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The IHT Systems Approach

Negative Pressure Wound Therapy is used for the treatment of chronic and acute wounds. Chronic wounds are defined as wounds that fail to proceed through a normal reparative process over a 30 day period of time. In most instances the factors that are responsible for non-healing wounds are arterial insufficiency, venous stasis, chronic disease such as diabetes or some form of pressure injury. Secondary factors can also impede the wound healing process. These may include factors such as obesity, alcohol, tobacco, medication and the methods used in wound healing. Local factors present within the chronic wound environment can be a major impediment to rapid wound healing. The presence of infectious bacteria within the wound, abundant in inflammatory products and inflammatory cytokines in addition to secondary lifestyle factors, makes the treatment of chronic wounds challenging. Inflammatory cytokines leads to the generation of proteolytic enzymes. The uneven balance between these wound enzymes and their inhibitors can lead to a cycle of escalating wound degradation and inflammation. The presence of bacterium, protected by the formation of a biofilm promotes further inflammation and inhibition of wound healing. The IHT systems approach to wound healing eliminates the local factors that contribute to poor wound healing through a sequential, continuous and synergistic use of wound care therapies. IHT refers to this process as a three-step process to better outcomes. The first step is directed at eliminating excessive bio-burden by disrupting eradicating bacteria that cause localized and, often times, systemic infections. The second step is to inactivate and remove the pathogens from the wound site. The third step is to apply negative pressure to control the amount of exudate, reduce the risk of infection by establishing a sealed environment, stimulate the formation of new tissue (granulation) and create pressure to draw the margins of the wound closer.

For Patients

  • Faster Healing
  • No Pain with Dressing Changes
  • No Wound Odor
  • Improved Mobility
  • Improved Quality of Life

For Caregivers

  • Simpler, Faster Dressing Change
  • No Pain Medications Required
  • No Wound Odor
  • Fewer Dressing Changes
  • Increased Patient Satisfaction

For Providers

  • Better Outcomes, Lower Costs
  • Saves Nursing Time
  • Increased Patient Satisfaction
  • Increased Patient Compliance
  • Reduces Financial Risk

Steps to eliminating local factors that contribute to poor wound healing

Step 1

PhaseOne (pure hypochlorous solution) in solution has been shown in lab studies to eradicate biofilm. It does so without the use of chemical stabilizers and other foreign agents such as bleach, which is commonly used in wound washes and antiseptics. Because PhaseOne mimics a naturally occurring enzyme produced by neutrophils, it is non-toxic to new tissue. The pathogens are more susceptible to pure hypochlorous solution than hypochlorite, giving way to extracellular and intracellular breakdown of the bacterial walls. PhaseOne in solution has been shown in laboratory studies to neutralize the released toxins, which clinically may result in reduced inflammation and wound odors. PhaseOne has no known antimicrobial resistance including MRSA and VRE and eliminates the need for local administration of antibiotics, which are only marginally effective in killing pathogens when organized in a protective biofilm barrier. With less reliance on antibiotics PhaseOne causes less antimicrobial resistance.

Step 2

Cutimed Sorbact through its primary mechanism of action, hydrophobicity, is also a non-chemical approach to eliminating excessive bio-burden. As opposed to the biocidal affects of PhaseOne, Cutimed Sorbact binds and inactivates the pathogens making them incapable of multiplying and rendering them inert. Because the Cutimed Sorbact does not cause intracellular or extracellular breakdown, harmful toxins are not introduced into the wound bed, making Cutimed Sorbact non-toxic and non-cytogenic. Once the dressing is changed the pathogens are removed from the wound environment intact. Cutimed Sorbact is also a non-adhering contact layer, which, under negative pressure, drastically reduces tissue ingrowth and the pain and damage that is associated with the removal of more adherent and porous materials such as foam. Less pain means less aggressive approaches to pain medication prior to initiating a dressing change. Without facilitating tissue ingrowth, combined by the capacity for pathogenic adhesion, Cutimed Sorbact depending on the characteristics of the wound, requires less frequent dressing changes. Fewer dressing changes results in less risk of infection, less disruption to the bed of the wound, less patient pain and discomfort, lower material cost and significant time savings for wound care clinicians.

Step 3

Negative Pressure is a key component to advanced wound healing. Steps one and two of the IHT integrated approach to wound healing highlight the importance of appropriately preparing the wound bed to reduce bio-burden and to use the appropriate dressing system for the unique characteristics of the wound. Once the Cutimed Sorbact is in place and the appropriate drain is selected, the semi-permeable drape is used as an adhesive occlusion over the wound. When applied correctly, the drape occludes the skin layer so that there is no leakage when the pump is activated. It also protects the underlying wound from external bacteria and fungi. There are numerous benefits of using Cutimed Sorbact as opposed to foam based negative pressure systems. The following table represents a few of the more significant clinical differences.

Cutimed Sorbact vs. Foam

Cutimed Sorbact Foam
An antimicrobial dressing that removes pathogens from the wound site without chemicals that cause tissue damage (cytotoxicity). Open cell or porous foam does not contain an antimicrobial unless it is impregnated with silver. Silver is cytotoxic and leads to tissue maceration damaging healthy skin and new tissue growth. When the foam is removed or the pump is inactive, the wound can be re-colonized with pathogens. Pathogens remain active and can freely multiply in the foam.
The IHT system allows for a choice of drains that all act at the wound bed, once wrapped with Cutimed Sorbact. The REVA is a proprietary, patent pending and FDA 510(k) device that combine the benefits of a flat drain with the ease of use of a dome, eliminating leakage. Flat drains are helpful for shallow wounds. Round channel drains are useful for deep wounds and wounds with tunneling with excessive exudate drainage. The REVA is a hybrid dome-drain that uses an integrated skirt to minimize leakage. These drains reside under the adhesive drape dressing. Foam systems use dome based dressings that adhere on the outside of the drape, gaining access to the foam through a small puncture.
Cutimed Sorbact does not require high negative pressure to create a vacuum due the porosity of the mesh material. Lower pressures cause less pain and far less tissue ingrowth. Foam is a more dense material and the amount of pressure required is directly related to the porosity of the material and the patient’s ability to tolerate pain. Most foam based pumps and dressing systems function between -125 and -150 mmHg.
Cutimed Sorbact is applied with a fluff and fill method. It is not packed into the wound as the negative pressure will increase the contact surface area. Due to its flexibility and pliability, Cutimed Sorbact can easily create contact with tunneled and undermined areas of the wound. Foam requires skilled attention to detail as it must be contoured to the size and shape of the wound. Tunneling and undermining can create problems as there is either little contact with the surface or there is the propensity to cause tissue in-growth under high negative pressure in the malformation areas. Many foams have been proven to lose integrity with PhaseOne (hypochlorous solution).
Cutimed Sorbact does not require cutting or contouring and therefore does not leave debris behind when it is removed. Foam can leave material debris in the wound bed, which serves as a medium for pathogen growth and infections.
PhaseOne is compatible with Cutimed Sorbact. Cutimed Sorbact may be moistened by PhaseOne or other liquids. Some foams have been proven to lose integrity by PhaseOne
Cutimed Sorbact in combination with PhaseOne under negative pressure is easy to remove with less likelihood of pain caused at the bed of the wound. Foam requires mechanical force to remove and may rupture capillaries and cause damage to new tissue. Bleeding, damage to the wound bed and pain are all consequences of dressing changes with foam.
Cutimed Sorbact dressing can be changed every 3-4 days. Due to the simplicity of the dressing application, Cutimed Sorbact may save a clinician’s time to perform a dressing change. Lightly filled Cutimed Sorbact also has the benefit if decreasing the potential for causing maceration at the edges of the wound (periwound), while still benefitting from macro and micro-deformation of the wound. Foam based system dressings are recommended to be changed every 2-3 days to help mitigate the complications of tissue in-growth and bacteria. Foam based systems often lead to complications such as maceration of the wound, around the margins of the wound (periwound).