to the

wound. The inner surface of the non-woven material consists of hydrophilic cellulose fibres with high capillary activity through which wound exudates can pass quickly to be retained in the absorbent core. Bleached cellulose tissue disperses the exudates, thereby making full use of the high retention capacity of the absorbent core. The absorbent core made of soft cellulose fluff has a high absorption capacity and exerts a good cushioning effect. The backing consists of a layer of cellulose, which although permeable to air, is hydrophobic and prevents the exudates from striking through it. Thus the wound is protected against contamination. It is used for the treatment of highly exudative wounds in all fields of medicine; for cushioning and protecting wounds. Grassolind is made of an open weave cotton cloth impregnated with a non-medicated ointment, which is neutral. It is therefore especially suitable for the treatment of wounds in dermatology, for patients with sensitive skin or those who are sensitive to certain medication and for long-term treatment of wounds with delayed healing [5]. During all stages of wound healing Grassolind keeps the edges of the wound supple and protects the wound from drying out. It promotes granulation and re-epithelialization and effectively prevents undesirable scar tissue contraction. The impregnated dressing does not adhere to the wound. It can be changed painlessly, granulation tissue and new epithelium are not irritated. The open weave cotton cloth allows free access of oxygen to the wound and provides good ventilation. Secretions can drain easily and maceration is avoided. Grassolind has no sensitizing or allergenic effects even when applied for long periods. Where necessary, specific topical medication can be added to the non-medicated ointment base. It is used for the gentle treatment of large surface lesions, e.g. abrasions, contusions, burns, scalds, acid burns, radiation damage, etc. In plastic and cosmetic surgery, nail removal, circumcisions, etc. As a dressing for the donor site in skin grafts and for fixing split-skin grafts. It is also ideal for the treatment of wounds in dermatology, for patients sensitive to certain medication and for long-term treatment of wounds with delayed healing, where there is often the risk of sensitization.

Atrauman is an ointment dressing that effectively supports all phases of wound healing. The properties of the cloth used and the composition of the ointment applied ensure atraumatic wound care. The thin, soft, open-weave tulle of hydrophobic polyester fibres with its smooth surface structure counteracts the tendency of adhesion to the wound by preventing new tissue from penetrating the dressing [5]. Atrauman's non-adhering properties are enhanced further by the ointment present in the dressing, thus permitting removal without tissue injury. Atrauman keeps wound surfaces and edges soft and supple and prevents the wound from drying out. Undesired contraction of scar tissue is avoided. The ointment itself is permeable to air and does not inhibit passage of secretions. In this way , the wound has sufficient contact with the air and the rapid transfer of excess secretions is assured. Secretions are absorbed into a secondary dressing applied on top of the Atrauman dressing. The ointment does not contain added vaseline or other paraffins. No ointment residues, which are difficult to remove, are produced. The condition of the wound may be assessed and cleaning of the wound is simplified. The ointment is non-medicated and does not lead to sensitization. Therapeutically active substances can be applied topically at the discretion of the physician. It is used for a traumatic wound treatment in all phases of healing, e.g. for cuts, lacerations, abrasions, leg ulcers, pressure sores, burns, scalds, acid burns, radiation burns, abscesses, boils, carbuncles, panaritia; for covering donor and recipient sites in skin grafting, following plastic and cosmetic surgery, nail extraction, phimosiectomy, etc. The non-medicated ointment base makes Atrauman also suitable in dermatology and in the treatment of patients with sensitive skin. Modern materials are presented by several producers of the wound contact layers [6]. In US patent [7] is described a special wound covering allowing air circulation around a wound suitable particularly for burns. This function is ensured by a loop (12), shown in Figure 7, made from a flexible material (foamed elastomeric, or bulky cotton material). A screen (26), made from air flexible (cotton) in a form of mesh, is attached to the loop and extends across the opening (24) of the loop.

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Figure 7: Cross section of a wound cover allowing air circulation around a wound. The screen mesh is fine enough to allow air past through but blocks particles, such as dust. A panel (28) made from a flexible material is attached to peripheral wall (14) of the loop and extends along, but does not extend over the opening (24). An adhesive covers the lower surface (32) of the panel. When applied to a wound, the loop keeps the screen away from the wound and this prevents the rubbing of the screen on the wound and ensures air circulation across the wound. Multi-layer absorbent wound dressing has been developed by 3M [8]. It is designed from several layers of different functions as shown in Figure 8. A backing layer (20), an adhesive layer (22), a porous or non-continuous wound contact layer (28) and a pressure sensitive adhesive (30) are extended along the whole dressing therefore forming a perimeter of nonabsorbent material. Only the first (24) and second (26) absorbent layers are positioned within the interior of the dressing. These layers are prepared by photo-initiated bulk polymerisation. The firs absorbent layer is 25 mm thick and comprises of an absorbent composite capable rapidly absorb moderate to heavy amount of exudates while retaining structural integrity and transparency. The layer may include: 0-40 parts by weight of an acrylic or methacrylic acid ester or a non-tertiary alcohol having 4-14 carbon atoms; 30-100 parts by weight of hydrophilic, ethylenically unsaturated monomer (acrylate and metacrylate esters prepared from mono-hydroxil-terminated poly lower alkylene oxides, such a PE-, PP-glycols); 0-40 parts by weight of a polar, ethylenically unsaturated monomer (partially neutraliyed acrylc acid and N-vinyl acetamid), different from the hydrophilic ehylenicaly monomer. The second absorbent layer is only 3 mm thick and less absorbent than the first one. It may contain the same componenets but will generally have higher concentration of the acrylic or metharylic ester monomer. Also one or more multifunctional cross-linking monomers can be included into absorbent layers.

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Figure 8: Multi-layered absorbent wound dressing article. An adhesive bandage, with antimacrobial and haemostatic properties, has been disclosed by Kimberly-Clark [9]. It is composed from layer an elastomeric layer for covering the wound and surrounding area (70), as shown in Figure 9, an adhesive layer (77) for adhering the adhesive bandage to wound site, an absorbent pad (80) for absorbing exudates made of a cellulose wadding or a nonwoven, non-stick perforated cover (85) such as PE film for allowing limited flow of exudates to the absorbent layer, a layer of an antibacterial agent and haemostatic agent or a single wound healing with haemostatic and antimicrobial functionality (90) coming into contact with the wound. Figure 9: An adhesive bandage with antimicrobial and heamostatic properties. Cosmopor steril is a self-adhesive wound dressing, which differs from traditional wound dressings in its novel combination of materials. It is ideal for postoperative wound management [5]. The main beneficial feature of Cosmopor steril is the waterrepellent microgrid wound contact layer. This allows exudate to pass quickly into the absorbent pad behind it whilst itself remaining absolutely dry. This prevents the dressing from sticking to the wound. The dressing can be changed painlessly. The absorbent pad is made of 100% pure cotton wool, conforms well to the body contours and has excellent absorbent and cushioning properties. The soft, non-woven support is permeable to both air and water vapour, thereby ensuring that Cosmopor steril does not interfere with the

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skin's natural functions. The non-woven support has rounded edges which prevent the dressing from becoming detached even when the dressing remains in place for a long period. The wide, continuous adhesive border ensures good closure. This, together with the waterrepellent, non-woven covering layer give reliable protection against contamination. Cosmopor steril is coated with a hypoallergenic polyacrylate adhesive which is very well tolerated by the skin. It serves for postoperative wound management and sterile dressing of minor injuries, e.g. in first aid.

Advanced Wound Dressings There is a large variability of the materials classified as advanced wound dressing summarised in Table 4 according to their origin, functional ability and form of applications. The description of the functionalities of most common dressings from Table 4 [2] are described in [3] and presented below. Film Dressings Film dressings are non-absorbent, permeable to moisture vapour and oxygen and impermeable to bacteria and viruses. They are typically made of a thin, transparent polymer membrane, which is coated with a layer of acrylic adhesive. Film dressings can be also combined with other dressing materials. Hydrogel Dressings Hydrogels maintain balanced hydration through controlled evaporation. Exudates are absorbed into the gel, moisture evaporates through semi-permeable film backing or a secondary dressing. Hydrocolloid Dressings Hydrocolloid dressings are backed by either a waterproof polyurethane foam or a thin film. In some cases, the backing extends beyond the margin of the hydrocolloid to form a border. The totally sealed hydrocolloid at the wound area keeps the moisture in while keeping the bacteria

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and fluids out. This limits any gas exchange between a wound and the environment. Fluid absorption is slow primary trough swelling of particles in the dressing. This swelling allows a soft, non-adherent gel formation over the wound.

Calcium Alginate Dressings The calcium alginates provide a moist healing environment by converting the exudates into a gel. Reaction between the calcium in the dressing and the sodium in a wound exudates results in a chemical ion exchange, which forms a gel-like substance. The gel conforms to the wound, providing a soft, moist healing environment. Due to its dehydration effect, this dressing should not be used with dry wounds. Foam Dressings Foam dressings are indicated for a partial thickness or superficial wounds. The open pore structure of a foam dressing gives it relatively Absorptive high moisture varies vapour by a transmission rate. ability

manufacturer. The pore size, texture and absorbency are controlled by the agents impregnated in the dressing. The degree of occlusion depends on a presence of a film backing. Silicon Dressings A soft silicone dressing is a dressing coated with a soft silicone as an adhesive or a wound contact layer. The intrinsic properties of soft silicone are such that these dressings may be removed without causing trauma to the wound or to the surrounding skin [10]. There are different types of soft silicone dressings including a traumatic wound contact layers, absorbent dressings for exuding wounds and also a dressing for the treatment of hypertrophic scars and keloids. The soft silicone cannot enter the circulatory system. It is insoluble in wound exudate and the silicone molecules are too big to penetrate through cell membranes or

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pass through the skin into blood vessels. They therefore cannot be transported around the body to produce any systemic effects. Soft silicone is not intrinsically absorbent, but it can be applied as a facing layer to dressings containing absorbent components that are used for the management of exuding wounds.

Collagen Dressings Collagen is the fibre forming protein of mammalian connective tissues. It is the major component of the extracellular matrix forming an organized structure bridging the basal cells to epidermis. At least 10 different types of collagen have been identified. In the wound dressing applications, the collagen has haemostatic and absorbent functions [14].

Table 4a: Summary of available advanced wound dressings according to their origin, functions and applications.
Types Films Examples Bioclusive C-View OpSite Tegaderm Hydrogels Agaflo GrauGel Intrsite Gel Nu-Gek Sterigel Function Vapour-permeable adhesive Form of Application films, Suitable for shallow wounds,. Used to

thin, very flexible, easy to mold prevent pressure ulcers and retention Plus around difficult shapes. They cool the dressing. surface of the wound. Excessive exudate may accumulate. Hydrophilic polymers, partially cross- Most require covering with a secondary linked to form 3D network. Can dressing, suitable for dry sloughy absorb up to 100% if their weight. wounds and lightly exuding wounds. Promote moist healing, non-adherent, They are not good for infected or by cooling of the wounds surface they heavily-exuding wounds. They are also can reduce pain. Amorphous good for drug delivery such a placental hydrogels are particularly useful for growth factors and antibiotics. treating cavity wounds.

Hydrocolloids Aquacel Comfeel Granuflex R. Ultec Pro

More complicated than hydrogels, Not contain constituets such

suitable

for

infected

wounds,

as usually require no secondary dressing,

methylcellulose, pectin, gelatin and hence patients can bath and shower. polyisobutylene, promote formation of granulation tissue and provide pain relief. Suitable for treatments of acurte and chronic wounds, for desloughung; light to heavily exuding wounds.

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Table 4b: Summary of available advanced wound dressings according to their origin, functions and applications.
Alginate dressing Algisite M Kaltostat SeaSorb Sorbsan Natural polysaccharides brown surface and hence the extracted Suitable for use of medium to heavily At exuding wounds and cavity. They are sodium- more used on infected wounds. Most exudates and Comfeel Plus from seaweed.

wound/dressing the dressing

calcium exchange takes place between alginates require secondary dressing. respectively swelling

formation of gel. Foams Avance Cavi-Care Flexipre Tielle Lyofoam Silicon dressing Cica-Care Mepiform N-A Ultra Silgel Collagens Oasis Opraskin Promogan Suabsorb C Fibre-forming protein of mammalian Collagen is used as haemostat, an connective tissue. It contributes to absorbable suture material, artificial differ of wound healing by attracting skin, bone filling and wound dressing granulocytes wounds De-odoriser dressing Actisorb Silver 220 Carboflex Denidor and fibreblasts reduces into and wound Polyurethane based, with or without Suitable for use on light to medium adhesive borders, main applications exuding wounds are to absorb large volumes of exudates reducing the need for dressing changes Consists of silicon gel, used to reduce Gel sheet can be sterilized and are rehypertrophic and keloid scarring, usable. cosmetically acceptable scars.

contraction, etc. Contain activate charcoal responsible They are used once or twice daily as for reduction of offensive odours. necessary. Suitable for discharging, purulent and contaminated wounds complicated by bacteria infection. Can contain silver

Metrotop Gel to inhibit bacterial growth. Non-adherent dressing Available non-impregnated or Most non-adherent dressings require a

impregnated and discourage foreign cover bandage or tape to hold them in a matter from becoming lodged in the place. wound bed. They can be used on skin tears, donor site and skin grafts.

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Examples of film wound dressings Hydrofilm is a self-adhesive, transparent film dressing that is indispensable in modern wound management [5]. It gives excellent protection against secondary infection and offers a number of additional benefits. Although waterproof and impermeable to micro-organisms, Hydrofilm does not prevent the passage of oxygen and water vapour. Thus, it provides an effective barrier for bacteria and germs, but at the same time does not inhibit cutaneous respiration.This helps to avoid skin irritation in the area around the wound. Hydrofilms skin compatibility is further enhanced by the use of a hypoallergenic adhesive which makes it well tolerated even by patients with extremely sensitive skin. Although it possesses excellent adhesive properties, the dressing can be removed painlessly without damaging new epithelium. Hydrofilm is extremely thin and elastic and adapts perfectly to the body contours. The support material consists of a resistant protective foil, which makes it easy to apply, even when wearing gloves. As Hydrofilm is completely transparent, the wound and the sourrounding skin can be inspected at any time without having to remove the dressing. The same applies when Hydrofilm is used to secure catheters or cannulae. Hydrofilm is waterproof, enabling the patient to shower while the dressing is in place. Hydrofilm is particularly useful as a protective cover against secondary infection or physical damage on dry wounds healing by first intention and nearly healed epithelial wounds. It may also be used to secure catheters or cannulae and is ideal as a secondary dressing to cover gel-forming calcium alginate dressings, e.g. Sorbalgon. It should not be used as a primary dressing on clinically infected, bleeding or heavily secreting wounds. Hydrofilm Plus is a self-adhesive transparent wound dressing with an absorbant pad, which does not stick to the wound. It provides safe protection of the wound and high degree of comfort for the patient [5]. The absorbent pad of Hydrofilm Plus has good absorbent and cushioning properties and is covered with a soft polyethylene wound contact layer which reliably prevents adherence to the wound. Although waterproof and impermeable to micro-organisms, the transparent,

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extremely thin Hydrofilm Plus does not prevent the passage of oxygen and water vapour. Thus, the wound dressing provides an effective barrier for bacteria but at the same time it does not inhibit cutaneous respiration. The skin compatibility of Hydrofilm Plus is further enhanced by the use of a hypoallergenic adhesive which makes it well tolerated even by patients with extremely sensitive skin. Due to the transparency of Hydrofilm Plus, the skin surrounding the wound and the secretion absorbed by the wound pad can be inspected at any time without having to remove the dressing. Due to the elasticity of the film, Hydrofilm Plus adapts perfectly to the body contours thereby guaranteeing a reliable fit. It is used for postoperative care of slightly secretory wounds, as protection against secondary infection, as well as for sterile dressing of minor injuries. Both, Hydrofilm and Hydrofilm Plus are waterproof, enabling the patient to shower while the dressing is in place.

Examples of hydrogels wound dressing Hydrosorb is a transparent, hydrocellular gel dressing made of absorbent polyurethane polymers covered with a semi-permeable polyurethane film, which prevents penetration of water and microorganisms. The three-dimensional gel structure of Hydrosorb has water content of 60 %. Thus, from the very beginning, Hydrosorb represents a moist dressing with

outstanding biocompatibility [5]. Hydrosorb immediately creates a moist environment and is thus particularly suitable for treating chronic wounds. It promotes the formation of new tissue during the granulation phase and maintains a moist wound environment. This is achieved without any risk of wound exudate accumulating, even during prolonged application. Granulation tissue is prevented from drying out. During the epithelialization phase, the moist environment created by Hydrosorb enhances the division and migration of epithelial cells. It also does not stick to the wound, therefore the dressing may be changed without damaging the new tissue. As Hydrosorb is transparent, the wound may be inspected at any time without having to remove the dressing. This considerably reduces the frequency of dressing changes. It is not dissolved by absorbed wound exudate. Thus it can be removed from the wound in one piece.

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No residues are left on the wound and assessment may be made without prior, timeconsuming rinsing being necessary; unpleasant odours do not occur. The soft elastic properties of the gel also give Hydrosorb a good cushioning effect. Hydrosorb has a slight self-adhesive effect. However, for fixation over a longer period of time, it should be secured additionally with a hypoallergenic strapping tape or a dressing retention bandage. Hydrosorb is especially suitable for the treatment of chronic, slow-healing wounds where the granulation process is not functioning satisfactorily, e.g. in leg ulcers, pressure sores, etc. It is also used to treat second-degree burns, and to promote re-epithelialization at split-skin graft donor sites after bleeding has stopped.

Waikatolink presents a honey based wound dressing [11]. The antibacterial nature of honey s the reason for its potential use as a wound dressing. Honey is modified with a viscosity increasing agent and is used in pliable or flexible sheets. The incorporation of modified honey into a gels applied to moist wound dressing is designed to provide antibacterial and anti inflammatory properties and the promotion of wound tissue growth. The dressing includes water absorbing, trapping or removing components to assist in the removal of exudates, which slowly dissolve in body fluids. The article is shown in Figure 10, where suitable material is embedded with modified honey gel (2l), which is covered by a sheet of gauze (23) and bonded to a backing sheet (25). The modified honey as ointments or self-adhesive gels are used on mouth ulcers.

Figure 10: The wound dressing with incorporated modified honey component.

TenderWet 24 is a wound dressing pad, which produces a "rinsing effect" continuously for up to 24 hours within the wound [5]. This action exceeds the cleansing mechanisms of other dressing systems used in moist wound treatment. TenderWet 24 facilitates interactive wet treatment, effectively supporting the

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spontaneous cleansing mechanisms of the wound, and encouraging the formation of granulation tissue. TenderWet 24 is a multilayer wound dressing pad containing a superabsorbent core with irrigating properties as its central component. TenderWet 24 dressings are activated before use with an appropriate volume of Ringer's solution, which is then delivered continuously to the wound for up to 24 hours. This constant supply of Ringer's solution actively softens and detaches necrotic tissue. At the same time, the absorbent core also reliably takes up and retains germ-laden wound exudate. This exchange is possible because the superabsorbent core has a greater affinity for protein-containing solutions than for salt-containing solutions. The wound exudate therefore displaces the Ringer's solution from the dressing pad. Thus, TenderWet 24 continuously renews the film of Ringer's solution in the wound bed over several hours, and simultaneously absorbs micro-organisms, released detritus and toxins. Hence, the wound is rinsed and rapidly cleansed. Furthermore, the physical properties of the superabsorbent compound, combined with the covering of knitted fabric, give TenderWet 24 a high degree of plasticity. This ensures direct contact with the wound bed, which is required for fluid exchange to occur. Moisture and the electrolytes of the Ringer's solution such as sodium, potassium and calcium, contribute to the stimulation of cell proliferation during the granulation phase. Wet therapy with TenderWet 24 is indicated especially when wound conditions require active wound cleansing and supportive treatment, for example in poorly-healing wounds with profuse exudation; in clinically infected wounds; or in chronic wounds of the most diverse aetiology, such as diabetic gangrene, pressure sores and leg ulcers. TenderWet standard is indicated for packing deep wounds. The isotonic TenderWet Solution is available for activation of the wound pads.

Examples of hydrocolloid wound dressing Cotoplast Group presents a range of hydrocolloid based wound contact layers that do not stick to a wound bed [12]. Physiotulle nd Physiotulle Ag are non-adherent, non-occlusive polyethylene nets with significant absorbency for contact layers, which is a secret to maintaining the moist environment around a wound.

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Figure 11: Hydrocolloid based contact layers of Cotoplast Goup. The netting is coated with Vaseline containing carboxymethylcellulose (CMC). The CMC absorbs exudates achieving the gelling effect known from using hydrocolloid dressing. Physiotulle provides faster healing by helping to prevent local infection, the coating ensures a moist wound healing environment, and the dressing is removable without damaging newly formed tissue. Physiotulle Ag contains Silver sulphadiazine in addition, which is homogenously dispersed in Vaseline and provides sustained and controlled silver release. In contact with a wound, the hydrocolloid particles absorb exudates and silver is released to into the wound bed and provides faster wound healing by helping to prevent local infection. Hydrocoll is a self-adhesive, absorbent hydrocolloid wound dressing covered with a semi-permeable polyurethane layer that prevents bacterial and moisture penetration. Upon absorption of exudates from the wound the hydrocolloidal particles swell to form a gel that expands into the wound and maintains a moist wound environment. The gel remains absorbent until the hydrocolloids are saturated [5]. Hydrocoll has a high absorbency due to the presence of hydroactive colloids. Contaminated exudates are quickly taken up and securely held in the structure during the swelling process. During the granulation phase, Hydrocoll enhances the formation of new tissue by stimulating the activity of fibroblasts, which are mainly responsible for initiating the process of tissue regeneration. Hydrocoll maintains the moist wound environment thus preventing the granulation tissue from drying out - without the risk of exudate accumulating in the wound, even during prolonged application.

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The division and migration of epithelial cells are supported by the moist environment during the epithelialization phase. If there are no complications, Hydrocoll can remain on the wound during this phase for several days until the epithelialization process is completed. The gel-forming layer prevents Hydrocoll from adhering to the wound. The dressing can be removed painlessly from the wound without damaging the granulation and epithelial tissue. Hydrocoll has the ability to adhere immediately, it is flexible and conformable and can thus be moulded easily onto the body's contours. The bevelled edges help to keep the dressing securely in place even in difficult areas. The top layer serves as a reliable barrier against bacteria and protects the wound from contamination and penetration of moisture. Ambulant patients can shower with the dressing in place. Hydrocoll is suitable for light to medium exudating wounds, especially in cases of chronic, slow-healing wounds where healing is delayed and where the granulation process is not functioning satisfactorily, as is seen with varicose leg ulcers or pressure sores. It is also indicated for the management of second degree burns. Hydrocoll sacral is indicated for the specific treatment of pressure sores within the sacral region; Hydrocoll concave is specially designed for treatment of wounds on the heel and elbow. Hydrocoll thin, having a lower absorption capacity, should preferably be used during the epithelialization phase.

Examples of calcium alginate wound dressing Sorbalgon is a conformable, non-medicated dressings made of calcium alginate fibres which form a hydrophilic non-adherent gel in contact with the sodium salts contained in blood and wound exudate; the gel fills the wound cavity and creates a favourable healing condition, drawing bacteria from the wound and keeping them inside the gel treatment of external wounds of any type; especially suitable for the treatment of bleeding or secreting wounds, since the gel-forming properties promote the wound healing process, e.g. venous leg ulcers, pressulre sores, abscesses, furuncles, burns, difficult wounds following accident or tumour surgery [5].

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Examples of foam wound dressing Smit&Nephew produce the range of wound contact layers Proguide WCL based on Trilaminate Hydrocellular Foam Technology [6]. The dressing is a centrally located highly absorbent hydrocellular pad, which absorbs and retains liquid in its microscopic structure, preventing leakage and reducing the risk of maceration of the surrounding skin. The pad is sandwiched between two perforated non-adherent polyurethane wound contact layers, which allow even viscous exudate to pass into the dressing. It is indicated for exudate absorption and the management of partial to full-thickness wounds, can effectively manage exudate under compression for up to 7 days. It also helps in the creation and maintenance of a moist wound environment. Moist wound environments have been established as optimal environments for the management of the wound. It also provides physical separation between the wound and external environments to assist in preventing bacterial contamination of the wound. Syspur-derm is a non-medicated dressing made of two layers of soft polyurethane foam. Its mode of action and therapeutic characteristics arise from the different physical structures of the two foam layers. The open-pored lower layer and the dense, finepored top layer are thermally bonded together without adhesives or other agents [5]. The open-pored lower layer, which rests on the wound surface, together with the capillary action of the dense top layer produce a high absorption capacity for exudates. Syspur-derm thus ensures rapid and intensive cleansing of infected wounds. Necrotic material, cell debris, pus and micro-organisms are eliminated with the dressing when it is removed. During the granulation phase, Syspur-derm's open-pored foam layer serves as a matrix for the development of new tissue und physically stimulates the granulation process. Within a short time a clean, well-vascularized granulation bed forms as a precondition for spontaneous epithelialization or successful skin grafts. The dense, fine-pored, top layer of Syspur-derm has a microporous labyrinth structure which assumes important physiological properties of the natural skin. It acts as a barrier against secondary infections, restricts fluid losses and, due to its permeability to gas, ensures the necessary ventilation of the wound.

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Syspur-derm is used for the cleansing of all mechanical and thermal surface wounds, e.g. infected abrasions, second and third degree burns, open fractures etc. It supports the formation of a well-vascularized granulation bed on cleaned or primarily clean deep and superficial wounds, e.g. on extensive mechanical lesions, open fractures, following vertical necrectomy, extensive surgical excisions, etc. It is also suitable for the cleansing of wounds and the promotion of granulation in cases where natural healing is compromised, e.g. leg ulcers, pressure sores, radiation ulcers; for the undisturbed re-epithelialization of clean abrasions, for covering skin graft donor sites, or following tangential necrectomy.

Examples of silicon wound dressing Cica-Care Gel Sheet is a technically advanced silicone gel sheet for scar care widely used by dermatologist and surgeons for management of hypertrophic and keloid scars [13]. It is soft, comfortable and simple to apply. The skin contact side is self-adhesive while the upper side is strengthening non-adhesive silicone membrane. The siliscone membrane and gel comnation akes the Cica-Care durable and less crumble than other silicon sheets.

Examples of collagen wound dressing PROMOGRAN Matrix combines oxidized regenerated cellulose (ORC) and collagen [15]. The combination has proved to promote an optimal healing environment, which is conductive to granulation tissue formation, epithelialization and rapid wound healing. PROMOGRAN is used for treatment of diabetic, venous and pressure ulcers, bleeding surface wounds, traumatic wounds by a secondary intention, dehisced surgical wounds. The PROMOGRAN is applied directly on a low exudate wound after infection treatment. The matrix forms a gel in contact with exudate or through saline hydration. The matrix is covered with a secondary dressing (type depends on level and exudates) to maintain a moist wound healing environment. References

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[1] Horrocks, A.R., Anand, S.C., Handbook of Technical Textiles, The Textile Institute, 2004. [2] Miraftab, M.: Woundcare Materials: An Overview, Medical Textiles and Biomedical Healthcare, Woodhead Publishing Limited, Cambridge 2006, ISBN-13: 978-1-85573-683-2, p. 273. [3]http://www.tycohealth-ece.com/index.php?folder=65 [4] Medical Textiles, S. Anand, International Conference 1999 [5] http://products.hartmann.info/main.asperl [6] http://wound.smith-nephew.com/us/Product.asp?NodeId=2847
[7] US Patent 6940000 [8] US Patent 6942628 [9] US Patent 6932785

[10]http://www.worldwidewounds.com/2003/october/Thomas/Soft-SiliconeFAQ.html [11] Medical Textiles, March 2006, pp. 1-3. [12] http://www.coloplast.com/ECompany/CorpMed/Homepage.nsf/
[13] http://www.nextag.com/SMITH-NEPHEW-Cica-Care-65268260/prices-html [14] http://www.pjonline.com/pdf/hp/200210/hp_200210_wounds_dressings.pdf

[15]http://www.jnjgateway.com/home.jhtml?loc=USENG&page=viewContent&contentId=09 008b9880edadf1&parentId=09008b9880edadf1

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