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    1. Poster

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

      Poster presented at EWMA 2020 18.11.2020 Virtual Conference

      Aim: 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 of NFD* and cotton gauze was investigated.

       

      Methods: Human dermal fibroblasts (DF) and human epidermal keratinocytes (HaCaT) were seeded into 6-well-plates and cultivated for 48h before scratching. NFD and gauze were cut aseptically (d=3.5cm), soaked in medium and applied directly on the cell scratches without further medium addition. Cells were stained with hematoxylin/eosin after 1, 6, 24, and 48h. Scratches were photographed using a digital microscope and evaluated using the Image J program.

       

      Results: It was found that NFD supported the scratch healing in vitro by promoting fibroblast and keratinocyte proliferation and migration through establishing a moist wound environment. Results were almost comparable to the medium control. In contrast, scratches covered with gauze remained open, probably due to the loss of moisture by drying of the wound dressing.

       

      Conclusions: It could be shown that NFD is able to promote wound healing by effectively creating humid conditions favouring wound closure while gauze was not able to maintain the moist environment resulting in non-healing cell scratch wounds in vitro.

       

      *NFD - Suprasorb® P sensitive (Lohmann&Rauscher)

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    2. Poster

      THE USE OF NIGHT TIME GARMENTS FOR CHRONIC EDEMA MANAGEMENT IMPACTS PATIENTS' QUALITY OF LIFE AND EDEMA MANAGEMENT

      Poster presented at WUWHS 2020 13.09.2020 Abu Dhabi, UAE

      Background and Aims

      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. To evaluate the performance of this debridement pad optimised for larger wounds and the surrounding skin, a small case series was performed.

       

      Methods

      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.

       

      Results

      Five patients between the ages of 64 and 83 were treated. All of them suffered from chronic ulcers covering a big area on their legs. At least some of the wounds were colonised with bacteria/biofilm. Two patients were suffering from hyperkeratosis, too. The debridement with the debridement pad was well tolerated by the patients. Biofilm as well as devitalised tissue were removed effectively. All wounds were healed or becoming better.

       

      Conclusions

      Most of the time one pad was sufficient, even for ulcers spreading to cover the entire gaiter area. A much larger area could be treated efficiently and 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.

      Further versions
    3. Poster

      REDUCED TISSUE FIBROSIS WITH ADDITION OF TEXTURED COMPRESSION GARMENTS TO EDEMA MANAGEMENT PROGRAM

      Poster presented at WUWHS 2020 13.09.2020 Abu Dhabi, UAE

      Background and Aims

      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. To evaluate the performance of this debridement pad optimised for larger wounds and the surrounding skin, a small case series was performed.

       

      Methods

      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.

       

      Results

      Five patients between the ages of 64 and 83 were treated. All of them suffered from chronic ulcers covering a big area on their legs. At least some of the wounds were colonised with bacteria/biofilm. Two patients were suffering from hyperkeratosis, too. The debridement with the debridement pad was well tolerated by the patients. Biofilm as well as devitalised tissue were removed effectively. All wounds were healed or becoming better.

       

      Conclusions

      Most of the time one pad was sufficient, even for ulcers spreading to cover the entire gaiter area. A much larger area could be treated efficiently and 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.

      Further versions
    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 WUWHS 2020 13.09.2020 Abu Dhabi, UAE

      Aim

      We present the case of a young female patient, with sequela from 2nd and 3rd degree burn wounds on her legs and forearms bilaterally. Within 3 month after injury and conservative treatment, the patient developed extended keloids on the dorsal side of her left hand and forearm with functional impairment at the wrist and elbow.

       

      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. 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.

       

      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.

       

      Conclusions

      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. 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 film is often difficult and time-consuming. Accordingly, NPWT that can be sealed by overlaying a sleeve simplifies the process, lowers the number of manipulations and thus speeds up the execution time.

       

      *Suprasorb CNP EasyDress - Lohmann & Rauscher

      Further versions
    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 WUWHS 2020 13.09.2020 Abu Dhabi, UAE

      Background and Aims

      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. To evaluate the performance of this debridement pad optimised for larger wounds and the surrounding skin, a small case series was performed.

       

      Methods

      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.

       

      Results

      Five patients between the ages of 64 and 83 were treated. All of them suffered from chronic ulcers covering a big area on their legs. At least some of the wounds were colonised with bacteria/biofilm. Two patients were suffering from hyperkeratosis, too. The debridement with the debridement pad was well tolerated by the patients. Biofilm as well as devitalised tissue were removed effectively. All wounds were healed or becoming better.

       

      Conclusions

      Most of the time one pad was sufficient, even for ulcers spreading to cover the entire gaiter area. A much larger area could be treated efficiently and 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.

      Products Debrisoft Pad
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    6. Poster

      Providing Compression Options: The Key to Better Compliance and Concordance

      Poster presented at ALA Virtual Conference 2020 28.05.2020 Hobart, Australia

      Aim:

      Compression remains the gold standard for long-term management of chronic edema. Reviews have shown that the benefits of compression diminish according to levels of non-adherence. Reasons commonly stated for nonadherence to compression include inconvenience, heat, cost, and pain. We hypothesize that offering compression options will have positive impact on patients’ compliance and concordance to compression regimens.

       

      Method:

      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 limb volume, range of motion (ROM), functional activity status using the Timed Up and Go(TUG), and assessment of quality of life (QOL) using the Lymphoedema QOL Tool (LYMQOL-LEG). 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.

       

      Results / 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.

       

      Conclusion:

      Offering multiple compression options including custom and ready-to-wear flat knit stockings*, an adjustable wrap ** and nighttime compression options*** had a positive impact on patients’ adherence 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.

      Products Rosidal TCS
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    7. Journal article

      Spezifischer biphasischer Druckaufbau unter nicht nachgiebigen Kompressionsverbänden beim intensiven Gehen

      Vasomed 2020 32(2) 5460

      Ziel

      110 Jahre nach Heinrich Fischers Veröffentlichung “Eine neue Therapie der Phlebitis” (7) möchten wir Daten aus unseren mobilen Grenzflächen-Druckmessungen unter nicht nachgiebigen Fischer-Verbänden veröffentlichen. Wir zeigen die biologisch physikalischen Gesetzmäßigkeiten auf, die über das Phänomen des biphasischen Druckaufbaus für die deutlich höheren Arbeitsdruckwerte unter nicht nachgiebigen Materialien im Vergleich zu nachgiebigen Kompressionsmedien beim schnellen und ausgedehnten Gehen verantwortlich sind.

       

      Methoden

      Wir verwendeten das von der Universitäts-Hautklinik Tübingen in Zusammenarbeit mit dem MIPM 1996 entwickelte Kompressionsdruck-Messsystem MCDI-1 (20) in der Spezialversion PIVI. Es arbeitet mit einem piezoresistiven Sensor. Darüber modellierten wir einen fixierten nicht nachgiebigen Unterschenkelkompressionsverband nach Heinrich Fischer (18). Die Gehstreckenlänge betrug 2 km, die Gehgeschwindigkeit 5,5 km/h. Die auf dem Handydisplay wiedergegebenen Einzelwerte wurden mit einer Digitalkamera gefilmt und danach zur Auswertung in Super-Slow-Motion ausgelesen. Dasselbe Verfahren durchlief ein Kompressionsstrumpf (KKl-2).

       

      Ergebnisse

      Bis zu einer Gehstreckendistanz von ca. 300 m liegen Fischer-Verband und Kompressionsstrumpf (KKl-2) mit intermittierenden Druckamplitudenspitzen von 80 mmHg gleichauf. Danach entwickelt sich die Phase 2 des biphasischen Druckanstiegs unter dem nicht elastischen Verband: Die Druckamplitudenspitzen steigen kontinuierlich weiter an, bis nach ca. 800 m ein Plateau mit einem durchschnittlichen Spitzendruck von 200 mmHg erreicht wird. Die Druckspitzendauer beträgt < 1/10 Sekunde.

       

      Schlussfolgerung

      3 Kraftquellen sind an der Druckgenese bei der Kompressionstherapie beteiligt: 1. der externe Anpressdruck des Kompressionsmediums, 2. die interne Kraft aus der Filament-Gleit-Schwellung der kontrahierenden Muskulatur, 3. die interne Kraft aus der zeitverzögert einsetzenden belastungsabhängigen vaskulär-metabolischen Pumpeffekt-Schwellung der Muskulatur. Sie ist verantwortlich für das spezifische Phänomen des biphasischen Druckanstiegs unter nicht nachgiebigen Kompressionsmedien. Der Anpressdruck (Anlagedruck) des Kompressionsmediums wirkt bei der nachgiebigen und nicht nachgiebigen Kompressionstherapie gleichermaßen. Die beiden internen Kraftquellen (Filament-Gleit-Schwellung und Pumpeffekt-Schwellung) summieren sich und entfalten nach Gehstrecken größer 800 m biphasisch eine Kraft, die je nach Steifheit des nicht nachgiebigen Materials im Binnenraum unter dem Verband (für < 1/10 sec.) vollständig in Druckkraft übergeht. Unter einer nachgiebigen Kompression verpufft diese Energie zum größten Teil in der Elastizität des textilen Materials. Beim flotten und ausgedehnten Gehen entwickeln sich deshalb (biphasisch) signifikant höhere Druckamplituden als unter elastischer Kompression. Als Resümee behält der alte phlebologische Leitsatz (15) “Therapie mit nicht nachgiebigen Verbänden und einem Laufprogramm, Halten des Ergebnisses mit Kompressionsstrümpfen” weiterhin seine berechtigte Gültigkeit.

       

      Schlüsselwörter

      Arbeitsdruck, Ruhedruck, Grenzflächen-Druckmessung, Biphasische Druckentwicklung, Filament-Gleit-Schwellung, Pumpeffekt-Schwellung, nicht nachgiebiger Kompressionsverband, nachgiebige textilelastische Kompression.

      Products Rosidal K, Varicex
    8. Journal article

      Sub-compression interface pressure measurements in vivo, comparing adjustable compression wraps and custom-made flat knit compression stockings

      Phlebologie 2020

      Background

      Adjustable Compression Wraps (ACW) are used as an alternative to flat-knitted compression stockings (CS) in the maintenance phase of complex decongestive therapy treating of lymphoedema.

       

      Methods

      Self-applied ACW and custom-made CS were compared using sub-compression interface pressure measurements in vivo. Measurements were recorded using manometer-based Picopress®-devices in a sample of n = 30 probands with bilateral symmetric lymphostatic lower leg oedema. Legs were randomised to CS side and ACW side. Following standardised instruction and initial pressure measurements for both systems, ACW pressure measurements were repeated after 2 and 4 hours. Static Stiffness Index and pressure gradients between measuring points B1-C were calculated.

       

      Results

      ACW showed resting pressures and SSI in therapeutic ranges and significantly higher than CS (p < 0.01; p < 0.001). ACW reached significantly higher working pressures (p < 0.001). Resting pressure sub-ACW did not show significant pressure drops after 2 and 4 hours, without re-adjusting. Average pressure gradients between ACW and CS did not differ significantly.

       

      Discussion

      The pressure values reached with ACW underline their therapeutic effects. Pressures under self-applied ACW are relatively stable, even without re-adjusting. Self-application is interpreted as effective. A thorough instruction of patients is essential.

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    9. Journal article

      Compression hosiery for venous disorders and oedema: a question of balance

      British journal of community nursing 2020 25(9) 2632

      Compression therapy for venous and lymphatic conditions may be delivered via a range of treatment modalities using many different technologies, depending on the patient's condition and needs. Clinical decision-making relies on accurate assessment of the patient, their presenting and underlying clinical condition, skill and training of the applier and the available resources. However, changes in the patient's condition or lifestyle may necessitate re-evaluation of the treatment pathway. Generally, compression bandages and Velcro wraps are used in the intensive acute phase of treatment, with self-management using compression hosiery or wraps being used for long-term maintenance to prevent recurrence. Although guidelines recommend the highest class of compression hosiery for maximum effectiveness, clinical evidence shows practical challenges associated with application and tolerance of higher pressures and stiffness. An audit of a new type of compression garment was conducted, and it showed that incorporating stiffness into circular knitted hosiery helped overcome some of these challenges with improvements in limb size, skin softening and wound size. Additionally, self-management was facilitated by the ease of donning and doffing.

      PMID 32886551
    10. 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