Swift Thomas, Westgate Gillian, Van Onselen Julie, Lee Stewart
Lecturer in Polymer Chemistry, University of Bradford.
Business Manager, Faculty of Life Sciences, University of Bradford.
Br J Nurs. 2020 Mar 26;29(6):S6-S15. doi: 10.12968/bjon.2020.29.6.S6.
Soft silicone's flexibility, adhesive capacity and non-toxic, non-odourous and hypoallergenic nature have made it an established material for adhesive and protective therapeutic devices. In wound care, silicone is a component of contact layer dressings for superficial wounds and silicone gel sheeting for reducing the risk of scarring, as well as of barriers for incontinence-associated dermatitis. Regarding stoma accessories, silicone is established in barrier films to prevent contact dermatitis, adhesive removers to prevent skin stripping and filler gels to prevent appliance leaks. Until recently, silicone has not been used in stoma appliances flanges, as its hydrophobic nature has not allowed for moisture management to permit trans-epidermal water loss and prevent maceration. Traditional hydrocolloid appliances manage moisture by absorbing water, but this can lead to saturation and moisture-associated skin damage (MASD), as well as increased adhesion and resultant skin tears on removal, known as medical adhesive-related skin injury (MARSI). However, novel silicone compounds have been developed with a distinct evaporation-based mechanism of moisture management. This uses colloidal separation to allow the passage of water vapour at a rate equivalent to normal trans-epidermal water loss. It has been shown to minimise MASD, increase wear time and permit atraumatic removal without the use of adhesive solvents. Trio Healthcare has introduced this technology with a range of silicone-based flange extenders and is working with the University of Bradford Centre for Skin Sciences on prototype silicone-based stoma appliance flanges designed to significantly reduce the incidence of peristomal skin complications, such as MARSI and MASD. It is hoped that this will also increase appliance wear time, reduce costs and improve patient quality of life.
柔软硅胶的柔韧性、黏附能力以及无毒、无味和低致敏性，使其成为用于黏附性和保护性治疗器械的成熟材料。在伤口护理中，硅胶是浅表伤口接触层敷料、用于降低瘢痕形成风险的硅胶凝胶片以及失禁相关性皮炎屏障的组成成分。在造口附件方面，硅胶用于屏障膜以预防接触性皮炎、用于黏合剂去除剂以防止皮肤剥离以及用于填充凝胶以防止器械渗漏。直到最近，硅胶尚未用于造口器械的法兰盘，因为其疏水性不允许进行水分管理以实现经皮水分散失并防止浸渍。传统的水胶体器械通过吸收水分来管理水分，但这可能导致饱和以及与水分相关的皮肤损伤（MASD），以及在移除时黏附力增加并导致皮肤撕裂，即所谓的医用黏合剂相关皮肤损伤（MARSI）。然而，已经开发出具有独特的基于蒸发的水分管理机制的新型硅胶化合物。这利用胶体分离使水蒸气以与正常经皮水分散失相当的速率通过。已证明这种方法可将MASD降至最低，延长佩戴时间，并允许在不使用黏合剂溶剂的情况下无创伤地移除。Trio Healthcare已推出一系列基于硅胶的法兰盘延长器来引入这项技术，并正在与布拉德福德大学皮肤科学中心合作开发基于硅胶的造口器械法兰盘原型，旨在显著降低造口周围皮肤并发症的发生率，如MARSI和MASD。人们希望这也将延长器械佩戴时间、降低成本并提高患者生活质量。
