(CR-002) Trial of an Available Technology Dressing for Resource Limited Settings

Introduction: Our lengthy quest to provide an evidence-based solution for wound management in remote and conflict areas of tropical developing countries culminated in this randomized controlled trial. We significantly modified a dressing technique proven successful for Japanese pressure injury patients whose public assistance benefits are depleted. After successful beta testing on a variety of wound types, we conducted a formal trial in the tropics on extremely challenging wounds (sickle cell leg ulcers) as an “acid test” of the method.

Methods: This three-armed 12-week evaluator-blinded randomized controlled trial compared the improvised Available Technology dressing (ATD) technique (cut-to-fit perforated food-grade plastic with a moisture barrier on the periwound and an absorbent over the perforations) to a negative control (wet-to-moist dressings, equal or superior to usual practice), and a positive control (polymeric membrane dressings). All three protocols were rigorously defined. Dressing changes were conducted by the patients. Data, including wound photos, were collected weekly via WhatsApp, with in-person visits initially and at weeks 1, 4, 8, and 12.

Results:

All three groups saw improvement when compared with their previous usual practice. ATD participants’ pain and quality of life scores were improved over their previous usual practice, and when compared with study participants using wet-to-moist dressings. Participants in the ATD group were far less likely than those in wet-to-moist dressings group to develop wound infections, and their wounds were far more likely to decrease in size. The ATDs were not dramatically inferior to the polymeric membrane dressings, and they were significantly less expensive. The patients found the ATDs acceptable.

Discussion:

ATDs performed well despite the harsh environment. Semi-literate participants could perform dressing changes unaided. The ATDs did not promote infection or clinically significant maceration; they did promote healing, pain relief, and improved quality of life.

Implications for clinical practice: Considering the wide range of settings, patient co-morbidities, and wound types in which this dressing technique has proven successful, it is likely that ATDs can be safely used in other resource-limited situations to promote wound healing. Teaching patients this technique could result in better outcomes than continuing to recommend gauze alone, which is clearly inferior, or advanced dressings, which are likely to be left in place too long (if obtained at all) due to cost constraints.

Trademarked Items:

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