Ethicon, 3M, Covidien and Various Local Manufacturers Compete in Growing Indian Wound and Tissue Management Market by Idataresearch

Ethicon, 3M, Covidien and Various Local Manufacturers Compete in Growing Indian Wound and Tissue Management Market

In 2015, the Tissue Sealant Market Exhibited the Highest Growth Rates in India; This Market Includes Fibrin, Protein-Based and Synthetic Tissue Sealants From Ethicon, Baxter and Reliance Life Science

VANCOUVER, BC–(Marketwired – March 31, 2016) – According to a new series of reports on the Indian market for wound and tissue management by iData Research (www.idataresearch.com), India has been rapidly adopting more advanced technologies for wound care. As surgeons and hospitals become aware of the increased benefits and long-term cost savings associated with anti-adhesion and tissue sealant products, the adoption rates will rise. Each of the advanced dressing markets is expected to grow rapidly over the forecast period. As a result, these markets will represent a larger proportion of the total wound management market by 2022.

In contrast, traditional wound care techniques and many other wound closure devices are very well-known to healthcare professionals in India. Increasing numbers of laparoscopic procedures has resulted in growing demand for the premium-priced endoscopic staplers, which has significantly contributed to the growth of the wound closure market. These products are generally less expensive than more advanced wound care products, which will contribute to continued customer demand. Therefore wherever possible, traditional dressings are preferred over the expensive moist and antimicrobial dressings, especially since there is no reimbursement for advanced wound dressings in India.

READ MORE HERE

pronto customer notificatin application NPWT Pump Rentals

Pronto Customer Notification Application for NPWT Rental Companies is now LIVE!

Pronto Customer Notification Application for NPWT Rental Companies is now LIVE!

Pronto Customer Notification Application final

Pronto is a patented customer notification application for durable medical equipment companies that are currently have NPWT rentals in their inventory portfolio.

Email reminders are the quickest way to connect with your customers, to provide your customer notice, that there are only two wound dressings left in their inventory.

Click Here To Learn More

Equinox Medical announces Pronto Customer Notification Application For NPWT Rental Management

INNOVATIVE TECHNOLOGY GIVING CUSTOMERS AN ADDITIONAL SAFEGUARD ON NPWT REFILLS .

Smithfield, RI, March 22,2016

Equinox Medical Introduces Pronto a Customer Notification Application to Help Bring NPWT Dealers and Their Customers Equinox Medical, LLC, developer of negative pressure wound therapy (NPWT) foam dressings, NPWT pump systems and NPWT advanced software, announced today that it will officially launch Pronto: Customer Notification Application. Pronto is a software application that was designed to help a NPWT dealer and their customers communicate via email. The automated email software application was created and designed to help bring a new way to communicate with every customer using NPWT products. This refill ordering process is easier and much more efficient. Pronto, will send an email reminder to any customer, who only has 2 foam dressing kits left in their inventory.

Pronto’s Features and Benefits: 
  • Every NPWT dealer will have an accurate invoice and report at the end of each month.
  • All order refills will be automated. Your customers will have 24hr access to their NPWT business.
  • The patients inventory and supplies will be accounted for on a daily, weekly and   monthly basis.
  • Pronto will reduce costly last minute orders, overnight shipping and same day   delivery.
  • Every customer can simply refill an order via email without having to call for a   reorder, saving time  and stress.
Pronto can be used by every clinician and NPWT dealer. It can be accessed via internet thru and encrypted HIPPA compliant server. The application is a proactive approach in providing a high tech communication solution to every NPWT dealer and their customers. Pronto is being offered for a 30 days FREE Trial. For more product information, please visit  Pronto Application or Free Webinar
EQUINOX MEDICAL, LLC
About EquinoxO2 Medical, LLC Equinoxo2 Medical, LLC, headquartered in Smithfield, RI is a privately held medical device company focused on the development of advanced wound healing technology. Equinox is dedicated to developing and designing innovative wound care products that are cost effective and delivers significant clinical outcomes. Our goal and strategy is to improve a patient’s quality of life. Our passion and dedication is to provide a better solution in repairing and healing the human body. For more information, please visit www.equinoxo2.com. Media Contact Gary Schear, Vice President of International and USA Sales Telephone: 800-504-3150 Ext 104 Email: Gary@equinoxo2.com
Media Contact
Media Contact
Gary Schear
Vice President of International and USA Sales
Telephone: 800-504-3150 Ext 104
Email: Gary@equinoxo2.com

Equinox Medical Latest “NPWT Black Foam Wound Dressing Clinical Webinar” By Holly Desimone, RN, BSN, WCC

 

Back On January 28, 2016 held a free clinical webinar on “NPWT Black Foam Wound Dressing Standard Application” hosted by Holly Desimone, RN, BSN, WCC.

Discussed what its inside the Equinox Medical  negative pressure wound therapy black foam wound dressing kits.

What is inside the UNI NPWT Wound Dressing Kit?

  1. Hydrophobic Black foam wound dressing
  2. UNI NPWT Drape
  3. UNI NPWT Dome Pad (suction dome)
  4. UNI Adapter

What tools you need before placing the wound dressing?

  • Pair of sharp scissors
  • Skin Prep
  • Oil Emulsion
  • Saline Bullets
  • Ruler (to measure the wound)

 

Video Transcript Below:

0:25
from a company I’m clinical
0:29
anybody else on I see a 570 and I was wondering who I was talking to a couple
0:48
of contraindications negative pressure in the past I’ve used it yes ok so we’ll
0:55
just sort of fly through this I always tell people know ask our present when
1:03
the sloth level of course have always preferred that it be depleted out but
1:08
maybe if you had like 5 or 10% of sale of you could put negative pressure on
1:15
you could still get that automatic debridement of course you don’t ever
1:21
want to use it over pacemaker where a malignancy was actually present have
1:27
been in any way surgically take it out we just don’t want to put anything
1:31
doctrinaire untreated osteo of course explores blood vessels nerves and
1:39
Oregon’s anything like that but I always say is just use really really extreme
1:45
caution when the leading shoes anti-coagulant a lot of people you are
1:50
on come within happen and they still going negative pressure
1:56
if there’s a type of bleeding warnings or anything like that
2:01
let me know don’t let me know but definitely sort of walk away from it if
2:07
the person had a shot to believe me I know sometimes the doctors like to put
2:11
it on but I always sort of say I I still feel like I was like a 24 hour ago
2:19
against doctors orders but sometimes I have in the past call the doctors and
2:23
just asked unexplored official is once you know where the official is going in
2:31
the physician can make a decision and always read all the book any negative
2:38
pressure or just go through the book make sure you really know what you doing
2:41
with the negative pressure on and how to properly use the machine but you’d be
2:45
surprised some of the calls I got people really you may know it very well but
2:48
some people really are on here so different ones that are sort of
2:57
appropriate and of course this is not i mean every situation but these are just
3:02
some things that they’ve been used in the past when should you see him all the
3:07
time
3:11
sort of had to have to figure out what made one chronic and then a lot of times
3:16
the negative pressure has been known
3:21
stimulate and every once in a while so kick start that once again I material
3:28
most of the time you’ll see that has to be protected
3:33
something in the air to protect if there’s attention exposed or anything
3:38
times a good opportunity is to put in something like and diabetic ulcers
3:45
pressure ulcers stage two three four and then of course you’ll also see them use
3:50
with grass as well and sometimes you’ll see them run at a lower setting it was
3:55
natural growth graft by Patricia I saw that you joined in
4:06
just by Patricia I did see that you joined in
4:15
Patricia can you hear me
4:20
ok so far anyway we’ll just keep going and maybe Patricia maybe you can write
4:26
me a note or something to let me know that you can hear me quickly I’m going
4:33
to educate you on the basics contraindications techniques and things
4:37
like that and then this is my email here so if by any chance you want any
4:45
information from me you can email me here and there are other opportunities
4:51
to do clinical education says well okay so here’s the kid ok and like I said
5:04
this is the unique platform dressing kit is completely sterile so when you get
5:12
everything pretty much everything inside that you’re going to need you need a few
5:15
extra things but this is what comes inside the kit you have no one to three
5:19
drape it is very easy to use
5:21
you’ll have your black foam and it will depend in large depending on what you
5:27
need at that time here is your don’t and it’s basically like
5:43
starting really good with extra I can try to assess the one that I think this
6:08
is the biggest thing that I always say anything you want to say this is where
6:11
you really want to know your mornings and contraindications is appropriate
6:15
so we’re going to be doing this weekend today and I have gotten a few calls in
6:21
the past about well why would you put the dome on this carrier because should
6:26
be bridge but this is not a bridging video so when I do is I do put it here
6:32
just for the safe I don’t have a lot of opportunities on the moon but I do have
6:40
other ones that would actually create bridges between and as she conceived
6:46
technically this would not be appropriate because here we have our
6:50
black US car so we definitely would not want to put up signs all over that on
6:55
here we have some potential of osteo has a whole bunch of stuff but again I’m
6:59
using this is a sample so just so you know I’m just gonna do very well and it
7:08
is important to irrigate I I know some nurses will just like poor little in but
7:13
especially when using the black phone there’s the potential telling small
7:16
particles and if the small particles in the air sometimes they sorta get
7:20
mistaken as tissue things like that so just know that we’re measuring the wound
7:29
and you’re probably gonna want to document that again for your fertility
7:33
protocol most likely every week so here we can prob around the edges of the just
7:44
as a barrier there is an on Steam version takes a little bit longer to dry
7:49
but I think the patients appreciate it you may also decide to protect this area
7:55
further with either so uptight song during whatever your facility protocol
8:04
is for window pane e ok so this is not put this in here and just so you have it
8:12
does not comment to get this is contact but because I do have a bone I want to
8:20
make sure I protect that area and this is one thing that you can use
8:24
I’m used that protect exposed bone it also helps in to utilize it to prevent
8:30
any type of sticking to the water bad this is an there’s a few different file
8:36
motions requests I think this one is like an Adaptec or something you just
8:41
don’t want to use one with us
8:43
oil based I think if you’ve ever used in their song that very thick oil that
8:48
would not be appropriate to use and of course you need a doctor’s order to be
8:51
able to put this and and the only other thing an ad about the real emotions just
8:57
be careful to avoid it does sort of disappear on the wound bed and blend in
9:02
so you just want to make sure whatever goes and comes back out
9:05
so this is the white phone the hydrophilic phone the difference the
9:09
black phone is hydrophobic it does not like water so that’s why everything
9:13
passes through very well it also doesn’t contain it doesn’t get soft up white
9:19
foam actually likes moisture on it’s a great thing
9:24
undermining tunneling
9:26
may be protecting an area there’s more sensitive if you do a problem with the
9:34
wind really sticking or something like that maybe putting this down again
9:39
need a physician’s order to add this but this phone has sort of a higher tensile
9:44
strength so it makes it a really good option for you know protecting those
9:51
areas
9:52
undermining in the tunnel yet we can’t really see him so I you just always and
9:57
I think I have a picture of it
9:59
ok I’m going to cut this is the reason I’m doing this is all my room to help
10:05
them undermining so I want to cut the white phone away from my bed so I know
10:11
fibers but we’ll see the white film is great you don’t get many fibers at all
10:14
now I’m gonna police into the wound bad gently and as you can see undermining
10:24
somewhere up like that so this is in they have you can see that’s quite a
10:30
long tail have left and I like really big tails on things because I want to
10:35
make sure that in no way could this get lost
10:42
platform I’m gonna get fantastic parish says hers because sometimes when I’m
10:48
gonna wanna do is I might have to fillet a fish and make the DEP more shallow for
10:54
example even on this one I have to sort of come down a little on one side
10:58
because it’s just that it’s just too much phone
11:04
so I cut my black foam to fit my bed again away from away from my warm bed
11:12
soon or fragments go in and then place it in and you’ll see here just as
11:18
exaggerated example I made sure they came up higher because it compresses
11:24
down I wanted to compress almost level I don’t want it to be like a holla when
11:32
you work with this one but it really impresses down really well so you might
11:37
see a little bit hollow leader now I wait for me in my black home in
11:45
everybody does things different people cut their whole after a place here to
11:52
read what I like to do is determine where I want my hole to be on my great
11:56
figure how much I can cut away like I don’t have that much on my mind you know
12:04
my margins doubling wanna be out of here so I get a nice good seal but this help
12:11
me determine they can cut the hole right here I what I do is I actually caught us
12:18
so I feel like a little nickel size allowed and that way represent prevents
12:26
any ripping my hole is nice and round it’s not a slip sometimes you get when
12:32
you lift the trade when you go to do it and then later you end up with a nice
12:35
little and then I want to make sure that my whole line over the center of my
12:40
phone for best results
12:44
love the Strip District was created definitely with a nurse in mind
12:51
energy of you guys that a listen I think there was somebody else joins us well
12:55
anybody listening the nightmares of draped with gloves this is not a
13:00
nightmare treat this is fantastic i’m able to hold here
13:05
great number one thing I can flip it over her position at some holes in the
13:14
middle and then very lightly go around and just make sure that I’m in here down
13:21
I don’t press my black home I just sitting around and want some I’ll put
13:26
like a little tiny be your something where maybe I have to follow the career
13:30
since it’s important to do that so here again I’m just doing everything very
13:37
gently on sealing edges i dont wanna pull on the tree I don’t a lot of times
13:42
that’s nothing keeping a treat to talk not a good thing because then the soon
13:47
as the patient gets up and you end up having buckles and it starts to cum alot
13:52
of the skin and that’s not what it really needs to follow those body curves
14:00
so that doesn’t happen now I’m just removing great number two and as you can
14:05
see I lift up the side and a call from the bottom so if you’re not used to that
14:11
type of a dream that’s where that is that little clout is underneath
14:18
and then I just press that down gently and neatly and follow my body
14:23
contractors and then I’m able to pull off that pollute out at the end
14:27
ok so this is number three what you can do is you gonna hold this blue tab here
14:34
and as you can see there’s little straight edge just grab this raided
14:38
edged up number three nothing sixty hymns is no issues at all and no
14:44
struggling with the removal of the top three and then you can pull off your
14:50
caps I was a little too quick on that but they pull up very nicely this is
14:54
what you’re left with it as you can see if the patient was to get up this one
14:59
bottle because I just made this will be here to make it a little bit easier
15:09
alright here’s a little video and this is how you do the new domes
15:24
is extremely user friendly as you can tell and then House pl to you can see
15:42
the Astros are going this way and then appealed to on this side of the arrows
15:47
coming this way and then just a number three that’s just don’t hold in tier so
15:52
what we’re gonna be doing is we’re gonna be lining up are doing with the whole
15:57
that we’ve gotten a transparent tree do that by just he’s only number 11 have
16:06
number one can see you gonna do it with just started where actual beings gonna
16:11
come out I’m gonna make sure the holes are completely lined up so that we don’t
16:18
end up having any blockages and we’re very gently to spin around edges then
16:24
we’re gonna grab your number two you can tell you it’s just left and thats and
16:38
these are number three that while this is his last year
16:42
take another crucial can now are to be connected to canister and turn it on
16:55
going to check the doctor’s orders what he actually quite a few millimeters of
16:59
mercury just to doublecheck gonna turn it on and you’re gonna be good to go
17:07
and very very good meaning nurses because what we want is once this is
17:14
done and it’s taking awhile God knows that sometimes you want to keep it on so
17:18
people will put transparent trip began over this whole area and that actually
17:26
causes like an airlock within it needs a transmission oxygen to some degree so
17:35
therefore
17:37
and alarming later on I might take a little while but you want to belong so
17:41
we don’t want to cover the stone had we might have to put some extra things like
17:48
that just two extra protective
17:57
that done we’ve connected to the canister and we compress picture was
18:05
taken but it’s all compressed and then here you can do all different things I
18:12
just happen to have a little piece of extra weight foam so I cut a little
18:15
tunnel I’ll because this patient happen to have very very bad skin integrity and
18:21
we’re worried about the tubing so there was an idea or you can do all different
18:27
things I then created like little Chevron or something
18:31
taped the tubing down is that some point you don’t want this to be pulling up and
18:37
then pulling this pop up because although it won’t completely break seal
18:41
it will cause alarms to go off and drive nurses crazy and I don’t want that to
18:45
happen this is just one way another way that way is this is natural Chevron just
18:52
putting the Chevron putting it down and making sure everything is completely
18:59
healed him up so that again you’re not gonna be sitting here and saying oh my
19:06
god this was a very simple basic of course there’s also bridging there is
19:13
bridging to offload this bridging two together some reasons you would do Y
19:19
port versus a bridge things like that so they come up in other mixed up w
19:27
abridging video next month they do want to thank you for joining me today in
19:33
what I would love is as people do I put my Holly WCC @ yahoo.com and what my
19:43
hope is that people realize these are
19:46
you know these I just given for the ability of helping out people so please
19:53
look at my other products please call me if you have any other educational hero
19:59
and please email me with where you’re from I know I have Taylor patricia is
20:06
Caroline today so please email me with you know your thoughts and also where
20:11
you’re from things like that so that as I get things like an email you were to
20:16
tease and things like that but thank you very much for today I hope you enjoyed
20:21
the webinar alright by anybody have any questions
20:29
forgot to ask that hollywood you do give me that email address again in fact I
20:37
don’t know what about screen doesn’t come off its Holly H O L ly WCC @
20:46
yahoo.com so it’s Holly we don’t care certified initials at yahoo.com and I’ll
20:53
also give you my number my number as I think I have a nurse’s on my numbers 40
20:58
1808
21:01
9301 it’s wonderful people let me know where they’re from there from long-term
21:07
key are there you know work with a certain product it’s great to know what
21:13
you know and sort of make up a nice little collaboration of nurses so feel
21:19
thank you you’re very welcome I hope everybody enjoyed it and my next one
21:28
thank you have a great day

 

The Power of KoCarbon Ag Antimicrobial Silver Carbon Wound Dressing by Equinox Medical

Power Of KoCarbon Ag Antimicrobal Silver Carbon Wound Dressing

Absorption

  • Clinically tested with 97% ammonia deodorizing rate
  • Absorbs Malodors, endotoxins and bacteria in the wound site
  • Gram-negative bacteria release endotoxins when drestoyed and the silver carbon wound dressing help absorps the endotoxins into the dressing.
  • Helps contain and absorps bacteria including E.Coli, P. Aeruginosa and S. Aureus and many more

Far-Infrared Ray Emitting

  • Increase tissue temperature and blood volume
  • Increase the secretion of collagen fiver and TGF-ß
  • Far-Infrared Ray (FIR) inhibit inflamation
  • Protects  cells from apoptosis after ischemia/reperfusion injury

X-ray and MRI Examination

  • Can stay on during X-ray or MRI Examination

Order Your Free Silver Carbon Wound Dressing Sample By Clicking On The Picture Below!

free kocarbon ag antimicrobial Silver carbon wound dressing from equinox medical

Free Clinical Webinar “NPWT Black Foam Wound Dressing Bridging Two Wounds Application by Equinox Medical

Free Clinical Webinar Black Foam Wound Dressing Bridging Application, Holly Desimone, Wound Nurse In New England

Equinox Medical is offering Free Clinical Webinar on February 26, 2016 at 10:00 AM Eastern Standard Time.

The webinar will cover how to use your negative pressure wound therapy (NPWT) black foam wound dressing when you have to bridge two wounds.

Bridging Two Wounds

Bridging between 2 black foam is a technique that may be useful to either incorporate more than one wound to one Halo MINI NPWT Pump unit or as a method to bring the suction from a site less assessable to a more convenient site, such as taking suction from a plantar wound to placing the suction at the dorsum of the foot. This may also be a useful method to move tubing away from an area already compromised to prevent breakdown from the tubing itself.

Webinar is hosted by:

Holly Desimone, RN, BSN, WCC and Joey Mallari, Product Marketing Manager at Equinox Medical

KoCarbon Ag Silver-Based Wound Dressings Reduce Bacterial Burden And Promote Wound Healing Clinical Study by Equinox Medical

kocarbon ag antimicrobial silver carbon wound dressing logo

Silver-Based Wound Dressings Reduce Bacterial Burden And Promote Wound Healing

Yu-Hsin Lin1, Wei-Shan Hsu2, Wan-Yu Chung3, Tse-Hao Ko4 & Jui-Hsiang Lin5
1 Department of Biological Science and Technology, China Medical University, Taichung, Taiwan
2 R&D Center, Bio-medical Carbon Technology Co., Ltd., Taichung, Taiwan
3 R&D Center, Bio-medical Carbon Technology Co., Ltd., Taichung, Taiwan
4 Department of Materials Science and Engineering, Feng Chia University, Taichung, Taiwan
5 R&D Center, Bio-medical Carbon Technology Co., Ltd., Taichung, Taiwan

Various types of wound dressings have been designed for different purposes and functions. Controlling bacterial burden in a wound during the early phase is important for successfulwound repair.Once bacterial burden is under control, the active promotion of wound healing is another important factor for efficient wound healing.

This study investigated the potential of three silver-containing dressings, namely KoCarbonAg®, Aquacel® Ag and Acticoat 7, in reducing bacterial survival and promoting wound healing. The ability of these dressings to block the entry of bacteria from external environment and retain intrinsic bacteria was studied in vitro.

In addition, the study used a rat model to compare the healing efficiencies of the three dressings and investigate the quantity of collagen synthesis in vivo. In vitro results indicated that the silver-containing dressings prevented bacterial growth in wounds by blocking the entry of external bacteria and by retaining the bacteria in the dressing. In vivo study indicated that reduction in bacterial burden accelerated wound healing.Wounds treated by the silver-containing dressings showed better healing than those treated with gauze. Moreover, KoCarbonAg® further accelerated wound healing by promoting collagen synthesis and arrangement.

download_the_kocarbon_ag_clinical_study.png

The skin is the biggest organ in the body that performs protective, sensory and thermoregulatory functions. Wound healing involves three phases: inflammation, proliferation and remodelling(1).

The inflammatory phase begins immediately after a skin injury. It is characterised by the release of platelet-derived growth factor by the platelets in the thrombus that attracts neutrophils and macrophages towards the wound bed to remove necrotic tissue, debris and bacteria (2,3). Macrophages then become the dominant cells in the inflammatory phase and further release various growth factors such as fibroblast growth factor and transforming growth factor beta (TGF-β) to induce fibroblast proliferation and collagen synthesis, respectively, thus, entering into the proliferation phase (2,4).

Fibroblast proliferationand collagen synthesis are the two prominent events in the proliferation phase. Meanwhile, this phase also involves other events, such as angiogenesis and epithelialisation, which promote the repair of the wound cavity and the formation of reepithelialised skin. In the remodelling phase, the irregularly arranged collagen would be degraded and replaced by regularly aligned collagen fibres to strengthen the newly formed skin (2,5).

Key Messages

• A multifunctional dressing that can control bacterial burden and promotewound healing at the same time provides a better choice for wound care
• This study investigated the potential of three silvercontaining dressings, namely KoCarbonAg®, Aquacel® Ag and Acticoat 7, in reducing bacterial survival and promoting wound healing process

• In vitro study, the silver-containing dressings can prevent bacterial growth in wounds by blocking the entry of external bacteria and by retaining the bacteria in the dressing. In vivo study, the KoCarbonAg® dressing
can accelerate wound healing by promoting collagen synthesis

Open wounds contain a certain degree of bacteria on their surface. States of contamination, colonisation, critical colonisation and invasive infection can be categorised depending on the amount and effects of bacteria in the wound (6,7).

Contamination is defined as the presence of non-replicating bacteria in the wound. Colonisation is defined as the presence of replicating bacteria in the wound without any tissue damage. These two states do not delay the healing processes. However, critical colonisation, in which bacteria do not invade the skin tissue, would delay wound healing. Invasive infection is characterised by bacterial density of 105 microorganisms per gram of the skin tissue (7–9).

Delayed wound healing occurs because of the increased levels of endotoxins produced by bacteria (7). Endotoxins are known to elevate the levels of proinflammatory cytokines, which in turn decrease the production of growth factors and the deposition of collagen in wounds, leading to critical colonisation and invasive infection (7,10,11).

Therefore, it is important to keep the bacterial burden in the wound bed below the level of critical colonisation. All the currently available wound dressings promote wound healing and prevent further harm to the wounded region. An ideal wound dressing maintains moisture in the wound, removes excess exudates, is non-adherent, prevents the entry of microorganisms, controls infection, allows gaseous exchange and leaves no foreign particles in the wound (12,13). Although different dressings have different properties, all the dressings function as a barrier (at various degrees) to prevent the entry of external microorganisms. A recent study by Fujiwara et al. put forth a new concept of bacterial retention in a wound dressing.

They proposed that the ability of a dressing to retain bacteria could be important for reducing bacterial burden in the wound bed. In addition to controlling bacterial burden, a wound dressing actively promotes wound healing, thus accelerating the healing processes (14).

In this study, we examined three silver-containing dressings made of different raw materials and compared their efficiency with that of gauze (control). These three dressings are as follows: (i) KoCarbonAg® (Biomedical Carbon Technology Co., Ltd., Taichung, Taiwan) containing activated carbon fibre (ACF) supported by silver particles, (ii) Acticoat 7 (Smith & Nephew, London, UK) containing alternate layers of rayon and silver-coated polyethylene film and (iii) Aquacel® Ag (ConvaTec Inc., Skillman, NJ) containing hydrofibres and ionic silver.We investigated the ability of these three dressings to block and retain bacteria in vitro and their wound healing efficacy in vivo in a rat model.

Methods

Bacteria Preparation

The bacteria Pseudomonas aeruginosa (ATCC 27853) were grown on tryptic soy broth (TSB) agar plates under

microaerophilic conditions for 24 hours at 37∘C. A single colony was selected and cultured in TSB medium to an optical density of 1⋅0 at 590 nm (OD590) measured by a visible spectrophotometer (Biochrom, England, UK). The suspension was diluted in TSB medium to achieve a final concentration of 1 × 105 colony-forming unit/ml (CFU/ml) for further use.

Analysis of bacterial blocking activity

For analysing the bacterial blocking activity, 6 ×6 cm2 pieces of the dressings were placed on agar plates with their skin-contacting surface facing downwards. Then, 3 ml suspension of P. aeruginosa (1 × 105 CFU/ml) was inoculated in the centre of the dressing on the exposed upper surface. The plates were incubated at 37∘C for 24 hours. The test pieces of the dressings were then removed aseptically, and the plates were further incubated for 24 hours at 37∘C. The area of bacterial growth in each plate was measured using Image Tool 3.0 (UTHSCSA, San Antonio, TX).

Analysis of bacterial retention activity

In a laminar flow cabinet, 3 ml suspension of P. aeruginosa (1 × 105 CFU/ml)was placed in the centre of the 6 × 6 cm2 piece of each test dressing on the skin-contacting surface. The pieces were incubated for 5minutes to allow the complete absorption of the bacterial suspension. The pieces were then placed on plates, with the skin-contacting surface facing downward, and the plates were incubated at 37∘C for 24 hours. The dressing pieces were then removed aseptically, and the agar plates were further incubated for another 24 hours at 37∘C. The area of bacterial growth in each plate was measured using Image Tool 3.0.

Quantification of bacterial quantity

The areas on the agar plates covered by the dressing pieces were cut and transferred to a new culture plate. Then, 10ml of TSB was added, and the plates were incubated at 37∘C. Next, 100 μL cultures incubated for 1 hour and 6 hours were used for water-soluble tetrazolium salt (WST-1) assay (Roche Diagnostics, Mannheim, Germany).

Wound healing and histologic analysis of wound tissue

Animal care and use complied with the 1996 revision of the ‘guide for the care and use of laboratory animals’ prepared by the Institute of Laboratory Animal Resources, National Research Council, and published by the National Academy Press. A total of 20 Sprague–Dawley (SD) rats weighing 250–300 g were individually housed in polycarbonate cages maintained at constant temperature (22±2∘C) and humidity (55%). The rats were subjected to a 12:12 hour light–dark cycle and were provided access to food and water. Their average weight and behaviour did not change significantly during the experiment. Rats were anaesthetised with an intraperitoneal injection of ketamine (90 mg/kg) with xylazine (10mg/kg) (15). The dorsal skin was shaved, application fields were outlined with a marker pen before skin excision and the surgical area was disinfected with 70% ethanol. On the back of each rat,

a full-thickness wound with dimensions of 1 × 1 cm2 was created on each side of the spine by dermo-epidermic excision.
Each of the wounded rats received 100 μl of P. aeruginosa (1⋅5 OD590) on the wound surface. Wound dressings with dimensions of 2 × 2 cm2 were applied onto the wounded rats after 24- hour infection. Each dressing was covered with a sterile compress secured with a hypoallergenic elastic adhesive bandage. Animals were caged individually following identification. The dressings were changed every 3 days; the wounds were photographed and examined to determine wound size reduction. Wound size measurements taken during surgery and at biopsy were used to calculate percentage size reductions of wounds (16).

Wound size reduction (%) = [(A0 –At) ∕A0] × 100

where A0 and At denote initial wound area and wound area after time interval ‘t’, respectively. Wound area was measured from photographs using the Image-Pro Plus (Media Cybernetics, Silver Spring, MD) following calibration. Histologic analysis on day 3 was carried out using light microscopy. Briefly, biopsies were fixed in buffered paraformaldehyde and embedded in paraffin wax (17,18). Sections of 5 μm were stained with Masson’s trichrome. The stained sections of each test sample were then examined under a light microscope for the analysis of collagen synthesis.

Western blotting analysis of wound tissue

Wound tissue extracts were fractionated by performing sodium dodecyl sulphate polyacrylamide gel electrophoresis (SDS-PAGE). The separated proteins were transferred onto a polyvinylidene difluoride membrane by using a transfer apparatus (Bio-Rad Laboratories Inc., Hercules, CA), according to the manufacturer’s protocols. After incubation with 5% non-fat milk in TBST (10mM Tris pH 8⋅0, 150mM NaCl, and 0⋅05% Tween-20) for 60minutes, the membrane was washed once with TBST and was incubated with primary antibodies against rabbit anti-collagen-1 antibody (1:500 dilution) or mouse anti-glyceraldehyde-3-phosphate dehydrogenase (GAPDH; 1:5000 dilution) at 4∘C for 16 hours.

The membrane was then washed three times and was incubated with horseradish peroxidase–conjugated anti-rabbit or anti-mouse antibodies (1:5000 dilution) for 1 hour. The blots were washed three times with TBST and the proteins were visualised by enhanced chemiluminescence western blotting detection reagents (GE Healthcare, Little Chalfont, UK) and detected by X-ray films (Kodak, New York, NY). Concentration of collagen-1 was quantified using ImageJ software (National Institute of Health, Bethesda, MD) after normalisation with GAPDH protein.

Results

Ability of the dressings to block the entry of bacteria from external environment

An important function of a wound dressing is to protect the wound area from any contamination from the external environment. In this study, the ability of the three dressings to block the entry of bacteria from the external environment was tested. Percentage bacterial growth on the agar plates after inoculating P. aeruginosa on the exposed surface of the dressings was investigated.

Data obtained from image analysis showed that growth area of P. aeruginosa on plates covered by gauze was 80⋅3%±4⋅9% of the covered area, indicating that gauze barely protected the wound area from the external environment (Figure 1A and B). The gauze blocked only 20% of the inoculated bacteria, and the remaining bacteria penetrated through the gauze and colonised the wound area. The growth area of P. aeruginosa on plates covered by KoCarbonAg® was 0⋅41%±0⋅3% of the covered area, indicating that KoCarbonAg® blocked the entry of >99% bacteria and prevented them from colonising on the wound area. 

The growth areas of P. aeruginosa on plates covered by Acticoat 7 and Aquacel® Ag were 18⋅6%±9⋅6% and 30⋅5%±2⋅4%, respectively, of the covered areas. However, this could be because of the interference by brown colour developed on the plate covered by Acticoat 7 or by fibres left on the plate covered by Aquacel® Ag (Figure 1A).

The amount of bacteria on each plate was quantified by performing the WST-1 assay. Bacteria were harvested from
the plates and were cultured in TBS for up to 6 hours. Relative bacterial counts at 1 hour and 6 hours are represented in
Figure 1C. The plate covered with gauze had large amount of bacteria (15- and 96-fold higher than that in the control plate
at 1 and 6 hours, respectively), which was consistent with the results of image analysis.

Plates covered by KoCarbonAg® and Aquacel® Ag had similar amounts of bacteria at both 1 and 6 hours, whereas the plate covered with Acticoat 7 had slightly increased amount of bacteria (1⋅5- and 2-fold higher amount of bacteria than that in the control plate at 1 and 6 hours, respectively). Results of the WST-1 assay indicated that both Aquacel® Ag and KoCarbonAg® had a similar capacity to protect wounds from environmental contamination, indicating that Aquacel® Ag could also block 99% of external bacteria (Figure 1C). The bacterial amount obtained from the plate covered with Acticoat 7 at 1 hour was approximately 1/10th of that obtained from the plate covered by gauze. Bacterial growth area in the plate covered by gauze was 80⋅3%, while it was estimated to be 8% in the plate covered by Acticoat 7.This indicated that Acticoat 7 blocked approximately 92% of external bacteria.

Ability for retaining bacteria in the dressing
Wound dressing is usually applied to the wounded area from a couple of hours to a few days. Besides the surrounding environment, the dressing itself is another source of bacterial contamination. If the dressing cannot retain the absorbed bacteria, then the bacteria would leak into the wound area to induce inflammation or to colonise, thus delaying wound healing. To examine the ability of the wound dressings to retain the absorbed  bacteria, the percentage growth of P. aeruginosa inoculated on the skin-contacting surface of the dressings was investigated.

The image analysis data showed that the growth area of P. aeruginosa on the plate covered by gauze was 93⋅2%±9⋅6% of the covered area, indicating that the gauze could not retain the absorbed bacteria (Figure 2A and B). Only approximately 7% of bacteria were retained in the gauze, and the remaining leaked out and colonised the wound area. The growth area of both 1 and 6 hours). The results of the WST-1 assay indicated that Aquacel® Ag and KoCarbonAg® had a similar capacity to retain bacteria, indicating that Aquacel® Ag could also prevent 99% of bacteria from leaking out. The bacterial amount in the Acticoat 7-covered plate at 1 hour was approximately 2⋅2/14 of that in the gauze-covered plate (Figure 2C). Bacterial growth area in the gauze-covered plate was 93⋅2% of the covered area, while that in the Acticoat 7-covered plate was estimated to be 15%, which indicated that Acticoat 7 prevented approximately 85% bacteria from leaking out. The results of blockage and retention tests also represent the antimicrobial activity of these silver-coated dressings. The results of the WST-1 Assay indicated that KoCarbonAg® and Aquacel® Ag eliminated almost all the bacteria that escaped from the dressing. However, Acticoat 7, which contains the highest concentration of silver (1⋅7mg/cm2) among these three dressings, could not eliminate all the bacteria that escaped the dressing. 

(Figure 2a, 2b and 2c below)

KoCarbon Ag Antimicrobial Silver Carbon accelerated wound healing
KoCarbon Ag Antimicrobial Silver Carbon accelerated wound healing
KoCarbon Ag Antimicrobial Silver Carbon accelerated wound healing

Wound healing of silver-containing dressing

Thus, the above data indicate that KoCarbonAg® and Aquacel® Ag have better capacity to block, retain and kill microbes than Acticoat 7 and gauze. To understand the effect of these factors on the outcome of wound healing, we analysed
the closure areas of infected wounds in a rat model. The results indicated that the factors mentioned above played important
roles in wound healing.

Throughout the experimental period, all the silver-containing dressings resulted in a greater reduction in the wound area than gauze (Figures 3 and 4), which barely prevented bacterial growth/contamination in the wound area.


However, these three factors only partly affect wound healing. Regardless, KoCarbonAg® and Aquacel® Ag showed similar
capacities in preventing bacterial growth/contamination in the wound area, with KoCarbonAg® exhibiting a greater reduction
of the wound area than Aquacel® Ag. In addition, although Aquacel® Ag showed better bacterial inhibition than Acticoat
7, these two dressings showed a similar reduction in the wound area throughout the experimental period (Figures 3 and 4).

This result suggested that once 85% of the bacterial growth was inhibited (minimal percentage of inhibition among these
three silver-containing dressings), the remaining small amount of replicating bacteria in the wound area did not reach the level
of critical colonisation, and thus did not interfere with wound healing. Besides reducing bacterial burden, KoCarbonAg®
actively promoted wound healing to accelerate the healing process.

Kocarbon Ag silver carbon wound dressing Accelerated wound healing on these wounds

Histologic analysis and western blotting analysis of wound tissue

To determine whether KoCarbonAg® promoted collagen synthesis during wound healing, tissue samples from wounds treated with gauze, KoCarbonAg®, Aquacel® Ag and Acticoat 7 were investigated using Masson’s trichrome staining after 3 days (Figure 5).

Results of Masson’s trichrome staining showed that KoCarbonAg®- and Aquacel® Ag-treated wounds showed higher collagen synthesis (red arrows). Moreover, collagen fibres were aligned more tightly in the wound treated with KoCarbonAg®. Acticoat 7-treated wounds showed less and loose collagen fibres than KoCarbonAg®- and Aquacel® Ag-treated wounds. In contrast, gauze-treated wounds showed loose and sporadic collagen fibres. To quantify the amount of collagen produced, western blotting was performed using anti-collagen-1 antibody (Figure 6A). On day 2, collagen-1 fibres in the wound area treated with KoCarbonAg® showed 2⋅11-fold increase, whereas those in the wounds area treated with Aquacel® Ag, Acticoat 7 and gauze showed 1⋅81-, 1⋅03-, and 1⋅36-fold increase, respectively (Figure 6B). These results indicated that KoCarbonAg® promoted wound healing by increasing collagen-1 synthesis.

kocarbon ag Silver-based_wound_dressings_reduce_bacterial_burden_and_promote_wound_healing-5_graph.png
kocarbon ag Silver-based_wound_dressings_reduce_bacterial_burden_and_promote_wound_healing-6.png

Discussion

Most chronic wounds are characterised by a prolonged inflammatory phase. Proinflammatory cytokines induced by bacteria decrease the level of growth factors and subsequently delay the entry of the wound into the proliferation phase. In vitro data indicate that silver-containing dressings block bacterial entry from the external environment and retain bacteria in the dressing to inhibit bacterial growth on the wounds. Silver may play a role in these two events but is not a decisive factor because dressings with low silver concentration, such as KoCarbonAg® and Aquacel® Ag, have better inhibition capacities. In the animal model, silver dressings promoted wound healing by blocking external bacteria, retaining bacteria in the dressing and exerting antimicrobial activity. Reduction in bacterial burden prevents the accumulation of proinflammatory cytokines and endotoxins, thus promoting the production of growth factors such as TGF-β, which is important for the entry into the proliferation phase.

Of the three dressings, KoCarbonAg® exhibited the greatest reduction in healing time. This may be partly because of the characteristic of its constituent material, that is, ACF. ACF has higher microporosity and substantial internal surface area, indicating that it has excellent capacity to absorb gases and chemicals, including endotoxins (19–23). Therefore, besides inhibiting bacterial growth in the wound, KoCarbonAg® may also adsorb deleterious endotoxins from the wound bed to decrease their interference in wound healing.

Furthermore, ACF emits far infrared radiation (FIR) that promotes wound healing by increasing the proliferation of fibroblasts and production of collagen in the wound (24,25). Moreover, FIR promotes wound healing by increasing skin microcirculation that is believed to be the mechanism of action of FIR therapy for treating different wounds (26,27). To confirm the FIR-emitting ability of KoCarbonAg®, emissivity of 2–22 μm at 25∘C, according to the JSC-3 inspection method, was tested by the Tze-Chiang Foundation of Science & Technology, Taiwan. Their results showed that the FIR emissivity rate of KoCarbonAg® was 90% (data upon request), indicating that KoCarbonAg® emitted FIR. Thus, wound dressings containing ACF, such as KoCarbonAg®, accelerate wound healing and induce the expression of collagen-1 compared with gauze and other commercial dressings. Thus, the better wound healing associated with KoCarbonAg® might be attributed to FIR emitted by ACF in the dressing.

kocarbon ag Silver-based_wound_dressings_reduce_bacterial_burden_and_promote_wound_healing-7.png

Conclusion

Wound healing is a complicated process involving many factors that interact reciprocally. Control of bacterial burden is critical in the early phase of wound healing. In the  proliferation phase, active promotion of wound healing is a prominent factor. In this study, we showed that the silver-containing dressing KoCarbonAg® not only reduced bacterial burden in the inflammatory phase but also promoted wound healing in the proliferation phase by promoting the production of collagen-1. Although an ideal dressing might not exist, choosing a multifunctional dressing might be cost-effective and helpful to both
patients and clinicians.

Acknowledgements
The authors would like to thank Enago (http://www.enago.tw) for the English language review.


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Joey Mallari, Product Marketing Manager @ Equinox Medical, LLC

Unboxing KoCarbon Ag Antimicrobial Silver Carbon Wound Dressing Video

Indication:General trauma, abrasions, post-surgical wounds / diabetes mellitus, pressure sores and other chronic wounds / first & second-degree burns / wounds caused by tumors or chemotherapy / wounds at the donor site and graft site / intubation site / full thickness & partial-thickness wounds

KoCarbonAg Antimicrobial Silver Carbon Wound Dressing is a new generation silver activated carbon fiber dressing clinically proven to provide antimicrobial effect.
KoCarbonAg Antimicrobial Silver Carbon Wound Dressing™ is designed for infectious acute/chronic wounds and difficult wounds. The lining (wound contact layer) of KoCarbonAg® Antimicrobial Dressing™ is primarily composed of PET non-woven fabric, silver activated carbon fiber fabric and PE membrane. The Antimicrobial Dressing contains silver at a level of 0.1 mg/cm2. When in contact with the wound, the bandage will provide excellent absorption and moisturizing effect to absorb blood exudate and bacteria and provide a moist environment for the wound. The silver ions in the dressing can inhibit the growth of bacteria absorbed by the dressing from the wound, and form an antimicrobial barrier that prevents infection and reduces wound odor.
The activated carbon fiber in the KoCarbonAg® Antimicrobial Silver Carbon Wound Dressing™ can moisturize the wound. It creates a moist environment for the wound to recover and shortens healing time. The dressing can be cut into the size of the wound. The low adhesion wound contact layer can effectively reduce the adhesion with the wound and reduce the pain when changing the dressing.

FREE SILVERSORB, MEPILEX, ACTICOAT, SILVERLON