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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

      A clinical evaluation of a hydroactive fibre dressing in the management of lower limb chronic wounds in a primary care setting.

      Poster presented at Wounds UK 2018 05.11.2018 Harrogate, UK

      Introduction

      The management of chronic wounds in primary care has been under the spotlight for several years (Guest et al, 2015). For the patient, the biggest challenge is exudate. For the nurse, the biggest challenge is time, which can be indirectly affected by exudate management.

      The main aim of this clinical evaluation was to see if exudate and the number of dressing changes could be influenced by changing the wound dressing to a new hydroactive fibre dressing* to the UK. Secondary aims were to evaluate the clinician and patient experiences using the new hydroactive fibre dressing.

       

      Method

      Ten patients were selected in a primary care wound clinic with moderate to high levels of exudate, suitable for a hydroactive fibre dressing. The mean age of the patients was 72 years and there were 9 leg ulcers and 1 diabetic foot ulcer. Seven of the patients had had their wounds for between 1 and 6 months and the other 3 for 1, 3 and 5 years. The wound bed was granulating in 4 patients and sloughy in 6 patients. The skin condition in 9 patients, despite the previous wound dressings used was macerated, excoriated and red/inflamed. Five patients had been using the UK market leading hydrofiber wound dressing** prior to the new hydroactive fibre dressing. The other 5 patients had been using an antimicrobial wound dressing. The hydroactive fibre dressing was evaluated over 4 dressing changes and data was collected on a data collection form by the lead author. Eight out of the 10 patients received compression therapy, 6 with a cohesive short stretch bandage***. Nine out of 10 patients had a standard superabsorbent secondary dressing.

       

      Results

      Seven out of the 10 patients benefited from a reduced number of dressing changes over the evaluation period, 3 of which were previously using the UK market leading hydrofiber wound dressing. This was probably due to exudate levels reducing in all 10 patients over the evaluation period when using a 0-10 scale where 10 was the highest exudate level.

      Patient reported pain was measured using a 0-10 scale where 10 was the worst ever pain.

      Seven patients benefited for a reduction in reported pain, some patients by as much as 67%. When evaluating the performance of the new hydroactive fibre dressing compared to the previously used dressing, 100% reported very good in ease of application, conformability, reduced dressing shrinkage, patient comfort from softness of gel, ease of removal in one piece and non-adherence. For wound condition and surrounding skin condition 90% reported good or very good. Using a 0-10 scale to evaluate clinician and patient satisfaction where 10 was the greatest satisfaction, 100% evaluated both patient and clinician satisfaction as either 8 or 9. On 9 out of 10 occasions, the author would recommend and/or use the new hydroactive fibre dressing again and on one there was no comment.

       

      Conclusion

      Whilst this is a small clinical evaluation, results demonstrate that the new hydroactive fibre wound dressing performed well when compared to the UK market leading hydrofiber dressing and antimicrobials in 10 patients with lower limb chronic wounds. Key findings were reduced exudate levels leading to reduced number of dressing changes, reduced patient reported pain during treatment and it was used successfully under compression therapy. The author and the patients were very satisfied during the evaluation period and patients commented on greater comfort, containment of exudate and improved quality of life due to better exudate management. The author commented that the UK market leading hydrofiber dressing ‘tends to adhere to the wound bed and proves difficult to remove whereas the new hydroactive fibre dressing came off with ease’.

    2. Poster

      IN VITRO ASSESSMENT OF THE COMPATIBILITY OF APPLICATION OF A PU FOAM* AND DRAINAGE FOIL** DURING NPWT USING DIFFERENT PUMPS

      Poster presented at EWMA 2018 09.05.2018

      Aim:

      NPWT has been advocated for virtually all kinds of acute and chronic wounds. Treatment is based on local negative pressure applied to the wound surface. NPWT is mainly carried out using open-cell polyurethane foams. It could be shown that cells show a significant tendency to grow into these foams which can be inhibited by application of drainage foil** without interfering with induction of cell migration. It is of interest to investigate if this combination is robust and workable with different vacuum pumps***.

       

      Method:

      Drainage foil** was placed on fibroblast 3D-cultures in combination with largepored PU foam*. Assemblies were positioned in Petri dishes and sealed with air-tight film after medium supply and vacuum pumps*** were connected. Experiments were carried out at -80mmHg and -120 mmHg for 48h. Cell viability and ingrowths of cells into samples was

      determined.

       

      Results / Discussion:

      Combination of drainage foil** and PU foam* samples during NPWT with different vacuum pumps*** led to the same cellular responses in vitro. With the PU foam* alone, cells did not stop at the pellicle edge but continued to migrate into the

      dressing. In contrast, placement of drainage foil** between collagen pellicle and PU foam* inhibited ingrowths of cells into the foam.

       

      Conclusion:

      It was shown that combination of drainage foil** with PU foam* for NPWT is workable with pumps from different manufacturers***. Ingrowths of cells into large-pored foams can be inhibited in vitro by application of drainage foil**. In vivo this may prevent disruption of newly formed tissue during dressing changes.

      Further versions
    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

      A super absorbent dressing* for management of patients with moderate-to-highly exuding wounds - a clinical study

      Poster presented at EWMA 2018 09.05.2018 Krakow, Poland

      Aim:

      A polyacrylate containing super absorbent dressing* can be used for patients with moderate-to-high exuding wounds. The study evaluated the performance of the superabsorbent dressing* in daily clinical practice.

       

      Method:

      German physicians from different specialisms participated: 23 general medicine, 13 surgery, 14 internal medicine and 3 other departments. Both the dressing and questionnaire were supplied by the sponsor. After dressing use the physicians scored on handling properties, absorbent capacity, user satisfaction and patient comfort. The super absorbent dressing* was used for at least 3 dressing changes in 171 patients (86 (50.3%) men, 78 (45.6%) women, 7 (4.1%) not scored).

       

      Results / Discussion:

      The centers used their current protocol. The patients had pressure ulcers (8 (4.7%), venous leg ulcers (113 (66%), diabetic foot ulcers (8 (4.7%), post-surgery (14 (8.2) and infected wounds (8 (4.7%). Dressing application was rated easy by 168 (95%) of the clinicians and the dressing demonstrated a good absorbent capacity as noted by 167 (98%) of the respondents. The dressing was rated easy to remove (168 (98.3%) and did not soil clothing according to 165 (97%) of the respondents. N=157 (94%) patients reported to be satisfied with the performance of the dressing as well as 166 (99%) of the physicians, who additionally reported (156 (94.6%) the dressing to be safe and reliable for the task at hand.

       

      Conclusion:

      The study design allowed for collecting data on the dressing in daily clinical practice. The evaluated dressing* was easy to use, comfortable and reliable for patients with moderate-to-high exuding wounds.

      Products Vliwasorb Pro
    5. 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
    6. 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
    7. 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
    8. 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
    9. 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.

    10. 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.