Perspectives in Circulation Today

A Wound Healing Meeting

American Professional Wound Care Association National Clinical Conference, April 19 - 21, 2007 Philadelphia PA

(www.apwca.org)

What's New in the Commercial Displays


Medical Equipment Suppliers

Better Living Boutique: 1-877-BET-LIV-NOW - Essential Care after Breast Surgery - Breast Forms, Fashion Swimwear, Brassieres and Lymphedema pumps.

Better Living Now: 1-800-756-8775 - Wound Care, Diabetic, Respiratory, Urological and Ostomy Supplies and Durable Medical Equipment - phone, internet and mail order.

EVLT EndoVenous Laser Treatment (Diomed) - 877-434-3633 or www.evlt.com - Duplex ultrasound maps the saphenous vein and a moving laser fiber scleroses it. See Min and Khilnani (www.circulatorboot/literature/venousul.html)

Health Care Logistics, Inc: 1-800-848-1633 - Leg cradles, spill pads, single dose saline jet, sharps containers....

ReMarx Medical Services: 1-888-673-6279 - Provides equipment and training in use of pneumatic compression devices in the treatment of venous and lymphatic disorders - Listed contraindications include severe arteriosclerosis, known or suspected DVT, edema due to CHF, untreated or infected wounds and severe inflammation of the treated limb.

PictZar CDM Medline Industries, Inc - 1-800-Medlinex4355 - Digital Planimetry Software.


Dressings, Colloids and Gels to Improve the Wound Microenvironment:

Allevyn Wound Dressings (smith & nephew) - www.allevyn.com or 1-800-876-1261 - Tri- and Bi-laminate dressings of many shapes for managing exudates at various anatomical sites.$$

Gentleheal (Medline Industries, Inc) - "Sensil", a silicone layer, next to the skin to ease removal, "Exulock" absorptive granules to lock fluid in back of dressing and a flexible film backing allowing vapor transmission while containing fluid and bacteria.$$

Iodosorb and Iodoflex (smith & nephew) - 1-800-876-1261 - "Cadexomer iodine" a formulated starch matrix formed into spherical absorbent microbeads containing 0.9% elemental iodine - Iodosorb gel comes in 40 g tubes and Iodoflex pads come as 5 pads of 5 g (1.5x 2 3/8) or 3 pads of 10g (2 3/8 x 3). Low concentration of iodine (0.9%) does not damage healthy cells while it kills most bacteria.$$

Manuka Honey (Wedderspoon) - 1-877-296-8403 - www.wedderspoon.com.

OASIS Wound Matrix (Healthpoint Ltd) - An extracellular matrix derived from the submucosal layers of the porcine jejunum and freeze-dried and sterilized with ethylene oxide gas for clinical use.$$$

Ocean Aid-TM Products - 877-507-8904 - "Ocean Aid Spray": reverse osmosis filtered water, coral reef sea salt, lysozyme and sodium benzoate. The lysozyme is obtained from eggs; it is a natural anti-infective agent also found in in body fluids (tears, saliva etc.). "Ocean Aid-TM Foam": deionized water, dimethicone, stearic acid, glycerine, coconut acid, caprylic/capric triglyceride, cetyl alcohol, triethanolamine, cetearyl alcohol, ceteareth-20, allantoin, methyl paraben, coral reef sea salt, sea kelp, propyl paraben and lysozyme.$$

Prisma Matrix (Johnson & Johnson) - 55% collagen, 44% Oxidized Regenerated Cellulose (ORC) and 1% silver-ORC - Applied directly to clean wound and hydrated with saline to produce a gel - absorbs wound exudate, maintains moist environment and suppresses or kills the bioburden.$$$

Puracol Plus (Medline) - 1-800-medline - Predominantly a type 1 bovine collagen dressing - Hopefully trapping destructive enzymes and providing a friendly environment for fibroblasts.$$

Sea Soaks (Circulator Boot Corp)- Avoids the toxicity of saline (salt being a historical food preservative) - http://www.circulatorboot.com/introduction/seasoaks.html - www.circulatorboot.com/Newsletter/vol1numb7.html.(cost~saline)

Select Silver (Milliken) - 1-800-497-1746 - www.select-silver.com - exudate absorbed in a secondary dressing.$$

Silvercel (Johnson & Johnson) - 1-877-384-4266 - A silver-releasing hydroalginate dressing - Effective against most bacteria and some viruses and fungi- Alginate forms a gel to absorb exudae. $$$

Silverlon (Argentum Medical, LLC) - 800-852-1776 - www.silverlon.com - among more economical silver dressings - warnings not to use chloride solutions which can deactivate the silver.$

SilverSeal (Noble Biomaterials) - 877-811-3522 - www.silverwoundcare.com - "X-Static": pure silver permanently bonded to the surface of a textile fiber - Several products: Multilayer compression dressings, clothing and stockings containing silver fibers, self-adhering hydroel dressings, wound contact dressings and tubular cast components.$$$

Tenderwet active (Medline Industries, Inc) - 1-800-MEDLINE - www.medline.com - A polyacrylate pad to absorb large protein molecules which replace Ringer's solution to bath the wound.$$

3M Cavilon No Sting Barrier Film (3M Medical) 1-800-228-2957 - www.3M.com/healthcare - A spray that dries leaving a protective film between skin and body fluids.$$


Vacuum Devices

Sea Soaks Concentrate (Circulator Boot Corp) - Produces a powerful osmotic gradient - cheap - adaptable to any surface - www.circulatorboot.com/Newsletter/vol1numb7.html.

Engenex (Boehringer Wound Systems, LLC) - 1-888-390-HEAL - "Bio-Dome Dressing structure"...$$

Invia TM Healing System (Medela, Inc) - 877-735-1626 - www.MedulaSuction.com - A low vacuum aspirator, specialty dressing kits and disposable canister.$$

Vista-TM (Blue Sky Medical) - 760-603-8130 - Commonly used at 40-80 mm Hg suction but can provide 200 mmHg suction - Portable - 4.3 pounds in weight - 100-240 VAC and has battery allowing operation up to 5 hours - Various sealing kits allows treatment of many different wounds. $$


Hyperbaric Chambers

Sechrist Monoplace Hyperbaric Chamber with Electronic Control Module (Sechrist Industries, Inc) - 714-579-8400 - www.sechristUSA.com.


Electrical Stimulation Systems

Microvas -1-86-MICROVAS - www.microvas.com - Multiple electrodes produce muscle fasciculations which moves blood through the microcirculation.

TENS (Medical Products Online Inc) - www.medicalproductsonline.org - TENS (Trans Electrical Nerve Stimulation) and various other electrical devices provided.


Arterial-Assist Devices

Circulator Boot Systems (Circulator Boot Corp)...The end-diastolic pneumatic compression boot... The only compression boot approved by the FDA as an arterial-assist device... For indications, see www.circulatorboot.com/introduction/whohelp.html.


Novel Mechanical Debriding Systems

The Qoustic-TM Wound Therapy System (Arobella Medical) - 952-345-6840 - Shaped like a miniature ice-cream scoop (perhaps 1 cm across), it delivers a focused ultrasound energy directly on the wound selectively removing soft and hard elements and killing bacteria while preserving healthy tissue - A rapid effective debridement technique - Minimal risk of producing bacteria-laden aerosols. $

Mist Therapy System (Celleration, Inc) 952-224-8700 - www.celleration.com - A noncontact, low-intensity, low-frequency therapeutic ultrasound device...atomiized saline is directed at wound bed (?potential for air-borne infection)... 3-20 minute treatments three times a week.$


Growth Factors

Regranex Gel (Johnson & Johnson) - 0.01% becaplermin, a recombinant human platelet-derived growth factor (rhPDGF-BB) produced by the insertion of the gene for the B chain of platelet derived growth factor (PDGF) into yeast. Becaplermin is produced by Chiron Corp and supplied to J & J. The preparation is recommended for clean well-vascularized diabetic neuropathic ulcers. Its use has not been established for venous or pressure ulcers. $$$


Tissue Engineered Skin Products

Apligraf (Organogenesis Inc) - 888-432-5232 - "A living, active dermal layer composed of human fibrocytes derived from neonatal foreskin in a bovine type 1 collagen matrix and a living, active epidermal layer formed by human keratinocytes (with a well-differentiated stratum corneum)" - Approved by the FDA for both diabetic foot ulcers and venous leg ulcers - For application to clean well-vascularized lesions. $$$

Creams - Emollients, Moisturizers and Other Preparations

Calmoseptine ointment (Calmoseptine Inc) - 800-800-3405 - Zinc oxide, menthol, thymol, lanolin, sodium bicarbonate, phenol, calamine, thlorothymol and glycerin in an ointment base - designed to protect skin from irritations from moisture or caustic drainage - an over-the-counter item.

Hypercare (Stratus Pharmaceuticals, Inc) - 1-800-442-7882 - www.stratuspharmaceuticals.com - To reduce hyperhidrosis of palms and soles - Aluminum chloride {hexahydrate} 20%W/V in anhydrous ethyl alcohol 93% V?V. X-Viate (Stratus Pharmaceuticals, Inc) - Urea 40% in either a cream base or lotion base. For hyperkeratotic surfaces.


Enzymatic Debriding Agents

Collagenase Santyl Ointment (Healthpoint) - 1-800-441-8227 - 250 collagenase units per gram of white petrolatum USP. The collagenase is derived from the fermentation by Clostridium histolyticum For other Dermatologicals see www.PDR.net

Some New Antibiotics

Cubicin or daptomycin for injection (Cubist Pharmaceuticals Inc) www.cubist.com - see Arbeit et al in our Library (www.circulatorboot.com/literature/cellulit.html).

Zyvox or linezolid (Pfizer)tablets and injection - perhaps more effective versus Methicillin-resistant staphylococcus than vancomycin. See Weigelt et al in our library.


Metabolic and Endocrine Factors Affecting Wound Healing and Vascular Disease - Not Usually Included at Wound Healing Meetings

Hyperlipidemias - Familar to most internists and treated with expensive drugs. Chinese Red Yeast Rice is an over-the counter item that is relatively cheap and contains lovastatin as well as other agents and is effective in lowering Cholesterol (Chinese red yeast rice (Monascus purpureus) for primary hyperlipidemia: a meta-analysis of randomized controlled trials. Chin Med 1:4. 2006).
Uncontrolled Diabetes
Myxedema - Hypothyroidism impedes wound healing and may promote fluid retention and hyperlipidemia.
Iatrogenic or spontaneous Cushings syndrome- Adverse steroid effect effect minimized by (a) utilizing as small a dose as possible; (b) mimicking normal diurnal rhythm (two-thirds dose at 8AM, one-third at 2PM and none thereafter; (c) using alternate day therapy; (d) adding estrogen (Pregnant women have very high cortisol levels but are protected by concomitant high estrogen levels)or DHEA (25-50 mg/day).
Hyperhomocysteinemia - Metanx (L-methylfolate, pyridoxal 5'-phosphate and methylcobalamin 2mg - If pernicious anemia actually present, parenteral vitamin B12 may be necessary.

Perspectives in Circulation Today

Volume 2, Number 5

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