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AIM

The optimal pressure to reduce chronic extremity swelling is still a matter of debate. The aim of this paper was to measure volume reduction of a swollen extremity depending on the amount of pressure exerted by compression stockings and inelastic bandages.

METHODS

Thirty-six patients with unilateral breast cancer related arm lymphedema were investigated in a lymph clinic in the Netherlands, 42 legs with chronic edema of the lower extremities were examined in a phlebological centre in Italy. The arm-patients were randomized to receive inelastic arm bandages with a pressure between 20-30 mmHg or 44-68 mmHg. The leg patients were either treated with compression stockings (23-32 mmHg) or with inelastic bandages (pressure 53-88 mmHg). Water-displacement volumetry and measurement of leg circumference was performed before and after compression.

RESULTS

In the arm-patients low pressure after 2 hours achieved a higher degree of volume reduction (-2.3%, 95% CI 1.0-3.6) than high pressure (-1.5%, 95% CI 0.2-2.8) (n.s.). In patients with leg edema compression stockings in the range between 20 and 40 mmHg showed a positive correlation between exerted pressure and volume reduction, bandages applied with an initial resting pressure of more than 60 mm Hg resulted in a decreasing volume reduction.

CONCLUSION

There is obviously an upper limit beyond which further increase of compression pressure seems counterproductive. For inelastic bandages this upper limit is around 30 Hg on the upper and around 50-60 mmHg on the lower extremity.

Currently, there are no generally accepted definitions for wounds at risk of infection. In clinical practice, too many chronic wounds are regarded as being at risk of infection, and therefore many topical antimicrobials - in terms of frequency and duration of use - are applied to wounds. Based on expert discussion and current knowledge, a clinical assessment score was developed. The objective of this wounds at risk (W.A.R.) score is to allow decision-making on the indication for the use of antiseptics on the basis of polihexanide. The proposed clinical classification of W.A.R. shall facilitate the decision for wound antisepsis and allow an appropriate general treatment regimen with the focus on the prevention of wound infection. The W.A.R. score is based on a clinically oriented risk assessment using concrete patient circumstances. The indication for the use of antiseptics results from the addition of differently weighted risk causes, for which points are assigned. Antimicrobial treatment is justified in the case of 3 or more points.

OBJECTIVE

This cohort study evaluated the clinical efficacy of a polyhexanide-containing biocellulose dressing, Suprasorb X+PHMB (Lohmann & Rauscher GmbH), for the eradication of biofilms in non-healing wounds. Polyhexanide (PHMB) has been shown to have microbicidal activity when applied to chronic wounds and burns.

METHOD

Twenty-eight patients, aged over 18 years, who presented at an outpatient wound clinic with non-healing locally infected and/or critically colonised wounds of various aetiologies that showed clinical signs of biofilm were included in the study. Sixteen patients (nine females), with a mean age of 60.9±21.6 years, were included in the analysis. The patients were prospectively followed for a maximum of 24 weeks or until healing for analysis of safety and efficacy endpoints. Evolution of wound size was conducted with tracings and standardised digital photographs as well as for determining healing rates.

RESULTS

At 24 weeks,12 wounds (75%) had healed (complete epithelialisation with no drainage). Of those wounds that had not closed, the mean wound area had reduced by 61% at week 24. Ten patients (63%) had a good reduction of the biofilm, five (32%) scored moderate and one (6%) had no reduction noted at week 24. The mean percentage of granulation tissue had increased significantly (p<0.04) when comparing day 0 (38%) with week 24 (77%). Yellow tissue present in the wound bed decreased (p<0.01): 62% (day 0) versus 23% (week 24). All patients reported reduced pain after dressing change.

CONCLUSION

The results suggest that continuous application of PHMB, using a biocellulose wound dressing, reduced biofilm in the stagnating wounds treated, thus promoting healing. The treatment was comfortable, safe and reduced wound pain at dressing change. The PHMB-containing biocellulose dressing seems to be suitable for lightly to moderately exuding wounds.

DECLARATION OF INTEREST

This study was supported by a scientific grant from Lohmann & Rauscher.

OBJECTIVE

A prospective, randomized, controlled single center study was designed to evaluate clinical efficacy of a polyhexanide containing bio-cellulose dressing (group B) compared to a silver-sulfadiazine cream (group A) in sixty partial-thickness burn patients.

PATIENTS AND METHODS

Local ethics committee approval was obtained and patients consented. Parameters were: pain reduction (VAS), healing time and wound bed condition, comparing day 0 (start) versus day 14 (end), as well as, ease of dressing use and treatment costs.

RESULTS

All completed the study (n=30/n=30) and were included in the ITT analysis, with a total of 72 burns (group A: n=38, group B: n=34). We noted no differences in healing time. Pain reduction was significantly faster and better in group B (p<0.01). There were fewer dressing changes in group B, compared to group A. Ease of use for the bio-cellulose dressing was rated better compared to group A. In group B, € 95.20 was saved for a 10 day treatment period, compared to group A.

CONCLUSION

Group B demonstrated a better and faster pain reduction in the treated partial-thickness burns, compared to group A. The results indicate the polyhexanide containing bio-cellulose dressing to be a safe and cost effective treatment for partial-thickness burns.

OBJECTIVE

To evaluate the clinical benefits, primarily tolerability and reduction in pain levels, associated with the use of a PHMB-impregnated biosynthetic cellulose dressing (Suprasorb X + PHMB) on paediatric heel lacerations.

METHOD

These lacerations were caused when children, who were being transported on their parents' bicycles, got their heels trapped in the wheel spokes. Where these injuries just comprised skin contusion and laceration, treatment had previously comprised cleansing followed by application of conventional dressings and moist wound healing dressings. However, the high incidence of infection necessitated regular dressing changes, which caused parents and children stress and anxiety. This clinical evaluation assessed the benefits of a new treatment protocol, where the PHMB-impregnated biocellulose dressing was applied and left in situ until epithelialisation occurred. A cork splint was used for 3 days to prevent pes equinus and to let the ankle joint rest. Change in wound size (cm²), incidence of local infection, wound bed characteristics and pain levels (measured on a 0-10 paediatric pain scale) were assessed at 3-day intervals during the 14-day treatment period. Satisfaction with the dressing was also evaluated.

RESULTS

Twenty children (mean age 5.6 years (± 1.33) were recruited into the study and included in the analysis. The mean baseline wound area was 8.60cm² (± 6.57). The mean time to complete wound closure was 12.95 days (± 7.69) with a mean total of 4.70 visits (± 1.56). The mean VAS pain score was 9.55 (± 0.69), compared with 0.15 (± 0.37) on day 14 (p<0.003). At the second visit (after 3 days) 17 of the 20 children were reported to be free of pain. No cases of local infection were noted.

CONCLUSION

The dressing was found to be child and parent friendly. The evaluation also showed that it was well tolerated and achieved good healing outcome. It has now been incorporated into the clinic's treatment protocol for these wounds.

CONFLICT OF INTEREST

None. The authors have no relevant financial interest in this article. All authors were involved in the critical revision of the manuscript for important intellectual content.