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2012-04-16

Askina Calgitrol Paste: new ionic silver-containing wound dressing

The innovative, highly conformable Askina Calgitrol Paste appears to be particularly valuable in difficult-to-manage wound shapes.

Melsungen (Germany) – Askina Calgitrol Paste is a new ionic silver-containing wound dressing which allows an optimized intimate contact between the wound area and the antimicrobial silver ions which are produced from the silver alginate matrix. It contains on average twelve milligram of ionic silver per gram of paste which is more than in most other dressings. ”The paste is easy to use, contributes to an effective wound healing-process and is well tolerated”, said the nurse Frans Meuleneire from Zottegem, Belgium. The new formulation complements the existing range of Askina Calgitrol dressings covering its use in all fields of infected or critically colonized wounds. Askina Calgitrol Paste appears to be particularly valuable in difficult-to-manage wound shapes such as those with tunnels and sinuses as seen in patients with second-degree burns and diabetic foot ulcers. This new presentation of Askina Calgitrol Ag overcomes the disadvantage of rigid forms of established fiber, foam and mesh-based wound dressings by its new semi-liquid and viscosity–adapted consistency [1].

Considering the increasing number of elderly patients with type-2-diabetes and chronic wounds, it is of particular importance to provide the best available dressing care, dressings should therefore be comfortable for patients, effective in their contribution to wound healing and easy to  handle. A major concern is the management of wound infections since bacterial colonization of wounds can delay wound healing and increases morbidity and mortality. Treatment-resistant wound infections frequently result in serious complications, including sepsis and amputations [1]. The use of ionic silver-containing wound dressings is a well-established approach [1] in the management of wounds infected with antibiotic resistant microorganisms, keeping in mind that silver exploits its antimicrobial activity even against antibiotic resistant strains of bacteria. Silver containing wound dressings may lead to a reduction of bacterial bioburden [2] and ionic silver has been shown to have a broad antimicrobial effect. This beneficial action is based on three bactericidal mechanisms: Firstly, disruption of synthesis, structure and function of bacterial enzymes and proteins important for bacterial metabolism and growth. Secondly, damage of the bacterial cell wall; thirdly, inhibition of bacterial DNA replication and cell division [3, 4]

Askina Calgitrol: Support of wound healing by release of silver ions
Askina Calgitrol is a range of wound care products which release ionic silver at bactericidal concentrations from an alginate matrix into the wound bed. Askina Calgitrol Paste, the newest product of the range, is an amorphous and homogeneous paste which contains a high ionic silver concentration of approximately 12 mg/g (i.e. 180 mg ionic silver/15 g paste) from the silver alginate matrix. The matrix provides a controlled and steady diffusion of silver ions into the wound, reaching immediate and effective antimicrobial concentrations in the wound bed. The controlled release of silver ions ensures a sufficiently high antimicrobial activity in the wound without the risk of over delivery, skin discoloration and systemic toxicity. Askina Calgitrol Paste demonstrates antimicrobial effectiveness against gram-positive and gram-negative bacterial strains including methicillin-resistant S. aureus (MRSA), P. aeruginosa, and E. coli. The paste has been shown to be well tolerated after topical application.

Intimate contact with the wound bed
Due to its amorphous substance characteristics Askina Calgitrol Paste fits easily into the wound bed, at the same time providing an optimal contact between the active ionic silver alginate matrix and the entire wound surface. Any “dead spaces” allowing bacterial colonization can therefore be prevented. The paste supports the maintenance of a moist wound healing environment and does not require any activation by water prior to use. Askina Calgitrol Paste is supplied sterile in a tube with a long cannula. By means of the cannula the paste may be applied easily into tunnels, sinuses and awkward wound shapes. After application, the wound is covered with a secondary dressing to keep the paste in close contact with the wound. Askina Calgitrol Paste can be removed by simple cleansing with sterile saline or Prontosan solution.

Broad range of indications
Askina Calgitrol Paste is indicated for the treatment of difficult-to-manage acute and chronic wounds, such as pressure ulcers , venous and arterial leg ulcers, diabetic foot ulcers, and second degree burns. It may be used on infected wounds under medical supervision. The new format complements the already existing ionic silver-containing wound dressings, Askina Calgitrol Ag and Askina Calgitrol THIN, which are adaptively suited to flat or superficial wounds.
Askina Calgitrol Paste seems to have a positive effect in the management of pressure ulcers as observed in a recent case series conducted by Frans Meuleneire in Zottegem, Belgium. In his observation patients (n=10) suffering from pressure ulcers graded at stage II were treated with Askina Calgitrol paste. “During the follow-up period of 8 weeks (or less if the wounds were completely healed) a significant positive evolution of the wounds was observed during the period where the evaluated silver alginate paste was used”, said Frans Meuleneire. The amorphous paste was reported to fill the entire wound bed area closely. Dressing change was said to be painless and comfortable for the patients [5]. In another pilot study conducted by the same investigator on complex diabetic foot wounds (n=5), it was observed that only a few weeks after surgery, the wound cavity is  covered by  granulation tissue; no pain was recorded. The paste was found to offer a new perspective in antibacterial treatment of diabetic foot ulcers [6].

Conclusion
Askina Calgitrol Paste can be considered an innovative and highly conformable wound dressing which provides an immediate and sustained release of ionic silver from the alginate matrix into the wound according to in-vitro studies. It complements the existing range of Askina Calgitrol dressings (Askina Calgitrol Ag and Askina Calgitrol Thin) containing ionic silver in the form of a patented silver alginate matrix. This technology makes them ready for use. These dressings do not require prior wetting to prime activity. The major advantage of the new product is its ability to conform to difficult-to-manage wound shapes, tunnel wounds, and small sinuses. Application and removal of Askina Calgitrol Paste was observed to be easy and painless for the patient.

B. Braun - Sharing Expertise. B. Braun supplies the global healthcare market with products for anesthesia, intensive medicine, cardiology, extra corporeal blood treatment and surgery, as well as services for hospitals, general practitioners and the homecare sector.  Through dialogue with those who are using B. Braun’s products, the company is continually gaining new knowledge which it incorporates into product development.  In this way, the company contributes with innovative products and services towards optimizing working procedures in hospitals and medical practices all over the world and improving safety – for patients, doctors and nursing staff. With 44,000 employees in 50 countries, B. Braun generated sales in 2011 of more than EUR 4.6 bn.


References
[1] Opasanon S et al.: Askina Calgitrol made easy. Wounds International, Volume 3, Issue 1, March 2012
[2] Leaper DJ: Silver dressings: their role in wound management. Int Wound J 2006; 3: 282-294
[3] Feng QL et al.: A mechanistic study of the antibacterial effect of silver ions on Escherichia coli and
     Staphylococcus aureus. J Biomed Mater Res 2000; 52: 662-668
[4] Lansdown AB et al.: A pharmacological and toxicological profile of silver as an antimicrobial agent in
     medical devices. Adv Pharmacol Sci 2010; 2010:910686
[5] Meuleneire, F.: Evaluation of a new silver alginate amorphous paste in the management of
     pressure ulcers, Abstract accepted, EWMA 2012
[6] Meuleneire, F.: New anti-bacterial wound care policy after partial diabetic foot amputation:
     a case study report. Abstract accepted, EWMA 2012.
 


          
        
    

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