Final Work

Fundamentals of Wounds
and
Wound Healing
Which is the largest organ of the body?
THE SKIN
The Skin….
There is constant exposure to the environment thus, maintaining the integrity of the skin
can be complex.
Surgical incisions, injuries (trauma), or burns can have life threatening effects.
Thickness varies from a thin membrane at internal flexures (e.g. elbows), to thicker at the
soles of the feet which bear considerable pressures.
Hair follicles, sebaceous glands, and sweat glands pass through the epidermis, but arise from
the dermal layer.
©Acelity 2014. ACELITY PROPRIETARY & CONFIDENTIAL INFORMATION (For internal use only).
3
Use or disclosure outside the Acelitycompanies without express written authorization is not permitted.
1
Facts and Figures
• The skin of an average adult covers approximately 1.5 - 2 square meters
• Receives one third of the body’s circulating blood volume
• Capable of self re-generation
• Can withstand limited mechanical and chemical assaults
Understanding The Skin Layers
Epidermis:
• Outermost layer of skin
• Made up of epithelial cells
• Renews every 26-42 days
Dermis:
• Thickest tissue layer of skin
• Supports a vascular blood supply and
nerve supply
• Made up of collagen and elastin
Subcutaneous:
• Contains the foundation of blood vessels
which rise into the dermis
• Adipose (fat) tissue
(https://www.youtube.com/watch?v=yKAzVC0WcmI)
Functions of The Skin

What are the functions of the skin?
• Protective covering
• Moisture retention
• Sensation
• Regulation of body temp
• Release of waste
• Absorption of nutrients – Vitamin D
2
Factors Affecting Skin Condition:
What do you need to know about the patient?
• Aging
• Obesity
• Sun
• Hydration
• Dryness
• Soap
• Nutrition
• Medication
What is a Wound and

What Does it Look Like?
“A cut or break in the continuity of

any tissue, caused by injury or
operation”
Baillière’s 23rd Ed
Classifying Wounds
Wounds can be classified according to their nature:
Abrasion : Contusion :
An abrasion is a wound caused by A region of injured tissue or skin in which

superficial damage to the skin, no blood capillaries have been ruptured; a bruise.
deeper than the epidermis.
3
Classifying Wounds
Incision : Laceration :
A surgical incision is a cut •A laceration is a wound that is

made through the skin to produced by the tearing of soft
facilitate an operation or body tissue.
procedure.
•Often irregular and jagged.
Classifying Wounds
Open: Penetrating :
An injury that occurs when an

An open wound is an injury
object pierces the skin and enters a
involving an external or internal
tissue of the body, creating an
break in body tissue.
open wound.
Classifying Wounds
Puncture: Septic :
A wound that has become infected.
A puncture wound has a small

entry hole caused by a pointed
object, such as a nail.
4
Classifying Wounds
Wounds may be classified according to the number of skin
layers involved:
Partial Full Thickness /

Superficial
Thickness Deep Wounds
Involves the
Involves the
Involves only the epidermis, dermis,
epidermis and the
epidermis fat, fascia and
dermis
exposes bone
Classifying Wounds
Superficial / Partial Thickness Wounds
– Also referred to as shallow wounds

– Defined by loss of the epidermal and partial dermal layers
– Most wounds can be painful due to damage to the dermal layers and
exposure of nerve endings
– Epidermal layer loss: Wound base appears bright pink or red
– Dermal layer loss: Wound base may appear pale pink with small red islets
Venous ulcer
Arterial ulcer
Leg ulcer
Skin graft donor site
Classifying Wounds
Full Thickness / Deep Wounds

– Total loss of the epidermal and dermal layers
– Can extend to the subcutaneous layer and
possible to muscle, fascia and bone
– Typically present as craters
– Are complicated by necrosis (death of
tissue), infection, extensive tissue damage
Trauma wound
Diabetic foot wound
Undermined wound
Wound with tunnels
Surgical dehiscence
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Physiology of Wound Healing
16
Use or disclosure outside the Acelity companies without express written authorization is not permitted.
Understanding The Wound Healing Repair Processes Allows Us

To Offer The Best Product Recommendations
1. Primary intention
2. Secondary
intention
3. Delayed primary
closure
Wound Healing Repair Processes

1. Primary:
– The wound is closed surgically
– Surgical closure helps the wound to reduce the volume of connective
tissue (scar tissue) filling the wound bed
– The epidermis (epithelium) is closed now and
can act as a barrier to bacteria
– Acute wounds are surgically closed
Advantages:
– Heals quickly
– Minimal scar formation
Example:
• A surgical incision is closed post-operatively with sutures or staples
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2. Secondary:
– Wounds left open and allowed to heal by secondary intention
– Chronic wounds are typical of secondary healing
Disadvantages:
– Slow to heal wounds
– Connective tissue is needed to fill defect
– Lack epidermal barrier to fight infection
Example:
– Tissue has been removed deliberately or by trauma leaving too large a defect for immediate
closure, so new granulation tissue is required to fill the gap. Dressings are used to protect the
wound as granulation tissue grows.

3. Delayed Primary Closure:
– Wounds that are delayed in their closure due to circumstances
– In healing with primary intention, a surgical wound is left open for 3-5 days
– This allows edema or infection to resolve or
exudate to drain
– Wound is closed with sutures, staples or
adhesive skin closures
Example:
– Abdominal Compartment Syndrome occurs, requiring emergency opening of the abdominal
cavity to allow the viscera to expand rapidly through the incision. Immediate closure is
impossible. The exposed viscera must be protected until it has reduced in size and fits back
inside the abdomen. The wound can then be closed primarily with sutures or staples.
Wound Healing Pathway
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Wound Healing
• Dynamic, sequential cascade of overlapping phases leading to the repair of injured tissues
• Stages of healing are characterised by appearance of particular cell types
• Within each phase a series of rapid changes in the specific cell type are responsible for preparing
the wound for the next phase
• Cells use surface membrane receptors to provide signals to cue the cascade of cellular interaction
Ref: Enoch 2004
Agren et al 2000
Phases of Wound Healing

• Haemostasis
• Inflammation
• Proliferation
• Maturation
• A healed wound is defined as one that has returned to its normal anatomical structure,
function and appearance within a reasonable period of time
(https://www.youtube.com/watch?v=zZpMQ_7qiRg)
Haemostasis
• Blood clots are formed

•
• Occurs immediately after the injury
• Damaged tissue releases histamines (causes your capillaries to leak)

releasing clotting factors and phagocytes (engulf bacteria, dead cells
and cellular debris)
• Blood vessel go through a transient period of vasoconstriction followed

by vasodilation
• Platelets move from the capillaries to seal the wounded area and lead
to the formation of blood clots
• Platelets release a multitude of growth factors Thrombin, protease

protein, further aids in blood coagulation
8
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Inflammation
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Inflammation
Inflammatory cells are released after haemostasis and include:
• Many different cells are released which are helpful to the wound healing process but too many
can have adverse effects.
• Leukocytes (white blood cells) and macrophages (attack foreign substances).
• One of the first leukocytes are neutrophils, which kill bacteria macrophages phagocytose
(engulf and digest) the dead neutrophils.
• Macrophages also phagocytose bacteria and secrete growth factors, one of which stimulates
angiogenesis (growth of new blood vessels).
• Inflammatory phase lasts approximately 5 days
9
Proliferation
Proliferation starts around day 3-4 and overlaps with the inflammatory stage:
• Wound begins to fill and epithelial cells migrate across the top.
• Macrophages are replaced by fibroblasts (tissue structural framework) and begin synthesising a
collagen matrix or ECM (extracellular matrix) which begins to fill wound and acts as a conduit.
• Fibroblasts deposit collagen (protein which gives tissue its strength), and elastin (protein that allows
tissue to resume their shape).
• New capillaries are formed (angiogenesis) which helps in delivering nutrients to migrating fibroblasts.
• A pink granular tissue begins to form – granulation tissue (fibrous connective tissue).
• Epithelialisation – epithelial cells migrate across the new tissue to form a barrier between the wound
and the environment
Angiogenesis
30
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Importance of Granulation Tissue
• In the absence of granulation tissue, re-epithelialisation will not occur
• Epithelialisation – epithelial cells migrate across the new tissue to form a barrier between the
wound and the environment
• Migrate from the wound edges and cease movement when they meet in the middle
Maturation
• Wound continues to heal and regain its strength and function
• Lengthy process – up to 2-years in duration
• Characterised by a change in ECM components:
– Collagen fibres restructure gaining tensile strength
– Greater cross-linking of collagen fibres = stronger and thicker collagen bundles

• Skin tensile strength regained approximately 80% of its original strength
Phases of Healing
Analogy to
Phase of Time Frame
Main cells
building a
Healing involved
house
Capping off
Haemostasis Immediate Platelets utility conduits
Macrophages Untrained
Inflammation Up to 5 days and laborers to
Neutrophils clean up a site
Cytokines, Supervisor cell for

3-4 days to 21 Macrophages, laborers: plumbers,
Proliferation days
fibroblast electricians,
migration, builders, roofers,
extracellular matrix etc
Interior
21 days up to Collagen fibres Decorators and
Maturation 2 years restructure Landscapers
11
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Infection
35
Definitions
Wound • All wounds may acquire micro-organisms. Their

presence is only transient and wound healing is not
contamination: delayed.
• Microbial species successfully grow and divide, but do

Wound colonization: not cause damage to the host or initiate wound
infection.
• Bacterial bioburden in the wound reaches a level in

Critical colonization: which it interferes with healing, but does not produce
the classic signs and symptoms of infection.
• Microbial growth, multiplication and invasion into host

Wound Infection: tissues leads to cellular injury and overt host
immunological reactions. Wound healing is interrupted.
1 EWMA position document: Identifying Criteria for Wound Infection.
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Infectious organisms
• Bacteria
• Viruses (e.g. HSV, HIV)
• FungWe(e.g. Candida) focus
• Protozoa (e.g. malaria)
• Helminths (worms, round, flat etc.)
Bacteria classification: aerobic/anaerobic

• Aerobic bacteria are bacteria that can grow and live in the presence of oxygen.
• Anaerobic bacteria are bacteria capable of growing in the absence of oxygen.
Bacteria classification: Gram positive/negative2

• Gram stain procedure: developed in 1884 by the Danish physician Hans Christian
Gram.
• Gram's Stain is a widely used method of staining bacteria as an aid to their

identification.
Gram positive cocci Gram negative rods
2 Gram HC, 1884
Bacteria classification: cocci/rods
Cocci, diplococci
Streptococci
Staphylococci
BacillWe(rods)
Streptobacilli
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Bacteria classification: antibiotics resistant/sensitive
• Antibiotic resistance is the ability of bacteria or other microbes to resist the
effects of an antibiotic.
• Antibiotic resistance occurs when bacteria change in some way that reduces or
eliminates the effectiveness of drugs, chemicals, or other agents designed to
cure or prevent infections.
Examples of bacteria species

COCCI Staphylococci
Streptococci
Anthrax
BACILLI
Tetanus
Diphtheria
BACTERIA
COCCI Meningococcal meningitis
Gonorrhoea
BACILLI E. Coli
Salmonella
Pseudomonas
OTHER BACTERIA Syphilis, Legionella, Mycoplasma
Biofilm
A community of microbes embedded in an organic polymer matrix

(slime they secreted), adhering to a surface.3
Bacteria
3 Prakash 2003
Bacterial burden continuum6
Contaminated No effect on healing

continuum
Colonized
Critically colonized
Local
Infected Healing delayed
Systemic
6 Kingsley 2003
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Wounds and bacteria
• All chronic wounds are contaminated by bacteria.
• Wound healing occurs in the presence of bacteria.
• Certain bacteria appear to aid wound healing4,5.
• Thus it is not the presence of organisms but their interaction with the patient that determines
their influence on wound healing.
4 Laato 1988; 5 Levenson 1983
Bacterial action
From infection to delayed healing – what happens?:
• Attach to host tissue
• Produce toxins and proteases that damage tissue and delay healing
• Consume nutrients and oxygen
• Induce local immunologic/inflammatory reactions that can delay healing.
Signs of wound infection7, 8
 Abscess
 Cellulitis
 Oedema
 Heat
 Discharge
 Delayed healing
 Discoloration/erythema
 Friable granulation tissue which bleeds easily
 Unexpected pain/tenderness
 Pocketing at the base of the wound
 Bridging of the epithelium or soft tissue
 Abnormal smell
7 Cutting and Harding 1994; 8 Gardner 2001
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Antimicrobials
Antimicrobial Agent:
• A chemical substance that destroys disease-causing microorganisms with minimal
damage to the host.
Examples:
• Antibiotics
focus
• Ionic silver
focus
• Alcohols
• Chlorine based
• Iodine based.
Silver
• Silver is a metallic element with atomic number 47 and atomic symbol Ag.
• Pure silver (Ag) is rare, but occurs naturally in the environment as a soft, "silver"
colored metal.
• It also occurs in powdery white

Silver with silver sulfide
– [silver nitrate (AgNO3) and silver chloride (AgCl)]
• or dark-gray to black compounds
– [silver sulfide (Ag2S) and silver oxide (Ag2O)].
Mechanism of Action: Silver
• Ag+ binds to specific chemical sites (thiol groups that contain sulphur and hydrogen) of multiple
proteins that play structural and functional roles in the bacterial cell 10, 12
• Ag+ interacts with the bases of DNA12, 13, 14
• Silver ions thereby interfere with the normal function of the bacteria cell causing the cell to
shut down and die11
10 Ovington 2004, 11 Lansdown 2002, 12 Thompson 1973, 13 Bragg and Rannie, 1974, 14 Batarseh, 2004
16
Wound Healing
Basic Principles of Wound Care
Identify and control the underlying causes

Support patient centered concerns
Optimize local wound care
Barriers and Complications in Wound Healing
The main barriers to healing in a chronic wound are:
• Necrotic tissue
• Debridement
• Bacterial imbalance
• Reduction of bacterial burden
• Altered exudate levels and composition
• Effective exudate management
Factors that affect wound healing

• Patient Compliance
• Inadequate perfusion
• Inflammation
• Nutrition
• Metabolic diseases
• Immunosuppression
• Smoking
• Infection
• Oedema
• Ischemia
• Topical agents
• Foreign bodies
17
Factors that affect wound healing

• Many medications have adverse effects, which interfere with or
delay wound healing:
– Steroids and anti-inflammatory drugs are immunosuppressive
and reduce the inflammatory phase of wound healing
• Many patients are on multiple drugs, some of which may affect
wound healing
Wound Management Principles Overall
• Wound management products are chosen depending on the

individual patient, the wound characteristics and treatment
goals
• What are the goals for the patient?
– Healing the wound
– Removing exudate
– Maintain a moist wound environment
– Protecting the wound from further injury and/or infection
– Comfort
– Decrease pain
– Cost
Wound Management Principles Dressings
• The principal function of a wound dressing is to provide an

optimum healing environment
• Dressings are put in place to only manage the current wound

situation
• No one dressing is appropriate for all wounds
• Will not change the wound healing process
• The choice of a wound dressing is dependent on:

– Cause Presence of infection
– Wound type Wound size and location
– Availability Adaptability
– Cost Stage of wound healing
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Wound Assessment – Monitoring Outcomes
Assess
Reassess
Evaluate
Reevaluate
Change treatment plan accordingly
Common Wound Care Dressings: Alginates and Hydrofibers
• Primary dressings for wounds that have moderate to heavy

exudate.
• Formed into flat squares or sheets of unwoven fibers or

twisted into ropes or pads.
• Placed in wound beds mainly for absorbing exudate and

keeping the wound moist.
• Once its wet with exudate, forms a gel-like plug in the wound.
• Can absorb up to 20 times its weight in exudate.
• Facilitates autolytic debridement and may require a secondary

dressing such as a bio-occlusive thin film.
http://jan.ucc.nau.edu/~daa/woundproducts/products.html
Common Wound Care Dressings: Hydrogels & Sheets
Hydrogels
• Primary used in wounds that are substantially or fully granulated to
keep tissue moist and helps with autolytic debridement of any
eschar in the wound
• Acts as a barrier against wound contamination from external sources
• Requires a secondary dressing
Hydrogel Sheets
• Keeps the wound moist
• Protects the wound against contamination
• Capable of absorbing some exudate and promotes healing
• Requires a secondary dressing
19
Common Wound Care Dressings: Foams
• Maintain a moist wound environment and are moderate to highly

absorbent
• Useful for cavity wounds to fill the wound bed while absorbing the
continuous exudate seen during the inflammatory phase of wound
healing
• May require a secondary dressing
Common Wound Care Dressings: Bio Occlusive Dressings
• Prevent the wound from desiccation as well as from

contamination by bacteria
• Help maintain a moist wound healing environment
• These dressings also promote autolysis of necrotic tissue
• Waterproof but are also semi-permeable to the passage of
oxygen and water vapor to and from the wound site.
• Good secondary dressings over wounds in areas where
there may be a good deal of shear such as the elbows,
heels, iliac crest, knees, and wrists
• Applied over wounds in which a primary dressing must be
held in place
Common Wound Care Dressings: Hydrocolloid

• Contain a dressing matrix which absorbs light to medium
exudate and creates a gel-like dressing.
• Helps maintain a moist wound environment.
• Help the wound to autolytically debride itself.
• Impermeable to water vapor, oxygen and bacteria.
• Can be placed on wet surrounding skin and will adhere to a

moist area.
20
Common Wound Care Dressings: Contact Layers
• Single layer, either woven or nonwoven

materials designed to protect fragile tissue in
the wound bed.
• Can be perforated or permeable, allowing

exudates to pass through into another
dressing layer or into a secondary dressing.
• Very thin and non-adherent.
• Requires a secondary dressing.
http://www.medscape.com/viewarticle/503524_5
Common Wound Care Dressings: Silver
• Silver can be used as an antibacterial agent

• Some dressings have silver impregnated in them, which is released by contact
with the exudate and attacks bacteria in the wound
• Commonly found as Silver Alginates or Silver Foams
Wound Management Principles: Hyperbaric Oxygen

Therapy
• The oxygenation of hypoxic tissue is one of the key mechanisms by which HBO2 accelerates wound
healing
– Increase in tissue oxygenation
– Decreased infection
– Increased fibroblast and epithelial proliferation
– Promotes collagen synthesis
– Increased angiogenesis
• Used only in specialist centres
http://medicaledu.com/hbo2.htm
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Wound Management Principles: Ultrasound
• Ultrasound is a mechanical vibration delivered at a frequency above the range of human
hearing
– Increased fibroblast activity
– Increased capillary permeability which increases calcium uptake
– Increased angiogenesis
– Conflicting results in literature
• Used only in a few centres
http://medicaledu.com/ultrasnd.htm
Wound Management Principles: Negative Pressure

Wound Therapy
• The V.A.C.® Therapy System:
– Protects the wound from external

environmental factors.
– Removes exudate and infectious material.
– Reduces edema.
– Promotes perfusion.
– Promotes granulation tissue formation.
– Maintains a moist wound environment
Wound Overview II
Wound Assessment
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Wound Assessment Encompasses Several Areas
• Superficial or full thickness
• Category (pertains only to pressure ulcers)
• Location
• Size
• Exudate
• Wound base
• Surrounding tissue
• Infection
Importance of Wound Location
• Help determine the type of wound

• Understand potential additional risk factors
• Prompt you for better questioning and understanding about the wound and what MOA’s
would be most relevant
– Pressure ulcers, arterial ulcer, sternal wound dehiscence
• Aid in product and therapy recommendation
Wound Assessment Measurements
• Size
– Length
– Width
– Depth
• Measured once a week
• Documented in centimeters
23
Wound Assessment Measurements
Converting
Undermining Tunneling/sinus tract measurements
Wound Assessment Exudate Description
• Amount • Type
• absent (dry), • serous,
• minimal, • serosanguineous,
• moderate, • sanguineous,
• high (heavy) • purulent
• Odour
• pungent,
• strong,
• foul,
• fecal,
• musty
Wound Assessment Wound Base Status
• Clean
• pale,
• pink,
• red,
• beefy red,
• Granulating
• Dirty
• necrotic,
• slough,
• eschar,
• Infected
• Moist or Dry
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Slide 73
Wound Assessment Infection
• Wound
• necrotic tissue,
• foul odor,
• oedema,
• erythema
• Systemic
• fever,
• chills,
• altered mental status
• Immunocompromised
patient
Wound Assessment Slough and Eschar
• Slough – Loose, stringy, necrotic tissue

• Yellow and wet
• Eschar – Thick, leathery, necrotic tissue

• Black and dry
Wound Assessment Periwound Skin
• Intact
• Red
• Macerated
• Blistered
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Wound Assessment Debridement
• Autolytic
• Enzymatic
• Mechanical
• Surgical/Sharp
TIME Concept
T -Tissue : Viable/ Non Viable
I- Inflammation/ Infection
M- Moisture Imbalance
E- Epithilialization/ Edges
77
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Advance Wound Care
Content
• Advance Wound Care
• Market Overview
• Competitive Landscape
• Our Offerings
• Current Market Situation
• Market Leaders
• Indications
• SWOT
• Gap analysis
• Strategic Positioning
Strategic Positioning
• Target segments
• Pricing strategy
• Distribution Strategy
• Coverage Plan & Launch Activities timelines
• Reach and Coverage
• Campaigns
• Sales Tools
• Sampling
• Commercials
2
Advanced Wound Care Market
Overview
The wound care products are an important part of the overall healthcare industry
in India. The growth in India wound care market has been largely impelled by the
augmenting demand for better quality of health care services and increasing
number of lifestyle diseases. Increasing demand for wound care products, as
contributed by the factors such as high population growth, rising incomes and a
growing middle class is anticipated to further stimulate the country’s overall
wound care products in the following years.
A higher demand of wound care products:
•Penetration of foreign players in the India wound care market
•Increased disposable income of the population of India.
Market:
• Gaining momentum, rapidly growing market
3 ©Acelity 2014. FOOTER TEXT HERE
27
India Wound Care Product Mix
Hydrogels
Burnol Dressings
Artificial
Burns Skin
WCL Foam
Silverx
Dressings
Typee of Wound
Betadine Hydrogels
Dressings Collagen
Acute Dressings
Wounds Foam
Ointments Dressings
Soframycin Ointments
Collagen
Chronic Dressings
Wounds Foam
Clotrimazole Dressings
Basic Wound Advanced Active

Care Wound Care Wound Care
Type of Treatment
Market Overview: 2015
• $ 52 M market. Growing at 8‐12% YoY
•Market leader is Smith & Nephew followed by 3M, Coloplast, Convatec & Molnlycke
• Multiple local players, presence of 5 leaders for over 5 years
• Channel partner selection is key for reach and user relationships
• Growing surgical beds in country
• Rise in asthetic and cosmetic beds
• Increasing insurance reach
80% of the market dominated by 4 MNC’s: S&N, 3M, Coloplast & ConvaTec
100%
Revenue ($ Mn)
80%
$7 , 13%
$1 , 3%
60% $3 , 5% $13 , 25%
40% $5 , 9%
$12 , 24%
$11 , 21%
20%
0%
Total Market Breakup
Foams Semipermiable Films S&N 3M Coloplast Convatec
Alginates Hydrogels
Hydrocolloids Superabsorbents Molnlycke BSN Others
Collagen Hdrofibers
Source: Global date, inter assessment, field data
5
Competitive Landscape
July, 2016
6
28
• Launched in India 2008 • Launched in 2011 • Launched in 2012

• HQ: Mumbai • HQ: Gurgaon • HQ in Bangalore
• 50 feets on ground • 15 feets on ground + 30 • 15 feet on ground
• Comprehensive AWC portfolio Distributor staff • Huge marketing spent for 1st 2
• Market leader with sales of
Market leader with sales of • Revenue estimates: 30Cr
Revenue estimates: 30Cr years
50Cr • Select portfolio • Wound clinics (MS Ramiyah &
• Local manufacturing (Jelonet & • Mepilex is leading brand NH): Both closed
Bactigras) • 50 distributors • Revenue estimate: 10Cr
• 70 strong distributor partners • Coverage: Only Metros, now • 40 distributors
• Coverage: All Metros & Tier 1/2 expanding to Tier 1 • Select range (Aquacel &
Duoderm)
7
• Launched in 1990’s • Launched in 2010 • Multiple local players

• HQ: Bangalore • HQ: Gurgaon • Quality perception
• 100 feet on ground • 15 feet on ground
• Major business from GWC • Select AWD range (Biatin range)
• Select AWD portfolio (Tegaderm)
Select AWD portfolio (Tegaderm) • Revenue estimates: 8‐10Cr
Revenue estimates: 8 10Cr
• Local manufacturing • 40 distributors across India
• Coverage: Metros & few Tier 1
8
Our Offerings
What is it? What is it?
The TIELLE® Family are a range of hydropolymer ADAPTIC® Non‐Adhering Dressing is a primary
foam dressings with LiquaLock® Advanced dressing made of knitted cellulose acetate
Absorption Technology. They are designed to mesh, impregnated with a specially formulated
manage different levels of exudate across a range petrolatum emulsion.
of wound types and they come in a wide selection
of shapes and sizes with or without an adhesive
border.
TIELLE® TIELLE® Sacrum TIELLE® Xtra
9
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Adoption of Advance & Active Wound Care as 1st Line of Defense
Inflammatory Granulation & Remodeling
Stage Epithelialization Stage
Stage
Platelet Response
Chemokines, Cytokines
Cell Migration, Macrophages, Monocytes
Angiogenesis DCM & Collagen

Collagen Synthesis &
Anti‐fibrolytic Cytokines Digestion degradation
Minutes Hours Days Weeks Months Years

Ideal Scenario
Wound Type
Basic Wound Care Active Wound Care
Advanced Wound Care Wound Type
Active
Present Scenario
Wound Type Wound
Basic Wound Care
Care
Advanced Wound Care
Wound Type
Adaptic
How these
h
work, Indications, Evidences, Competito
r information
Advanced Wound Care – The Concept
Advanced Wound Care means the integration of technological advances with the wound healing pathway.
Advanced wound care products offer effective treatment and healing environment for extensive and
complex wounds like deep cuts, lacerations, bleeding under the skin, severe blisters, puncture
wounds, necrosis, infected wounds, trauma wounds, DFUs, pressure ulcers, burns etc.
The basic concept behind advanced wound care is ‘moist wound healing’ which helps maintain wound site
moisture promoting the natural cell repair mechanisms. These products are designed in a way that they lock
in moisture, conform to the wound, and remove bacteria.
The advanced wound care treatments focus on:
9Maintaining a stable temperature around the wound
9Facilitating oxygen flow
9Protection of the wound from infection
9Removal of dead tissue to prevent scarring and allowing new cells to emerge
9Removing exudates and reducing edema
9Promoting healthy granulation
12 Wound care: The role of advanced wound healing technologies; Wu et al, JOURNAL OF VASCULAR SURGERY, September Supplement 2010
30
Wound Management Principles Dressings
• The principal function of a wound dressing is to provide an

optimum healing environment
• Dressings are put in place to only manage the current wound

situation
• No one dressing is appropriate for all wounds
• Will not change the wound healing process
• The choice of a wound dressing is dependent on:

– Cause Presence of infection
– Wound type Wound size and location
– Availability Adaptability
– Cost Stage of wound healing
Common Wound Care Dressings: Foams
• Maintain a moist wound environment and are moderate to highly
absorbent
• Useful for cavity wounds to fill the wound bed while absorbing the
continuous exudate seen during the inflammatory phase of wound
healing
• May require a secondary dressing
Common Wound Care Dressings: Contact Layers
• Single layer, either woven or nonwoven

materials designed to protect fragile tissue in
the wound bed.
• Can be perforated or permeable, allowing

exudates to pass through into another
dressing layer or into a secondary dressing.
• Very thin and non‐adherent.
• Requires a secondary dressing.
http://www.medscape.com/viewarticle/503524_5
31
ADAPTIC® Non‐Adhering
Dressing
Protects the wound, minimises pain and
wound maceration
d ti
16
ADAPTIC®
ADAPTIC® Non‐Adhering Dressing is a primary dressing made of knitted cellulose acetate
mesh, impregnated with a specially formulated petrolatum emulsion.
What makes it unique?
ADAPTIC® is non‐adhering due to:
• The fabric – cellulose acetate to
Knitted cellulose
prevent fibre shed acetate
mesh, impregnate
• The knitted structure ‐ designed to d with petrolatum
create minimum number of contact emulsion
points
• The fine mesh – the small size
minimises the risk of granulation
minimises the risk of granulation
tissue growing into and through the
dressing
• The ointment – a thin petroleum
emulsion, which covers the fabric but
does not occlude the mesh so
exudate can pass through freely and
the dressing doesn’t dry out
18
32
ADAPTIC™ NON‐ADHERING DRESSING
The pore size of ADAPTIC® mesh reduces the risk of maceration
and adherence
9The pore size is designed
to minimize the pooling of
fluid at the wound site.
9It allows free passage of
exudate through the
dressing.
9Reduces the risk of tissue
adherence to both
ADAPTIC® and the
secondary dressing.
Key Benefits
Knitted cellulose acetate mesh, impregnated with
petrolatum emulsion
9PROTECTS THE WOUND.
9MINIMIZES PAIN.
9MINIMIZES MACERATION.
x20 magnification
How does it work?
Easy to remove minimising pain
The unique cellulose acetate mesh of ADAPTIC® protects
regenerating tissue by minimising wound trauma at dressing
change1.
Reduces the risk of maceration and adherence
The pore size of ADAPTIC®::
The pore size of ADAPTIC
• Allows easy passage of exudate to the secondary
absorbent dressing, thus minimising the risk of pooling
and maceration at the wound site.
• Reduces the risk of tissue adherence to both the ADAPTIC®
Non‐Adhering dressing and the secondary dressing2.
PRBC1460
21
33
When to use it?
ADAPTIC® is indicated for dry to highly exuding
wounds including:
• 1st and 2nd degree burns
• Lacerations and abrasions
• Grafts
• Venous ulcers
• Pressure ulcers
ADAPTIC® can be
• Nail extractions
Nail extractions used with
• Eczema compression
therapy2.
• Staples and suture lines
• Surgical incisions and reconstructive procedures
ADAPTIC® Non‐
Adhering Dressing
can be cut to suit the
size of the wound
without unravelling
and shredding.
* % patients reported pain free removal: ADAPTIC® 75%, Mepitel 56%, Jelonet 51%
PRBC1460
References:
1. Moffatt, C.J. et al. Understanding wound pain and trauma: an international perspective. In: European Wound Management Association (EWMA). Position Document: Pain at Wound Dressing Changes.
22 2002. 2. Terrill, P.J., and Varughese, G. A comparison of three primary non‐adherent dressings applied to hand surgery wounds. J Wound Care. 2000; 9:359‐363.3. Vin, F. et al. The healing properties of
Promogran in venous leg ulcers. J. Wound Care 2002; 11(9):335‐41.
APDAPTIC® Non‐Adhering Dressing should be applied as a single layer (do not fold or
overlap as this will limit ability of exudate to easily flow through into secondary
dressing)
How to use it?
Secondary Dressing Dressing

Dressing Preparation Dressing Application
pp
Application Removal/Change
Place ADAPTIC™ dressing Cover ADAPTIC™ with a Dressing change

Directly over the wound secondary dressing such frequency is dictated by
If needed ADAPTIC™ using surgical tongs or as TIELLE™. good wound care
may be cut to size with forceps and smooth in place Choose the secondary practice and will
sterile scissors. around the wound. dressing based on the depend on the condition
level of exudate. of the wound.
If more than one piece of
ADAPTIC™is Apply any secondary cover ADAPTIC™ may be left
required, ensure dressings or retention/compression in place for several days
overlap, toavoid secondary bandage. depending upon amount
dressing adherence to of exudate
thewound. Overlap should
be minimised to prevent
occlusion of holes.
24
34
Evidence
A comparison of three primary non‐adherent dressings applied to hand surgery wounds
Assessment Results
A multicentre RCT comparing Ease of use Very easy to remove
ADAPTIC®, Jelonet and Mepitel ADAPTIC® was easier to 90%
in hand surgery wounds (108 remove, required less 70% 88% 84%
patients) with regards to ease soaking, was less painful to
50%
of application and remove and caused less 57%
30%
removal, pain (upon removal) maceration than Jelonet.
and wound appearance. Mepitel performed similarly to 10%
ADAPTIC® ADAPTIC®
® MEPITEL JELONET
• ADAPTIC® – cellulose
acetate fibre dressing Quality of life
coated with petrolatum Significantly less pain was Pain free removal
emulsion associated with the removal of
ADAPTIC® than Jelonet 80%
• Jelonet – traditional 60% 75%
paraffin‐impregnated gauze • ADAPTIC® – 75% patients 56%
40% 51%
• Mepitel – polyamide net experienced no pain
20%
dressing impregnated with • Mepitel – 56% patients 0%
silicone gel experienced no pain
ADAPTIC® MEPITEL JELONET
• Jelonet – 51% patients
experienced no pain
Terrill, P.J. And Varughese G, J Wound Care 2000, 9(8): 359‐363
Evidence
Clinical difference ADAPTIC® vs. Jelonet
Clinical consequences of the differences
seen on a donor site:
Substantially more tissue disruption seen
on the Jelonet dressed wound than on the
ADAPTIC® dressed wound after removing
secondary dressing.
EWMA position document 2002: Pain at
EWMA position document 2002: Pain at
wound dressing changes:
• “Pain experienced is most likely caused
by dried out dressings and adherent ADAPTIC® Jelonet
products that are unable to protect the
regenerating tissue without sticking to One donor site on upper thigh, half of the wound is
it”. dressed with ADAPTIC®, the other half with Jelonet. This
image is taken after the secondary dressing was removed;
the primary dressings are both still on the wound
35
Supporting Literature
Supporting literature
A comparison of three primary non‐adherent dressings
applied to hand surgery wounds. Terrill, P.J. And
Varughese G, J Wound Care 2000, 9(8): 359‐363.
Multicentre RCT comparing ADAPTIC® Non‐Adhering
Dressing, Jelonet and Mepitel in hand surgery wounds
(99 patients)
• ADAPTIC® was significantly easier to remove, required
less soaking was less painful to remove and caused
less soaking, was less painful to remove and caused
less maceration than Jelonet
• ADAPTIC® had a significant advantage over Jelonet in
terms of performance
• Mepitel performed similar to ADAPTIC® but was not
significantly better than Jelonet, and was significantly
more expensive Clinical evidence
summary and
sales support
sheet available
29
Key objections
“Why should I care about avoiding dressing adherence?”
• No adherence to the wound surface and the surrounding skin
means:
– Less pain at dressing removal1
– Better preservation of the newly formed tissue2
L i di f 1
– Less patient discomfort
1. Moffatt, C.J. et al. Understanding wound pain and trauma: an international perspective. In: European Wound Management Association
30 (EWMA). Position Document: Pain at Wound Dressing Changes. 2002
2. Bell, A. and Hart, J. Evaluation of two absorbent silver dressings in a porcine partial‐thickness excisional wound model. J Wound Care
2007; 16(10): 445‐53.
36
Demonstrating ADAPTIC® Non‐Adhering Dressing
1. Take a dressing out of the box for the
customer to see and touch it.
2. Discuss with the customer about how
ADAPTIC® Non‐Adhering Dressing works.
3. Go through the key features of the
dressing with the customer:
– Show the knitted structure designed to p
minimise the number of wound contact
points
– Focus on the small size of the
pores, designed to minimise the risk of
tissue growth into and through the
dressing
– Make the customer touch the specially
formulated petrolatum emulsion which
covers the fabric without occluding the
mesh
– Cut the dressing to prove no fibres
shedding
31
Codes and sizes
Adaptic® Non‐ Adherent Dressing
Competitive Selling
37
Strategic Positioning
9 Easy To Remove Minimizing Pain
9Reduces The Risk Of Maceration And Adherence
34
Adaptic®: Protects the Wound‐ Minimizes pain
& Maceration
Brand Competitive Capability
Adaptic®
Strong Medium Low
• Easy to remove
minimising pain Range (Dry to
Strong highly exuding Price
Easy lift
Maarket Attractiveness
•
wounds)
t h l
technology
•Reduces the risk of
maceration and
adherence (Tissue & Use to paraffin
Medium gauge
secondary dressing)
Low
Target Segments & Key Indications
General Plastic Vascular Ortho/trauma
Neuro Intensivists
• 1st and 2nd degree burns
• Lacerations and abrasions
• Grafts
• Venous ulcers
• Pressure ulcers
• Nail extractions
• Eczema
• Staples and suture lines
36 • Surgical incisions and reconstructive procedures
38
Key Competitors and Market Share
$'000
¾ Smith & Nephew
1.8, 18%
1.2, 12%
1, 10%
5.8, 58%
0.2, 2%
Bactigras Jelonet Cuticel Mepital Others
37
Adaptic® Non‐Adherent Dressing
The Competitive Edge
SWOT Analysis: Adaptic® vs. Others
STRENGTH
OPPORTUNITIES
‐ Easy to remove
‐ Burns, graft where macerations
‐ Permeability
major problem
‐ Flexibility
‐
SWOT
WEAKNESS
THREATS
‐ Competition with traditional WLC
e.g. Bactigras and Jelonet ‐ Users perception and satisfaction
with Bactigras & Jelonet
‐
39
39
Adaptic® vs Mepitel
VS
40
Mepitel‐ Mölnlycke Healthcare
Mepitel is a porous, semi‐transparent, low‐adherent primary wound
contact layer, consisting of a flexible polyamide net coated with soft
silicone
The silicone coating is slightly tacky, which facilitates the application
and retention of the dressing to the periwound area.
This gentle adhesion also tends to prevent maceration by inhibiting
the lateral movement of exudate from the wound on to the
surrounding skin.
41
Key features highlighted by Mölnlycke Healthcare
¾ Safetac technology minimises pain and trauma at dressing changes as well
as the spread of exudate.
¾ Can remain in place for up to 14 days
¾ Does not leave residues and maintains functional qualities over time.
¾ Can cost‐effectively be used in a wide variety of indications.
¾ Good transparency lets you instantly assess healing progress without
removing the contact layer
42
40
Rebuttals
1. Efficacy:
RCT study shows that ADAPTIC® performs as well as Mepitel on ease of removal
and pain at removal1 (both important criteria for a non‐adhering dressing).
2. Price:
Mölnlycke tries to overcome challenges around price by suggesting the product
can be left in place for up to 14 days (challenge this claim by asking your
customer how often they actually leave a primary contact layer on a wound is it
customer how often they actually leave a primary contact layer on a wound, is it
really up to 14 days? How common is that?).
43
Adaptic® vs Mepitel
According to in vivo studies,
¾ The larger pore size of Mepitel may mean increased risk of secondary
dressing adherence to the wound bed through the primary layer
¾ This may lead to tissue damage and pain during dressing change and
removal
44
Adaptic® Vs Mepitel
Feature Adaptic Mepitel Benefit Adaptic Vs Mepitel
Cellulose Acetate mesh with Flexible Polyamide net with Ease of removal

Material Petrolatum silicone Less Pain
Allows easy passage of
exudates and smaller pore size
minimizes risk of tissue Larger pore size increases the
Pore Size adherence risk of tissue adherence Less adherence to wound bed
Fine mesh reduces the chances
of granulation tissue growing
Mesh Structure
Mesh Structure inside the dressing
inside the dressing Mesh structure not present
Mesh structure not present Protection of new granulation tissue
Protection of new granulation tissue
Helps prevent pooling of No defined mechanism for
Exudate Management exudates exudate management Less maceration and adherence
Reduced risk of maceration and Some “anchoring” of fibrinous
Risk of adherence adherence material /dried exudate seen Protection and Safety
Can be cut without unravelling Cutting can be messy due to
Ease of cutting and shredding Safetac® Adhesive Customization
Sizes 6 sizes available 4 sizes available Versatility
Price Cost effective
45
41
Points to highlight
9 Easy and pain free removal
9Protection of new granulation tissue
9Less adherence to wound bed
9Protection and safety
9 Versatality
9Cost effective
46
Adaptic® vs Jelonet
VS
47
Jelonet‐ Smith & Nephew
¾ The gauze has interlocking threads which
minimise fraying when the dressing is cut to
shape
¾ Jelonet is a sterile paraffin tulle gras
dressing made from open weave gauze
48
42
Key features highlighted by Smith & Nephew
¾ Soothes and protects the wound
¾ Allows free passage of exudate.
¾ Since it is not medicated, it is ideal for use with the topical antiseptic or
antibiotic of choice.
Rebuttals
Efficacy:
ADAPTIC® is easier to remove, causes less maceration and is less painful at
dressing removal
49
ADAPTIC® Non‐Adhering dressing has a completely different structure.
ADAPTIC® Jelonet ADAPTIC® (top)

versus Jelonet
ADAPTIC® Jelonet
Knitted Loosely woven
Emulsion Thick and greasy
Cellulose acetate Cotton
Fine mesh Coarse mesh
50
Clinical performance: substantially more tissue disruption have been seen on wounds
dressed with Jelonet rather than ADAPTIC® after removal of secondary dressing.
ADAPTIC®
Jelonet
One donor site on upper thigh, half of the
Scanning Electron Micrograph Light microscopy photo (x20) of wound is dressed with ADAPTIC® (top),
(x20) of ADAPTIC® (top) versus ADAPTIC® (top) versus Jelonet. the other half with Jelonet. This image is
Jelonet. taken after the secondary dressing was
removed; the primary dressings are both
51 still on the wound.
43
Adaptic® Vs Jelonet
Feature Adaptic Jelonet Benefit Adaptic Vs Jelonet
Fine Cellulose Acetate mesh Sterile paraffin tulle gras open Ease of removal

Material with Petrolatum weave gauze Less Pain
Structure Knitted Loosely woven Fine and strong mesh
Mesh Structure Fine Coarse Protection of new granulation tissue
Helps prevent pooling of
Exudate Management exudates Easy passage of exudates Less maceration and adherence
Reduced risk of maceration and Increased risk of adherence to
Risk of adherence and tissue adherence leading to tissue wound bed and hence increased
disruption disruption tissue disruption Protection and Safety
Can be cut without unravelling Can be cut with less fraying of
Ease of cutting and shredding threads Customization
Sizes 6 sizes available 4 sizes available Versatility
Indications Dry to high exuding wounds Minor burns, grazes and cuts Wide coverage
52
Points to highlight
9Less maceration and adherence
9Reduced chances of maceration
9Effective exudate management
9Cost effective
9Versatality
9Wide coverage
53
54
44
TIELLE® Family
55
56
57
45
TIELLE® Family
What is it?
The TIELLE® Family are a range of hydropolymer foam dressings with LiquaLock® Advanced
Absorption Technology. They are designed to manage different levels of exudate across a range of
wound types and they come in a wide selection of shapes and sizes with or without an adhesive
border.
TIELLE® TIELLE® Plus TIELLE® Lite TIELLE® Xtra TIELLE® Packing

PRB C1274
58
What is it?
• TIELLE® Family
The TIELLE® Family has a unique design compared to

ordinary foams:
• It contains LiquaLock® technology, which cleverly retains
exudate while also letting moisture vapour pass through
the dressing, helping to provide an optimal moist wound
healing environment.
• Managing exudate better helps wounds heal faster and
increases patient comfort. For instance, in a clinical
evaluation of 6,993 patients TIELLE
l f ® dressings were proven
d
to be clinically efficacious in all wound types studied, with
95% healing or improvement after 4 weeks of treatment,
and to improve the patients’ quality of life1
• The TIELLE® Family comes in a wide range of sizes, shapes
and absorbencies, allowing you to find a dressing that suits
your patients’ needs
59
How does it work?
• TIELLE® Family Comfort Plus for the wound
The TIELLE® Family has a pretty unique way of dealing with wound
exudate
• As exudate is absorbed by the dressing, it is designed to expand and
conform to the contours of the wound bed, which helps minimise
exudate build‐up and the chance of maceration
• Under normal use, the LiquaLock® technology locks fluid into the cell
walls, which means reduced potential for it to be released back into the
wound2‐4
• TIELLE® Family variants are more absorbent*, increasing by up to 41% in
some variants*
i t * ‐ look for the Comfort Plus sticker on the pack.
l k f th C f t Pl ti k th k
• The vapour‐permeable backing allows moisture vapour to transfer
through the back of the dressing, allowing for absorption of additional
exudate
• Comfort Plus for you
All the TIELLE® Family dressings are easy to use
• The adhesive dressings allow repositioning as needed on initial
application yet stay where placed
• The non‐adhesive dressings are cut‐able and can be used for all levels of
exudate
60
46
How does it work?
Superior absorption and expansion
TIELLE® Family offers optimal exudate management The superabsorbent
minimising the risk of maceration through their: layer in TIELLE® Plus
and TIELLE® Xtra can
• Superior absorbency1‐4 absorb up to 30x its
• Ability to expand and conform to the wound bed1,2,4 own weight in fluid2.
Fluid absorbent capacity of a range of adhesive dressings5
PRB C1274
61
How does it work?
Fluid retention
All TIELLE® Family dressings contain LiquaLock® In vitro TIELLE® Xtra can
Technology to enable them to retain retain over 40% more fluid
significantly more fluid than market leading than leading competitor
dressings under pressure6*
competitor dressings7.
(40mmHg).
1. Fluid fills the
hydropolymer cells
2. Fluid then permeates
into the cell walls
3. Locks majority of the
fluid even under
movement and
pressure
PRB C1274
62
How does it work?
Moisture vapour transmission
The moisture permeable An in vitro study shows that
the TIELLE® polyurethane
polyurethane backing facilitates
backing prevents the risk of
moisture vapour transfer while at the strikethrough10‐11.
same time protecting against external
contamination1,8,9.
Flexibility In a clinical evaluation of
The unique adhesive allows: 6 foams, over a 6 week
TIELLE® period, TIELLE® was the
• Repositioning as needed on initial
p g Allevyn
Allevyn 0% Biatain only dressing not to be
application 29% 39% discontinued for reasons
• Dressing flexibility to conform to such as inability to stay in
difficult to dress areas place and skin reactions
(vs 39% for Biatain and
29% for Allevyn)12.
PRB C1274
63
47
Key features and benefits – mode of action 1
Superior absorption and expansion
• TIELLE® Family expands and conforms into the wound1:
– The dressing expands to fit the wound bed, reducing the
risk of exudate pooling that may cause maceration or
infection
• TIELLE® Family does not adhere to the wound bed, and can be
removed in one piece leaving no debris2:
removed in one piece, leaving no debris
– Less complications and trauma to the wound
TIELLE® expands and conforms to the wound bed
• The super absorbent layer in TIELLE® Plus and Max can absorb
up to 30 times its own weight:
– Superior absorption3
1. Mellor J & Boothman, S. TIELLE® hydropolymer dressings: wound responsive technology, 2003 Br J Comm Nurs (Product Review).
2. Carter, K. Hydropolymer dressings in the management of wound exudate. Br. J. Comm. Nursing 2003, 8(9) Suppl: 10‐16.
3. Schulze, H.J. Clinical evaluation of TIELLE® Plus dressing in the management of exudating chronic wounds. Br. J. Comm. Nursing 2003, 8(11):18‐22.
64
LiquaLock®technology
1. During absorption and expansion fluid fills the
hydropolymer cells
2. Fluid is then transferred to the cell walls
3. Fluid is locked away under normal conditions of use,
movement and pressure1
What is the benefit?
• Reduced potential for leakage
• Competitive advantage: other foams have not this unique
technology and do not lock the fluid into the cell walls,
therefore there is more potential to leakage1
65 1. Foster, S. et al. Evaluation of the liquid retention capabilities of foam dressings. Poster submitted to Wounds UK 2010.
66
48
Vapour transmission
Moisture vapour is transferred from the hydropolymer and
released through the back of the dressing
What is the benefit?
• Optimal exudate management, minimising the risk of
maceration1
• The dressing continuously transfers fluid away from the
wound bed until saturated
• Reduced frequency of dressing changes2,3
1. Foster, S. et al. Evaluation of the liquid retention capabilities of foam dressings. Poster submitted to Wounds UK 2010.
2. Schulze, H.J. Clinical evaluation of TIELLE® Plus dressing in the management of exudating chronic wounds. Br. J. Comm. Nursing
2003, 8(11):18‐22.
67 3. Schulze, H.J. et Al. Evaluating a superabsorbent hydropolymer dressing for exudating venous leg ulcers. J Wound Care
2001, 10(1):511‐518.
Key features and benefits
Resulting in better quality of life
The unique adhesive allows repositioning as needed on
initial application yet stays in place
Adhesive dressings conform to awkward areas and are
shower proof1
STERILE WATER
Reduced risk of strike‐through and leakage2
Reduced risk of strike‐through and leakage REMOVAL TECHNIQUE
REMOVAL TECHNIQUE
Skin‐friendly removal1,3 with sterile water removal technique
The non‐adhesive dressings are cut‐able for
those awkward to dress areas
STRIKETHROUGH AND
LEAKAGE AS SEEN ON
COMPETITOR PRODUCT
2. Aickin, S. et al. Evaluation of High Breathability Foam Dressings to prevent Strikethrough of Fluid. Wounds UK 2008.
3. Diehm, C. and Lawall, H. Int. Wound J. 2005, 2(1):26‐35. Evaluation of TIELLE® hydropolymer dressings in the management of
68
chronic exudating wounds in primary care.
Meet the family
The TIELLE® range of dressings is
indicated for the management of
different types of wounds and exudate
levels.
Please refer in full to the Instructions
for use leaflet provided in the product
packaging.
Some of the adhesive dressing outer edges/borders can be cut to assist application to wounds in awkward
locations ‐ please contact us for a cutting guide.
References
1. Mellor J. and Boothman S. TIELLE® hydropolymer dressings: wound responsive technology, The Exudate Supplement Part two P14‐17. Br J Nurs Vol 12 No 20 & Br J, Community Nurs Vol 8 No.11.
2. Turton, K. et al. Evaluation Of The Fluid Handling Properties Of Hydropolymer Foam Dressings For Managing Wound Exudate. Wounds UK 2011.
3. Schulze, H.J. Clinical evaluation of TIELLE® Plus dressing in the management of exudating chronic wounds. Br. J. Comm. Nursing 2003, 8(11):18‐22.
5. Data on fi le.
6. Foster, S. and Mistry, P. Evaluating The Performance of Foam Dressings When Used in Combination With Compression Therapy. WIC 2010
7. Foster, S. and Mistry, P. Evaluation of the liquid retention capabilities of foam dressings. Wounds UK 2010..
8. Boothman S. et al. Testing of the Bacterial Barrier Properties of TIELLE Dressings Using a Modifi ed Version of the Draft CEN Test Method (prEN 13726‐5). Poster 2001.
PRB C1274
9. Diehm C. and Lawall, H. Evaluation of TIELLE® hydropolymer dressings in the management of chronic exudating wounds in primary care. Int. Wound J. 2005, 2(1):26‐35.
10. Aickin, S. And DelBono, M. Evaluation of High Breathability Foam Dressings to prevent Strikethrough of Fluid. Poster, Wounds UK 2008.
69 11. Aickin, S. et al. Evaluating Current in‐vitro Assays for Assessing Fluid Handling Properties of Dressings and their Clinical Relevance, Poster 2010.
12. Peach, V. Evaluating adhesive foam wound care dressings in clinical practice. Wounds UK 2011.
49
TIELLE® Family provides
• Superior fluid management1:
– LiquaLock® Advanced Absorption Technology
– Minimal strike‐through and leakage *After 4 weeks:
– Reduced maceration Improved: 51.6%
• Clinically proven faster healing2 Healed 43.3%
– 95% wounds healed or improved after 4 weeks* of
Note: ‘Improved’ here means
treatment with TIELLE® Classic (study of 6993 patients)
ANY improvement as per
ANY improvement as per
• Comfort clinician’s subjective
– Improved patient’s quality of life1,2 assessment.
• Cost effectiveness1‐3
– Longer wear time meaning fewer dressing changes
1. Schulze, H.J. Clinical evaluation of TIELLE® Plus dressing in the management of exudating chronic wounds. Br. J. Comm. Nursing 2003,

8(11):18‐22.
2. Diehm C., Lawall, H. Evaluation of TIELLE® Family hydropolymer dressings in the management of chronic exudating wounds in primary
care. Int. Wound J. 2005, 2(1):26‐35.
70 3. Schulze, H.J. et Al. Evaluating a superabsorbent hydropolymer dressing for exudating venous leg ulcers. J Wound Care 2001, 10(1):511‐
518.
TIELLE® Family mode of action
1. Superior absorption and expansion1,2
2. LiquaLock®
3. Vapour transmission1
Resulting in better quality of life3,4
2. Mellor J. & Boothman, S. TIELLE® hydropolymer dressings: wound responsive technology. (2003) Br J Comm Nurs (Product
Review).
2003, 8(11):18‐22.
4. Diehm C. and Lawall, H. Evaluation of TIELLE® hydropolymer dressings in the management of chronic exudating wounds in
71
primary care. Int. Wound J. 2005, 2(1):26‐35.
TIELLE®
TIELLE® Hydropolymer Adhesive Dressing is an adhesive hydropolymer foam dressing with LiquaLock®
Advanced Absorption Technology for low to moderately exuding wounds.
Polyurethane foam backing
Unique skin‐friendly • Vapour permeable2,4,5
adhesive border • Physical bacterial barrier2,4,5
Enables pain free • Shower proof2,4,5
removal and
repositioning on
initial application1
Non woven wicking layer*
Distributes fluid across the
H d
Hydropolymer foam with
l f ith dressing2, minimising the
LiquaLock® Technology risk of leakage and
• Expands and conforms to maceration3
the wound bed 2,3
• Maintains a moist wound
healing environment
95%
improved
In a clinical evaluation of 6,993 patients TIELLE® was proven to be
clinically efficacious in all wound types and it improved the condition
of the wound in 95% of cases within 4 weeks5
(*No wicking layer present on 7cm x 9cm dressing )
References
1. Ballard, K. Clinical and scientific data of a hydropolymer range of dressings. J Nursing 2002; 11(20).
PRB C1274
2. Mellor J. and Boothman S. TIELLE® hydropolymer dressings: wound responsive technology, The Exudate Supplement Part two P14‐17. Br J Nurs Vol 12 No 20 & Br J, Community Nurs Vol 8 No.11.
3. Carter, K. Hydropolymer dressings in the management of wound exudate, 2003.
72 4.Boothman S. et al. Testing of the Bacterial Barrier Properties of TIELLE Dressings Using a Modifi ed Version of the Draft CEN Test Method (prEN 13726‐5). Poster 2001.
5.Diehm C. and Lawall, H. Evaluation of TIELLE® hydropolymer dressings in the management of chronic exudating wounds in primary care. Int. Wound J. 2005, 2(1):26‐35. .
50
HOW DOES IT WORK?
Absorbency and fluid handling
TIELLE® helps maintain a moist wound healing
environment through the combination of
absorbency and moisture vapour transmission. +
The hydropolymer with LiquaLock®
Technology:
• Expands and conforms to the wound bed2
• Ensures fluid is locked away, minimising the
risk of leakage and maceration6
Comfort
TIELLE® dressings contribute to a decrease
in:
• Maceration1‐3,6
• Excoriation2
• Leakage1‐3,6,7
• Number of dressing changes2 In a clinical evaluation of 6,993 patients TIELLE® was
proven to be clinically efficacious in all wound types and it
• Skin reactions (to the adhesive border)8 improved the condition of the wound in 95% of cases
within 4 weeks5
73
Flexibility
The unique adhesive allows4 :
• Repositioning as needed on initial application
• Dressing flexibility to conform to difficult to
dress areas
Pain‐free removal technique
74
51
TIELLE® Xtra
TIELLE® Xtra Non‐Adhesive Hydropolymer Dressing is a non‐adhesive, cuttable hydropolymer foam dressing
with LiquaLock® Advanced Absorption Technology for low to highly exuding wounds.
Polyurethane foam
backing
• Vapour permeable4
• Physical bacterial barrier4
Hydropolymer foam
with LiquaLock
Technology
Super absorbent
Expands and conforms
wicking layer
to the wound bed1
to the wound bed
Absorbs up to 30x
• Ensures fluid is locked
its own weight in
away2,3
fluid5
• Minimises the risk of
leakage and
maceration, even
under compression
bandaging2,3
An in vitro test proved TIELLE® Xtra
to have the longest wear time
before dressing failure (5‐7 days)
compared to other foam dressings6
References
1.Mellor J. and Boothman S. TIELLE® hydropolymer dressings: wound responsive technology, The Exudate Supplement Part two P14‐17. Br J Nurs Vol 12 No 20 & Br J, Community Nurs Vol 8 No.11;
2. Delbono, M. et al. The Development of a Leg Simulation Model to Assess the Fluid Handling Capabilities of Dressings. WIC 2011.
PRB C1274
3. Foster, S. and Mistry, P. Evaluating The Performance of Foam Dressings When Used in Combination With Compression Therapy. WIC 2010.
4. Boothman S. et al. Testing of the Bacterial Barrier Properties of TIELLE Dressings Using a Modifi ed Version of the Draft CEN Test Method (prEN 13726‐5). Poster 2001.
76 5. Turton, K. et al. Evaluation Of The Fluid Handling Properties Of Hydropolymer Foam Dressings For Managing Wound Exudate. Wounds UK 2011
6. Aickin, S. et al. Evaluating Current in‐vitro Assays for Assessing Fluid Handling Properties of Dressings and their Clinical Relevance, Poster, Wounds UK 2010.
HOW DOES IT WORK?
Absorbency and fluid handling In vitro TIELLE® Xtra can
TIELLE® Xtra helps maintain a moist wound retain over 40% more
fluid than leading
healing environment through the combination of competitor dressings
absorbency and moisture vapour transfer. under pressure
LiquaLock® Technology ensures fluid is locked equivalent to that of
compression bandages6
away, minimising the risk of leakage and (40mmHg)
maceration, even under the pressures exerted by
compression bandaging2,3
Cost‐effectiveness
An in vitro test showed
• Due to longer wear time, treatment with that when compared
TIELLE® Xtra may result in fewer dressing to other foam dressings
changes and reduce the risk of maceration7. studied, TIELLE® Xtra
proved to have the
• TIELLE® Xtra is a cost‐effective treatment, due longest wear time
to the longer wear time7. before dressing
Failure2 (5‐7 days)
77
52
How to demonstrate LiquaLock®
TIELLE® Family is the optimum visual demo product
A well conducted demonstration of TIELLE® Family is crucial
to demonstrate the product features and benefits.
REQUIRED:
1. A sample of TIELLE® Xtra/Max/S (if you use a different
TIELLE® Family dressing the amount of liquid may be
decreased))
2. A plastic syringe
3. 10 ml of coloured water (or fruit juice)
79
Step 1: Fill the syringe with 10 ml of coloured water (use body temperature water), apply 2
ml to centre of dressing and agitate the fluid into the dressing
For 1 minute speak about superior absorption and expansion
Step 2: When initial fluid has been absorbed add 3 ml more and agitate into the dressing
For 1 minute speak about optimal vapour transmission
p g g g
Step 3: When the fluid has been absorbed, add the last 5 ml agitating the fluid again
For 1 minute speak about fluid locking
Step 4: Squeeze the dressing to demonstrate that the fluid is locked into the dressing
Step 5: Offer the dressing to the customer to prove it!
80
Example 1: Hydropolymer with LiquaLock® technology.
• The hydropolymer chemically locks the fluid into the cell walls of the foam
• Minimal leakage even under movement and pressure
Example 2: Ordinary Foam
Due to no fluid locking competitor dressings may leak
81
53
We tested a selection of foam dressings on a simulated leg model…
Superior fluid handling means fewer dressing changes, but how may that look in a simulated
clinical setting?
Dressing
Tubing delivering a
continuous flow of
simulated wound fluid
with blue dye
cylinder
Aickin, S. et al. Evaluating Current in‐vitro Assays for Assessing Fluid Handling Properties of Dressings and their Clinical
82 Relevance, Poster, Wounds UK 2010
...and these were the results*
Dressings at 24 Hours (rear view)
TIELLE® Xtra had the longest wear time
of up to 7 days*
TIELLE® Xtra Versiva XC Non‐adhesive
Dressings at 24 Hour (rear view), Test fluid reached edge of dressing
Mepilex ActivHeal Non‐adhesive Biatain Soft Hold Biatain Non‐adhesive Allevyn Non‐adhesive
* Clinical results may vary from simulation
83 Aickin, S. et al. Evaluating Current in‐vitro Assays for Assessing Fluid Handling Properties of Dressings and their Clinical Relevance,
Poster, Wounds UK 2010
Summary of time for dressings to failure1*
Dressing Time to dressing edge Time to failure

(leakage)
TIELLE® Xtra 4‐6 days Range 5‐7 days
Versiva XC Non‐adhesive 4 ‐6 days Range 5‐6 days
Allevyn Non‐adhesive 1‐2 days Inconsistent results

Range 2 6 days
Range 2‐6 days
ActivHeal Non‐adhesive Less than 1 day Inconsistent results
Range 1‐5 days
Biatain Soft‐hold Less than 1 day Range 1‐2 days
Biatain Non‐adhesive Less than 1 day Range 1‐4 days
Mepilex Less than 1 day Range 3‐4 days
Simulation with high levels of exudate representing a highly exudative wound (flow rate of 5.5 – 8mls / 24hrs)2
1. Aickin, S. et al. Evaluating Current in‐vitro Assays for Assessing Fluid Handling Properties of Dressings and their Clinical
84 Relevance, Poster, Wounds UK 2010
2. Cohen, Diegelmann & Lindblad in Wound Healing: Biochemical and Clinical aspects, Pages 574‐575.
54
Allevyn Non‐Adhesive performed inconsistently*
Example: Failed 2 days Allevyn Non‐adhesive
Rear view: Test fluid leaked
out side
of dressing
of dressing
Rear view Rear view
Front view
• The dressings’ time to failure ranged between 2 to 6 days
• The test fluid reached the edge of the dressing in between 1 to 2 days
• The dressings did not distribute the test fluid evenly and the fluid tracked to the bottom of
the dressing
• In a clinical setting this may cause wound maceration
Aickin, S. et al. Evaluating Current in‐vitro Assays for Assessing Fluid Handling Properties of Dressings and their Clinical Relevance,
Poster, Wounds UK 2010
85
and data on file
Mepilex only lasted between 3 to 4 days*
Example: Failed < 3 days Mepilex
Front view Rear view Rear view
• The dressing only lasted between 3 and 4 days
• The test fluid reached the edge of the dressing after less than 1 day
• The test fluid tracked to the bottom of the dressing and filled upwards only a short way before
failure: In a clinical setting this may cause wound maceration
86 Poster, Wounds UK 2010
and data on file
Biatain Soft Hold only lasted between 1 and 2 days*
Example: Failed 2 days Biatain Soft Hold
Front view Rear view
Front view
• The test fluid reach the edge of the dressing after less than 1 day and the dressings failed after
1 to 2 days
• The dressings did not distribute the test fluid evenly: In a clinical setting this type of lateral
wicking without fluid locking may cause maceration
• The dressing swelled considerably away from the simulated wound where the test fluid was
absorbed
87 Poster, Wounds UK 2010
and data on file
55
Biatain Non‐Adhesive performed inconsistently*
Example: Failed < 1 days Biatain Non‐adhesive
Front view Rear view Front view
• Not consistent performance: Failed at between 1 to 4 days
• The dressings did not distribute the test fluid evenly: In a clinical setting this type of lateral
wicking without fluid locking may cause maceration
• The dressing swelled considerably away from the simulated wound where the test fluid was
absorbed
88 Aickin, S. et al. Evaluating Current in‐vitro Assays for Assessing Fluid Handling Properties of Dressings
and their Clinical Relevance, Poster, Wounds UK 2010
and TIELLE® Xtra*…?
Example: Failed <7 days TIELLE* Xtra
Front view Rear view Rear view
• Consistent performance
• The test fluid did not reach the edge of the dressing for at least 4 days, with relatively even
distribution of test fluid
• The dressings failed at between 5 and 7 days
89 Aickin, S. et al. Evaluating Current in‐vitro Assays for Assessing Fluid Handling Properties of Dressings and their Clinical
Relevance, Poster, Wounds UK 2010
56
Evidences and Supporting Literature
Evidence
Evidence Year of
Type Author Title
type publication
Level one ‐ RCT Schulze, H. J., Evaluating a superabsorbent hydropolymer dressing for exudating venous
Article 2001
study et al. leg ulcers
Level one ‐ RCT Thomas, S.,
Article 1997 A comparison of two dressings in the management of chronic wounds
study et al.
Level two ‐
Diehm C., Evaluation of TIELLE® hydropolymer dressings in the management of
clinical Article 2005
Lawall, H. chronic exudating wounds in primary care
evaluation
Level two ‐
Clinical evaluation of TIELLE® Plus dressing in the management of
clinical Article 2003 Schulze, H. J.
exudating chronic wounds
evaluation
Level two ‐
Taylor, A., A non‐comparative multicentre clinical evaluation of a new hydropolymer
clinical Article 1999
et al. adhesive dressing
evaluation
Delbono, M., The development of a leg simulation model to assess the fluid handling
In vitro Poster 2011
et al. capabilities of dressings
Turton, K., Evaluation of the fluid handling properties of hydropolymer foam
et al. dressings for managing wound exudate
Cullen, B., An evaluation of wound dressings to manage wound exudate and
et al. conform to the wound bed
Aickin, S., Evaluation of high breathability foam dressings to prevent strikethrough
et al. of fluid
Aickin, S., Evaluating current in‐vitro assays for assessing fluid handling properties of
et al. dressings and their clinical relevance
Foster, S.,
In vitro Poster 2010 The evaluation of fluid retention in foam dressings
Mistry, P.
Boothman, S., Bacterial barrier characteristics of TIELLE® to the proposed CEN test
et al. method
Case study 2010 Brennan, P. PROMOGRAN PRISMA® and TIELLE® dressing on a donor site
92
How does it work?
Clinical evaluations
Clinical 1 Clinical 2 Wound progress by dressing group

Evaluation of TIELLE® hydropolymer Meaume S et al. A study to 90%
dressings in the management of compare a new self‐adherent soft
chronic exudating wounds in silicone dressing with a self‐ 70% 50%
primary care. Diehm C., Lawall, H. adherent polymer dressing in stage 44%
Int. Wound J. 2005, 2(1):26‐35 II pressure ulcers. Ostomy Wound 50%
In a clinical evaluation of 6993

In a clinical evaluation of 6993 g ( );
Management 2000:49(9);44‐51. Healed
30%
patients TIELLE® Adhesive TIELLE® showed better healing 45% 39%
Hydropolymer Dressing was proven rates in stage II pressure ulcers, as 10%
to be clinically efficacious in all represented in the chart:
wound types included in the study ‐10%
(venous leg ulcers, pressure sores,
TIELLE® Mepilex
diabetic foot ulcers and other
wounds including traumatic and
post‐operative) and improved the
condition of the wound in 95% of
cases within 4 weeks.
57
Evidence
TIELLE®
An evaluation was conducted Conclusions Wound progress after 12 weeks

to assess TIELLE® dressings in 80
the treatment of chronic • 95% patients benefited from
70
exudating wounds of all the use of TIELLE® dressings
Percentage of patients
in terms of efficacy 60
types, with regards to Healed
efficacy, tolerability and ease of independent of wound type 50
use over a period of 12 weeks. 40 Improv
• 92.5% physicians rated the
30 ed
6993 patients were assessed
6993 patients were assessed overall performance of
overall performance of
with wounds as follows: TIELLE® as superior to 20
previous treatments 10
• 59.8% venous leg ulcers
• Patients’ quality of life was 0
• 26.6% pressure sores improved by high Pressure Venous Diabetic foot Other
ulcers ulcers disease wounds
• 9.8% diabetic foot ulcers tolerability, easy handling
and low rate of adverse
• 5.1% other wound types
events
(including traumatic & post‐
operative) • TIELLE® may also be cost
saving because of longer
wear time
Evaluation of TIELLE® hydropolymer dressings in the management of chronic exudating wounds in primary care Diehm C., Lawall, H. Int. Wound J. 2005, 2(1):26‐35..
Evidence
TIELLE® Xtra
Foam dressings have varying absorbency1: Foam dressings absorbency
16,000
ng (g/m2 /24hrs)
14,000
12,000
10,000
8,000
In vitro testin
13 804
13,804
6,000
4,000
5,350
2,000
0
TIELLE® XTRA Allevyn Non‐adherent
…but how may that look in a simulated clinical setting?
1. Turton, K. et al. Evaluation Of The Fluid Handling Properties Of Hydropolymer Foam Dressings For Managing Wound Exudate. Poster, Wounds UK 2011
Evidence
TIELLE® Xtra
We tested a selection of
foam dressings on a
simulated leg model…
• Images show various
dressings at 24 hours (rear
view) and dispersion of
TIELLE® Xt
TIELLE® Xtra V i XC N
Versiva XC Non‐adhesive
dh i Mepilex
simulated wound fluid
l d d fl d Activheal Non‐adhesive
i h l dh i
• TIELLE® Xtra had the longest
time to failure of 7 days*
(Failure was defined as
leakage). Table of results on
next slide.
Biatain Soft Hold Biatain Non‐adhesive Allevyn Non‐adhesive
Aickin, S. et al. Evaluating Current in‐vitro Assays for Assessing Fluid Handling Properties of Dressings and their Clinical Relevance, Poster, Wounds UK 2010
58
Evidence
TIELLE® Xtra
Summary of time for dressings to
Dressing Time to failure (leakage)
failure1*
• Simulation with high levels of exudate TIELLE® Xtra Range 5‐7 days
representing a highly exudative wound
(flow rate of 5.5 – 8mls / 24hrs)2
Versiva XC Non‐adhesive Range 5‐6 days
Inconsistent results
Allevyn Non‐adhesive
g y
Range 2‐6 days
Inconsistent results
ActivHeal Non‐adhesive
Range 1‐5 days
Biatain Soft‐hold Range 1‐2 days
Biatain Non‐adhesive Range 1‐4 days
Mepilex Range 3‐4 days
1. Aickin, S. et al. Evaluating Current in‐vitro Assays for Assessing Fluid Handling Properties of Dressings and their Clinical Relevance, Poster, Wounds UK 2010
2. Cohen, Diegelmann & Lindblad in Wound Healing: Biochemical and Clinical aspects, Pages 574‐575.
Evaluation of TIELLE® hydropolymer dressings in the
management of chronic exudating wounds in primary care
Diehm C., Lawall, H. Int. Wound J. 2005, 2(1):26‐35.
• 6993 patients
• Duration of the treatment: 4 or 12 weeks.
• Results:
– 95% healing or improvement after 4 weeks of treatment with
TIELLE® dressings
– Frequency of dressing change was reduced from 5 to 3 per week
– Patients’ quality of life was improved
Clinical evidence
– 96.1% physicians wanted to include TIELLE® as part of their
summary and sales
standard therapy
support sheet available
– Physicians’ rating of cosmetic results were excellent or good in
96.6% of the healed wounds
98
A comparison of two dressings in the management of chronic
wounds. Thomas, S. et al. J Wound Care 1997, 6(8): 383‐386.
• RCT comparing TIELLE® with a hydrocolloid dressing (n=199)
• Results:
TIELLE® performs significantly better than GRANUFLEX
– Promotes faster healing
– Less instances of dressing leakage
– No maceration
– Odour reduction
– Better quality of life Clinical evidence
summary and sales
– More comfort support sheet available
99
59
Evaluating adhesive foam wound care dressings in clinical practice
Peach, V. Wounds UK Journal 2012, Vol 8, No 3.
• Aim: Assess the performance of 6 foam dressings
• Key aspects: exudate management, conformability, adherence, ease of
application, ease of removal and the condition of surrounding skin.
• Duration of the study: 6weeks
• 18 district nursing teams have been involved
• 489 dressing changes were recorded on a variety of wounds
Cheat sheet available!
• Results:
– The majority of the foams performed similarly in clinical practice
– Biatain’s performance is very poor compared to the others
– Based on the outcomes of this study ,TIELLE® and one other foam
were included on the formulary as they performed better (i.e. skin
reactions and maceration).
100
Evaluating adhesive foam wound care dressings in clinical practice
Peach, V. Wounds UK Journal 2012, Vol 8, No 3. (CONT.)
Conclusions:
– TIELLE® performs comparable, if not better across all the key areas assessed
– TIELLE® had zero dressings discontinued for reasons such as inability to stay in place and skin
reactions, compared to 39% Biatain, 29% Allevyn and 19% Tegaderm
101
The effect of the environment on modern wound dressings.
Mellor, J. et al. Poster, WUWHS 2012.
• Object: Evaluate the performance of modern wound
dressings in varying environmental conditions.
• Modern wound management dressings rely on both absorbency and
evaporation (MVTR ‐ Moisture Vapour Transport Rate) to create a
moist wound healing environment
• Absorbency and MVTR are often quoted jointly as a dressing’s total
fluid handling capacity (TFHC)
• Methodology:
– Two foam dressings were evaluated in vitro for their fluid handling
properties
– In order to see how temperature and humidity may vary in a
clinical setting, a series of measurements in vivo were taken
102
60
The effect of the environment on modern wound dressings.
Mellor, J. et al. Poster, WUWHS 2012 (CONT.)
• Data show that:
– Environmental conditions impact on the TFHC
– Temperature and humidity impact on how the dressings perform
– Comparing the in‐vitro data to clinically relevant situations it appears that the same dressing
will differ in its performance
• Conclusions:
– It is difficult to make direct comparisons between the laboratory data and how dressings will
perform in a clinical setting
f i li i l tti
– In clinical practice dressings will not necessarily perform in the exact way a manufacturer
states from conducting standardised testing
103
Evaluating an Improved Foam For Absorbent Capacity and Tensile Strength
Mellor, J. and Thistlethwaite , J. Poster, EWMA 2012.
104
Developing a more relevant test system to evaluate
dressing performance. Mistry, P. et al. Poster, EWMA 2011.
• Total fluid handling capacity (TFHC) is a common parameter to
evaluate absorbent dressings, however, it does not explain how
dressings perform in a clinical situation.
• A new model, the Leg simulation model has been developed to
assess dressing wear time in a clinically relevant environment.
– The leg model was positioned vertically to simulate the effect of
gravity
i
– Coloured simulated wound fluid was slowly fed onto the
dressing
– Time for fluid to reach the edge of the dressing and dressing
failure (excessive pooling/leakage) was recorded
• Results:
– TFHC not always reflects dressing performance in a clinically
relevant situation
105
61
Developing a more relevant test system to evaluate dressing performance
Mistry, P. et al. Poster, EWMA 2011.
• TIELLE® Max/Xtra has been compared to six main competitors
– Only TIELLE® Max/Xtra and Versiva did not show pooling of liquid until at least day 4
(all other dressings tested were pooling after 24h)
– Dressings were also tested until failure:
TIELLE® Max/Xtra performed better than other dressings, with minimal leakage of
fluid longest time until failure and better distribution of fluid
fluid, longest time until failure and better distribution of fluid
• Conclusions:
– TIELLE® Max/Xtra may result in fewer dressing changes when compared to other
moist wound healing dressings tested
– TIELLE® Max/Xtra demonstrated the longest time until failure(5‐7days) and minimum
dressing leakage
106
Key objections
“The adhesive is too weak”
• However, if the skin is prepared as per the instructions
in the IFU then the adhesive works as intended.
107
Key objections
“The adhesive is too strong”
• Studies indicate that there is very little pain on
removing TIELLE® Family as long as you use the
sterile water removal technique as demonstrated in
the detail aid.
108
62
Key objections
“The dressing is too expensive”
• This objection is based on dressing cost alone
However, the total cost of the care should consider also:
– The number of dressings required
– The number of changes required (nurse time)
• Several studies have shown that TIELLE® is more cost‐effective1‐3 than other products (alginates,
hydrocolloids and other foams) due to:
hydrocolloids and other foams) due to:
– Longer wear time
– Reduced number of dressing changes
2003, 8(11):18‐22.
2. Diehm C., Lawall, H. Evaluation of TIELLE® Family hydropolymer dressings in the management of chronic exudating wounds in primary care.
109 Int. Wound J. 2005, 2(1):26‐35.
3. Schulze, H.J. et Al. Evaluating a superabsorbent hydropolymer dressing for exudating venous leg ulcers. J Wound Care 2001, 10(1):511‐518.
Codes and sizes
1. Mistry, P. Et al. Evaluating an Improved Absorbent Foam Layer for Fluid Handling Capabilities and Tensile Strength, poster, Wounds UK 2011
Codes and sizes
1. Mistry, P. Et al. Evaluating an Improved Absorbent Foam Layer for Fluid Handling Capabilities and Tensile Strength, poster, Wounds UK 2011
63
Designed NOT to Leak
Tielle Range: Competitive Selling
July, 2016
113
Tielle: Designed NOT to Leak
9Superior absorption and expansion
9Moisture vapor transmission
9Flexibility
114
64
Target Segments & Key Indications
General Plastic Vascular Ortho/trauma
Neuro Intensivists
• Exuding partial and full thickness wounds,
• Pressure ulcers,
• Lower extremity ulcers, (e.g. venous, arterial and mixed aetiology),
• Diabetic ulcers, donor sites, minor burns.
• Suitable for use under compression therapy.
• All variants except for Packing can be used both as a primary or a secondary
dressing.
115
Tielle: Designed NOT to Leak
Brand Competitive Capability
Tielle
Strong Medium Low
• Fluid retention
Marke
Strong • Conforms to Range (current) AG??

wound bed
et Attractiveness
Medium Flexibility Price
Low Shower proof
Tielle®
The Competitive Edge
65
Tielle® vs Allevyn
VS
118
Allevyn‐ Smith & Nephew
¾Allevyn is a polyurethane foam dressing.
¾Non‐Adhesive Hydrocellular Polyurethane Dressing
¾Smith and Nephew offers a wide range of sizes and variants
e.g.: Adhesive, Plus Adhesive, Cavity, Sacrum, Heel, non‐adhesive.
POLYURETHANE FOAM DRESSING
119
SWOT Analysis: Tielle vs. Allevyn
OPPORTUNITIES
STRENGHT
‐ Unhappy Allevyn users
‐ Higher absorption
‐ Untapped market
‐ LiquaLock technology
‐ Existing relations and customer
‐ Flexibility
base
SWOT
WEAKNESS THREATS
‐ Late starter/entry ‐ Biatin, Mepilex
‐ Tielle plus, lite & packing not ‐ Brand loyalty
registered ‐ Local players/Price
120
66
Tielle® vs Allevyn : Key Differentiators
Absorbency Comfort Exudate Fluid

and TFHC management retention
TIELLE® was the
TIELLE® Family offers
only dressing
only dressing
excellent exudate
not to be
Superior Management through
discontinued for
absorption and their:
reasons such as \
expansion • Superior absorbency
inability
• Ability to expand and
to stay in place
conform to the
and skin
wound bed
reactions
121
Tielle® vs Allevyn
POSTER FROM 2010:
We tested a selection of dressings using the WRAP model:
Allevyn Adhesive shows strike‐through of fluid through the backing after a
simulated wear time of only 1 day1
TIELLE® PLUS
Allevyn ADHESIVE
In vitro testing, WRAP wound model simulating dressing in‐use
Simulated wound fluid ‐ 140mmol NaCl, 3mmol CaCl2 containing a blue dye
122 1. Aickin S. and Delbono, M. Evaluation of high breathability foam dressings to prevent strikethrough of fluid,. Poster, SAWC 2010.
Tielle® Vs Allevyn
Feature Tielle Allevyn Benefit Tielle Vs Allevyn
Non‐Adhesive Hydrocellular Dressing stays in place ensuring

Material Adhesive Hydropolymer foam
Polyurethane Dressing better outcome
Low to high exuding
Indications Medium to High exuding wounds Comparable
wounds(Tielle, Tielle Xtra)
Wear Time 5‐7 days 7 days Comparable
Liqualock Technology No Liqualock Technology Effectively locks away fluids and

Fluid Handling Capacity
g p y
12155 / 2/ 24h
12155 g/m2/ 11717 / 2/ 24h
11717 g/m2/ exudates; no maceration
d t ti
Superior absorbency
• Ability to expand and conform
Exudate Management Cannot conform to wound bed Effective exudate management
to the
wound bed
Less skin reactions and stays in Increased chances of skin
Comfort More comfort to the patient
place reactions
Leakage and Strikethrough Low risk High risk Added protection
Range Tielle, Tielle Xtra, Tielle Sacrum Wide range of dressings Comparable
Effective vapor transmission;
MVTR 4016 g/m2/ 24h 3005 g/m2/ 24h
123
promotes moist wound healing
67
Points to Highlight
9Superior fluid handling capacity
9Reduced chances of maceration
9Better comfort to patient
9Added protection
9Cost effective
124
Tielle® vs Mepilex
VS
125
Mepilex‐ Mölnlycke Healthcare
¾Mepilex is an absorbent dressing made of polyurethane foam
¾The wound contact surface is coated with a soft silicone layer, called Safetac.
¾The silicone layer is intended to reduce trauma to new tissue upon removal.
¾Atraumatic removal is focus of sales and marketing strategy.

¾Atraumatic removal is focus of sales and marketing strategy
126
68
Key features highlighted by Mölnlycke Healthcare
¾ “Safetac” adhesive
It is all about adhesion.
¾ Focus on minimising wound pain at dressing Ask your customer: Does it
stay in place during
change wear time?
What about the fluid
¾ Sponsorship of research, education on wound handling capability?
pain in general
pain in general Ask about dressing cost?
g
¾ Skin‐friendly
¾ No trauma
¾ Easy to remove, to replace or re‐position
¾ No need for water removal technique
127
Tielle® vs Mepilex
¾For TIELLE®: 95 % of the wounds
healed or improved
¾Over 12% more than with Mepilex
Meaume S et al. A study to compare a new self‐adherent soft silicone dressing with a self‐adherent polymer dressing in stage II pressure ulcers.
128 Ostomy Wound Management 2000:49(9);44‐51.
Tielle® vs Mepilex
There is more to
a foam than just
an adhesive
129
69
Tielle® Vs Mepilex
Feature Tielle Mepilex Benefit Tielle Vs Mepilex
Polyurethane foam coated
with silicone layer called Easy and pain free removal
Material Adhesive Hydropolymer foam Safetac® comparable
Wear Time 5‐7 days Relatively shorter Cost effective
Fluid is not distributed
Fluid Distribution Even distribution of fluid uniformly Better Exudate Management
Fluid Handling LiquaLock Technology No LiquaLock Technology Effectively locks away fluids

Capacity 12155 g/m2/ 24h 7887 g/m2/ 24h and exudates; no maceration
Absorbent Capacity 8138 g/m2/ 24h 3682 g/m2/ 24h Less maceration and leakage
Leakage and
Strikethrough Low risk High risk Added protection
MVTR 4016 g/m2/ 24h 4205 g/m2/ 24h Comparable

Can conform to the wound bed Cannot conform to the
Mode of Action
130 and locks away the exudates wound bed effectively Better clinical outcome
Points to highlight
9Superior fluid handling capacity
9Reduce chances of maceration
9Better comfort to patient
9Added protection
9Cost effective
131
Commercials
Advance Wound Care
July, 2016
132
70
Market Overview: 2015
• $ 52 M market. Growing at 8‐12% YoY
•Market leader is Smith & Nephew followed by 3M, Coloplast, Convatec & Molnlycke
• Multiple local players, presence of 5 leaders for over 5 years
• Channel partner selection is key for reach and user relationships
• Growing surgical beds in country
• Rise in asthetic and cosmetic beds
• Increasing insurance reach
80% of the market dominated by 4 MNC’s: S&N, 3M, Coloplast & ConvaTec
100%
Revenue ($ Mn)
80%
$1 , 3% $7 , 13%
60% $3 , 5% $13 , 25%
40% $5 , 9%
$12 , 24%
$11 , 21%
20%
0%
Total Market Breakup
Foams Semipermiable Films S&N 3M Coloplast Convatec
Alginates Hydrogels
Hydrocolloids Superabsorbents Molnlycke BSN Others
Collagen Hdrofibers
Source: Global date, inter assessment, field data
133
Market Situation
July, 2016
134
Market Situation: Foams
• Foams are leading the market revenue; $ 14Mn
• Market growing at 15‐18% YoY
• Major MNC: S&N, Coloplast, Molnlycke
Foams
Allevyn (S&N) Biatin (Coloplast)
•Brand leader Allevyn (S&N) •Runner up
•Revenue estimate $ 500K •Revenue estimate $300K
•Strong brand recall •Limited SKU’s
•SKU’s ( 10 with comprehensive sizes)
Sales $'000
0.5, 25%
Mepilex (Molnlycke) Allevyn
•Revenue estimate $ 200K
Biatin
1, 50% 0.3, 15% Mepilex
Others
0.2, 10%
135
71
Market Situation: WCL
• Wound Contact Layer (WCL) follows with $ 10MN
• Market growing at 4‐5% YoY
• Multiple regional player
WCL
Bactigras (S&N) Jelonet (S&N)
•Brand leader •Runner up
•Revenue estimate $ 2Mn •Revenue estimate $1.5Mn
•Strong brand recall •Strong brand recall
•Text book product
Sales $'000
1.8, 18%
4.5, 45%
1.2, 12% Bactigras
Mepitel (Molnlycke)
Jelonet
•Revenue estimate $ 50K
Cuticell
3M
Others
1.5, 15%
1, 10%
136
Key Indications
•Pressure ulcers •Staples,
•Lower extremity ulcers, (e.g. •Surgical incisions,
venous, arterial and mixed •Lacerations,
aetiology) •suture lines.
•Dehisced wounds and post surgical •Venous ulcers,
wounds healing by secondary
g y y Pressure ulcers,
•Pressure ulcers,
intention •First and second degree burns,
•Diabetic foot ulcers •Abrasions,
•Donor sites •Grafts,
•Minor Burns •Nail extractions,
•Reconstructive procedures and
•Eczema,
137
138
72

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Fundamentals of Wounds

Which is the largest organ of the body?

• Receives one third of the body’s circulating blood volume

• Capable of self re-generation

• Can withstand limited mechanical and chemical assaults

Understanding The Skin Layers

Functions of The Skin

• Regulation of body temp

• Absorption of nutrients – Vitamin D

What is a Wound and

“A cut or break in the continuity of

Wounds can be classified according to their nature:

An abrasion is a wound caused by A region of injured tissue or skin in which

Wounds can be classified according to their nature:

A surgical incision is a cut •A laceration is a wound that is

Wounds can be classified according to their nature:

An injury that occurs when an

Wounds can be classified according to their nature:

A puncture wound has a small

Partial Full Thickness /

– Also referred to as shallow wounds

Full Thickness / Deep Wounds

Understanding The Wound Healing Repair Processes Allows Us

Wound Healing Repair Processes

Wound Healing Repair Processes

Wound Healing Pathway

Phases of Wound Healing

• Blood clots are formed

• Damaged tissue releases histamines (causes your capillaries to leak)

• Blood vessel go through a transient period of vasoconstriction followed

• Platelets release a multitude of growth factors Thrombin, protease

Inflammatory cells are released after haemostasis and include:

• Leukocytes (white blood cells) and macrophages (attack foreign substances).

• Inflammatory phase lasts approximately 5 days

• Lengthy process – up to 2-years in duration

• Characterised by a change in ECM components:

– Collagen fibres restructure gaining tensile strength

– Greater cross-linking of collagen fibres = stronger and thicker collagen bundles

Cytokines, Supervisor cell for

Wound • All wounds may acquire micro-organisms. Their

• Microbial species successfully grow and divide, but do

• Bacterial bioburden in the wound reaches a level in

• Microbial growth, multiplication and invasion into host

1 EWMA position document: Identifying Criteria for Wound Infection.

Bacteria classification: aerobic/anaerobic

• Anaerobic bacteria are bacteria capable of growing in the absence of oxygen.

Bacteria classification: Gram positive/negative2

• Gram's Stain is a widely used method of staining bacteria as an aid to their

Gram positive cocci Gram negative rods

2 Gram HC, 1884

Bacteria classification: cocci/rods

Examples of bacteria species

A community of microbes embedded in an organic polymer matrix

Bacterial burden continuum6

Contaminated No effect on healing

• All chronic wounds are contaminated by bacteria.

• Wound healing occurs in the presence of bacteria.

• Certain bacteria appear to aid wound healing4,5.

4 Laato 1988; 5 Levenson 1983

• Attach to host tissue

• Consume nutrients and oxygen

• Induce local immunologic/inflammatory reactions that can delay healing.

Signs of wound infection7, 8

7 Cutting and Harding 1994; 8 Gardner 2001