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Aim:

At present many care professionals are under pressure for time. Therefore there is a need to avoid delays in wound treatment due to mismanagement or incorrect treatment of the wound. Correct assessment and diagnosis should be the starting point for follow on management to implement good patient care and cost efficient wound treatment. Good debridement enables visualisation and assessment.

Method:

In this centre more than 200 patients have been treated according to the same protocol, all starting with wound debridement using a monofilament fibre debridement pad for acute and chronic wounds. Most of the patients had chronic wounds of varying duration, severity and causes. The case studies follow 4 patients with ulcer to show the wound status before and immediately after debridement. Photographs were taken.

Results / Discussion:

Photographic evidence was a very easy way of documenting outcomes when the debridement pad had removed devitalised tissue and the skin and wound were revealed. In all patients the average number of pads were 2 and the average time for debridement was 2 – 4 minutes per episode. Some patients required additional treatment episodes depending on the condition. Appropriate treatment regimens were implemented as a result of good assessment.

Conclusion:

Even wounds that appear non-complex often require debridement to aid diagnosis. The use of a very easy method which can be performed by all care professionals helps to simplify wound treatment and save time.

Aim:

Time constraints and reimbursement for managing patients with chronic lymphedema present challenges for healthcare professionals. The case series demonstrates how a debridement device and a Velcro compression wrap were used to implement self-care as a solution.

Method:

20 patients with primary and secondary lymphedema were enrolled into the study. Following assessment of the patient’s condition and ability to understand and apply the treatment, each patient was educated and trained how to:

1. Use the monofilament fibre debridement pad for skin and wound preparation.

2. Apply the Velcro compression wrap system for treatment and maintenance.

3. Perform correct application and to record clinical improvements.

Time for each treatment episode, frequency of visits and overall treatment time were measured

Results / Discussion:

The number of treatment episodes reduced from 3 to 2 per week. The time for each episode reduced on average from 1 hour to 30 minutes. Improvements in the condition of each patient showed improvement in mobility, less independency, and leads to more time left for the patients. Additionally patients were able to participate in their care, giving them control.

Conclusion:

The use of simple solutions for self-care such as those used in this study could provide solutions to benefit the patient and healthcare professionals. Reductions in treatment times and the use of patients instead of a more costly therapist could equate to cost savings for the organisation.

Aim:

To investigate the synergistic use of monofilament debridement (MFD) in conjunction with three different types of common debridement methods -enzymatic (ED) conservative sharp debridement (CSD), and autolytic debridement (AD) in order to determine the reduction of devitalized tissue and improve overall effectiveness of wound management.

Method:

Three patients with recalcitrant wounds of similar condition were managed with the above mentioned debridement methods in outpatient clinics and skilled care settings. In this small study a monofilament debridement pad was introduced to improve overall effectiveness. The study period was four weeks with dressing changes three times per week. Following debridement, the wounds were covered with prescribed dressing and managed according to standard local practice. Percentage of necrotic tissue removal and wound size were measured prior to implementing the monofilament debridement with dressing changes and afterward to determine effectiveness of a synergistic approach to appropriate wound bed preparation. Photographs were taken.

Conclusion:

Use of the monofilament debridement device was found to work synergistically with all three types of debridement modalities to efficiently and effectively remove devitalized tissue safely and painlessly. There was noted reduction of devitalized tissue, which allowed for appropriate wound bed preparation and healing environment.

Aim:

Clinical nurses specialist - Tissue Viability Nurses (TVNs) are no exceptions to significant change and challlenges in terms of their role and scope of practice. The use of advanced treatment modalities such as Conservative sharp debridement (CSD) and Negative pressure wound therapy (NPWT) are amongst the skill they posses for the healing of complex wounds. Debridement in wound bed preparation is a well recognised concept to aid wound bed prepation in order to facilitate wound healing. This can be an intergral part in the management of complex infected surgical wounds where devitalised tissue is present prior to application NPWT. Sharp debridment over a vital organ is high risk, costly and can be life-threatening if done under aneasthetic. And CSD over bowel can equally be a high risk procedure and this will demand a surgeons skill for precision and safety. However, if left untreated this can impead wound healing and lead to other serious complications. Many TVNs are competent to perform CSD but the associated risk and complications of CSD over bowel cannot be ignored. This case study will look at the efficacy of the use of a Monofilament Fibre Lolly (MFL) by a TVN to debride devitalised tissue over bowel in a high risk patient.

Method:

Patient BH is a 46 year old lady who was admitted with a wound infection two weeks after a midline incisional hernia repair with application of mesh. She has asthma and was also diagnosed with alcoholic liver disease . On admission, she was septic and was treated with intravenous antibitiotic and she was taken to theatre for wound debridement. She went to theatre twice for repeat debridement of necrotic tissue causing significant bowel exposure at wound bed with some loose mesh. NPWT was used post-operatively by the surgical team to manage the wound. TVN input was sought to complete a wound assessment and for the re-application of NPWT due to patients compromised medical condition. And she was deemed unfit for anaesthetic. The use of the MFL was chosen as part of a product evaluation by the TVN. MLF was deemed to be atraumatic and has the ability to reach deep undermined areas to an open abdominal wound. It was moistened with 10mls of normal saline and was used to gently lift the devitalised tissue over the bowel using a circular motion with light pressure. Two MFL were used to cover all areas of the wound bed to effectively remove all devitalised tissue and reduce bacterial bioburden. NPWT was applied with careful consideration and protection applied over all exposed bowel.

Results / Discussion:

With the TVNs knowledge and competence in CSD the use of a new debridement tool such as MFL over bowel at the bedside was performed safely and in a timely fashion. MFL for debridement showed significant reduction of bacterial bioburden through removal of devitalised tissue and infected loose mesh with no complications such as bleeding and trauma that

are associated with other forms of debridement. 40% of slough/infected loose mesh were removed using the MFL and 60% were loosened and softened).

Conclusion:

This case study is an example of the increasing complexity of cases and ithe wound management faced by TVNs. With the availability of a new debridement tool such as the MFL, high risk patients not fit for anaesthetic are able to receive timely and safe wound bed preparation. The MFL was found to be less invasive compared to CSD and can be safely used over bowel.

Aim:

This abstract reports on a multi-centre, UK wide case series of a new monofilament fibre debridement (MFD) lolly in an acute and community setting for the management of cavity wounds and hard to reach areas.

Method:

Twelve UK Healthcare centres have produced 25 patient case studies. All of the clinicians involved utilised the same data collection form which included patient consent and images.

Results / Discussion:

Of the 25 patients 14 were male and 11 female with an average age of 70. Wound type was 11 surgical, 8 leg ulcers, 5 pressure ulcers and 1 hyperkeratosis. The MFD lolly was used once in 9 patients, twice for 6 patients and three times for 10

patients. In all 3 groups there was 100% reduction in devitilised tissue apart from 2 patients who had no devitilised tissue only signs of a biofilm. Pain was assessed using the VAS scale and 12 patients had a consistent score of 0. Average pain scores of 1-3 were obtained for 7 patients and a score of 4-6 for 4 patients. One patient was unable to communicate and one patients has an extensive painful ulcer score 9 and 10 but after MFD lolly this was 8. Free text comments reinforced this along with it being easy to use and handle.

Conclusion:

The new MFD lolly was shown to be very effective at removing devitilised tissue and biofilm, easy to use and handle and was either pain free or associated with low levels of pain.

Aim:

The efficacy of a wound dressing including effective exudate management and pain reduction, tolerability and user/patient satisfaction are the most important factors beside the treatment of the underlying disease. Therefore a clinical study with a new developed hydroactive wound dressing* was performed to evaluate the key factors of successful wound treatment in patients with chronic wounds.

Methods:

During an international, multicentre study data were collected regarding dressing performance (application, adaptability, shrinking, convenience, removability, improvement wound condition, wound edge protection, skin condition, exudate management) and rating of pain (VAS 0-10). Conclusion and general notes took place after an additional final visit.

Results:

64 patients (68 wounds: burns, leg ulcer, DFS, pressure ulcer, donor sites, other) existing since 0,5 – 31 months are included into the statistical evaluation. The wounds were superficial (77,4 %) and deep (22,6%) at the first visit. Infection was assessed in 18 % (n=12). Dressing performance (easiness of application, shrinkage of dressing, improvement of wound, wound edge, skin condition, uncomplicated use, reduction of maceration, would you use it again) was assessed in median with 1,51 (1=excellent, 2=very good). Regarding patient convenience (softness, non-adherence, removability in one piece), the hydroactive dressing was assessed in median with 1,74. Improvement of wound condition was confirmed in 95,2 %. Significant pain reduction was demonstrated (3,37 visit 1, 1,80 visit 4). Decrease of amount of exudate was also found (4,26 at visit 1, 2,85 at visit 4). The electronic evaluation (W.H.A.T.) showed a decrease of sloughy /necrotic tissue and an increase of granulation tissue. No safety-related reports have been served.

Conclusion:

The hydroactive dressing* showed clinical effectiveness and safety in a wide range of indications offering a noticeable facilitation in daily routine. Pain reduction and patient convenience leads to better quality of life and treatment satisfaction of the patient.

Introduction

Superabsorbent polymers based on polyacrylates have been used with great success in baby diapers and ladies’ hygiene products ever since the mid-1980s. They are also ideal for absorbing and retaining large amounts of liquids in wound dressings. The design of the marketed superabsorbent dressing was changed for a better ergonomic behavior, better application and due to another SAP core a higher absorption rate. The use of the new product on patients should be investigated during a case series.

Method

A case series was planned in 5 centers in Germany. The patients should be treated according to the instruction for use up to three weeks with the superabsorbent dressing. The products and a questionnaire with the parameters of interest as guidance for the investigators was provided. Documentation should be done every week. Thereafter the ergonomic behavior, performance and tolerability should be evaluated.

Results

Up to now 5 patients had been successfully treated (3 leg ulcer, 2 diabetic foot syndrome). In one patient suffering from diabetic foot syndrome with high exudation level, the wound shift was significant (start: 70% of fibrinous tissue and 30% of granulation tissue; after three weeks: 10% fibrinous tissue, 80 % granulation tissue and 10 % epithelization) indicating wound healing. Also the wound surrounding skin showed improvement. The patient was asked to assess the wound dressing revealing that the wound dressing was easy to apply, was comfortable, showed no pressure marks, and had a good absorption capacity. The user found that the dressing could be removed without damage of the wound ground. Exudation degree slightly decreased, no odour could be noticed and the dressing was easy to apply without causing folds. The second patient showed also improvement but did not show significant results due to lack of cooperation (did not wear off-loading shoes) after 3 weeks. Three patients suffering from leg ulcer were treated with the superabsorbent dressing as secondary dressing and a hydrofibre as primary dressing. All wounds showed reduced wound size and intact wound surrounding skin (also in one patient with atrophic skin) after three weeks of treatment. Dressing changes were performed once a day up three times a week.

Summary

The new designed superabsorbent dressing showed a good absorption capacity in high exuding wounds as leg ulcer and diabetic foot syndrome. In all cases the wound healing could be supported which could be confirmed by wound shift and reduced wound area. The patients found the dressing easy to apply, comfortable and had no complaints confirming the tolerability.

Introduction :

La détersion est une étape fondamentale dans l’induction du processus de cicatrisation(1). Dans le service cette étape est essentiellement réalisée à l’aide d’une curette ou d’un scalpel(2). Lors de notre consultation ces dernières posent souvent le problème de la tolérance par le patient, de la durée des soins, et de son efficacité selon l’opérateur.

Objectifs :

L’objectif de notre étude était d’évaluer l’intérêt d’une technologie fibreuse en pratique quotidienne de consultation de plaies chroniques.

Matériels et méthodes :

Cohorte constituée de 10 patients vus en consultations de suivi de plaies chroniques durant la période de septembre à octobre 2015. Chaque patient a bénéficié d’un débridement par Debrisoft® en remplacement du dispositif de détersion habituellement utilisé en consultation (curette métallique et scalpel). L’évaluation a été réalisée immédiatement à l’inclusion via une fiche de recueil comprenant : l’étiologie de la plaie ou de l’ulcère, la douleur avant, pendant et après les soins (Echelle Visuelle Analogique), le temps de débridement chronométré durant le soin et le ressenti du patient (Echelle de Likert de 1 à 5 en comparaison du dispositif de détersion habituel). Nous avons réalisé une photographie avant et après les soins.

Résultats :

Dix patients dont 6 femmes et 4 hommes ont été inclus durant une période de 3 semaines. Les soins ont tous été réalisés sans anesthésie ni antalgie, selon le protocole du service sans modification du pansement initialement prescrit (Hydrocellullaire, Alginate de Calcium ou Superobsorbant). La facilité, la qualité et la rapidité de débridement ont été appréciées par l’équipe soignante. Le temps moyen a été de 113 secondes par plaie. Le score de douleur est resté bas pendant la procédure (EVA moyennes = 2/3,3/2,5). Le ressenti du patient est globalement satisfaisant (Likert moyennes = 3,4).

Conclusion :

Cette technologie fournit une méthode rapide, facile et indolore de détersion. Le Debrisoft® a été jugé très utile par l’équipe soignante et nécessite un faible temps d’apprentissage. Ce dispositif de détersion a sans doute un intérêt dans la pratique des infirmières libérales et hospitalières qui prennent en charge des plaies chroniques. D’autres études avec un suivi prospectif doivent être effectuées pour confirmer ses effets bénéfiques sur la cicatrisation complète.