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Introduction:

Wound debridement represents a central pillar of the treatment of patients with chronic wounds and is essential in order to be able to carry out further therapeutic measures. Debridement can however often be associated with considerable pain for patients, so that either a radical debridement is not carried out, or analgesia or even surgical intervention with endotracheal anaesthesia are necessary. For patients on whom a particularly adherent fibrinous coating must be removed, a new wound debridement product* made of polyester monofilament fibres represents a new pain-free, therapeutic option.

Material and Methods:

In our case series, we present five patients from a dermatology wound care clinic with very painful, chronic wounds. The following were diagnosed amongst the patients: one epidermolysis bullosa simplex, one pyoderma gangraenosum, one Martorell’s hypertensive leg ulcer, one leg ulcer in metabolic disease, and one gram-negative infection of the foot. With all patients, it was impossible to carry out surgical debridement under local anaesthetic due to extreme pain. In order to avoid surgical debridement with endotracheal anaesthesia, debridement was carried out on these patients using the new product*.

Results:

With all patients, it was possible to achieve a virtually complete removal of the fibrinous coating through single use of the debridement product*, heavily humidified with physiological saline solution, without other analgesic measures.

Conclusion:

Wound debridement using the new debridement product* presents a non-invasive, virtually pain-free alternative, in particular for patients with very painful chronic wounds with pronounced fibrinous coatings. This new treatment option can also be carried out ambulant without the need for considerable material or time.

Introduction:

Efficacy of a adebridement product and a bcollagen dressing on inflammation reduction and re-starting healing was evaluated in ten frail elderly patients with stagnating skin lacerations, treated in a nursing home setting. Skin tears often occur in these patients, due to their poor condition and their medication such as corticosteroids and anti-coagulants.

Methods:

Case ascertainment was used. Patients received a bcollagen dressing and a cfoam or an dalginate as a secondary dressing, for a maximum of 14 days, after which the bcollagen dressing was discontinued and the cfoam used as a primary dressing. A tubular compressione system was used to reduce oedema that was present

in the leg. Wound healing was assessed using clinical observation and digital photographs, comparing day 0 versus day 14 results. Patients were then followed up until wound closure.

Results:

Eight women and two men were included and completed the study period. Patients had a mean age of 76 years (ranging from 62-100 years). All included wounds had closed within 12 weeks of treatment. Two typical cases are included to demonstrate the results.

Conclusion:

The results indicate that the use of the bcollagen dressing stimulated wound healing in these stagnating wounds. Moreover the bcollagen dressing has effectively stopped the bleeding.

Introduction:

Evaluation of a treatment regime to prevent lower limb amputation in a patient with a venous – arterial - lymphatic leg ulcer. The 66-years-old female patient had an extensive leg ulcer (28.6 cm2) that had been stagnant for three years (Fig.1). She is divorced, lives alone and has two daughters. She has a long history of severe rheumatoid arthritis and is a heavy smoker (25 cigarettes/day). She is somewhat mobile with a walker but spends most of her time in a wheelchair. Her nutritional status is moderate. Patient reported pain was VAS 8.5.

Methods:

The vascular surgeon has proposed an amputation, but the patient is adamant to keep her leg. She was therefore discharged from the rehabilitation clinic and received her care now in the community. She reports to be angry with the surgeon and is anxious about her future. Although her leg is slim there is edema present (Fig. 3). The wound bed is covered with 95% slough and a small amount of unhealthy looking granulation tissue is present (Fig. 2). Further vascular assessment and biopsies ruled out vasculitis and malignancies (Fig. 4 and Fig. 5).

Results :

After 8 months the ulcer area had reduced from 28.6 cm2 to 19.1 cm2 (66%) with a healthy looking wound bed. She has stopped smoking, her mobility has improved. The patient is motivated to continue with the treatment and is much more active than at the start of the treatment. She expressed that slowly but gradually she is getting back her life.

Conclusion :

The multidisciplinary approach provided effective care in the community enabling the patient to improve her condition to spare her leg.