Tegaderm Matrix dressing is a unique solution for healing stalled chronic wounds. This dressing 'kick-starts' the healing process of a chronic wound that is stuck in the inflammatory stage and can work when other dressings have failed.
If it's TIME to HEAL your patients' chronic, stalled wounds, try Tegaderm Matrix dressing - it could be the last dressing you need for that wound to close.
The TIME framework is a systematic approach to wound bed preparation, introduced by the International Advisory Board on Wound Bed Preparation
T - Tissue Non Viable - Debride
I - Infection - Reduce bacterial load, reduce infection
M - Moisture Imbalance - Remove exudate from wound, protect the periwound
E - Epithelial Advancement - Reassess wound and patient
H - Holistic Assessment of the patient prior to dressing selection is essential, and should incorporate the TIME principles of wound bed preparation above
E - Environment of the wound is key to wound healing. Tegaderm Matrix dressing normalises the balance of MMPs and TIMPs 1 2 3, regulating overproduction of MMPs 4 at their source
A - Accelerated Healing is achieved 4 5 when the wound enviroment is brought back into balance
L - Lower cost of treatment through appropriate dressing choice
1Hoekstra M, Pirayesh A, (2003), Poly Hydrated Ionogens regulate Matrix dressing Metalloproteinases Expression and Reactive Oxygen Species in Recalcitrant Wounds. European Tissue Repair Society Congress, September 2003 2Korber A, Freise J, Rietkotter J, Grabbe X, Dissemond J (2006). Erfolgreiche Behandlung therapierefraktarer chronischer Wunden mit DerMax (Successful treatment of therapy-refractory chronic wounds with Tegaderm Matrix dressing), Zeitschrift fur Wundheiling 6; 310-314 3Van den Berg AJJ, Halkes SBA, Quarles van Ufford HC, Hoekstra MJ, Beukelman CJ. (2003). A novel formulation of metal ions and citric acid reduces reactive oxygen species in vitro. J Wound Care 12(10) 4Monroe S, Sampson EM, Popp MP, Lobman R, Schultz GS. 2005. Effect of Polyhydrated Ionogens (PHI) on Viability and Matrix dressing Metalloproteinase Levels in Cultures of Normal and Diabetic Human Dermal Fibroblast. Poster presentation WHS. Chicago. May 2005 5Karim RB, Brito BR, Dutrieux RP, Lassance FP, Hage JJ. (2006) MMP-2 Assessment as an Indicator of Wound Healing: A Feasibility Study, Advances in Skin & Wound Care 19(6); 324-327
How does it work?
Tegaderm Matrix dressing is appropriate to be used on the following wounds, following the TIME concept,
burns
pressure ulcers
venous leg ulcers
diabetic foot ulcers
Method of Application
Cleanse the wound according to local guidelines / protocols.
Apply Tegaderm Matrix dressing directly to the wound ensuring intimate contact is made with wound bed. Tegaderm Matrix dressing may be cut to fit the wound. Folding the dressing is also acceptable practice. Overlaying on surrounding skin will not harm the skin or affect tissue integrity.
Always apply a secondary dressing to Tegaderm Matrix dressing to maintain a moist wound healing environment:
for moderate to high exuding wounds : 3M™ Tegaderm™ Foam Dressing (adhesive or non-adhesive)
for low to non exuding wounds : 3M™ Tegaderm™ Film Dressing
To protect the peri-wound use 3M™ Cavilon™ No Sting Barrier Film at each dressing change.
At dressing change remove secondary dressing and gently lift Tegaderm Matrix dressing away from the wound.
In wounds where exudate levels have significantly diminished Tegaderm Matrix dressing may be moistened to aid gentle removal.
If desiccation has occurred review secondary dressing suitability.
Treatment of an intractable pressure ulcer with Tegaderm Matrix dressing
Mrs Peters
Mrs Peters (name changed) is an 83 year old lady who lives with her husband at home but had become increasingly weak and was taken to hospital for investigations. Nothing was identified during hospitalisation, and it was thought that the weakness was age related. She could no longer cope at home and was transferred to a nursing home. Due to her immobility and frailty, in the day she sat in a chair, with a gel cushion in situ and had an air mattress on the bed during night time. Sacral pressure damage was caused by her immobility prior to the use of air mattress and cushion. However, even with the use of these pressure relieving aids, the wound, which was clean and without slough was not healing.
Previously a foam adhesive, sacral shaped dressing was used. It was changed on a daily basis and use of this product, as a secondary dressing, continued when Tegaderm Matrix dressing was introduced on the 28th October. This dressing combination remained the same until the wound healed (17th December). During the trial the dressing change frequency gradually reduced from daily dressing to twice weekly. Using this particular foam adhesive sacral dressing, size 22cm x 22cm, at cost of £11.00, on a daily dressing change basis, led to a dressing materials cost of £309.00 per month for care of this wound.
Once the wound was dressed with Tegaderm Matrix, the wound rapidly moved from indolent to a healing state and dressing changes were reduced to two changes per week, at a cost saving of £220.64 per month.
Treatment with Tegaderm Matrix dressing: a diabetic patient with a heel pressure ulcer
Mrs Cooper
Mrs Cooper (name changed) is a 79 year old diabetic lady who had previously had an amputated left leg due to pressure damage over the heel. She had a Waterlow score of 20 which placed her at very high risk of development of further pressure ulcers. There was now a pressure ulcer on the right heel that had been present for 8.5 months. Her previous treatment included an electrical dressing and then a hydrogel sheet dressing which had greatly improved the wound and it had almost reached closure. At this point there was a severe breakdown of the wound and dressings (hydrofibre – cost £7.70 per dressing and foam – cost £8.00 per dressing) were being changed on alternate days over several months at a cost of £235.00 per month.
Tegaderm Matrix dressing was first applied on 18th July. The secondary dressing used was gauze and this was held in place by orthopaedic wool and a simple retention bandage. Healing was slow, possibly due to the diabetic pathology. Within a short period of time dressing changes were reduced to twice weekly for 8 weeks and then reduced to once per week until 18th October (92 days) by which time the wound had almost reached full closure. Following the study, the wound completely healed. The overall cost of treatment with Tegaderm Matrix dressing was £170.00 showing a cost saving of £520.00 over the previous dressing regimen used to treat this wound.
Treatment of an intractable pressure ulcer with Tegaderm Matrix dressing
Mrs Roper
Mrs Roper (name changed) a 72 year old lady with a pressure ulcer was admitted to a nursing home from hospital, in May 2005. Mrs Roper had severe Parkinson’s disease, but was fully compus-mentus and bright and knew exactly how to direct her care. With a little help she was mobile and directed the health care professionals in how she wanted her wound photographed at each visit, sometimes when standing, sometimes when lying down. Previous dressings used were a simple foam at a cost of £1.70 per dressing. The dressing was changed daily at a material cost of £51 per month. The wound appeared to have clean granulating tissue in the base which normally indicates a healing wound. Nevertheless, the wound was not progressing and had been static for several months.
Tegaderm Matrix dressing was commenced on the 12th August. A secondary dressing was required to hold the Tegaderm Matrix dressing in place, and an adhesive bordered foam was the selected dressing at a cost of £3.40 per dressing. Dressing changes were gradually reduced from daily to weekly and by the 20th October (69 days) the wound healed at a material cost of £321.00. Although the material cost of this treatment was higher than the initial dressing costs, cost-effectiveness was still fully demonstrated as this previously non-healing wound went on to heal without complications and without any pain in less than 10 weeks. A very successful outcome for the patient and the funders.
Treatment of an intractable pressure ulcer with Tegaderm Matrix dressing
Mrs Morris
Mrs Morris, an 81 year old lady, with Parkinson’s disease was admitted to a nursing home on the 25 July with an established EPUAP grade IV pressure ulcer. She had a Waterlow score of 25 which placed her at very high risk of further tissue damage. The score reduced to 19 during the period of the case study, although this is still high risk.
Previous treatment of her wound included use of a range of dressing combinations including hydrofibre ribbon covered by a hydrocolloid dressing; Metrotop™ gel and a hydrogel sheet. Use of a hydrofibre dressing covered with an adhesive foam sacral dressing was the most recent treatment. This was changed every three days at a cost of £243.00 per month. Mrs Morris always insisted on sitting out in a chair on a static cushion. She would nap on her bed following lunch and then sit out again.
The only change to her care was the introduction of Tegaderm Matrix dressing to replace the hydrofibre dressing, which was applied initially on the 4th August. A simple adhesive foam was used as a secondary dressing. Dressing changes were gradually reduced to two changes per week at a cost of £199.00 per month representing a saving of £44.00.
Treatment with Tegaderm Matrix dressing: treatment of a pressure ulcer over the elbow
Mrs Ashford
Mrs Ashford was a 75 year old lady who lived in a nursing home. She was nursed on an air mattress when in bed but she developed a very nasty pressure ulcer on her elbow which was grade IV, (down to bone). It was thought that she had developed the sore from the arm of her chair when sitting out during the day. This had been rectified a month previously by padding her elbow. She was placed on bed rest but the ulcer did not improve. After 3 months the wound was indolent and required stimulating to initiate the healing process.
The previous dressing used was a hydrofibre dressing which was held in place by retention bandages. As the dressing was changed twice weekly the cost of treatment was low (approximately £77.00 per month).
Tegaderm Matrix dressing was first applied on 15th July. It was covered with a simple foam dressing to absorb fluid and provide a moist wound healing environment. Orthopaedic wool and a simple retention bandage held the dressings in place and padded the elbow.
The progress of the wound was remarkable, healing within 1 month from a large grade IV ulcer to complete closure. Since a healed wound bears no cost of treatment, a saving of £77 per month resulted from the use of Tegaderm Matrix dressing after one month’s treatment.
Treatment of a grade II pressure ulcer with Tegaderm Matrix dressing
Mr Andrews
Mr Andrews (name changed) was a 62 year old gentleman with diabetes and several pathologies, including multiple sites of cancer that placed him at very high risk of pressure damage. He was admitted into a nursing home from hospital with a pressure ulcer over his left hip and sacrum. The hip wound was extremely sore and, even though he was placed on an air mattress, was not healing.
Tegaderm Matrix dressing was applied on the 9th May with a simple adhesive foam as a secondary dressing. The wound healed within 6 weeks and without problems. Rapid healing was achieved despite his multiple pathology including throat cancer, which meant nutrition was poor. Unfortunately, shortly after his wound healed, Mr Andrews died.
Tegaderm Matrix dressing is a wound dressing impregnated with polyhydrated ionogens (PHI) ointment which balances the chronic wound environment accelerating the healing process. PHI is composed of a mixture of metal ions in a citric acid buffered, hydrophilic Matrix dressing.
MMPs are a specific group of zinc containing proteolytic enzymes. They play an important role in remodelling the extracellular Matrix during wound healing in both degradation and regeneration and in supporting epithelialisation. During normal wound healing there is a balance between the clearing of the damaged tissue and the building of the new tissue. However in chronic wounds an imbalance exists in this process, resulting in slower or arrested wound healing.
Many research studies have identified raised levels of MMPs in chronic wounds. Prolonged high levels of MMPs can destroy new tissue which impairs the wound’s ability to heal. TIMP (Tissue Inhibitors of MMP) are the natural inhibitors of MMPs.
In normal wound healing the levels of TIMPs and MMPs are balanced allowing the new wound structure to be laid down in a regular, progressive manner. In chronic wounds there exists an imbalance between TIMPs and MMPs which leads to an unstable extracellular Matrix and impedes the wound healing process. In order to accelerate wound healing the balance of MMPs and TIMPs needs to be restored.
There are many different types of MMPs but MMPs 2 and 9 are of greatest importance to wound healing and are often over expressed in hard to heal wounds.
The metal ions in Tegaderm Matrix dressing inhibit the production of MMPs at cellular level thus creating balance between the activity of Tissue Inhibitor Metalloproteinases (TIMPs) and the relevant MMPs.
Tegaderm Matrix dressing consists of an acetate carrier impregnated with PHI ointment which consists of a blend of metal ions (rubidium, calcium, zinc and potassium), carried in polyethylene glycol (PEGs) and citric acid buffer.
The acetate carrier is made of cellulose acetate which allows passage of exudate and is non fibre shedding.
PEGs allow delivery of the polyhydrated ionogens (PHI) into the wound bed, activating delivery of the metal ions. PEGs are hydrophilic, requiring warmth and moisture to activate the release of the formula into the wound bed. In the presence of exudate a gradual release of the PHI formulation into the wound is stimulated, allowing the metal ions to enter the fibroblast cells.
There are 4 metal ions in the PHI ointment: rubidium, calcium, zinc and potassium. Production of MMP-2 by fibroblasts will be down-regulated by the metal ion formulation.
Rubidium is the first ion to enter the cell membrane, opening up a channel for the other ions to pass through.
Calcium inhibits the production of MMPs.
Zinc inhibits the production of MMPs and is required for tissue regeneration.
Potassium depolarizes cell membranes as it switches the protein manufacturing and inhibits the MMP production. Potassium is also required for tissue regeneration.
Citric Acid - in the initial phase of wound healing, pH plays an important role in the synthesis of neutral complexes facilitating transport of metal ions over the cell membrane. In normal wound healing the wound pH is slightly acidic (pH5), whereas it is neutral to alkaline in many chronic wounds. A high pH has been found to slow cell proliferation thus retarding wound healing. The rate of wound healing has been found to increase when reducing the pH of the wound with an effective buffer such as citric acid.
Yes, Tegaderm Matrix dressing can be used beneath compression bandaging. A secondary dressing will be required to maintain a moist wound healing environment.
Tegaderm Matrix dressing is not indicated for use in infected wounds and we currently have no evidence supporting its use together with other active dressings.
Yes, Tegaderm Matrix dressing may be cut to fit the wound however, folding the dressing is also acceptable practice, depending on wound location. Overlaying on surrounding skin will not harm the skin or affect tissue integrity. Choose whether to cut or fold based on wound characteristics and best solution for patient comfort.
Tegaderm Matrix dressing should be re-applied at every dressing change. Clinical evaluations to date demonstrate improved healing in patients having daily, twice weekly and weekly dressing change.
It is important to note that in the initial stages more frequent dressing applications will maximise delivery of metal ions and thus accelerate healing outcomes.
