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Advances in Diabetic Foot Care Explorer and Post Hoc Studies by Prof Michael Edmonds
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Clinical Evaluation of a Dressing with Poly-Absorbent Fibres and a Silver Matrix for Managing Chronic Wounds at Risk of Infection A Non-Comparative Trial
Objective: To assess the efficacy, safety and acceptability of a new
silver poly absorbent dressing (UrgoCleanAg) in the local management
of exudative chronic wounds at risk of infection, with inflammatory
signs suggesting heavy bacterial load.
Method: This prospective, multicentre, non-comparative clinical trial
was conducted in French hospital wards (dermatology and vascular
medicine) or specialised private-practice physicians. Patients were
considered at high-risk of infection when presenting with at least three
of five selected inflammatory clinical signs, suggesting a heavy
bacterial load (pain between two dressing changes, erythema, oedema,
malodorous wound and presence of a heavy exudate). They were
treated for a maximum period of four weeks, and followed by the
physician on a weekly basis, including a clinical examination, area
tracings and photographs. The primary efficacy criterion of the trial was
the relative wound surface area reduction at the end of the four weeks
of treatment. Acceptability was documented by the nursing staff at
each dressing change between the weekly evaluations.
Results: We recruited 37 patients with chronic wounds. Wound
surface area, mostly covered by sloughy tissue, was reduced by 32.5%
at the end of the treatment (median value), while the clinical score
(maximum value of 5, based on inflammatory clinical signs) decreased
from 4.0 to 2.0. Effective debridement properties were documented
(62.5% relative reduction of sloughy tissue at week 4; 58.8% of
debrided wounds at week 4) and improvement of the periwound skin
status was noted (healthy for 28.6% of the patients at week 4 versus
2.7% at baseline). In addition, the tested wound dressing presented a
good safety profile associated to a high level of acceptability, noted by
both patients and nursing staff.
Conclusion: These clinical data support that the tested dressing is a
credible therapeutic alternative for the management of chronic
wounds at risk of infection with inflammatory signs suggesting heavy
bacterial load.
Declaration of interest: This study was sponsored by a grant from
the pharmaceutical company Laboratoires Urgo. S. Bohbot and Z.
Lemdjadi are employees of Laboratoires Urgo. L. Sigal has received
monetary compensation as a speaker for Laboratoires Urgo. Data
management and statistical analyses were conducted independently
by Altizem.
Use of a TLC-Ag dressing on 2270 patients with wounds at risk or with signs of local infection an observational study
Objective: A description of wounds treated with a poly-absorbent silver dressing (with technology lipido-colloid with silver ions, TLC-Ag), and evaluation of the short-term clinical impact of the dressing on the wound healing process, under real-life conditions.Method: A large, prospective, multicentre, observational study of patients in 81 centres in Germany, presenting with an exuding wound at risk or with clinical signs of local infection for whom the evaluated TLC-Ag dressing (UrgoClean Ag, Laboratoires Urgo, France) has been prescribed. Main outcomes included: reduction in number of wound infections diagnosed and clinical signs of local infection, wound healing rate, clinical assessment of wound healing progression, relative wound area reduction (RWAR), local tolerability, handling and acceptance of the dressing.Results: A total of 2270 patients with acute and chronic wounds of various aetiologies were treated with the evaluated dressing for a mean duration of 22±13 days. All clinical signs of local infection and the diagnosed wound infections were substantially reduced at two weeks after the treatment initiation. All wound infection parameters continued to reduce until the last visit. In the meantime, clinical improvement in wound healing was reported in 98.9% of acute wounds, with a wound closure rate of 68.5%. In chronic wounds, a median RWAR of 57.4% was achieved, with an improvement in healing process documented by clinicians in 90.6% of cases, stabilisation in 6.1% and worsening in 3.2%. Similar results were reported, regardless of exudate level and proportion of sloughy and granulation tissues in the wound bed at baseline. The dressing was well tolerated and well accepted by both patients and health professionals.Conclusion: These results, documented in a large cohort of patients treated in current practice, support and complete the clinical evidence on the healing properties and safety prole of the TLC-Ag dressing in the management of wounds at risk or with clinical signs of local infection, regardless of wound and patient characteristics.Declaration of interest: This study was supported by a grant from Laboratoires Urgo. UM, EB, LT and SB are employees of Laboratoires Urgo. JD, KCM and MD provided advisory and speaking services to pharmaceutical and other healthcare organisations including, but not limited to, Laboratoires Urgo. Data management and statistical analyses were conducted independently by INPADS GmbH, Germany
TLC-Ag dressings a prospective, multicentre study on 728 patients with wounds at risk of or with local infection
Objective:This study aimed to evaluate the management of an unselected cohort of patients with wounds at risk of or with clinical signs of local infection, treated with two antimicrobial contact layers impregnated with silver (TLC-Ag healing matrix), under real-life conditions during the COVID-19 pandemic.
Method:A large, prospective, multicentre, observational study with two TLC-Ag dressings (UrgoTul Ag/Silver and UrgoTul Ag Lite Border, Laboratoires Urgo, France) was conducted in Germany between May 2020 and May 2021. The main outcomes included a description of the treated patients and their wound management, the changes in wound infection and wound healing outcomes over a maximum period of four weeks of treatment, as well as the overall clinical assessment of the performance, local tolerance and acceptability of dressings.
Results:A total of 728 patients with wounds of various aetiologies and wound infection status were treated with the evaluated dressings in 39 centres for a mean duration of 26±19 days, with an intermediate visit conducted in 712 (97.8%) patients after a mean period of 12±9 days. At the initial visit, it was established that the majority of patients (60.4%) had a wound infection, while the remaining cohort presented first clinical signs of a local wound infection (25.1%) or were at risk of wound infection (13.2%) (unclear status in 1.2%). Throughout the study period, all the parameters of wound infection continuously decreased, resulting at the final visit in a reduction by 78.9% of the prevalence of local wound infections and by 72.0% of the clinical signs of wound infection, the most rapidly diminished clinical sign being wound deterioration. Concurrently, in terms of the healing process, 92.1% of the wounds healed or improved, 3.2% remained unchanged and 1.7% worsened (data missing for 3.0%), and an improvement of the periwound skin was reported in 65.7% of the patients. Overall, the two dressings were ‘very well accepted’ by the majority of patients, with no uncomfortable feeling at wearing and no pain at dressing removal, and were assessed by the physicians as ‘very useful’ in the majority of the cases with a ‘very good’ efficacy in terms of antimicrobial activity and promotion of the wound healing process. Similar results were reported regardless of the wound type treated or of the TLC-Ag dressing evaluated.
Conclusion:These results are consistent with previous clinical evidence on TLC-Ag dressings. They support the good efficacy, good tolerability and usefulness of these antimicrobial dressings in the management of patients with wounds at risk or with clinical signs of local infection, in association with appropriate standard of care.