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BREAKAWAY® Wound Dressing
CASE STUDY
Preventing Disruption of Healthy Tissues
Using A New Patented Separable Component Dressing
Anne Myer, PT, GCS, CWS
Geriatric Certified Specialist
Certified Wound Specialist
Disruption of healthy tissues when dressings are changed has a multi-faceted effect on the patient. It
traumatizes the tissue and leaves it susceptible to a host of problems. Coincidentally, the pain caused by dressing changes presents several physical and mental health issues, too. Disruption of viable tissues has a couple of implications. It is simply inconsistent with current concepts of wound healing. The central principle of wound care is to promote the formation of healthy granulation tissue and prevent damage from occurring to it. When healthy granulation tissue is pulled from the wound, healing is delayed by repeatedly disrupting the wound bed. Bleeding may occur as another unfortunate result. With delayed healing the patient is exposed to higher risks of infection and the depletion of the
patient's financial reserves, possibly requiring a change in the patient's living arrangements. The wound care community has sought new methods to reduce the risk of damage occurring to these tissues.
The perception and presence of pain are perhaps as important as the disruption of tissue. Increasingly,
medical literature is detailing the broad, negative effect that pain has on a patient's ability to cope with a wound. Pain occurring during dressing changes can lead to patients refusing to have a dressing changed. That simple patient reaction can cause a host of other problems, ranging from maceration due to
excessive exudate to significantly higher levels of bacteria present in the wound. If perceived pain is strong enough, the patient may ask for pain medications. This can effect a patient's nutritional status. The medications may impair the patient's desire to eat, the patient's appetite, and mental alertness. The influence of pain upon mobility is self-evident. If something hurts, chances are that the patient will not move, hoping to not reinstate a pain sequence.
The physiological aspects of pain, fear, and anxiety all influence healing by affecting a patient's frame of mind. Dallam and colleagues determined that:
- Patients with chronic wounds often have severe pain
- These patients are often under-treated for their pain experience
- Stage IV wounds are often more painful than those of other stages
- Simply because a patient could not express pain did not mean they were not experiencing pain.
The search for a wound contact material that eliminates these issues is always an area of interest to the practicing clinician. In the last few years there has been substantial emphasis on different topical agents and coverings that will not adhere to the wound. However, despite manufacturer claims about Brand X not sticking to wounds, all too often Brand X still sticks.
The purpose of this case presentation is simply to relate to you a clinical experience I have had with
BreakAway Wound Dressing and its
N-TERFACE® Material wound contact layer. The results with this dressing met all my requirements for a wound covering for this particular patient, namely:
- It did not stick and cause pain,
- The dressing helped to maintain a moist environment for healing,
- As the characteristics of the wound changed, it was able to absorb various amounts of exudate, finally,
- The dressing protected the wound from environmental trauma.
II. Case Description
The patient in this case study is an active 81 year old white woman with a very extensive wound to her lower extremity. She and her husband share a home in a nearby retirement community. She is able to ambulate independently in her home and community by using a single point cane. She is extremely healthy. Her medical history disclosed only a right total knee replacement and high blood pressure.
The injury that resulted in the wound occurred at home. Apparently, while she was sitting on a revolving
stool, she "whirled" around and hit her leg on a nearby table. As a managed care patient, her primary care physician initially treated her. He cleansed the wound with betadine and placed steristrips and gauze pads across tissues.
Three weeks later, she returned to her primary care physician for follow up. I was contacted by facsimile, with an authorization from her physician to use a whirlpool to remove "imbedded steristrips." After collecting her history and course of treatment, she told us in no uncertain terms that she was at our clinic only because she told the doctor that she would not allow anyone to touch her wound. She would only allow the outer layer of the wound dressing to be unwrapped. We coaxed her into agreeing to let the whirlpool help soak off the adherent gauze sponges. After the whirlpool we
were able to remove all of the dressing, except the imbedded steristrips. After cajoling and distracting, her steristrips were removed, using forceps and a scalpel. We felt it was vital
to use a dressing that would not adhere to the wound bed and cause additional pain and anxiety.
The characteristics of her wound at evaluation were as follows:
- Size 19.5cm x 6.5cm x undetermined depth = 126.75cm2.
- No undermining present
- The edges of the wound were not attached
- The wound was 85% red granulation tissue, and 15% yellow slough
- There was no odor
- The surrounding tissues had multiple areas of bruising
- Edal pulses were 2+
- There was 0 epithelial tissue
- There was a large amount of serosanguinous drainage present
- The patient rated her pain as 10+ on a scale from 1 to 10.
The first wound covering we used was a hydrogel and a non-adherent pad product. The dressings were
secured in place by a kerlex wrap. The patient was told that these dressings would not stick to her wound and that removal should be quite easy and relatively pain free. When the physician was contacted, he was ecstatic that the steri-strips had been removed. Further authorization was given to continue
treating this patient with high voltage pulsed current using dressings of our selection.
The next day the patient returned to our clinic. She was very agitated again and was dreading the removal of the dressing. Unfortunately, her fears were borne out to some extent: the non-adherent pad stuck to the wound and had to be soaked off.
Our credibility sank and so did her spirits. Following her treatment with HVPC, I decided to use a hydrogel and the BreakAway Wound Dressing and the N-TERFACE Material over her wounds.
BreakAway Wound Dressing with the N-TERFACE Material is a product manufactured by Winfield Laboratories,
Inc. of Dallas, Texas. The product seemed well suited for this patient. It is advertised as the only dressing on the market currently with a "releasably" attached wound contact layer.
The BreakAway design of this dressing seemed like it would help increase patient comfort and decrease trauma to the healing wound, two extremely important goals in the management of this patient's wound.
On the third day, the BreakAway Wound Dressing separated, preventing pain and tissue disruption. The
patient was surprised, and I was relieved. She was nervous and rated pain as a 7 out of 10. When we asked her if this was actual or anticipated pain, she admitted that it was anticipated. The N-TERFACE Wound Contact Layer remained on the wound and provided protection, as well as a shear viewing of
the wound surface. This layer also allowed the wound to be cleansed through it and allowed the application of HVPC through saline soaked gauze over it. Following HVPC, the gauze was removed and another BreakAway Wound Dressing applied over it.
After one week the size of the wound had decreased from 126.7cm2 to 58.45cm2. The wound now had scattered areas of wound edge attachment. Drainage was now a moderate amount of serosanguinous exudate. Ninety percent of the wound bed was granulation tissue, and the wound
was about 53% epithelial tissues. Significantly, pain had decreased by more than 40%, from 10+ out of 10 to 6 out of ten.
The next week the N-TERFACE Wound Contact Layer did not even separate from the BreakAway Wound Dressing. The whole dressing simply lifted off as the kerlex that held it in place was removed. Seeing the dressing literally "fall" off the wound decreased her anxiety and pain level each day. The moderate amount of exudate present in this wound initially caused me some concern about maceration
of the surrounding tissues. This did not turn out to be a problem since the absorbent layer wicked away the exudate.
Week two the size of the wound was 49.5cm2. This was a 61% decrease in its size. The edges were now attached with the depth only being present near the center of the wound. The wound exhibited 100% granulation tissue. Drainage was now a moderate amount of serous exudate. Epithelial tissues increased to approximately 60%. Pain perception had decreased from 6 the previous week to 4 out of 10. With each dressing change the patient grew more confident in us and her ability to heal.
By the third week the size had decreased to 12.3cm2. Epithelial tissues grew to approximately 90% of the wound. Her pain perception had dropped to 2 out of 10. At this point, she was looking forward to coming to therapy. Her primary care physician was also extremely pleased with her progress and wanted to assume responsibility for her wound's treatment. She refused, saying she only felt "confident for treatment where they knew how to put on dressings that did not hurt." The physician good humoredly agreed to let us manage her wound until closure, something almost unheard of in the managed care or Medicare environment.
The next week the size of the wound decreased to 1.9cm2. The wound was now approximately 98% healed. The patient rated her pain as 0 out of ten. Within a week the wound closed.
III. Outcomes
The clinical study ran for 5 weeks. Outcomes were measured in terms of wound healing (a decrease in size), pain relief, and quality of life.
The initial size of the wound was 126.75cm2. During the first week of treatment, the average healing rate was 53%, as measured by decreased area. By end of the 5th week the wound had healed. At the beginning of treatment, granulation tissue initially was 85% of the wound and epithelial tissue 0. At the end of 5 weeks 100% epithelization had occurred.
Given her initial reaction to treatment, perhaps the most striking element of treatment was the rapid decrease in pain perception. Initially, it was rated as 10+ out of ten.
After 1 week of the BreakAway Wound Dressing pain perception had decreased by more than 40%. By the
second week pain was down another 33%. By the third week pain was rated at 2 out of 10, and overall decrease of more than 80%. By the fourth week the patient rated her pain as 0 out of 10. This patient demonstrated a steady and constant decrease in wound size and pain perception.
Quality of life was improved by her being able to return to her prior activities, including swimming,
walking and social affairs with friends since she was not longer "embarrassed" by her injury. By eliminating pain her quality of life improved since she did not have to use pain medication that could impair her cognitive levels.
IV. Discussion
BreakAway Wound Dressing with N-TERFACE Wound Contact layer did not adhere to the wound bed.
As a result, it did not disrupt healthy tissues and did not delay healing. Its use contributed to the patient's perception of reduced pain. The extent of pain relief experienced by the patient undoubtedly influenced her giving us permission to allow treatments to continue and healing to occur.
Advantages to the use of this dressing were as follows:
- Initially, it allowed the wound to be observed under the
N-TERFACE Wound Contact Layer without its removal.
- The BreakAway feature allowed for easier dressing removal.
- Pain was reduced with the use of this dressing. The patient no longer requiring the use of pain medications. She was more relaxed and confident during treatment and generally had a more positive outlook towards wound recovery.
- There was no adhesive surface applied to the wound or surrounding tissue.
- Due to the nonadherent surfaced no trauma occurred to the wound bed.
- It allowed for the absorption of a large amount of wound exudate, preventing maceration of surrounding tissues.
- The BreakAway Wound Dressing was compatible with the use of a hydrogel to help maintain a moist environment.
- It prevented shearing of the epithelial tissues.
The BreakAway Wound Dressing is the first of a family of products that will utilize this patented releasable wound contact layer design. Future products will feature composite dressings including foams, alginates, hydrocolloids and hydrogels. These future products will have a variety of wound contact layers and dressing components. They are designed to regulate the micro-climate of the wound through the
releasable wound contact layer.
I hope other clinicians will be encouraged to include the BreakAway Wound Dressing as a treatment option
when absorption, nonadherence, prevention of trauma, and pain control are part of their overall treatment objectives.
N-TERFACE® is a registered trademark of Winfield Laboratories, Inc.
BreakAway® is a registered trademark of Winfield Laboratories, Inc.
N-TERFACE® is U.S. patent protected.
BreakAway® is U.S. and Foreign Patent Protected
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