The removal of biofilms which are detrimental to wound healing and the successful management of wounds at risk of infection were in the focus of the “Modern Wound Management – Challenges and Solutions” symposium held at the European Wound Conference hosted by the EWMA, ICW and WundD-A-CH in Bremen, Germany, on 11th May.1 At the event initiated by Lohmann & Rauscher (L&R), experts emphasised the significance of proper communication between medical and healthcare staff and demonstrated the implementation of wound treatment concepts in practice by using examples. Debridement is an important starting point for wound therapy. The L&R monofilament fibre pad Debrisoft® – an effective and low-pain option for the mechanical removal of biofilms and deposits – has a prominent role in both inpatient and outpatient settings.
According to Dr. Karsten Glockemann, a surgeon with his own medical practice in Hanover, Germany, there are 2.7 million individuals with wounds of various indications in Germany alone. In approximately one-third of cases (at least 900,000), these wounds will become chronic, i.e., the treatment will last for longer than eight weeks.
These include lower leg ulcers, decubitus ulcers and diabetic foot syndrome (DFS), which can often have a serious impact on the patient’s quality of life. “Whilst acute wounds can often be treated without any problems, chronic wounds pose a challenge to all those involved,” explained Björn Jäger, a wound expert of ICW / Lingen (Germany).
Biofilms are detrimental to wound healing
Biofilms often develop on chronic wounds. “The microorganisms colonise the wound in these mucilaginous structures made from sugars and proteins and impair wound healing through a number of different mechanisms – shortage of oxygen, increased consumption of nutrients, mechanical extension of the diffusion pathways,” explained Werner Sellmer, a member of the board at Wundzentrum Hamburg e.V. He also added that biofilms and deposits cannot be removed with simple wound lavage, antibiotics, antiseptics and other chemical products such as organic acids. According to a guideline on the handling of biofilms, they can only be significantly reduced with thorough wound cleansing (debridement)2.
Debrisoft for effective, low-pain, cost-conscious wound cleansing
“Sharp instruments – scalpels, curettes, tweezers – have been able to retain their traditional role in the therapeutic approach to combating deposits and biofilms. However, other techniques and products are also becoming increasingly popular for the reduction of bacterial burden and removal of biofilm in outpatient care,” emphasised Mr Sellmer.The Debrisoft monofilament fibre pad is particularly suitable for the rapid, effective and low-pain mechanical debridement of superficial wounds. The angled tips of the monofilament fibres detach deposits from wounds and remove debris and exudate from wounds as well as skin flakes and keratosis from the skin surrounding the wound. They trap the particles and are thus gentle on the surrounding skin.
“Increasing budget restrictions mean that cost-conscious treatment is also unavoidable. However, patient care should not suffer as a result of this,” affirmed Dr. Glockemann. There is also evidence for Debrisoft’s efficacy in this respect. The British National Institute for Health and Care Excellence (NICE) supports the use of the monofilament fibre pad, as it benefits patients and may also help reduce healthcare costs3.
Phase-oriented wound management – the right combination
The recommended treatment of biofilms1-2 consists of reducing the biofilm burden and preventing the biofilm from reforming. L&R offers a range of specially designed product solutions for this purpose: For example, the Debrisoft monofilament fibre pad can be used very effectively for mechanical debridement and the wound can be treated with the recently introduced antimicrobial, moisture-regulating foam dressing Suprasorb P + PHMB (Class III, MDD 93/42/EEC) as locally applied antimicrobial therapy.
Suprasorb P + PHMB was specially designed for infected wounds and wounds at risk of infection with moderate to high levels of exudate. PHMB (polyhexamethylene biguanide, polyhexanide) has broad antimicrobial potential and acts reliably against MRSA (methicillin-resistant Staphylococcus aureus) and VRE (vancomycin-resistant enterococci). With the new foam dressing, it is now possible to reduce the bacterial burden by 99.99% within six hours. The open-pored foam structure of the PU foam dressing and the perforated wound contact layer ensure reliable absorption of exudate and promote a moist wound healing environment.
L&R also offers a concept solution for the complete treatment of chronic wounds such as venous lower leg ulcers: In addition to Debrisoft for gentle, mechanical debridement, it includes various dressings from the Suprasorb range for phase-oriented, moist wound management and a variety of compression systems including Rosidal set systems.
Complex wounds require networked structures
“In addition to the specific local wound therapy, involving the different professions in the healing process and their proper coordination is of particular importance. The complex treatment of diabetic foot ulcers is a prime example of the interdisciplinary treatment of patients. In this case, for example, diabetologists, vascular surgeons, chiropodists, orthopaedic shoemakers and specialist nurses work together as part of a multidisciplinary team. Without the multidisciplinary cooperation among the individual occupational groups, it is scarcely possible to guarantee the complex healing process of chronic wounds,” said Björn Jäger, a wound expert at ICW / Lingen (Germany).
1 “Modern Wound Management – Challenges and Solutions” symposium held at the EWMA (European Wound Management Association, ICW (Initiative Chronische Wunden e.V.) and WundD-A-CH on 11 May 2016 in Bremen
2 Phillips PL, Wolcott RD, Fletcher J, Schultz GS. Biofilms Made Easy. Wounds International 2010; 1(3)
3 Pressemitteilung NICE, 25. März 2014 und Meads C, Lovato E, Longworth L. The Debrisoft(®) Monofilament Debridement Pad for Use in Acute or Chronic Wounds: A NICE Medical Technology Guidance. Appl Health Econ Health Policy. 2015 Dec;13(6):583-94.
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