Modern wound care – practical aspects of non-interventional topical treatment of patients with chronic wounds

Authors


  • Conflict of interest

    Joachim Dissemond has served as consultant and/or paid speaker for and/or ­participated in clinical trials sponsored by companies including 3M, B. Braun, BSN, Coloplast, Convatec, Draco, Hartmann AG, KCI, Lohmann & Rauscher, Medoderm, Sastomed, Systagenix, UCB and Urgo. Matthias Augustin has served as consultant and/or paid speaker for and/or participated in clinical trials sponsored by companies that manufacture drugs used for the treatment of psoriasis including Abbott, Almirall, Amgen, Biogen Idec, Celgene, Centocor, Janssen-Cilag, Leo, Medac, MSD (formerly Essex, Schering-Plough), Novartis, Pfizer (formerly Wyeth). Sabine Eming has been advisor to Paul Hartmann AG. Tobias George has received honoraria for lectures from Urgo and Lohmann & Rauscher. Hauke Schumann has been advisor to Birken AG. Thomas Horn, Sigrid Karrer, Markus Stücker declare no conflict of interest.

  • Section Editor

    Prof. Dr. Jan C. Simon, Leipzig

  • Chronic wounds are presently defined as those which have persisted for more than eight weeks.

  • Today it is generally accepted that ­proper wound care should aim to ­create a moist wound milieu.

  • At the beginning of wound therapy, it is often necessary to perform débridement, or at least to cleanse the wound.

  • For wound care, Ringer solution or ­physiological saline solution are the ­cleansers of choice.

  • The use of tap water is only permissible in Germany if filters with a maximum pore size of 0.2 μm are used.

  • Mechanical débridement using sterile compresses is often sufficient for the removal of loosely adherent coatings, such as fibrin.

  • Activated carbon wound care dressings are used, for example, for foul-smelling wounds and ulcerated tumors.

  • Given that alginates also have hemostatic effects, they are also suitable for achieving hemostasis, for instance, following surgical débridement.

  • Fly larvae may be used for selective ­biosurgical débridement.

  • Chitosan products may be used for hemostasis, for example, after surgical débridement.

  • Honey preparations used in osmotic débridement can cause severe pain.

  • Products containing hyaluronic acid are often used for wounds with a large amount of exudate to promote granulation and for wound cleansing.

  • Hydrofiber dressings can rapidly absorb up to 40 times their weight in exudate.

  • They are used especially for dry wounds to facilitate autolytic débridement.

  • Hydrocolloids are used mainly for superficial wounds, with little exudate, to promote granulation or epithelization.

  • Collagens are believed to bind excess levels of proteases in chronic wounds.

  • Foam wound dressings should be in ­direct contact with the wound bed.

  • Wound products containing silver are used for antimicrobial treatment.

  • They can absorb up to 100 times their own weight and store the exudate in their polymer structure.

  • Currently available products for proteolytic débridement include collagenase as well as streptodornase and streptokinase.

  • Advanced wound care products are a new, highly diverse group of therapies which aim to actively influence the wound milieu.

  • There are also increasing numbers of reports of contact sensitization to products which are used directly for wound treatment.

  • Negative pressure therapy may be a first-line option for promoting ­granulation.

  • Specific hygienic measures should be used in patients with problem bacteria, such as MRSA. In patients with chronic wounds who have colonization, but who do not have a systemic infection, topical treatment with modern antiseptics is considered adequate [27-29].

  • Polyhexanide and octenidine are currently the first-line antiseptics for patients with chronic wounds.

  • All patients should assess their pain ­level using instruments such as the ­visual analogue scale.

Summary

The treatment of patients with chronic wounds is becoming increasingly complex. It was therefore the aim of the members of the working group for wound healing (AGW) of the German Society of Dermatology (DDG) to report on the currently relevant aspects of non-interventional, topical wound treatment for daily practice. ­Beside necessary procedures, such as wound cleansing and débridement, we describe commonly used wound dressings, their indications and practical use. Modern antiseptics, which are currently used in wound therapy, usually contain polyhexanide or octenidine. Physical methods, such as negative-pressure treatment, are also interesting options. It is always important to objectify and adequately treat pain symptoms which often affect these patients. Modern moist wound therapy may promote healing, reduce complications, and improve the quality of life in patients with chronic wounds. Together with the improvement of the underlying causes, modern wound therapy is an important aspect in the overall treatment regime for patients with chronic wounds.

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