Historically wound dressings made from readily available absorbent materials
such as cotton were easily sterilised and relatively inexpensive. They
were used with the major objectives of absorbing blood and exudate and
assisting with infection control. Their major disadvantage was that
they did not satisfy the requirement for a moist wound environment demonstrated
to be necessary for optimal healing in the 1960s. Following this discovery
a range of materials were introduced that were selected for their fluid
handling properties to achieve a moist wound environment. Some of the
dressing components, such as alginates (Thomas A, 2000) were subsequently
found to exert a bioactivity that possibly affects the healing process.
These properties were not deliberately engineered into wound management
products but this is now an achievable objective.
One
of the most difficult challenges for laboratory scientists is to translate
their theoretical knowledge into a practical reality that is of use
to both the practitioner and the patient. The advanced therapies described
above demonstrate how understanding defects within the chronic wound
(Table
1) has allowed definition of therapeutic targets and development
of appropriate modes of treatment. The linkage of various factors also
indicates how an appropriate choice of target will rectify multiple
defects.
Advanced
therapies tend to be more expensive than conventional treatments and
are likely to be used for non-responsive wounds. All the studies evaluating
these treatments demonstrate that they are only effective in a subset
of patients and indiscriminate use will lead to unnecessary expense.
This in turn requires development of diagnostic systems that will identify
appropriate therapies for individual patients.
Our
knowledge of the cell biology of wound healing now allows for the rationale
design of wound management products that will stimulate healing of compromised
wounds such as diabetic ulcers and venous leg ulcers. This process has
been demonstrated by the development of recently introduced products
that represent a new generation of bioactive therapies that will interact
with various phases of the healing process and enhance our ability to
treat compromised wounds.
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