Transcript

Windy Cole, DPM:

Hi, I'm Dr. Windy Cole. I'm the director of wound care research at Kent State University College of Podiatric Medicine.

Well, I think clinicians can get bogged down in a couple areas that will prevent optimal healing. I think one of the ways is inadequate wound hygiene or inadequate wound debridement. Many practitioners may overlook the importance of thorough wound hygiene and debridement to remove that bioburden, biofilm, contaminants in the wound bed. Also I think that the overuse of antimicrobials is a big problem within our sector of medicine. These agents can be beneficial when used judiciously, but the excess or overuse or prolonged use can actually be detrimental to healthy tissue and lead to more infections down the road. I think the other big factor is inconsistent follow-up or delays in care. So seeing the patients regularly for those debridements, for that wound hygiene, to manage and assess the wound environment, to make changes in the treatment plan, it's helpful in order to really support better outcomes for the patients.

So the BIOMES℠ tool is basically a tick box or a checklist, which is really helpful so that you don't overlook any of these important points or assessments. So the BIOMES stands for, it's a mnemonic, it's a tool that stands for Blood flow, so making certain that we optimize perfusion in the wound area and then also control infection. Then it’s the I, infection or bioburden, and that kind of points back to that wound hygiene, debridement tick box if you will. Offloading or overload, so offloading any pressure areas so that that can support tissue repair and regeneration. The M in biomes is metabolic, so for metabolic or their morbidities, so managing comorbidities and systemic health conditions in order to optimize the patient so that they are ready to, they repair, they're ready to repair the wounds, they prepare to repair. And the E is exudate or edema, so managing wound exudate with the appropriate dressings, the appropriate dressing change schedule, and then E for edema, if we're talking about a venous leg ulcer or a mixed arterial venous wound of the leg, we have to manage that edema appropriately. And then S is social and also economic barriers, so just making certain that they have the social structure. It's home that they have someone available to give them rides to clinic to help them change dressings, whatever the case may be, so that we have all of our ducks in a row to support our patients' good outcomes.

Yeah, so dressing selection is key to really have good outcomes in our patients. So we have to pick the right type of dressing based on the exudate level. So if you have scant or minimal drainage, you don't need a dressing that's heavily absorbent. But conversely, if you have a heavily exudating wound, you would possibly need a super absorber or something that can manage all that exudate. So exudate level is really one of the key factors when you're selecting your dressing. Also the wound characteristics, other wound characteristics like the type of wound, the size of the wound, the depth of the wound, the location of the wound is really key when you're trying to decide what type of dressing you're going to use. And then again, that dressing change frequency. Infection risk, if a patient is more apt to have an infection or has had infections in the past or you are concerned that the wound is possibly becoming contaminated to the point where it could be infected, making certain that you use antimicrobial dressings, again, only in cases where they're indicated, but that would be something that would have to be considered when you're choosing your dressing. Additionally, if patients have any sensitivity or allergies to any of the dressing components, you have to obviously consider that when choosing a dressing for that patient. And the location of the wound and the mobility of the patient will also come into play. And then the ability of the patient to change the dressing. So you wouldn't want maybe a multilayer compression system that the patient has to put on that would be very difficult for them to handle at home. And do they have any support system at home that can help them with dressings if they can't reach the dressing or if the dressing is elaborate, that would come into play as well.

So proteases are actually, when they're at a good level, beneficial for acute wound healing, because they break down devitalized tissue. But unfortunately, in hard-to-heal or chronic wounds, proteases are elevated to the point where the body doesn't keep them in check and they start to break down that extracellular matrix or the good tissue components in the wound. So it's been estimated that 90% or more of hard-to-heal wounds have excess proteases. We don't have a point of care diagnostic here in the US for them but maybe that'll come down the road. So we just kind of labor under the idea that these wounds, these hard-to-heal wounds, when we first see them probably have excess proteases. So the use of advanced dressings can help because that will absorb the excess exudate and can incorporate some protease absorption as well. Plus it will give the wound, the optimal environment for healing, which is very important as well. Any type of dressings that can act as a sacrificial substrate, also to cut down the protease level in the wounds, could be beneficial, and this would be partnered with that wound hygiene and that debridement that we talked about already. 

I think it's important to be proactive. Sometimes in wound care, we're very reactive, right? But having this proactive protocol or this, you know, treatment plan is very helpful when we're choosing the interventions along the continuum of care. So by using all of these problems that are outlined in the BIOMES pathway, we can really help to target what pathophysiology is off in the wound at any given time and hopefully prevent long-term ill effects like infection or increased inflammation or improper offloading or not managing exudate or edema, so then we could help our patients avoid hospital admissions, interventions like surgery or amputation, and it will also help with the patient's quality of life and not to mention their long-term outcomes.

_{BIOMES^SM was created by Trent Brookshier, DPM, and is a service mark of HARTMANN USA, Inc, © 2024 HARTMANN USA, Inc.}