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    1. Poster

      Providing Therapeutic Compression Options: the key to better patient compliance and concordance with edema management regiment

      Poster presented at ILF 2019 13.06.2019 Chicago, USA

      Aim

      Observational study of 10 patients who had presented with lower extremity swelling and history of non-compliance with compression regiment. We hypothesized that offering a variety of therapeutic compression options would have a positive impact on patient’s compliance and concordance with a compression regiment. Objective data measured included limb volume (cm3), range of motion (ROM), Functional status (Timed Up and Go), Quality of Life (QOL) using the lymphoedema QOL Tool (LYMQOL-LEG) and IP pressure measurements.

       

      Methodology

      Observational study performed at 2 different edema management clinics. Ten patients presenting with lower extremity swelling and history of non-compliance with previous compression regiments were observed. Objective data measured included the following:

      Limb volume (cm3)

      Range of motion (ROM)

      Functional activity status

      Timed Up and Go(TUG)

      4 M Walk Test

      Quality of life (QOL) using the Lymphoedema QOL Tool (LYMQOL-LEG).4

      Measurements were taken at four different intervals over a minimum of 3 months. Compression options were individualized to patient's physical presentation and lifestyle for long term management of their edema.

       

      Presented here are focused case studies with photos and individual outcomes, as well as group data

       

      Results

      Limb volume remained constant in eight subjects throughout the observation period. Two of the subjects experienced a slight increase at initial follow-up however subsequent assessment revealed volume returned to baseline. LYMQOL scores showed improvement over baseline and functional performance level remained consistent. Therapeutic compression dose was observed for all forms of compression at initial prescription. The ready-made and custom flat knit medical elastic stockings (MES) and the Velcro adjustable compression wrap showed consistent therapeutic compression dosage throughout the observation period. Ready-made circular knit stockings demonstrated a steady decline in the therapeutic dose of compression over the observation period. Of note, the two subjects who experienced a slight increase in volume at two weeks follow up presented with compression dosage that was below therapeutic. After patient was instructed with proper application, therapeutic compression was observed, and overall volume achieved stable levels.

       

      Discussion

      Compression therapy had a positive impact on all outcomes measured during the intensive phase of therapy. Follow-up outside the intensive phase of therapy demonstrated further volume loss in 6/10 subjects; Volume remained constant 3/10, increased slightly 1/10 . LYMQOL scores and functional performance level maintained stable during the follow-up period.

      Offering multiple compression options including custom and ready-to-wear flat knit stockings***, Velcro adjustable wrap** and night-time compression options* had a positive impact on patients’ adherence6 to compression regimens during the study period compared to single compression modalities offered previously. Individualizing the compression regimen to each patient’s lifestyle improved their adherence to chronic edema management.

       

      Conclusion

      The optimal compression is the product the patient can apply independently and finds acceptable to his/her lifestyle. Individualizing the compression regimen to each patient’s lifestyle improves adherence to chronic edema management. Further study should be performed on individual MES to provide the compression prescriber with additional information about the fatigue of the garment with normal wear/use/longevity of therapeutic compression.

      Further versions
    2. Poster

      REDUCED TISSUE FIBROSIS WITH ADDITION OF TEXTURED COMPRESSION GARMENTS TO EDEMA MANAGEMENT PROGRAM

      Poster presented at ILF 2019 13.06.2019 Chicago, USA

      Aim

      Chronic edema is associated with significant trophic changes including not only increased volume but also trophic changes.1-3 Compression has been shown to have a positive impact on trophic changes including reduced tissue fibrosis.1-4 It has been observed that textured compression, utilizing chipped foam or channeled foam, has a significant improvement on tissue fibrosis.5 Aim of this study was to objectively measure the change in tissue fibrosis following the use of a textured compression product.

       

      Methodology

      Observational study tracking outcomes of four patients (n=4) utilizing a textured compression garment at night. Garments were chosen as best fit for patient by therapist and were not the same across the subjects. Measurements included: volume of the limb, tissue density, and subject self-reported quality of life. Measurements were taken at three different intervals over a two month period. Tissue fibrosis was taken as a tissue density measurement using a tissue tonometer.6-8 The Lymphedema Quality of Life (LYM-QOL) questionnaire was used to capture patient’s self-reported improvement in quality of life. 9

       

      Results

      In all subjects, both volume and tissue fibrosis were reduced. Two out of four subjects were recorded with at least a 5% reduction in volume and three out of four subjects recorded a 5% or greater tissue density improvement.

       

      Conclusion

      This study was limited by several variables. Such as, garments were chosen as best fit for patient by therapist and were not from same manufacturer or style across the subjects. Generally, these patients had previous lymphedema treatment and had nearly stable volumes, but significant fibrosis limiting their concordance with regimen. There are other tools, such as, an indurometer, which may allow more accurate measurement of fibrosis.

      The use of textured compression garments as part of a night time regimen reduced tissue fibrosis for patients with chronic edema. Patients in this study demonstrated improved concordance as evidenced by stable volume and reports of compliance, with improved quality of life in all subjects. Additional study is warranted to assess further impact on overall compliance and concordance in garment regimen with reduction in fibrosis of the limb.

      Further versions
    3. Poster

      THE USE OF NIGHT TIME GARMENTS FOR CHRONIC EDEMA MANAGEMENT IMPACTS PATIENTS' QUALITY OF LIFE AND EDEMA MANAGEMENT

      Poster presented at ILF 2019 13.06.2019 Chicago, USA

      Aim

      Successful management of chronic edema requires a commitment to compression bandaging, garments and/or use of alternative bandage wraps.1-2 Some patients require continuous compression day and night.1,3 The aim of this investigation was to assess the impact on volume control and patients’ quality of life (QOL) with the addition of a nighttime garment to their compression regiment.

       

      Methodology

      This observational study details four patients (n=4) medical history, subjective reports and objective measurements of limb volume and self-reported QOL before, during and after the addition of a nighttime garment to their compression regiment. Circumferential measurements were taken to track limb volume and The Lymphedema Quality of Life (LYM-QOL)4 questionnaire was used to capture patient’s self-reported improvement in quality of life. The assessment period was over a minimum of 6 weeks. Measurements were taken at three different intervals.

       

      Results

      It was observed that all subjects had an improvement in their self-reported quality of life (via LYM-QOL). Limb volume was stable in two out of four patients. Two out of four demonstrated further volume loss with the addition of nighttime product.

       

      Conclusion

      The addition of a nighttime compression device demonstrated positive change in self-reported QOL as well as better overall edema management. Patients who previously had struggled with long term edema management demonstrated improved edema control. Additional investigation is warranted to study impact of inclusion of a night time garment as part of the standard of care for those patients living with chronic edema.

      Further versions
    4. Poster

      REAL-WORLD WOUND DEBRIDEMENT: CLINICAL OUTCOMES AND USER SATISFACTION AFTER BIOFILM PATHWAY MANAGEMENT USING MONOFILAMENT FIBRE DEBRIDEMENT TECHNOLOGY* OVER 2 WEEKS

      Poster presented at EWMA 2019 05.06.2019 Gothenburg, Sweden

      Aim

      The study aimed to investigate clinical outcomes and clinicians’ and patients’ satisfaction with standard care delivered with debridement by monofilament fibre technology (MFDT) in chronic wounds with biofilm over 2 weeks.

       

      Method

      Chronic wounds were evaluated in a real-world setting. Biofilm-containing chronic wounds that had not improved with standard care, and required debridement and antimicrobial dressings were included. Any wound meeting the inclusion criteria was eligible. Wounds were managed over 2 weeks using a biofilm management pathway [Figure 1], including debridement with MFDT 3x in week 1 and twice in week 2, and the clinician’s choice of antimicrobial dressing. Care and outcomes were recorded in normal patient records. Clinicians completed a web-based survey to report clinical outcomes and clinician / patient satisfaction with the pathway. Outcomes were summarised descriptively.

       

      Results / Discussion

      706 clinicians participated and completed the survey. 83% had previously used MFDT. Venous ulcers (67.4%), pressure ulcers (10%), dehisced surgical wounds (1.7%), diabetic foot ulcers (7.4%) and other wounds (13.4%) were managed in the study [Figure 2]. Antimicrobial dressings included silver (34%), iodine (23%), honey (19%), PHMB (4%), other (14%) [Figure 3]. Secondary dressings included all-in-one dressing (11%), compression (32%), and unspecified secondary dressing (47%) [Figure 4]. 77% of clinicians reported a positive change in wound characteristics and clinical outcome after 2 weeks. Overall >73% of clinicians and patients were completely satisfied or satisfied with outcomes [Figure 5].

       

      Conclusion

      The biofilm pathway with MFDT supports positive outcomes in a high proportion of static chronic wounds and leads to high levels of clinician and patient satisfaction.

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    5. Poster

      EVOLUTION OF A NATIONALLY ADOPTED VENOUS LEG ULCER BEST PRACTICE TREATMENT PATHWAY TO REFLECT NEW EVIDENCE

      Poster presented at EWMA 2019 05.06.2019 Gothenburg, Sweden

      Aim:

      A National Best Practice Statement for the holistic management of venous leg ulcers¹ presents a treatment pathway, originally developed by Atkin and Tickle². The aim was to revise this treatment pathway to reflect new evidence³.

       

      Method:

      The treatment pathway was originally developed to reflect published RCT evidence for venous intervention reducing episodes of reoccurrence (ESCHAR trial)⁴ and with leg ulcer hosiery kits as first line as a result of the publication of the VenUS lV study⁵. The treatment pathway has been used since 2016 and needed further updating to reflect the recent evidence investigating the impact of early venous ablation in patients with venous leg ulcers (EVRA)⁶.

       

      Results / Discussion:

      In a group of 34 patients with leg ulceration the implementation of this pathway into everyday clinical practice has been shown after 3 months to deliver a number of benefits including increased healing rates, improved documentation and a reduction of nursing visits⁷;

       From 0% to 76% having their leg ulcer diagnosis recorded

       From 34% to 76% having their ABPI recorded

       From 13% to 83% use of compression therapy

       From 7% to 56% healing or signs of healing

       43% reduction in nursing visits

       

      Conclusion:

      It is vital to ensure that current research evidence is adopted within frontline services as soon as possible. Formalised evidence-based pathways provide a practical treatment guide and can help reduce unwanted variations, as standardising clinical processes through the use of a pathway is known to optimise the quality of treatments and improve patient satisfaction.

    6. Poster

      RAPID WOUND DEBRIDEMENT: CLINICAL OUTCOMES AND CLINICIAN SATISFACTION AFTER UP TO 2 APPLICATIONS OF MONOFILAMENT FIBRE DEBRIDEMENT TECHNOLOGY

      Poster presented at EWMA 2019 05.06.2019 Gothenburg, Sweden

      Aim

      To investigate clinical outcomes and clinicians’ and patients’ satisfaction with standard care delivered using 1 or 2 debridements by monofilament fibre technology (MFDT) [Figure 1] in chronic wounds.

       

      Method

      Chronic wounds were evaluated in a real-world setting. Chronic wounds or skin with visible debris and/or slough that required debridement were included. Any patient who met the inclusion criteria was eligible. Patients were managed according to local standard care and debridement was undertaken with MFDT once or twice. Care and outcomes were recorded in normal patient records. Clinicians completed a web-based survey to report clinical outcomes and clinician and patient satisfaction following debridement. Outcomes were summarised descriptively.

       

      Results / Discussion

      1,180 clinicians participated and completed the survey. 70% had previously used MFDT. Venous ulcers (LU: 63%), pressure ulcers (PU: 10%), dehisced surgical wounds (DW: 3%), diabetic foot ulcers (DFU: 8%) and other wounds (13%) were managed using MFDT in the evaluation [Figure 2]. Visible change was reported after one use of MFDT for all wound types ranging from 69% (DW) to 83% (other wounds). Visible change in wound characteristics was reported after two uses of MFDT in 91% of LU, PU, and other wounds, 93% of DFU and 95% of DW [Figure 3]. Overall, >80% of clinicians and patients who answered the survey question were completely satisfied or satisfied with outcomes [Figure 4].

       

      Conclusion

      Debridement of skin and wounds with 2 applications of MFDT leads to visible change in a high proportion of chronic wounds, and high levels of clinician and patient satisfaction.

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    7. Poster

      COMPREHENSIVE IN VITRO APPROACH FOR TESTING THE PERFORMANCE OF A HYDROACTIVE DRESSING (HAD) IN VITRO

      Poster presented at EWMA 2019 05.06.2019 Gothenburg, Sweden

      Introduction:

      Maceration is the elixation of the skin by prolonged exposure to moisture impeding healing due to failure of skin protection and possible microbial infections. Chronic wounds are often colonized by different kinds of microorganisms, mostly S.aureus and P.aeruginosa. Bacterial load on the wound surface perpetuates an inflammatory environment. It is of interest to elucidate dressing performance by comprehensive in vitro testing including binding capacity for elastase, determination of antibacterial activity, and assessment of fluid handling capability.

       

      Methods:

      A hydroactive dressing (HAD) consisting of cellulose/ethyl-sulfonate-cellulose fibres has been investigated. An in vitro maceration model was used to quantify and evaluate fluid uptake, fluid distribution, and shape changes. Binding capacity for elastase was determined over 24h. Determination of antimicrobial activity was performed according to JIS L 1902:2008 against S.aureus and P.aeruginosa.

       

      Results:

      HAD exhibited significantly higher fluid uptake than an alginate (AD) or a sodiumcarboxymethylcellulose dressing (SCD). It was shown that it possess a distinctly higher form stability. The SCD already macerated before the dressing was completely soaked while leakage with HAD and AD was only observed after they were completely gelled. HAD is further able to reduce the activity of elastase in vitro. And it exhibited a strong antibacterial activity against S.aureus and a significant antibacterial activity against P.aeruginosa.

       

      Conclusions:

      Performance of dressings can be assessed and compared under standard conditions in vitro. Here, HAD is able to reduce elastase activity, inhibit bacterial growth, and possess superior fluid handling capacity compared to AD and SCD.

      Further versions
    8. Poster

      Surgical treatment of extended Keloid scar with dermal substitute, negative pressure wound therapy and partial thickness skin graft: A case study

      Poster presented at EWMA 2019 05.06.2019 Gothenburg, Sweden

      Aim:

      We present the case of a young female patient, with sequela from 2nd and 3rd degree burn wounds on her legs and forearms bilaterally. Within 3 month after injury and conservative treatment, the patient developed extended keloids on the dorsal side of her left hand and forearm with functional impairment at the wrist and elbow.

       

      Method:

      After the excision of the scar lesion, the full thickness skin defect was reconstructed in stages. To reconstruct a sufficient dermal layer, we locally applied a dermal substitute, initially covered with a meshed silicone sheet. To adequately steady the matrix and avoid shear stress, we used the technique of NPWT in general and a very easily manageable sleeve-like dressing* in particular.

       

      Results:

      After complete healing of the graft, the patient is pain-free and no longer limited in her movements. At 1.5 years of follow-up there is no sign of recurrence for keloid.

       

      Conclusion:

      The excision of large surface keloids overpassing joints and the use of a dermal matrix associated with skin grafts is a useful technique for restoring full thickness skin defects, particularly on the extremities. NPWT is known to perfectly mold the grafts to the wound. Yet, its application using gauzes or cut out foams and several pieces of transparent and self-adhering film is often difficult and time-consuming. Accordingly, NPWT that can be sealed by overlaying a sleeve simplifies the process, lowers the number of manipulations and thus speeds up the execution time.

    9. Poster

      Der Stumpfcast des HGZ Bad Bevensen:Innovation in der Wundheilung zur frühen Behandlung von Unterschenkel-Amputationen

      Poster presented at DEWU 2019 08.05.2019 Bremen, Germany
    10. Poster

      Achieving healing in a young adult with a venous leg ulcer using a biofilm pathway and short stretch bandaging

      Poster presented at Wound Care Today 2019 27.02.2019 Milton Keynes, UK

      Introduction

      Liam is a 26 year old man who suffered a post trauma DVT when just 18 years old. He has Warfarin therapy and has a history of venous leg ulceration for 8 years. Because of the damage to his primary, deep veins he had developed a collateral venous circulation.

      Liam describes having a leg ulcer at a young age as “life changing”. It stopped him playing sport and swimming and it changed how he interacting with friends. Because of his damaged circulation and medication he lived with the constant fear that his leg was going to deteriorate or bleed. Despite this, Liam continued to work full time and support his family.

       

      Method

      In the summer of 2018, Liam’s nurse changes his treatment from a combination long-stretch cohesive bandage system, to a cohesive short stretch bandage system. She also implemented a Monofilament fibre biofilm based treatment regime to expedite wound bed preparation and disruption of the biofilm (Morris et al, 2016).

       

      Results

      There was a dramatic reduction in leg oedema and improvement in leg shape almost immediately the new bandage system was started. Things continued to improve over the following months. Liam reported that the cohesive short stretch bandage system made “his leg feels much more comfortable with less ridging and less slippage”. His leg shape was much better, and it was easier to wear socks and shoes. Liam said that nobody noticed he had a bandage on.

      In December 2018, after 8 years of ulceration, Liam’s venous leg ulcer healed.

       

      Conclusion

      This case study demonstrates how learning and implementing new knowledge, technology and skills can translate into improved patient outcomes. By sharing Liam’s story we can really understand the devastating effect a leg ulcer can have, especially on a teenager and young adult.

      Liam now has a bespoke plan for the prevention of future venous leg ulcers which will include higher compression during working periods when he will be on his feet for long periods. This is achieved by using short stretch wrap systems to encourage continued self-care and ownership of his long term condition.

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