The second of a two-part blog series, this blog examines the adoption and continued evolution of silicone advanced wound care dressings.
After finding some footing in the late 1990s for their ability to reduce the pain and trauma associated with the removal of advanced wound care dressings such as hydrocolloids and those that utilize variations of polyacrylate adhesives, silicone wound dressings started to evolve.
For instance, in the mid 1980s, Mölnlycke was first to apply a soft silicone coating to simple polyacrimide wound contact nets to create Mepitel®, utilizing the gentle adhesive properties of soft silicone to ensure reversible gentle adhesion to the skin surrounding the wound (meaning that it can be reapplied). It also ensured a superior absence of adhesion to the moist wound surface and open spaces within the net structure to allow the passage of exudate into secondary dressings placed over the silicone wound contact layer.
Although the soft silicone coating gave Mepitel advantages as a reliable non-adherent wound contact layer (since silicone will not wash away to expose potentially adherent fibers), Mölnlycke was quick to recognize and differentiate the adhesive properties of soft silicone (specifically, an intimate surface contact) with those of traditional adhesives used in the construction of wound dressings.
During the 1980s, common adhesives in use were acrylic adhesives as seen on transparent wound dressings, adhesives that exploited the natural adhesive properties of hydrocolloids (e.g., Versiva® hydrofiber adhesive dressings), zinc oxide thermoplastic adhesives (e.g., Hy-Tape®), and the ubiquitous latex adhesives during the “tape and gauze era.”
Around this same time, Mölnlycke acquired patents to protect its Safetac® from use by competitors. Their timing was excellent, as the field of advanced wound care had just begun to recognize the work of Dr. Diane Krasner (who pioneered the recognition of pain as a part of the chronic wound experience), and quality-of-life issues were being defined and documented worldwide. Patents in hand, Mölnlycke set out to expand the use of the gentle adhesive to other wound care applications.
Soft silicone dressings, which started as occlusive sheets for scar reduction, soon evolved to non-adherent wound contact layers and eventually found use as an adhesive layer in multilayer dressings. A perfect combination was the marriage of the adhesive wound contact layer to absorbent foam to produce Mepilex foam dressings and Mepilex border dressings with additional layers of outer waterproof transparent film, super absorber and non-woven spreading layer that distributes exudate over more of the foam and super absorber.
The soft silicone adhesive products were promoted as a kinder more gentle approach to wound dressing purpose designed to reduce skin trauma and pain at dressing changes. Mölnlycke’s Mepilex® foam line with super absorber marginalized another source of skin trauma by reducing the number for dressing changes and giving skin more time to recover from less frequent and less traumatic dressing changes. With a less traumatic product available, those that were concerned about pain, quality-of-life and could afford the premium price quickly moved to the new product, making it line the fastest-growing dressing offering for several years.
Since soft silicone adhesive systems are non-adherent to the wound bed, trauma to new granulation tissue and the associated pain are reduced. Dr. Kevin Y. Woo showed that wound pain could stimulate inflammatory reactions that trap wounds in the inflammatory phase and prolong wound healing. Just the anticipation of painful wound changes can reduce one’s quality-of-life index, increase the need for pain medication, and induce inflammatory mediators—so learning that dressing changes will not be painful has numerous and obvious positive associated consequences. Further, caregivers could become positively affected by their ability to manage wounds with less painful wound dressing changes and the positive feeling of inducing less fear and pain in their patients.
Soft silicone adhesive dressing are said to be both non-adherent to the wound bed and low-adhesive/tack to skin, which helps avoid trauma to periwound skin. To differentiate the properties of soft silicone adhesives from other low-tack or non-adherent products, Dr. Steve Thomas coined the term “atraumatic dressing,” which has found significant use in the literature and marketing of these products.
After many years of exclusivity by Mölnlycke, soft silicone adhesive systems have now been introduced by several competitors—first in Europe, more recently in North America. Recent introduction of soft silicone wound contact layers include Adaptic Touch® (Systagenix), Silflex® (Advancis) and Silon® (Bio Med Sciences). Atraumatic foam dressings now include Allevyn® Gentle (with or without silver), Allevyn® Gentle Border, Advasorb Silflo® (Advancis), Biatain® silicone (Coloplast), and Optifoam® Gentle/Ag (Medline). Transparent dressings with soft silicone adhesive include IV Clear® and SurgiClear™ (with silver and chlorhexidine, from Covalon), and 3M has added a soft silicone adhesive tape to their line (Kind Removal Silicone Tape), as has Medline (Gentac™) and Mölnlycke (Mepitac®).
We can be certain that the use of “atraumatic” adhesives will expand with more entries from Europe and the United States of America. Competition amongst the new entries should help reduce the cost differential between soft silicone systems and traditional adhesives, and, perhaps, increase the utility of silicone systems by improving the balance between secure tack and low-trauma removal. Lower costs and improved performance should expand their usage and the benefits of low pain and trauma to a wider selection of patients.
Tags: Advanced Wound Care Dressings