Clinical use of myskin™

Who can prescribe myskin?
Treatment Schedule
Biopsy / Wound preparation
DOC concept
Application of myskin document (Acrobat Reader required)

The DOC Concept

Debride
The aim of Debridement is to remove all non viable tissue, such as slough and necrotic tissue, from the wound to expose a healthy wound bed. Once all the non viable tissue has been removed a pink, granulating wound bed should be evident.

The method of debridement chosen depends on the size, type of tissue to be debrided and the speed at which you want the debridement to take place (1).

Surgical/Sharp - A local or general anaesthetic will usually be required for sharp debridement. This method is suitable for larger wounds and further debridement may be required to remove all non viable tissue effectively.
Chemical - This method uses enzymes which are introduced to the wound to break down the non viable tissue which can then be removed. There are a variety of enzymes available though further debridement may be required.
Larval Therapy - This can be used alone or as a secondary debridement after sharp or chemical debridement on small to medium sized wounds. Maggots from the Green bottle fly can be used on any wound with non viable tissue. The maggots produce proteolytic enzymes that break down the slough and necrotic tissue which they then ingest. Maggots have been found to reduce wound odour, ingest bacteria including methicillin resistant staphylococcus aureus (MRSA) and may promote the formation of granulation tissue (2).
Autolytic - This form of debridement uses the body's own debridement properties. By maintaining a moist environment, with the use of occlusive dressings or moisture donating dressings, such as hydrogels, promotes the bodies’ natural phagocytic activity (1).

Optimise
Once all non-viable tissue has been removed the wound must be prepared so that it can continue healing. Wound moisture should be controlled or stabilised either by exudate management or by donating moisture to a dry wound.

It is also essential to reduce the bacterial burden so that the wound is either infection free or non-critically colonised. This can be achieved with the use of silver dressings or topical or systemic antibiotics. If the wound is infection free, a protease-modulating matrix may be used to stabilise the wound in preparation for closure.

Close
Many wounds will progress on to healing after adequate debridement and optimisation. However a large proportion of wounds may become static and not exhibit signs of closure without further intervention. At this stage an intervention such as skin grafting may be considered.

Large wounds are often treated using a skin graft, a surgical procedure performed under general anaesthetic. Skin grafting is limited to one application. Subsequent applications require either a new donor site or re-epithelialisation of the original site. Infection or inflammation may lead to reduced take or rejection of the graft.

To overcome the drawbacks of skin grafts, myskin delivers autologous keratinocytes which have undergone cell culture, allowing repeat applications from a small biopsy. This biopsy is taken under local anaesthetic. Applications are timed according to clinical convenience and myskin is applied under standard type dressings.

Myskin can be used in combination with skin grafting for instance in the treatment of extensive burns where the cell culture expansion facilitates broader application of autologous cells. Myskin can be applied over meshed grafts and used for the re-epithelialisation of graft donor sites.

Secondary Dressing
The type of secondary dressings chosen may depend on the location of the wound or on personal preference. Suggested dressings for use over myskin include soft silicone dressings such as Mepitel^® or foams such as Suprasorb-P. If a foam is used this can be secured with an adhesive tape or a soft bandage. If a net dressing is used then a form of padding must first be applied and secured with either adhesive tape or a soft bandage.

References
1) Vowden, K and Vowden, P (2002) Wound Bed Preparation. View web site
2) Biosurgical Research Unit (SMTL) (2004) LarvE Data Card.

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