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BACKGROUND

Adjustable compression wraps (ACWs) may represent the future of compression for the treatment of the most severe stages of chronic venous diseases and lymphedema. We tested in five healthy subjects: Coolflex® from Sigvaris®; Juzo wrap 6000®, Readywrap® from Lohmann Rauscher®; Juxtafit® and Juxtalite® from Medi®, Compreflex® from Sigvaris®. The objective of this pilot study was to study the stretch, interface pressures, and Static Stiffness Index (SSI) of the six ACWs applied to the leg.

METHODS

The stretch was evaluated by stretching the ACWs to their maximum length. Interface pressure measurements were performed using a PicoPress® transducer and a probe placed at point B1. Interface pressures were measured in the supine resting position and in the standing position. We calculated the SSI. We started the measurements at 20 mmHg in the supine position and increased the pressures by 5 mmHg to 5 mmHg.

RESULTS

Coolflex® (inelastic ACW) cannot exceed a maximum pressure of 30 mmHg at rest with a maximum SSI of approximately 30 mmHg. Juzo wrap 6000® (a 50% stretch) and Readywrap® (a 60% stretch) have a profile of stiffness very near one to the other. The optimal stiffness for Juzo is from 16 mmHg to of 30 mmHg for a resting pressure between 25 mmHg and 40 mmHg. For Readywrap, the optimal stiffness is from 17 mmHg to 30 mmHg with a maximum SSI of 35mmHg. The optimal application zone of this wrap at rest is 30 to 45 mmHg. Juxtafit®, Juxtalite® and Compreflex® (respectively 70%, 80%, 124% stretch) can be applied with pressures above 60 mmHg but with maximum SSI of 20 mmHg for Circaid® and>30 mmHg for Compreflex®.

CONCLUSIONS

This pilot study allows us to propose a classification of wraps according to their stretch: inelastic ACW and short or long stretch ACW (50-60% and 70%, 80%, and 124% stretch). Their stretch and stiffness could help to better determine what could be expected of ACWs in clinical practice.

Aim:

We report on the case of a 14-year-old girl with extensive soft tissue defects on the right lower extremity up to the right hip following a traffic accident. The patient suffered a subtotal amputation of the right lower extremity with a rupture of the external iliac artery and the iliac vein.

Method:

After CTA, the pulseless, ischemic leg was treated with autologous arterial und venous vascular graft. Perfusion resumed 4 hours post-accident. Osteosynthesis was carried out using an external fixator. Despite fasciotomy, extensive soft tissue necrosis occurred on the right lower extremity. Due to pre-terminal multiple organ failure caused by SIRS, a large-area necrosectomy was performed and NPWT started. The occlusive dressing was applied to the entire right lower extremity including the anogenital area up to the iliac crest using a tubular bandage*.

Results / Discussion:

This method allowed for sufficient negative pressure on the entire hip area and the entire right lower extremity. Septic condition improved immediately. After stimulating wound granulation, the secondary, serial split skin coverage of the defects was possible.

Conclusion:

In the case of extensive soft tissue defects on the lower extremity with deep substance defects in the area of the hip and simultaneous external fixation on the pelvic ring as well as cystofix and colostoma creation, the establishment of an NPWT system typically is difficult and time-consuming. With the tubular bandage it was possible to use a reliable, reproducible, time-saving occlusive and elastic system for the NPWT.

Aim:

Alginate dressings play an important role in modern wound care. Areas of application include exudate management, autolytic debridement and hemostasis. Users of the alginate dressings have high demands on performance, handling and safety. In order to meet these requirements, a new alginate wound dressing* was developed from a mixture of 80% alginate and 20% viscose. In the study presented, the wound dressing was tested for the properties described.

Method:

An observational study was carried out in clinical as well as outpatient settings at study centers in Germany, Austria and Poland. The users were asked to treat up to 8 patients with the new alginate according to the instructions for use. All patients were adults and suffered from highly exuding wounds which were either pressure injuries, arterial/venous ulcers, diabetic ulcers or postoperative wounds.

Results / Discussion:

The performance, measured in the parameters of time required for application and adaptation to the wound bed in dry and gelled conditions, was rated on average by users as good or very good/excellent on a 6-point Likert scale. More than 90% of the users stated that they could achieve their treatment goals, in particular exudate management, autolytic debridement and hemostasis. All handling parameters were also rated as good or very good on average. The alginate caused almost no maceration of the wound edge and was usually removed very easily in one piece.

Conclusion:

The alginate dressing met the performance, handling and safety requirements and was very positively received by users.

Introduction:

The treatment of infected chronic wounds is a challenge in everyday clinical practice. In the treatment of these wounds polyhexanide (PHMB) is the antiseptic of choice [1]. Patients with difficult personal backgrounds further complicate the successful treatment of these wounds. Two case studies of infected chronic lower leg ulcers are presented. The treatment was carried out with an antimicrobial wound dressing made of cellulose containing PHMB*.

Method:

Patient 1: A 27-year-old male patient from the UK with an infected venous leg ulcer on the right lower leg that had been present for 11 months (size: 315 cm², depth: 0.1 cm). Moderate exudation, odour and pain of VAS=7 present. A deep vein thrombosis has recently occurred. In addition, the patient suffers from drug addiction (intravenous), alcohol addiction and mental disorder. The patient was previously treated with a hydrogel-impregnated antimicrobial wound pad and a medical-grade honey dressing. The new treatment consisted of cleaning with a monofilament fibre debridement pad**, the antimicrobial cellulose dressing, a sterile absorbent compress and a tubular dressing as a secondary dressing.

Patient 2: An 80-year-old male patient from Germany with a mixed gaiter ulcer on the right lower leg (size: 450 cm², depth: 1 cm). Before the patient was admitted for treatment, he had already had several inpatient hospital stays. Therapy with a split-thickness skin graft was unsuccessful. The wound is infected with multidrug resistant gram-negative bacteria (MDRGN bacteria). The patient has had several antibiosis. The patient showed a constant incompliance with regard to the therapy attempts. Finally, a healing attempt with medicinal clay took place on the advice of his alternative (non-medical) practitioner. The patient was taken over with a massive infection, severe exudation and odour formation. Wound and lower leg pain correspondent to 8 on the Visual Analogue Scale (VAS). The entire lower leg was oedematous and papular indurations were present in the area of the forefoot. The wound was covered with biofilm and partially with fibrin. The wound edges and the surrounding skin were inflamed. Individual lesions were present. The patient's hygiene was poor. The weekly treatment was as follows: The wound was first cleaned with a wound irrigation solution containing sodium hypochlorite and a monofilament fibre debridement pad. The primary wound dressing was the cellulose dressing with PHMB. A highly absorbent wound compress*** and a superabsorbent wound dressing‡ served as a secondary dressing. In addition, the edema was treated with a compression bandage‡‡.

Results:

Patient 1: After 14 days and 5 dressing changes, the wound pain had decreased significantly (VAS = 1). The wound odour was gone. While the beginning granulation of the previously stagnant wound was particularly positive from the point of view of the user, the patient was particularly pleased that the wound odour had disappeared and that wound exudate no longer penetrated the dressing. The treatment was continued accordingly.

Patient 2: After 3 weeks, not only had the wound pain (VAS = 6-7) decreased, but the wound odour and signs of infection had disappeared. Granulation tissue was visible. After 4 weeks, the wound pain (VAS = 5-6) decreased even more. Although the patient acknowledged the success of the therapy and the reduction in pain, he stopped the treatment on the advice of his alternative practitioner.

Discussion:

Although the two cases involved patients with longstanding chronic wounds and difficult personal backgrounds, the users were able to heal the wound within a short time with the help of the antimicrobial cellulose wound dressing and adequate modern wound care. For the two users, the rapid treatment success, in the form of the beginning healing, was gratifying. For the patients, it was primarily the pain reduction and the decrease in wound odour that were particularly well received. This is not surprising, as these two factors play a major role in the patient's quality of life.

Conclusion:

The antimicrobial wound dressing proved to be a suitable for the treatment of infected chronic wounds.

Aim:

82 year old man with diabetes, congestive cardiac failure and mixed arterial vascular insufficiency had been treated in the home for diabetic health management and a chronic history of leg ulcers.

Patient was suffering from hyperkeratosis and previous treatment was an elastic tubular bandage which was left on for 24 hours a day, 7 days a week.

Method:

A solution was required which would manage the hyperkeratosis, prevent further skin breakdown and prevent bacterial or fungal build up in the feet and legs. The solution had to be cost effective, gentle on skin and ensure quick, easy removal of excessive skin and debris.

A monofilament fibre debridement pad* was used to clean, remove and descale the hyperkeratosis without damaging healthy skin.

Results / Discussion:

After initial treatment with monofilament fibre debridement pad, there was visible improvement and reduction in hyperkeratosis, no itch and reduction in odour.

Once dead skin and hyperkeratosis was removed, patient was put on a structured skin care regime including cleansing, exfoliation and replenishing the skin barrier using emollients.

Conclusion:

Hyperkeratosis of the lower limb is a common skin condition that typically affects patients with chronic venous insufficiency. Patients are often embarrassed by the appearance of their skin, the hyperkeratotic scales and the unpleasant odour. The monofilament fibre debridement pad can be used by all healthcare professionals working in the community, and by patients. It’s effectiveness and ease of use may encourage patients or carers to take an active role in their care.

Aim: Stasis dermatitis is a common inflammatory dermatosis of the lower extremities. The mainstay is treatment of the underlying chronic venous insufficiency (CVI) with multimodal therapy, which is aimed at reducing oedema and venous hypertension. External compression with short stretch bandages, impregnated with zinc oxide, is used as first line therapy simultaneously reducing swelling and employing anti-inflammatory effects of zinc. Our aim was to compare two different short-stretch systems with zinc oxide, both from the patients and staff point of view.

Method: 10 patients with bilateral stasis dermatitis were included in the study. 2 patients had only CVI, while 8 patients had phlebolymphoedema. Both legs were treated simultaneously. Self-adherent two-layer bandaging system with zinc1 was applied on one leg and zinc paste bandage2 and adhesive short-stretch system3 was applied on the other leg for 7 days. A questionnaire with was filled out by the patients and the staff. Overall skin inflammation improvement was also assessed.

Results: Both systems proved to be easy and fast to apply. There were no differences in slippage or compliance during wear. Patients had no difficulties with mobility and wearing footwear while using either compression systems. 90% of patients reported that self-adherent bandaging system was at least as comfortable to wear as adhesive bandage. The skin condition was equally improved with both systems.

Conclusion: Both self-adherent and adhesive short-stretch systems with zinc proved to be suitable treatment of stasis dermatitis in patients with venous insufficiency and phlebolymphoedema.

Situation

Patient presented with bi-lateral leg ulceration and was being treated daily by a GP. Wounds had been present for the past 133 weeks and compression therapy was not part of the treatment regime.

Action(s) taken/treatment provided

Upon referral to the Nurse Navigator service at Princess Alexandra Hospital, routine vascular tests were carried out and he was deemed suitable for light compression therapy in addition to a wound care treatment plan, including wound bed preparation with monofilament fibre debridement pad. Compression bandaging is the gold standard treatment for those suffering from venous ulceration. The short-stretch bandage of choice delivers safe, light compression and is washable to help reduce the costs of ongoing treatment.

Outcome(s)

Wound healing progress was slow but consistent with the use of short stretch compression and the wound care treatment plan. Patient was adherent to care and found compression bandage to be comfortable, affordable, helped to reduce pain and improve quality of life. Leg ulcers fully healed after 32 weeks of treatment.

Lesson(s) learned

The Nurse Navigator supported patient care at GP practice to enable collaboration and education of those involved in ongoing care. This ensured a holistic approach to care allowing for systems improvement, patient centred care, improving patient outcomes and most importantly creating partnership between the GP practice and hospital.

Situation

Patient is a 73 year old lady who has been suffering with venous leg ulcers since 2016. On presentation, she had leg ulcers measuring more than 50cm2 which were very painful with high levels of exudate.

Action(s) taken/ treatment provided

Compression therapy was initially commenced with a long stretch compression bandage. This was changed to a 2 layer resuable short stretch system due to ease of use and patient comfort. This was a cost effective option as patient was able to wash, re-roll and reuse the bandages throughout her treatment from September 2019 to February 2020. The bandages were skin friendly and comfortable for the patient who is prone to dermatitis. The wounds were managed with alternate combinations of ionic gel dressing for pain relief, cadexomer iodine, antimicrobial dressings and biocellulose hydrobalance dressings.

Outcome(s)

In the first 4 weeks, the ulcers had reduced in size by 50% and after 6 months of treatment the wounds had fully closed.

Lesson(s) learned

In the absence of corrective surgery, compression therapy has been found to be the most effective treatment for venous leg ulcers (VLUs)1. Achieving healing rests on patients’ adherence to treatment and in this case it was found that compression bandages which are both cost effective and comfortable for the patient are more likely to encourage patient concordance. Compression therapy alongside effective wound care resulted in full healing for this patient after 4 years of suffering with venous leg ulcers.

Background and Aims

To investigate clinical outcomes and clinicians’ and patients’ satisfaction with standard care delivered using 1 or 2 debridements by monofilament fibre technology (MFDT) in chronic wounds.

Methods

Chronic wounds were evaluated in a real-world setting. Chronic wounds or skin with visible debris and/or slough that required debridement were included. Any patient who met the inclusion criteria was eligible. Patients were managed according to local standard care and debridement was undertaken with MFDT once or twice. Care and outcomes were recorded in normal patient records. Clinicians completed a web-based survey to report clinical outcomes and clinician and patient satisfaction following debridement. Outcomes were summarised descriptively.

Results

1,180 clinicians participated and completed the survey. 70% had previously used MFDT. Venous ulcers (LU: 63%), pressure ulcers (PU: 10%), dehisced surgical wounds (DW: 3%), diabetic foot ulcers (DFU: 8%) and other wounds (13%) were managed using MFDT in the evaluation. Visible change was reported after one use of MFDT for all wound types ranging from 69% (DW) to 83% (other wounds). Visible change in wound characteristics was reported after two uses of MFDT in 91% of LU, PU, and other wounds, 93% of DFU and 95% of DW. Overall, >63% of clinicians and patients who answered the survey question were completely satisfied or satisfied with outcomes.

Conclusions

Debridement of skin and wounds with 2 applications of MFDT leads to visible change in a high proportion of chronic wounds, and high levels of clinician and patient satisfaction.

*Debrisoft®, Lohmann & Rauscher

Background and Aims

The study aimed to investigate clinical outcomes and clinicians’ and patients’ satisfaction with standard care delivered with debridement by monofilament fibre technology (MFDT) in chronic wounds with biofilm over 2 weeks.

Methods

Chronic wounds were evaluated in a real-world setting. Biofilm-containing chronic wounds that had not improved with standard care, and required debridement and antimicrobial dressings were included. Any wound meeting the inclusion criteria was eligible. Wounds were managed over 2 weeks using a biofilm management pathway, including debridement with MFDT 3x in week 1 and twice in week 2, and the clinician’s choice of antimicrobial dressing. Care and outcomes were recorded in normal patient records. Clinicians completed a web-based survey to report clinical outcomes and clinician / patient satisfaction with the pathway. Outcomes were summarised descriptively.

Results

814 clinicians participated and completed the survey. 83% had previously used MFDT. Venous ulcers (67.4%), pressure ulcers (10%), dehisced surgical wounds (1.7%), diabetic foot ulcers (7.4%) and other wounds (13.4%) were managed in the study. Antimicrobial dressings included silver (34%), iodine (23%), honey (19%), PHMB (4%), other (14%). Secondary dressings included all-in-one dressing (11%), compression (32%), and unspecified secondary dressing (47%). 77% of clinicians reported a positive change in wound characteristics and clinical outcome after 2 weeks. Overall >73% of clinicians and patients were completely satisfied or satisfied with outcomes.

Conclusion

The biofilm pathway with MFDT supports positive outcomes in a high proportion of static chronic wounds and leads to high levels of clinician and patient satisfaction.

*Debrisoft, Lohmann & Rauscher