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BACKGROUND

The pressure exerted by a compression device on a part of the body corresponds to the dosage of the compression therapy. Therefore, the pressure course under compression materials should be investigated in different clinical situations.

MATERIAL AND METHODS

Pressure measurements were carried out under different compression materials in lying, standing and walking positions within the framework of training, self-experimentation and in patients with venous leg ulcers.

RESULTS

The results showed that the pressure varied considerably depending on the material used, the firmness of application, the local configuration (body position) and the time interval between applications. A loss of pressure occurred under each compression therapy, especially under inelastic short-stretch material, mainly due to movement and edema reduction. This pressure loss is decisive for the timing of dressing changes and a reason for the good tolerance of high-pressure levels in mobile patients.

CONCLUSION

Low pressures are particularly suitable for edema reduction. Hemodynamic effects require higher pressures (60-80 mmHg). For this purpose, inelastic materials are preferred which enable lower pressures when lying down (40-60 mmHg). As compression bandages are too loosely applied by many users, pressure indicators on bandages or adaptive bandages with templates are helpful to apply the material with the correct pressure. As a consequence of these findings it is postulated that, at least in studies comparing different compression media, pressure measurements should be carried out in the future, whereby the measuring point and body position should be documented.

Anastomoseninsuffizienz (AI) des Gastrointestinaltraktes sind schwerwiegende chirurgische Komplikationen in der Visceralchirurgie, die den Patienten durch eine deutlich erhöhte Morbidität und Mortalität gefärden. Der Erfolg des operativen Eingriffes ist eingeschränkt.

Background and study aims

Endoscopic negative pressure therapy (ENPT) is used to close transmural defects in the rectum and esophagus. Very few reports have described

ENPT to manage duodenal defects. This study was designed to demonstrate ENPT in a population of 11 patients with transmural duodenal leakages.

Patients and methods

The method of ENPT was adapted for duodenal use. Open-pore polyurethane-foam or a thin, open-pore double-layered film was wrapped around the distal end of a gastroduodenal tube. First, this open-pore element was placed on the inner wound in the duodenum with endoscopy. Second, continuous negative pressure of –125mmHg was applied with an electronic pump. Drains were changed after 2 to 7 days.

Results

Eleven patients were treated with duodenal leaks. Eight defects occurred after operative closure of perforated duodenal ulcers, papillectomy or stricturoplasty, one anastomotic leakage after Billroth – 1 distal gastric resection, one iatrogenic perforation in endoscopic retrograde cholangiopancreatography, and one by a surgical drain. Median duration of therapy was 11 days (range 7 – 24 days). Complete healing of defects was achieved in all patients.

Conclusion

ENPT is an innovative endoscopic alternative for treatment of transmural duodenal defects.

In the current first report, it is shown how a post-laryngectomy pharyngocutaneous fistula was successfully closed by endoscopic negative pressure therapy (ENPT; also termed endoscopic vacuum therapy, EVT). The duration of negative pressure treatment was 14 days. Up until now, ENPT has been used for treatment of transmural defects in the rectum and esophagus. The new endoscopic method can also be used in the ENT field for closure of pharyngocutaneous fistulas.

The cost that chronic wound care imposes on both patients and health services worldwide is well recognised. Most patients with venous leg ulcers require compression therapy over the long term, for both treatment as well as to prevent recurrence of these wounds. Caring for patients with chronic wounds makes up a large part of the workload for district and community nurses, and encouraging self-management among patients is a worthwhile effort to limit the costs and resources directed for this purpose. The present article describes the practical use of the ReadyWrap range of compression garments, which are available in various different styles, and aid patients, their families and carers in the self-management of venous leg ulcers. These products are designed with their long-term use in mind, and, as described in the case studies in this article, patients show good concordance to compression therapy involving ReadyWrap.

Introduction

This comparative clinical evaluation was conducted to compare a gel forming wound contact layer with the market leader wound contact layer with Safetac. Wound contact layers are a popular choice of wound dressing as they can be used through many stages of the wound healing process¹. There is however, a considerable difference in price depending on which type of wound contact layer you use.

Method

The comparative clinical evaluation was conducted in podiatry out patients clinics. One patient group used a gel forming wound contact layer and the other clinic continued to use their existing product, a wound contact layer with Safetac. All of the patients had undergone toe nail avulsion and the dressings were used post-procedure. Thirty eight patients were recruited in total, 20 in the gel forming wound contact layer group and 18 (four double procedures) in the wound contact layer with Safetac group. Data was collected on an evaluation form and measured the performance of the dressings, pain assessment on dressing removal, clinician satisfaction and patient satisfaction. It was also recorded if the user would recommend and continue to use the trial product.

Results

When evaluating the ease of application of the dressings, 100% of users in both groups said that the gel forming wound contact layer and wound contact layer with Safetac were either good or very good. When evaluating the conformability of the dressings, 100% of users in both groups said that the gel forming wound contact layer and wound contact layer with Safetac were either good or very good. When evaluating the draining of exudate through the dressings, 100% of users in both groups said that the gel forming wound contact layer and wound contact layer with Safetac was either good or very good. When evaluating patient comfort and softness of the dressings, 100% of the wound contact layer with Safetac group were either good or very good and 90% in the gel forming wound contact layer. When evaluating ease of removal of the dressings, 100% of the wound contact layer with Safetac group were either good or very good and 95% in the gel forming wound contact layer. Pain assessment was completed using a numerical scale where 0 was no pain and 10 was the worst ever. In the gel forming wound contact layer group, 95% scored 0 for pain on removal of the dressing and 93.75% scored 0 in the wound contact layer with Safetac. Clinician and patient satisfaction was measured using a numerical scale where 10 was the greatest satisfaction. In the wound contact layer with Safetac group, 100% scored 10 for both clinician and patient satisfaction. In the gel forming wound contact layer group, 95% scored 10 for both clinician and patient satisfaction. When users in the gel forming wound contact layer group were asked if they would recommend or continue to use the dressing, 100% said yes, they would.

Conclusion

This comparative clinical evaluation demonstrated that the more cost-effective gel forming wound contact layer performed very well when compared with the market leader, as a primary layer for the postoperative dressing, in the management of toe nail avulsions. The gel forming wound contact layer also offers other wound healing advantages as it contains a hydrocolloid, which has both wound and skin advantages².

Introduction

The management of chronic wounds in primary care has been under the spotlight for several years (Guest et al, 2015). For the patient, the biggest challenge is exudate. For the nurse, the biggest challenge is time, which can be indirectly affected by exudate management.

The main aim of this clinical evaluation was to see if exudate and the number of dressing changes could be influenced by changing the wound dressing to a new hydroactive fibre dressing* to the UK. Secondary aims were to evaluate the clinician and patient experiences using the new hydroactive fibre dressing.

Method

Ten patients were selected in a primary care wound clinic with moderate to high levels of exudate, suitable for a hydroactive fibre dressing. The mean age of the patients was 72 years and there were 9 leg ulcers and 1 diabetic foot ulcer. Seven of the patients had had their wounds for between 1 and 6 months and the other 3 for 1, 3 and 5 years. The wound bed was granulating in 4 patients and sloughy in 6 patients. The skin condition in 9 patients, despite the previous wound dressings used was macerated, excoriated and red/inflamed. Five patients had been using the UK market leading hydrofiber wound dressing** prior to the new hydroactive fibre dressing. The other 5 patients had been using an antimicrobial wound dressing. The hydroactive fibre dressing was evaluated over 4 dressing changes and data was collected on a data collection form by the lead author. Eight out of the 10 patients received compression therapy, 6 with a cohesive short stretch bandage***. Nine out of 10 patients had a standard superabsorbent secondary dressing.

Results

Seven out of the 10 patients benefited from a reduced number of dressing changes over the evaluation period, 3 of which were previously using the UK market leading hydrofiber wound dressing. This was probably due to exudate levels reducing in all 10 patients over the evaluation period when using a 0-10 scale where 10 was the highest exudate level.

Patient reported pain was measured using a 0-10 scale where 10 was the worst ever pain.

Seven patients benefited for a reduction in reported pain, some patients by as much as 67%. When evaluating the performance of the new hydroactive fibre dressing compared to the previously used dressing, 100% reported very good in ease of application, conformability, reduced dressing shrinkage, patient comfort from softness of gel, ease of removal in one piece and non-adherence. For wound condition and surrounding skin condition 90% reported good or very good. Using a 0-10 scale to evaluate clinician and patient satisfaction where 10 was the greatest satisfaction, 100% evaluated both patient and clinician satisfaction as either 8 or 9. On 9 out of 10 occasions, the author would recommend and/or use the new hydroactive fibre dressing again and on one there was no comment.

Conclusion

Whilst this is a small clinical evaluation, results demonstrate that the new hydroactive fibre wound dressing performed well when compared to the UK market leading hydrofiber dressing and antimicrobials in 10 patients with lower limb chronic wounds. Key findings were reduced exudate levels leading to reduced number of dressing changes, reduced patient reported pain during treatment and it was used successfully under compression therapy. The author and the patients were very satisfied during the evaluation period and patients commented on greater comfort, containment of exudate and improved quality of life due to better exudate management. The author commented that the UK market leading hydrofiber dressing ‘tends to adhere to the wound bed and proves difficult to remove whereas the new hydroactive fibre dressing came off with ease’.

Introduction

This clinical evaluation was conducted to validate the usage of a three step treatment plan for patients with highly exuding leg ulcers which included monofilament fibre pad, superabsorbent dressing and cohesive, short stretch bandages. The primary outcome measure was a reduction in the levels of exudate of patients with highly exuding leg ulcers with a simple three step approach. The secondary outcome measures were reduction in nurse visits, reduction in pain, reduction in materials cost, increase in patient quality of life.

Method

The trial design was a planned sample size of 10 patients over a 4 week period with a review at 2 weeks. The inclusion criteria was that all patients in the trial must have had a full holistic assessment with an Ankle Brachial Pressure Index (ABPI) of between 0.8 and 1.3. Patients must be willing to tolerate a full compression system and must be experiencing issues with ‘leaky legs’/ highly exuding leg ulcers. The exclusion criteria included non-concordant patients and patients with an ABPI of lower than 0.8 or higher than 1.3

Results

Three patients who had previously been in a reduced compression system became non concordant towards the end of the trial due to wanting to be more comfortable and although had significant improvements in wound healing which have been included in the results, could not be included in the cost analysis. One patient was hospitalised during the trial and therefore had to be removed from the analysis. Eight patients have had the leg ulcer for longer than 12 months and 90% of patients were in no compression or a reduced compression system. Regarding the Doppler assessment, 100% of patients had a doppler assessment and 90% of patients had a doppler reading between 0.8 - 1.3. Before the evaluation started, 5 patients had very high exudate and 5 patients had moderate exudate levels. Fifty percent of patients had had those levels of exudate for over 6 months and forty percent of patients for between 3-6 months. After the evaluation one patient was admitted to hospital for an unrelated reason and so couldn’t complete the trial. From the remaining 9 patients 7 had dramatically reduced exudate levels to low. When looking at the patient pain scores pre and post evaluation, 8 out of the 10 patients recorded a pain score pre evaluation and 6 post evaluation. All 6 patients reported a reduction in pain with an overall 45% reduction in pain. Reduction in wound size area was recorded in 9 cases and in all 9 cases there was a reduction in wound size of between 0.5cm and 5.5cm in dimensions. During the 4 week evaluation in 9 patients, there was a 58% reduction in nurse visits.The total number of nurse visits per week across 6 patients before the clinical evaluation was 24 and this reduced to 11 visits per week after the clinical evaluation. Across the same 6 patients there was a weekly product cost saving of £145. Before the clinical evaluation started 9 out of 10 patients stated that their leg ulcer affected the quality of their life. At the end of the 4 week evaluation, 7 out of 9 patients reported an improvement in their quality of life and expressed some thought provoking comments.

Discussion and conclusion

Many patients who have venous leg ulcers experience high levels of exudate and pain and this may lead the healthcare professional and patient to decide that implementing full, therapeutic compression is not possible. They may opt for ‘reduced compression therapy’ or ‘light bandaging’ thinking some compression is better than nothing. This evaluation clearly demonstrated in a small group of patients that by implementing a three step solution of effective wound bed preparation using a monofilament fibre pad, a high quality superabsorbent dressing and full, therapeutic compression has a dramatic effect on exudate levels and pain experienced by the patients. This leads to reduced nursing visits, reduced costs and ultimately, an improved patient experience and quality of life.

Aim:

NPWT has been advocated for virtually all kinds of acute and chronic wounds. Treatment is based on local negative pressure applied to the wound surface. NPWT is mainly carried out using open-cell polyurethane foams. It could be shown that cells show a significant tendency to grow into these foams which can be inhibited by application of drainage foil** without interfering with induction of cell migration. It is of interest to investigate if this combination is robust and workable with different vacuum pumps***.

Method:

Drainage foil** was placed on fibroblast 3D-cultures in combination with largepored PU foam*. Assemblies were positioned in Petri dishes and sealed with air-tight film after medium supply and vacuum pumps*** were connected. Experiments were carried out at -80mmHg and -120 mmHg for 48h. Cell viability and ingrowths of cells into samples was

determined.

Results / Discussion:

Combination of drainage foil** and PU foam* samples during NPWT with different vacuum pumps*** led to the same cellular responses in vitro. With the PU foam* alone, cells did not stop at the pellicle edge but continued to migrate into the

dressing. In contrast, placement of drainage foil** between collagen pellicle and PU foam* inhibited ingrowths of cells into the foam.

Conclusion:

It was shown that combination of drainage foil** with PU foam* for NPWT is workable with pumps from different manufacturers***. Ingrowths of cells into large-pored foams can be inhibited in vitro by application of drainage foil**. In vivo this may prevent disruption of newly formed tissue during dressing changes.