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Aim:

The study compared clinical efficacy and cost of autolitic, enzymatic and mechanical debridement using a monofillament pad* and a pad with a handle.

Method:

A monofilament debrider was proposed for its efficacy, safety, tolerability and ease of use. Eighty community patients with complex wounds containing sloughy tissue were allocated to the treatment groups at random, after they consented. They were followed for 15 days. At baseline medical history, wound characteristics and privious treatment was recorded. During visits wound condition, patient reported pain during debridement, time required for the procedure and product handling, were scored. Costs calculation took into account clinical efficacy, time to debridement, number of home visits, nursing costs, costs

per product used.

Results / Discussion:

Debridement was effective and comfortable using all evaluated methods (on a 5-point Likert scale, the 2 monofilament products scored a mean of 4,9 and 4,8, enzymatic sored a mean of 4,6 and autolytic debridement a mean of 3,6). The total costs for debridement using the monofilament pad* and product with handle was Euro 58,67 and Euro 72,47 respectively. For enzymatic debridement the total costs were Euro 213,35 and for autolytic debridement Euro 98,67. Cost was significantly lower in the monofilament group due to a reduction in debridement time, number of visits and nursing time.

Conclusion:

The addition of the monofilament products to our debridement portfolio use for wound management in the community represents an added value in the treatment available for patients with complex wounds with appropriate use of tight resources.

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.

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.

Objective:

In clinical studies, mechanical wound cleansing and debridement using a monofilament fibre product has been shown to be effective, and pain and traumafree.

Methods:

Two new monofilament fibre devices, both refinements of the existing Debrisoft pad, were created. The first added a pocket grip, and the second increased the size to 13 × 20 cm and retained the pocket grip. They were assessed in two acceptance evaluations.

Results:

The pads were assessed by 65 clinicians, split into two evaluations. The two new products with pocket grip was easy to handle, with a very good grip and hold. They fitted hands well, could be handled safely and were controlled and intuitive.

Conclusions:

The first product with the hand pocket met the design criteria (flexibility and stretchability of the pocket, softness and grip/hold, and easy handling). The larger pad met the design criteria regarding the fit of the pocket, safe and controlled use, and intuitive handling.

Compression, in the form of either a compression bandage or a compression stocking, has been touted as the gold standard for treatment of swelling and venous leg ulcers (VLUs). Adjustable Velcro wraps have been marketed as compression alternative. Although there is a growing body of evidence to support use of these products, there has not been a critical evaluation of the functionality of the devices to best matching product to patient presentation and ability to use the device effectively. Unlike compression garments, which are classified by compression category (class I/II or flat knit/circular), there is not an algorithm to direct health professionals to best match a specific adjustable Velcro wrap to an individual patient presentation. This small case series demonstrates that although each product performed as marketed in vitro, performance in clinical setting varied greatly dependent on patient presentation and functional skill level.

Cotton-based surgical invasive devices with their desired hemostyptic properties have been used for decades in the surgical field. However, in cardiac surgery using the heart-lung machine with direct retransfusion of suction blood, activated blood may re-enter the circulation without filtration and may trigger a cascade reaction leading to systemic inflammation and thrombosis. We therefore set out to evaluate the inflammatory potential of untreated and pyrogen-impregnated cotton-based surgical invasive medical devices. After incubation of the swabs with whole blood or PBMC, the cell-free supernatant was investigated for IL1β and IL6. While the reaction of human whole blood toward cotton swabs could not be influenced by any sterilization technique, dry heat and gamma-irradiation were able to diminish the inflammatory reaction of PBMC toward the material and the used pyrogens. In conclusion, using PBMC in direct contact to cotton we are the first to establish a suitable test method for quantification of the pyrogenic/inflammatory activity of this material. The unaltered reaction of whole blood, however, suggests a crosstalk of cells and plasma proteins in the inflammation activation that is not prevented by sterilization of the swabs. This new in vitro testing methodology may help to better display the clinical situation during development of new materials. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res B Part B: Appl Biomater, 2018.

Objective:

Effective and comfortable debridement is an important part of managing complex wounds. This user test evaluated a monofilament-fibre pad (with handle) (Debrisoft Lolly, Lohmann & Rauscher GmbH & Co. KG) in the debridement of various hard-to-reach wounds.

Method:

The multicentre, international user test was performed by experienced physicians and nurses in Germany and the UK, who used the monofilament-fibre pad in their clinical practice. After debridement, using the monofilament-fibre pad, the clinicians completed an evaluation questionnaire. The assessment comprised of performance, usability, tolerability, safety and suitability of the device for debridement, comparing it with standard methods used in the clinicians' centres.

Results:

A total of 23 clinicians in 20 centres each treated between six and 10 patients with the monofilament-fibre pad (a total of 155 wounds of different aetiologies). Most participating patients had deep wounds (n=63 (41%)) or cavity (n=31 (20%)) wounds. When compared with the standard debridement method used at the centres, the tested device was scored as ‘easier’ or ‘equally easy’ to use in all cases. When comparing the standard debridement procedure with the monofilament-fibre pad, debridement duration was reported as equal to or shorter than the standard method in 90% of cases when using the monofilament-fibre pad. Debridement efficacy was scored by the clinician as ‘better’ or ‘equal’ for the monofilament-fibre pad in 67% of cases. Overall, patients reported that the study device was comfortable.

Conclusion:

The monofilament-fibre pad effectively, easily and safely removed slough and debris from wounds of various aetiologies and was effective in wounds of different shapes, such as in cavity wounds and those in hard-to-reach locations.