Publication search

Introduction

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 [1] monofilament fibre debridement pad* has been increased in size to tackle this issues. The handling has been improved [2] 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.

Method

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.

Results

Case 1:

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.

Case 2:

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.

Case 3:

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.

Case 4:

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.

Case 5:

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.

Discussion

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.

Conclusion

The larger monofilament fibre debridement pad is a useful addition to the existing smaller versions. Especially useful and effective for bigger wounds and areas.

Introduction:

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.

Methods:

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.

Results:

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.

Conclusions:

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.

Aim:

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.

Method:

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

Conclusion:

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.

Introduction

Liam is a 26 year old man who suffered a post trauma DVT when just 18 years old. He has Warfarin therapy and has a history of venous leg ulceration for 8 years. Because of the damage to his primary, deep veins he had developed a collateral venous circulation.

Liam describes having a leg ulcer at a young age as “life changing”. It stopped him playing sport and swimming and it changed how he interacting with friends. Because of his damaged circulation and medication he lived with the constant fear that his leg was going to deteriorate or bleed. Despite this, Liam continued to work full time and support his family.

Method

In the summer of 2018, Liam’s nurse changes his treatment from a combination long-stretch cohesive bandage system, to a cohesive short stretch bandage system. She also implemented a Monofilament fibre biofilm based treatment regime to expedite wound bed preparation and disruption of the biofilm (Morris et al, 2016).

Results

There was a dramatic reduction in leg oedema and improvement in leg shape almost immediately the new bandage system was started. Things continued to improve over the following months. Liam reported that the cohesive short stretch bandage system made “his leg feels much more comfortable with less ridging and less slippage”. His leg shape was much better, and it was easier to wear socks and shoes. Liam said that nobody noticed he had a bandage on.

In December 2018, after 8 years of ulceration, Liam’s venous leg ulcer healed.

Conclusion

This case study demonstrates how learning and implementing new knowledge, technology and skills can translate into improved patient outcomes. By sharing Liam’s story we can really understand the devastating effect a leg ulcer can have, especially on a teenager and young adult.

Liam now has a bespoke plan for the prevention of future venous leg ulcers which will include higher compression during working periods when he will be on his feet for long periods. This is achieved by using short stretch wrap systems to encourage continued self-care and ownership of his long term condition.

Introduction

This national, multicentre patient evaluation examines the enhancements that have recently been made to a superabsorbent dressing* and how this product improvement** has led to enhanced performance and improved patient related outcomes. The enhancements are a wider border and more ergonomic shape and a new structure to the superabsorbent polymer which increases absorbency.

Method

The recently developed and improved superabsorbent wound dressing was evaluated in six clinical sites on 27 patients with wounds requiring management of exudate of varying levels.

Results

The mean age of the patients who participated was 70 years and the main wound type was leg ulcer. At the start of the evaluation the surrounding skin was mostly reported to be macerated and/or red and excoriated. Exudate levels were light in 4 cases, moderate in 12 cases and heavy in 11 cases. The improved superabsorbent was used on its own as a primary dressing in only 5 cases and in combination with another primary dressing in 15 cases (7 did not answer the question). A topical antimicrobial was combined with the new superabsorbent in 60% of cases and a contact layer in 20% of cases. It was used under full or reduced compression in 21 cases. In most cases the improved superabsorbent replaced either another superabsorbent or absorbent dressing. The frequency of dressing changes varied from daily to weekly prior to the evaluation with 7 clinicians stating that the new and improved superabsorbent had reduced the frequency of dressing changes. The others either did not comment on this, or did not see a change. Other parameters were rated as good and very good and are outlined in Table 1.

Discussion

Although the improved superabsorbent dressing includes a very effective wound contact layer, 20% of cases used the product in combination with another contact layer. Use with another contact layer would not be recommended as this is not necessary and increases costs. Superabsorbent dressings are designed for the management of medium to high levels of exudate and should not be considered in low exudate.

Conclusion

The new and improved superabsorbent wound dressing demonstrated clear advantages for clinicians managing exudate. The patient shown in Figure 1 - 3 is still being managed with the improved product as this is the only dressing he doesn’t react to.

OBJECTIVE

To determine the clinical effect and consequential levels of health professionals and patient satisfaction with the results of debridement episodes of wounds with visible slough and/or scaly skin using monofilament fibre debridement technology.

METHODS

This was a non-comparative, open label evaluation conducted in static/non-healing acute and chronic wounds with visible slough and/or scaly skin that required debridement. Monofilament fibre debridement technology was applied in 1-2 sequential treatment episodes during normal clinical practice which followed local practice, guidelines or formularies. Following the clinical phase of the evaluation, health professionals were invited to complete an online survey of the clinical outcomes and their satisfaction with them.

RESULTS

Survey questions were answered by 1129 health professionals. Wounds managed using the monofilament fibre debridement technology during this evaluation included leg ulcers (63%), pressure ulcers (10%), dehisced surgical wounds (3%), diabetic foot ulcers (8%) and other wounds (13%). 'Other' wound types included acute dirty wounds, burns, cellulitis, psoriasis, diabetic amputation wounds, dry flaky skin, moisture wounds, trauma, varicose eczema. Of the wounds, 12% were reported as non-static. There was visible change in the wound and/or skin after first use of the monofilament fibre debridement technology in a high proportion of all wound types, and a further increase in the proportion of wounds with visible change after the second use. The visible difference was significant for both static and non-static wounds. User and patient satisfaction with all clinical outcomes were high, whether or not the user and patient had previous experience of monofilament fibre debridement technology.

CONCLUSION

Monofilament fibre debridement technology provides rapid, visible and effective debridement of slough and scaly skin after one application and further visible improvement after two applications in static and non-static wounds. Health professionals and patients report high levels of satisfaction with outcomes following application of the monofilament fibre debridement technology.

BACKGROUND

Application of controlled in vitro techniques can be used as a screening tool for the development of new hemostatic agents allowing quantitative assessment of overall hemostatic potential.

MATERIALS AND METHODS

Several tests were selected to evaluate the efficacy of cotton gauze, collagen, and oxidized regenerated cellulose for enhancing blood clotting, coagulation, and platelet activation.

RESULTS

Visual inspection of dressings after blood contact proved the formation of blood clots. Scanning electron microscopy demonstrated the adsorption of blood cells and plasma proteins. Significantly enhanced blood clot formation was observed for collagen together with β-thromboglobulin increase and platelet count reduction. Oxidized regenerated cellulose demonstrated slower clotting rates not yielding any thrombin generation; yet, led to significantly increased thrombin-anti-thrombin-III complex levels compared to the other dressings. As hemostyptica ought to function without triggering any adverse events, induction of hemolysis, instigation of inflammatory reactions, and initiation of the innate complement system were also tested. Here, cotton gauze provoked high PMN elastase and elevated SC5b-9 concentrations.

CONCLUSIONS

A range of tests for desired and undesired effects of materials need to be combined to gain some degree of predictability of the in vivo situation. Collagen-based dressings demonstrated the highest hemostyptic properties with lowest adverse reactions whereas gauze did not induce high coagulation activation but rather activated leukocytes and complement.

Objective:

Best practice in wound bed preparation and biofilm-based wound management includes debridement to create a clean wound bed and to assist in minimising the redevelopment of biofilm. Biofilm that is not removed inhibits healing and redevelops if not prevented from doing so with topical antimicrobial agents. Monofilament fibre debriding technology (MFDT) is used for effective and rapid mechanical debridement of loose material, slough and biofilm. The objective of this evaluation was to determine the clinical effect and consequential levels of health professional and patient satisfaction with the results of a biofilm pathway that included MFDT to achieve debridement.

Methods:

This non-comparative, open label evaluation was conducted in static and non-static wounds that required debridement. MFDT was used to debride in a two-week evaluation of a biofilm pathway. Wounds were debrided three times in week one and twice in week two. Each debridement was followed by treatment with an antimicrobial dressing. Other care included secondary dressings and compression delivered according to local practice, guidelines and formularies. After the clinical evaluation, health professionals were invited to complete an online survey of the clinical outcomes and their satisfaction with the biofilm pathway.

Results:

There were 706 health professionals who provided answers to the survey questions. Wound types evaluated were leg ulcers (67.4%), pressure ulcers (10%), dehisced surgical wounds (1.7%), diabetic foot ulcers (7.4%) and other wounds (13.4%). Of the wounds, 9% were reported as non-static despite the eligibility criteria. Not all wounds followed the pathway. The most frequently-used antimicrobial was silver. Non-antimicrobial products used included all-in-one dressings, other secondary dressings and compression. There was a change in 77% of wounds overall after two weeks. Change was reported almost equally for both static and non-static wounds. Health professionals who did or did not follow the pathway were ‘completely satisfied’ or ‘satisfied’ with the overall clinical outcome 96% and 95%, respectively. Of the patients, 77% were ‘completely satisfied’ or ‘satisfied’ with healing after following the pathway, as reported by the treating health professional.

Conclusion:

The biofilm pathway that includes MFDT appears effective. Wounds managed on the pathway were debrided effectively and healing progressed to the satisfaction of both health professionals and patients.

OBJECTIVE

Compression devices have been shown to reduce venous stasis, increase blood flow and skin tissue oxygenation (StO2), promoting healthy tissue. This study aimed to explore the efficacy of a new compression garment in three different positions in healthy adults.

METHODS

In this quantitative study, potential participants were screened and recruited using the Physical Activity Readiness Questionnaire (PAR-Q, Canada). Participants attended three separate, one-hour sessions to evaluate StO2 in supine-lying, chair-sitting and long-sitting positions. StO2 was recorded for 20 minutes pre-, during and post- a 20-minute intervention using a compression garment, TributeWrap (Lohmann-Rauscher, Germany). A repeated-measures analysis of variance (ANOVA) was followed by post-hoc pairwise comparisons.

RESULTS

A total of 28 healthy volunteers took part (aged 24.6 ±8.4years; 13 males, 15 females). A significant difference was seen between the three positions (p<0.001). Chair-sitting had the lowest StO2 pre-intervention, increasing StO2 significantly (32.25%, p<0.001) during wear of the compression garment (24.8% higher than baseline post-intervention). No significant difference was seen between long sitting and supine-lying (p=1.000). In contrast, long-sitting and supine-lying StO2 was higher pre-intervention compared with chair-sitting and only increased post-intervention (11% and 16.8% respectively, p<0.001) compared with baseline.

CONCLUSION

The compression garment significantly increased StO2 levels in both seating positions. Further studies are required to determine if increasing StO2 through short intervention sessions with this device has the potential to improve self-management of tissue health in individuals with reduced mobility, oedema or venous insufficiency.