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Keywords: DEBRIDEMENT INFECTION / INFLAMMATION MOISTURE CONTROL EDGE ENVIRONMENT SilvaSorb • Puracol Plus • Optifoam • Derma-Gel • Skintegrity • Arglaes Exuderm OdorShield • Suresite • Stratasorb • Maxorb Extra • FourFlex Skintegrity Wound Cleanser • ThreeFlex • Sureprep No-Sting • Medigrip Medfix • Bordered Gauze • TenderWet Active • Optifoam Ag • Maxorb Extra Ag SilvaSorb • Puracol Plus • Optifoam • Derma-Gel • MatriStem • Gentac TODAY’S WOUND CARE TREATMENTS FROM MEDLINE Wound Bed Preparation Paradigm Person with Chronic Wounds Treat Cause: (e.g. vascular supply, edema, pressure, shear) Local Wound Care Patient-Centered Concerns: Pain Treat Cause: (e.g. vascular supply, edema, pressure, shear) including pain Debridement of Devitalized Tissue pressure redistribution Infection (superficial/deep) Inflammation Moisture Balance Edge – Non-healing Wound Biological agents, Growth factors, Skin substitutes, Adjunctive therapies Support with Products, Services and Education To provide today’s wound care treatments Today’s Wound Care Treatments from Medline® 2 The assessment and treatment of chronic wounds is a daily challenge. Clinicians need guidance on their wound care journey as they move between care settings with financial constraints, finite resources and the need to optimize wound care.1 With this in mind, Medline has adopted the DIMES© system of wound bed preparation and treatment options providing a simple guide to assist you in selecting the right product, at the right time, for your patient’s wounds. Figure 1 DIMES serves as an easy framework for planning and implementing an effective treatment plan for chronic wounds while saving money and using valuable resources wisely. We all realize that preparation is the key to care. This is also true in preparing wounds for healing. The Wound Bed Preparation (WBP) Paradigm was created as a practical guide for the treatment of chronic wounds (see Figure 1).1,2,3,4 What do DIMES have to do with chronic wound care? © Sibbald, Woo and Ayello Today’s Wound Care Treatments from Medline 3 The removal of nonviable tissue Addressing bioburden and inflammation within the wound Achieving and maintaining moisture balance in and around the wound Debridement Infection/Inflammation Moisture Balance D I M DIMES an organized and consistent approach toWound Care Evidence Based References 1. Woo KY, Ayello EA, Sibbald RG. Using DIMES to your advantage: Treating chronic wounds. Healthy Skin. 2008:5(1):22-27. 2. Sibbald RG, Williamson D, Orsted HL et al. Preparing the wound bed: debridement, bacterial balance and moisture balance. Ostomy Wound Management. 2000;46(11): 14-22, 24-8, 30-5; quiz 36-7. 3. Sibbald RG, Orsted H, Schultz GS, Coutts P, Keast D. International Wound Bed Preparation Advisory Board. Canadian Chronic Wound Advisory Board. Preparing the wound bed 2003: focus on infection and inflammation. Ostomy Wound Management. 2003; 49(11): 23-51. 4. Sibbald RG, Orsted HL, Coutts PM, Keast DL. Best practice recommendations for preparing the wound bed: update 2006. Advances in Skin & Wound Care. 2007;20:390-405. 5. Woo K, Ayello EA, Sibbald RG. The edge effect: Current therapeutic options to advance the wound edge. Advances in Skin & Wound Care. 2007; 20(2): 99-117. The initial components of local care are1: Edge/Environment Supportive Products, Services and Education Treating stalled wounds where epithelium fails to migrate Appropriate support promotes optimal outcomes E S As always, the patient comes first. Start by addressing patient-centered concerns, then treat the cause of the wound before optimizing local wound care.1 DIM before DIMES4: Is there anything else that can be done to promote faster wound edge migration after local wound care has been optimized? What else is needed to support healing? This might include selecting products for stalled chronic wounds combined with patient education to strengthen partnerships and promote adherence to treatment.1 D I M E S 4 Support Edge /Environment Moisture Balance Infection/ Inflammation Debridement It is important to understand that DIMES is not just an acronym but a roadmap for practice.1 Debridement For wounds with the ability to heal, adequate and repeated debridement is an important first step in removing necrotic tissue. Debridement may also help healing by removing both senescent cells that are no longer capable of normal cellular activities and biofilms that shield the bacterial colonies.1 Infection/Inflammation All chronic wounds contain bacteria.The level of bacterial damage may include contamination (organisms present), colonization (organisms present and may cause surface damage if critically colonized) or infection (deep and surrounding skin damage).There are many antimicrobial products available, and no one product is going to be right for all patients. Clinicians need to match appropriate product characteristics with the clinical features of the wound bed.1 Moisture Balance Achieving moisture balance is a delicate act. Cells and the various cellular signals all need the right amount of moisture to move across the wound bed. Too much moisture can damage the surrounding skin, leading to periwound maceration and skin breakdown. Conversely, too little moisture in the wound environment can impede cellular activities and promote eschar formation, resulting in poor wound healing.1 Edge/Environment If the wound edge is not migrating after appropriate wound bed preparation (debridement, infection/inflammation, moisture balance) and healing is stalled, then advanced therapies should be considered.1 There are other products that complement DIMES but do not fit into one of these immediate categories. Therefore, always consider the “other” supportive products to complete the treatment. Additionally, supportive services (i.e. nutritional therapy) and education are paramount to achieving the best possible outcome.1 Supportive Products, Services and Education Today’s Wound Care Treatments from Medline 5 Connecting the right product to the right application is critical. Today’s Wound Care Treatments from Medline is organized in this catalog using the first letter of each component of care, D-I-M-E-S. To make it even easier we’ve provided a chart to guide you through each component of the DIMES system and solutions that Medline provides. Note each section is color coded by letter. DIMES Components Products Page No. D Debridement • TenderWet®Active 6 I Infection/Inflammation • Arglaes® 8 • Maxorb® Extra Ag 10 • Optifoam® Ag 12 • SilvaSorb® 14 M Moisture Balance • Derma-Gel® 16 • Exuderm OdorShield™ 18 • Maxorb® Extra 20 • Optifoam® 22 • Skintegrity® 24 • Suresite® 26 E Edge/Environment • Puracol® Plus 30 • Puracol® Plus Ag 32 • MatriStem™ 34 S Supportive Products Services and Education • Bordered Gauze 42 • FourFlex 36 • Gentac™ 40 • Medfix 41 • Medigrip 38 • Skintegrity®Wound Cleanser 44 • Stratasorb® 42 • Sureprep® 46 • Sureprep® No Sting 46 • ThreeFlex 36 • Classification of Tissue Destruction 49 • Compass 51 • Educare Hotline 53 • Educare Seminars 52 • Educational Packaging 50 • Medline University 52 • Product Selection Guide 48 • Wound and Skin Care Product Specialists 53 • www.medline.com/woundcare 53 Evidence Based References 1. Woo KY, Ayello EA, Sibbald RG. Using DIMES to your advantage: Treating chronic wounds. Healthy Skin. 2008:5(1):22-27. D I M E S Table of Contents About TenderWet Active • Helps debride necrotic wounds1,2 • Absorbs and retains microorganisms (biofilm) in pad3 • Uses Ringer’s physiologically-compatible solution4 • More effective than wet gauze therapy5 • Will not stick to wound bed, which helps ease the pain of dressing changes6 • Cost-effective5,7 • Helps create an ideal moist healing environment • High fluid retention • Easy application and removal TenderWet Active Polyacrylate Debriding Wound Dressing Support Edge /Environment Moisture Balance Infection/ Inflammation Debridement Indications Pressure ulcers Partial and full-thickness wounds Leg ulcers Diabetic ulcers Surgical wounds Lacerations and abrasions Skin tears Dry, light and moderately draining wounds First and second-degree burns Contraindications None Change Frequency TenderWet may be left in place for up to 24 hours Dressing change frequency will depend on the amount of drainage Recommended Secondary Dressings Medfix Tape Bordered Gauze Stratasorb Composite Evidence Based References 1. Konig M, VanscheidtW, Augustin M, Kapp H. Enzymatic versus autolytic debridement of chronic leg ulcers: a prospective randomized trial. Journal ofWound Care. 2005;14(7):320- 323. 2. Paustian C, Stegman MR. Preparing the wound for healing: the effect of activated polyacrylate dressing on debridement.Ostomy/Wound Management. 2003;49(9):34-42. 3. Bruggisser R. Bacterial and fungal absorption properties of a hydrogel dressing with a superabsorbent polymer core. Journal ofWound Care. 2005;14(9):1-5. 4. Biocompatibility data on file. 5. Coyne N. Eliminating wet-to-dry treatments.Remington Report. 2003:8-11. 6. Mueller V, Doucette M, Jasper J, VandenBeld K.Reduction of Pain Through the Utilization of Polyacrylate Activated Dressings. Presented at SAWC.Orlando, FL. 2004. 7. Edwards J. Wound Care is NotWhat it Used to Be: Finding the Most Efficient Debridement Method for ChronicWounds. Presented at SAWC.Orlando, FL. 2004.8. Flemister B. The use of a superabsorbent wound dressing pad for interactive moist wound healing. Presented at the 13th Annual Symposium on Advanced Wound Care. Dallas TX, April 1-4, 2000. ® 6 TenderWet Debridement Rate2 POLYMER GEL PAD RecommendedWound Conditions Shallow No/minimal drainage Primary dressing Deep Moderate/Heavy drainage Secondary dressing Today’s Wound Care Treatments from Medline TenderWet Active Ideal for all wounds Debridement Ordering Information Debrides necrotic wounds while providing an ideal wound healing environment. For more information, visit www.medline.com/woundcare or contact your sales specialist. Item Number Description HCPCS Packaging MSC8301 1.6”, (4.06 cm) round A6242 7/bx, 6 bx/cs MSC8302 2.2”, (5.59 cm) round A6242 7/bx, 6 bx/cs MSC8303 3” x 3”, (7.62 cm x 7.62 cm) square A6242 7/bx, 6 bx/cs MSC8305 4” x 5”, (10.16 cm x 12.7 cm) rectangle A6243 7/bx, 6 bx/cs TenderWet Active Cavity Ideal for all wounds Item Number Description HCPCS Packaging MSC8401 1.6”, (4.06 cm) round A6242 7/bx, 6 bx/cs MSC8402 2.2”, (5.59 cm) round A6242 7/bx, 6 bx/cs MSC8403 3” x 3”, (7.62 cm x 7.62 cm) square A6242 7/bx, 6 bx/cs MSC8405 4” x 5”, (10.16 cm x 12.7 cm) rectangle A6243 7/bx, 6 bx/cs MSC8438 3” x 8”, (7.62 cm x 20.32 cm) rectangle A6243 7/bx, 6 bx/cs 7 ® D I M E S D = Debridement TenderWet Active Debrides NecroticWounds8 Day 1 Day 16 To order by the box, add a “Z” to the end of the item number. Arglaes Antimicrobial Silver Wound Dressing Support Edge /Environment Moisture Balance Infection/ Inflammation Debridement RecommendedWound Conditions Shallow No/Minimal drainage** Primary dressing Deep* Moderate/Heavy drainage* Secondary dressing * Powder only ** Film Only Indications Pressure ulcers Diabetic foot ulcers2 Partial and full-thickness wounds Leg ulcers3,4,5 Central lines, CVPs and PICC lines (Arglaes Film only)6 Surgical wounds7,8 Negative pressure wound therapy (Arglaes Powder only)9 Grafted wounds (Arglaes Powder only) Donor sites Lacerations and abrasions First and second-degree burns Contraindications Third-degree burns Patients with a known sensitivity to silver As a surgical implant (Arglaes Powder) Do not use topical antibiotics in conjunction with Arglaes Powder Change Frequency Arglaes Film may be left in place for up to 7 days Arglaes Island and Arglaes Powder may be left in place for up to 5 days Dressing change frequency will depend upon the amount of drainage Recommended Secondary Dressings Stratasorb Composite Bordered Gauze About Arglaes • Manages bacterial burden1 • Continuous antimicrobial protection1 • Non-cytotoxic1 • Extended wear time1 • Non-staining • Can convert any other dressing to an antimicrobial (Arglaes Powder) ® 8 Sustained-Release10 0 10 100 1,000 10,000 100,000 1,000,000 10,000,000 8 48 72 96 288 nil Time (hours) Numbers of viable bacteria 0 10 100 1,000 10,000 100,000 1,000,000 10,000,000 8 48 72 96 288 nil Time (hours) Numbers of viable bacteria 0 10 100 1,000 10,000 100,000 1,000,000 10,000,000 8 48 72 96 288 nil Time (hours) Numbers of viable bacteria Greater than 90% reduction in viable bacterial numbers after 48 hours. Greater than 90% reduction in viable bacterial numbers after 48 hours. Greater than 90% reduction in viable bacterial numbers after 48 hours. VERSATILE SILVER Today’s Wound Care Treatments from Medline Powerful antimicrobial activity-up to 6 logs of reduction (in vitro studies) Arglaes Film Ideal for post-op incisions and line sites Item Number Description Packaging MSC9023 2?” x 3?” (6.03 cm x 7.94 cm) 10/bx, 10 bx/cs MSC9045 4” x 4¾” (10.16 cm x 12.07 cm) 10/bx, 10 bx/cs MSC9069 4¾” x 10” (12.07 cm x 25.4 cm) 10/bx, 5 bx/cs MSC9314 3¼” x 14”, Post-Op Style (8.26 cm x 25.4 cm) 10/bx, 5 bx/cs Arglaes Island Manages fluid and bioburden Arglaes Powder Ideal for difficult to dress wounds. Single patient use, multi dose vial Item Number Description HCPCS Packaging MSC9205 5 gm bottle A6262 5/bx, 4 bx/cs MSC9210 10 gm bottle A6262 5/bx, 4 bx/cs Infection/ Inflammation Ordering Information Controlled-release, ionic silver for targeted antimicrobial protection. For more information, visit www.medline.com/woundcare or contact your sales specialist. 9 Evidence Based References 1. Internal report on file. 2. LaJoie J. Improving diabetic foot ulcer outcomes with hyperbaric oxygen and ionic silver powder. Presented at SAWC. San Diego, CA. 2005. 3. Rogers RS, Patel M, Alvarez OM. Effect of a silver ion containing wound dressing on the bacterial burden of chronic venous ulcers. Presented at SAWC. Dallas, TX. 2000. 4. Sparks-Evans K. Charcot-Marie-Tooth Foot Deformities, Osteomyelitis with Open Wounds on a Child. Presented at Clinical Symposium on Advances in Skin and Wound Care. Phoenix, AZ. 2004. 5. Strilko BL, Barna A. The versatile use of a silver alginate powder in the treatment of a variety of wounds. Presented at WOCN. Salt Lake City, Utah. 2007. 6. Brooks KL, Dauenhauer SA, Evans JT. Decreased incidence of central line-related bloodstream infections associated with use of silver impregnated dressings at central venous catheter sites. Presented at Decennial International Conference on Nosocomial and Healthcare Associated Infections. Atlanta, GA. 2000. 7. Pittman J, Tape J, Tanner D, Peliccia J. Comparative study of the use of antimicrobial barrier film dressing in post-operative care. Presented at WOCN. Las Vegas, NV. 2005. 8. Gonzalez VR, Segal CG, Tillman C, Houston S, Pruitt V. Changing clinical practice to reduce sternal surgical site infections (S-SSI) in open bypass surgery. Presented at Association for Professionals in Infection Control and Epidemiology, Inc. Seattle, WA. 2001. 9. Curran M, Paz-Altschul OJ. The use of silver antimicrobial powder with negative pressure wound therapy. Presented at Clinical Symposium on Advances in Skin and Wound Care. Dallas, TX. 2002. 10. Independent study preformed by Wickham Laboratories Limited, Hampshire, England. ® Item Number Description Packaging MSC9123 2?” x 3?”, 1” x 2” pad 10/bx, 10 bx/cs (6.03 x 7.94 cm), (2.54 x 5.08 cm) MSC9145 4” x 4¾”, 2” x 2” pad 10/bx, 10 bx/cs (10.16 x 12.07 cm), (5.08 x 5.08 cm) MSC9169 4¾” x 10”, 2¾” x 8” pad 10/bx, 5 bx/cs (12.07 x 25.4 cm), (6.99 x 20.32 cm) D I M E S I = Infection/ Inflammation To order by the box, add a “Z” to the end of the item number. Maxorb Extra Ag Antimicrobial Silver Wound Dressing Support Edge /Environment Moisture Balance Infection/ Inflammation Debridement Indications Pressure ulcers6,7 Leg ulcers6,7 First and second-degree burns8 Moderate to heavily draining partial and full-thickness wounds Diabetic foot ulcers Surgical wounds Graft and donor sites Trauma wounds Contraindications Third-degree burns Dry or lightly draining wounds Patients with a known sensitivity to alginates or silver To control heavy bleeding As a surgical implant Change Frequency Maxorb Extra Ag may be left in place for up to 21 days Dressing change frequency will depend on amount of drainage Initially it may be necessary to change the dressing every 24 hours Recommended Secondary Dressings Stratasorb Composite Bordered Gauze About Maxorb Extra Ag • Helps manage bacterial burden1,2 • Continuous antimicrobial protection1,3 • Cost-effective4 • Easy dressing changes • Highly absorbent5 • Superior gelling and fluid handling5 • Reduces odor6 • Fluid will not wick laterally ® 10 Modified ASEPSIS Index9 Absorbency Comparisons6,7 0 5 10 15 20 25 30 Maxorb Extra Ag Aquacel Ag Acticoat™Absorbent 26 17.5 18 Absorbency (g/100cm2) ® 0.0 Pre-treatment Week 1 Week 2 Week 3 Week 4 Average Score Maxorb® Extra Ag Kaltostat® 2.0 4.0 6.0 8.0 10.0 RecommendedWound Conditions Shallow No/minimal drainage Primary dressing Deep Moderate/Heavy drainage Secondary dressing ALGINATE WITH SILVER Today’s Wound Care Treatments from Medline Asepsis index is a measure of 10 wound healing parameters. A lower score is preferable. Maxorb Extra Ag For moderate to heavily draining, partial and full-thickness wounds Item Number Description HCPCS Packaging MSC9422EP 2” x 2” (5.08 cm x 5.08 cm) A6196 10/bx, 10 bx/cs MSC9445EP 4” x 4¾” (10.16 cm x 12.07 cm) A6197 10/bx, 5 bx/cs MSC9448EP 4” x 8” (10.16 cm x 20.32 cm) A6197 5/bx, 10 bx/cs *MSC94812 8” x 12” (20.32 cm x 30.48 cm) Pending 5/bx, 10 bx/cs Maxorb Extra Ag Rope For moderate to heavily draining, partial and full-thickness wounds Item Number Description HCPCS Packaging MSC9412EP 1” x 12” (2.54 cm x 30.48 cm), rope A6199 5/bx, 4 bx/cs Infection/ Inflammation Ordering Information Ionic silver for targeted antimicrobial protection and fluid management. For more information, visit www.medline.com/woundcare or contact your sales specialist. 11 Evidence Based References 1. Chakravarthy D, Falconio-West M.A comparison of the antimicrobial efficacy of two silver ion containing absorptive fiber dressings. Presented at SAWC. Las Vegas, NV. 2006. 2. Chakravarthy D, Fleck C, Falconio-West M.An evaluation of two polysaccharide-silver based high absorbency wound dressings. Presented at SAWC. Las Vegas, NV. 2006. 3. Freeman R, Bradford C. 21 day in vitro study of sustained antimicrobial activity of a new silver alginate dressing. Presented atWounds UK.Harrogate. 2006. 4. DeLeon J, Nagel M, Hill D, Fudge M, Lucius A, Garcia B.Cost comparison of silver impregnated Hydrofiber® and alginate dressings. Presented at SAWC. Las Vegas, NV. 2006. 5. Data on file. 6. Chakravarthy D, Freeman R, Beele H, Meuleneire F, Nahuys M.Detailed clinical report: prospective randomized open label pilot study to evaluate a new silver alginate antimicrobial wound dressing on critically colonized chronic wounds. Internal report on file. 7. Freeman R, Beele H, Meuleneire F, Nahuys M.Results of a multicentre randomized prospective open label pilot study to evaluate a new silver alginate antimicrobial wound dressing on critically colonized chronic wounds. Presented atWounds UK Conference.Harrogate. 2006. 8. Serena T, Chakravarthy D.Maxorb® AG in the treatment of burn wounds. Symposium on AdvancedWound Care.Tampa, FL. 2007. 9. Data on file. ® D I M E S I = Infection/ Inflammation To order by the box, add a “Z” to the end of the item number. *MSC94812 will be available in January 2009 About Optifoam Ag • Ionic silver provides antimicrobial barrier1 • Continuous antimicrobial protection1 • Highly absorbent1 • Non-cytotoxic1 • Conformable1 • Can manage repeated bacteria introduction • Non-staining Optifoam Ag Antimicrobial Silver Wound Dressing Support Edge /Environment Moisture Balance Infection/ Inflammation Debridement Indications Pressure ulcers Partial and full-thickness wounds Surgical wounds Wounds with colonization Leg ulcers Diabetic foot ulcers Donor sites Lacerations and abrasions Skin tears First and second-degree burns Under compression bandages Contraindications Third-degree burns Lesions with active vasculitis Change Frequency Optifoam Ag may be left in place for up to 7 days Dressing change frequency will depend on amount of drainage Recommended Secondary Dressings Medfix Tape Elastic Net Medigrip Tubular Bandage Evidence Based References 1. Data on file. ® 12 RecommendedWound Conditions Shallow No/minimal drainage Primary dressing Deep Moderate/Heavy drainage Secondary dressing FOAM WITH SILVER Today’s Wound Care Treatments from Medline 0 5 10 15 20 25 30 Fluid Handling Comparative Study1 g/10cm2/72hrs Optifoam Ag Adhesive Contreet® Ag Foam Allevyn™ Non-Adhesive Allevyn™ Adhesive DuoDERM® CGF Hydrocolloid Polymem® Non-Adhesive Powerful ability to manage (absorb + transpire) wound fluids. Optifoam Ag Non-Adhesive   Moisture Vapor Loss Absorption Optifoam Ag Adhesive For wounds with intact periwound skin Item Number Description HCPCS Packaging MSC9604EP 4” x 4” (10.16 cm x 10.16 cm), A6212 10/bx, 10 bx/cs 2½” x 2½” (6.35 cm x 6.35 cm) pad Optifoam Ag Non-Adhesive For wounds with fragile periwound skin Item Number Description HCPCS Packaging MSC9614EP 4” x 4” (10.16 cm x 10.16 cm) A6209 10/bx, 10 bx/cs Infection/ Inflammation Ordering Information Ionic silver foam dressing for targeted antimicrobial protection and fluid management. For more information, visit www.medline.com/woundcare or contact your sales specialist. 13 ® 0 50 100 150 200 250 Number of Surviving Colony Forming Units Optifoam Ag Non-adhesive Contreet® Acticoat™ Moisture Control D I M E S I = Infection/Inflammation Comparative Antimicrobial Effect Study1 Optifoam Ag has the least number of surviving colony forming units at 4 hours. To order by the box, add a “Z” to the end of the item number. MRSA P.aeruginosa 4 hrs. at 37° C exposure to 4 sq cm of each dressing 106 -107 Colony Forming Units (CFUs) initial population   SilvaSorb Antimicrobial Silver Wound Dressing Support Edge /Environment Moisture Balance Infection/ Inflammation Debridement Indications Pressure ulcers Partial and full-thickness wounds Leg ulcers Diabetic foot ulcers Graft wounds and donor sites Skin tears Surgical wounds Lacerations and abrasions First and second-degree burns Contraindications Patients with a known sensitivity to silver Change Frequency Sheets may be left in place for up to 7 days Amorphous gel may be left in place for up to 3 days Dressing change frequency will depend on amount of drainage Recommended Secondary Dressings Stratasorb Composite Bordered Gauze Evidence Based References 1. Data on file 2. Castellano JJ, Shafil SM, Ko F, Donate G,Wright TE, Mannari RJ, Payne WG, Smith DJ, Robson MC. Comparative evaluation of silver containing antimicrobial dressings and drugs. IntWound Journal. 4: 114-122. 3. Nametka M. Silver antimicrobial hydrophilic dressing benefits management of recurrent non-healing wounds. Symposium on AdvancedWound Care. Baltimore. 2002. 4. Copty T, Kiran R, Glat P. Assessing the risk of skin irritation with the use of a silver based site* dressing on pediatric patients. Symposium on Advanced Skin andWound Care. Orlando, FL. 2007. 5. Nametka M.Antimicrobial silver polymer contact layer for treatment of venous leg ulcers. Symposium on AdvancedWound Care. Las Vegas. 2001. 6. Nametka M.A hydrophilic silver antimicrobial wound dressing for site preparation and maintenance of human skin equivalent grafts to venous leg ulcers: Technical and clinical considerations. Clinical Symposium on Advances in Skin &Wound Care, Nashville. 2000. 7. Nametka M. Silver antimicrobial absorbent wound dressing can contribute to cost control in home care. Annual Clinical Symposium on Advances in Skin andWound Care. Dallas. 2002. 8. US Patent 6,605,751. About SilvaSorb • Helps manage bacterial burden1,2 • Continuous antimicrobial protection1,3 • Gentle for the patient4,5 • Advanced fluid management1 • Extended wear time3,6,7 • Non-staining1 Survival Curve with SilvaSorb1 ® 14 RecommendedWound Conditions Shallow No/minimal drainage Primary dressing Deep Moderate/Heavy drainage Secondary dressing 8 7 6 5 4 3 2 1 0 1 2 3 4 5 6 E. coli MRSA VRE Time (hours) Log10 Viable Bacteria HYDROGEL WITH SILVER Today’s Wound Care Treatments from Medline SilvaSorb has powerful antimicrobial activity (invitro), 6-8 log reduction within four hours. SilvaSorb Sheets For flat wounds with no to moderate drainage Item Number Description HCPCS Packaging MSC9322EP 2” x 2” (5.08 cm x 5.08 cm) A6242 5/bx, 5 bx/cs MSC9344EP 4¼” x 4¼” (10.8 cm x 10.8 cm) A6243 5/bx, 5 bx/cs MSC9348EP 4” x 8” (10.16 cm x 20.32 cm) A6243 5/bx, 5 bx/cs SilvaSorb Perforated Sheets For flat wounds with moderate to heavy drainage Item Number Description HCPCS Packaging MSC9340EP 4¼” x 4¼” (10.8 cm x 10.8 cm) A6243 5/bx, 5 bx/cs MSC93410EP 4” x 10” (10.16 cm x 25.4 cm) A6243 5/bx, 5 bx/cs SilvaSorb Cavity For cavity wounds with all drainage levels Item Number Description HCPCS Packaging MSC9360EP 6 gram None 5/bx, 5 bx/cs SilvaSorb Site For IV catheters, central venous and arterial lines, dialysis catheters and orthopedic pin sites Item Number Description HCPCS Packaging MSC9310EP 1” (2.54 cm) circular with slit A6242 30/cs MSC9320EP 1¾” (4.45 cm) circular with slit A6242 30/cs SilvaSorb Gel For dry wounds Infection/ Inflammation Ordering Information Controlled-release8, ionic silver for targeted antimicrobial protection. For more information, visit www.medline.com/woundcare or contact your sales specialist. Item Number Description HCPCS Packaging MSC93025EP .25 oz tube A6248 25/bx MSC9301EP 1.5 oz tube A6248 12/cs MSC9303 3 oz tube 12/cs MSC9308 8 oz tube A6248 6/cs MSC9316 16 oz net wt. jar A6248 8/cs 15 ® D I M E S I = Infection/ Inflammation To order by the box, add a “Z” to the end of the item number. Derma-Gel Hydrogel Sheet Wound Dressing Support Edge /Environment Moisture Balance Infection/ Inflammation Debridement RecommendedWound Conditions Shallow No/Minimal drainage Primary dressing Deep Moderate/Heavy drainage Secondary dressing Indications Pressure ulcers Partial and full-thickness wounds4,5 Leg ulcers Surgical wounds Lacerations and abrasions First and second-degree burns Contraindications Patients with known hypersensitivity to components of the gel Change Frequency Derma-Gel may be left in place for up to 5 days Dressing change frequency will depend on amount of drainage Recommended Secondary Dressings Medfix Tape Suresite® Film (for waterproofing) Elastic Net Medigrip Tubular Bandage Evidence Based References 1. Oliveria-Gardia M, Davis SC, Mertz PM.Can occlusion dressing composition influence proliferation of bacterial wound pathogens?WOUNDS. 1998;10(1):4-11. 2. Independent study performed by NAMSA, Northwood, Ohio. 3. Morse, K. Elasto-Gel:A Product with Unique Properties Especially Suited for the Treatment of Infants and Children with Special Needs. Presented at SAWC.Reno, NV. 1996. 4. Kollenberg, LO.A Clinical Comparison of a Glycerine Hydrogel Sheet or a Thin Hydrocolloid to the Standard of Care on Heel Blisters. Presented at Clinical Symposium on Advances in Skin andWound Care.Denver, CO. 1999. 5. Harris AH.When Underlying Problems Make Total Healing an Unobtainable Goal.GM Associates, Inc. 1994:1(3). 6. Independent study performed by NAmSA, Northwood, Ohio About Derma-Gel • Manages bacterial burden1 • Highly absorbent2 • Cushions and protects wound3 • Helps create moist wound environment • Easy to apply and remove ® 16 HYDROGEL SHEET Absorption Comparison2 140 160 180 80 100 120 20 40 60 0 KALTOSTAT ® DUODERM POLYMEM VIGILON CLEARSITE DERMA-GEL .5 HR 1 HR 96 HR 48 HR 3 HR 6 HR 12 HR 24 HR ® ® ® ® Today’s Wound Care Treatments from Medline Derma-Gel has a very high absoption capacity. Derma-Gel Item Number Description HCPCS Packaging NON8000 4” x 4” (10.16 cm x 10.16 cm) A6242 25/bx, 4 bx/cs Moisture Balance Ordering Information Soft and flexible, Derma-Gel promotes a moist environment and can absorb up to five times its weight. For more information, visit www.medline.com/woundcare or contact your sales specialist. 17 ® D I M E S M = Moisture Balance To order by the box, add a “Z” to the end of the item number. Exuderm OdorShield Hydrocolloid Wound Dressing Support Edge /Environment Moisture Balance Infection/ Inflammation Debridement RecommendedWound Conditions Shallow No/Minimal drainage Primary dressing Deep Moderate/Heavy drainage Secondary dressing Indications Pressure ulcers Partial and full-thickness wounds Leg ulcers Donor sites Wounds with light to moderate drainage Lacerations and abrasions First and second-degree burns Contraindications Third-degree burns Change Frequency Exuderm OdorShield can be left in place for up to 7 days Dressing change frequency will depend on amount of drainage Recommended Secondary Dressings N/A Evidence Based References 1. Lipman RDA, Van Bavel D.Odor absorbing hydrocolloid dressings for direct wound contact.Wounds. 2007;19(5):138-146. 2. Lipman R, Van Bavel D, Chakravarthy D.Odor absorbing hydrocolloid dressings that are not inactivated by serum protein. Presented at Symposium on AdvancedWound Care.Tampa, FL. 2007. 3. Absorption properties of some commercial hydrocolloid dressings, compared to Exuderm OdorShield. Internal report.May 5, 2006. 4. Data on file. About Exuderm OdorShield • Absorbs odor with cyclodextrin technology1,2 • Not inactivated by wound protein2 • Manages drainage3 • Longer wear time • Low residue formula4 • Protective, occlusive barrier • Satin finish backing TM 18 Fluid Absorption4 Time (h) Absorption of water (g/m2) ACTISORB™ Silver Carboflex® Carbonet® Exuderm OdorShield™ DuoDERM®Extra Thin DuoDERM®CGF 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 500 1000 1500 2000 2500 3000 HYDROCOLLOID WITH ODOR CONTROL Today’s Wound Care Treatments from Medline Though much thinner, Exuderm OdorShield (0.6 mm) absorbs as much as the much thicker DuoDERM CGF. Exuderm OdorShield Ideal for shallow wounds with odor Moisture Balance Ordering Information Odor absorbing technology combined with excellent fluid management. For more information, visit www.medline.com/woundcare or contact your sales specialist. Item Number Description HCPCS Packaging MSC5522 2” x 2” (5.08 cm x 5.08 cm) A6234 10/bx MSC5544 4” x 4” (10.16 cm x 10.16 cm) A6234 10/bx MSC5566 6” x 6” (15.24 cm x 15.24 cm) A6235 5/bx MSC5588 8” x 8” (20.32 cm x 20.32 cm) A6236 5/bx Exuderm OdorShield Sacral Ideal for sacral wounds with odor Item Number Description HCPCS Packaging MSC5570 4” x 3.6” (10.16 cm x 9.14 cm) A6234 10/bx MSC5575 6.4” x 6.5” (16.26 cm x 16.51 cm A6235 5/bx 19 ® Psychosensory Test Results4 0 1 2 3 4 5 Valeric acid Rating: 0 No odor in vial 1 Very slight odor 2 Moderate odor 3 High odor 4 Comparable to reference odor Butyric acid Putrescine Cadaverine Exuderm OdorShield™ DuoDERM® Reference odor D I M E S M = Moisture Balance The human nose can detect the odor absorbing capacity of Exuderm OdorShield compared to DuoDERM. Maxorb Extra Alginate Wound Dressing Support Edge /Environment Moisture Balance Infection/ Inflammation Debridement RecommendedWound Conditions Shallow No/Minimal drainage Primary dressing Deep Moderate/Heavy drainage Secondary dressing Indications Pressure ulcers Partial and full-thickness wounds Leg ulcers Diabetic ulcers Surgical wounds Donor sites Lacerations and abrasions First and second-degree burns Contraindications Third-degree burns For use as a surgical sponge Dry wounds Patients with a known sensitivity to alginates Change Frequency Maxorb Extra may be left in place for up to 5 days Dressing change frequency will depend on amount of drainage Recommended Secondary Dressings Stratasorb Composite Bordered Gauze Evidence Based References 1. Data on file. About Maxorb Extra • Highly absorbent • Superior gelling and fluid handling • Fluid will not wick laterally • Easy dressing changes ® 20 ALGINATE Maxorb Extra Absorbency Comparison1 0 5 10 15 20 25 Maxorb Extra Aquacel® Kaltostat Algisite® M Today’s Wound Care Treatments from Medline Maxorb Extra absorbs better than many other competitive dressings. Maxorb Extra For moderate to heavily draining, partial and full-thickness wounds Moisture Balance Ordering Information Fast-acting absorption without lateral wicking. For more information, visit www.medline.com/woundcare or contact your sales specialist. Item Number Description HCPCS Packaging MSC7022EP 2” x 2” (5.08 cm x 5.08 cm) A6196 10/bx, 10 bx/cs MSC7044EP 4” x 4” (10.16 cm x 10.16 cm) A6196 10/bx, 5 bx/cs MSC7048EP 4” x 8” (10.16 cm x 20.32 cm) A6197 5/bx, 10 bx/cs Maxorb Extra Rope For moderate to heavily draining, partial and full-thickness wounds Item Number Description HCPCS Packaging MSC7012EP 1” x 12” (2.54 cm x 30.48 cm), rope A6199 5/bx, 4 bx/cs Maxorb Extra Post-Op Rope For moderate to heavily draining, partial and full-thickness wounds Item Number Description HCPCS Packaging MSC7112EP 1” x 12” (2.54 cm x 30.48 cm), A6196 5/bx, 4 bx/cs post-op, flat 21 ® D I M E S M = Moisture Balance To order by the box, add a “Z” to the end of the item number. Optifoam Foam Wound Dressing Support Edge /Environment Moisture Balance Infection/ Inflammation Debridement RecommendedWound Conditions Shallow No/Minimal drainage Primary dressing Deep Moderate/Heavy drainage Secondary dressing Indications Pressure ulcers Partial and full-thickness wounds Leg ulcers Donor sites Lacerations and abrasions Skin tears First and second-degree burns Contraindications Third-degree burns Lesions with active vasculitis Change Frequency Optifoam may be left in place for up to 7 days Dressing change frequency will depend on amount of drainage Recommended Secondary Dressings Medfix Tape (for Optifoam Non-Adhesive) Elastic Net (for Optifoam Non-Adhesive) Optifoam Thin and Optifoam can be used as a secondary dressing Evidence Based References 1. Data on file. About Optifoam • Moisture vapor transmission rate (MVTR) adjusts to fluid level • Will not curl at edges (adhesive) • Highly absorbent • Helps create ideal healing environment • Waterproof outer layer protects wound and keeps bacteria out ® 22 FOAM Fluid Handling Comparative Study1 15 12 9 6 3 0 Optifoam Adhesive Optifoam Non-Adhesive Allevyn® Adhesive g/10cm2/72hrs Allevyn® Non-Adhesive Polymem® DuoDerm® Today’s Wound Care Treatments from Medline Powerful ability to manage (absorb + transpire) wound fluids due to MVTR. Absorbency MVT   Optifoam Non-Adhesive Superb fluid handling with a variety of applications Item Number Description HCPCS Packaging MSC1244EP 4” x 4” (10.16 x 10.16 cm) A6209 10/bx, 10 bx/cs MSC1266EP 6” x 6” (15.24 x 15.24 cm) A6210 10/bx, 10 bx/cs OptifoamThin Extremely conformable, protective dressing Item Number Description HCPCS Packaging MSC1523 2” x 3” (5.08 x 7.62 cm) Pending 10/bx, 20 bx/cs MSC1544 4” x 4” (10.16 x 10.16 cm) Pending 10/bx, 10 bx/cs Optifoam Basic For general wounds or tube site care Optifoam Site Designed specifically for tube sites with radial slit and starburst opening Item Number Description HCPCS Packaging MSC1104 4” (10.16 cm) round, 2” (5.08 cm) pad A6212 30/bag, 4 bags/cs Optifoam Adhesive An all-in-one dressing for fluid handling Moisture Balance Ordering Information Soft, conformable foam dressing. For more information, visit www.medline.com/woundcare or contact your sales specialist. Item Number Description HCPCS Packaging MSC1044EP 4” x 4” (10.16 x 10.16 cm), A6212 10/bx, 10 bx/cs 2.5” x 2.5” (6.35 x 6.35 cm) pad MSC1066EP 6” x 6” (15.24 x 15.24 cm), A6213 10/bx, 10 bx/cs 4.5” x 4.5” (11.43 x 11.43 cm) pad MSC1065EP 6.1” x 5.6” (15.49 x 14.22 cm), sacral Pending 10/bx, 10 bx/cs 23 Item Number Description HCPCS Packaging MSC1133 3” x 3” (7.62 x 7.62 cm) A6209 10/bx, 10 bx/cs MSC1133F 3” x 3” (7.62 x 7.62 cm) A6209 10/bx, 10 bx/cs with fenestration MSC1145 4” x 5” (10.16 x 12.7 cm) A6210 10/bx, 10 bx/cs ® D I M E S M = Moisture Balance To order by the box, add a “Z” to the end of the item number. Skintegrity Hydrogel Wound Dressing Support Edge /Environment Moisture Balance Infection/ Inflammation Debridement RecommendedWound Conditions Shallow No/Minimal drainage Primary dressing Deep Moderate/Heavy drainage Secondary dressing Indications Pressure ulcers Partial and full-thickness wounds Leg ulcers Surgical wounds Lacerations, abrasions and skin tears First and second-degree burns Contraindications Patients with a known sensitivity to components of the gel Heavily draining wounds Change Frequency Skintegrity may be left in place for up to 3 days Dressing change frequency will depend on amount of drainage Recommended Secondary Dressings Stratasorb Composite Bordered Gauze Suresite Film Evidence Based References 1. Independent cytotoxicity study performed by Thomas J. Stephens & Associates, Inc. Study Number 93-0070 (AOL). About Skintegrity • Helps create a moist wound environment • Balanced formulation • Easy irrigation ® 24 HYDROGEL Cytotoxicity Test For Skintegrity Hydrogel1 Using Murine L929 Embryo Fibroblasts Agar Overlay Neutral Red Assay Test Material lDRCC #278 Negative Control Positive Control (Wound Gel) Concentration % 100% N/A 100% Exposure (Time) 21 Hours 21 Hours 21 Hours Zone of Inhibition (mm) 0 0 0 Comments/ Observations 0 / None 0 / None Entire disk (Grade and Reactivity) was clear/ cells dead Today’s Wound Care Treatments from Medline Skintegrity Hydrogel is not harmful to tissue. Skintegrity Hydrogel Ideal for dry-to-moist clean wounds Item Number Description HCPCS Packaging MSC6102 Bellows Bottle, 1 oz. (29.5 ml) A6248 30/cs MSC6104 Tube, 4 oz. (118 ml) A6248 12/cs Skintegrity Hydrogel Impregnated Gauze For convenience to fill deeper wounds Item Number Description HCPCS Packaging MSC6022 2” x 2” (5.08 x 5.08 cm), 12-ply A6231 1/pk, 50 pk/cs MSC6044 4” x 4” (10.16 x 10.16 cm), 12-ply A6231 1/pk, 30 pk/cs MSC6144 4” x 4” (10.16 x 10.16 cm), 12-ply A6231 2/pk, 30 pk/cs Skintegrity Hydrogel Sheet For shallow wounds, painful wounds, burns and tumors Item Number Description HCPCS Packaging MSC6268 6” x 8” (15.24 x 20.32 cm) Pending 5/bx, 20 bx/cs Moisture Balance Ordering Information Clear, colorless gel for providing a moist wound environment. For more information, visit www.medline.com/woundcare or contact your sales specialist. 25 ® D I M E S M = Moisture Balance To order by the box, add a “Z” to the end of the item number. Suresite Transparent Film Wound Dressing Support Edge /Environment Moisture Balance Infection/ Inflammation Debridement RecommendedWound Conditions Shallow No/Minimal drainage Primary dressing Deep Moderate/Heavy drainage Secondary dressing Indications Partial-thickness wounds Full-thickness wounds (secondary dressing) Peripheral and central I.V. lines Skin tears Lacerations and abrasions To help prevent skin breakdown caused by friction to epidermis Contraindications Contraindicated as a primary dressing on moderately-to-heavily draining wounds Change Frequency Suresite may be left in place for up to 7 days Dressing change frequency will depend on amount of drainage Recommended Secondary Dressings N/A Evidence Based References 1. “Inverted Juice Cup” test method ASTM 1249 Independent study performed by Mylan Technologies, Inc. About Suresite • Traditional moisture vapor transmission rate (MVTR) • Conformable • Has memory – won’t stick to itself • Microporous technology • Permits continuous observation • Variety of delivery systems ® 26 TRANSPARENT FILM MVTR Data for Suresite1 Transparent Film MVTR Suresite 1,209 g/M sq/24 Today’s Wound Care Treatments from Medline Suresite has the ability to transpire wound fluid to support moist wound healing. Suresite 123 Easy to apply transparent film with thumbprint design SuresiteWindow An easy-to-use window frame delivery Ordering Information Ideal dressing for a variety of wound situations. For more information, visit www.medline.com/woundcare or contact your sales specialist. Item Number Description HCPCS Packaging MSC2302 2?” x 2¾” (6.03 x 6.99 cm) A6257 100/bx MSC2304 4” x 4½” (10.16 x 11.43 cm) A6257 50/bx 27 Suresite 123+Pad Easy delivery of an all-in-one cover dressing with minimal absorbtion Item Number Description HCPCS Packaging MSC2603 2.4” x 2.8” (6.1 x 7.11 cm), A6203 100/bx, 4 bx/cs 1.3” x 1.6” (3.3 x 4.06 cm) pad MSC2605 4” x 4.8” (10.16 x 12.19 cm), A6203 50/bx, 4 bx/cs 2.4” x 3.2” (6.1 x 8.13 cm) pad MSC2610 3.5” x 10” (8.89 x 25.4 cm), Pending 25/bx, 4 bx/cs 1.5” x 8” (3.81 x 20.32 cm) pad MSC2613 3.5” x 13.75” (8.89 x 34.93 cm), Pending 25/bx, 4 bx/cs 2” x 12” (5.08 x 30.48 cm) pad MSC2636 3.5” x 6” (8.89 x 15.24 cm), Pending 25/bx, 4 bx/cs 1.5” x 4” (3.81 x 10.16 cm) pad MSC2638 3.5” x 8” (8.89 x 20.32 cm), Pending 25/bx, 4 bx/cs 1.5” x 5.5” (3.81 x 13.97 cm) pad MSC2666 6” x 6” (15.24 x 15.24 cm), Pending 25/bx, 4 bx/cs 4” x 4” (10.16 x 10.16 cm) pad Item Number Description HCPCS Packaging MSC2701 1.52” x 1.52” (3.86 x 3.86 cm) A6257 100/bx, 4 bx/cs MSC2703 2.4” x 2.8” (6.1x 7.11 cm) A6257 100/bx, 4 bx/cs MSC2705 4” x 4.8” (10.16 x 12.19 cm) A6257 50/bx, 4 bx/cs MSC2706 6” x 8” (15.24 x 20.32 cm) A6258 25/bx, 4 bx/cs MSC2710 4” x 10” (10.16 x 25.4 cm) A6258 25/bx, 4 bx/cs MSC2712 8” x 12” (20.32 x 30.48 cm) A6259 25/bx, 4 bx/cs Moisture Balance ® D I M E S M = Moisture Balance To order by the box, add a “Z” to the end of the item number. Suresite I.V. Convenient, sized for I.V. sites Suresite Roll Allows for customization of size and shape of transparent film Item Number Description HCPCS Packaging MSC2402 2” x 11yd. (5.08 x 10.06 m) Pending 1 roll/bx, 12 bx/cs MSC2404 4” x 11yd. (10.16 x 10.06 m) Pending 1 roll/bx, 12 bx/cs MSC2406 6” x 11yd. (15.24 x 10.06 m) Pending 1 roll/bx, 12 bx/cs Item Number Description HCPCS Packaging MSC2002 2” x 3” (5.08 x 7.62 cm) A6257 100/bx Sureview Film Fabric Frame Easy to apply I.V. cover dressing Item Number Description HCPCS Packaging MSC2502 2?” x 2¾” (6.03 x 6.99 cm) Pending 50/bx MSC2504 4” x 4½” (10.16 x 11.43 cm) Pending 25/bx Support Edge /Environment Moisture Balance Infection/ Inflammation Debridement 28 Suresite continued Transparent Film Wound Dressing ® Ordering Information continued Ideal dressing for a variety of wound situations. TRANSPARENT FILM Today’s Wound Care Treatments from Medline Suresite 2 Handle Traditional delivery system Item Number Description HCPCS Packaging MSC2104 4” x 5” (10.16 x 12.7 cm) A6258 50/bx For more information, visit www.medline.com/woundcare or contact your sales specialist. 29 Moisture Balance ® D I M E S M = Moisture Balance Item Number Description HCPCS Packaging MSC2204 4” x 4½” (10.16 x 11.43 cm) 50/bx MSC2206 6” x 8” (15.24 x 20.32 cm) A6258 10/bx, 10 bx/cs Suresite Matrix Top layer allows you to trace wound margins Puracol Plus Collagen Microscaffold™ Wound Dressing Support Edge /Environment Moisture Balance Infection/ Inflammation Debridement RecommendedWound Conditions Shallow No/minimal drainage Primary dressing Deep Moderate/Heavy drainage Secondary dressing Indications Pressure ulcers Partial and full-thickness wounds Venous ulcers Ulcers caused by mixed vascular etiologies Diabetic ulcers Burns Donor sites and other bleeding surface wounds Abrasions Traumatic wounds healing by secondary intention Dehisced surgical wounds Contraindications Active vasculitis or patients with known sensitivity to collagen Change Frequency Puracol Plus may be left in place for up to 7 days Dressing change frequency will depend on amount of drainage Recommended Secondary Dressings Stratasorb Composite Bordered Gauze Evidence Based References 1. Data on file. 2. Picrosirius Assay to Determine Relative Nativity of Two Collagenous Dressings, internal report. 3. Comparative Physical Properties of Two Collagenous Dressings, Promogran and Puracol Plus, data on file. 4. Driver V, French M, Cain J, Hagen H, Hijazin M, Patel M.The Use of Native Collagen Dressings on Chronic Lower Extremity Wounds: Case Studies. Presented at SAWC.Tampa, FL. 2007. 5. A Clinical Safety and Efficacy Evaluation on Seriously ChronicWounds with a Native Collagen Dressing, data on file. 6. Rogers LC, Armstrong DG.The promise of stem cells. Podiatry Management. June/July 2007:65-70. About Puracol Plus • 100% collagen with a high degree of nativity1,2 • High gel integrity3 • Helps promote epithelialization4,5 • Jump-starts stalled wounds4,5,6 • Biodegradable ® 30 Measure of Collagen Nativity2 Microscopic View1 optical microscope. The intact super-structure provides strong evidence that the nativity of the collagen triple helix is preserved. Puracol Plus Microscaffold1 The open porous structure increases the internal surface area for maximal interaction with wound fluids and wound fibroblasts. 0.0 0.3 0.6 0.9 1.2 1.5 Puracol Plus Promogran* OD 540 nm* Nativity *Proportional to the extent of nativity, higher nativity is desirable. COLLAGEN Today’s Wound Care Treatments from Medline Puracol Plus Ideal for wounds that are chronic or stalled Item Number Description HCPCS Packaging MSC8622EP 2” x 2.25” (5.08 x 5.72 cm) A6021 10/bx, 5 bx/cs MSC8644EP 4.25” x 4.5” (10.8 x 11.43 cm) A6022 10/bx, 5 bx/cs Edge /Environment Ordering Information Advanced, native collagen with a unique three dimensional structure that helps promote cell growth. For more information, visit www.medline.com/woundcare or contact your sales specialist. 31 ® D I M E S E = Edge/Environment To order by the box, add a “Z” to the end of the item number. Support Edge /Environment Moisture Balance Infection/ Inflammation Debridement 32 Medline Advanced Wound Care Products Puracol Plus Ag+ Silver Collagen Microscaffold™ Wound Dressing RecommendedWound Conditions Shallow No/minimal drainage Primary dressing Deep Moderate/Heavy drainage Secondary dressing Indications Pressure ulcers Partial and full-thickness wounds Venous ulcers Ulcers caused by mixed vascular etiologies Diabetic ulcers Burns Donor sites and other bleeding surface wounds Abrasions Traumatic wounds healing by secondary intention Dehisced surgical wounds Contraindications Active vasculitis or patients with known sensitivity to collagen Change Frequency Puracol Plus Ag+ may be left in place for up to 7 days Dressing change frequency will depend on amount of drainage Recommended Secondary Dressings Stratasorb Composite Bordered Gauze Evidence Based References 1. Data on file. 2. Picrosirius Assay to Determine Relative Nativity of Two Collagenous Dressings, internal report. 3. Comparative Physical Properties of Two Collagenous Dressings, Promogran and Puracol Plus, data on file. 4. Driver V, French M, Cain J, Hagen H, Hijazin M, Patel M. The Use of Native Collagen Dressings on Chronic Lower Extremity Wounds: Case Studies. Presented at SAWC. Tampa, FL. 2007. 5. A Clinical Safety and Efficacy Evaluation on Seriously Chronic Wounds with a Native Collagen Dressing, data on file. 6. Rogers LC, Armstrong DG. The promise of stem cells. Podiatry Management. June/July 2007:65-70. 7. Fliegel S et al. Collagen Degradation in Aged/Photodamaged Skin In Vivo and After Exposure to Matrix Metalloproteinase-1 In Vitro. J Invest Dermatol 12: 842-848, 2003. 8. Sibbald RG et al, Increased bacterial burden and infection, the story of NERDS and STONES, Advances in Skin and Wound Care 19: 447-61, 2006. 9. The antimicrobial benefits of silver and the relevance of Microlattice® technology. Ostomy/Wound Management. 49 (2A), 4-7, 2003. About Puracol Plus Ag+ • Noncytotoxic1 • 100% collagen with a high degree of nativity1,2 • High gel integrity3 • Helps promote epithelialization4,5 • Jump-starts stalled wounds4,5,6 • Ionic silver provodes antimicrobial barrier8,9 • Non-staining • Biodegradable ® Measure of Collagen Nativity COLLAGEN WITH SILVER The open porous structure increases the internal surface area for maximal interaction with wound fluids and wound fibroblasts. 0 500 1,000 1,500 2,000 * Proportional to the extent of nativity, higher nativity is desirable.2,7 Denatured Collagen Alginate-Silver Collagen/ORC-Silver Puracol® Plus Ag+ Absorbance mOD 540* Puracol Plus Microscaffold1 Edge /Environment 33 E = Edge/Environment Puracol Plus Ag+ Ideal for wounds that are chronic or stalled Item Number Description HCPCS Packaging MSC8722EP 2” x 2.25” (5.08 cm x 5.72 cm) A6021 10/bx, 5 bx/cs MSC8744EP 4.25” x 4.5” (10.8 cm x 11.43 cm) A6022 10/bx, 5 bx/cs Ordering Information Advanced, native collagen with antimicrobial ionic silver8,9 and a unique three dimensional structure that helps promote cell growth. For more information, visit www.medline.com/woundcare or contact your sales specialist. ® To order by the box, add a “Z” to the end of the item number. D I M E S Test Organism Log Reduction with Puracol Plus Ag+ Staphylococcus aureus (MRSA) 5.20 Enterobacter cloacae 5.08 Pseudomonas aeruginosa 5.18 Enterococcus faecalis (VRE) 5.11 Escherichia coli 5.20 Staphylococcus epidermidis (coagulase negative) 5.08 *In vitro test data on file This table shows the log reduction in bacteria levels (in vitro) observed in testing of selected microorganisms, including MRSA, when large populations of these microbes are allowed to come into contact with the Puracol Plus Ag+. (Method: AATCC-100) MatriStem™ Extracellular Matrix (ECM) Wound Sheet Support Edge /Environment Moisture Balance Infection/ Inflammation Debridement RecommendedWound Conditions Shallow No/minimal drainage Primary dressing Deep Moderate/Heavy drainage Secondary dressing Indications Partial and full thickness wounds Pressure ulcers Venous ulcers Diabetic ulcers Donor sites and graft sites Dehisced surgical wounds Abrasions Burns Contraindications Patients with a known sensitivity or allergy to porcine materials Third degree burns Change Frequency MatriStem may be left in place for 2-7 days Recommended Secondary Dressings For wet wounds: a non adherent dressing followed by an absorptive dressing Non-adherent dressings: Medline’s oil emulsion dressing, Non Adherent Pad, Xeroform or any other non adherent dressing Absorptive dressings:Maxorb Extra calcium alginate, Optifoam foam or any other absorptive dressing For dry wounds: a non adherent dressing (as listed above) followed by a hydrogel dressing such as Skintegrity hydrogel to keep the wound moist. About MatriStem • An ECM derived from porcine • Maintains and supports a healing environment for wound management1 • Jump-starts stalled wounds • Biodegradable • Basementmembrane unique toMatriStem contains a number of proteins2,3,4 • Facilitates to replenish epithelial cells 34 Medline Advanced Wound Care Products Clinical Study1 Evidence Based References 1. Human use of ACell® wound matrix: Use of UBM in leg ulcers. Internal Report, 2005. 2. Brown B, Lindberg K, Reing J, Stolz DB, Badylak SF. The basement membrane component of biologic scaffolds derived from extracellular matrix. Tissue Eng. 2006 Mar;12(3):519-26. 3. US Pat. No. 6,576,265. 4. US Pat. No. 6,849,273. • MatriStem is supported by a clinical study on patients with chronic wounds • Average area of closure per day: • MatriStem - 0.08 sq.cm. • Control - 0.04 sq.cm. Standard Care MatriStem 300 Days 59 Days Average Rate of Closure MatriStem Wound sheet can help the body restart the natural healing process Edge /Environment Ordering Information A natural extracellular matrix that maintains and supports a healing environment for wound management For more information, see www.medline.com/woundcare or contact your sales specialist. Item Number Description HCPCS Packaging MSC1811EP 3 cm x 3.5 cm (1.2” x 1.4”) Pending 5 ea/bx MSC1813EP 3 cm x 7 cm (1.2” x 2.7”) Pending 5 ea/bx E = Edge/Environment 35 ® D I M E S To order by the each, add a “H” to the end of the item number. FourFlex and ThreeFlex Multi-Layer Bandage System Support Edge /Environment Moisture Balance Infection/ Inflammation Debridement Indications Treatment of chronic venous insufficiency Contraindications Patients with an Ankle Brachial Pressure Index (ABI) of less than 0.8. An ABI of less than 0.8 may mean that the patient has arterial insufficiency or the leg ulcer is of mixed etiology. Change Frequency Multi-layer compression bandages may be left in place for up to 7 days Dressing change frequency will depend on amount of drainage Recommended Secondary Dressings Usually no secondary dressing is required About FourFlex and ThreeFlex • Effective appropriate compression • Extended wear time • Absorbs drainage • Efficient packaging 36 RecommendedWound Conditions Venous leg ulcers COMPRESSION BANDAGE ABI Chart To determine the Ankle Brachial Index (ABI), divide the ankle systolic pressure by the brachial systolic pressure, through doppler. Ankle Pressure Brachial Pressure = ABI Interpretation of the Ankle Brachial Index Greater than 1.3 Abnormally high range (more studies are needed) 0.95 to 1.3 Normal Range 0.80 to 0.95 Compression is considered safe at this level 0.50 to 0.80 Indicates mild to moderate arterial disease, compression should only be used under direct medical supervision Below 0.5 Severe arterial insufficiency, compression is contraindicated Today’s Wound Care Treatments from Medline Support Ordering Information Effective compression treatment for venous insufficiency (or venous stasis disease). For more information, visit www.medline.com/woundcare or contact your sales specialist. 37 ® FourFlex For the treatment of Chronic Venous Insufficiency (includes 3 pieces of tape) Item Number Description HCPCS Packaging MSC4400 FourFlex Kit 8 kits/cs Components Include: 1) Padding 4” x 3.8 yd. (10.16 cm x 3.47 m), A6441 un-stretched 2) Light Conforming 4½” x 3 yd. (11.43 cm x 2.74 m), A6449 un-stretched 3) Compression 4” x 10 yd. (10.16 cm x 9.14 m), A6452 stretched 4) Cohesive 4” x 6.5 yd. (10.16 cm x 5.94 m), A6454 stretched 5) Steri Strips ThreeFlex For lighter compression or for mixed etiology (includes 3 pieces of tape) Item Number Description HCPCS Packaging MSC4300 ThreeFlex Kit 8 kits/cs Components Include: 1) Padding 4” x 3.8 yd. (10.16 cm x 3.47 m), A6441 un-stretched 2) Light Conforming 4½” x 3 yd. (11.43 cm x 2.74 m), A6449 un-stretched 3) Cohesive 4” x 6.5 yd. (10.16 cm x 5.94 m), A6454 stretched 4) Steri Strips D I M E S S = Supportive Products 1 2 3 4 5 1 2 3 4 Medigrip Elastic Tubular Bandage Support Edge /Environment Moisture Balance Infection/ Inflammation Debridement Indications Edema Treatment of chronic venous insufficiency Dislocations Sprains Hypertrophic scarring Contraindications None Change Frequency Medigrip may be left in place for up to 7 days Dressing change frequency will depend on amount of drainage Recommended Secondary Dressings N/A About Medigrip • Provides excellent support for joints • Easy to apply and reapply • Wide range of applications • Good for securing dressings • Can be used as mild compression when doubled 38 ELASTIC BANDAGE Today’s Wound Care Treatments from Medline RecommendedWound Conditions Secondary dressing Compression Testing of Bandages Based on principles contained in BS 66121 TestMaterial Test Limb Circumference (cm) Pressure (mm/Hg) Medigrip 1 17.2 7.2 Tubigrip 1 17.2 5.8 Medigrip 2 18.7 7.0 Tubigrip 2 18.7 6.1 Independent study performed by SMTL, Bridgend,Wales 1 British Standards Institution, "Graduated Compression Hosiery", BS6612, (1985, 1993) Summary: Although the statistical analysis indicated that the pressures produced by the two products are different, this difference is unlikely to prove significant in the clinical situation. Medigrip Each roll is 11 yards (10 meters) in length Support Ordering Information Provides even support and pressure to reduce edema and assist in venous return. For more information, visit www.medline.com/woundcare or contact your sales specialist. Item Number Size Width Application HCPCS Packaging MSC9500 A 1¾” wide (4.5 cm) Infant feet and arms A6457 1 roll/bx MSC9501 B 2½” wide (6.25 cm) Small hands and limbs A6457 1 roll/bx MSC9502 C 2?” wide (6.75 cm) Adult hands, arms or legs A6457 1 roll/bx MSC9503 D 3” wide (7.5 cm) Large arms or legs A6457 1 roll/bx MSC9504 E 3½” wide (8.75 cm) Legs or small thighs A6457 1 roll/bx MSC9505 F 4” wide (10 cm) Large knees or thighs A6457 1 roll/bx MSC9506 G 4¾” wide (12 cm) Large thighs A6457 1 roll/bx 39 D I M E S S = Supportive Products Support Infection/ Inflammation Debridement 40 Today’s Wound Care Treatments from Medline Gentac Silicone tape offers customized sizing Ordering Information Gentle fixation tape. Item Number Description HCPCS Packaging MSC1583 .8” x 3.3 yd. (2 cm x 3 m) 12 rolls/bx MSC1585 2” x 5 yd. (5.08 cm x 12.7 m) 6 rolls/bx Gentac™ Silicone Fixation Tape Indications To secure primary or secondary dressings To secure gastrostomy tubes and other feeding tubes Contraindications Contraindicated as a primary dressing Change Frequency Gentac may be left in place for up to 7 days Dressing change frequency will depend on amount of drainage Recommended Secondary Dressings N/A About Gentac • Silicone adhesive • Gentle for patient • Cut to size needed • Easy to apply with extended release liner • Water proof DRESSING RETENTION TAPE RecommendedWound Conditions Secondary dressing ® To order by the each, add a “H” to the end of the item number. Edge /Environment Moisture Balance Medfix EZ Linerless with 2” perforations Item Number Description HCPCS Packaging MSC4102 2” x 11 yd. (5.08 cm x 10.06 m) A4452 12 rolls/bx MSC4104 4” x 11 yd. (10.16 cm x 10.06 m) A4452 12 rolls/bx MSC4106 6” x 11 yd. (15.24 cm x 10.06 m) A4452 12 rolls/bx MSC4122 2” x 2 yd. (5.08 cm x 1.83 m) A4452 12 rolls/bx MSC4124 4” x 2 yd. (10.16 cm x 1.83 m) A4452 12 rolls/bx MSC4126 6” x 2 yd. (15.24 cm x 1.83 m) A4452 12 rolls/bx Medfix Printed-release liner allows flexibility and customized sizing Support Ordering Information Flexible, skin-friendly tape. For more information, visit www.medline.com/woundcare or contact your sales specialist. Item Number Description HCPCS Packaging MSC4002 2” x 11 yd. (5.08 cm x 10.06 m) A4452 1 roll/bx MSC4004 4” x 11 yd. (10.16 cm x 10.06 m) A4452 1 roll/bx MSC4006 6” x 11 yd. (15.24 cm x 10.06 m) A4452 1 roll/bx 41 Medfix Low Sensitivity Adhesive Indications To secure primary dressings To secure gastrostomy tubes and other feeding tubes Contraindications Contraindicated as a primary dressing Change Frequency Medfix may be left in place for up to 7 days Dressing change frequency will depend on amount of drainage Recommended Secondary Dressings N/A About Medfix • Low sensitivity adhesive, gentle for the patient • Medfix has a printed s-curve release liner • Medfix EZ is linerless and perforated • Water resistant ® DRESSING RETENTION TAPE D I M E S S = Supportive Products RecommendedWound Conditions Secondary dressing Secondary Dressings Adhesive Island Wound Dressings Support Edge /Environment Moisture Balance Infection/ Inflammation Debridement RecommendedWound Conditions Shallow No/Minimal drainage Primary dressing Deep Moderate/Heavy drainage Secondary dressing Indications Pressure ulcers Partial and full-thickness wounds Contraindications Third-degree burns Patients with a known sensitivity to components of the dressing Change Frequency Change the dressing as indicated by the amount of drainage or as frequently as the primary dressing indicates Recommended Secondary Dressings N/A About Secondary Dressings • Deluxe soaker pad • Non-woven adhesive border • Waterproof backing (Stratasorb) • Water resistant backing (Bordered Gauze) • Ideal for incision sites 42 SECONDARY DRESSINGS Today’s Wound Care Treatments from Medline Stratasorb Composite Waterproof, convenient secondary dressing Item Number Description HCPCS Packaging MSC3044 4” x 4”, (10.16 x 10.16 cm), A6203 10/bx, 10 bx/cs 2½” x 2”, (6.35 x 5.08 cm) pad MSC3066 6” x 6”, (15.24 x 15.24 cm), A6203 10/bx, 10 bx/cs 4” x 4”, (10.16 x 10.16 cm) pad MSC3068 6” x 7½”, (15.24 x 19.05 cm), A6204 10/bx, 10 bx/cs 4” x 6”, (10.16 x 15.24 cm) pad MSC30410 4” x 10”, (10.16 x 25.4 cm), A6203 10/bx, 10 bx/cs 2” x 8”, (5.08 x 20.32 cm) pad MSC30414 4” x 14”, (10.16 x 35.56 cm), A6204 10/bx, 10 bx/cs 2” x 12”, (5.08 x 30.48 cm) pad Bordered Gauze Water resistant, easy-to-use secondary dressing Ordering Information Island dressings protect, absorb and help maintain proper wound moisture. For more information, visit www.medline.com/woundcare or contact your sales specialist. Item Number Description HCPCS Packaging MSC3222 2” x 2”, (5.08 x 5.08 cm), A6219 15/bx, 10 bx/cs 1” x 1”, (2.54 x 2.54 cm) pad MSC3244 4” x 4”, (10.16 x 10.16 cm), A6219 15/bx, 10 bx/cs 2½” x 2½”, (6.35 x 6.35 cm) pad MSC3245 4” x 5”, (10.16 x 12.7 cm), A6219 15/bx, 10 bx/cs 2½” x 2½”, (6.35 x 6.35 cm) pad MSC3248 4” x 8”, (10.16 x 20.32 cm), A6219 15/bx, 10 bx/cs 2” x 6”, (5.08 x 15.24 cm) pad MSC3266 6” x 6”, (15.24 x 15.24 cm), A6220 15/bx, 10 bx/cs 4” x 4”, (10.16 x 10.16 cm) pad MSC32410 4” x 10”, (10.16 x 25.4 cm), A6219 15/bx, 10 bx/cs 2” x 8”, (5.08 x 20.32 cm) pad MSC32414 4” x 14”, (10.16 x 35.56 cm), A6220 15/bx, 10 bx/cs 2” x 12”, (5.08 x 30.48 cm) pad 43 Support S = Supportive Products D I M E S ® To order by the box, add a “Z” to the end of the item number. Skintegrity Wound Cleanser Support Edge /Environment Moisture Balance Infection/ Inflammation Debridement Indications To clean a wide variety of wounds including: Pressure ulcers Partial and full-thickness wounds Infected and non-infected wounds Contraindications Patients with a known sensitivity to ingredients in Skintegrity Wound Cleanser Change Frequency With every dressing change Recommended Secondary Dressings N/A About SkintegrityWound Cleanser • Easy cleansing • Non-cytotoxic • Adjustable trigger, PSI of 8.6 at 3” • Within AHCPR guidelines ® 44 Evidence Based References 1. Independent cytotoxicity study performed by Thomas J. Stephens & Associates, Inc. Study Number 93-0070 (AOL). WOUND CLEANSER Today’s Wound Care Treatments from Medline SkintegrityWound Cleanser Item Number Description HCPCS Packaging MSC6008 8 oz. (236 ml) Spray Bottle N/A 6/cs MSC6016 16 oz. (472 ml) Spray Bottle N/A 6/cs Support Ordering Information Delivers gentle yet thorough cleansing. For more information, visit www.medline.com/woundcare or contact your sales specialist. 45 ® S = Supportive Products D I M E S Sureprep and Sureprep No-Sting Sureprep Support Edge /Environment Moisture Balance Infection/ Inflammation Debridement Indications Periwound skin Peristomal skin Damaged skin (Sureprep No-Sting) Contraindications Direct application to wound bed Denuded or macerated skin (Sureprep) Change Frequency With every dressing change Recommended Secondary Dressings Stratasorb Composite Bordered Gauze About Sureprep and Sureprep No Sting • Protects from adhesive stripping1,2 • Safe for delicate skin3 • Fast drying4 • Vapor permeable film • Creates a waterproof barrier on periwound skin • Protection from friction and body fluids • Non-cytotoxic • Transparent yet visible ® ® 46 Evidence Based References 1. Chakravarthy D, Falconio-West M.A Randomized, Controlled Trial of Two Sting Free Polymeric Skin Barrier Products, OneWater Based, the Other Solvent Based. Presented at Clinical Symposium on Advances in Skin andWound Care.Nashville, TN. 2007. 2. Grove GL, Zerweck C.CyberDERM Inc.Research Report #506-71, data on file. 3. 510(k) K051082,WOVE, 2005. 4. Data on file. SKIN PROTECTIVE WIPES Today’s Wound Care Treatments from Medline Sureprep No Sting Ideal for damaged or delicate skin, does not contain alcohol Item Number Description HCPCS Packaging MSC1505 No-Sting Protective Wipes A5120 50/bx, 10 bx/cs Sureprep Ideal for routine periwound skin protection, contains alcohol Item Number Description HCPCS Packaging MSC1500 Skin Protective Wipes 50/bx, 20 bx/cs Support Ordering Information Helps create a barrier on periwound skin to prevent maceration, and for preventing adhesive stripping. For more information, visit www.medline.com/woundcare or contact your sales specialist. S = Supportive Products 47 ® D I M E S To order by the box, add a “Z” to the end of the item number. Use to ease removal of adhesive tape and adhesive residue. Saturated with perchlorethylene, aliphatic naphtas and isopropyl stearate. Textured, 11/4" x 11/2", folded. Adhesive Tape Remover Pads Adhesive Tape Remover Ordering Information Item No. Description Packaging MDS090855 Adhesive Remover Pad 100/bx, 1000/cs Sureprep No-StingWand Ideal delivery for damaged or delicate skin, does not contain alcohol Item Number Description HCPCS Packaging MSC1510 No-Sting Protective Wand Applicator Pending 25/bx, 5 bx/cs OPTIFOAM THIN AMORPHOUS AND GAUZE AS A SECONDARY DRESSING AS A SECONDARY DRESSING AS A SECONDARY DRESSING SILVASORB SHEET AND PERFORATED SILVASORB CAVITY SILVASORB GEL ARGLAES FILM ARGLAES ISLAND ARGLAES POWDER TENDERWET ACTIVE DRESSING - DRAINAGE - Dry/No Drainage Moist/Minimal Moderate Heavy M M M M M M I I I I D M E Suresite Transparent Film Exuderm Odorshield Hydrocolloid Skintegrity Hydrogel Skintegrity Hydrogel Sheet Derma-Gel Hydrogel Sheet Puracol Plus Stratasorb Composite Bordered Gauze Arglaes Antimicrobial Silver Dressing SilvaSorb Antimicrobial Silver Dressing Tenderwet Active Polyacrylate Gel Pad Maxorb Extra Alginate Optifoam Foam Maxorb Extra Ag Alginate Optifoam Ag Foam Puracol Plus Ag+ Collagen S S E MatriStem 48 Support Edge /Environment Moisture Balance Infection/ Inflammation Debridement Product Selection Guide Based on Fluid Handling and DIMES© Today’s Wound Care Treatments from Medline Intact skin with non-blanchable redness of a localized area usually over a bony prominence. Darkly pigmented skin may not have visible blanching; its color may differ from the surrounding area. Further description: The area may be painful, firm, soft, warmer or cooler as compared to adjacent tissue. Stage I may be difficult to detect in individuals with dark skin tones. May indicate “at risk” persons (a heralding sign of risk). Full-thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. Slough may be present but does not obscure the depth of tissue loss. May include undermining and tunneling. Further description: The depth of a stage III pressure ulcer varies by anatomical location. The bridge of the nose, ear, occiput and malleolus do not have subcutaneous tissue and stage III ulcers can be shallow. In contrast, areas of significant adiposity can develop extremely deep stage III pressure ulcers. Bone/tendon is not visible or directly palpable. Full-thickness tissue loss with exposed bone, tendon or muscle. Slough or eschar may be present on some parts of the wound bed. Often include undermining and tunneling. Further description: The depth of a stage IV pressure ulcer varies by anatomical location. The bridge of the nose, ear, occiput and malleolus do not have subcutaneous tissue and these ulcers can be shallow. Stage IV ulcers can extend into muscle and/or supporting structures (e.g., fascia, tendon or joint capsule) making osteomyelitis possible. Exposed bone/tendon is visible or directly palpable. Partial-thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough. May also present as an intact or open/ruptured serum-filled blister. Further description: Presents as a shiny or dry shallow ulcer without slough or bruising.* This stage should not be used to describe skin tears, tape burns, perineal dermatitis, maceration or excoriation. *Bruising indicates suspected deep tissue injury. For more information, visit www.medline.com/woundcare or contact your sales specialist. 49 Classification of Tissue Destruction Support Wounds not caused by pressure such as skin tears, donor sites, vascular ulcers, surgical wounds and burns are described as partial or full-thickness to indicate the depth of tissue destruction. • Partial-Thickness (like Stage II) • Full-Thickness (like Stage III or IV) Ulcers caused by pressure are staged. This is a method of classifying pressure ulcers, describing the degree of tissue damage observed. According to the NPUAP, pressure ulcer is a localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction. A number of contributing or confounding factors are also associated with pressure ulcers; the significance of these factors is yet to be elucidated. NPUAP, 2007 STAGE I STAGE III STAGE IV STAGE II Purple or maroon localized area of discolored intact skin or bloodfilled blister due to damage of underlying soft tissue from pressure and/or shear. The area may be preceded by tissue that is painful, firm, mushy, boggy, warmer or cooler as compared to adjacent tissue. Further description: Deep tissue injury may be difficult to detect in individuals with dark skin tones. Evolution may include a thin blister over a dark wound bed. The wound may further evolve and become covered by thin eschar. Evolution may be rapid exposing additional layers of tissue even with optimal treatment. Full-thickness tissue loss in which the base of the ulcer is covered by slough (yellow, tan, gray, green or brown) and/or eschar (tan, brown or black) in the wound bed. Further description: Until enough slough and/or eschar is removed to expose the base of the wound, the true depth, and therefore stage, cannot be determined. Stable (dry, adherent, intact without erythema or fluctuance) eschar on the heels serves as “the body’s natural (biological) cover” and should not be removed. SUSPECTED Deep Tissue Injury (DTI) UNSTAGEABLE D I M E S S = Supportive Services and Education Photo from NPUAP 2007 50 Support Edge /Environment Moisture Balance Infection/ Inflammation Debridement Many nurses find themselves in situations on a daily basis where valuable time is wasted searching for the right dressing. Often the wrong dressing is used or the dressing is not used properly. By listening to you, we found a way to improve this process and ensure that nurses have the information they need. It is called EP… Educational Packaging. Products available in EP will now have an “EP” at the end of the item number. The package focuses on patient safety and correct product application. Each package serves as a 2-Minute Course on Wound Care™. Many times the outer box is thrown away and the product is distributed to the end user by the inner package. For that reason Medline provides an educational show-and-tell booklet of all the pertinent information needed to provide bedside support to the nurse, the patient, and the family. Education is not just for clinicians so they know and use the latest evidence base in their practice, but it is essential for their patients and their families. Making sure the patients and their family are taught the expected outcomes and the plan to achieve them is vital for successful wound treatment Educational Packaging Medline Advanced Wound Care Products For more information, visit www.medline.com/woundcare or contact your sales specialist. 51 Our Compass Wound Care Prevention and Treatment program contains education at every level from the wound care champion at your facility to the bedside nurse to the patient/resident and their family. The program contains The Wound Care Handbook, wound care pocket guides, patient education brochures, and a CD containing 225 images organized by wound categories. Survey Readiness for Long-Term Care Tags F309/314 CompassWound Care Programs 1. D.O.N. instructional manual (teacher’s guide) 2. Survey readiness resource books 3. Self study education programs (CE credit) 4. Wound measuring rulers 5. Wound care application videos 6. Continuous pressure ulcer prevention booklets Wound Care Handbook Pocket Guide Patient /Family Education Wound Image CD (to create your own education) Support S = Supportive Products D I M E S 52 Support Edge /Environment Moisture Balance Infection/ Inflammation Debridement Medline University Medline University offers continuing education programs and accredited continuing nursing education opportunities.We offer a wide array of educational opportunities on topics that are current and relevant to your staff. The courses are presented in an online format so you can take them at your convenience. All you need is a connection to the internet! The course content, test and CE certificate are online. Visit our Web site www.medlineuniversity.com for more information. Educare® Seminars Medline offers Educare seminars in cities across the United States. These in-depth programs provide wound and skin care education for all levels of clinical staff. Educare programs are approved for continuing education hours and are taught by board-certified wound care nurses. Medline also has a number of other educational programs available to meet the needs of your patients, facility and caregivers. Education Medline Advanced Wound Care Products For more information, visit www.medline.com/woundcare or contact your sales specialist. 53 Educare® Hotline Managed by Wound Care Nurse Specialists An important number to remember is 1-888-701-SKIN (7546) because it provides access to our Educare Hotline. It is managed by board-certified Wound Care Nurses and supported by a network of advanced wound care product specialists. The nurses are available to answer questions and concerns on product usage such as application and appropriateness of the dressing for the wound condition. The Educare Hotline is staffedMonday through Friday from8 a.m. to 5 p.m.Central StandardTime. Product Support at www.medline.com/woundcare Medline’s Web site is another way to get up-todate product information.You will find the latest brochures as well as application videos online at www.medline.com/woundcare. The interactive product selector can also help you choose the best product based upon the wound conditions. More Than 50Wound and Skin Care Product Specialists Receiving help from one of Medline’s 50+ wound care product specialists has never been easier. In addition to our 800 person sales force, the wound care product specialists are devoted to supplying you with appropriate wound care products, services and educational support. This team is highly trained and available to deliver on-site, face-to-face in-servicing for your staff. 2-Minute Course on Wound Care™ is a trademark of Medline Industries, Inc. Acticoat™ is a trademark of T.J. Smith & Nephew Limited Corporation Actisorb™ is a trademark of Johnson & Johnson Corporation Algisite® is a registered trademark of T.J. Smith & Nephew Limited Corporation Allevyn® is a registered trademark of T.J. Smith & Nephew, Limited Corporation Arglaes® is a registered trademark of Giltech Limited Corporation Aquacel® is a registered trademark of E.R. Squibb & Sons, LLC LTD Liab Co Carboflex® is a registered trademark of E.R. Squibb & Sons, LLC LTD Liab Co Carbonet® is a registered trademark of T.J. Smith & Nephew Limited Corporation Clearsite® is a registered trademark of NDM, Inc. Contreet® is a registered trademark of Coloplast A/S Corporation Derma-Gel® is a registered trademark of Medline Industries, Inc. DuoDerm® is a registered trademark of E.R. Squibb & Sons, Inc. Educare® is a registered trademark of Medline Industries, Inc. EP™ is a trademark of Medline Industries, Inc. Exuderm OdorShield™ is a trademark of Medline Industries, Inc. Febreze® is a registered trademark of The Procter & Gamble Company Gentac™ is a trademark of Medline Industries, Inc. Hydrofiber® is a registered trademark of E.R. Squibb & Sons, L.L.C. Hydrogel® is a registered trademark of Dow Pharmaceutical Sciences, Inc. Kaltostat® is a registered trademark of E.R. Squibb & Sons, Inc. MatriStem™ is a trademark of Acell, Inc. Maxorb® is a registered trademark of Medline Industries, Inc. Medline® is a registered trademark of Medline Industries, Inc. Microscaffold™ is a trademark of Medline Industries, Inc. Optifoam® is a registered trademark of Medline Industries, Inc. Polymem® is a registered trademark of Ferris Pharmaceuticals Inc. Promogran® is a registered trademark of Johnson & Johnson Corporation Puracol® Plus is a trademark of Medline Industries, Inc. Restore® is a registered trademark of Hollister Wound Care LLC LTD Liab Co SilvaSorb® is a registered trademark of Acrymed, Inc. Skintegrity® is a registered trademark of Medline Industries, Inc. Stratasorb® is a registered trademark of Medline Industries, Inc. Sureprep® is a registered trademark of Medline Industries, Inc. Suresite® is a registered trademark of Medline Industries, Inc. TenderWet® is a registered trademark of IVF Hartman AG Corporation Vigilon® is a registered trademark of C.R. Bard, Inc. Summary In summary, the concept of wound bed preparation includes the treatment of the whole patient before the hole in the patient (treat the cause and the patient-centered concerns). Local wound bed preparation includes DIM (debridement, infection/inflammation and moisture balance) plus advanced edge effect therapies (for wounds with the ability to heal) and support in the way of “other products,” services and nutrition. Finally, always remember that education is the scaffold for practice.Without it, clinicians cannot advance practice and improve patient wound healing outcomes. Support S = Supportive Products D I M E S 54 Support Edge /Environment Moisture Balance Infection/ Inflammation Debridement Medline Advanced Wound Care Products For more information, see www.medline.com/woundcare or contact your sales specialist. 55 Support D I M E S MKT209069/LIT049/25M/4CLC 1-800-MEDLINE (633-5463) www.medline.com Medline Industries, Inc. | One Medline Place, Mundelein, IL 60060 USA Medline Canada 1-800-396-6996 www.medline.ca | [email protected] Not all products are currently available for sale in Canada. Please contact your Account Representative for additional information. Medline México S. De R.L De C.V. 01-800-831-0898 [email protected] Not all products are currently available for sale in Mexico. Please contact your Account Representative for additional information. ©2009 Medline Industries, Inc. Medline is a registered trademark of Medline Industries, Inc. We reserve the right to correct any errors that may occur within this brochure. NEED MORE CLINICAL INFORMATION? CALL OUR EDUCARE HOTLINE AT 1-888-701-SKIN (7546)
 

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