The challenges of wound related pain

Wound related pain is commonly experienced and can be distressing for both patients and clinicians (White, 2008; Mudge and Orsted, 2010). One cause of wound pain can be attributed to dressing changes and is largely preventable (Brown, 2014). A commonly adopted strategy of reducing pain related to dressings is avoiding the use of adhesive dressings and choosing a non-adherent wound product designed to minimise pain on removal, such as silicone-coated dressings (Brown, 2014). Silicone-coated dressings, such as Mepitel^® One with Safetac^® technology, can overcome the problems of adherence to the wound and damage to the surrounding skin (White, 2005; White, 2008) resulting in minimal pain for patients.  
 

What is Mepitel^® One?

Mepitel^® One (figure 1) is a wound contact layer with Safetac^® technology. Wound contact layer dressings are primarily used to protect granulation and re-epithelialisation tissue from external stresses, thereby facilitating the healing process while minimising wound trauma and pain (David et al, 2018). Mepitel^® One is a development of Mepitel^®. Some clinicians found the outside silicone layer stuck to their gloves, although some liked this feature as it helped keep the secondary dressing in place. Mepitel^® One also allows for better visualisation of the wound bed and surrounding skin.  

Mepitel^® One consists of:

• a soft silicone wound contact layer (Safetac^® technology) on one side
• a transparent, flexible, thin and perforated polyurethane film.

Figure 1. Mepitel^® One with Safetac^® technology

What are the key benefits of using Mepitel^® One?

GENTLE

Mepitel^® One has one side of silicone adhesion to minimise pain and discomfort at dressing removal and reduces skin damage for patients (Patton et al, 2013; David et al, 2018). Safetac^® technology does not adhere to the wound bed, but forms a seal around the wound margin, therefore reducing the risk of maceration (Patton et al, 2013; David et al, 2018).  
 

DURABLE

Because Mepitel^® One can remain in place for up to 14 days, the wound bed is left undisturbed, further minimising pain and discomfort from more frequent dressing changes and supporting undisturbed healing (Collin, 2009; Edwards and Mason, 2013; Patton et al, 2013; David et al, 2018). The properties of the product remain over time, leaving no residue and without drying out (Adamietz et al, 1995).
 

SAFE TO USE

The transparent net enables visualisation of the wound bad and periwound skin area enabling wound assessment avoiding unnecessary dressing changes (David et al, 2018). It has a pre-printed symbol (figure 2) which can facilitate safe removal when managing skin tears with fully or partially intact flap. The perforated structure allows it to be used in combination with gels (Adamietz et al, 1995).
 

Figure 2. Pre-printed symbol which can facilitate safe removal when managing skin tears.
 

SAFETAC^® TECHNOLOGY

Safetac^® technology silicone adhesion was designed to create less pain for the patient. It moulds softly to the skin, protecting new tissue and skin, without adhering to the wound bed (White, 2005; Gee Kee et al, 2015) and leaves no residue (Adamietz et al, 1995). This enables it to be easily removed without damaging the wound bed or periwound skin (Zillmer et al, 2006; Waring et al, 2011).
 

When to use Mepitel^® One

Mepitel^® One can be used in the management of a wide range of acute and chronic wounds (table 1).
 

Acute wounds	Chronic wounds	Protective layer on non-exuding wounds
Partial and full thickness skin grafts and donor sites	Venous, mixed aetiology and arterial leg ulcers	Fragile skin
Skin tears	Pressure ulcers	Blisters
Partial thickness burns	Diabetic foot ulcers	Exposed fragile tissue
Lacerations, traumatic wounds and skin abrasions	Dermatological disorders, e.g. Epidermolysis  Bullosa	Protection during irradiation
Sutured/surgical wounds	Painful and fragile wounds	Radiated skin

Table 1. The range of wounds suitable for Mepitel^® One.

The open structure of Mepitel^® One allows, where clinically indicated, topical ointments to pass through onto the wound.
It can be applied together with Mesorb^®; or for high-exuding wounds with Mextra^® Superabsorbent; with tubular fixation such Tubifast^® 2-Way Stretch^® or under compression bandages.
 

How to use Mepitel^® One

In order to function correctly, clinical experience suggests that Mepitel® needs to be kept in intimate contact with the surface of the wound (White, 2005; Gee Kee et al, 2015). Wounds on convex areas present few problems but on concave, contoured or jointed areas, adequate padding must be applied to exclude voids beneath the dressing where fluid might accumulate.

Click here how to easily apply Mepitel^® One.
 

There are certain precautions to be aware of when using Mepitel^® One:

• If you see signs of infection e.g. fever or the wound or surrounding skin becoming red, warm or swollen, consult a health care professional for appropriate treatment
• Always consult a health care professional before using on Epidermolysis Bullosa patients
• When using on partial thickness burns with high risk of rapid granulation or after facial resurfacing, avoid placing pressure on the dressing. Lift and reposition the dressing at least every second day
• When using for the fixation of skin grafts and protection of blisters, the dressing should not be changed before the fifth day post application
• Do not reuse. If reused performance of the product may deteriorate, cross contamination may occur.

Clinical evidence for Mepitel^® One

Since the launch of Mepitel^® in 1989, there has been a considerable amount of clinical evidence to support its use, beginning with the first randomised study comparing the efficiency of Mepitel^® with silver sulfadiazine in children with partial thickness scalds (Gotschall et al, 1998). Wounds in children treated with Mepitel^® healed significantly faster and demonstrated less eschar formation (e.g. slough, necrotic tissue) (Gotschall et al, 1998). The children also experienced less pain at dressing change and there was a significant reduction in the costs associated with dressing changes and analgesia relating to dressing changes (Gotschall et al, 1998).

Since its launch in 2009, a number of studies have highlighted the benefits of using Mepitel^® One.

In an open, two-arm, multi-centre, parallel-group randomised controlled trial of outpatients with moderately exudating, uncomplicated acute wounds, David et al (2017) compared Mepitel^® One with a soft silicone adhesive layer with a lipido-colloid adhesive layer. In 123 patients, the randomised clinical trial found Mepitel^® One was significantly less painful to remove compared to a lipido-colloid adhesive layer. A comparison on healing by day 21 was made. At this time, significantly more patients treated with Mepitel One had healed compared to those treated with a lipido-colloid adhesive layer.

Collin (2009) describes the use of Mepitel^® One following hand surgery in a non-comparative, ten patient case series. The author found dressing conformability was rated by the investigator as ‘good’ to ‘very good’; handling at application and ease of removal were generally rated as ‘easy’ to ‘very easy’. The patients also rated dressing conformability and comfort as ‘good’ to ‘very good’. No pain was associated with the removal of the Mepitel One dressings. There were no reports of leakage or dressing displacement. All wounds responded well and were associated with, at worst, minimal bleeding or exudation (as would be expected of this type of wound). No odour or signs of infection/ inflammation were reported. The condition of the peri-wound skin was generally healthy although mild maceration developed around one of the wounds.   
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