3M Tegaderm Matrix Matrix Dressing. Conquer Non-healing. Wounds

Transcription

1 Conquer Non-healing Wounds

2 Chronic wounds Chronic wounds have been defined as those that fail to progress through a normal, orderly and timely sequence of repair. Or, wounds that pass through the repair process without restoring anatomic and functional results. 1 Recent research into chronic wounds has revealed that the bioburden and protease enzyme imbalance, in particular differential expression of matrix metalloproteinases (or MMPs) and their inhibitors (TIMPs), are strongly associated with delayed healing in these wound types. 2,3 Acknowledgement to: Richard White Ph.D., M.I.Biol., Professor of Tissue Viability Institute of Health, Social Care and Psychology, University of Worcester, WR2 6AJ. Biochemistry of chronic wounds Increase in matrix metalloproteinases (MMPs) MMP-2 and MMP-9 are significant in the wound healing process Decrease in tissue inhibitors of metalloproteinases (TIMPs) Decrease in growth factors Increase in reactive oxygen species (ROS) Fibroblast senescence Reduced keratinocyte migration High levels of MMPs destroys local cells/tissue 2

3 What are MMPs and how do they influence the wound healing process? MMPs are a specific group of zinc-containing proteolytic enzymes 4 Play an important role in remodelling the extracellular matrix Important role in re-epithelialization Balance required between matrix metalloproteinases (MMPs) and their natural inhibitors, tissue inhibitors of metalloproteinases (TIMPs) 5 During normal wound healing, removal of damaged tissue is balanced against rebuilding of new tissue Balanced MMP production Balanced TIMP production MMP-TIMP regulation affects build-up and breakdown of extracellular matrix 5 Increased rebuilding of new tissue In chronic wounds, an imbalance between MMP and TIMP production slows down the healing process. Prolonged MMP expression destroys growth factors, impairing the wound s ability to heal. 5 3

4 Preparing the wound bed is an essential component of wound management. Local factors can be represented by DIME (Debridement, Infection or Inflammation, Moisture Balance and Edge of wound). A template is presented as a basis for the discussion of the evidence base and expert opinion corresponding to each step in the paradigm of preparing the wound bed. Preparing the wound bed is an essential part of wound management. Person with a Chronic Wound Treat the Cause Address causes and co-factors affecting healing Local Wound Care Patient-centred Concerns Adherence to plan of care Quality of life Caregiver/family Debridement Inflammation or Infection Control Moisture Balance Edge of the Wound Active therapies Biological agents (acellular and cellular) Skin grafting Adjunctive therapies Adapted from Sibbald RG, Orsted HL, Schultz GS, et al Consequences of unhealed wounds Significant resource implications (both in time and materials) Prolonged suffering for the patient 4

5 3M TM Tegaderm TM is a wound dressing impregnated with polyhydrated ionogen (PHI) ointment which down-regulates MMPs, balancing the chronic wound environment and accelerating healing. 5,6 Matrix dressing PHI ointment containing a unique blend of metallic ions Metal ions are released into the wound in the presence of exudate acting directly on the fibroblast Rubidium Opens cell channel to allow other metal ions to enter the cell. Calcium One of the components of MMPs helps to stop MMP production. Potassium Depolarizes cell membrane as it switches protein production and stops MMP production. Needed for tissue regeneration (fibroblast epithelialization). Zinc Helps to stop MMP production. Needed for tissue regeneration (fibroblast epithelialization). Citric acid Helps to normalize the ph of the wound that has been demonstrated to improve wound healing compared to higher ph. 3M TM Tegaderm TM contains polyethylene glycol hydrophilic delivery agent activated by warmth and moisture from the wound environment to activate the release of PHI into the wound bed. 5

6 Case story patient A (Stage III pressure ulcer) Before treatment Female, 96 years old, various underlying pathologies Wound size: 5 cm x 3 cm Wound duration: 10 months After treatment Case story patient B (diabetic foot ulcer) Wound nearly closed after 9 weeks of treatment with 3M TM Tegaderm TM Before treatment Male, 56 years old, diabetic Wound size: 3 cm diameter Wound duration: 2.5 yrs Case story patient C (pressure ulcer) After treatment Wound nearly closed after 8 weeks of treatment with 3M TM Tegaderm TM Before treatment Male, 57 years old, diabetes Wound size: Great Toe: 2.8 cm x 0.5 cm 3rd Toe Amputation site: 0.6 cm x 0.4 cm Wound duration: 2-3 months 6 After treatment After four weeks of care with 3M TM Tegaderm TM the wound was considered closed

7 Indications for use Chronic, non-infected wounds, including diabetic foot ulcers, venous stasis ulcers and pressure ulcers (stages II - IV). Contraindications for use When dry necrotic tissue is present, in clinically-infected wounds, or if there is a known allergy to any of the ingredients. Instructions for application 1 Cleanse the wound according to local protocol guidelines. 2 Apply 3M TM Tegaderm TM directly to the wound ensuring intimate contact is made with wound bed. 3 Always apply a secondary dressing to 3M TM Tegaderm TM to maintain a moist wound healing environment. For moderate to highly-exuding wounds: 3M Tegaderm Foam Dressing (adhesive or nonadhesive) For low to moderately-exuding wounds: 3M Tegaderm + Pad Film Dressing with Non-Adherent Pad For low to non-exuding wounds: 3M Tegaderm Film Dressing To protect the peri-wound skin use 3M Cavilon No Sting Barrier Film at each dressing change. At dressing change remove secondary dressing and gently lift 3M TM Tegaderm TM away from the wound. Instructions for removal In wounds where exudate levels have significantly diminished 3M TM Tegaderm TM may be moistened to aid gentle removal. If desiccation has occurred review secondary dressing suitability. 7

8 Supports faster healing in chronic wounds 7 Ordering information Normalizes the wound micro-environment 8-10 Regulates MMPs (matrix metalloproteinases) 6 Facilitates re-epithelialization 8 Catalogue No. Size Dressings/Box Boxes/Case in x 2 3 /8 in cm x 6 cm /8 in x 4 in cm x 10 cm References: 1. Lazarus GS, Cooper DM, Knighton DR et al. (1994). Definitions and guidelines for assessment for wounds and evaluation of healing. Arch Dermatol 130; Lobmann R, Zemlin C, Motzkau M et al. (2006). Expression of matrix metalloproteases and growth factors in diabetic foot wounds. J Diabet Complic 20(5); Mwaura B, Mahendran B, Hynes N et al. (2006).The impact of differential expression of extracellular matrix metalloproteases on the chronicity of venous leg ulcers. Eur J Vasc Endovasc Surg 31(3); Whittaker M & Ayscough A. Matrix Metalloproteinases and their Inhibitors Current Status and Future Challenges. Celltransmissions Vol. 17(i); 3-11, Karim RB, Brito BR, Dutrieux RP, Lassance FP, Hage JJ. (2006). MMP-2 Assessment as an Indicator of Wound Healing: A Feasability Study, Advances in Skin & Wound Care 19(6); Monroe S, Sampson EM, Popp MP, Lobman R, Schultz GS. (2005). Effect of Polyhydrated Ionogens (PHI) on Viability and Matrix Metalloproteinase Levels in Cultures of Normal and Diabetic Human Dermal Fibroblast. Poster Presentation WHS. Chicago. May Hampton S, Young S, Kerr A, King L. (2006). An observational study of the use of a polyhydrated ionogen impregnated dressing (DerMax) in the treatment of wounds. Poster presentation, EWMA, Prague, Czech Republic. May Hoekstra M, Pirayesh A. (2003). Poly Hydrated Ionogens regulate Matrix Metalloproteinases Expression and Reactive Oxygen Species in Recalcitrant Wounds. European Tissue Repair Society Congress, September Körber A, Freise J, Rietkötter J, Grabbe S, Dissemond J. (2006). Erfolgreiche Behandlung therapierefraktärer chronischer Wunden mit DerMax (Successful treatment of therapy-refractory chronic wounds with Tegaderm Matrix). Zeitschrift fur Wundheiling 6; van den Berg AJJ, Halkes SBA, Quarles van Ufford HC, Hoekstra MJ, Beukelman CJ. (2003). A novel formulation of metal ions and citric acid reduces reactive oxygen species in vitro. J Wound Care 12(10). PHI: Polyhydrated ionogens 3M Canada P.O. Box 5757 London, ON N6A 4T1 Canada 3M Medica D Neuss Germany M, Cavilon and Tegaderm are trademarks of 3M. Used under license in Canada. 2007, 3M. All rights reserved E