The UKM StimuGold (UKMSG) Wound Bed
Preparation Method: A unique technique in
combining Superabsorbent Polymer
Polyacrylate Sodium with Collagen–Glycerine
ISSN: 2754-8880
Published 00 11 0000		amorphous base dressing: A case series
Sim Lin Kiat1* and Farrah-Hani Imran2
1Faculty of Medicine and Health Sciences, Department of Surgery, Universiti Tunku Abdul
Rahman, Malaysia
2 Plastic, Reconstructive, Burns Wound Care Team, Department of Surgery, Universiti
Kebangsaan Malaysia Medical Centre
* Correspondence author: Sim Lin Kiat ; kelvsim@gmail.com
ORIGINAL
Abstract
Introduction: A wound is a disruption of the normal structure and function of the skin and its
architecture. An acute wound heals predictably, time frame, if any, with few complications but
the result is a well-healed wound. A chronic wound is defined as one that is physiologically
impaired due to the disruption of the wound healing cycle. Advanced dressings are designed to
maintain a moist environment at the site of application, allowing the fluids to remain close to the
wound and not spread to the unaffected, healthy skin areas. We developed a unique technique of
dressing combining Superabsorbent Polyacrylate Sodium (Gold Dust®) with Collagen-Glycerine
base amorphous gel (Stimulen®), A.K.A, UKMSG, in six patients with acute and chronic wounds
of various aetiology; referred for recalcitrant, non-healing wound.
Case Presentation & Methods: Six patients with acute and chronic wounds of various aetiology
were referred for recalcitrant, non-healing wounds. Patients’ data were obtained from medical
files and surgical databases. Depending on the size and condition of the wound, the average
duration of treatment varies from 1 - 6 weeks. The dressing was done mainly by wound nurses.
Dressings were changed from daily to once every three days, based on the type of wounds. It does
not need a lot of experience for the application of UKMSG. A short briefing and demonstration on
how to apply the dressing would suffice. We did not start adjuvant antibiotics for all our wounds.
OPEN ACCESSAntibiotics were only started for infected wounds and based on cultures & sensitivity. There were
Edited bytwo females and four males. The youngest in the group was 2 years old and the oldest was 72
A.Hussainyears old. We had two pressure ulcers, one gangrenous penis, one Surgical Site Infection wound
Submitted 15 July. 2022breakdown post total hysterectomy, one lower abdominal wall necrotizing fasciitis, and a 23%
Accepted 23 July. 2022infected burn wound. All patients’ wounds were initially managed by respective primary teams
Citation(except the infected burn wound) with dressings and surgical debridement is done at least once
Sim Lin Kiat, Farrah-Hanibut a healthy wound bed was still not achieved.
Imran. The UKM StimuGold
(UKMSG) Wound BedResults: The UKMSG is part of our Wound Care Team approach to wound management across
Preparation Method: Aa variety of wounds. Through the case series, we noted that UKMSG is ideal for the treatment
unique technique inof recalcitrant, non-healing, moderate to highly exudative wounds. It produces a good result in
combiPniolnyg mSeurp Peroalybascorrybleatnetwound bed preparation. It is also easy to apply and removed, comfortable, has fewer peri-wound
Sodium withcomplications, and does not need an expensive secondary dressing. In the future, we aim to
Collagen–Glycerineperform an RCT and comparison study to further evaluate the UKMSG method.
amorphous base dressing: A
case series
:BJOSS::2022:(3);71-78
Keywords : A chronic wound, recalcitrant wound, UKMSG method, Collagen-Glycerine base
amorphous gel, Superabsorbent Polyacrylate Sodium, dressing, wound debridement.
Introduction
A wound is a disruption of the normal structure and function of the skin and its architecture (1).
An acute wound heals predictably, time frame, if any, with few complications but the result is a
well-healed wound. A chronic wound is defined as one that is physiologically impaired due to the
disruption of the wound healing cycle (2). Wound dressings aim to provide an ideal environment
for its healing. Advanced dressings are designed to maintain a moist environment at the site of
application, allowing the fluids to remain close to the wound but not spread to the unaffected,
healthy skin areas (3).
Advance dressing like a hydrogel is a three-dimensional, hydrophilic polymeric network capable of
absorbing large amounts of water or biological fluids and it closely simulates natural living tissue
materials (4). Superabsorbent polymer (SAP) like Polyacrylate Sodium is a special type of hydrogel
that is ideal for treating recalcitrant, non-healing wounds as it is effective in removing excessive
exudate-containing inflammatory mediators that ultimately hinder wound healing, not just that,
it is also an excellent autolytic debridement agent. Collagen, on the other hand, has long been
known to have a pivotal role in stimulating cell proliferation by acting as a chemo-attractant for
fibroblasts, hence “jump-starting” the healing processes (5; 6).
Wound bed preparation (WBP) is the process of removing local barriers to wound healing to
maximize the potential for successful healing. WBP can be done through debriding nonviable
tissue, pathogens (biofilm), contaminants, foreign (or other) materials, and drain areas of infection.
Chronic wounds may require serial surgical wound debridement (WD) to sufficiently prepare the
wound bed (2). We present a case series of six patients with recalcitrant, non-healing wounds;
referred to us, The Plastic, Reconstructive, Burns & Wound Care Team, Universiti Kebangsaan
Malaysia Medical Centre (UKMMC). We developed a unique dressing technique, also known
as UKM StimuGold (UKMSG), constituting the combination of 2 dressings, ie; Superabsorbent
Polyacrylate Sodium (Gold Dust®) with Collagen-Glycerine base amorphous gel (Stimulen®) for
wound management and wound bed preparation (WBP).
Case Series & Methods
UKMMC is a Quaternary Referral Centre and Level 1 Trauma Centre situated in Kuala Lumpur,
Malaysia. Between July 2014 to October 2015, The Plastic, Reconstructive, Burns & Wound
Care Team, UKMMC developed a unique technique of dressing constituting the combining of
Superabsorbent Polyacrylate Sodium (Gold Dust®) with Collagen-Glycerine base amorphous gel
(Stimulen®), in six patients with acute and chronic wounds of various aetiology being referred for
recalcitrant, non-healing wounds. All wounds were initially managed by the respective primary
team with dressings and surgical WD but a healthy wound bed was still not achieved. Patients’
data were obtained from medical files and surgical databases. There were two females and
four males. The youngest in the group was 2 years old and the oldest was 72 years old. We
had two pressure ulcers, one gangrenous penis, one Surgical Site Infection wound breakdown
post total hysterectomy, one lower abdominal wall necrotizing fasciitis, and a 23% infected burn
wound. Informed consent was obtained after a thorough history, wound examination, and clinical
indication for types of dressing before commencing the UKMSG technique.
The technique involved initial cleansing of the wound with either sterile water, normal saline, or
superoxide solutions. A small amount of Stimulen® gel is then mixed with the Gold Dust® paste.
Finally, apply the mixture to the wound bed cavity. The secondary dressing was with gauze and
gamgee secured with Elastoplast bandages.
The Gold Dust® comes in sachets, crystalline form. To prepare the Gold Dust® paste, 30mls to
15mls of sterile water was added into a full pack (30g) or half pack (15g) of Gold Dust® crystal
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respectively and stirred gently to form a paste. Regular wound bed assessment and monitoring
were done on all patients via photo documentation noting its granulation tissue, evidence of
infection, wound moisture, and wound edges. Several assessment criteria were also evaluated
including pain, dour, pruritus, adverse reaction, comfort, and well-being of the patient. Dressing
nurses were also interviewed.
Case Management And Outcomes
Dressings were changed from daily to once every three days, based on the clinician’s judgment
and type of wounds. The average duration of treatment is about 1 to 6 weeks. The dressing is
done mainly by wound nurses. However, it does not need a lot of experience for the application of
UKMSG. A short briefing and demonstration on how to apply the dressing would suffice. We did
not start adjuvant antibiotics for all our wounds. Antibiotics were started for infected wounds and
based on cultures& sensitivity. In all patients, frequent dressing changes were needed initially but
when exudates level decreased and the wound becomes healthier, dressings were changed once
every three days. Inspecting the degree of saturation of dressing was easy by simply inspecting
the secondary dressing. If it was wet, the dressing will be changed.
From the feedback of patients and wound nurses, UKMSG dressing is easy to apply and removed.
It is generally comfortable and does not need expensive secondary dressings. There was no
adverse reaction in all patients. It had fewer peri-wound complications like itchiness, irritations,
and eczema due to its remarkable absorptive ability. It is also a good chemical debridement agent.
However, some patients did complain of a slight tingling sensation upon initial application of
UKMSG dressing and an unpleasant odour if the dressing was kept for too long. But all these
quickly go away once the dressing was changed. Due to its transparency paste form, certain
characteristics of bacterial infection like pseudomonas can be easily observed during wound
inspection as the entire mixture of dressing would turn green. We found that UKMSG produced
an ideal result in WBP, particularly in wounds with moderate to high exudative levels.
Case 1:
72-years-old man with lower abdominal necrotizing fasciitis, Fournier’s gangrene. 8-surgical WD
done. (1a) Started UKMSG for WBP along with serial surgical WD. (1b) A healthy less-exudative
granulation tissue.
(a) Before UKMSG(b) After 24-days
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Case 2:
64-years-old man, post CABG 2 weeks, excoriation at sacral region progressed into pressure ulcer,
grade II. WD done once, refused further WD. (2a) slough with discharge before UKMSG. (2b)
Healthy granulation tissue with minimal slough.
(a) Before UKMSG(b) After 20-days
Case 3:
41-years-old lady, post total hysterectomy for symptomatic multiple uterine fibroids. Presented
with SSI and wound breakdown. Surgical WD did once. (3a) Highly exudative wound, slough at
the base, and foul-smelling discharge before UKMSG. (3b) Healthy moist granulation tissue.
(a) Before UKMSG (b) After 7 days
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Case 4: 2-years-old girl admitted for 23% mixed thickness infected burn wounds at the posterior
trunk. 2 surgical WD done. (4a) Resistant exudative wound with discharge. (4b) Healthy epithelized
wound.
(a) Before UKMSG(b) After 42-days
Case 5:
30-years old man, Retro-viral (RVD) positive, presented with gangrenous penis due to penis
siliconoma. Surgical WD did once. (5a) Sloughy base with discharge. (5b) Healthy granulating
tissue.
(a) Before UKMSG(b) After 3 days
Case 6:
43-years-old man with traumatic paraplegia for 20 years and a complex network of clean, static
pressure ulcers. Multiple admission for infected pressure ulcer at the sacrum, grade IV. At least
3-surgical wound debridement done. (6a) Deep communicating cavity with discharge. (6b)
Obliterated communicating-cavity, clean.
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(a) Before UKMSG (b) After 24-days
Discussion
The right choice of dressing for a wound is important for optimum healing, therefore, improving
the quality of patients’ life (7). Studies have shown that recalcitrant, non-healing wounds contain
exudate with high levels of inflammatory mediators like matrix metalloproteinases (MMPs) (8),
polymorphonuclear granulocyte-derived elastase (PMN elastase) (9) with high concentrations
of free radicals (10); which causes a shift in the balance of matrix synthesis leading to tissues
destruction. Another study attributed the increase of protease activities in exudates as the main
pathology of non-healing wounds. Therefore, removal of the above will have a major therapeutic
effect on WBP and granulation tissue formation (8). Eming S at al showed that SAP can inhibit
MMP activity in vitro and ex vivo (11). SAP also exhibits a high binding capacity for PMN elastase,
and protease and is able to inhibit free radical formation in vitro (12). It also takes up multiple
amounts of water (bio-fluids/exudate) of their dry weight which is crucial in chronic wounds and
wounds with moderate to high exudative levels. Due to its ability to take up and retain proteins as
well as cell debris and micro-organisms (12), it serves as an excellent autolytic debridement agent.
Collagen, on the other hand, creates the most physiological interface between the wound surface
and its environment and it is impermeable to bacteria (13). It is easy to apply, being natural,
non-immunogenic, nonpyrogenic, hypo-allergenic, and pain-free (14). Collagen also inhibits the
actions of MMPs and the facilitation of migration of fibroblasts into the wound (5; 15). Glycerine
is found in many common products such as cosmetics, conditioners, soaps, foods, etc. It is a
humectant by definition and has the ability to absorb moisture from the wound. We believe that
by combining Gold Dust® and Stimulen® gel in UKMSG, both dressings augment each other
therefore producing promising dressing as results in our case series.
Conclusion
The UKMSG is part of our Wound Care Team approach to wound management across a variety
of wounds. We conclude that UKMSG is ideal for the treatment of recalcitrant, non-healing,
moderate to highly exudative wounds. It produces a good result in WBP. It is also easy to apply
and removed, comfortable, has fewer peri-wound complications, and does not need an expensive
secondary dressing. In the future, we aim to perform an RCT and comparison study to further
evaluate the UKMSG method.
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Disclosure
Authors have no potential conflicts of interest to disclose.
Author Contributions
Dr. Sim Lin Kiat; author/ correspondence Associate Professor Dr. Farah Hani; supervisor All
authors have read and agreed to the published version of the manuscript.
ORCID ID
Sim Lin Kiat. https://orcid.org/my-orcid?orcid=0000-0002-2466-8721
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