In this episode of The PODdoctors podcast, Dr. Damien Dauphinee explores the latest innovations in wound care technology, with a spotlight on SAM (Synthetic Antimicrobial Matrix), a breakthrough solution that integrates lidocaine for effective pain management. Joined by Dr. Victoria Miles and Brad Wiggins from Imbed Biosciences, we discuss how this cutting-edge technology is reshaping burn care and podiatric surgery. The conversation highlights SAM’s dual-action approach, supporting wound healing while delivering meaningful pain relief, leading to improved postoperative outcomes and a reduced reliance on opioid medications. 

Listen as they examine how innovation and evidence-based medicine come together to elevate patient care and improve quality of life.

Top Takeaways:

• Introduction to SAM (Synthetic Antimicrobial Matrix) and its role in next-generation wound care
• How lidocaine integration enhances pain management at the wound site
• Insights from Dr. Victoria Miles and Brad Wiggins of Embed Biosciences
• Applications of SAM technology in burn care and podiatric surgery
• Benefits of a dual-action matrix: accelerated healing and meaningful pain relief
• Impact on postoperative outcomes and reduced reliance on opioid medications
• The importance of clinical research and early case studies in validating new technologies
• Real-world patient experiences demonstrating improved comfort and recovery
• The future of wound care innovation and its role in improving patient quality of life

Resources:

Visit our website: https://thepoddoctors.com/

The POD Doctors is brought to you by the Kindle book, Saving Limbs, Saving Lives. Advanced Treatments to Prevent Amputations in Diabetic Populations.

Dr. Dauphine distills these options down to show patients and physicians treating these patients how combinations of these products can be used to save limbs and save lives. Welcome to the Pod Doctors. I'm Dr. Damien Dauphinee, board certified foot and ankle surgeon.

My partner Dr. Rafa Hussain, fellowship trained podiatric surgeon and we are the POD Doctors.

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Welcome to the Pod Doctors. I'm Dr. Damian Dauphine and today I have with me Dr. Victoria Miles and Brad Wiggins from Imbed. Dr. Miles is a burn surgeon from New Orleans.

Welcome Dr. Miles.

Yeah, thanks for having me.

This is great. And Brad, how long have you been working for Embed now?

Yeah, so I'm in the role of the VP of Clinical affairs for Embed Biosciences and I've been with Embed since May of this year after a long career at the University of Utah Burn center, about a 31 year career from there. So extensive burn care.

So yes, hopefully we'll get to talk a lot about what we're able to accomplish with pain guard in the burn realm and then we'll talk a little bit about how we're using it in foot and ankle surgery. But Brad, do you want to start just give an overview of what the SAM technology is all about?

Yeah, absolutely. I'd love to be able to give a little bit of an overview.

Obviously I think you've highlighted on a previous podcast our microlight technology and then over the last few years into the hospital environment, we've come out with Surgiflex and with Pelashield and both of those products are used in the surgery setting as well as into the burn setting. The Pelashield has larger sizes available than that of the Surgiflex.

So in general, our material is the only fully synthetic porous matrix, bioabsorbable material out there on the market. So what that means to you, you get to see a quick little video here of this. For me wanting to come and work from bed.

This video changed kind of everything for me.

I had not seen anything like this in my burn career over so many years of something that embedded itself down into the tissue that really made an instant difference. This is video that you're seeing is not sped up. This is actually just real time of the product going on to granulation tissue in this case.

And I think that that's the piece that we love to highlight is just the key attributes. Fully synthetic, it's incredibly thin. It conforms to the microtextures of the wound bed. It's antimicrobial.

So it's containing both ionic and metallic silver. And that non toxic level which really provides us with 99.99% reduction in micro in microbial burden.

And that's only with 1 part per million of the silver, which is amazing.

And to highlight today's episode, in addition to the silver technology, we've now added lidocaine technology to both the Surgiflex portfolio and the Pelashied portfolio. That's just something that's incredibly unique also to both of your communities.

It's is the ability to provide pain relief for your patients with an actual matrix thin material that incorporates itself into the patient. And again, we don't like to call it a dressing because you don't remove it and change it. It's completely bioabsorbable down into the patient.

And I think that's some of the things that we'll highlight a little bit more today.

That's excellent. Yeah, I agree with you. When I first saw what the material does when you put it into a wound, I was impressed.

I think the, the term for it is interdigitation. But it looks to me like it sort of almost melts right into the granulation tissue. Yeah.

And it's amazing to see that. And I think both of you have had the experience of the clinical side of getting to watch how the material actually works.

For those people that don't have any idea what we're about, a lot of times we like to tell people, think large Listerine strip, it really is kind of the same material. It's made of polyvinyl alcohol. So it is very thin it does activate very quickly when it makes contact with moisture.

But I think that those are all really important things. The other piece to highlight here is just the added benefit of that lidocaine release.

You're seeing that release for acute pain relief, you're getting about 80% of that release of the lidocaine within 30 minutes. But as Dr. Miles is gonna highlight, she's also seen some nice benefits of it with longer outcomes for pain management.

And I think, Dr. Davinet, you've seen the same with some of your podiatry patients, with some of your bunionectomies and things like that. So excited to be able to look at that. I know a lot of times when we talk about any kind of dosing, people might say, what's that dosing look like?

And again, this is a unit dose uniform release of the lidocaine is comparable to the 4% lidocaine ointments in general. So we've worked really hard to maintain that safety for your patients.

And then I think the coverage is clearly attacking the, the usual suspects with regard to chronic wounds. For us with the staph aureus, mrsa, vre, pseudomonas, E. Coli, klebsiella and cannabis.

So, you know, it's gonna wipe out the things that we're clearly concerned about with those types of wounds.

Yeah, the results for us are really impactful. You know, to be able to have something that hits the gram positive, bacteria hit your gram negative, includes fungus management and yeast management.

And the other thing that we try to highlight here between this bar graph that you're looking at on your screen is both the 24 hour mark and the 72 hour mark is that we don't have any taper off. Right. You don't get to see that sometimes when you use different products, you see that general taper off.

We're maintaining that throughout the 72 hour mark and beyond.

And I think that that's a really nice piece to be able to highlight, is that you're getting that consistent efficacy against these different microbes that are, that really make a lot of our patient outcomes so challenging.

Now, Dr. Miles, in the burn world, you're dealing with wounds that are, I'm assuming, several orders of magnitude greater than our little foot wounds.

So how are you, how do you manage the dosing with those patients? I'm sure there's gotta be an upper limit to how many of these you can use.

Yeah, absolutely. So they provide you with a chart where you can see your surface area.

And that's actually one of My complaints recently when I was, I was talking to Brad at a conference as I was like, I need more, I need more surface area.

Because as you can imagine for our big burns, the surface area of their, of their donor sites is quite large to get full coverage in the cases that we do. So we talked about, like, could we perforate this? What could we do to get more expansion?

But they provide you in the package insert with a max dose that you can use in the surface area. So we have to use that sometimes and we push those limits a bit. We'll spread out pieces to get better coverage.

Because we're primarily using this for pain relief at our donor sites.

Gotcha, gotcha.

So when you're using it on the split thickness donor site, so how are you using that right now?

Yeah, so we tend to use skin cell suspension, autograph, the spray on skin, as people say, technology on all of our donor sites to get them to heal faster and with a better result and for improved pain as well.

Um, and, and even still with the use of that, we still have our patients consistently tell us that the donor side is more painful than their grafted wounds at. When we're done with surgery.

And to the point that I often have patients wake up in the post anesthesia care unit and pack you and tell me you operated on the wrong thing, you know, Cause the donor side is what hurts them so much. Um, and I was pretty skeptical, Brad will tell you, I was pretty skeptical that this would do much.

But when we did, the first couple of patients, they came out of surgery and they're like, oh, donor site's fine. Yeah, my wound really hurts. And you never hear that. So that I've never heard that in my entire burn career that anyone has ever told me that.

And then the interesting thing about it is that persisted for days and it was never that the donor site pain was worse than the wound site.

So I think it has to be something, and maybe I'm getting a little ahead in your presentation, but I think it has to be something about blocking that initial pain response and the initial activation of those pain fibers with the application of this while they're still under general anesthesia, that then it never really hits that level. And it's so funny because when we use this product, our patients tell the nurses, well, y' all kept telling me this donor site was gonna be terrible.

It's fine. You're like, uh huh, yeah, why don't we go down the hall? You know, so we've seen this. And don't just Mother people.

Yeah, I mean, I think it's, it's, it all comes down to sort of preemptive, the local anesthesia. And we do that for surgery.

Obviously we try to pre inject and then you don't get that upregulation of all of the inflammatory stuff that goes on with surgery.

And I think that's got to have something to do with it because we're seeing the same thing using this in like lapidus bunionectomy patients where you're lining the incision. This is a fairly significant bone surgery where you're fusing bones. These people are going to have post op pain.

And I was amazed at how quickly folks were stopping their hydrocodone. So they were stopping their hydrocodone 24 to 48 hours after the surgery, when generally people are gonna use that for a week, that type of surgery.

So.

And then the other place that we were using the pain guard product was lining the incision lines in some of the nerve work that we're doing in diabetic patients who are gonna be susceptible to post op infections.

And then, you know, who also further up on their leg where we're doing common fibular nerve or superficial fibular nerve work, those people still have pain in those areas. And it's again, it's really blunting that initial pain response in a beautiful way, much beyond the half life of lidocaine. So I agree with you.

There's another, there's another aspect of this that's kind of hard to put your finger on, but has to have something to do with, I think, preemptive strike for sure.

Yeah, you know, you're exactly right in regards to lidocaine. I've published previously under my maiden name some studies about the use of liposomal bupivacaine exparel on donor sites.

And we just do not see much effect from it. Not, and definitely and definitely not a profound effect. I think a donor site is unique in that it's constantly leaking.

So if you've ever taken care of a donor site, you constantly have proteinaceous fluid, that plasma essentially that leaks from that donor site when you don't have your epithelium there anymore. And so I think that's probably why that injecting something into the sub Q, it likely just leaks out of that region.

So it's nice that this slowly dissolves over the course of days and it is there in the product. And I think that's what makes the difference.

And that's a simple concept, but it's something that We've never tried before in burn care, at least to my knowledge.

I love hearing that. Yeah, I think some of those things also.

You mentioned exparel, you mentioned, I guess, you know, people previous to Exparel would have been using just Marcaine or pure bupivacaine. Are you using any of those in your patients at this point?

I am not. No, I am not. We didn't find them to very, very effective. And then it becomes an issue if it's not very cost effective, if it's not very effective.

The skin cell suspension autografting got the donor sites to heal much quicker and thereby reducing pain because they heal faster over the course of their hospitalization. And so we had, we had bought into that for sure and know that that works. This is just complimentary to that.

So Brad, I think you asked me earlier, how do I use it?

So we still spray the skin cell suspension autograft onto the donor sites and then we place our product on top of that and then still put our Telfa clear layer on it, our non adherent layer, like we always did in the past. So it really hasn't changed per se, any of our dressing protocols, any of our care protocols. It's just reduced pain.

And I think that's really nice to be able to hear, you know, and I think people that are listening will benefit the most from understanding the algorithm of care delivery.

I think so often in these situations when we talk about trying something new and using some new technology, it's hard to always understand how people are using it in that capacity.

Dr. Daphne, in your experience, so you mentioned the types of patients you were putting it on earlier, how did you see some of that impact your patients? What was that like for you and what kind of algorithm of care were you doing on both that lapidus patient and the neurolysis patients?

Well, I think we were using it twofold. A lot of the lapidus patients were actually diabetics as well.

And so we do a lot of preemptive strike with regard to forefoot deformities in those patients who have neuropathy because if, if we don't address the mechanics, then they tend to get recurrent ulcers. So, you know, we were looking for pain relief in those patients because a lot of them still have some sensation.

But we were using, you know, the silver to prevent post op infections in those folks when it's significantly higher.

But the patients that were non diabetic, you know, it was just a fantastic way to do a preemptive strike for their Post op pain, it's diminished their hydrocodone use, which diminishes their problems with constipation and you know, everything that goes on with, with the use of opioids in that population.

The, the other place that we were using it again was in the, our peripheral nerve work where we're doing either neurolysis or, or doing reconstruction. Because infections in those patients are catastrophic.

When you get a post op infection and you've just reconstructed a nerve, you're going to get scar tissue, you're going to get neuroma, incontinenuity or other problems with your repair that almost require a second shot at it, which is never going to be as successful as the first attempt. So anything we can do to prevent post op infections in those patients is really important.

So I think we get that combination of pain relief, but also sort of the insurance policy that we're not going to get an incision line or a post op infections. I think it's really cool. This slide here is really neat.

With the same technology showing that you can get proliferation of cells onto this material almost as good or as good as just simply any other, like the coated glass slide as your com as your comparable. But you're seeing this the same, if not better proliferation of these cells onto the same technology.

So it's clearly helping, adding a scaffolding effect to this entire construct, which has been great.

Yeah. And I think that's one of the really key pieces here between the two different types of care that both of you were talking about.

So for me, as a longtime clinician, I think highlighting Dr. Miles is putting this on over the top of a split thickness autograph donor site.

Right.

Where she's treating more topically. And you have done that when the microlight cases with your DFUs and VLU.

But you've also taken the Surgiflex with pain guard and actually put that inside the patient and actually closed up around it.

Right.

So two very different types of care delivery mechanisms here that really allow for the pain guard to really get its full, you know, impactful benefit.

And I think we're just starting to scratch the surface to really understand what other care modalities could really use this technology to assist their patients in pain reduction.

Yeah, I mean, I think from the standards, from the standpoint of the DFU patient, these patients are pretty neuropathic. I don't know that pain guard would be that helpful for a plantar wound that we're trying to get closed.

So we're typically using a different SAM version That doesn't necessarily have the lidocaine, but yeah, up on the leg, when you're operating on those folks, they still have, you know, significant sensation up there oftentimes. And so you were. It's a. It's a benefit. Both sides are a benefit to those folks. And this stuff is so easy to use. I mean, Doc, Dr. Miles, you.

You know this. You basically just remove it. You. You slap it into the wound bed and let it do its thing.

Yeah, I don't have to trim mine. My sights are big. There's not much trimming going on.

We do a little trimming, but. Yeah, the nice thing is it comes in a variety of sizes. And so we've got. We have options. But, yeah, the stuff's really easy to use.

And that video really, that we started off with was really impactful for me because of the way it gets into the granulation tissue and can really help prevent some of those colonies that may be embedded within your granulation tissue from being problematic later on. Is there anything that we want to mention on this one, Brad? We pretty much covered this. Oh, this is the. Yeah, this is your.

That's my chart.

There you go.

Yeah, so say that's my chart. That's what we use.

And perforation might. Might help because it would reduce the dosing. You get a broader. A broader piece. You guys playing around with that? Maybe.

That'S a Brad question.

Are we playing around with a larger.

Sheet or perforating it so that you'd have a larger sheet with the same.

Yeah, it's something we're discussing. I mean, Dr.

Miles comes from a community where, you know, meshing something to cover larger TBSA is a super important piece, something we're discussing for sure. Dr.

Miles has taken advantage of some of our early sizing and used some of our early sizing where we have much larger sizing that might cover those significant areas more.

So, you know, we go up to a 15 by 15 centimeter and a 10 by 23 centimeter now for both of those sizes in the lapella shield, which we think will be impactful that way. And when it comes to the pain guard, you know, both of those on the dosing sheet will give you total amount of sheets that you can use.

And again, we're talking low dose lidocaine here. So just 0.4 milligrams per centimeter squared of that lidocaine.

So really, you know, working in conjunction with your pharmacist, understanding what this is gonna look like on the type of patient you're Using on, we picked the bare minimum safety to be able to make sure that when we were putting this product out to market that we maintain that FDA requirement of what this dosagene looked like.

And I think it's up to clinicians to evaluate again at their local level of what's best for them, size wise to be able to try to chase through those things. And as you know, I mean, you've highlighted with your Surgiflex usage on your patients.

I mean probably your common size has been that 4 to 6 or the 4 by 10 or even in a long incision, the 4 by 20, which is in a strip. Right. So that you.

It's really made for an incisional wound where you can lay it down into the incision, which I think's a game changer as well, versus the larger surface area coverage of the pellet shield.

Yeah, yeah, yeah. Important to note that 10 centimeters corresponds to that 4 inch guard on the dermatome when you take your donor site that we all use.

So that was, that was intentional, but it corresponds well to that.

Yeah. And we did do that intentionally to try to look at that and to really think through it.

So, you know, one of the other really important things that we wanted to try to highlight today was just looking at the impact that are, you know, you have something that's got the silver in it, you've got the piece of zain. We do know that we're making a difference when it comes to surgical site infections.

This slide just simply, you know, shows off what it might be like in a different type of care setting within the hospital setting. On the hospital side, you know, your NISQIP data through the American College of Surgeons is really something that's highly important to understand.

They have the surgical risk calculator that really looks at the different types of patients and different types of outcomes. Dr. Miles, can you highlight a little bit about why these things are so important within your acute setting?

Yeah, I mean, all of these things, as you point out, are reasons that wounds won't heal. Right. Which is, which is the bane of my existence. So when we have patients that have these comorbidities, then we see difficulty with graft take.

We see difficulty with getting our wounds closed. And when wounds don't close, they, they stay chronically infected. Um, so all of these factors play into what I do every day.

That's great.

And I think that, you know, these are all places where whether or not you're using it in burn care, whether or not you're using it in the podiatry world and reconstructive surgery of foot and ankle, whether or not you're using it in an orthopedic community, whether or not you're using in the surgical oncology community, possibly neurospine, we really are finding ourselves with usage across all these different care areas, which I think is the most exciting and encouraging part about bettering patient outcomes across all different care areas. So excited about that for sure.

Yeah, this slide is really great, I think, highlighting, you know, you've got three or four of these things going on and that's a patient that it's a slam dunk. You should be using something like this because you're asking for trouble with the comorbidities for sure.

I think the pain levels that we were measuring for the post op lapidus, because bunion surgery is actually a very popular surgical model for any new pain medication coming down the pike. And so nucynta and some of the newer, longer acting pain drugs, they all use bunion surgery as a model because it's a pretty standard surgery.

The amount of post op pain is pretty standard for most patients. And so it's an easy surgical model to use in that realm.

So I think using the pain guard in those patients, in those bunion chations has really been eye opening in our ability to diminish their opioid use and really get them up and moving much faster.

Yeah, I think that's great. This slide just demonstrates for us.

When we got ready to do our initial launch into different areas, we were looking for some limited market release sites. We had six different facilities that invested in using the SAM pain guard technology.

And in those early adopters, we've treated many more than 23 patients at this point. But those 23 patients during that early adoption had a range of different wound types. Everything that we're talking about with Dr.

Miles and her autografting donor sites to surgical sites that you highlighted, the bunionectomies, neurolysis, even patients with had osteomyelitis case outcomes, as well as some tib fib fractures in the orthopedic setting.

So I really think that, you know, one of the things we wanted to highlight is just this has been demonstrated already in very early results that, that we're making a difference with initial pain relief. And I think we'll highlight that through some of the cases here of yours. Dr. Duffney.

Yeah, this is a common fibular nerve up at the knee. And we essentially use the pain guard to line the incision line underneath our initial closures and these patients.

The.

This was actually a diabetic patient, but clearly is still sensate at this level. And so this was beneficial for them in that regard.

And then here's a superficial fibular nerve that we used it over and got the video showing how we just sort of layered it in there. It's. That's literally that simple. So we don't close the fascia in these cases because we're literally doing a fasciotomy to decompress the nerve.

And so we're just essentially lining this over the neurolysis itself and then closing dermis and closing skin. So pretty simple. And it stays out of the way. It doesn't usually bunch up.

We can literally just mobilize the skin on either side and close it like you normally would. So it doesn't require any additional work.

For anyone that has a general surgery background. It's similar to seprofilm that we use to prevent adhesions in the abdomen. Seprofilm, it has is. It kind of holds and feels similar to seprofilm.

And so, again, this sort of speaks to that initial pain relief that the patients are getting, and then it goes well beyond the half life of lidocaine. So I think these patients are benefiting much longer than. Than you would typically expect. And here's a lapidus bunionectomy incision line.

So we're lining that entire incision with. With the pain guard and getting tremendous pain relief postoperatively. Really doesn't change our approach or what we're using to close.

So it's a simple thing to add to our closure protocol.

Yeah. Dr.

Miles highlighted at the beginning of our conversation today that she feels like maybe it's the matrix impact of maybe covering the wound bed early. Could we talk a little bit more about that? Like, why are we seeing longer pain support outside of the half life of lidocaine?

I think it's that you blunt the initial pain response so those fibers are never activated in the first place. And like Damian said, that's often why we use local before we make an incision in patients. And we know that to be effective.

So I think the same thing holds. Holds true. So we're applying this prior to them waking from anesthesia, and I think it just blunts that initial pain response.

And then you see kind of a profound impact then, at least for us, over the next one to two to three days in some of these patients that just never reach the same level of pain as we would expect. And patients with. With normal untreated Donor sites.

Yeah, I totally agree. This, this lapidus patient, completely sensate, non diabetic. You know, she, she took herself off her opioids on Sunday after a Friday surgery.

So that was remarkable. That just, it never happens.

So we were very pleased with this and so we've made it, you know, trying to make it one of our, our protocols with those folks.

That's great. I love, love seeing that in place. And uh, some of those, if you go back one slide. Dr. Daphne.

The one piece there that I think we're highlighting is just, you know, this patient was reporting a pain of six prior to the procedure. At 45 minutes post operatively, no pain. And at the three hour mark, no pain.

And then again you highlight them reducing and stopping, using their, their opioids at the 24 hour mark. Which is, which is outstanding.

Right.

I think that those are the things that we continue to hear across lots of different care delivery providers is the outcome that they're seeing from their patient.

A standout for me that we don't have highlighted today was just an orthopedic case on a tib fib fracture where the provider placed it in this tib fib fracture area and had dramatic difference from also an injury on the same patient, same leg, who complained about their knee issue but never talked about their tib fib fracture which was down at their ankle. Right. So I think those are the exciting pieces on those for sure. So that's great.

Here's your. This appears to be a donor site right here.

Yeah. So yeah, that's a 4 inch dermatome donor site on the thigh as we usually do. And you can see that the healing is uniform throughout.

So we didn't see a difference in healing even when we, when we placed this over the skin cell suspension, suspension autograph, like I mentioned, it's uniform healing, uniform contour, uniform pigmentation.

Obviously this is an early donor site here when, when wounds, especially in Caucasian people look more injected in appearance, this will continue to turn to more normal coloration usually over the following 12 months. But you still see the color is uniform. And they're using a Telfa clear dressing just like I do over my donor sites that you see there.

And yeah, so exactly what it looks like. I, I, I did laugh with Brad. Cause I said when we first opened the packaging, it was, it looked like a Listerine strip. And I was like, is this it?

Is this all we do? Um, so, so yeah, I did laugh with him about that. When we first opened it, my PA and I were like, ah, but yeah, it's. It's super simple.

Just don't get it wet before you place it.

I love you highlighting that, Dr. Miles, just because I think that the simplicity of it is just that you open up the package and it's a little underwhelming.

Like, you're looking at, like, this is it. You know what it reminds me of? It looks like the cellophane you used to wrap Easter baskets with.

Yeah, yeah, yeah, yeah.

Thicker than that, right?

Repurposing Easter basket cellophane. What are they doing? Yeah.

And I think that that's the piece that surprises people.

And one of my favorite comments I've gotten from a leader in skin regeneration is her comment to me was, who is it that determined that a matrix material has to be thick? Who was it that determined that?

And how did we get educated to thinking that this thicker material meant that it was better and that it would work any differently? And so I love that conversation topic when it comes to this. And the outcomes that we're seeing from these types of treatments are really fun to see.

So I think that's. That's a really nice piece. Different references here, for sure. Different things for us to consider and talk a little bit about.

I think one of the big things that I'd love to say to people that might be listening to this is we're in the early phases of this.

We're looking for as much opportunity to spread this knowledge, to get people trying this, to do active research projects, to launch into different things to highlight their case studies that they're currently doing. So both of you have been active in sharing your case studies with that, which we're super excited about. Dr.

Miles and the team at her burn center have been working diligently to put some abstracts out there for different meetings.

Could either of you just kind of highlight for me why you think it's so important to demonstrate, you know, things through research? What's that really do for you on the. On. On a newer product like this?

Well, I'll just tell you, I told you just before that you got to drag me kicking and screaming into research. So we. We tried to put out. We. We put out a manuscript recently, and. And yeah, it's like, it's painful for me to do that it's just not my thing.

But, but talking about this product is easy and it's extremely applicable to what I do for a living. And so it's easy to talk about this. The research side being part of a major academic center out in LSU. I'm sure Dr.

Miles, you probably enjoy this stuff more than I do. So I'm going to hand it off as well.

Say I think I'm the exact opposite.

Whereas we won't use anything Brad knows unless the that's that we see the research first followed by the cost efficacy profile of it which Brad's aware of too. My partner, Dr. Jeff Carter is this year's American Burn association president.

And I think many would argue that he's one of the leading burn researchers of his, of his era, I think for sure. And so that's a big part of what we do. It's part of my daily job to do research. So I, we, this is our just small case series of our first five cases.

Um, I will tell you that if you look down to the results, I think most impressively average pain scores were, were zero at baseline. Cause it was a donor site that had not yet been taken. So 0 baseline but 2 at 45 minutes and 2.6 at 3 hours post op.

Those numbers would have been 5 out of 5 for everyone who had not gotten this product. And, and I can assure you of that. And so that alone is impressive. And then our research into this is ongoing.

Fortunately, at least at my center, we don't see a lot of infections, but we didn't have any infections in these cases either.

We pay a lot of attention to our infection prevention practices here and we don't see a lot of infections, especially in donor sites, but we did not see any infections.

And, and I, you know we don't have any evidence to show us this but I would assume if you didn't have any bacterial contamination, maybe not an infection of the donor side, it may heal faster and heal better. I, I, I would believe that to be true. Um, and so you know, I can't say for sure that that antimicrobial profile isn't helping in any way.

Um, I, I would say it probably is helping and probably helping us heal faster. Um, on the next slide think is one of our cases too. So you can see there we now have the bigger sheets as Brad mentioned.

It's just for me it's always what's next, what's next. And maybe that's because I'm young.

But then I want to know what I'M going to do when I have someone with donor sides all the way around, both sides, because I'm going to reach that maximum. So that's the next question. But spreading these pieces out, they still had the same pain control, so.

So I think the answer there is just maybe spread out smaller pieces, cut pieces, spread em out across the donor site and it should disseminate just fine.

That's remarkable. So even all that extra space, their pain was expected.

Uniform throughout, low and uniform throughout. Yeah.

This was a, this was a young kid who was like up walking on a treadmill a few hours later and normally it'd be like, oh my gosh, my thigh, my thigh. Do you not understand something's wrong with my thigh? You know, and, and that, and it's just incredible.

Yeah.

Do you think there's an opportunity to use this in partial thickness injuries as well? So you have a pediatric patient in clinic that you can put it on or anybody that is in that environment?

Because some of the early reports are some of my other providers that are using it in those situations, they're having the same results.

A child that's in clinic with a secondary burn, excruciating pain, they're managing with the pain guard after debridement and then these kids are up and walking around. So it's, it's increasing that mobility that we know is so challenging for so many people post burn injury.

So Brad, I actually talked to Carmen Flores about this in Southern region burn. So she's a burn surgeon as well. And she said that it's working great for her a hundred percent.

And you know where I could see it is when we have those cases in clinic that we've sent home, we thought they would do fine with their final takedown outpatient. And they're having a lot of trouble. And we're balancing.

Do we schedule them for a procedural sedation the next day and discontinue wound care right now cause it's too painful or could we use this product? And in my mind that for sure is where I could see this going. I did a ton of peds in my fellowship.

I don't do a ton of pediatrics now, but I can imagine if I had second degree wounds that I was trying to get Mepilex fitted to in an ER setting that I 100% would love to use this product on some of my PD patients as well.

Yeah.

And I hope we're able to continue to highlight some of these cases in all the different ways.

And a lot of those are going to be Presented at research about the American Burn association meeting as well as the upcoming Boswick Burn and Wound conference in Maui in January. So excited about all of the places where we're going with this. You know, it starts with case studies, but it builds out to larger IRB studies.

It builds out to the opportunity for multicenter studies as well.

So if anyone's listening that's interested on that side of the, of the research, I would, you know, don't hesitate to reach out, don't hesitate to think about what that might look like for your patient population and to be able to work together for really reduction in pain management, which across my burn community time, we spent so much time chasing that issue. It's really such a large issue.

We battle infection, which this helps with, and we battle pain and the ability for patients to work through their pain with different physical therapy needs as well as just return to life and normal activity of their daily living.

Excellent. And then I guess this is the maximum number of pieces again at the end.

Yeah, that's fine. We threw it on there just to be able to highlight for people just the different dosaging and have it as a reference for people if necessary.

But yeah, I think in general the pain guard technology is adding the lidocaine into something that we knew was already very effective. We have strong research background through several different studies that we're looking at the microlight technology that we originally came out.

Most of those studies were all done in the DFU and vlu, which is lovely, but we also saw that in dehist wounds and a lot of different types of chronic wound setting for that community. So being able to grow into the Surgiflex community and then be able to grow into the Pelashield community has just been exciting.

And I tell people all the time I'm a little bit giddy about what's going on right now because this technology is new to the field. We're trying to get word of mouth out there.

We're trying to really ensure that people understand how this technology can make a difference in their carrier algorithm. I have people that are using it for prep to graft.

I have people that are using it on top of their skin grafts when they do that so they'll lay a piece over the top of their skin graft. It really does a nice job of conforming down in the interstices of the skin graft, working well in that environment.

We know we have ortho doctors that are using it in ortho cases for both brand new knees and hips which is a game changing for that community. We know we have trauma ortho that's using it post, you know, on cleanup once they admit a patient.

And then we also know that for some of providers, they come back, they have a dehist wound for some reason that was unforeseen for happening. Maybe the patient fell. I know that happened with my mom as an example. She had a simple knee procedure and she fell and opened it up.

And I wish I would have had this technology when she struggled with that open wound.

I just think it's such a nice feature to be able to clean and maintain these type of wound bed environments that need the extra microbial support at such an integral level. And I think that's the piece that, you know, you highlighted earlier. We talked about cell proliferation.

The cells, the healthy cells love to grow on this. That's why it works so well for a stalled wound. And you're killing the antimicrobial.

And now we're adding the lidocaine piece to really make that difference.

Yeah, it'll be really interesting to see how you guys develop that Sam technology and maybe other ways in the future. It's a really unique platform that really has some possibilities. Thank you, Dr. Miles and Brad for joining us on the Pod Doctors today.

If you guys have any questions, we'll leave some information about embed and Dr. Miles in the show notes and this should be up on all your podcast sites soon, within the next week or so.

So thanks again guys and we will see you next time on the pod. Thank you for listening to the POD Doctors. We appreciate, appreciate all of our listeners and subscribers.

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