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INTRUDUCTION

Biofilm, one of the main issues that prevent a chronic wound from healing, is a combination of bacterial and fungal cells, embedded in an extracellular matrix composed of hydrated polymers and debris [1]. Antibiotics are of limited use in biofilm-infected wounds, because biofilm can be polymicrobial [2] and the cells are many times more resistant to it [3]. Therefore the biofilm has to be physically disrupted and removed by debridement. This survey was designed to investigate on a 2 week wound management pathway, including the use of a monofilament fiber debridement pad (Debrisoft® - Lohmann & Rauscher) in combination with an antimicrobial dressing.

MATERIALS AND METHODS

The survey includes data of 706 professional users located in the UK. The users were asked to treat chronic non-healing wounds by following a 2-weeks wound management pathway including mechanical debridement and an antimicrobial treatment. Clinicians reported on the outcomes and the potential impact on the healing of chronic wounds. Even if the clinicians were asked to follow the wound management pathway, 21% of them were only using the debridement pad without the antimicrobial treatment. This analysis compares these two groups, showing the impact of mechanical debridement in combination with antimicrobial treatment compared to mechanical debridement alone.

RESULTS

454 (64%) of the users followed the 2-weeks wound management pathway (Group A). 147 (21%) used Debrisoft alone (Group B). 105 (15%) did not give that information. 76% of the treated wounds were static/non-healing and 9% were healing. 15% of the users did not give that information. 94% of all wounds in Group A showed a visible change after 2 weeks, but only 79% in Group B (p<0.0001). For static wounds only 94% of patients in Group A and 85% in Group B (p<0.001) showed improvement and for non-static wounds 97% and 52% respectively (p<0,0001). On a scale of 1 (completely satisfied) to 5 (dissatisfied) the overall clinical outcome was rated 1.543 in Group A and 1.617 in Group B. The healing progression and skin improvement was rated 1,657 in Group A and 1,807 in Group B. The patient satisfaction was rated 1.593 in Group A and 1.778 in Group B.

CONCLUSION

In conclusion the debridement with Debrisoft® shows its capability to put a biofilm-infected non-healing wound into the position to heal. By using mechanical debridement in combination with antimicrobial treatment by following the 2-weeks wound management pathway the positive effect is even more prominent.

Aim:

This study set out to examine the impact of a biofilm pathway in chronic static wounds.

Method:

A survey of 500 nurses who had been using a Biofilm treatment pathway combining a monofilament fibre pad and a topical antimicrobial on static wounds for a period of two weeks was undertaken to gather information on wound healing in those patients who received the new treatment pathway.

Results / Discussion:

A total of 142 nurses, out of 171 respondents, completed all questions in the survey. 82 % of the patients (n=156) had a leg ulcer. The average duration of the wounds was 6 months prior to the change in treatment (range 2-52 weeks). 12 patients had wounds for longer than one year, with one patient having her wound for 11 years. These patients were not included in

the statistical analysis. All wounds were reported as ‘static’ prior to implementing the change in treatment. A total of 66 (46%) wounds had healed following the change in treatment. 39 (58%) patients healed in 1 month or less, with 16 healed in 2 months and 11 taking more than 2 months to heal. A further 32 patients were recorded as having 50-75% healing since using the pathway, with 26 patients showing 25% healing.

Conclusion:

Although this data was non-comparative, it can be concluded that there is a positive effect from using a monofilament debridement pad in combination with antimicrobial dressings to remove and prevent biofilm build up in static wounds. This could result in significant cost savings to the health service and improved outcomes for patients with static chronic wounds.

Aim:

Traumatic implantation of pigmented particles in the skin require removal as quickly as possible to prevent deeper penetration and persisting skin tattoo. We present the case of a patient with accidental contamination during his work as a channel digger. A cushions were inflated under pressure. the cushion burst when the patient was just 1-2 metres away. Water and mud exploded within the channel and covered the face and hands of the patient. Dirt particles penetrated the skin, eyes and cornea.

Method:

The particles in the eyes and cornea were removed surgically and a systemic antibiotic therapy was started. Laboratory examination revealed a C-reactive protein of 49.3 mg/l (normal: <5 mg/l). Cheeks and periocular region showed remarkable oedema. After a rehydration of the skin with aliphatic ointments (0.4 mg/ml Polihexanid in Unguentum leniens) under semi-occlusive dressing over 4 hours, a mechanical debridement with a monofilament fibre debridement pad* was performed.

Results:

Almost all particles could be eliminated leaving superficial skin lesions - pain-free. Antiseptic ointment (Clioquinol 5 mg/g) was recommended for the further skin treatment. The systemic antibiotic therapy was also continued. A follow-up two days after the debridement showed a decrease of oedema and inflammation and a skin totally cleared from dirt particles.

Conclusion:

The immediate comparison with the use of moistened compresses showed a clear predominance of the monofilament pad in the efficiency of particle removal. Usual treatments with scalpel blade or dermabrasion are time-consuming and painful for the patients. By the use of a monofilament fibre debridement pad in an early stage of traumatic tattoo, a very satisfying cosmetic result could be achieved.