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    1. Journal article

      Pre-emptive active drainage of reflux (PARD) in Ivor-Lewis oesophagectomy with negative pressure and simultaneous enteral nutrition using a double-lumen open-pore film drain (dOFD)

      Surgical endoscopy 2022

      BACKGROUND

      Postoperative reflux can compromise anastomotic healing after Ivor-Lewis oesophagectomy (ILE). We report on Pre-emptive Active Reflux Drainage (PARD) using a new double-lumen open-pore film drain (dOFD) with negative pressure to protect the anastomosis.

      METHODS

      To prepare a dOFD, the gastric channel of a triluminal tube (Freka®Trelumina, Fresenius) is coated with a double-layered open-pore film (Suprasorb®CNP drainage film, Lohmann & Rauscher) over 25 cm. The ventilation channel is blocked. The filmcoated segment is placed in the stomach and the intestinal feeding tube in the duodenum. Negative pressure is applied with an electronic vacuum pump (- 125 mmHg, continuous suction) to the gastric channel. Depending on the findings in the endoscopic control, PARD will either be continued or terminated.

      RESULTS

      PARD was used in 24 patients with ILE and started intraoperatively. Healing was observed in all the anastomoses. The median duration of PARD was 8 days (range 4-21). In 10 of 24 patients (40%) there were issues with anastomotic healing which we defined as "at-risk anastomosis". No additional endoscopic procedures or surgical revisions to the anastomoses were required.

      CONCLUSIONS

      PARD with dOFD contributes to the protection of anastomosis after ILE. Negative pressure applied to the dOFD (a nasogastric tube) enables enteral nutrition to be delivered simultaneously with permanent evacuation and decompression.

      PMID 34973079
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    2. Poster

      Multinational observational study on the performance, handling and safety of a new alginate wound dressing

      Poster presented at WoundsUK 2021 08.11.2021 Harrogate, UK

      Aim:

      Alginate dressings play an important role in modern wound care. Areas of application include exudate management, autolytic debridement and hemostasis. Users of the alginate dressings have high demands on performance, handling and safety. In order to meet these requirements, a new alginate wound dressing* was developed from a mixture of 80% alginate and 20% viscose. In the study presented, the wound dressing was tested for the properties described.

       

      Method:

      An observational study was carried out in clinical as well as outpatient settings at study centers in Germany, Austria and Poland. The users were asked to treat up to 8 patients with the new alginate according to the instructions for use. All patients were adults and suffered from highly exuding wounds which were either pressure injuries, arterial/venous ulcers, diabetic ulcers or postoperative wounds.

       

      Results / Discussion:

      The performance, measured in the parameters of time required for application and adaptation to the wound bed in dry and gelled conditions, was rated on average by users as good or very good/excellent on a 6-point Likert scale. More than 90% of the users stated that they could achieve their treatment goals, in particular exudate management, autolytic debridement and hemostasis. All handling parameters were also rated as good or very good on average. The alginate caused almost no maceration of the wound edge and was usually removed very easily in one piece.

       

      Conclusion:

      The alginate dressing met the performance, handling and safety requirements and was very positively received by users.

      Products Suprasorb A Pro
    3. Poster

      Application of an antimicrobial cellulose wound dressing on infected lower leg ulcers: 2 case studies

      Poster presented at WoundsUK 2021 08.11.2021 Harrogate, UK

      Introduction:

      The treatment of infected chronic wounds is a challenge in everyday clinical practice. In the treatment of these wounds polyhexanide (PHMB) is the antiseptic of choice [1]. Patients with difficult personal backgrounds further complicate the successful treatment of these wounds. Two case studies of infected chronic lower leg ulcers are presented. The treatment was carried out with an antimicrobial wound dressing made of cellulose containing PHMB*.

       

      Method:

      Patient 1: A 27-year-old male patient from the UK with an infected venous leg ulcer on the right lower leg that had been present for 11 months (size: 315 cm², depth: 0.1 cm). Moderate exudation, odour and pain of VAS=7 present. A deep vein thrombosis has recently occurred. In addition, the patient suffers from drug addiction (intravenous), alcohol addiction and mental disorder. The patient was previously treated with a hydrogel-impregnated antimicrobial wound pad and a medical-grade honey dressing. The new treatment consisted of cleaning with a monofilament fibre debridement pad**, the antimicrobial cellulose dressing, a sterile absorbent compress and a tubular dressing as a secondary dressing.

       

      Patient 2: An 80-year-old male patient from Germany with a mixed gaiter ulcer on the right lower leg (size: 450 cm², depth: 1 cm). Before the patient was admitted for treatment, he had already had several inpatient hospital stays. Therapy with a split-thickness skin graft was unsuccessful. The wound is infected with multidrug resistant gram-negative bacteria (MDRGN bacteria). The patient has had several antibiosis. The patient showed a constant incompliance with regard to the therapy attempts. Finally, a healing attempt with medicinal clay took place on the advice of his alternative (non-medical) practitioner. The patient was taken over with a massive infection, severe exudation and odour formation. Wound and lower leg pain correspondent to 8 on the Visual Analogue Scale (VAS). The entire lower leg was oedematous and papular indurations were present in the area of the forefoot. The wound was covered with biofilm and partially with fibrin. The wound edges and the surrounding skin were inflamed. Individual lesions were present. The patient's hygiene was poor. The weekly treatment was as follows: The wound was first cleaned with a wound irrigation solution containing sodium hypochlorite and a monofilament fibre debridement pad. The primary wound dressing was the cellulose dressing with PHMB. A highly absorbent wound compress*** and a superabsorbent wound dressing‡ served as a secondary dressing. In addition, the edema was treated with a compression bandage‡‡.

       

      Results:

      Patient 1: After 14 days and 5 dressing changes, the wound pain had decreased significantly (VAS = 1). The wound odour was gone. While the beginning granulation of the previously stagnant wound was particularly positive from the point of view of the user, the patient was particularly pleased that the wound odour had disappeared and that wound exudate no longer penetrated the dressing. The treatment was continued accordingly.

       

      Patient 2: After 3 weeks, not only had the wound pain (VAS = 6-7) decreased, but the wound odour and signs of infection had disappeared. Granulation tissue was visible. After 4 weeks, the wound pain (VAS = 5-6) decreased even more. Although the patient acknowledged the success of the therapy and the reduction in pain, he stopped the treatment on the advice of his alternative practitioner.

       

      Discussion:

      Although the two cases involved patients with longstanding chronic wounds and difficult personal backgrounds, the users were able to heal the wound within a short time with the help of the antimicrobial cellulose wound dressing and adequate modern wound care. For the two users, the rapid treatment success, in the form of the beginning healing, was gratifying. For the patients, it was primarily the pain reduction and the decrease in wound odour that were particularly well received. This is not surprising, as these two factors play a major role in the patient's quality of life.

       

      Conclusion:

      The antimicrobial wound dressing proved to be a suitable for the treatment of infected chronic wounds.

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    4. Poster

      Evaluation of different schort-stretch compression systems with zinc for stasis dermatitis

      Poster presented at EWMA 2021 26.10.2021 Virtual Conference

      Aim: Stasis dermatitis is a common inflammatory dermatosis of the lower extremities. The mainstay is treatment of the underlying chronic venous insufficiency (CVI) with multimodal therapy, which is aimed at reducing oedema and venous hypertension. External compression with short stretch bandages, impregnated with zinc oxide, is used as first line therapy simultaneously reducing swelling and employing anti-inflammatory effects of zinc. Our aim was to compare two different short-stretch systems with zinc oxide, both from the patients and staff point of view.

      Method: 10 patients with bilateral stasis dermatitis were included in the study. 2 patients had only CVI, while 8 patients had phlebolymphoedema. Both legs were treated simultaneously. Self-adherent two-layer bandaging system with zinc1 was applied on one leg and zinc paste bandage2 and adhesive short-stretch system3 was applied on the other leg for 7 days. A questionnaire with was filled out by the patients and the staff. Overall skin inflammation improvement was also assessed.

      Results: Both systems proved to be easy and fast to apply. There were no differences in slippage or compliance during wear. Patients had no difficulties with mobility and wearing footwear while using either compression systems. 90% of patients reported that self-adherent bandaging system was at least as comfortable to wear as adhesive bandage. The skin condition was equally improved with both systems.

      Conclusion: Both self-adherent and adhesive short-stretch systems with zinc proved to be suitable treatment of stasis dermatitis in patients with venous insufficiency and phlebolymphoedema.

      Products Varicex
      Downloads Citation (RIS)
    5. Poster

      Use of monofilament fibre debridement pad for hyperkeratosis in the community

      Poster presented at EWMA 2021 26.10.2021 Virtual Conference

      Aim:

      82 year old man with diabetes, congestive cardiac failure and mixed arterial vascular insufficiency had been treated in the home for diabetic health management and a chronic history of leg ulcers.

      Patient was suffering from hyperkeratosis and previous treatment was an elastic tubular bandage which was left on for 24 hours a day, 7 days a week.

      Method:

      A solution was required which would manage the hyperkeratosis, prevent further skin breakdown and prevent bacterial or fungal build up in the feet and legs. The solution had to be cost effective, gentle on skin and ensure quick, easy removal of excessive skin and debris.

      A monofilament fibre debridement pad* was used to clean, remove and descale the hyperkeratosis without damaging healthy skin.

      Results / Discussion:

      After initial treatment with monofilament fibre debridement pad, there was visible improvement and reduction in hyperkeratosis, no itch and reduction in odour.

      Once dead skin and hyperkeratosis was removed, patient was put on a structured skin care regime including cleansing, exfoliation and replenishing the skin barrier using emollients.

      Conclusion:

      Hyperkeratosis of the lower limb is a common skin condition that typically affects patients with chronic venous insufficiency. Patients are often embarrassed by the appearance of their skin, the hyperkeratotic scales and the unpleasant odour. The monofilament fibre debridement pad can be used by all healthcare professionals working in the community, and by patients. It’s effectiveness and ease of use may encourage patients or carers to take an active role in their care.

      Products Debrisoft Pad
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    6. Poster

      Treatment of hard to heal DFU with monofilament debridement lolly and hydrobalance dressing

      Poster presented at Wounds Australia National Conference 2021 04.05.2021 Virtual Conference, Australia

      Situation

      Intellectually disabled 54 year old man with diabetes, obesity and hypertension. The patient has peripheral neuropathy of feet and developed a diabetic foot ulcer. Surgical debridement was performed in OR and wound was initially treated with impregnated gauze ribbon changed twice daily and cleaned with PHMB solution.

       

      Action(s) taken/ treatment provided

      A review of treatment regime and dressings was conducted at 5 weeks post-operation due to deterioration of wound, odour and possibility of future amputation of foot. New treatment plan included cleansing and debridement with and monofilament fibre pad and use of biocellulose hydrobalance dressing dipped in PHMB solution to improve rate of healing.

       

      Outcome(s)

      After 9 days, wound was granulating with reduced level of exudate and odour. Total cost of dressings over 9 days of treatment was $114.51. Patient was able to be transferred to a rehabilitation facility and avoided amputation.

       

      Lesson(s) learned

      After 5 weeks using a wound dressing regime including gauze and time consuming twice-daily dressing changes, the wound had deteriorated, rather than progressed towards healing. The change of dressing plan resulted in granulation and wound progression in just 9 days. Dressings were cost effective and saved time as did not need to be changed so regularly.

    7. Poster

      First experience with new second generation ionic gel dressing: A spider bite gone wrong

      Poster presented at Wounds Australia National Conference 2021 04.05.2021 Virtual Conference, Australia

      Situation

      Patient presented to Hospital in the Home with large wound on the right leg which was suspected to have been caused by a spider bite. The patient was suffering from extreme pain, swelling and blistering.

       

      Action(s) taken/ treatment provided

      Wound needed debridement in the clinic to remove necrotic tissue and hardened slough. Due to the wound size and complexity, a combination of debridement methods were chosen, including mechanical with monofilament fibre pad, sharp and autolytic with ionic gel dressing. After full debridement was achieved, the wound bed was able to be thoroughly assessed and wound care plan put in place. Dressing regime included ongoing use of monofilament fibre pad for mechanical debridement and wound bed preparation and gel dressing for pain relief and dynamic fluid management.

       

      Outcome(s)

      The dressings were well tolerated and comfortable for the patient. Over the 4 months of treatment, the wound progressed towards healing and no surgical/specialist intervention or lengthy hospital stay was required.

       

      Lesson(s) learned

      Wounds with this level of complexity are often not expected to be treated in community settings. With introduction of new products onto the hospital formulary due to a new contract, new technologies were able to be used by the community nurse with successful patient outcomes. The products selected were cost effective, easy to use and reduced the need for antimicrobial dressings. Moving forward, products such as the new second generation ionic gel dressing can be used effectively in the community, reducing the need for specialist intervention.

    8. Poster

      Treatment of post-surgical toe wound with monofilament fibre pad and second generation ionic hydrogel dressing

      Poster presented at Wounds Australia National Conference 2021 04.05.2021 Virtual Conference, Australia

      Situation

      44 year old man with chronic history of gout in many joints. The patient had surgical intervention on right big toe due to infection of joint, pain and bone osteomyelitis.

      At 2 week post-surgery, the patient experienced delayed healing, pain and odour from the wound. On presentation, the wound had heavy thick slough, undermining of edges and slight hypergranulation at base of wound.

       

      Action(s) taken/treatment(s) provided

      Monofilament fibre lolly was used to clean wound bed, disrupt and remove biofilm and slough. Second generation hydrogel dressing then applied to wound bed for autolytic debridement and softening of slough. Pain relief was instant and patient no longer required oral pain medication. Biocellulose hydrobalance dressing was also applied at day 4 to improve and speed up epithelialisation process.

       

      Outcome(s)

      Patient and clinician happy with progress in first 7 days. The treatment and dressings reduced pain and allowed the patient to walk and wear his own shoes. Wound was fully healed after 26 days.

       

      Lesson(s) learned

      The use of monofilament fibre lolly combined with additional autolytic debridement with second generation ionic hydrogel dressing helped to prepare the wound bed and removed slough, debris and other barriers to healing. Further treatment with hydrogel dressing and hydrobalance dressing helped to create optimal conditions for wound healing.

    9. Poster

      Compression therapy using reusable short stretch bandaging for treatment of VLU

      Poster presented at Wounds Australia National Conference 2021 04.05.2021 Virtual Conference, Australia

      Situation

      Patient presented with bi-lateral leg ulceration and was being treated daily by a GP. Wounds had been present for the past 133 weeks and compression therapy was not part of the treatment regime.

       

      Action(s) taken/treatment provided

      Upon referral to the Nurse Navigator service at Princess Alexandra Hospital, routine vascular tests were carried out and he was deemed suitable for light compression therapy in addition to a wound care treatment plan, including wound bed preparation with monofilament fibre debridement pad. Compression bandaging is the gold standard treatment for those suffering from venous ulceration. The short-stretch bandage of choice delivers safe, light compression and is washable to help reduce the costs of ongoing treatment.

       

      Outcome(s)

      Wound healing progress was slow but consistent with the use of short stretch compression and the wound care treatment plan. Patient was adherent to care and found compression bandage to be comfortable, affordable, helped to reduce pain and improve quality of life. Leg ulcers fully healed after 32 weeks of treatment.

       

      Lesson(s) learned

      The Nurse Navigator supported patient care at GP practice to enable collaboration and education of those involved in ongoing care. This ensured a holistic approach to care allowing for systems improvement, patient centred care, improving patient outcomes and most importantly creating partnership between the GP practice and hospital.

    10. Poster

      Just in the Nick of T.I.M.E.S.: The importance of debridement for wound assessment

      Poster presented at Wounds Australia National Conference 2021 04.05.2021 Virtual Conference, Australia

      Situation

      Patient presented with a traumatic injury to left hand sustained while sailing. The wound was 3 weeks old and covered in hardened necrotic tissue.

       

      Action(s) taken/ treatment provided

      Upon advice from clinician, patient covered wound in plastic wrap overnight to soften and visited hospital the following morning. A monofilament fibre debridement lolly was used to mechanically debride outer necrotic eschar. An ionic hydrogel dressing was then applied for further autolytic debridement and deeper wound assessment. The dressing was removed after 24 hours and mechanically debrided again with monofilament fibre debridement lolly. After full wound assessment, decision was made to intervene surgically and patient received a skin graft within 24 hours.

       

      Outcome(s)

      After 3 months, the skin graft had healed and patient regained full use and movement of his hand.

       

      Lesson(s) learned

      The combination of mechanical and autolytic debridement using two simple, easy to use, community based products allowed for full assessment of the wound bed. The treating clinician was able to assess, dress, reassess and refer, resulting in a fast decision to send the patient for surgical intervention and improved overall clinical outcome.