Understanding and Addressing Medical Adhesive-Related Skin Injury

This podcast is supported by AliMed.

Welcome back, everyone. Today we are thrilled to bring you a special edition of our podcast that is a joint episode with Podiatry Today Podcasts and the Speaking of Wounds Podcast from our colleagues at the Wound Care Learning Network. I'm Dr. Jennifer Spector, the Assistant Editorial Director for Podiatry Today and our platforms are joining forces today to speak with Howard Rosing, MD, PhD, about adhesive skin injuries and a unique solution available to wound care clinicians. Our podcast today is supported by AliMed, please stay tuned after our podcast for a brief message from our sponsor. Just as a reminder, this podcast is intended as an informational tool for clinicians and is not intended to diagnose or treat any medical conditions. Dr. Rosing, welcome and thank you so much for being with us today. Could you start us out by letting us know just a little bit about yourself and your background?

 Dr. Howard Rosing:

Oh, absolutely. Jennifer, first, thank you for the invitation to participate in this podcast. And of course, to AliMed for its contribution and being our supporter. My background is I was a practicing physician in the Atlanta metropolitan area for many years, I'm board certified. My background is actually not in wound care, I began this journey into solving a wound care problem based on a problem that a family member had. I'm actually a board-certified neurologist, so I decided to devote my time, efforts into a solution, which I hope to present during today's podcast.

Dr. Jennifer Spector:

Well, we'll be sure to touch on some of those challenges that wound care clinicians face, shortly. But to set the stage, can you tell us more about how Comfort Release came about and your partnership with AliMed?

Dr. Howard Rosing:

While I was practicing medicine, I had a close family member who was being treated for cancer and she had a IV port and she had a transparent dressing over that port. And when that transparent dressing was removed, she suffered a significant skin injury, what's considered a skin tear. She suffered a secondary skin infection and became septic and required extensive hospitalization, further therapy treatments. At first, we all thought this was a nursing problem, a nursing error, but I learned that this was actually very common to this sort of device, that skin injuries and skin tears were a common side effect to the removal of transparent dressings that cover IV sites or wounds. And that this issue had been almost swept under the carpet, so to speak, in that it was just simply accepted as a potential side effect. And I said, no, I didn't agree with that and decided that I was going to do something about it.

Dr. Jennifer Spector:

Well, transparent dressings absolutely are very common for our audience. So on that note, how does Comfort Release work?

Dr. Howard Rosing:

I was fortunate to collaborate with a biomedical engineer in the Atlanta area, his name is Dr. Wang and he is now a full professor at the biomedical engineering department at Cornell. And he and I discovered, patented and produced a new polymer, which was able to be blended into a standard medical grade acrylic adhesive. And that patented polymer provides that acrylic adhesive a new characteristic. And that characteristic is that it provides the ability to turn on and turn off the adhesive bond to the skin.

There's nothing on the market like that. It's never been commercialized before, there's nothing available that matches that characteristic in which an adhesive bandage, tape, dressing, foam dressing, transparent dressing, basically any medical adhesive device in which it's attached to the skin, that adhesive bond to the skin can actually be turned off before the device is removed. Totally eliminating any pain or discomfort associated with the removal of that device, as well as removing any skin injury that commonly occurs with removal of devices like foam dressings or medical tapes or again, as we mentioned, transparent dressings. This feature actually is switchable, it allows us to turn off the adhesive bond but also turn the adhesive bond back on.

Dr. Jennifer Spector:

From a clinical standpoint, how would the practitioner invoke that feature?

Dr. Howard Rosing:

We do it by actually exposing the acrylic adhesive to common isopropyl or rubbing alcohol. The alcohol is absorbed by the adhesive, it breaks the hydrogen bonds to the skin and then when the alcohol evaporates, that hydrogen bonding to the skin returns. It's the first truly switchable medical adhesive that is now commercially available to wound care and healthcare professionals.

Dr. Jennifer Spector:

Now that we know more about Comfort Release, let's dive into why this is so important. As you mentioned, prevention of adhesive skin injuries for all patients is vital, but who specifically is at risk and what are some of the clinical outcomes associated with this concern?

Dr. Howard Rosing:

Well, that's a very good question, Jennifer. Actually, everyone, to a certain degree, has a risk of developing an adhesive skin injury to the removal of an adhesive device. And again, when I say device, we're referring to a bandages, tapes, foam dressings, transparent dressings, negative pressure wound therapy, drapes, ECG electro pads, basically anything that adheres to the skin with an adhesive. But we also know that some people are actually at a higher risk. Well, the risk factors are common sense that you can think about them. For example, if somebody is elderly, frail, they typically have thin skin.

Now, there are other things that occur in much younger patients, things like comorbidities in somebody who's diabetic, somebody who has heart disease. Those illnesses can affect blood flow and again, blood flow to the skin and compromising blood flow will alter the ability to sustain or prevent adhesive skin injury from an acrylic adhesive removal. Third is anybody with a compromised immunity such as cancer, an autoimmune disease. And then the last of course, the most common, and that is somebody with compromised skin integrity, somebody who's on blood thinners, biologics, chemotherapy, all of these medications typically affect the skin.

Dr. Jennifer Spector:

So are there different kinds of injuries that a patient might sustain?

Dr. Howard Rosing:

Those injuries actually are multiple different types. There are skin tears, skin stripping, folliculitis, maceration, tension blisters and allergic in contact dermatitis. This group of injuries are all considered as medical adhesive-related skin injuries or MARSI, M-A-R-S-I. All of these are fairly common side effects to adhesive removals and when they do occur, they cause obviously delay of the wound healing, they can cause increased infections, they can cause decreased quality of life, and obviously there is an associated cost associated with treatment of these problems.

Dr. Jennifer Spector:

So decision making regarding the right dressing for a patient can be intimidating. How does Comfort Release compare with silicone dressings and other competitive products on the market?

Dr. Howard Rosing:

I'm sure your listeners know that when they're trying to choose a bandage or foam dressing, that there's a wide range of products to choose from. I look at it as five characteristics to decide on the choice. The first is the adhesion. How strong does it bond to the skin? Now, there are alternate adhesives made out of silicone that were developed in order to try to prevent the injuries of adhesive removals. The problem with silicones is they don't bond to the skin very strong, they tend to fall off, the adhesive dressing is thicker, they almost always roll up, they don't bond well. For an elderly patient or a pediatric patient, a younger patient who suffers, simply the pain of ripping off their bandage, they don't really work very well because they won't stay on for the length of time that you want.

And that's the second feature wear time, how long does the device stay on your skin? It may adhere strongly but not wear long. And wear time's important. So as you're going to learn, as we were developing Comfort Release, I looked at all these five features and optimized wear time. We typically want wear times to be at least three days up to seven days. And within that three to seven-day period, every bandage, dressing, tape or whatever should be changed. The third feature, of course, is release from the skin. And that means is the release painless? Is it causing a lot of discomfort? And if it's painless, is there an associated skin injury to it? Comfort Release's feature is that our products, when they are exposed to simple isopropyl alcohol swiped to the outside of the device, the adhesive bond turns off, be it a bandage, tape, dressing, foam dressing. It comes off totally painlessly, no irritation to the skin, no erythema to the skin, no residue left on the skin, the optimum the way that the product should be removed.

The next feature is cost. We want obviously a product to not be costly, and I can tell you that Comfort Release as it was developed is about half the price than the silicon product. Silicones are expensive, mainly because I think the adhesive is more expensive. What we've done is we've created a polymer, as I mentioned earlier, that's added into a base acrylic adhesive. And we can actually choose almost any acrylic to use. So we pick out the physical characteristics of the adhesive acrylic and match it to the patient, match it to the wear time, adhesive level and the release from the skin and that's how we develop our products. The last feature I should add is really just physical features and that's basically what I've just been going over. Some of the features that are important have to do with what's called moisture vapor transmission rate, that's breathability.

And breathability is important in all medical products. The fact that if something is breathable makes it more useful, it's better for not just the wound to heal, but also it's healthier for the skin around the wound. So moisture vapor transmission rate also decreases maceration, that's fluid accumulation and improves and decreases wound size. So we take those five features, I'm going to review them one more time. That's the adhesion. How strong does it adhere to the skin? The wear time. Does it last three to seven days? The release. Does it release from the skin painlessly and atraumatically or without any skin trauma? It's features, like moisture vapor transmission rate, breathability. And then of course cost. Those are the five features that went into the development of Comfort Release. And we optimized those five to get the product that healthcare professionals would use, easily learn how to use, and consumers or patients would quickly grasp how important and demand that they receive these types of products.

Dr. Jennifer Spector:

So when a clinician does decide that Comfort Release is best for their patient, how can they go about deciding which type of solution is ideal?

Dr. Howard Rosing:

Well, that's an interesting question because I think some of it depends on the healthcare professional and the patient. Where is the wound that the healthcare professional, doctor, nurse or other clinician is actually treating? So if we're dealing with lowered leg wounds, podiatrists typically see, then really there are three, maybe four products that they could potentially use. One is the Comfort Release foam dressing. Now, in the foam dressing you have a hydrophilic foam pad which absorbs a moderately draining wound, typically a venous stasis ulcer or traumatic wound that has some drainage and that foam pad absorbs the exudate. The product has the Comfort Release feature, so it releases painlessly, it absorbs the exudate, there is no residual adhesive left on the skin. So that's typically for a wound that has moderately draining exudate. On the other hand, if there is no or a low amount of exudate, then our transparent dressings are probably the best product.

They're waterproof, it allows the patients obviously to bathe and shower and the products will not come off when exposed to water. Remember I said that the adhesive bond is only turned off when it's exposed to isopropyl alcohol. Even in our common bandage and our bandage might be good for lower leg wounds, depending how small they are. And our bandage basically allow the patient to be bathed and showered without that falling off. The last probably is our tapes. Our tapes are very good for securing a primary dressing or gauze. And the advantages of our Comfort Release tapes are that the tape can be applied directly to the skin without concern for causing additional skin injuries, skin tears, like we've been talking about. The dressing that the tape is holding will stay in place, it typically won't slide down the leg or foot as patients ambulate and walk about, and the tape is water resistant, will hold up while bathing or showering.

So again, the conclusion is which product? I think it depends on the clinician deciding whether the wound, if it's in the lower leg, has drainage, whether the clinician is using a therapeutic pad like a silver alginate or a collagen or a honey product. If they're using a therapeutic pad, then you want to cover that therapeutic pad and you can cover it with either our foam dressing or our transparent dressing. The advantage of our transparent dressing is that it makes waterproof and it's transparent so that the clinician can actually see the therapeutic pad. And these therapeutic pads are typically non-adhesive, so they have to be covered. A lot of podiatrists are now using and treating their lower leg wounds with certain antimicrobials like silver alginate, they're using collagen, different derivatives of collagen, Manuka honey products are being used and other types of absorptive devices.

So the secondary dressing to cover that can either be the transparent dressing or the foam, depending on what that clinician is looking for and of course the size of the wound. So if you are wrapping it over some gauze, then they would typically stick with our tape. If it's small and then the other at the other range is just simply using perhaps a bandage. So we've got the full range of products from a small wound, using a bandage to a larger wound with no exudate and one with exudate. So it has to be that a clinicians making the decision, but understand that the patients have to be educated.

We are doing extensive amount with the help of AliMed, for example, in getting our patients to understand this new technology and how it works and explaining that this on/off feature allows them to lift the dressing off their skin without any trauma, without any discomfort, without any secondary injuries. And that's really what my goal was. And that goal started, as I mentioned at the beginning of the podcast, probably almost 14 years ago. So it's been a long path to get here, but finally a successful one. And I'm very pleased with the product line that we've developed and very pleased with the response that we're getting from both patients and from clinicians. So thank you very much, Jennifer, for the invitation and I hope the audience can appreciate the technology that I've described and where and how it's used.

Dr. Jennifer Spector:

Well, Dr. Rosing, thank you so much for taking the time to speak with us on this important topic. For more engaging information on wound care, be sure to check out the resources available from Podiatry Today and the Wound Care Learning Network, including previous podcast episodes. There will be exclusive supplemental information on the podcast page for this episode on WCLN and Podiatry Today, including photos and a link to shop the products. For specific questions, feel free to reach out to customer service at Alimed.com, that's at A-L-I-M-E-D.com, and they'll be sure to get the right answers for you or even get you right to Dr. Rosing. And now for a message from our sponsor, AliMed, a trusted provider of medical supplies and healthcare products,