Wound Care Products

6 Various Wound Care Products
6.1 Getting the Wound Care Products you need
6.2 Cleansers and Topical Products
6.3 Dressing Basics
6.4 First or Contact Layer Dressings
6.5 Secondary Dressings

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Listed below are some wound care products that some people affected with EB have found helpful.

Note: Many of the dressings listed below are prescribed by the physician after evaluation of wounds. Please review appropriate use of the product prescribed with your physician. This is just a small list of the various wound care products helpful to some people affected with EB.

Some of the companies listed below do not sell products directly to customers, so please check with your distributor.

6.1 Getting the Wound Care Products you need

Wound care is part of the supportive care given to those with EB. It is important to note that no one product works for every person. Wound healing is primary goal, but dressings must also:

Provide comfort
Prevent pain and re-injury
Be easy to apply and remove
Be cost effective

As a result, selection is often based on personal preferences. (Ly, L., Su, JC J of Wound Care Vol. 17, No 11, November 2008: 482-492)

Your physician or nurse will help you decide which dressings to use for your wounds. These products vary and are used for different purposes. Please make sure to review the proper way to use your dressings with your medical team.

Some of the products listed below need to be obtained through your wound care supplier or distributor. If you do not have one yet, you may wish to contact one of the EB experienced distributors below:

Byram Healthcare: www.byramhealthcare.com ( 877) 902-9726
CCS Medical: www.ccsmed.com (800) 690-1255
Direct Medical: www.ebdressings.com (800) 659-8037
Edgepark Medical Supplies: www.edgepark.com (800) 321-0591
National Rehab: www.nationalrehab.com (800) 451-6510
Wound Care Resources: www.woundcareresources.net (888) 287-9797

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6.2 Cleansers and Topical Products:

Cleansers (mild):

Some cleansers used successfully in EB include:

Cetaphil mild non soap cleanser
Dove mild soap
Restore Wound Cleanser

It is important to use gentle cleaners and wash the wounds and skin routinely. We have found that if bathing is painful, the addition of one pound of pool salt in a tub of water really decrease the pain with bathing.

Topical:

  1. Moisturizers:
    Alwyn cream: ( Alwyn Company, Inc.) allantoin containing skin cream
    Emu oil : purified from the refined fat of an Emu
    Restore Dimethicreme: dimethicone-based protective layer
    A&D ( Schering-Plough HealthCare Products, Inc)
    Aquaphor (Beiersdorf, Inc.)
    White petroleum

    These are some of the non-medicated topicals that when used alone, or on a dressing, help maintain a moist environment on wound bed. When used on dressings, it helps to prevent sticking to the wound.

  2. Antibiotic Ointments:
    1. Over the counter (OTC) antibiotic ointments:
      Bacitracin
      Polysporin

      Apply topical antibiotics to lesions: Mild, over-the-counter antibiotics (Polysporin, Bacitracin) are effective in preventing infection and may be rotated every month or two to discourage bacterial resistance.

      It is important to note that some data suggests that white petrolatum is a better antibacterial agent than those listed above and it does not cause allergic contact dermatitis. There are EB providers who advocate its use for that reason.

    2. Prescription antibiotic ointments:
      Bactroban (Mupricin) (GlaxoSmithKline)
      Centany(Mupricin) (OrthoNeutrogena)

      Mupricin should be used only when infection is present. (Signs of infection include increased redness, swelling, pain and warmth).

      Prolonged use of antibiotics has been associated with the development of resistant Staph infections.

  3. Antimicrobial Topicals - Honey:
    MediHoney (DermaScience)

    Recently approved for use in the USA, these products can be helpful in cleaning up draining wounds. The ointment can be applied to the dressings already used by the family.

    *It is very important to remember that you must use medical grade honey and that honey form your local grocery store is not to be used under any circumstances.*.

  4. Antimicrobial Topicals - Silver (AG) Products:
    Silvadine cream 1% ( silver sulfadiazine ) (Monarch Pharmaceuticals, Inc.) - a soft, white, water-miscible cream
    Restore Silver contact layer and foam (Hollister WoundCare)
    Mepilex AG (Molnlycke)
    Acticoat (Smith & Nephew)
    Aquacel AG (Convatec)
    SilvaSorb (Medline)
    Silverlon ( Argentum Medical, LLC)
    Contreet (Coloplast)

    Different modes of silver delivery can lead to varying rates of absorption.

    There are many unanswered questions about the safety of long-term use of silver products and there is not consensus among EB providers regarding its use in EB. Until clinical trials are conducted that prove these products are safe to use on a regular long-term basis, individuals should use the products cautiously and for limited periods of time.

    With improper use there have been a few documented cases in the laboratory of bacteria becoming resistant to silver.

  5. Additional Antimicrobial Dressings:
    Xeroform Kendall Health Care contains a medication called Bismuthtribromophenate. Please consult physician prior to using. It may not be appropriate for infants and children.
    AMD Kendall Health Care (www.kendallhq.com)

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6.3 Dressing Basics

After lancing and gently draining EB blisters, dressings are applied. In most cases, dressings consist of three layers:

The first or primary layer is non-adherent and the products used are variable and primarily based on individual tolerance and family preference.
The secondary layer stabilizes the primary layer and provides padding and protection.
The third layer is used to maintain the dressing in place. It is usually somewhat elastic in nature.

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6.4 First or Contact Layer Dressings

The contact layer sits on top of a wound protect against trauma during dressing changes and allow for the passage of drainage through the holes onto an outer secondary dressing.

One of the benefits of using contact layers is the fact that they can stay on the wound bed for several days without disturbing the newly healed skin. Depending on the condition of the wound, the surrounding skin and the presence of infection, the physician may modify the frequency of dressing changes.

These dressings are made up of a single layer, non-adherent woven mesh like material. Examples include:

Mepitel Molnlycke Health Care (877-460-5888, ext.1107) (www.molnlycke.com) made of a silicone safetac material
N-Terface Winifield Laboratories, Inc (1-800-527-4616) made of a high density polyethylene
Conformant 2 Smith & Nephew (1-800-876-1261) ( www.snwmd.com) made of a high density polyethylene
Restore Contact Layer Hollister wound care (1- 800-323-4060 ) ( www.hollisterwoundcare.com) a non-occlusive, fine polyester mesh with a petrolatum-based formula

Hydrogels:

Hydrogels may be in the form of either a gel, impregnated into gauze or in the form of a hydrated sheet dressing. Basically made up of glycerin or water, they hydrate wounds providing a moist environment enhancing re-epithelialization. These dressings may be cooled in the refrigerator to provide a soothing effect on painful wounds.

Hydrogels may be helpful as primary or secondary dressings to a varied number of wounds. They are not usually recommended for wounds with heavy exudate. Please note in some instances hydrogels may dehydrate if not covered appropriately. If this happens, the dressing will need to be moistened for removal. Please review product application carefully.

Vigilon Bard ( www.bardmedical.com )
DermaGuaze DermaRiteIndustries LLC (www.dermarite.com)
Normlgel Molnlycke Health Care (877-460-5888, ext.1107) (www.molnlycke.com)
(Please note Normlgel contains normal saline, has been known to sting.)
Restore Hydrogel wound care (1- 800-323-4060 ) (www.hollisterwoundcare.com)

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6.5 Secondary Dressings

If a contact layer product is not being used a secondary dressing will go directly on the wound area

  1. Impregnated Gauze:

    The gauze dressings listed below are impregnated with Vaseline, Aquaphor or Zinc Oxide. They can be used as primary dressings. Adding additional ointment will help prevent the gauze from drying out and hardening.

    Vaseline Gauze Kendall Health Care (www.kendallhq.com)
    Aquaphor Gauze Smith & Nephew (1-800-876-1261) (www.snwmd.com)
    Viscopaste Zinc Oxide Paste Gauze Smith & Nephew
  2. Basic Non-Adherent Gauze:

    Provides a non-stick covering for the wounds. Can be used with or without a contact layer.

    Telfa (Composite) Kendall Health Care (www.kendallhq.com)
    Release Johnson & Johnson
    Non Adhesive Pads Medline
  3. Foams:

    These dressings are non-adherent and absorbent.

    Most foams provide insulation and a moist environment. Foam dressings are used on wounds with light to heavy amounts of drainage. Please keep in mind if the dressing becomes saturated with drainage, it could irritate the surrounding skin.

    Foams can also be used for heavier draining, non-infected wounds and can be used over a contact layer.

    Depending on the condition of the wound, the surrounding skin and the presence of infection, the physician may modify the frequency of dressing changes.

    Allevyn Smith & Nephew (1-800-876-1261) (www.snwmd.com)
    Cutinova Foam Smith & Nephew (1-800-876-1261) (www.snwmd.com)
    Gentleheal Medline Industries, Inc. (1-800-Medline) (www.medline.com)
    Mepilex Molnlycke Health Care (877-460-5888, ext.1107) (www.molnlycke.com)
    Mepilex Transfer Molnlycke Health Care (877-460-5888, ext.1107) (www.molnlycke.com)
    Mepilex Lite, Molnlycke Health Care (877-460-5888, ext.1107) (www.molnlycke.com)
    Mepilex Border Molnlycke Health Care (877-460-5888, ext.1107) (www.molnlycke.com)
    Mepilex Border Lite Molnlycke Health Care (877-460-5888, ext.1107) (www.molnlycke.com)
    PolyMem QuadraFoam (800-765-9636) (www.PolyMem.com)
    Restore Foam Hollister wound care (1-800-323-4060) (www.hollisterwoundcare.com)
  4. Specialty Absorptive Dressings:

    These dressings provide a non shearing, non-adherent, absorbent environment that allows for the wicking away of drainage. They can be utilized on wounds with mild or heavy drainage and can be used to provide a cushion/padding for areas of the skin that can come into contact with pressure such as crib, playpen, high chair and play areas. Special use: some hospitals will use a large sheet of Exu-dry under a newborn.

    Exu-dry Smith & Nephew (1-800-876-1261) (www.snwmd.com): Two non-adherent wound contact layers which helps to prevent friction and shear. The drainage is wicked away into an absorbent layer.
  5. Hydrofiber Wound Dressing:

    When applied to a wound it creates a gel after coming into contact with wound exudate. This provides a moist environment and helps reduce damage of newly forming tissue upon removal and should only be used on moderately to heavily draining wounds. These dressings are not indicated for dry (non-draining) wounds. The gel can be rinsed or soaked away with saline, allowing removal of the dressing without re-traumatizing the wound bed and minimizing pain. Depending on the condition of the wound, the surrounding skin and the presence of infection, the physician may modify the frequency of dressing changes.

    Aquacel ConvaTec (1-800-422-8811) A sterile, absorbent pad made from sodium carboxymethylcellulose fibers
    Restore Calcium Alginate wound care (1- 800-323-4060 ) (www.hollisterwoundcare.com) Alginates are made of soft non-woven fibers which are derived from seaweed
  6. Gauze:

    Cotton mesh interwoven material

    Rolled gauze: can be used to hold dressings in place. Available in both sterile and non-sterile packaging, in various length and sizes by many venders
    Kerlix: Cypress Medical Products 1202 South Rt. 31 McHenry, IL 60050 (P: 800.334.3646) (F: 815.385.0114

    Gauze pads can be used for cleansing and covering. It is available from many vendors and comes in various widths.

  7. Retention Gauze:

    The outermost layer, these help hold the dressings in place. These mesh dressings are packaged as a roll, and are cut to length based on the bandaged area. They are washable and can be used more than once. There are many options:

    Promed Elastic Net ProMed, Inc. (1-800-888-6143) This is packaged as a roll, and is cut to length based on the bandaged area
    Surilast Derma Sciences (www.dermasciences.com)
    Tubifast Molnlycke Health Care (877-460-5888, ext.1107) ( www.molnlycke.com) This is also available in garments, though in most cases these are unlikely to be covered by insurance

    Similar in look to a roller bandage, these options come in many colors and the layers will adhere to itself, which helps it stay in place.

    Coban: Similar in look to a roller bandage, this comes in many colors and will adhere to itself, which helps it stay in place
    Coflex: Similar in look to a roller bandage, this comes in many colors and will adhere to itself, which helps it stay in place
  8. Adhesive removers:

    While it is better to avoid having adhesives and tape applied to EB skin, accidents happen. These are some suggestions of products that can help remove things that stick to skin and wounds.

    AllKare Adhesive Remover Wipes ConvaTec
    Uni-Solve Adhesive Remover Smith & Nephew
    Detachol Ferndale Labs
    Trio Niltac Medical Adhesive Remover (www.ttwmedical.com) (currently not available in the USA or Canada)

Advanced Wound Care: For non-healing wounds, your medical provider may decide to use a specialized product to help close the wounds. With the advancement of science there are many useful wound care products that are either collagen based or even live cells. All of these products are expensive and should only be used in those individuals with chronic wound that will not heal with simple good wound care. Your healthcare provider, or a specialist in wound care, can help you determine if one of these advance wound care products are right for a non-healing wound.

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Other In Depth Topics

1 About EB
2 EB Simplex
3 Junctional EB
4 Dystrophic EB
5 Wound Care
6 Various Wound Care Products
7 Other Healthcare Problems
8 Bibliography

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Frequently Asked Questions
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