PROBLEMATIC WOUNDS UNDER COMPRESSION

EXPERIENCES IN TREATING LARGE AND/OR INFECTED VENOUS

LEG ULCERS WITH A COMPREHENSIVE THERAPY APPROACH

Roberto Brambilla1, Daniele Aloisi2, Iris Weingard3, Marco Fioruzzi4,

Thomas Heisterkamp5, Edith Janthur6, Peter Kurz7, Katrin Will8

1 Instituti Clinici Zucchi (Monza, Italy) 2 Poliambulatotio Mengoli (Bologna, Italy) 3 Venenzentrum Freiburg (Freiburg, Germany) 4 Policlinico San Marco (Zingonia, Italy) 5 Dermatologische-Phlebologische Praxis GESCHER, (Gescher, Germany) 6 Venenzentrum SAARLOUIS,(Saarlouis, Germany) 7 Wund Pflege Management GmbH (Bad Pirawarth, Austria) 8 BSN medical GmbH (Germany)

EWMA Conference 2013,

16 – 17 May, Copenhagen, Denmark

PROBLEMATIC WOUNDS UNDER COMPRESSION

Participants

EWMA Conference 2013,

16 – 17 May, Copenhagen, Denmark

Dr. I. Weingard Veins center

Dermatologist,

Phlebologist

Freiburg

Dr. E. Janthur Veins center

Dermatologist,

Phlebologist

Saarlouis

Dr. T. Heisterkamp Dermalogical-phlebological

center

Dermatologist, Phlebologist

Gescher

Dr. R. Brambilla Instituti Clinici Zucchi

Monza

Dr. D. Aloisi Poliambulatotio Mengoli

Bologna Dr. M. Fioruzzi Policlinico San Marco

Zingonia

P. Kurz Wund Pflege Management GmbH

Bad Pirawarth

PROBLEMATIC WOUNDS UNDER COMPRESSION

Venous leg ulcers represent the most important group within the family of chronic wounds.

Among them are quite large wounds or multiple smaller wounds with high microbial load.

To find treatment options applicable even for patients with multiple or larger sometimes

infected wounds, various wounds were treated according to a comprehensive therapy

conceptof compression therapy and moist wound care in daily medical practice.

Aim

EWMA Conference 2013,

16 – 17 May, Copenhagen, Denmark

PROBLEMATIC WOUNDS UNDER COMPRESSION

Methods

Large oedema

• Phase-adapted moisture management

and antimicrobial treatment without antibiotics by using a hydrophobic

wound dressing

• Reduction of oedema by short stretch bandages with high stiffness

characteristics

Reduced oedema

• Phase-adapted moisture management

and antimicrobial treatment without antibiotics by using

a hydrophobic wound dressing

• Control of oedema by a compression stocking system with

high stiffness characteristics, high working pressure during walking &

comfortably low resting pressure)

Treatment time: 2-12 weeks depending on the wound status

EWMA Conference 2013,

16 – 17 May, Copenhagen, Denmark

PROBLEMATIC WOUNDS UNDER COMPRESSION

Methods 65 cases of venous leg ulcers in in Germany, Italy, Austria were treated with compression

therapy and moist wound care: oedema reduction by stiff short-stretch compression

bandages, followed by oedema control using a stiff two-layer compression stocking

system*** (40 mmHg) in combination with phase-adapted, moist wound healing** and

antimicrobial control using a hydrophobic wound dressing***.

*JOBST® UlcerCARE Compression System, BSN medical GmbH

**Phase-adapted, moisture management Cutimed® Siltec® /L/B, BSN medical GmbH

***Antimicrobial control using a microbe-binding wound dressing Cutimed® Sorbact, BSN

medical GmbH

EWMA Conference 2013,

16 – 17 May, Copenhagen, Denmark

PROBLEMATIC WOUNDS UNDER COMPRESSION

Methods

Compression therapy

Compression stocking

system consisting of an

inner and outer stocking

delivering 40 mmHg in total.

Antimicrobial treatment

without antibiotics by using

a hydrophobic wound

dressing*

Phase-adapted moisture

management**

Compression therapy

(Short stretch

compression bandage)

EWMA Conference 2013,

16 – 17 May, Copenhagen, Denmark

*Cutimed® Sorbact, BSN medical GmbH

**Cutimed® Siltec®/B, BSN medical GmbH

***Comprilan, BSN medical GmbH

****JOBST® UlcerCARE, BSN medical GmbH

PROBLEMATIC WOUNDS UNDER COMPRESSION

Results

82 % of all wounds reduced in size significantly,

54 % of all wounds healed completely.

Also larger wounds and multiple smaller wounds were treated successfully.

Very large ulcer could be stabilized but were subsequently mesh grafted to speed up the

healing process.

As the majority of patients had not experienced any progress in healing for extended

periods of time due to their complicated health situation (e.g. underlying diseases, obesity,

signs of infection, skin problems) or inadequate treatments, the healing results were rated

very positively by patients and physicians.

The patients’ well-being was substantially improved leading to high patient compliance.

EWMA Conference 2013,

16 – 17 May, Copenhagen, Denmark

PROBLEMATIC WOUNDS UNDER COMPRESSION

August 9 2012

August 9 2012

August 9 2012

October 3 2012

September 26 2012

September 26 2012

68 years, male, smoker, ABPI 1, multiple ulcers around the leg, since 3

months, slough.

EWMA Conference 2013,

16 – 17 May, Copenhagen, Denmark

Multiple Venous Leg Ulcers

PROBLEMATIC WOUNDS UNDER COMPRESSION

August 8 2012

April 19 2011

October 12 2012

June 31 2011

EWMA Conference 2013,

16 – 17 May, Copenhagen, Denmark

59 years old, male, adipositas, inhibited perfusion, since 3 months, disturbed

wound healing, signs of infection

82 years, male, hypertension, inhibited perfusion of the leg, ulcer since 3

months, ABPI 1

Large Venous Leg Ulcers

PROBLEMATIC WOUNDS UNDER COMPRESSION

Conclusion

EWMA Conference 2013,

16 – 17 May, Copenhagen, Denmark

Even multiple or larger venous leg ulcers can successfully be treated, if a clear

comprehensive treatment concept, consisting of phase adapted moist wound healing,

anti-microbial wound treatment and compression is followed.