What is the best wound product that could address the numerous challenges of wound management such as shortest healing time, patient comfort, best aesthetic result in a cost-effective manner? What are the factors that determine, based on patient needs, the adequate product inventory and based on what factors the practitioners select the best wound healing product?
Healers, thousand years ago, when they were trying to manage wound healing to the best interest of their patients had the same questions. It is of remarkable note that a clay tablet in 2,200 B.C. described as the “three healing gestures” namely being “washing the wounds, making the plasters, and bandaging the wound” (Ackerknecht, 1982; Carmichael and Ratzan, 1991). Ancient plasters are today’s wound dressings. These “plasters” were described as mixtures of materials such as mud or clay, oil, beer, plants, and herbs and were used by different civilizations, such as the Egyptians, Sumerians and Indians to provide protection and to absorb exudate from wounds. The Egyptians were the first to use bandages made from lint soaked in grease and honey, as an anti-bacterial barrier to the wounds and painted the wounds with copper to also take advantage of its anti-bacterial properties (Carmichael and Ratzan, 1991). Several thousand years later, honey is still used in advanced wound dressings, known in clinical practice as MANUKAhdâ, MediHoneyâ or TheraHoneyâ dressings. The Greeks focused on the importance of the cleaning of the wounds and in their manuscripts recommended “washing the wound with clean boiled water, vinegar (acetic acid), and wine (ethanol)” and they differentially diagnosed between “fresh” (acute wounds) and “non-healing”, (chronic) wounds. Hippocrates in one of his manuscripts wrote: “For an obstinate ulcer, sweet wine and a lot of patience should be enough”, (Carmichael and Ratzan, 1991).
5,000 years later, there are more than 5,000 wound care products (dressings, ointments, debridement agents, cleansers, antimicrobial solutions, creams, lotions, bandages, skin substitutes and not otherwise specified-NOC). The expectations however over the years for an effective wound care product remained almost the same. Despite the technological revolution of the last 50 years, we are still looking for products that are capable of maintaining high humidity at the wound site while they remove exudate, they are free of particles and toxic contaminants, they are non-toxic and non-allergenic, they can be removed without creating further trauma to the wound, they cannot be penetrated by bacteria, they allow gaseous exchange, they are thermally insulated, they are comfortable, they do not need to be changed frequently, they stimulate the host to regenerate lost tissue and replace the wound with functional skin and, most recently, we realized how important it is to have products that have long shelf life, are cost effective and available to all socio-economic backgrounds (Arudchelvam 2019; Dickison and Gerecht, 2018).
