Recherche de publication

Introduction:

Not every debridement technique is effective, safe, cost-effective. In home care and in the first-level-hospital, adequate debridement could be a problem; Italian nurses use autolytic, enzymatic, mechanical methods, requiring several accesses. In a first-level-hospital, the surgical debridement may be difficult. A new method – polyester monofilament fibres debrider*- allows fast, almost painless, effective debridement in sloughy, fibrinous wounds and in peri-wound skin: we demonstrate that this debrider* is effective, safe, cost effective.

Methods:

27 patients (average age 76) with ulcers of various aetiology were treated.

This prospective documented group was compared with another group (25 patients, average age 78), retrospectively. The wounds were fibrinous, sloughy; periwound with keratosis, desiccated exudate or dressing; max area of wounds approx 60cm2. The costs at home includes: time, all materials.

Results:

The mean cost for single use were similar in both groups (mean: € 30,29 autolytic; € 35,54 debrider*), the results were different (best for debrider*). One use of the debrider gives a mean of 92% of debrided tissue, 2 uses of autolytic gives 38.4%. The autolytic requires 8-10 times to give the same results as the debrider*. Using the debrider* 1 time, the cost saving would be approx € 115 when compared with 5 times using autolytic. The costs for similar results are lower with the debrider*.

Conclusions:

This debrider* is a very fast, effective, safe method to debride wounds in the homecare / ambulant area; it cares the granulation, it helps to remove bacteria and is not expensive.

Aim:

A case study was conducted to look at clinical efficacy of a *monofilament debridement (DB) product and a polyhexanide (PHMB) containing **bio-cellulose dressing in a partial-thickness burn patient. Previous studies showed the **dressing to be effective in burns as well as in young children with lacerations. Especially the pain reducing properties are deemed attractive for use in painful partial-thickness burns.

Method:

Case ascertainment was used. Parameters were: Debridement efficacy, pain reduction (VAS, 10 point-scale), healing time and wound bed condition, comparing day 0 (start) versus day 14 (end), as well as, ease of dressing use. The 32 year-old male had a partial thickness scald on his left hand. At the first visit the blister roof was removed and debridement was performed. The burn was covered with a **bio-cellulose + PHMB dressing, which was left in situ until it came off by itself.

Results:

Healing time was 7 days. One debridement session was sufficient to obtain a clean wound bed. At day 0, VAS: 8, reduced to VAS: 2 immediately after dressing application. There were fewer dressing changes compared to previous regimes as the dressing could be left in place up to epithelialization. Ease of use for *DB and the **biocellulose dressing was rated excellent.

Conclusion:

The results indicate the *monofilament debridement product and the PHMB-containing **bio-cellulose dressing to be safe and effective in the treatment of a patient with a partial-thickness burn injury.

Introduction:

Fungating malignant ulcers develop when breast cancer penetrates the chest wall and skin. The aim of this case series was to provide and evaluate an ulcer treatment regime for three patients with fungating breast tumours.

Methods:

Case ascertainment was used. Patient 1: The 62-year old female had breast conserving surgery for a T1NO carcinoma in her right breast. She received radiotherapy (4272 cGy in 16 sessions) resulting in severe radiation dermatitis with wet and dry desquamation. Patient 2: The 49-year old female had lost 7 pounds over 6 months and had a painful hip for over a year. The X-ray showed lytic foci related to a fungating right breast tumour (T4cNO), which she had kept hidden for two years. Patient 3: 50-year old female with locally spreading breast cancer (T4aNO) on the left side for which she received chemotherapy.

Results:

All three patients received a *bio-cellulose dressing + PHMB for pain and odour reduction. An adhesive **superabsorbent pad was used as a secondary dressing. The dressing regime both reduced odour and pain and could be left in place for an average of two days. The dressings were easy to apply and to remove and in case of leakage could be handled by the patients themselves.

Conclusion:

Fungating breast cancer should be managed by a multidisciplinary team, with early intervention of a wound healing specialist. The *bio-cellulose dressing + PHMB was shown to reduce pain and odour effectively in the treated patients.