It is estimated that two million people in Germany have chronic wounds1 – a problem that will affect increasing numbers of people and overburden our healthcare system in future because of an ageing population. Speaking at the press workshop “High-tech encounters tradition: standards and trends in wound therapy”, organized by Lohmann & Rauscher (L&R), on 28 October 2014 at the BMW Welt media centre in Munich, Professor Robert Strohal emphasized the importance of holistic management of chronic wounds by debridement, wound care and compression . In his lecture, the dermatologist presented an overview of the scientific standards in wound therapy which are not yet universally applied in clinical practice today however.
According to the BARMER GEK 2014 report on remedies and medical aids, the majority of their insured persons with incident lower leg ulcers are treated with hydroactive wound dressings, which shows that treatment is phase-appropriate, but that only a small proportion of these patients (40 %) is given compression therapy. The health insurance company rates this situation as “seriously deficient treatment of the persons insured“1.
Quoting this study, Strohal emphasized the importance of a holistic approach to wound treatment: “Correct management of chronic wounds until they heal requires a package of measures. This includes medical diagnosis of the cause of the wound, correct assessment of the wound situation, e.g. using the T.I.M.E. assessment or W.A.R. Score2 and finally a wound-phase-adapted treatment of the patient. The aim, reduced healing time and improved quality of life for the patient, can only be achieved by 1) adequate debridement, 2) phase-appropriate management with wound dressings and 3) suitable compression therapy.“ Through its concept of the L&R supplier of solutions, L&R offers suitable products for all phases of wound care.
An essential initial treatment step: Debridement
In phase 1 of wound treatment, during wound bed preparation or debridement, necrotic material, scabs and infected tissue are removed from the centre of the wound, wound edge and surrounding skin. As co-author of the EWMA3 core document on debridement, Strohal underlined the major significance of debridement as an essential step at the start of all wound therapy, because modern wound care products can only be completely effective if the wound has been carefully cleaned4. When comparing mechanical debridement procedures, the international team of authors rated debridement with a monofilament fibre pad as highly promising4. As early as 2012, L&R launched a monofilament fibre pad of this kind (Debrisoft) onto the market for rapid, virtually painless and effective debridement.
L&R solutions for wound care and compression
L&R supplies a wide range of products for conventional and moist wound care in phase 2, treating the wound with wound dressings. The medical device supplier has recently enhanced its portfolio with the new wound dressing Suprasorb P silicone. The latter was specially developed for the gentle treatment of wounds with low to moderate levels of exudate. The foam dressing is easy to apply, can be removed virtually painlessly and promotes a moist wound healing Environment5, 6,7.
Phase 3 finally incorporates therapy of the underlying disease (e.g. chronic venous insufficiency), consisting of compression, pressure relief and metabolic control. For compression therapy L&R offers products and sets that are part of the Rosidal brand such as the disposable system Rosidal TCS (a two-component system). A multicentre international post-marketing surveillance study8 conducted on 102 patients with leg ulcer confirms that the two-component system is suitable for treating all ulcers of various origins (venous, mixed or arterial) with or without oedema. In addition, the study testifies that the system is easy to use thanks to the ease with which it achieves adequate pressure and shows that Rosidal TCS is very well tolerated by the patient.
Notes & references:
1) K. Sauer, H. Rothgang, G. Glaeske, BARMER GEK Heil- und Hilfsmittelreport 2014. Evaluation of the BARMER GEK Heil- und Hilfsmitteldaten from 2012 to 2013. Schriftenreihe zur Gesundheitsanalyse, vol 28, 2014, Berlin
2) The T.I.M.E. concept is a method which can be used to evaluate wounds in accordance with various indicators such as wound tissue (Tissue), degree of infection (Infection), exudate (Moisture) and the wound edge (Edge). To evaluate infected wounds or those at risk of becoming infected – the particularly problematic wounds due to their stagnation or chronic nature – L&R developed the practical W.A.R. score (Wounds At Risk), which enables wound managers to draw up a clinically-oriented, soundly-based risk assessment using a checklist and existing patient situations.
3) European Wound Management Association. Der Verband veröffentlicht regelmäßig aktuelle Standards in der Wundversorgung.
4) European Wound Management Association (EWMA), Position Document: Wound Bed Preparation in Practice. MEP Ltd, 2004, London
5) Bambilla R et al., Evaluation of ergonomic aspects in the daily routine of a new foam dressing with silicone adhesive layer. IWWT 2014, Paris (Poster)
6) Wiegand C et al., Comparison of the adhesion disposition of conventional and modern wound dressings in vitro. IWWT 2014 Paris, Wounds UK, 2013 Harrogate (Poster)
7) Wiegand C., Measurement of the adhesion disposition of silicone-coated PU foam dressings in vitro. IWWT 2014, Paris (Poster)
8) Dr. Martin Abel und Dr. Christiane Zell, Post Marketing Surveillance Study 2012-04 CaS Abschlussbericht (Status: 20.02.2013)
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