Challenging Our Beliefs: Disruptive Technology

Dear Readers:

At the turn of the century, wound care experienced what many of us think of as the introduction of its last truly disruptive technology, of course this was negative pressure wound therapy. Since then, there have been many advances including a very large number of tissue-based therapies. More recently, diagnostic technologies have the potential to be disruptive. However, as of yet these technologies are not clear cut, and their use does not lead to definitive outcomes. 

Personally, the most disruptive technology we currently have, will not disrupt how we take care of patients necessarily, such as negative pressure wound therapy did, but it will disrupt how we think about therapies for our patients. This disruptive advance is the use of synthetic materials for tissue regeneration. For more than 25 years, we as wound care practitioners have learned the nuances of the extracellular matrix (ECM) and believed we understand the role of proteoglycans, glycosaminoglycans, and collagen as well as the effect of “pore” size, to name a few. How does the importance of replacing the ECM in a chronic wound, especially one that is missing its dermis, fit in with wholly synthetic materials? 

In the United States, this development begins with the entrance of a biodegradable polyurethane dressing to the market and another product which is a synthetic terpolymer that regenerates dermal-like tissue. There are several others which include self-assembling peptide matrices and nanofiber-spun matrices that mimic the architecture of the ECM and lower the pH of the chronic wound. In the European market, there is a device that delivers a spun polymer to the patient’s wound, and other matrices include elemental engineered (eg, glass and nanofilm scaffolds). Some of these therapies are applied in the operating room and may stay in place for up to a month, while other patients may receive their therapy in the outpatient setting with weekly applications. There is much to learn about the best applications for these therapies. 

These therapies certainly appear to have utility. More importantly though: what do they say about our understanding of the chronic wound environment? Do these agents simply facilitate the patient’s native ability to heal a wound? Will they behave differently in a patient who is older, who is disabled, or who has a greater number of comorbidities? As a clinician who has studied the wound bed and tried to develop therapies around the needs of the wound bed for over 20 years, these new modalities make me question some of the underpinnings of my knowledge.

This disruption in my thought process, and its potential change in doctrine, in my mind is a good thing. Re-evaluating well-held beliefs can lead to new horizons. To date, I am enjoying experimenting with these new therapies, bringing more technology to the care of our patients, and possibly reducing costs. I would recommend—if you are in the correct environment—embracing and experimenting with these new technologies. You may end up not wishing to adopt them; that is totally fine. For me, the exposure to this new technology changes my thoughts about the chronic wound and has an effect upon my point of view. These new technologies cannot help but make us question some of our long-held beliefs about wound closure, and I would argue this is a good disruption.  

John C. Lantis II, MD, FACS

Editor-in-Chief, Wounds 

woundseditor@hmpglobal.com