This paper presents a reflection of my journey as a patient following a breast
abscess. As an experienced community nurse with a specialist interest in tissue
viability, we daily assess a range of different wound types and are adept at early
identification and management of an infected wound. We instinctively know which
dressing type to use to manage localised wound infection and slough and reduce
pain for patients; however, when the nurse becomes the patient with a wound and
has welcomed a new born child into the world, we can suddenly lose the specialist
knowledge. This paper reflects on a journey I recently experienced.
Archives
Silver Dressings for the Healing of Venous Leg Ulcer a Meta-Analysis and Systematic Review
Abstract
This study was aimed to evaluate whether silver-containing dressings were superior to other types of dressings in the treatment of
venous leg ulcers (VLU) and their specific advantages.
Eight databases (Cochrane Library, PubMed, Web of Science, Ovid-Medline, Wanfang, VIP, China Biology Medicine, and China
National Knowledge Infrastructure) were systematically reviewed from inception to May 2019 for randomized controlled trials (RCTs).
The primary outcome was complete wound healing, and the secondary outcomes included absolute wound size changes (change of
cm2 area since baseline), relative changes (percentage change of area relative to baseline), and healing rate. Two reviewers
independently evaluated the risk of bias using the Cochrane Collaboration assessment tool and extracted the data according to the
predesigned table. All analyses were performed using the latest Review Manager Software (version 5.3).
A total of 8 studies qualified and were included in the meta-analysis, including 1057 patients (experiment: 526, control: 531). Both
complete wound healing and wound healing rates were reported in 5 studies. Two and 3 studies reported the effect of silver
dressings on absolute and relative wound size changes, respectively. Most of the studies used intention-to-treat analysis.
There was sufficient evidence that silver-containing dressings can accelerate the healing rate of chronic VLU and improve their
healing in a short duration of time. However, compared with other dressings, clinical trials with long-term follow-up data are needed to
confirm whether silver dressings have advantages regarding complete wound healing.
Abbreviations: CBM = China Biology Medicine, CI = confidence interval, CNKI = China National Knowledge Infrastructure,
PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analysis, Q test = Chi-Squared test, RCTs = randomized
controlled trials, RD = risk difference, SMD = standardized mean difference, VLU = venous leg ulcers, WMD = weighted mean
difference.
Keywords: silver dressings, venous leg ulcer, wound healing, meta-analysis
Addressing Wound Chronicity Factors UrgoClean AG® and UrgoStart® Case Studies
Chronic wounds are a perennial problem in clinical practice and place a burden
on patients, their families and healthcare providers. By addressing factors that
contribute to chronicity (slough, biofilm, elevated levels of metalloproteinases
and impaired angiogenesis), in addition to managing a patient’s comorbidities,
nutritional status and lifestyle, there is a greater chance of healing. This article
discusses the mechanisms by which UrgoClean Ag and UrgoStart support a
healthy wound environment, along with two case studies of their use in practice.
A Prospective Randomized Study The Usefulness and Efficacy of Negative Pressure Wound Therapy with Lipido-Colloid Polyester Mesh Compared to Traditional Negative Pressure Wound Therapy for Treatment of Pressure Ulcers
To improve healing of pressure ulcer wounds, it is important to optimize the conditions
of the area surrounding the wound. Negative pressure wound therapy (NPWT) promotes wound
healing, however, the removal of NPWT can cause pain or focal bleeding, delaying wound healing or
causing infection. In this study, we reviewed the e cacy of the lipidocolloid non-adherent dressing
(Urgotul®) as a wound contact layer. A total of 38 patients from the same facility who applied
NPWT from April 2016 to October 2019 were included and divided into two groups; NPWT with
the lipidocolloid non-adherent dressing (group 1, experimental group, 19 patients) and NPWT only
(group 2, control group, 19 patients). The condition of the wound was examined prior to NPWT
application, at one week, and again at three weeks after application. No significant di erences were
found between groups for general characteristics, bacterial culture or photo analysis. However,
when comparing groups based on the time of examination, there was a significant reduction of the
wound size in group 1 (p = 0.001) but not in group 2 (p = 0.082). Therefore, the current study finds
that using the lipidocolloid non-adherent dressing as a wound contact layer in NPWT stimulates
healing by shrinking the size of the pressure ulcer wound.
Moving the chronic wound along the healing trajectory
Chronic wounds are an ever-growing challenge for clinicians and represent a
huge burden on healthcare resources (Harding, 2002). They have been referred
to as a silent epidemic that is affecting a large number of people in the world
population (Gottrup, 2004). However, due to a better understanding of what
makes a wound chronic, several new treatments that offer better outcomes
for the patient and a broader choice for the clinician have been developed
(Harding, 2002). A sterile, non-adherent, slough-trapping, poly-absorbent fibre
dressing with the technologie lipido-colloïde (TLC) healing matrix to promote
wound healing and enable pain-free dressing changes, which can be used for
gentle desloughing, has been developed by Urgo. The slough-trapping fibres
(poly-absorbent) have been shown to bind and trap the slough within the
dressing, providing safe and effective desloughing (Kelly et al, 2013), while the
silver lipido-colloid matrix in the antimicrobial version, has been established
in its efficacy in the management of chronic wounds presenting with a risk
of infection as demonstrated through previous randomised controlled trials
(Harding et al, 2012; Lazareth et al, 2012).
Clinical Evaluation of Technology Lipido-Colloid in the Management of Acute Wounds in China
Wound management has evolved from considering wound
dressings as a means to provide protection to a medium that enhances
wound healing and also takes into consideration patient aspects such as
atraumatic removal. Technology-lipido colloid (TLC) is described as a healing
matrix as it stimulates fibroblasts, which is achieved through maintaining a
moist wound environment. It also provides atraumatic removal, thus it not
only protects the wound but avoids unnecessary pain for the patients. This
article discusses five cases from China where the TLC was used on a variety
of wounds with positive outcomes both for the wound and the patients.
Clinical Evaluation of UrgoClean AG (Poly-Absorbent Dressing based on Technology Lipido-Colloid with Silver Ions) in the Management of Infected Wounds in Asia
Wound infections, including biofilms play a significant role in delaying
wound healing and are considered to be one of the major challenges in
wound management. The presence of non-viable tissue, such as slough, is a
prominent feature of chronic wounds and is considered as a barrier against
successful wound healing. A key component in wound care is to integrate
in our care evidence-based dressings that provides continuous cleaning,
antimicrobial activity and which are also effective against biofilms.
UrgoClean Ag is a dressing composed of cohesive poly-absorbent fibres
impregnated with a silver lipido-colloid matrix (Technology Lipido-Coloid Ag healing matrix [TLC-Ag]) that has shown very good results in clinical trials,
including a prospective, multicentre, non-comparative clinical trial, but also
large scale observational studies. In this article, we attempt to replicate the
results obtained in Europe in patients from different countries in the Asian
Continent by means of a case series.
The Importance of Pain Reduction through Dressing Selection in Routine Wound Management The MAPP Study
Objective: To discover the incidence of pain in patients with acute or chronic wounds of various
causes during dressing removal, and the effect of switching to a non-adherent dressing.
l Method: A total of 656 primary care physicians reported the relevant details of all acute or chronic
wounds observed during routine visits throughout the study period. The pain experienced during
dressing changes was systematically evaluated. In patients with moderate to severe pain, a more
extensive evaluation was performed and they were invited to complete a self-evaluation questionnaire.
If the patients were seen at a subsequent visit, a new evaluation was performed.
l Results: In total 5850 patients were seen: 2914 with acute wounds and 2936 with chronic wounds.
During dressing changes, a similar number of patients with acute and chronic wounds reported
‘moderate to severe’ pain during the medical screening visit (79.9% and 79.7%) and ‘very severe’ pain in
their self-evaluation questionnaire completed at home (47% and 59% respectively). Dressing removal
was most painful when there was adherence to the wound bed. Switching to a new, non-adherent
dressing reduced pain during dressing changes in 88% of patients with chronic wounds and 95% of
patients with acute wounds.
l Conclusion: This study demonstrates that similar problems with patient acceptability arise
irrespective of wound aetiology. Pain is a major problem and is most often related to dressing selection.
Selecting a suitable, non-adherent dressing improves patient acceptability.
Management of Burn Wounds by a Technology Lipido-Colloid Polyacrylate Dressing Impregnated with Silver A Case Series from Vietnam
Burn injuries are a mostly avoidable trauma that affect millions of people
worldwide every year. Wound healing in burn patients is complex, and
infection is one of the main clinical complications associated with wound
care in burn patients. Biofilms are mostly associated with chronic wounds,
but have also been identified in acute, traumatic wounds. This article
shows an evaluation of a TLC-polyacrylate fibre dressing impregnated with
silver to manage burn wounds of different severities, in nine patients of
different ages from Vietnam. The outcomes show encouraging results in
the management of burns when considering healing properties, and also
management of infection, desloughing and wound healing outcomes.
Evaluation of a Lipido-Colloid Wound Dressing in the Local Management of Leg Ulcers
Objective: To evaluate the efficacy, tolerance and acceptability of Urgotul and DuoDERM E dressings
in the local management of venous or mixed-aetiology leg ulcers.
l Method: This was a prospective multicentre randomised phase IV clinical trial conducted open-label
in parallel groups. It involved 20 investigating centres, including hospital dermatology and vascular
medicine departments, and private practices. Dermatologists and angiologists/phlebologists took part.
Subjects were adult, non-immunosuppressed patients presenting with a non-infected, non-malignant leg
ulcer of predominantly venous origin (ABPI >0.8). Ulcers were between 4cm2 and 40cm2 in size, with
granulation tissue covering more than 50% of their surface area. Ulcer duration ranged from three to
18 months. Patients were followed-up by the investigating physician for eight weeks on a weekly basis;
this included clinical examination, wound area tracings and photographs. Nurses (hospital or visiting)
assessed exudate volume and clinical appearance at dressing changes.
l Results: Ninety-one patients were included: 47 in the Urgotul group and 44 in the DuoDERM E
group. Baseline patient demographic data and wound characteristics were comparable in the two groups.
After eight weeks of treatment wound surface area had reduced by a mean of 61.3% in the Urgotul
group and 52.1% in the DuoDERM E group (NS); dressings were changed more frequently in the
DuoDERM E group (2.54 ± 0.57 times per week versus 2.31 ± 0.45 in the Urgotul group, p=0.047).
Thirty-three local adverse events were recorded in 27 patients: 10 in the Urgotul group and 23 in the
DuoDERM E group (p=0.039). Nurses reported better acceptability for the Urgotul dressing, based on
pain on removal, maceration and odour (p<0.0001).
l Conclusion: Both dressings showed similar efficacy for the local treatment of venous leg ulcers.
Nevertheless, medical and nursing staff reported better tolerance and acceptability for the
Urgotul dressing.