Hydroconductive Dressing Options for Cost-Effective Acute & Chronic Wound Healing

  With healthcare reform now a reality, there is a need to improve outcomes while reducing provider and patient costs. The wound care industry is in need of developing healing strategies that will have improved effectiveness.^1,2 As an alternative to more costly advanced wound therapies for decreasing edema in and around the wound bed and for removing excess exudate, debris, slough, tissue bacteria, and deleterious chemicals that impede wound healing, Drawtex Hydroconductive Wound Dressing (SteadMed Medical LLC, Fort Worth, TX) has been evaluated and has demonstrated to perform each of those functions as a wound dressing.^3-6 Additionally, it has been reported to be able to serve as an alternative to negative pressure wound therapy (NPWT).^7,8

––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––
RELATED CONTENT
New & Emerging Concepts in Wound Care Products
Ultimate Standardization of First-Line Wound Dressings to a Single Type
––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––

  Two illustrative examples of cost savings occurred in a case comparing NPWT with Drawtex and a case comparing advanced wound dressing therapy with Drawtex.

  This article offers a review of both case studies.

Case No. 1: Gluteal Abscesses

  The first case featured a 56-year-old woman who presented with bilateral gluteal-area swellings with a history of multiple abscesses in the buttock and gluteal areas for three years secondary to self-injection of an unknown substance. The abscesses had been treated with multiple extensive debridements and prolonged hospitalizations using NPWT. On several of those admissions, more than one (and up to four) NPWT devices were used following incision and drainage of the abscesses (Figure 1). Typical daily costs for a single NPWT device for treatment of a deep abscess is shown in Table 1. These costs will be higher with multiple devices as used to treat this patient and can be even higher if the patient is treated with NPWT as an outpatient requiring visiting home healthcare nursing visits.

  On this admission, a decision was made to evaluate the hydroconductive dressing as an alternative to NPWT after incision and drainage of five deep gluteal abscesses. The dressing was cut into strips and inserted as wicks deep into the abscess cavities (Figure 2). The wounds were then dressed with Drawtex dressings to draw out the purulent material and debris. The dressings were changed on a daily basis. Also, a single 8x8 dressing was cut into multiple pieces to cover each of the draining areas (Figure 3). The daily costs for this treatment are shown in Table 2. At the time of the dressing changes, abscess contents had been wicked out and drawn by the Drawtex dressings. After one week of daily dressing changes, the abscesses were cleared with no drainage, the edema resolved, and wounds had positive healing trajectories (Figure 4).

Case No. 2: Crohn’s Disease & Ileostomy

  The second case followed a 72-year-old woman living with Crohn’s Disease and an ileostomy who presented with painful peristomal ulcers due to pyoderma gangrenosum. She was treated with systemic corticosteroids and daily changes of silver alginate dressings and foam dressings. Her pain on a pain scale was rated 8-10. When the peristomal ulcer failed to improve with the advanced wound dressing protocol, a decision was made to switch to hydroconductive dressings. At that time the wound measured 5.0-x-3.0-x-1.25 cm (Figure 5). The daily costs for the advanced wound dressing therapy with silver alginate dressings are shown in Table 3. After 12 weeks of Drawtex treatment, all depth of the ulcer had filled in and size was 3.5-x-2.5-x-0 cm. (Figure 6). The patient’s pain on the pain scale measurement had decreased to 2-3. As the ulcer healed, the frequency of dressing changes decreased from daily to twice per week. By 20 weeks of Drawtex treatment the ulcer was almost entirely epithelialized and could be treated with only a small dressing (Figure 7). Furthermore, the patient reported longer wearing time of her pouch system and complete comfort (Figure 8). The maximum costs for her treatment with hydroconductive dressings are shown in Table 4. Costs were further reduced because she required smaller pieces of dressing as her ulcer healed.

Considering Cost Savings

  These two cases demonstrate the possible cost savings when using a dressing designed to remove deterrents to wound healing and promote wound bed preparation to allow healing to occur or to prepare the wound for wound closure.⁹ In the first case, the cost of using Drawtex as an alternative to NPWT was 23.5% the cost of NPWT on a daily basis (Tables 1 & 2). This 75% daily cost savings was only for the cost of using a single NPWT device, so it would be even greater with multiple devices or home use of the NPWT. As both Scott⁷ and Couch and Cnossen⁸ have reported, using Drawtex as an alternative to NPWT is effective and safe for the patient. The second case demonstrates that even comparing costs to other wound dressings such as silver alginates can result in significant cost savings. In that case, the cost of Drawtex daily dressing treatment was 61.4% the cost of daily treatment with silver alginate dressings (Tables 3 & 4). This 38.6% cost savings on a daily basis becomes quite significant over several weeks of daily dressing changes.

  The mechanisms of action of the hydroconductive dressing have been shown to be a unique combination of capillary action, hydroconductive action, and electrostatic action.^10,11 These mechanisms are responsible for the various actions reported for wound improvement.

Shawna Philbin is in the wound care department at Health First Palm Bay (FL) Hospital.

References

1. Weinstein MC, Skinner JA. Comparative effectiveness and health care spending - implications for reform. N Engl J Med. 2010;362:1845-1846.

2. Rossi PG, Camilloni L, Todini AR, Fortino A, DiBernardo L, Frigerio L, et al: Health technology assessment of the negative pressure wound therapy for the treatment of acute and chronic wounds: Efficacy, safety, cost effectiveness, organizational and ethical impact. IJPH. 2012;9(2).

3. Wolvos T, Livingston M. Wound fluid management in wound care: The role of a hydro-conductive dressing. WOUNDS. 2013;25(1):7-14.

4. Ochs D, Uberti MG, Donati GA, Abercrombie M, Mannari R, Payne WG. Evaluation of mechanisms of action of a hydroconductive dressing, drawtex, in chronic wounds. WOUNDS. 2012; 24(9 suppl):6-8.

5. Robson MC. Advancing the science of wound bed preparation for chronic wounds. OWM. 2012;58(11):12.

6. Robson MC. Innovations for wound preparation: The role of drawtex hydroconductive dressings. WOUNDS. 2012;24(9 Suppl):1-27.

7. Scott RG. A hydroconductive dressing as a potential alternative to negative pressure wound therapy. OWM. 2012;58(5):10.

8. Couch KS, Cnossen LA. Hypochlorous acid and hydroconductive dressings used in conjunction for management of complex wounds. OWM. 2013;59(4):10.

9. Smith DJ, Karnoski RA, Patel A, Cruse CW, Brown KS, Robson MC: The treatment of partial-thickness burns with a hydroconductive wound dressing: clinical and mechanistic effects. Surg Sci. 2013;4:268-272.

10. Winkler M, Steadman ME. Removing deterrents without adding potentially harmful agents: A new paradigm for effective wound healing. Today’s Wound Clinic. 2014;8(3):26.

11. McGuire J, Sadoughi N. Hydroconductive wound dressings. Podiatry Management. 2013;32(6).