Evaluation of three nonwoven sponges in the debridement of chronic wounds.

A total of 15 evaluable patients were entered into a non-randomized evaluation with a primary goal to determine the efficacy of three approved nonwoven sponges, an 8 x 8 mesh with 64 apertures per square inch, a 13 x 13 mesh with 169 apertures per square inch, and a 19 x 8 mesh with 152 apertures per square inch, in the debridement of necrotic and fibrotic tissue. Patients were assigned to one of three sponge categories and then followed on a twice-a-week basis for four weeks. At each visit, the wound status was evaluated for the presence of necrotic and fibrotic tissue in the wound. Wounds were cleansed with sterile saline solution, and a saline moistened nonwoven fluffed sponge was applied to the wound surface and covered with a secondary wound dressing. Dressings were changed twice a day. The results suggest that all products were effective in debridement of nonviable tissue, but the best overall results were obtained with the 8 x 8 mesh product which more effectively debrided the wounds than the nonwoven sponges with the smaller apertures. The study results suggest that open mesh 100 percent cotton nonwoven sponges are effective in debriding nonviable tissue with minimal damage to viable tissue when appropriately used and not allowed to desiccate.

Cost-effective managed care: gel versus wet-to-dry for debridement.

Cost-effective managed care must take into consideration all funds expended for treatment, including related materials and labor from treatment initiation until treatment endpoint is attained. The cost-effective debridement of a chronic wound is dependent on the total labor and materials cost entailed from initiation of treatment up to the transition period (time when the wound is debrided). The purpose of this analysis was to compare the cost of a hypertonic hydrogel with polyurethane secondary dressing to a saline moistened gauze (standard wet-to-dry technique) as debriding agents for dry eschar. The results showed that the daily cost of treatment was slightly higher with the hydrogel/polyurethane method than with the wet-to-dry method. However, the hydrogel/polyurethane method was a more cost-effective means of debriding these wounds when taking into account the time required to reach > or = 50 percent debridement along with time to change dressings and amount of materials needed. Considerations in choosing a treatment modality must include product cost along with average number of treatment days required to reach the treatment goal. This study shows that neither individual cost nor daily cost of a material may necessarily dictate overall cost-effectiveness.

Enhanced healing of ulcers in patients with diabetes by topical treatment with glycyl-l-histidyl-l-lysine copper.

A multicenter, randomized, evaluator-blinded, placebo-controlled clinical study was conducted to evaluate the safety and effectiveness of glycyl-l-histidyl-l-lysine: copper complex (lamin Gel) in the treatment of diabetic neuropathic ulcers. All patients were enrolled in an aggressive standardized wound care protocol consisting of sharp debridement at study entry, daily application of a metered dose of drug, standardized pressure-relieving footwear, and patient education relating to diabetes control and activity modifications. Treatment with lamin Gel significantly increased the percentage of closure of plantar ulcers (98.5% median area percentage closure compared with 60.8% for vehicle; p < 0.05) and the proportion of patients healing 98% or better. The rate of closure was three times faster with lamin Gel treatment compared with standard care and vehicle. The enhancement of wound closure was more pronounced (median of 89.2% compared with -10.3% for vehicle; p < 0.01) in larger (greater than 100 mm(2) initial area at study entry) plantar ulcers caused by the failure of this size of ulcer to respond adequately to standardized wound care treatments in the absence of lamin Gel. Treatment must commence immediately after the initial wound debridement to obtain optimal enhancement of the ulcer closure. The incidence of ulcer infections was significantly lower (7% incidence compared with 34% for vehicle, p < 0.05) in the plantar ulcers treated immediately after debridement with the lamin Gel.

Prospective randomized study of the efficacy of hydrogel, hydrocolloid, and saline solution-moistened dressings on the management of pressure ulcers.

A total of 67 patients with pressure ulcers were randomized into one of three treatment modalities: hydrogel sheet dressing, hydrocolloid, or wet-to-moist gauze. Safety, efficacy, and physical attributes of the three dressings were evaluated. No statistical significance was found in wound healing rate among the three treatments. Hydrogel sheets were advantageous in allowing wound visualization without dressing or wound disruption.

Treatment of open-skin wounds with electric stimulation.

A randomized double blind multi-center study of electric stimulation compared with sham units enrolled 59 patients (67 wounds) with open wounds of pressure, vascular and surgical etiology at nine sites. The 14-week study consisted of a four-week phase, randomized, parallel-group, double blind, sham stimulation controlled group comparing effectiveness and tolerance of electric and sham stimulation of open wounds. Patients with wounds not completely closed at the end of the four weeks were allowed to cross over to actual treatment. After four weeks of treatment, the electric stimulation group showed a 56% decrease in size with only a 33% decrease in size with sham treatment. Available data suggest that pulsed electric stimulation should be considered by health care practitioners as an adjunct for treating open wounds.

Venous ulcers: pathophysiology and medical therapy.

Venous ulcers may occur as a result of lower extremity calf pump failure, with ensuing edema, trapping of white blood cells and deposition of pericapillary fibrin. Acute, smaller lesions are easily treated with adequate compression and occlusive dressings. Larger, more chronic wounds often benefit from some form of external compression. Occlusive dressings and local wound care are most effective when used simultaneously with compression. Sequential compression pumps merit study and may prove to be of therapeutic and prophylactic value. In refractory cases, long-term use of compression devices may be required to prevent ulcer recurrence.

Ulceration and osteomyelitis.

The pathophysiology, mortality, and morbidity of osteomyelitis and ulcers are discussed, including making the diagnoses. Treatments described include topical and surgical methods as well as hyperbaric oxygen therapy.

Preliminary observations on clotting under three hydrocolloid dressings.

Four patients with five wounds were randomly assigned to treatment with three occlusive dressings: DuoDERM, Restore and Comfeel Ulcus; the dressings were left intact for 24-48 h. When the dressings were removed, it was found that wounds that had been covered with Restore and Comfeel contained coagulated sanguinous material. Two wounds that had been covered with Comfeel and Restore, respectively, were then covered with DuoDERM, while one wound previously covered with DuoDERM was covered with Restore. Either no clotting occurred under DuoDERM or clots may have resolved. Although these preliminary data suggest that DuoDERM gel may have fibrinolytic properties, more extensive and controlled studies are needed to assess the characteristics of this dressing.

Decubitus ulcers: update on new approaches to treatment.

Decubitus ulcers are best treated by eliminating the primary etiology, pressure, while supplementing care with the best available treatment modality. Knowledge of new treatment modalities and appropriate selection will help expedite wound closure. Pressure-relieving devices should not be relied upon to eliminate all pressure from the wound. Pressure relief should be supplemented with choice of appropriate dressings and additional therapy. The use of electrical stimulation, biomaterials, and growth factors may soon become available as additional modalities to expedite closure and facilitate wound repair.

Synthetic membranes. Use in diabetic ulcers.

Diabetic ulcers may increase patient morbidity and mortality, necessitating fast and effective treatment to obtain wound closure. Synthetic membranes, when appropriately used, provide a simple and efficient means of treating more superficial lesions. When used as an adjunct to proper wound debridement and care, successful closure can be expected.

Clinical evaluation of a new occlusive hydrocolloid dressing.

Eighteen patients with a total of twenty-four dermal ulcers of varying causes and unresponsive to other conservative treatment were treated with a new hydrocolloid dressing. All lesions healed in less time than with other modalities. This hydrocolloid dressing is more effective than others presently available for the treatment of noninfected dermal ulcers.