Abstract:
A wound dressing apparatus for use in subatmospheric pressure therapy includes an outer member dimensioned for positioning relative to a wound bed and defining an internal reservoir, a port associated with the outer member and in communication with the internal reservoir for applying subatmospheric pressure to the internal reservoir to facilitate treatment of the wound bed and removal of fluid therefrom, an inner member at least partially positionable within the wound bed and confined within the outer member, and an adhesive agent in contact with a peripheral section of the outer member to facilitate attachment of the peripheral section to the periwound tissue. The adhesive agent is preferably substantially devoid of contact with the inner member. In one embodiment, a layer of adhesive material is disposed on the peripheral section of the outer member.

Description:
BACKGROUND 
       [0001]    1. Technical Field 
         [0002]    The present disclosure relates to an apparatus for treating an open wound, and, more specifically, relates to a wound dressing for use in a subatmospheric pressure wound therapy procedure. 
         [0003]    2. Description of Related Art 
         [0004]    Wound closure involves the migration of epithelial and subcutaneous tissue adjacent the wound towards the center of the wound until the wound closes. Unfortunately, closure is difficult with large wounds or wounds that have become infected. In such wounds, a zone of stasis (i.e. an area in which localized swelling of tissue restricts the flow of blood to the tissues) forms near the surface of the wound. Without sufficient blood flow, the epithelial and subcutaneous tissues surrounding the wound not only receive diminished oxygen and nutrients, but, are also less able to successfully fight microbial infection and, thus, are less able to close the wound naturally. Such wounds have presented difficulties to medical personnel for many years. 
         [0005]    Wound dressings have been used in the medical industry to protect and/or facilitate healing of open wounds. One popular technique has been to use negative pressure therapy, which is also known as suction or vacuum therapy. A variety of negative pressure devices have been developed to allow excess wound fluids, i.e., exudates, to be removed while at the same time isolating the wound to protect the wound and, consequently, reduce recovery time. Various wound dressings have been employed to promote the healing of open wounds. 
       SUMMARY 
       [0006]    Accordingly, the present disclosure is directed to further improvements in subatmospheric pressure wound therapy. In one preferred embodiment, a wound dressing apparatus includes an outer member dimensioned for positioning relative to a wound bed and defining an internal reservoir, a port associated with the outer member and in communication with the internal reservoir for applying subatmospheric pressure to the internal reservoir to facilitate treatment of the wound bed and removal of fluid therefrom, an inner member at least partially positionable within the wound bed and confined within the outer member, and an adhesive agent in contact with a peripheral section of the outer member to facilitate attachment of the peripheral section to the periwound tissue. The adhesive agent is preferably substantially devoid of contact with the inner member such that the integrity of the inner member is not affected or degraded, due to its otherwise contact with the inner member. In one embodiment, a layer of adhesive material is disposed on the peripheral section of the outer member. 
         [0007]    A release member may be mounted to the layer of the adhesive material in at least partial superposed relation with the outer member. The release member is removable to expose the adhesive material. The layer of the adhesive material may be disposed on a major portion of one surface of the outer member. In another embodiment, the release member may define a plurality of release sections. The release sections may be selectively separable to expose a predetermined area of the layer of the adhesive material for attachment to the periwound tissue. 
         [0008]    A supplemental member may be positioned over the inner member, to prevent contact of the adhesive layer with the inner member. The supplemental member may include a layer of gauze. 
         [0009]    The adhesive agent may be a liquid agent applicable to the peripheral section of the outer member or applicable to the periwound tissue prior to attachment thereof to the periwound tissue. The adhesive agent may be thermally activated, adapted to be activated through application of ultraviolet energy, or adapted to be activated upon exposure to an exothermic catalyst. 
         [0010]    In another embodiment, a pad member has the adhesive agent on one surface thereof. The pad member is dimensioned to be positioned about the peripheral section of the outer member to at least partially overlap and adhere to each of the peripheral section and the periwound tissue to thereby secure the outer member to the periwound tissue. 
         [0011]    The inner member may include a material selected from the group consisting of foams, beads, nonwoven composite fabrics, hydrogels, cellulosic fabrics, super absorbent polymers, and combinations thereof. The inner member further may include at least one of a medicament, an anti-infective agent, an antimicrobial, polyhexamethylene biguanide (hereinafter, “PHMB”), antibiotics, analgesics, healing factors, vitamins, growth factors, debridement agents and nutrients. 
         [0012]    A subatmospheric pressure source may be in fluid communication with the port. The subatmospheric pressure source supplies subatmospheric pressure to the internal reservoir. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0013]    Various embodiments of the subject wound dressing are described herein with reference to the drawings wherein: 
           [0014]      FIG. 1  is a side cross-sectional view of the wound dressing apparatus in accordance with the principles of the present disclosure positioned about a wound bed illustrating the outer member, inner member, adhesive member and the wound liner; 
           [0015]      FIG. 2  is a view similar to the view of  FIG. 1  illustrating the wound dressing subjected to subatmospheric pressure; 
           [0016]      FIG. 3  is a plan view of an outer member in accordance with an alternate embodiment of the wound dressing; 
           [0017]      FIG. 4  is a side cross-sectioned similar to the view of  FIG. 2  illustrating the wound dressing of  FIG. 3  positioned about the wound bed; 
           [0018]      FIG. 5  is a side cross-sectional view similar to the view of  FIG. 2  illustrating another embodiment of the wound dressing apparatus; and 
           [0019]      FIG. 6  is a side cross-sectioned view similar to the view of  FIG. 2  illustrating another embodiment of the wound dressing apparatus. 
       
    
    
     DESCRIPTION OF THE PREFERRED EMBODIMENTS 
       [0020]    The composite wound dressing of the present disclosure promotes healing of a wound via the use of a subatmospheric pressure reservoir. The subatmospheric pressure reservoir subjects the wound to subatmospheric pressure or a vacuum to effectively draw wound fluid, including liquid, exudates from the wound bed with continuous, or non-continuous, application of a subatmospheric pressure source or pump. Hence, subatmospheric pressure can be applied once, or in varying intervals, depending on the nature and severity of the wound until the composite wound dressing is saturated with exudate or the wound is healed. If the wound dressing is saturated with exudate and the wound is not healed, the composite wound dressing can be replaced and the process of applying subatmospheric pressure can be repeated. 
         [0021]    Referring now to  FIGS. 1-2 , the composite wound dressing apparatus  100  in accordance with a preferred embodiment of the present disclosure is illustrated in the form of an article with multiple layers arranged in juxtaposed or superposed relation. The multiple layers include, but, are not limited to a wound liner  102 , an inner member  104  an adhesive agent or member  106 , and an outer member  108  which includes and/or defines the internal subatmospheric pressure reservoir  110 . 
         [0022]    The wound liner  102  is in direct contact with the wound bed “w”. The wound liner  102  is typically porous allowing passage of subatmospheric pressure to the wound bed. In one preferred embodiment, the base layer includes a “non-adherent” material. “Non-adherent” as used herein refers to a material that does not adhere to tissues in and around the wound bed. “Porous” as used herein refers to a material which contains numerous small perforations or pores which allow wound fluids to pass through the material to the dressing layers above. The passage of wound fluid through the porous material may be unidirectional such that wound exudate does not flow back to the wound bed. This direction flow feature could be in the form of directional apertures imparted into the material layer, a lamination of materials of different absorption to the wound liner  102  or specific material selection that encourages directional flow. Exemplary materials used as the wound liner  102  include a contact layer sold under the trademark XEROFLOW® by Kendall Corp., a division of TycoHealthcare. In the alternative, wound dressing apparatus  100  may be devoid of the wound liner  102 . 
         [0023]    In addition, agents such as hydrogels, adhesives and medicaments could be bonded or coated to the wound liner  102  to reduce bioburden in the wound, promote healing and reduce pain associated with dressing changes or removal. Medicaments include, for example, antimicrobial agents, growth factors, antibiotics, analgesics, debridement agents and the like. Furthermore, when an analgesic is used, the analgesic could include a mechanism that would allow the release of that agent prior to dressing removal or change. Exemplary triggers of a release mechanism could be temperature change, moisture, ph, pressure and the like. 
         [0024]    Inner member  104  may serve as an absorbent/packing layer. In this capacity, inner member  104  is intended to absorb and capture wound fluid and exudates. Exemplary absorbent materials include foams, nonwoven composite fabrics, fibers, hydrogels, cellulosic fabrics, alginates, super absorbent polymers, hydrophilic and hydrophobic beads, and combinations thereof. Typically, the inner member  104  can absorb up to about 100 cubic centimeters (cc) or more of wound fluid. The absorbent material may include the antimicrobial dressing sold under the trademark KERLIX® by Kendall Corp., a division of TycoHealthcare. In one embodiment, the inner member  104  could be preformed or shaped to conform to varying shapes of the wound bed. Those skilled in the art will recognize that the inner member  104  can be formed in any suitable shape. The inner member  104  may include multiple layers. 
         [0025]    Additionally, the inner member  104  could be treated with medicaments. Medicaments include, for example, an anti-infective agent such as an antiseptic or other suitable antimicrobial or combination of antimicrobials, polyhexamethylene biguanide (hereinafter, “PHMB”), antibiotics, analgesics, healing factors such as vitamins, growth factors, nutrients and the like, as well as a flushing agent such as isotonic saline solution. 
         [0026]    With continued reference to  FIGS. 1-2 , the adhesive member  106  at least encompasses the perimeter of the wound dressing  100  to surround the wound bed to provide a seal around the perimeter of the wound bed “w”. For instance, the sealing mechanism may be any adhesive bonded to a layer that surrounds the wound bed “w” or an adhesive applied directly to the skin. The adhesive must provide acceptable adhesion to the periwound tissue “t” surrounding the wound bed “w” skin, e.g., the periwound area, and be acceptable for use on skin without contact deterioration (for example, the adhesive should preferably be non-irritating and non-sensitizing.) Typical adhesives can include acrylics, silicone, urethanes, hydrogels, rubber-based hydrogels and the like. The adhesive may be semi-permeable to permit the contacted skin to transmit moisture or may be impermeable. Additionally, the adhesive could be activated or de-activated by an external stimulus such as heat, light or a given fluid solution or chemical reaction. Adhesives include, for example, the dressing sold under the trademark ULTEC® Hydrocolloid or hydrogel sold under the trademarks of Curagel® or Aqua Flo® dressing by Kendall Corp., a division of TycoHealthcare. 
         [0027]    In one embodiment, the adhesive member  106  is a layer of adhesive material, i.e., incorporated within or a component of the outer member  108 . Releasable contact liners may be incorporated within the outer member  108  to protect the adhesive member  106  prior to use as will be discussed. The adhesive member  106  may also be in the form of an entire layer proximal to the inner member  104 , or, may be annular or “donut shaped” as shown. Preferably, the adhesive member  106  is not bonded to the inner member  104 . In one embodiment, the adhesive member  106  is a component of the periphery of the outer member  108 . The adhesive member  106  is secured to the outskirts of the wound liner  102  and at least bonded to the periwound tissue “t” to be in overlapping relation with the tissue “t”. Alternatively, the adhesive member  106  may be positioned on the peripheral portion of the outer member  108  and secured to the tissue “t” about the wound bed “w”, and not bonded to the wound liner  102 . As a further alternative, the adhesive member  106  may be a liquid substance applied to the peripheral portion of the outer member  108  or the periwound tissue “t” prior to application of the wound dressing apparatus  100 . Preferably, the adhesive member  106  is substantially devoid of contact with the inner member  104 . With this relation, the adhesive member  106  will not affect the integrity of the inner member  104  nor come into contact with the healing tissue within the wound bed “w”. 
         [0028]    The outer member  108  typically seals the top of the wound dressing  100  and helps maintain the appropriate subatmospheric pressure level within the wound dressing  100 . In one preferred embodiment, the outer member  108  includes the flexible transparent dressing manufactured under the trademark POLYSKIN® II by Kendall Corp., a division of TycoHealthcare. POLYSKIN® II is a transparent, semi-permeable material which permits moisture and oxygen exchange with the wound site, and provides a barrier to microbes and fluid containment. In another approach, the outer member  110  may be impermeable. As a further alternative, the outer member  108  may include a resilient, e.g., elastomeric, material in the shape, e.g., of a dome. 
         [0029]    The outer member  108  defines a sealed or enclosed subatmospheric pressure reservoir  110 . The subatmospheric pressure reservoir  110  is preferably maintained at an appropriate subatmospheric pressure level for a predetermined period of time sufficient to initiate or complete healing of the wound bed “w”, i.e., to draw wound fluid and exudate away from the wound bed “w” while subjecting the wound to subatmospheric pressure. The subatmospheric pressure may be re-applied as needed to maintain a therapeutic effect. The subatmospheric pressure may be continuous or intermittent as desired. 
         [0030]    As best seen in  FIG. 1 , the subatmospheric pressure reservoir  110  is defined within the dome of the outer member  108 . As shown in  FIG. 2 , once subatmospheric pressure is applied via the subatmospheric pressure source  112 , the dome of the outer member  108  is drawn downwardly toward the inner member  104  with the subatmospheric pressure or subatmospheric reservoir  110  created beneath the outer member  108 . Typically, the outer member  108  includes a subatmospheric pressure port or connector  114  in fluid communication with the subatmospheric pressure reservoir  110 . Preferably, the subatmospheric pressure port  114  includes a one-way valve (shown schematically as reference numeral  116 ) which provides unidirectional flow of suction and may provide a means for allowing connection of the composite wound dressing  100  to the subatmospheric pressure source  112 . The one way valve  116  may be incorporated within the subatmospheric pressure port  114  or, alternatively, be “in line” with the subatmospheric pressure source  112 . A flexible tubing  118  is connected to the subatmospheric pressure port  114  and the subatmospheric pressure source  112 . The tubing  118  provides suction to the wound from the subatmospheric pressure source  112  and enables the wound fluid or exudates to be transferred from the wound dressing  100 . The tubing  118  may be fabricated from PVC, silicone based material or other flexible materials (polymers). The tubing  118  may optionally include a connection to a collection canister  120  for wound drainage and debris. Hence, the subatmospheric pressure source  112  can draw wound fluid through the composite wound dressing  100  and tubing  118  into the canister  120 . In a preferred embodiment of the present disclosure, the canister  120  is portable so that the patient will have the freedom to move about rather than being confined to a fixed location. The canister  120  may also house an absorbent material to absorb wound fluid and exudate. 
         [0031]    The subatmospheric pressure source  112  may apply subatmospheric pressure to the wound by means such as a manual pump as disclosed in commonly assigned U.S. Pat. No. 5,549,584 to Gross, the entire contents of which are hereby incorporated herein by reference. In the alternative, the subatmospheric pressure source  112  may include an automated pump. Typically, the subatmospheric pressure level is applied to achieve a range between about 20 mmHg to about 500 mmHg, more preferably, about 40 mmHg and about 125 mmHg. The automated pump may be a wall suction apparatus such as those available in an acute or sub-acute care facility. The automated pump may be in the form of a portable pump. The portable pump may include a small or miniature pump that maintains or draws adequate and therapeutic subatmospheric pressure levels. In a preferred embodiment, the pump is a portable, lightweight, battery operated, suction pump which attaches to the distal end of the tubing. Typically, the subatmospheric pressure source  112  has regulation means  122  to apply the optimal subatmospheric pressure for healing the wound. The regulation means  122  may include one or more pressure sensors  124 ,  126 . One pressure sensor  124  may be utilized to detect the pressure within the subatmospheric reservoir  110 , and with the appropriate circuitry or logic associated with the regulations means  122 , may adjust (e.g., increase or decrease), delay, halt, and/or commence the operation of the subatmospheric pressure source  112  to achieve a subatmospheric pressure objective adjacent the wound. The pressure sensor  124  may be remote from the wound and in fluid communication with the subatmospheric reservoir  110  through the tubing  118 , or alternatively, may be positioned directly within the subatmospheric reservoir  110  and/or the wound dressing  100  and in electrical communication with the regulation means  122  through wiring or conduit extending through the tubing  118 . It is further envisioned that the pressure sensor  124  may be capable of sending remote, e.g., wireless signals, from the wound site to the regulation means  122  through a transmitter  128  to control operation of the subatmospheric pressure source  112 . 
         [0032]    The pressure sensor  126  is envisioned to detect a change in pressure, e.g., an increase in negative pressure indicating that the canister  120  is full or near a full condition. In this embodiment, a filter  130  is disposed between the canister  120  and the subatmospheric pressure source  112 . Once the canister  120  becomes full and the exudates communicates with the filter  130 , the filter  130  becomes clogged or blocked and the subatmospheric pressure is substantially increased as detected by the pressure sensor  126 . As a result, the subatmospheric pressure source  112  is switched to an off condition to permit subsequent emptying or disposal of the canister  120 . 
         [0033]    Tubing connector  114 , one-way valve  116  or tubing  118  may incorporate vent (schematically identified as numeral  132 ) to permit the clinician to manually vent to the atmosphere when a clog is connected, or to clear the lines of fluid. Vent  132  may be a valve which opens and closes or a perforated filter which may control leak rate so that the exudates may be able to be deposited into canister  120 . 
         [0034]    Furthermore, the subatmospheric pressure source  112  would preferably contain a mechanism to detect a leak in the system if the optimal subatmospheric pressure is not achieved. Preferably, the subatmospheric pressure source  112  would also contain an indicator (not shown) to indicate when the optimal subatmospheric pressure is achieved. In the alternative, a hand pump in the form of a squeeze bulb or a foot pump may serve as the subatmospheric pressure source  112 . 
         [0035]    Preferably, a pump is used as the subatmospheric pressure source  112 . Typical pumps include diaphragm or voice coil activated styles that can deliver variable subatmospheric pressure up to 18 liters/minute. 
         [0036]      FIGS. 3-4  illustrate an alternate embodiment of the wound dressing apparatus  200  of the present disclosure. In accordance with this embodiment, outer member  202  includes a plurality of releasable liner sections  204  which cover the adhesive agent or member  206  disposed on the lower surface of the outer member  202 . The releasable liner sections  204  are independently separable from the outer member  202  about the perforated lines or score lines  208  to selectively expose the adhesive member  206  to generally correspond to the size of the wound bed. In one embodiment, the outer member  202  includes a plurality of concentric annular or circular releasable liner sections  204 . Thus, the clinician may remove the outer liner sections  204  as desired to expose the adhesive member  206  for securement of the outer member  202  to the periwound tissue “t”. The inner releasable liner sections  204  may be retained on the outer member  202  as desired to ensure that the adhesive member  206  will not come into contact with the inner member  210  as shown in  FIG. 4 . 
         [0037]      FIG. 5  illustrates an alternate embodiment of the wound dressing apparatus  300 . Wound dressing apparatus  300  may incorporate a supplemental member  302  positionable between the inner member  304  and the adhesive member  306  which may or may not be a component of the outer member  308 . The supplemental member  302 , thus, is in contact with the adhesive member  306  thereby preventing exposure of the inner member  304  to the adhesive member  306 . In one embodiment, the supplemental member  302  may be a gauze material such as the aforementioned KERLIX® and the inner member  304  may include a foam material. 
         [0038]      FIG. 6  illustrates an alternative embodiment of the wound dressing apparatus  400 . In accordance with this embodiment, the adhesive member  402  is an annular or ring like member which is positionable onto the upper surface of the outer member  404 . The adhesive member  402  may include a base member  406  having a layer of adhesive  408  disposed on the base member  406 . A releasable liner may be positioned on the adhesive member  402  to protect the adhesive during transport. In use, the releasable liner may be removed to expose the adhesive member  402 . Thereafter, the adhesive member  402  is mounted to the outer surface of the outer member  404  and arranged to overlap the outer member  404  and the periwound tissue “t’ thus securing the outer member  404  to the patient. In one embodiment, the adhesive member  402 , i.e., the layer of adhesive material  408 , is thermally activated with the application of a thermal energy source as shown schematically by arrows  410 . In one aspect, the adhesive member  402  is activated by ultraviolet light. Alternatively, the adhesive member  402  is adapted to be activated upon exposure to an exothermic catalyst. 
         [0039]    It is further contemplated that the wound dressing apparatus may incorporate external means or applications to stimulate tissue growth and/or healing. For example, an ultrasonic transducer may be incorporated into the wound dressing apparatus to impart mechanical energy for the treatment of the tissue such as, for instance, directing thermal or vibratory energy on the wound area to stimulate healing and/or further encouraging exudates removal by subatmospheric pressure and/or introducing various drugs into the human body through the skin. Other sensor types are also contemplated for incorporation into the wound dressing apparatus including oxygen, chemical, microbial and/or temperature sensors. The detection of oxygen adjacent the wound area would assist the clinician in determining the status of wound healing. The presence of an elevated temperature may be indicative of an infection. 
         [0040]    While the disclosure has been illustrated and described, it is not intended to be limited to the details shown, since various modifications and substitutions can be made without departing in any way from the spirit of the present disclosure. Accordingly, further modifications and equivalents of the invention herein disclosed can occur to persons skilled in the art using no more than routine experimentation, and all such modifications and equivalents are believed to be within the spirit and scope of the disclosure as defined by the following claims.