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Introduction: According to the European guidelines, the first step for local wound preparation is debridement, which stands for removing of devitalized tissue such as slough or necrosis. There are numerous types of debridement, but not all of them can be performed by non-specialists. Most of the research investigating efficiency of novel debridement products are carried out or funded by pharmaceutical companies.

Aim: To compare the efficacy of relative necrotic tissue removal after 30 days on patients subjected to debridement with sterile sponge, monofilament fibre cloth, non-woven cloth impregnated with sodium hyaluronate and phospholipids and traditional sterile gauze.

Material and methods: By use of photographic documentation at 7 days’ intervals and planimetry methods, the total wound surface area and sloughy tissue area was measured.

Results: Results have shown that monofilament cloth was the most effective, removing on average 63.44 ±32.91% of necrotic tissue after the first procedure and 74.65 ±30.95% within 30 days of application, in comparison to the sterile gauze group that had on average only 23.53 ±19.16% of necrotic tissue removed at day 0 and 44.95 ±31.47% removed at day 30. Moreover, patients using all 3 products tested reported higher satisfaction with that treatment than those treated with gauze.

Conclusions: Results imply that all those methods could be considered as they are well accepted by patients and cause less pain during the procedure, which is essential for good compliance and complete resolution of the lesions.

In recent years, the impact of biofilms on non-healing wounds has gained increasing interest and it has been reported that between 80% to 100% of non-healing wounds have a biofilm associated with them that impedes wound healing (Bjarnsholt et al, 2017; Malone et al, 2017). Biofilms consist of a complex community of microorganisms, which tend to attach to surfaces, and are encased within a matrix consisting of extracellular polymeric substances (EPS) (Malone et al, 2017). This matrix provides

the microorganisms with protection against antimicrobial treatment and an individual’s immune system. There is an increasing focus and awareness around the use of biofilm based wound care (BBWC) pathways, and they are recommended in several consensus documents (Bianchi et al, 2016; Shultz et al, 2017; Murphy et al, 2020; International Wound Infection Institute (IWII), 2022), This article will discuss the evidence behind BBWC and the potential for introduction of a BBWC pathway into the community setting.

After gastrointestinal resections, leakages can occur, persist despite conventional therapy and result in enterocutaneous fistulae. We developed a combination method using flexible endoscopic techniques to seal the enteric orifice with an absorbable plug in addition to a percutaneously and fistuloscopically guided open-pore film drainage (Vac-Plug method). We retrospectively searched our endoscopy database to identify patients treated with the outlined technique. The clinical and pathological data were assessed, the method analyzed and characterized and the technical and clinical success determined. We identified 14 patients that were treated with the Vac-Plug method (4 females, 10 males with a mean age of 56 years, range 50-74). The patients were treated over a time period of 23 days (range 4-119) in between one to thirteen interventions (mean n = 5). One patient had to be excluded due to short follow-up after successful closure. Seventy-seven percent (10/13) were successfully treated with a median follow-up of 453 days (range 35-1246) thereafter. No treatment related complications occurred during the therapy. The data of the analysis showed that the Vac-Plug therapy is safe and successful in a relevant proportion of the patients. It is easy to learn and to apply and is well tolerated. In our opinion, it is a promising addition to the armamentarium of interventional methods of these difficult to treat patients. Of course, its usefulness must be further validated in larger prospective studies.

Debridement is the removal of non-viable tissue from the wound bed and surrounding skin and is an important part of wound healing and wound bed preparation. Devitalised tissue, such as necrosis, slough and hyperkeratosis, interfere with the process of wound healing. When a wound fails to progress, there is a need to assess the wound bed and surrounding tissue and promote an optimum environment that encourages the formation of healthy granulation tissue (Young, 2014). Recent advances in debridement techniques using monofilament fibre technology can be practised by nonspecialist nurses and used safely and effectively in a patient’s home. In a recent audit, a dataset of 486 patients who had been newly prescribed a monofilament fibre debridement pad was obtained to validate clinical effectiveness and cost efficiency. The total cost of wound care prescribing fell by 14% or £101,723 in the six months after the intervention compared with the six months before. The average monthly expenditure per patient fell from £244 before the intervention to £209 after (Burnett et al, 2021). This evidence reinforces the National Institute for Health and Care Excellence (NICE) recommendations for use of monofilament fibre debridement in the community, based on evidence of its effectiveness and estimated cost savings (NICE, 2019).

Nanotechnology has opened a new area of scientific research. This field deals with materials within the dimensions of 1–100nm and a plethora of new technologies have emerged. In wound care, silver nanoparticles are used to aid wound healing as an antimicrobial agent, but also as an anti-inflammatory agent. The properties of silver nanoparticles differ from that of the material on a larger scale and their production can be controlled to give varied properties and characteristics that have different uses. These resultant properties are very important and differences in characterisation can alter their biological and physical attributes. All wound dressings have to undergo rigorous scrutiny around toxicity and safety when regulatory review is undertaken, yet some users still have concerns over long-term effects of silver nanoparticles in vivo. This review will address some of these concerns and reviews the current health and safety data associated with introduction of new products containing silver nanoparticles using Venus Ag dressings (SFM LTD, UK) as an example.

The treatment of chronic wounds presents a major challenge in medical care. In particular, the effective treatment of bacterial infections that occur in the form of biofilms is of crucial importance. To develop successful antibiofilm strategies for chronic wound treatment, biofilm models are needed that resemble the in vivo situation, are easy to handle, standardizable, and where results are readily transferable to the clinical situation. We established two 3D biofilm models to distinguish the effectiveness of wound dressings on important microorganisms present in chronic wounds. The first 3D biofilm model contains Staphylococcus aureus, Escherichia coli, and Acinetobacter baumannii, while the second is based on Pseudomonas aeruginosa. Bacteria are cultivated in a nutrient-rich agar/gelatin mix, into which air bubbles are incorporated. This results in a mature biofilm growing in clusters similar to its organization in chronic wounds. The models are convenient to use, have low variability and are easy to establish in the laboratory. Treatment with polihexanide and silver-containing wound dressings showed that the models are very well suited for antimicrobial testing and that they can detect differences in the efficacy of antimicrobial substances. Therefore, these models present valuable tools in the development of effective antibiofilm strategies in chronic wounds.

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: 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.

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.