Vyhledávání publikace

Naše výzkumné a vývojové týmy pracují po celém světě a vytvářejí synergie z našich odborných znalostí a souvisejících odborných disciplín. Jsme v mezinárodním kontaktu s nezávislými odbornými institucemi, názorovými vůdci a multiplikátory, abychom tak mohli zajistit kooperativní a znalostní management na nejvyšší úrovni. V rámci toho provádíme rozsáhlé výzkumy, které jsou průběžně prezentovány na kongresech ve formě plakátů nebo přednášek našich spolupracujících partnerů a také na sympoziích a workshopech a publikovány v uznávaných odborných vědeckých časopisech. Odborné publikace, založené na důkazech a hodnocené většinou nezávislými znalci, jsou k dispozici v této databázi:

  1. Poster

    Establishment of a moist environment by a new foam dressing* beneficial for wound healing in vitro

    Poster presented at CICA 2020 26.01.2020 Paris, France

    Introduction

    Modern wound dressings are expected to maintain a humid wound milieu, which is thought to aid cell proliferation and migration resulting in faster and better wound healing. Foam dressings are thought to aid in the establishment of a beneficial moist wound environment as they exhibit excellent fluid management capacity by absorbing as well as donating fluid. Therefore, a scratch wound healing model using human fibroblasts and keratinocytes was developed depending on the donation of fluid by the applied dressings. The effect on cell proliferation and migration necessary for wound healing and epithelization was investigated for the new foam dressing (NFD)* and compared to cotton gauze as standard of care dressing (SOCD)**.

     

    Material & Methods

    Human dermal fibroblasts (DF) and human epidermal keratinocytes (HaCaT) were seeded into 6-well-plates and cultivated for 48h until confluence before scratching. Cell scratches cultivated in medium served as positive controls for optimal wound healing (figure 1). Samples of NFD (*Suprasorb® P sensitive, Lohmann&Rauscher) and SOCD (**cotton gauze, Fuhrmann) were cut aseptically (d = 3.5 cm), soaked in medium and applied directly on the cell scratches without further addition of medium supply. Cells were stained with hematoxylin/eosin after 1, 6, 24, and 48 hours. Scratches were photographed using a digital microscope (Keyence) and the scratch area was evaluated using the Image J program.

     

    Results

    Scratches covered with SOCD cotton gauze exhibited no tendency for healing (figures 2 and 3), which could be attributed to a distinct parching of the cells under the conditions of the scratch wound assay+. Accordingly, cells featured a roundish phenotype and cell confluence was partly lost with the scratches remaining open at the end of the experiment. In contrast, NFD supported the scratch healing in vitro by promoting keratinocyte (figure 2) and fibroblast (figure 3) proliferation and migration through establishing a moist wound environment. A slight tendency of the cells to adhere to the foam dressing, which provides a 3D matrix for the cells, could be observed featuring a possible explanation why scratch healing under the dressing samples was slower compared to the medium control.

     

    Conclusion

    A scratch wound healing model using human fibroblasts and keratinocytes depending on the donation of fluid by the applied dressings could be successfully developed. It can be used to assess the capacity of wound dressings for establishing a moist wound environment that is thought beneficial for healing. Here, it could be shown that the NFD is able to promote wound healing in vitro by effectively creating humid conditions favouring wound closure while the SOCD was not able to maintain the moist environment resulting in nonhealing cell scratch wounds in vitro.

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  2. Journal article

    Adjustable Compression Wraps are Non-Inferior to Custom-Made Flat Knit Compression Stockings in the Maintenance Phase of Complex Decongestive Therapy

    Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin 2020

    Background

    Evidence supports the use of adjustable compression wraps (ACW) in the intensive phase of complex decongestive therapy (CDT), whereas evidence of its use in the maintenance phase of oedema therapy is sparse.

     

    Methods

    Randomised controlled non-inferiority trial in the maintenance phase of oedema therapy (CDT phase II) of symmetric lymphostatic oedema of the lower leg. Oedema therapy was performed with ACW and custom-made flat knit compression stockings (FCS) as a reference therapy in parallel over 3 days in n = 30 subjects. The primary outcome was lower leg volume as measured with perometer. Safety of ACW self-application and the patient perspective were secondary outcomes.

     

    Results

    ACW is non-inferior to custom-made FCS in CDT phase II of lymphostatic lower leg oedema. The differences of volume effects lie within the apriori defined equivalence interval of ± 50 ml (p = 0.163; 95 %-CI [ − 38.2; + 6.8]). Self-administration of ACW has shown no relevant side effects. ACW are easier to put on and off, while wearing comfort is comparable.

     

    Conclusions

    ACW are an alternative therapy option in the maintenance phase of CDT. Self-application seems to be safe, subject to diligent instruction of patients. Patients with difficulties putting on and off compression stockings could benefit from the use of ACW. Patients with pronounced limb volume may need to wear shoes with bigger sizes when wearing ACW. Further research with a longer observation time is to follow.

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  3. Journal article

    A small scale quality improvement study trialling the use of a monofilament-fibre (Debrisoft®) debridement lolly on chronic ulcers

    Wounds UK 2020 16(1)

    Objective:

    A small-scale quality improvement study to determine the clinical effectiveness and patient satisfaction of the long-handled monofilament fibre (Debrisoft®) debriding lolly on foot ulcers that were considered to be slow healing in nature.

     

    Methods:

    This was a non-comparative, small-scale quality improvement study conducted on ulcers with slough (non-fibrous) at the ulcer base. The longhandled monofilament fibre (Debrisoft®) debriding lolly was used to treat seven patients during ulcer management, following the Trust's guidance for podiatric ulcer treatment.

     

    Results:

    Improvement was noted to the majority of ulcers within the second to third week and visible changes were evident, particularly in healing times and slough reduction. Both user and patient satisfaction were high.

     

    Conclusion:

    The long-handled monofilament fibre (Debrisoft®) debriding lolly provides an easy-to-use method of debriding foot ulcers. It allows easy access to difficult areas and enables the healing mechanism to commence. Patients verbally reported positive satisfaction when the long-handled monofilament fibre (Debrisoft®) debriding lolly was used.

    Products Debrisoft Lolly
  4. 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 Wounds UK 2019 04.11.2019 Harrogate, UK

    Introduction

    Keloids (keloid disorder and keloidal scars) develop at the site of a previous injury as a thick fibrous lesion as a result of aberrant wound healing that is characterized by ongoing, yet localized inflammation. Keloids result as the overgrowth of granulation tissue (collagen type 3) at the site of healed skin, which is then slowly replaced by collagen type 1. Keloids are benign lesions that usually are firm, rubbery and shiny. They can vary from pink to the patient’s skin color and be accompanied by severe itchiness and pain. Keloids can be distinguished from hypertrophic scars by their horizontal growth surpassing the original wound margins and their failure to resolve over time. [1,2] Keloid development rests on genetic and environmental factors, they tend to occur more frequently in female patients aged 10-30. [3] A positive correlation to skin pigmentation has been observed, meaning a higher prevalence in individuals with coloured skin. [2] Keloids are often associated – not only with cosmetic issues – but with functional impairment due to its contractional behavior. [4] Surgical excision of keloids alone has consistently shown poor results, as it generally results in high recurrence-rates of 40 to 100 percent. [3] Often therapy of keloid is multi-modal, combining local pressure, silicone sheeting, intralesional injection of cortisone and/or local radiotherapy. [4]

     

    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 (bilayer dermal matrix). 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. The dressing was changed approximately every 5-6 days and the arm was further immobilized with a removable splint. Once the three-dimensional dermal matrix showed a sufficient ingrowth of granulation tissue, the silicone layer was detached and a meshed partial thickness skin graft harvested with a dermatome from the ipsilateral thigh was applied. It was again temporarily sealed with a NPWT-device, in order to adequately steady the graft, accelerate its attachment to the dermal matrix and eliminate exudate. [5]

     

    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.

     

    Discussion

    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. Yet, adequate immobilization to avoid local shear stress is often difficult and cumbersome. 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 films is often difficult and time-consuming. Accordingly, NPWT (gauzes or foams) that can be sealed by overlaying a sleeve simplifies the process, lowers the number of manipulations and thus speeds up the execution time.

     

    Conclusion

    This type of dressing is therefore particularly interesting for extremities (including hand and foot) in a setting where repeated dressing changes are needed.

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  5. Poster

    Mechanical debridement of leg ulcers and the surrounding skin using a monofilament fibre debridement pad designed for larger wounds and surface areas

    Poster presented at Wounds UK 2019 04.11.2019 Harrogate, UK

    Introduction

    In the management of leg ulcers and hyperkeratosis of the surrounding skin, it is not uncommon for them to affect very large areas of the leg. The large size also leads to an increase in the level of exudate and the amount of devitalised tissue. As a result, a larger amount of material is needed to loosen and remove the devitalised tissue than is the case with smaller wounds. The size of the area of the wound that can be treated at the same time is limited by size of your debridement device. An already well established and proven [1] monofilament fibre debridement pad* has been increased in size to tackle this issues. The handling has been improved [2] by adding a mitten on the back side. To evaluate the performance of this debridement pad optimised for larger wounds and the surrounding skin, a small case series was performed.

     

    Method

    For the case series leg ulcers of various origins that needed debridement were treated once or over a longer period of time with the larger pad when indicated. The treatment was documented both photographically and in writing. The patients gave their written consent to the preparation of the case studies and the use of the image material.

     

    Results

    Case 1:

    A 64 year old female patient with mixed aitiology leg ulcers with a history of reoccurrence since 2000 and has been in our treatment since 2015. Over the least 5 years she has ulcers spreading to cover the entire gaiter area of both lower legs. The wounds were colonised regularly with bacteria/biofilm. The patient suffers from pain of 8-9 on the VAS scale especially at night but the debridement was well tolerated and biofilm removal effective.

     

    Case 2:

    A 83 year old female patient suffering from venous leg ulcers since August 2017 and has been in our treatment since April 2019. There were many small superficial ulcers and erosions with hyperkeratosis on the whole lower leg and a red inflammation of the wound surrounding area due to infection. After a few uses of the debridement pad most of the ulcers and erosion were healed.

     

    Case 3:

    A 70 year old male patient with venous leg ulcer on his left lower leg which has been present for 4 month and in our treatment since April 2019. Several ulcers had firmly adhering slough and necrotic tissue. After the debridement more granulation tissue became visible.

     

    Case 4:

    A 64 year old patient suffering from obesity associated leg ulcers. The ulcer on the left lower leg occurred in November 2017 as a result of a trauma from a fall and was extremely painful making wound dressing difficult. The debridement with the larger pad was well tolerated and efficient. Some additional surgical debridement was necessary.

     

    Case 5:

    A 70 year old male patient has been treated since July 2017 due to ulcers spreading to cover the entire gaiter area of both lower legs. The ulcers had almost healed leaving the wound surrounding skin covered with hyperkeratosis. Debridement with the larger pad was pain-free for the patient with some superficial bleeding because large, adhered pieces of the hyperkeratosis have been removed.

     

    Discussion

    Due to the increased size of the monofilament fibre debridement pad, large areas could be treated very efficiently. Most of the time one pad was sufficient, even for ulcers spreading to cover the entire gaiter area. For the treatment of smaller wounds or areas, smaller versions of the device are available and might be more efficient. The mitten on the back of the pad enables the user to easily use the whole surface of the debridement pad at the same time. As a result, a much larger area could be treated quicker than it would have been possible with a smaller device. In addition, the enlargement of the device is accompanied by an increase in the absorption capacity for exudate, slough and debris.

     

    Conclusion

    The larger monofilament fibre debridement pad is a useful addition to the existing smaller versions. Especially useful and effective for bigger wounds and areas.

    Products Debrisoft Pad
  6. Poster

    When you have End Stage Heart Failure, 85, your legs leak and you’ve had previous ulcers…. Help!‘

    Poster presented at Wounds UK 2019 04.11.2019 Harrogate, UK
  7. Poster

    Can monofilament fibre technology help in chronic wound overgranulation? A case study

    Poster presented at Wounds UK 2019 04.11.2019 Harrogate, UK
  8. 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
  9. 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.

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  10. 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.

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