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2012-05-29

Advances in chronic wound and burn management

Wound cleansing and moistening with Prontosan Wound Gel X promotes rapid and complication-free healing of burns.

“Clinical practice shows that Prontosan Wound Irrigation Solution with its active substances polihexanide and betaine can support rapid wound healing in burns and reduce the risk of infection”, says Dr. Björn Behr from the burn unit in Ludwigshafen, Germany while explaining his treatment approach for handling burns. Since all burn wounds are at risk for infection, wound cleansing is very important. Burns destroy the natural skin barrier and reduce blood circulation to the skin, with varying degrees of severity, depending on the depth of the burn. Therefore, despite major advances in therapy, infection still remains a major cause of morbidity and mortality in severe burn patients. Infected wounds not only heal more slowly, but prevent adequate skin grafting and may lead to sepsis (Atiyeh et al., 2005).

An ideal topical agent for the treatment of burn wounds is yet to be found. Although not many studies have been completed assessing the use of polihexanide in the field of burns, first results and clinical practice tend to show a positive effect on wounds with and without infection. “The combination of polihexanide (PHMB) and the surface active tenside betaine is beneficial, since the first  substance is an antimicrobial agent and the second optimizes its cleansing activity,” says the physician Dr. Behr. The burn unit has been treating patients with Prontosan and is in the process of starting a study to verify the efficacy and tolerability of the new B. Braun product, Prontosan Wound Gel X in the treatment of adult patients with burns. It is designed as a prospective, descriptive cohort study with Prontosan Wound Gel X in partial and full thickness burns requiring split thickness skin grafts.

The Prontosan product line has been successfully used for the cleansing and moistening of acute and chronic wounds, as well as for the prevention of biofilm formation for more than ten years throughout Europe.

Prontosan Wound Gel – painless application

Prontosan Wound Gel X has been especially developed to provide advantages in the treatment of burn patients. Prontosan Wound Gel X was registered as a medical device, class III in 2011. Prontosan Wound Gel X has a high viscosity, therefore adheres well to large wound surfaces and can be applied without pain to the patient. It keeps wounds moist and can therefore help to release encrusted coatings and layers. Prontosan Wound Gel X comes in a 250 gram tube for easy application to large wound surfaces. It is also colorless and clear, so that affected area can be easily assessed. “The gel can prevent biofilms from forming on the wound, and reduce possible bacterial contamination,” reports Dr. Behr. Prontosan Wound Irrigation Solution and Prontosan Wound Gel are approved for 1st and 2nd degree burns. The new Prontosan Wound Gel X is additionally approved for 3rd and 4th degree burns.

Clinical data show the efficacy of Prontosan when used on chronic wounds: it was found to reduce bioburden, to aid wound healing and to reduce the time to closure in a randomized, controlled trial with 142 patients (Valenzuella et al., 2008). Another comparative retrospective study with 112 patients found that Prontosan Wound Irrigation Solution can decrease healing time and reduce the number of wound infections (Andriessen et al., 2008). Prontosan has also been shown in an in-vitro study (Seipp et al., 2005) as well as in an animal model (Perez et al., 2010) to be effective against biofilm. The effectiveness of a topical agent against biofilm plays an important role as biofilms have been shown to play a significant role in burn wound infections and subsequent sepsis (Kennedy et al., 2010).


A new amorphous silver paste for infected wounds
The use of ionic silver-containing wound dressings is also a well-established approach (Opasanon et al., 2012) in the management of infected wounds, since silver exploits its antimicrobial activity even against antibiotic resistant strains of bacteria. The B. Braun company offers a new ionic silver-containing wound paste, called Askina Calgitrol Paste, which appears to be particularly valuable in handling difficult-to-manage wound shapes, such as those with tunnels and sinuses as seen in patients with second-degree burns and diabetic foot ulcers. First clinical case studies at the St Elisabeth Woundcare Centre in Zottegem, Belgium, show advantages over traditional products on the market.

“Within a week of the paste being applied, we tend to see a significant improvement,” said the wound care expert Frans Meuleneire from Belgium. “The paste seems to possess ongoing antibacterial effects and it can be removed without pain.” It overcomes the disadvantage of the rigid forms of established fiber, foam and mesh-based wound dressings by its new semi-liquid and viscosity–adapted consistency (Opasanon et al.) Askina Calgitrol Paste allows an optimized intimate contact with the wound bed enabling rapid killing of microorganisms. The product 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 Ag Paste can be removed by simple cleansing with sterile saline or Prontosan Wound Irrigation Solution. The new formulation complements the existing range of Askina Calgitrol Ag dressings covering its use in all fields of infected or critically colonized wounds. One advantage of this product line is that the ready-to-use silver alginate matrices release antimicrobial silver ions immediately and continuously at a steady rate up to seven days.

B. Braun Wound Care products focus on wound cleansing and effective wound dressings for each state of wound healing. The choice of the right product at the right time can improve wound healing and quality of life while limiting complications and costs. B. Braun’s full range of wound care products offer responses to basic needs for moist treatments, complex wounds and non-healing wounds, thus providing a novel approach to wound repair. Silicone technology and new amorphous dressings and gels such as Askina Calgitrol Paste and Prontosan Wound Gel provide a new standard of a wound care treatment. This comprehensive approach and quality is one reason why Frans Meuleneire from the WoundCare Centre of Zottegem in Belgium and many other wound care specialists in many countries use B. Braun Wound Care products for their patients. “Each wound and each patient is different, which means that evidence-based treatment options are hard to develop. Nevertheless, we always strive to provide our patients with the best possible standard of care,” he said.

Additional Information:
Askina Calgitrol Paste: new ionic silver-containing wound dressing

Prontosan Wound Gel X