Our research and development teams operate at a global level and generate synergies from our collective expertise and by drawing on related disciplines. We are also constantly exchanging information at an international level with independent technical institutions, key opinion leaders and multipliers in order to be able to ensure cooperation and knowledge management of the highest order. As part of this process, we also conduct extensive research, the results of which we continually present in workshops, at conferences and symposiums - either in documentation or talks given by our cooperation partners - and also publish in renowned scientific journals. This database contains a large number of these evidence-based scientific articles, most of which have been evaluated by independent assessors:
Mechanical debridement of leg ulcers and the surrounding skin using a monofilament fibre debridement pad designed for larger wounds and surface areasPoster presented at Wounds UK 2019 04.11.2019 Harrogate, UK
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  monofilament fibre debridement pad* has been increased in size to tackle this issues. The handling has been improved  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.
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.
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.
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.
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.
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.
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.
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.
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
Surgical treatment of extended Keloid scar with dermal substitute, negative pressure wound therapy and partial thickness skin graft: A case studyPoster presented at Wounds UK 2019 04.11.2019 Harrogate, UK
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.  A positive correlation to skin pigmentation has been observed, meaning a higher prevalence in individuals with coloured skin.  Keloids are often associated – not only with cosmetic issues – but with functional impairment due to its contractional behavior.  Surgical excision of keloids alone has consistently shown poor results, as it generally results in high recurrence-rates of 40 to 100 percent.  Often therapy of keloid is multi-modal, combining local pressure, silicone sheeting, intralesional injection of cortisone and/or local radiotherapy. 
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. 
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.
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.
This type of dressing is therefore particularly interesting for extremities (including hand and foot) in a setting where repeated dressing changes are needed.Products Suprasorb CNP EasyDressFurther versions
REDUCED TISSUE FIBROSIS WITH ADDITION OF TEXTURED COMPRESSION GARMENTS TO EDEMA MANAGEMENT PROGRAMPoster presented at ILF 2019 13.06.2019 Chicago, USA
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.
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
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.
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.Further versions
Providing Therapeutic Compression Options: the key to better patient compliance and concordance with edema management regimentPoster presented at ILF 2019 13.06.2019 Chicago, USA
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.
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
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.
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.
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
THE USE OF NIGHT TIME GARMENTS FOR CHRONIC EDEMA MANAGEMENT IMPACTS PATIENTS' QUALITY OF LIFE AND EDEMA MANAGEMENTPoster presented at ILF 2019 13.06.2019 Chicago, USA
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.
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.
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.
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.Further versions
COMPREHENSIVE IN VITRO APPROACH FOR TESTING THE PERFORMANCE OF A HYDROACTIVE DRESSING (HAD) IN VITROPoster presented at EWMA 2019 05.06.2019 Gothenburg, Sweden
Maceration is the elixation of the skin by prolonged exposure to moisture impeding healing due to failure of skin protection and possible microbial infections. Chronic wounds are often colonized by different kinds of microorganisms, mostly S.aureus and P.aeruginosa. Bacterial load on the wound surface perpetuates an inflammatory environment. It is of interest to elucidate dressing performance by comprehensive in vitro testing including binding capacity for elastase, determination of antibacterial activity, and assessment of fluid handling capability.
A hydroactive dressing (HAD) consisting of cellulose/ethyl-sulfonate-cellulose fibres has been investigated. An in vitro maceration model was used to quantify and evaluate fluid uptake, fluid distribution, and shape changes. Binding capacity for elastase was determined over 24h. Determination of antimicrobial activity was performed according to JIS L 1902:2008 against S.aureus and P.aeruginosa.
HAD exhibited significantly higher fluid uptake than an alginate (AD) or a sodiumcarboxymethylcellulose dressing (SCD). It was shown that it possess a distinctly higher form stability. The SCD already macerated before the dressing was completely soaked while leakage with HAD and AD was only observed after they were completely gelled. HAD is further able to reduce the activity of elastase in vitro. And it exhibited a strong antibacterial activity against S.aureus and a significant antibacterial activity against P.aeruginosa.
Performance of dressings can be assessed and compared under standard conditions in vitro. Here, HAD is able to reduce elastase activity, inhibit bacterial growth, and possess superior fluid handling capacity compared to AD and SCD.Further versions
EVOLUTION OF A NATIONALLY ADOPTED VENOUS LEG ULCER BEST PRACTICE TREATMENT PATHWAY TO REFLECT NEW EVIDENCEPoster presented at EWMA 2019 05.06.2019 Gothenburg, Sweden
A National Best Practice Statement for the holistic management of venous leg ulcers¹ presents a treatment pathway, originally developed by Atkin and Tickle². The aim was to revise this treatment pathway to reflect new evidence³.
The treatment pathway was originally developed to reflect published RCT evidence for venous intervention reducing episodes of reoccurrence (ESCHAR trial)⁴ and with leg ulcer hosiery kits as first line as a result of the publication of the VenUS lV study⁵. The treatment pathway has been used since 2016 and needed further updating to reflect the recent evidence investigating the impact of early venous ablation in patients with venous leg ulcers (EVRA)⁶.
Results / Discussion:
In a group of 34 patients with leg ulceration the implementation of this pathway into everyday clinical practice has been shown after 3 months to deliver a number of benefits including increased healing rates, improved documentation and a reduction of nursing visits⁷;
From 0% to 76% having their leg ulcer diagnosis recorded
From 34% to 76% having their ABPI recorded
From 13% to 83% use of compression therapy
From 7% to 56% healing or signs of healing
43% reduction in nursing visits
It is vital to ensure that current research evidence is adopted within frontline services as soon as possible. Formalised evidence-based pathways provide a practical treatment guide and can help reduce unwanted variations, as standardising clinical processes through the use of a pathway is known to optimise the quality of treatments and improve patient satisfaction.
Der Stumpfcast des HGZ Bad Bevensen:Innovation in der Wundheilung zur frühen Behandlung von Unterschenkel-Amputationen