ABSTRACT

With our aging population, chronic diseases that compromise skin integrity such as diabetes mellitus, peripheral vascular diseases are becoming increasingly common. Skin breakdown with ulcer and chronic wound formation is a frequent consequence of these diseases.

Chronic wounds are frequently stalled in the inflammatory stage. Moving past the inflammation stage requires considering the bacterial burden, necrotic tissue, and moisture balance of the wound being treated. Bacterial overgrowth or infection needs to be treated with topical or systemic agents. In most cases, necrotic tissue needs to be debrided and moisture balance needs to be addressed by wetting dry tissue and drying wet tissue. Special dressing have been developed to accomplish these tasks. They include films, hydrocolloids, hydrogel dressing, foams, hydrofibers, composite and alginate dressing. Novel bioengineered skin substitutes and genetically derived growth factors offer innovative approaches to reduce the burden of foot ulcers for both patients and health care systems. However, they frequently are very costly.Definitive protocols for these wound dressings have not yet developed. Currently, adhesive films are used for superficial wounds with hydrocolloids being used for shallow ulcers and alginates for the deep cavities. Foams are used as an adjunct for heavily exudative wounds. Hydrogels are used increasingly in the debridement of dry or necrotic ulcers, particularly when used with an adhesive film to retain the gel at the wound surface.Choices of dressings increasingly represent a cost/benefit analysis where the high cost of the latest dressing is balanced against savings in time and labour involved in dressing changes.