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Science Says: No Magic Bullet to Wound Healing

What is worse than an open wound? Not knowing how to close it, says 30-year industry expert Dr. Mark Rippon. With 30 years in the industry, wound physiologist Dr. Mark Rippon shares his views on the challenges – and innovations – of modern wound therapy.

What is worse than an open wound? Not knowing how to close it.

As a wound physiologist, my responsibility is to understand why some wounds heal, why others do not and what impacts the state of a wound, for better or for worse.

After nearly thirty years within the industry and thousands of wounds later, I’ve found that there are still numerous unanswered questions relating to how and why wound healing -- or wound closure -- may or may not occur.

This month, we have the opportunity to look closely at the topic of wounds and wound healing. During November, we celebrate World Diabetes Day (Nov. 14) and Stop Pressure Ulcer Day (Nov. 17). Each of these days brings special attention to conditions that can lead to the development of chronic wounds; wounds that show no signs of healing for six weeks or more.

From analysing cellular structure and biochemical components to evaluating skin integrity, my life’s work is anchored in evidence-based, substantiated wound science. And to this day, it pains (yet fuels) me to know that we still don’t have the key to efficient wound healing.


Causes are incongruent

The causes of chronic wounds, including diabetic foot ulcers, may be different from that of other wounds like a venous leg ulcer, and yet the effect and clinical outcome for the patient can be equally as devastating and comparable. For diabetes patients, a simple cut can become a chronic wound exacerbated by comorbidities such as poor circulation or neuropathy (loss of feeling).

According to the International Diabetes Federation, last year there were 415 million adults living with diabetes.

The American Podiatric Medical Association (APMA) found that Diabetes is the leading cause of non-traumatic lower extremity amputations in the United States. Approximately 14-24 percent of patients with diabetes who develop a diabetic foot ulcer will require an amputation. Further findings from APMA state that foot ulceration precedes 85 percent of diabetes-related amputations.
Grandma and daughter
When it comes to pressure ulcers, the UK National Health System (NHS), has found that nearly 700,000 people are affected with pressure ulcers each year across all care settings and 186,617 patients develop hospital-acquired pressure ulcers each year.

The European Pressure Ulcer Advisory Panel states that prevalence and incidence rates of this category of wounds are generally higher in populations who are receiving palliative care, those with spinal cord injuries, neonates and infants, and individuals in critical care. These individuals are susceptible to skin damage and poor vascular circulation which can delay wound healing and lead to pressure ulcers.

With the occurrence of wounds, and working to heal them, there is no level playing field. No wound is created equal and neither is the approach to healing it. But that is one of the greatest things about being a scientist – seeking knowledge that enables better patient outcomes in the healing of their wound.

Care is inventive

Goup of doctors
In 1874, HARTMANN received the rights to produce the first antiseptic wound dressings. Carbolated gauze represented a breakthrough in antiseptic wound treatment and changed surgical wound dressings forever.

As scientists involved in wound care exploration, with each new solution, we hope that we are one step closer to “the next big thing” that can impact wound healing.

Chronic wound healing in particular is still a “dark arts” process. But with the advancement of science and the emphasis on evidence-based medicine, the wound care world is changing and hopefully providing options of better outcomes for the patient and clinician. And today, I can tell you, the world of wounds is still an exhilarating area to work in, especially when you get it right.
Several years ago, I found myself as a part of a team that was introducing a honey dressing to a patient with Meningococcal Septicemia. Honey, as we know now has potent antibacterial and debriding properties. In those days, it was an untested treatment option. This patient was in danger of death and four-limb amputation. Following her honey dressing treatment, the only part of the body that she lost was just a small part of her finger.

These success stories re-invigorate the clinician and the scientist to go further -- pushing boundaries to investigate wound treatments that might possibly be outside the bounds of their normal experience.

Fast forward to 2016. Hydro-responsive wound dressings like HydroClean® plus are proving to be an effective option in many wounds such as diabetic foot ulcers, venous leg ulcers and pressure ulcers.

Long story short, here is what we know: HydroClean® plus works. And it works well. Right now, it is the only product on the market that cleanses, debrides, and prepares an optimally-moist wound bed to progress natural healing in a variety of acute to chronic wounds.

But what would have happened with the Meningococcal patient if we had HydroClean® plus and the knowledge we have now? It would be interesting to see if it would have had the same effect of debridement and healing support.

Now we have the chance to expand the knowledge and capability of Hydroclean® plus with science and clinical experience.

Science says: Care for the individual

You see, science still has a number of pieces of the puzzle that it needs to put together. But in my 30 years as a wound scientist, as I’ve strived to find the key to efficient wound healing, I remember these three things:

1. You cannot isolate the wound from the patient.
2. Some wounds you can heal. Some wounds you can’t.
3. There is a difference between healing and managing. Some wounds you will always manage -- along with your patients’ perspective and expectations.

Clinicians tend to look at the patient as a whole, scientists need to do the same to fully understand the consequences of a wound and help develop new treatments

So, as I think about it, maybe I should revisit the answer to my first question. What is worse than an open wound? Neglecting your patients’ needs.
1Ellermann J. HydroClean 2.0: Design validation customer/user interviews. Internal Report, International
Marketing Department (2015).

2Dowsett C, Claxton K. Reviewing the evidence for wound bed preparation. J Wound Care (2006); 15:439–42.

3Ousey K, Rogers A, Rippon M, HydroClean® plus: a new perspective to wound cleansing and debridement.
Wounds UK (2016); 12(1)

4Young T, Debridement — is it time to revisit clinical practice? Br J Nurs (2011); 20: 24–28.

5Strohal, R., Apelqvist, J., Dissemond, J. et al. EWMA Document: Debridement. J Wound Care. (2013); 22:

6Ousey K, Rogers A, A, Rippon M, HydroClean® plus: a new perspective to wound cleansing and debridement.
Wounds UK (2016); 12(1).

7Humbert P., Faivre B, Véran Y et al. on behalf of the CLEANSITE study group. Protease-modulating polyacrylate-
based hydrogel stimulates wound bed preparation in venous leg ulcers a randomized controlled trial. Journal of
the European Academy of Dermatology and Venereology (2014); 28:12, 1742-1750.

8Kaspar, D. Therapeutic effectiveness, compatibility and handling in the daily routine of hospitals or
physicians’s practices. HARTMANN Data on file: Hydro-Responsive Wound Dressing (HRWD) and AquaClear
Technology are trademarks of HARTMANN. (2011)

9Eming S, Smola H, Hartmann B, et al (2008). The inhibition of matrix metalloproteinase activity in chronic wounds
by a polyacrylate superabsorber. Biomaterials 29: 2, 2932-2940.

10Knestele, M. The treatment of problematic wounds with HydroClean plus - tried and tested over many years in
clinical practice. HARTMANN Data on file. (2004)

11Bruggisser, R. Bacterial and fungal absorption properties of a hydrogel dressing with a superabsorbent
polymer core. J Wound Care (2005); 14: 438 -439.

12Smola H.: Stimulation of epithelial migration - novel material based approaches. Presented at EWMA Congress,
London. Data on file: in-vivio study, (2015).