Repithel: removing the barriers to wound healing.
BACKGROUND
Various standardized and/or validated models exist to test wound healing products. This article discusses their usefulness in clinical practice.


OBJECTIVE
Major barriers to wound healing have been identified after intense interaction of research and practitioners. Although extensively tested, wound healing products are still associated with trial and error due to the high variability and complexity associated with the treatment of wounds. Therefore, the results of preclinical testing are compared and contrasted with clinical observations of a liposomal hydrogel containing 3% povidone-iodine (Repithel, PVP-ILH) to assess their expressiveness and to give the practitioner more guidance in application.


METHODS
Testing of PVP-ILH included physicochemical testing according to ISO norms, testing in in vitro and in vivo models. The obtained results are compared to the clinical profile of the obtained product in randomized controlled trials and ultimately expressive case studies.


RESULTS
PVP-ILH displays good local tolerance, the basis for use in sensitive and predamaged tissue. As observed in laboratory testing, it readily provides moisture and takes up limited amounts of moisture. This was also seen in the clinical testing, as the ability to keep wounds moist and incorporate a certain -- but not large -- amount of exudates. Clinical results also show clean, well-debrided wounds, an effect that (in the absence of an established model for wound cleansing) was traced to the hydrogel component carbomer.


CONCLUSIONS
Recent consensus advocates the concept of wound bed preparation as a systematic approach to removing barriers to healing (TIME). Based on the results, tissue (removing non-viable tissue and debris) and moisture (balance) can now be better understood, and infection/inflammation (control) and edge (progressing, non-advancing or undermining wound edges) are reviewed together with previously published data to assess all aspects potentially impeding wound healing.


CONCLUSIONS
PVP-ILH successfully removes barriers to wound healing, thus laying the foundation to high-quality wound closure. Results from many scientific disciplines can help the user to better understand a product, standardization of testing is the only way of making results comparable.
Mundipharma Research GmbH & Co. KG, Limburg/Lahn, Germany. stefan.mueller@mundipharma.de
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Mueller
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Vogt
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Steinau
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Leuner
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Hopp
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Bosse
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Fleischer
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Reimer
D000042:Absorption / Q000187:drug effects; D000287:Administration, Topical; D000362:Agar / Q000494:pharmacology; D000818:Animals; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage / Q000494:pharmacology*; D003646:Debridement; D003879:Dermatologic Agents / Q000008:administration & dosage / Q000494:pharmacology*; D005780:Gelatin / Q000494:pharmacology; D006801:Humans; D020136:Hydrogel, Polyethylene Glycol Dimethacrylate / Q000008:administration & dosage / Q000494:pharmacology*; D066298:In Vitro Techniques; D007249:Inflammation / Q000517:prevention & control; D008081:Liposomes / Q000008:administration & dosage / Q000494:pharmacology; D011206:Povidone-Iodine / Q000008:administration & dosage / Q000494:pharmacology*; D011817:Rabbits; D012882:Skin Tests; D014867:Water / Q000494:pharmacology; D014945:Wound Healing / Q000187:drug effects*; D014946:Wound Infection / Q000517:prevention & control
D000891:Anti-Infective Agents, Local; D003879:Dermatologic Agents; D008081:Liposomes; D014867:Water; D020136:Hydrogel, Polyethylene Glycol Dimethacrylate; D011206:Povidone-Iodine; D005780:Gelatin; D000362:Agar