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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

      Assessment of The Cleansing Capacity of a Monofilament Debrider Compared to Conventional Cosmetic Pads in an Acne Sebum Model

      Poster presented at EWMA 2018 09.05.2018

      Aim:

      Acne is a long-term, multiform skin disease that is characterized by increased sebum production (seborrhea) and comedo formation (blackheads or whiteheads). However, over time, inflammatory papules, pustules, and nodules may develop. For acne treatment, several options are available with the aim to normalize skin cell shedding and sebum production in the pore to prevent blockage and kill bacteria (such as P. acnes) to reduce inflammation. Hence, frequent cleansing of the skin is necessary without adding to the skin irritation. The recently introduced monofilament debrider may present a beneficial option, removing the protein-rich crusts, effectively, fast, and pain-free.

       

      Method:

      The sebum model consists of glass plates coated with an oil-red-stained layer of artificial sebum. The monofilament debrider* and conventional cosmetic pads**,***,**** were used to clean the glass plates under standardized conditions (p=0.067N/cm2, v=1.6cm/s). Images were obtained before and after treatment and processed using ImageJ 1.45m.

       

      Results / Discussion:

      The monofilament debrider* exhibited a significantly higher cleansingefficacy compared to the cosmetic pads in vitro. While the monofilament debrider* was able to remove the artificial sebum almost completely (98.9% cleansed area), significantly lower efficiencies were noted for the conventional cosmetic pad**(46.9%), the conventional cosmetic pad***(76.2%), and the conventional cosmetic pad**** (54.7%).

       

      Conclusion:

      Treatment of acne vulgaris requires an efficient skin cleansing to remove surplus sebum and prevent pore blockage. However, added irritation of the skin should be avoided. Using a model with artificial sebum, it could be shown that the cleansing capacity of the new monofilament debrider is significantly higher compared to commercially available cosmetic pads.

      Products Debrisoft Pad
    2. Poster

      A NEW PHMB-CONTAINING PU FOAM* EXERTS ANTIBACTERIAL EFFECTS ON PSEUDOMONAS AERUGINOSA AND A STAPHYLOCOCCUS AUREUS BIOFILM

      Poster presented at EWMA 2018 09.05.2018 Krakow, Poland

      Aim:

      Chronic wounds are often colonized by different microorganisms, the most prominent being Staphylococcus aureus and Pseudomonas aeruginosa. PHMB-containing dressings have been shown to effectively inhibit bacterial progeny. However, bacteria do not act alone and the concept of biofilm formation and presence is now widely accepted. Therefore, current research targets antibiofilm strategies to restore an optimal wound-healing environment. A combined treatment approach involving debridement and the addition of antibacterial agents may then provide the highest success rates. Here, the efficacy of the new PHMB-containing PU foam* against a Staphylococcus aureus biofilm was evaluated in vitro. Moreover, antibacterial activity was evaluated in a direct contact method against Staphylococcus aureus and Pseusomonas aeruginosa.

       

      Method:

      Antibacterial activity against S. aureus and P.aeruginosa was tested according to JISL1902:2002. S.aureus biofilm was cultivated on glass plates, covered with dressings, and incubated for 24h at 37°C. Biomass was evaluated directly after dressing removal and following 48h regrowth period using the alamar blue assay.

       

      Results / Discussion:

      The new PHMB-containing PU foam* displayed complete inhibition of S.aureus and P.aeruginosa in the direct contact test, rated as strong antibacterial activity according to JISL1902:2002 (log-reduction>3). Treatment of S.aureus biofilm with the new PHMBcontaining PU foam* efficiently reduced biomass and significantly less viable bacteria were observed.

       

      Conclusion:

      It was found that the new PHMB-containing PU foam* exhibits a strong antibacterial activity against prominent microorganisms in chronic wounds. Moreover, it could be shown to reduce biofilm. Hence, it can be expected to exert beneficial effects in stagnating wounds and promote healing.

      Further versions
    3. Poster

      NON-ANTIBIOTIC ANTIMICROBIAL TECHNOLOGY WOUND DRESSINGS EXERTING AN ANTIBACTERIAL EFFECT ON PSEUDOMONAS AERUGINOSA AND A STAPHYLOCOCCUS AUREUS BIOFILM IN VITRO

      Poster presented at EWMA 2018 09.05.2018 Krakow, Poland

      Aim:

      Increased bacterial loads on the wound surface amplify and/or perpetuate a proinflammatory environment. It was suggested that lower probability of healing is seen when ≥4 pathogens are present. Biofilm formation further lowers the probability of healing. Hence, it was postulated that it is necessary to create conditions that are unfavourable to microorganisms and favourable for host repair mechanisms. Dressings featuring active antimicrobial agents or a passive antimicrobial mechanism may help in the treatment of chronic wounds.

       

      Method:

      DACC-coated1, SAP2, activated-charcoal/Ag3, and biocellulose/PHMB4 dressings were investigated. Antibacterial activity against P.aeruginosa was tested according to JISL1902:2002. S.aureus biofilm was cultivated on glass plates, covered with dressings, and incubated for 24h at 37°C. Biomass was evaluated directly after dressing removal and following 48h regrowth period using the alamar blue assay.

       

      Results / Discussion:

      All dressings displayed complete inhibition of P.aeruginosa, rated as strong antibacterial activity according to JISL1902:2002 (log-reduction>3). Treatment of S.aureus biofilm with the dressings efficiently reduced biomass and significantly less viable bacteria were observed. However, only the biocellulose/PHMB4 dressing exhibited a remanescent effect and was able to inhibit biofilm regrowth over 48h.

       

      Conclusion:

      Antimicrobial dressings can decrease multiplication of bacteria by passive mechanisms based on securely binding microbes in or to the dressing as observed for DACC-coated1 or SAP2 dressing. Dressings actively releasing agents like Ag+ or PHMB have additional effects reaching bacteria beyond direct dressing contact. Here, PHMB was found to be superior to Ag+ demonstrating a remanescent effect and preventing biofilm regrowth.

      Further versions
      Further languages
    4. 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
    5. 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
    6. 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.

    7. 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.

    8. Poster

      A review of monofilament fibre technology in the management of a variety of dermatological conditions

      Poster presented at EWMA 2018 09.05.2018 Krakow, Poland

      Aim:

      To review the evidence supporting the use of Monofilament fibre debridement technology (MFDT) in dermatological conditions.

       

      Method:

      MFDT has been successfully used for 7 years in the debridement and management of chronic wounds¹ and hyperkeratosis². In recent years clinicians have been utilizing the MFT in specific dermatological skin conditions.

       

      Results / Discussion:

      MFDT has been shown in case studies and case series to be a useful emerging treatment, especially when self-care is a priority, in the management of dermatological conditions resulting in:

       

       Varicose eczema

       Epidermolysis bullosa

       Chronic wounds in dermatological patients

       Dry, scaly and flaky skin conditions

       Hyperkeratosis associated with venous disease

       Secondary skin changes associated with chronic oedema and lymphoedema

       Actinic keratosis

       Prior to photodynamic therapy

       Acne vulgaris

       

      The 18 million special monofilament fibres which have angled tips to reach uneven areas of the skin or wound bed are able to remove unwanted tissue, materials and skin, allowing other concurrent treatment to reach their target area without the barriers imposed by for e.g. devitilised tissue, dry, scaly and flaky skin and other debris and materials. This technology has received positive NICE guidance¹⁷ for use in acute and chronic wounds. MFDT is very soft, comfortable and gentle on patients. It is safe and easy to use and can also be used by patients for self-care.

       

      Conclusion:

      A review of the supporting evidence clearly supports the continued research and interest in MFDT related to dermatological conditions.

    9. 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
    10. Poster

      Pain · Anxiety · Inflammation · Non-healing

      Poster presented at SAWC Spring 2018 25.04.2018 Charlotte, USA