A Novel Topical Wound Therapy Delivery System

Ingrid Herskovitz, MD; Flor E. MacQuhae, MD; Luis J. Borda, MD; Stephanie Bhagwandin, BSN, RN-BC; Juan A. Paredes, MD; Thais Polanco, MD; John C. Lantis II, MD; Paul J. Kim, DPM, MS; Tania J. Phillips, MD Robert S. Kirsner, MD, PhD

Disclosures

Wounds. 2017;29(9):269-276. 

In This Article

Abstract and Introduction

Abstract

Introduction. Wound care dressings have evolved over time, from bandaging to the development of occlusive dressings to negative pressure wound therapy. A novel therapeutic delivery system dressing has been cleared by the United States Food and Drug Administration. This semi occlusive wound dressing has been developed to provide local, continuous delivery of aqueous topical agents, such as therapeutics (anesthetics, antiseptics, antibiotics, steroids, topical beta-blockers, immune modulatory agents, growth factors, and fibrinolytic agents, among others), at a rate of about ¾ mL per day, thus maintaining a hydrated environment and providing topical treatment. This type of system may be beneficial in situations where systemic therapies cannot be used, wounds are small and few, wounds may need frequent application of medication or moisture, or low and steady delivery of medications is needed. Objective. The authors assessed a delivery system dressing with different types of liquid medications for the management of hard-to-heal, chronic lower extremity wounds.

Materials and Methods. Patients aged ≥ 18 and ≤ 90 years with stalled chronic wounds > 30 days' duration were selected for the use of a topical delivery system, which consists of a semi occlusive wound dressing and fluid delivery unit that can provide local application of small therapeutic quantities of medication directly to the wound.

Results. Several successful cases with the use of this device are presented in which pain relief, enhancement of epithelial migration, inflammation reduction, bacterial control, and wound size reduction were achieved.

Conclusions. This delivery system dressing is an effective and safe treatment option for wounds. Advantages include reduced potential of systemic side effects, flexibility in what can be delivered, constant rate of medication delivery, and convenience.

Introduction

Dressings for acute and chronic wounds have evolved over time. In fact, reference to wound care has been made throughout man's recorded history and has grown significantly. In the mid-1900s, covering wounds was considered objectionable because of fear of increased infection. However, work by Winter and Scales, Hinman and Maibach, and others[1,2] demonstrated improved healing when wounds were covered. An occlusive, and therefore moist, environment (as opposed to a dry environment leading to a desiccated wound) facilitates healing through the retained presence of growth factors and matrix materials, improved keratinocyte migration, fibroblast growth, and maintenance of the electrical gradient within the wound bed and at the wound edge.[3]

Wounds managed in a moist environment heal faster with less pain, fewer infections, and less scarring.[4–6] This suggests that the natural formation of a dry scab on an exposed wound is an impediment for wound healing. Other studies[7,8] involving dry techniques showed a decrease in the speed of epidermal regeneration when the surface of the wound was dried.

A prevalent but unjustified concern with the use of occlusive dressings has been risk of infection and contamination. The search for an alternative to occlusive dressings that provides a moist healing environment in these situations led, in part, to treatment with topical irrigation, which not only provides a moist wound environment but also cleans contaminated wounds and removes debris, exudate, and bacteria.[9] Initially conceived for burns, the use of instillation and wound irrigation has now been incorporated into treatment for chronic wounds. Negative pressure wound therapy (NPWT) and negative pressure wound therapy with instillation (NPWTi) have been used in infected and noninfected surgical wounds, traumatic wounds, pressure ulcers, wounds with bone exposure, diabetic foot ulcers, and venous ulcers, among others.[10] In the most recent iteration, NPWTi uses a highly porous polyurethane foam, a semipermeable covering, connecting tubing, and a vacuum source.[11,12]

New therapies for moist wound healing with the use of devices to deliver antimicrobials, analgesics, and a variety of bioactive molecules (ie, growth factors and micrografts) are emerging.[13] The authors evaluated Acton Topical Delivery System (Aplion Medical, Salt Lake City, UT), a semi occlusive wound dressing that provides a steady delivery of multiple types of medications to a wound. In this case series, 4 patients with stalled lower extremity wounds were treated with different types of medication. Distinct from irrigation systems, this technology allows for the local application of small quantities of medication as opposed to larger volume irrigation of the wound. To the best of the authors' knowledge, this is the first published series to evaluate this dressing.

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