Technology and product reviews On admission : Mar 28, 2009


Useful links and further reading


ACTICOATTM and ALLEVYNTM AG Made Easy


Webcast: Improving clinical and economic outcomes in hard to heal wounds


Hard-to-Heal Wounds: a holistic approach


Week 2: April 10, 2009


Week 6: May 8, 2009 References


38. Vowden P, Vowden K, Carville K. Antimicrobial dressings made easy. Wounds Int 2011; 2(1). Available at: http://www.woundsinternational. com/article.php?issueid=330


39. Cutting K. Why use topical antiseptics? J Wound Care 2011; 4–7.


40. Roberts C, Ivins N, Widgerow A. ACTICOAT and TM Ag made easy


Wounds Int 2011; 2(2). Available at: http://www.woundsinternational. com/article.php?issueid=333.


41. EWMA. Position Document: Identifying Criteria for Wound Infection. MEP Ltd: London, 2005.


42. Lansdown AB. Silver I: its antibacterial properties and


mechanisms of action. J Wound Care 2002; 11(4): 125–30.


43. Agranoff D, Krishna S. Metal ion homeostasis and intracellular parasitism. Mol Microbiol 1998; 28(3): 403–12.


44. Cutting K, White R, Hoekstra H. Topical silver–impregnated dressings and the importance of


the dressing technology. Int Wound J 2009 Oct;6(5):396–402.


45. Michaels JA, Campbell B, King B et al. Randomized controlled trial and cost–effectiveness analysis of silver–donating antimicrobial dressings for venous leg ulcers (VULCAN trial). Br J Surg 2009; 96(10): 1147–56.


46. Mudge E, Orsted H. Wound infection and pain


management made easy. Wounds Int 1(3). Available at www. woundsinternational.com


Week 12: June 20, 2009


Figure 2 – This patient had a reduction in maceration, periwound erythema and oedema with complete closure of the wound at 12 weeks.


patients experienced non-progression of their ulcer[54]


. The most prevalent species at initial


biopsy was Enterococcus faecalis (9/24), while 79% (19/24) of patients had S. aureus at some point during treatment of which 62% (15/24) had a methicillin-resistant strain. During the study, all patients had


ALLEVYN Ag applied to their wounds under compression, using a multilayer bandaging system (PROFORETM


, Smith & Nephew).


All wounds were assessed on a weekly basis or until wound closure [Figs 1 and 2]. Debridement was performed at each weekly dressing change. Biopsies and semi-quantitative swab cultures


were taken to assess bioburden. At week eight, the level of bioburden had reduced to less than 105


cfu/g tissue in 13 patients (54%) compared


with 10 patients (42%) at week two. There was also evidence of a significant reduction (p<0.001) in the level of bioburden after eight weeks. All clinical signs of infection were resolved at a median time of 91 days with the median number of clinical signs of infection reduced from 5 at baseline to 0.5 (mean 1.6; range 0–7) at treatment discontinuation. There was also a significant reduction (p<0.001) in pain in the last week and exudate level at week 12. Ten (42%) patients complained of malodour at baseline, reducing to five (21%) at treatment discontinuation[54]


. There was a significant reduction in


ulcer area from baseline to treatment discontinuation (p<0.001), while the median wound area reduction after eight weeks was


33 Wounds International Vol 2 | Issue 4 | ©Wounds International 2011


93%. Of the 24 patients, 19 achieved at least a 75% reduction in ulcer size within eight weeks from baseline. Patients with ulcers less than or equal to the median size (12.3cm2


)


achieved a slightly higher percentage area reduction than those with an ulcer greater than the median[54]


. . A closure rate of 46% was


achieved within an 81-day median treatment duration and a median time to closure of 91 days [Fig 3][54]


These findings are significant for this


difficult-to-treat cohort of patients, who rarely fall within the inclusion criteria for randomised controlled trials and compare favourably with previously published wound closure rates with active agents, for example, protease-


modulating dressings (41% closure in 12 weeks) [13]


weeks)[14] closure at mean 61 days)[55]


; extracellular matrices (55% closure rate at 12 ; and bilayered skin substitutes (63% .


Throughout the Lantis and Gendics[54] study period, debridement was performed on a weekly basis and its frequency may be a contributory factor to the wound closure rate achieved[14]


. In addition, the significant


reduction in pain and exudate levels may have contributed to a good level of patient concordance — no patients interrupted the treatment protocol for longer than seven days. Dressings were changed weekly (mean 7.2 days between dressing changes), providing evidence for longer wear times, compared to an average of 2.7 per week found in a separate study[16]


, and efficacy when worn under compression bandaging.


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