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Polyurethane foam covering for wounds, burns and ulcers
Wound Medicine 2–3 (2013) 6–8
Contents lists available at ScienceDirect
Wound Medicine journal homepage: www.elsevier.com/locate/wndm
Polyurethane foam covering for wounds, burns and ulcers S.V. Smirnov a, M.V. Shakhlamov a, M.A. Litinsky a,*, D.V. Yanshin a, A.V. Sachkov a, V.N. Obolensky b a b
City Burn Centre, N.V. Sklifosovsky Research Institute of Emergency Care, Moscow, Russia Moscow City Hospital#13, Department of Infected Wound Treatment, Velozavodskaya 1/1, Moscow, Russia
A R T I C L E I N F O
A B S T R A C T
Article history: Received 31 May 2013 Accepted 27 September 2013 Available online 9 October 2013
An experience of a new wound covering based on ‘‘Locus’’ polyurethane foam use in topical treatment of skin injuries with various etiology which has shown high effectiveness and versatility. Treatment of the second-degree burns, bedsores, trophic ulcers, and chronic non-healing wounds resulted in a positive outcome assessed as an active phase change in the wound healing process. This covering goes well with antiseptics, enzymes, and hypo-adhesive coverings. The application of ‘‘Locus’’ covering is noticed to be convenient for medical staff and comfortable for the patients. ß 2013 Published by Elsevier GmbH.
Keywords: Self-expanding polyurethane polymer Wound treatment Skin defects Burns
1. Introduction Over many centuries, materials that served for closing wound surfaces were made up of natural raw materials. The large consumption, high cost, and drawbacks of using the traditional dressings compel to search for new dressing materials. The modern medicine necessitates high requirements for the ‘‘ideal’’ covering for treating wounds, burns, and ulcers. The dressing that is as close as possible to the ‘‘ideal’’ should meet the following requirements: maintains necessary moisture in the wound; removes excess exudate; impermeable to bacteria in both directions (as into wound, and out from it); permeable to gas; and mechanical properties providing not only comfort while being applied, fixated, and carried along, preventing the wound from further injuries, least possible reapplication of dressing, but also no traumatization while removing the covering. Apart from that, the covering should be non-toxic, hypoallergenic, with a long shelf-life and a low cost. ‘‘Locus’’ represents dressing best complying with majority of the above-mentioned requirements for dressing materials and
* Corresponding author at: City Burn Centre, N.V. Sklifosovsky Research Institute of Emergency Care, B. Sukharevskaya Square, 3, Moscow, Russia. E-mail address: [email protected] (M.A. Litinsky). 2213-9095/$ – see front matter ß 2013 Published by Elsevier GmbH. http://dx.doi.org/10.1016/j.wndm.2013.10.001
with no parallels is the polyurethane foam covering for wounds, burns, and ulcers. The ‘‘Locus’’ polyurethane medical foam covering comes in a dual chamber reactor package made up of aluminized polyethylene. Components of the covering (polyol and isocyanate) are mixed after the partition there between is ruptured by compression of one of the chambers. After applying onto the wound, the liquid foamed mass obtained by mixing polyol and isocyanate components sets and forms finely porous elastic covering with the thickness of about 1.5 cm. The covering has bactericidal properties in the liquid phase. It well protects against secondary infections, and traumatization. Reliable fixation to healthy skin around the wound does not require an additional support for the covering. Removal of the covering takes place easily and painlessly. 2. Study materials and methods During years 2011–2012, ‘‘Locus’’ was used in the topical treatment of burns, bedsores, trophic ulcers, and chronic nonhealing wounds. 74 patients were treated: those with superficial burns, bedsores, and chronic non-healing wounds. The ‘‘Locus’’ polyurethane foam covering was used both separately as well as in combination with ointment antiseptics and liquid antiseptics, enzymes, hydrogels, and hypo-adhesive wound coverings. ‘‘Locus’’ created a microenvironment that was suitable for wound by performing drainage function and protecting against infection and secondary traumatization. The covering was applied in liquid phase, which provided a complete filling of the wound.
S.V. Smirnov et al. / Wound Medicine 2–3 (2013) 6–8 Table 1 Results of treating the patients with second-degree burns with ‘‘Locus’’ PMFC (polyurethane medical foam covering). Healing criteria
Average treatment duration with ‘‘Locus’’ covering (in days)
Average standard treatment duration (in days)
Beginning of epithelialization Complete epithelialization
6 10
8 14
The wound surface was cleaned. Enzymes, antiseptics, medications stimulating regeneration and epithelialization were applied when necessary. After mixing the components of the ‘‘Locus’’ polyurethane foam covering, the foamed mass was applied on the whole depth of the injury in such a way that the dry uninjured skin 1–2 cm away from edges of the wound is also covered. The complete polymerization time is 5–7 min. Reapplication of wound covering was performed on the extent of its self-detachment, which took place ranging from 2 to 7 days depending upon the activity of exudation. 3. Results Patients noticed pain relief and comfort with the covering. The beginning and completion of epithelialization served as the criteria for evaluating the effectiveness of combined treatment of second-degree burns. (Table 1). Following properties of the covering were noticed during application:
Fig. 1. Skin and sternal defect, open mediastinum.
high adhesion to dry skin; absorption capacity – up to 100% of the covering; gas permeability, vapor permeability; and easy, quick, and painless removal.
‘‘Locus’’ was used in 37 patients with bedsores. ‘‘Locus’’ was applied on to bedsore immediately after mechanical removal of necrotic tissues. The covering was applied by encompassing wide area of healthy skin for improving fixation and reducing pressure in the region of bedsore. Using ‘‘Locus’’ facilitated transformation of the necrotic phase into the reparative phase within 1.5–2 weeks. Using ‘‘Locus’’ in the treatment of trophic ulcers leads to cleansing and activation of marginal as well as insular epithelialization within the 3–5 weeks. Application of ‘‘Locus’’ brought pain relief in patients with painful wounds. Edema and hyperemia were significantly reduced by the third day. After 2–3-fold reapplication of covering, the wounds were cleansed of necrotic tissues, that took place for about 10 days from the beginning of the covering application, after which active epithelialization began. A significant reduction in skin defect was observed by day 20 from the beginning of the treatment.
Fig. 2. Polyurethane foam dressing on the thorax.
4. Clinical cases Patient with sternal defect, defect of soft tissue of the thoracic cage, and mediastinitis, 400 sq cm skin defect, 15 sq cm sternal defect, and open mediastinum. The defect was completely closed by ‘‘Locus’’ covering; and the mediastinum was sealed. Application of ‘‘Locus’’ allowed not only performing an effective treatment of the wound but also resolving problem of the open mediastinum. Within 2 weeks, the defect was corrected using skinmuscle flap (Figs. 1 and 2). Patient with 300 sq cm chronic calf wound. A complete epithelialization of the wound was observed on day 17 from the beginning of out-patient treatment with ‘‘Locus’’ (Figs. 3–5).
Fig. 3. Painful chronic calf skin defect.
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Fig. 4. Polyurethane foam dressing on calf. Fig. 7. Polyurethane foam dressing on the bones and wound.
Fig. 5. Healed wound.
Fig. 8. Wound surface after the removal of polyurethane foam dressing.
5. Conclusion
Fig. 6. Comminuted open fracture.
Patient with comminuted open bone fracture of the left lower leg, thrombosis of left popliteal artery, as well as ischemia of left lower leg and foot. After surgical cleaning of the wound, ‘‘Locus’’ was applied; and on day 21, the wound was cleansed and was covered with granulations (Figs. 6–8). The effectiveness of the conservative topical treatment was evaluated based on the duration of stage completion: closure of ‘‘pockets’’, wound cleansing, its filling with granulation tissue, which was considered as a sign to prepare for plastic surgery.
1. Combination of antimicrobial properties, high absorption capacity (up to 100% of the polyurethane foam covering), protection against traumatization and infection, as well as reliable adhesion to the surrounding tissue make ‘‘Locus’’ an effective and comfortable covering to be used in treating wounds of various etiology. 2. ‘‘Locus’’ use in the treatment of burns, trophic ulcers, and chronic non-healing wounds resulted in reduction in the duration of healing. 3. ‘‘Locus’’ covering can be used as a monotherapy and when indicated can be combined with antimicrobial drugs, enzymes, and regeneration stimulants that is equally effective. Appendix A. Supplementary data The Russian version of this article can be found, in the online version, at doi:10.1016/j.wndm.2013.10.001.
Contents lists available at ScienceDirect
Wound Medicine journal homepage: www.elsevier.com/locate/wndm
Polyurethane foam covering for wounds, burns and ulcers S.V. Smirnov a, M.V. Shakhlamov a, M.A. Litinsky a,*, D.V. Yanshin a, A.V. Sachkov a, V.N. Obolensky b a b
City Burn Centre, N.V. Sklifosovsky Research Institute of Emergency Care, Moscow, Russia Moscow City Hospital#13, Department of Infected Wound Treatment, Velozavodskaya 1/1, Moscow, Russia
A R T I C L E I N F O
A B S T R A C T
Article history: Received 31 May 2013 Accepted 27 September 2013 Available online 9 October 2013
An experience of a new wound covering based on ‘‘Locus’’ polyurethane foam use in topical treatment of skin injuries with various etiology which has shown high effectiveness and versatility. Treatment of the second-degree burns, bedsores, trophic ulcers, and chronic non-healing wounds resulted in a positive outcome assessed as an active phase change in the wound healing process. This covering goes well with antiseptics, enzymes, and hypo-adhesive coverings. The application of ‘‘Locus’’ covering is noticed to be convenient for medical staff and comfortable for the patients. ß 2013 Published by Elsevier GmbH.
Keywords: Self-expanding polyurethane polymer Wound treatment Skin defects Burns
1. Introduction Over many centuries, materials that served for closing wound surfaces were made up of natural raw materials. The large consumption, high cost, and drawbacks of using the traditional dressings compel to search for new dressing materials. The modern medicine necessitates high requirements for the ‘‘ideal’’ covering for treating wounds, burns, and ulcers. The dressing that is as close as possible to the ‘‘ideal’’ should meet the following requirements: maintains necessary moisture in the wound; removes excess exudate; impermeable to bacteria in both directions (as into wound, and out from it); permeable to gas; and mechanical properties providing not only comfort while being applied, fixated, and carried along, preventing the wound from further injuries, least possible reapplication of dressing, but also no traumatization while removing the covering. Apart from that, the covering should be non-toxic, hypoallergenic, with a long shelf-life and a low cost. ‘‘Locus’’ represents dressing best complying with majority of the above-mentioned requirements for dressing materials and
* Corresponding author at: City Burn Centre, N.V. Sklifosovsky Research Institute of Emergency Care, B. Sukharevskaya Square, 3, Moscow, Russia. E-mail address: [email protected] (M.A. Litinsky). 2213-9095/$ – see front matter ß 2013 Published by Elsevier GmbH. http://dx.doi.org/10.1016/j.wndm.2013.10.001
with no parallels is the polyurethane foam covering for wounds, burns, and ulcers. The ‘‘Locus’’ polyurethane medical foam covering comes in a dual chamber reactor package made up of aluminized polyethylene. Components of the covering (polyol and isocyanate) are mixed after the partition there between is ruptured by compression of one of the chambers. After applying onto the wound, the liquid foamed mass obtained by mixing polyol and isocyanate components sets and forms finely porous elastic covering with the thickness of about 1.5 cm. The covering has bactericidal properties in the liquid phase. It well protects against secondary infections, and traumatization. Reliable fixation to healthy skin around the wound does not require an additional support for the covering. Removal of the covering takes place easily and painlessly. 2. Study materials and methods During years 2011–2012, ‘‘Locus’’ was used in the topical treatment of burns, bedsores, trophic ulcers, and chronic nonhealing wounds. 74 patients were treated: those with superficial burns, bedsores, and chronic non-healing wounds. The ‘‘Locus’’ polyurethane foam covering was used both separately as well as in combination with ointment antiseptics and liquid antiseptics, enzymes, hydrogels, and hypo-adhesive wound coverings. ‘‘Locus’’ created a microenvironment that was suitable for wound by performing drainage function and protecting against infection and secondary traumatization. The covering was applied in liquid phase, which provided a complete filling of the wound.
S.V. Smirnov et al. / Wound Medicine 2–3 (2013) 6–8 Table 1 Results of treating the patients with second-degree burns with ‘‘Locus’’ PMFC (polyurethane medical foam covering). Healing criteria
Average treatment duration with ‘‘Locus’’ covering (in days)
Average standard treatment duration (in days)
Beginning of epithelialization Complete epithelialization
6 10
8 14
The wound surface was cleaned. Enzymes, antiseptics, medications stimulating regeneration and epithelialization were applied when necessary. After mixing the components of the ‘‘Locus’’ polyurethane foam covering, the foamed mass was applied on the whole depth of the injury in such a way that the dry uninjured skin 1–2 cm away from edges of the wound is also covered. The complete polymerization time is 5–7 min. Reapplication of wound covering was performed on the extent of its self-detachment, which took place ranging from 2 to 7 days depending upon the activity of exudation. 3. Results Patients noticed pain relief and comfort with the covering. The beginning and completion of epithelialization served as the criteria for evaluating the effectiveness of combined treatment of second-degree burns. (Table 1). Following properties of the covering were noticed during application:
Fig. 1. Skin and sternal defect, open mediastinum.
high adhesion to dry skin; absorption capacity – up to 100% of the covering; gas permeability, vapor permeability; and easy, quick, and painless removal.
‘‘Locus’’ was used in 37 patients with bedsores. ‘‘Locus’’ was applied on to bedsore immediately after mechanical removal of necrotic tissues. The covering was applied by encompassing wide area of healthy skin for improving fixation and reducing pressure in the region of bedsore. Using ‘‘Locus’’ facilitated transformation of the necrotic phase into the reparative phase within 1.5–2 weeks. Using ‘‘Locus’’ in the treatment of trophic ulcers leads to cleansing and activation of marginal as well as insular epithelialization within the 3–5 weeks. Application of ‘‘Locus’’ brought pain relief in patients with painful wounds. Edema and hyperemia were significantly reduced by the third day. After 2–3-fold reapplication of covering, the wounds were cleansed of necrotic tissues, that took place for about 10 days from the beginning of the covering application, after which active epithelialization began. A significant reduction in skin defect was observed by day 20 from the beginning of the treatment.
Fig. 2. Polyurethane foam dressing on the thorax.
4. Clinical cases Patient with sternal defect, defect of soft tissue of the thoracic cage, and mediastinitis, 400 sq cm skin defect, 15 sq cm sternal defect, and open mediastinum. The defect was completely closed by ‘‘Locus’’ covering; and the mediastinum was sealed. Application of ‘‘Locus’’ allowed not only performing an effective treatment of the wound but also resolving problem of the open mediastinum. Within 2 weeks, the defect was corrected using skinmuscle flap (Figs. 1 and 2). Patient with 300 sq cm chronic calf wound. A complete epithelialization of the wound was observed on day 17 from the beginning of out-patient treatment with ‘‘Locus’’ (Figs. 3–5).
Fig. 3. Painful chronic calf skin defect.
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S.V. Smirnov et al. / Wound Medicine 2–3 (2013) 6–8
8
Fig. 4. Polyurethane foam dressing on calf. Fig. 7. Polyurethane foam dressing on the bones and wound.
Fig. 5. Healed wound.
Fig. 8. Wound surface after the removal of polyurethane foam dressing.
5. Conclusion
Fig. 6. Comminuted open fracture.
Patient with comminuted open bone fracture of the left lower leg, thrombosis of left popliteal artery, as well as ischemia of left lower leg and foot. After surgical cleaning of the wound, ‘‘Locus’’ was applied; and on day 21, the wound was cleansed and was covered with granulations (Figs. 6–8). The effectiveness of the conservative topical treatment was evaluated based on the duration of stage completion: closure of ‘‘pockets’’, wound cleansing, its filling with granulation tissue, which was considered as a sign to prepare for plastic surgery.
1. Combination of antimicrobial properties, high absorption capacity (up to 100% of the polyurethane foam covering), protection against traumatization and infection, as well as reliable adhesion to the surrounding tissue make ‘‘Locus’’ an effective and comfortable covering to be used in treating wounds of various etiology. 2. ‘‘Locus’’ use in the treatment of burns, trophic ulcers, and chronic non-healing wounds resulted in reduction in the duration of healing. 3. ‘‘Locus’’ covering can be used as a monotherapy and when indicated can be combined with antimicrobial drugs, enzymes, and regeneration stimulants that is equally effective. Appendix A. Supplementary data The Russian version of this article can be found, in the online version, at doi:10.1016/j.wndm.2013.10.001.