Development of the Available Technology Dressing: An Evidence-Based, Sustainable Solution for Wound Management in Low-Resource Settings

Abstract

Background. Incapacitating wounds are common in rural areas of tropical developing countries. In this setting, injury and bite wounds often become chronic due to poor wound management. Objective. To summarize more than 20 years of research, culminating with testing the use of Available Technology Dressings (ATDs), a very specific sustainable moist dressing technique, which can be taught to patients and lay health care providers. Methods. Case studies, literature reviews, and qualitative and quantitative usual practice surveys provided the foundation for a 3-armed 12-week, evaluator-blinded, noninferiority RCT of the ATD technique. The ATD technique consists of (1) daily thorough wound irrigation, (2) protecting the periwound with a moisture barrier, (3) protecting the wound by conforming cut-to-fit thin food-grade plastic with slits to the wound bed, (4) fluffing absorbent material over the slits, and (5) holding the dressing in place (and, if possible, applying compression) with a snug wrap. ATDs were compared with saline-soaked wet-to-moist gauze (WTM, the negative control) and polymeric membrane dressings (PMDs, the positive control), evaluating safety, effectiveness, quality of life, pain, cost, dressing time, and acceptability in 40 Jamaicans with SCLUs. Results. Wound experts throughout rural areas of Ghana, Zambia, and Cambodia prefer moist wound management, but lack the tools to provide it consistently. Food-grade plastic outperforms all other improvised dressings. Thin plastic bags are affordable and available worldwide. In the RCT, ATDs (13 participants) outperformed WTMs (16 participants) and were only modestly inferior to PMDs (11 participants) for the parameters of wound size, pain, and safety. ATDs were the least expensive, most available, most acceptable choice. Conclusion. ATDs warrant further study.