Wound Care Dressing overview presented to a physician and nursing class at CMC in Vellore,India

3. Ambrose Pare 1520 to 1590 “ I dress the wounds God Heals them”

19. Moist Wound Healing The moist environment provided by covering a wound (left) allows the epidermal cells to move easily across the wound surface, healing the wound. In a dry environment (right), the epidermal cells must tunnel down to a moist level and secrete enzymes to lift the scab away from thw wound surfae before the cells can migrate and begin to allow healing to occur.

33. Wound Dressings Technology and product proliferation varies by geography, usually as a function of economics and health care policy.

34. History Of Dressings

37. Biology of Chronic Wounds Wound Exudate Burden

40. Managing moisture balance

42. Transparent films

45. Hydrogels

48. Hydrogel

50. Hydrogels

51. Hydrocolloids

54. Hydrocolloid

57. Importance of Debridement Removal of callus and necrotic tissue Decreasing the bacterial burden Removal of phenotypically altered cells: the cellular burden

62. Calcium alginate

64. Calcium Alginate

66. Foam dressings

73. Biology of Chronic Wounds Bioburden

78. Biofilm formation

109. Wounds without the ability to Heal

110. Wounds where bacterial burden outweighs cellular toxicity

111. Four stages of life

131. Negative pressure wound therapy

133. Living Skin Equivalents

135. Apligraf ® — Manufacturing Process Human Dermal Fibroblasts Connective Tissue Proteins Dermal Matrix Human Epidermal Keratinocytes Apligraf Data on file, Organogenesis Inc., Canton, MA.

136. Parentau NL, et al. J Cell Biochem . 1991;45:245-251.

137. Apligraf ® Why Fibroblasts and Keratinocytes?

138. Components of Wound Healing Injury Hours Days Weeks Coagulation Process Inflammatory Process Migratory/ Proliferative Process Remodeling Process Platelets Platelets Macrophages Neutrophils Fibroblasts Cell Types Involved Kane DP, Krasner D. Inc. Chronic Wound Care . 2nd ed. Health Management Publications Inc; 1997:1-4. Macrophages Lymphocytes Fibroblasts Epithelial cells Endothelial cells

140. Role of Fibroblasts in Wound Healing Fibroblast Migration/ Proliferation Protease release ECM production Growth factor/ cytokine production Angiogenesis ECM = extracellular matrix.

142. Role of Keratinocytes in Wound Healing ECM = extracellular matrix. Keratinocyte Migration/ Proliferation Matrix synthesis regulation ECM production Growth factor/ cytokine production Angiogenesis

144. Apligraf ® FDA Approved for the Treatment of Venous and Diabetic Neuropathic Ulcers

145. A B D C Progression of Healing in a Venous Ulcer After Extensive Debridement and Apligraf Treatment

146. Apligraf ® FDA Approved for the Treatment of Venous and Diabetic Neuropathic Ulcers

147. Diabetic Ulcer Healed With Apligraf ® : Treatment Sequence