Executive Spotlight: Hamid Khosrowshahi, President of Prospera® Negative Pressure Wound Therapy

     Q: How were you first introduced to the arena of wound care?
     A: I grew up in Iran where my family owned a large pharmaceutical and healthcare company, so as early as I can remember, I have had a keen interest in the medical field. I have been quite fortunate throughout my career to be involved in unique products that make a difference for the patient by providing effectiveness and quality of life. In 1987, I was responsible for the development, manufacturing, and launch of EXU-DRY®, a patented concept for a “non-adherent, super-absorbent” dressing for burns and wound care. It was a very successful, breakthrough product, which was later sold to Smith & Nephew. In 1991, I became involved in the development and introduction of the first type-I collagen dressings in proper molecular structure that actually worked to heal chronic wounds with over a 95% success rate. Unfortunately we were ahead of our time, and the market did not embrace collagen in the way it is being embraced and promoted today. In 1997, I worked on another unique product made of 100% type-I collagen for neurosurgical application. I spearheaded the marketing and launch of DuraGen® dural graft matrix for duraplasty, which is now a market leader and multi-million dollar product line. My interest in collagen and collagen based products for wound care eventually lead to my involvement with negative pressure wound therapy (NPWT).

     Q: Please tell us how you became involved in NPWT.
     A: Several years ago, our parent company became a distributor of Bluesky Medical and V1 Versatile pumps. Our main objective at the time was to use a combination of NPWT and collagen to promote cost effective wound closure outcomes on a local/regional basis. NPWT was an accepted adjunctive modality for wound care and we knew from our field and clinical experience that the combination of NPWT and collagen was very powerful. We had no intention of getting involved in direct manufacturing of NPWT pumps or for that matter, entering the market on a national level. I remember taking a V1 pump and dressing kit home with me and applied it on myself to get a better feel for the concept. It took me only 1 hour after the application of the dressing and operation of the pump before I realized V1 was not the right pump for NPWT. It was poorly designed, extremely noisy, and quite uncomfortable. If I could not stand the loud noise of the pump, how could I expect any patient to accept it? We continued to search out a suitable pump and finally realized that we needed to develop and engineer our own pump. After over a year of research and development work we introduced our first generation PRO-I pump. It was officially launched at the Symposium on Advanced Wound Care and Wound Healing Society (SAWC) meeting in San Diego in April 2008.

     Q: What do you find most fascinating about NPWT? What exactly does NPWT mean to you as a top-level Executive?
     A: What I am most fascinated about is the science of NPWT and how it works with the body at a cellular level to improve healing. New scientific studies coming out of South Africa, Japan, and Sweden are investigating the mechanisms by which NPWT confers its benefits and how these biological mechanisms work at a cellular level. Investigators are exploring areas related to blood flow, and differences in the use of continuous and intermittent therapy. They are also investigating how to best manage ischemic zones which develop around the wound edge, use of lower negative pressures, and if there is any effect on outcomes when using different dressing mediums, to name a few. I find this exciting and exhilarating and as an executive, I believe that keeping abreast of the new science, to ensure that new findings are reflected in the devices we engineer and therapies we recommend is our obligation to the patients, clinicians, payors, and facilities who depend on our products.

     Q: Prospera’s PRO series of NPWT pumps are engineered specifically for NPWT and provide: a) simplicity of use, b) comfort for patients, and c) cost effectiveness. Please explain how these three components were developed and how Prospera makes them not just a mission statement but an everyday reality:
     A: The key criterion for the design of our PRO series pumps began with science and the patient. Unlike other NPWT devices, the Prospera system is specifically designed and engineered for NPWT.

Patient Comfort

     In terms of patient comfort, there are several overlapping features, which distinguish the Prospera system. Without oversimplifying, they fall into three basic categories:
     1. We recommend lower negative pressures, which deliver optimal results without pain associated with higher pressures;
     2. We know that intermittent therapy is more effective than continuous but there were a lot of limitations to existing systems, which made it impractical, so we developed VPT® Variable Pressure Therapy. VPT® features high pressures of -80 mmHg and a low pressure of -20 mmHg changing in small 5 mmHg increments. As a result of this mechanism, there is always negative pressure at the wound bed and the patient experiences a gentle massage rather than the sudden, jarring “saw-tooth” pattern of on-off pressure (0 to -125 mmHg);
     3. Moist AMD™ gauze under negative pressure, our recommended dressing medium, will not adhere to the wound, it will not allow in-growth of new tissue and will not be painful during use or during dressing changes. Lastly, the Prospera pumps are virtually silent which makes it easier for the patient to sleep at night and reduces noise pollution at the bedside during waking hours.

Simplicity for Clinicians

     The Prospera system is completely customizable, has a digital control panel, and the newer models will track patient compliance (for home use), and have a color-coded display read-out. The gauze dressing protocol is simple to apply and remove with little to no pain for the patient.

Cost Effectiveness

     When analyzing cost effectiveness there are several areas to consider. The rental cost of our pumps is more competitive than most pumps on the market, the dressing kits are also lower in cost (especially when compared to foam based systems), and our system requires fewer dressing changes (based upon exudate). Since, in most cases, there is no pain associated with the dressing change, there are no hidden costs associated with the use of pain medication.

     Q: Tell me about your professional team at Prospera. How close do you get to work with Mrs. Cindy Ahearn, Prospera’s Clinical Director?
     A: I work very closely with all the members of our team on a daily basis because NPWT is quite a dynamic market in a very competitive field. Essentially, it is our shared passion for wound care and our mission to put patients first. It is the driving force behind our relationship as wound care professionals. From day one, Cindy Ahearn and I have worked very closely. When I began the process of designing “the perfect pump,” I called Cindy and asked her to come on board. I knew Cindy from her earlier work when she was the Clinical Assistant to the late Dr. Charles Baxter, the world renowned expert in burn and wound care. She had extensive knowledge regarding the use of negative pressure and had worked extensively with Dr. Baxter at the Baxter Wound Clinic in Dallas, Texas where they did pioneering work with type-I collagen. At first she was reluctant, but finally agreed to provide her clinical advice if we agreed to do everything she asked for in the design. We agreed and the rest is history. She was instrumental in the design of the first Prospera system and every improvement since. Cindy is an MS, RN, ET, CWCN, FNP-C with over 30 years of experience and we couldn’t have asked for better clinical support. We share a 24/7 work ethic and take our responsibility to patients, science, and wound care very seriously.

     Q: How do you measure the success of the PRO-I™?
     A: The success of PRO-I is measured by the continued and positive response that we get from clinicians and patients. When the patients can get a good night's rest due to the silent operation of the pump, the clinical outcome of the therapy is equal or better than the previously used system, and the patients do not experience pain and there is virtually no need for premedication to remove dressings, we know we are on the right track. Seeing patients prosper through use of our system is what motivates us to strive for more advanced and better protocols and outcomes.

     Q: Aside from being a portable version of the PRO-I™, are there any other distinct differences found in the PRO-II™? Also, what inspired the shape and design of the PRO-II?
     A: We knew even at the time that we launched the PRO-I that we would need to design a portable system. We listened carefully to clinicians who had been working with the PRO-I and came out with the PRO-II. Weighing under 3 lbs, the PRO-II is a powerhouse that delivers all the features and functionality of the PRO-I but in a portable package. It is fully customizable and features continuous and VPT® settings, a discreet built in collection canister, odor control, virtually silent operation and a long battery run time. Regarding patient comfort, which is always on our mind, the PRO-II features a curved design to fit comfortably on the waist and comes with a disposable carrying case, which is disposable and designed as a single patient use only that can be worn over the shoulder or as a belt around the waist.

     Q: What makes a Prospera dressing kit/tubing patient friendly and resourceful for clinicians?
     A: Simplicity and comfort! The dressing system is so simple, it is enlightening. We recommend AMD™ gauze dressings because they are currently the most suitable dressing medium for NPWT.
     1. Gauze is a natural, biodegradable product;
     2. It is simple to apply and remove in one piece and good for use in tunneled and undermined areas;
     3. Moist gauze under negative pressure will not adhere to the wound and will not allow in-growth of new granulation tissue, which means reduced trauma to the wound bed and reduced pain for the patient;
     4. Less pain means reduced nursing time. The dressing kit eliminates the expense of premedication for dressing changes and reduces patient anxiety with dressing changes and;
     5. Seeing that AMD™ gauze is hydrophilic and antimicrobial, it requires fewer dressing changes and eliminates the “2 hour rule” that governs foam based dressing systems.

     Q: What are some of the topics being discussed between wound care specialists today?
     A: The buzzword these days is “evidence-based” wound care. The term “evidence-based” is used quite loosely and as a marketing tool. However, it is the quality and not the quantity of the evidence that counts. Often clinicians are left confused by huge quantities of information and question the validity of the material. In NPWT, most of the RCTs and many of the published case studies compare foam dressings to wet-to-dry gauze. This misleads the industry to believe that “wet-to-dry gauze” is the same as “moist gauze under negative pressure.” Not so. Wet-to-dry gauze is a non-selective debridement modality and not a wound care protocol. There has been no published study of direct clinical comparison between foam under negative pressure and moist gauze under negative pressure. At Prospera, we strongly believe in evidence-based care, but as an industry we need to address the quality of the evidence.

     Q: Looking forward, will there by any further additions made to the PRO series?
     A: Yes. Our PRO-III system is currently in the Alpha phase and will launch officially at the SAWC meeting in April (Dallas, Tex). We are exhibiting at booth 329. It is the next generation of the PRO series for the acute care setting. In addition to all the features of the PRO-I and PRO-II systems, the PRO-III provides even more advanced engineering, functionality and safety features. It also weighs less than 5 lbs. The biggest advance will be in the area of safety. The PRO-III features a dual filtration system. It will be the only pump on the market with separate internal and external filters, which is very important because it ensures that the pump cannot be contaminated with backwash from exudate. In the past, this has been very difficult to ensure and can be an important safety issue. And of course, the PRO-V and PRO-VI series are in development. 

For more information regarding Prospera NPWT, please visit, www.prospera-npwt.com.