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Wound management: old myths and scientific evidence

At a B. Braun symposium in Brussels new scientific and clinical findings were presented. A summary.

Melsungen/Brussels. Optimal treatment for difficult-to-treat wounds can be challenging for healthcare professionals and caregivers – especially with concern to the growing number of elderly patients. Chronic wounds have an enormous impact on patients’ quality of life and on health care resources. At the B. Braun symposium intriguing new scientific and clinical findings were presented which provide an overview of the latest research, perspectives and the state of the art in wound management. Leading experts in the field of wound care address how wound treatment can be standardized and optimized with proper wound bed preparation and innovative wound dressings.

In the first lecture, Prof. Dr. Luc Téot, Montpellier/France, discussed the problem that a universal consensus for the best available procedures in wound care does not exist. However, different protocols of care depending upon practitioner habits, patients’ demands, agency and/or company recommendations are available. Standards for optimized wound treatment must be easy to implement, easy to teach and affordable, Téot emphasized. Beside the therapist’s experience and the patient’s condition, further relevant parameters of successful wound healing are  the hygienic state of the wound, properly performed wound bed preparation and the choice of appropriate wound dressings. Optimization of care is the most important parameter because it is often the only possibility to facilitate healing. This, in turn, depends mainly on the application of the right product at the right time. Given the local reimbursement situation in different countries, there is of course a risk that cost factors may lead to an inadequate and sometimes even inappropriate treatment regime.

Wound bed preparation – what has changed?
With the introduction of the TIME framework as a tool for the “best practice” in wound bed preparation (WBP) the four main and most important components of wound care are: tissue, infection, inflammation, moisture and edge. One of the central requirements to accelerate wound healing is a properly performed debridement followed by thorough wound cleansing to diminish bacterial biofilm, necrotic tissue and detritus. These wound coatings may inhibit the processes involved in wound healing. Prof. Dr. Gerit D. Mulder, San Diego/USA, reviewed recent advances in promoting endogenous wound healing by a cleansing solution and gel which contain polyhexanide and betaine (Prontosan). Several clinical trials demonstrate the success of WPS with a  polyhexanide and betaine containing agent. In a randomized controlled trial, the cleansing solution reduced the pH value in wounds which is a surrogate marker for bacterial burden.  In a further randomized study the gel was shown to lead to  faster wound size reduction in chronic wounds.  Moreover, it has been demonstrated that a combination of the solution and the gel lead to a wound closure in 80% of the patients with improved wound assessment findings.  Additionally, it has been reported that wound cleansing with the polyhexanide and betaine containing solution may accelerate healing compared with traditional cleansers such as normal saline or Ringer’s solution.

New challenges in wound dressings
The increasing understanding of wound biology has led to major improvements in wound dressings. Modern wound management not only focuses on healing the wound but also on the patients’ quality of life, Prof. Dr. Sylvie Meaume, Paris/France, reported. Moist wound therapy provides a healing environment conductive to natural healing conditions. The most advanced wound dressings consist of polymers which provide  good control of absorption and fluid handling. In dressings from the Askina range, silicone adhesives have been integrated to provide more comfort through atraumatic dressing removal. On the other hand, exudate may pass through the silicone adhesive quickly into the polymer foam. Due to the controlled absorption, there is a reduced risk of maceration at the wound edges. Moreover, the addition of ionic silver into the matrix formulation may reduce bacterial load and local infection. Given, the increasing number of elderly patients with chronic wounds, cost-effectiveness of wound care is a further challenge in the management of chronic wounds. Strategies should be developed to identify and deliver best available care while limiting complications and costs, Meaume emphasized. With the Askina product range – utilizing different technologies – effective dressings for each phase of wound healing are available. By applying the right products, at the right time, in the right order and manner, faster and sustained wound healing could be achieved. This, in turn, may be beneficial for  patients and cost-effective for health systems.

B. Braun has developed a comprehensive range of wound care products which enables optimal wound management by supporting and accelerating endogenous healing. B. Braun Wound Care products focus on every type of wound at each phase of wound healing. By providing innovative solutions such as Prontosan Wound Irrigation Solution, bacterial biofilm can be efficiently removed thereby clearing the way for application of advanced wound dressings from the Askina range, to assist in the complex task of tissue repair.

Please visit www.prontosan-bbraun.com and www.bbraun.com for more information.


Symposium „Myth or Reality in Chronic Wound Management “, EWMA congress, Brussels, May 25th, 2011
  Romanelli  et al. Evaluation of the efficacy and tolerability of a solution containing propyl betaine and polihexanide. Skin Pharmacol Physiol 2010; 23 (Suppl 1): 41-44
  Valenzuela AR, Perucho NS. The effectiveness of a 0.1% polyhexanide gel. Rev ROL Enf 2008; 31: 247-252
  Moeller A et al. Experiences in using polyhexanide containing wound products in the management of chronic wounds – results of a methodical and retrospective analysis of 953 cases. Wundmanagement 2008; 3: 112-117
  Andriessen AE, Eberlein TE. Assessment of a wound cleansing solution in the treatment of problem wounds. Wounds 2008; 20: 171-175