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    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:

    1. Poster

      BINDING CAPACITY OF TWO POLYACRYLATE SUPERABSORBER DRESSINGS FOR THE INFLAMMATORY PROTEASES PMN ELASTASE AND MMP-2 IN VITRO

      Poster presented at EWMA 2018 09.05.2018 Krakow, Poland

      Aim:

      Non-healing wounds contain elevated levels of neutrophil elastase and matrix metalloproteinases (MMPs) which are responsible for degradation of extracellular matrix and growth factors. These destructive processes prevent wound closure and lead to persisting wounds. Binding of these proteases contributes to the treatment of chronic wounds. The aim of this study was to compare the binding capacity of two polyacrylatesuperabsorber dressings* for elastase and MMP-2 in vitro.

       

      Method:

      Samples of SAP* and SAP Pro** were cut (0.5 cm2), taken in a final volume of 1mL of protease solution (PMN elastase: 250ng/mL; MMP-2: 4000pg/mL), and incubated up to 24h at 37°C. Concentrations of unbound protein were determined by specific immunoassays for PMN elastase and MMP-2. In addition, it was checked if proteases can be eluted from the dressing samples subsequently.

       

      Results / Discussion:

      SAP* exhibited high binding capacity for both proteases. After 24h elastase concentrations were significantly reduced about 95% (p<0.001) and MMP-2 amounts completely abolished (100%, p<0.001). Only marginal amounts of elastase andMMP-2 could be eluted from the samples after incubation. SAP Pro** demonstrated a comparable high binding of elastase and MMP-2. No distinct differences in the performance of the dressings were noted.

       

      Conclusion:

      The polyacrylate superabsorber dressings SAP* and SAP Pro** are able to shortly bind large amounts of elastase and MMP-2 in vitro. Elution of the dressing samples revealed a strong, possibly irreversible binding of both proteases. Decrease of these matrix degrading proteases should aid establishment of a physiological wound milieu in vivo and thus support the healing process.

      Further versions
    2. Poster

      Combining different compression approaches to achieve quality of life

      Poster presented at EWMA 2018 09.05.2018 Krakow, Poland

      Aim:

      Improving Quality of life should be paramount to every patient’s care-pathway. Many quantitative tools are available but rarely capture the individuals true goal. Individual goal setting however difficult to achieve, should always be considered. A selection of compression devices available and applied in a novel way were adapted to improve one lady’s quality of life and achieve her goal.

       

      Method:

      A 48-year-old lady with unilateral lymphoedema of her left leg, secondary to surgery for endometriosis was referred for Decongestive Lymphoedema Treatment (DLT). DLT consisted of compression bandaging using a foam roll and cohesive inelastic bandages* and lymphatic drainage using a hand-held negative pressure device**, for 6 sessions over 10 days. Following DLT a class IV flat-knit compression stocking was fitted with a below-knee velcro wrap system over the top of the stocking to prevent ‘rebound’ oedema. Individual aims were set by the patient – to ride her horse again.

       

      Results / Discussion:

      Limb volumes reduced following DLT and maintained with monthly lymph drainage, compression stocking and velcro wrap system. Sub-bandage pressures were measured to indicate pressure and stiffness of combined treatment.

       

      Conclusion:

      Combining existing products available on the market to achieve known pressures from scientific research has resulted in preventing rebound oedema post DLT. Most importantly the patient’s individual goals were achieved and she can ride her horse again. This is possible by understanding the tissue density, material properties and the combined prescription of compression used, without causing physical and functional restriction.

      Products Rosidal soft
    3. Poster

      A case series report using a gel forming wound contact layer and monofilament fibre debridement technology in the management of chronic wounds

      Poster presented at EWMA 2018 09.05.2018 Krakow, Poland

      Aims

      To evaluate the performance of a gel forming wound contact layer* in static or slow-to-heal chronic wounds following wound bed preparation using monofilament fibre debridement technology**.

       

      Methods

      Eleven patients (9 females, 2 males) were selected with low to moderately exuding wounds – 10 of which were leg ulcers. The mean age was 71 years. All patients underwent wound bed preparation using monofilament fibre debridement technology at dressing changes followed by application of a gel forming wound contact layer. The patients were followed up weekly or twice weekly for five dressing changes or until healed. Both quantitative and qualitative parameters were measured at each dressing change.

       

      Results/Discussion

      In all cases, the chronic wounds went on to show positive signs of healing, with many reducing greatly in size or healing.

      The gel forming wound contact layer resulted in 100% reduction in pain scores during treatment, 100% rated very good application and removal (non-adherent) and 100% rated very good or good improvement of the condition of peri-wound skin.

      Results demonstrated very high patient and clinician satisfaction scores with 90% receiving 8 – 10 out of 10.

       

      Conclusion

      The gel forming wound contact layer proved easy to use, safe, effective and highly recommended by patients and clinician.

    4. Poster

      Supporting self-management of fragile elderly patients with oedema and a venous leg ulcer using a short-strech wrap-on compression device

      Poster presented at EWMA 2018 09.05.2018 Krakow, Poland

      Aim:

      In The Netherlands health-insurance companies aim to reduce costs for complex wound and oedema treatment. For this purpose an adjustable short-stretch compression device (ACD) may be used [1,2]. Some of the available long-stretch systems have caused skin damage [1]. The objective of this care series was to stimulate self-management of fragile elderly patients with oedema and/or a venous leg ulcer using an easy and safe to apply short-stretch wrap-on compression1 device, which was selected for patients in our region [1,2].

       

      Method:

      Twenty out-patients with oedema and a venous leg ulcer received the ACD1 and were followed during the treatment and maintenance phase. Scabs and sloughy tissue were removed using a monofilament debridement pad2 after which the ulcer was covered with a superabsorbent pad3. Those with fragile skin conditions, prone to skin lesions received a “silk”stocking4 applied under the ACD1 which provided an additional 10 mmHg and skin protection.

       

      Results:

      Many patients requiring compression treatment are elderly and fragile. Self-management is often not an option. When using traditional compression bandages correct application and an optimal pressure level is not always achieved. The 20 patients treated with ACD1 achieved ulcer closure and oedema reduction in a comfortable fashion, stimulating self-management. Within 2 weeks often more than 3 cm ankle circumference reduction was achieved. It was easy to select the correct size and colour coding enabled a correct overlap upon application. From 2015 onwards, since education on compression was put in place for physicians and nurses throughout the care-chain in our region, the number of adverse events has reduced and quality of care has improved.

       

      Conclusion:

      It is important to select a suitable and effective compression system for especially frail elderly patients. Although the general practitioners (GP) take time to getting used to ACD1, collaboration with leg measurement sites and training GPs may enable choosing and applying suitable compression. The tested ACD1 enabled effective and safe compression. Complete ulcer closure was achieved in a comfortable fashion that suited the individual needs of the patients.

    5. Poster

      Succesfull treatment of a 96 year-old patient with an infected wound after osteosynthesis

      Poster presented at EWMA 2018 09.05.2018 Krakow, Poland

      Aim:

      Complex case management in a fragile elderly patient to achieve an optimal outcome.

       

      Method:

      The 96 year-old female had a deep wound infection after osteosynthesis of her left ankle. In the hospital she was treated with negative pressure wound therapy (NPWT). Upon arrival on March 2, 2017 in the rehabilitation centre the wound surface was 8 x 3 cm, the wound bed contained 10% yellow and 90% granulation tissue with some hyper-granulation present. The wound edges were non vital and there was oedema in her left ankle. The surrounding skin was slightly red.

       

      Results:

      The patient received nutritional supplements twice daily. NPWT was discontinued and the treatment regime now comprised: Debridement using a monofilament1 pad, followed by cleansing with water and disinfection with an antiseptic. The peri-wound skin was protected with a spray on film, a collagen2 and an alginate3 dressing were covered with a superabsorbent pad fixed with an adhesive film dressing.4 Dressing changes were on average twice weekly. For compression 2 layers (20 mmHg) of a tubular compression5 system were applied during the day and reduced to one layer at night. Wound closure was achieved after 41 days of treatment. The patient continued with the compression system for another 6 weeks to protect the fragile area and to prevent oedema from reoccurring.

       

      Conclusion:

      Complex wound closure was achieved in a comfortable fashion that suited the individual needs of this elderly fragile patient.

    6. Poster

      Simple solution to reduce edema before Medical Elastic Hosiery

      Poster presented at EWMA 2018 09.05.2018 Krakow, Poland

      Aim:

      Although hosiery is the golden standard in the maintenance phase for treating lymphedema or venous leg ulcers, clinical challenges exist where hosiery may not be suitable due to unresolved edema or practical application issues. In this study a practical solution for this group of patients was implemented using a Leg Ulcer Hosiery Treatment System.*

       

      Method:

      9 patients, 5 males, 4 females aged between 45 – 87 years old. 7/9 edema, I erysipelas and I DVT. Previous treatment: 6/7 no treatment, 2 Tubigrip, 1 ill-fitting hosiery Referrals from the General Practitioner or Medical Specialists to the bandager Medical Stockings measurement. In all cases edema persisted and an alternative solutions was chosen using the new system for 4 – 6 weeks for treatment of the edema.

       

      Results / Discussion:

      After evaluation, there was an immediate effect reduction in edema, from 6 to 14%. Comfort and Donning was good to very good. Doffing was average to good. Patients were able to wear their own shoes, stay active and in some cases, continue working. They were measured for follow on Medical Stockings. The system was simple, effective, promoted self-care and was available off the shelf. Costs of bandager and community nurse time were reduced.

       

      Conclusion:

      Simple solutions such as the 2 layer Leg Ulcer System can help patients and caregivers for the treatment of edema with or without a wound. Benefits are self-management and cost efficiency instead of 2 – 3 x week bandaging. All patients could fit into their own shoes, and this motivates mobility.

      Products Actico UlcerSys
    7. Poster

      MEASURING THE IMPACT OF EDEMA MANAGEMENT - MORE THAN JUST A VOLUME REDUCTION

      Poster presented at EWMA 2018 09.05.2018 Krakow, Poland

      Aim:

      Chronic edema of the lower leg has a negative impact on functional performance. Chronic edema impairs foot wear use and normal gait patterns, impairs calf muscle pump and most importantly limits the patient’s ability to interact with his/her environment. This negative spiral of progressive edema and progressive decline in functional status can be

      reversed simply by addressing the edema.

       

      Method:

      Observational study performed at 2 separate outpatient edema management clinics. Eight patients were referred for lower extremity edema management to a physical therapist. Objective data measured including limb volume, ankle range of motion (ROM), functional activity status utilizing the Timed Up and Go (TUG) and the 4 meter walk test (4MWT), and assessment of quality of life (QOL) via the Lymphoedema QOL tool (LYMQOLLeg). Measurements were taken at initial evaluation, upon completion of treatment, and 2 weeks post treatment. Patients received compression therapies* and instruction in home exercise program only. Gait training was performed during the sessions for safety with assistive device when appropriate.

       

      Results / Discussion:

      Reduction of swelling had a direct positive impact on all outcomes measured. LYMQOL-Leg scores and functional performance scores (TUG and 4MWT) improved by 15% and 0.1m/sec respectively. Functional performance continued to improve after active therapy had been discontinued with further increased TUG scores at the 2-week follow-up assessment. The reduced edema allowed for normal footwear use, normalized gait patterns which increased mobility and enhanced QOL.

       

      Conclusion:

      Management of lower extremity edema has a positive impact on both patient’s functional status and QOL.

    8. Poster

      Effectiveness of Monofilament Debridement Tools in Neonatal Wound and Skin Management

      Poster presented at SAWC Spring 2018 25.04.2018 Charlotte, USA
      Products Debrisoft Pad
    9. Poster

      Pain · Anxiety · Inflammation · Non-healing

      Poster presented at SAWC Spring 2018 25.04.2018 Charlotte, USA
    10. Poster

      Implementing a Mechanical Debridement Protocol Process Improvement Plan

      Poster presented at SAWC Spring 2018 25.04.2018 Charlotte, USA