Practice development


Practice development Innovations


Innovations in dressing technology for leg ulcer patients


Achieving the best possible wound care when treating leg ulcers creates challenges for the clinician. These include providing appropriate compression, managing exudate and controlling infection. The author describes how new developments in bandaging and dressing technology are helping to achieve effective leg ulcer management in one German hospital.


INTRODUCTION The author works in a group of three hospitals near Stuttgart in southern Germany and is responsible for wound care management. The largest of the three hospitals, the Klinikum am Steinenberg, has 540 beds and in 2010 treated 725 wound patients, of whom 60% had leg ulcers.


CHALLENGES OF BANDAGE APPLICATION Achieving optimum pressure when applying compression to leg ulcer patients creates challenges for the clinician. The pressure is often either too weak or too strong to be effective and only a few clinics have a system available to measure the applied pressure. Training is clearly a major factor for optimising bandage application and, for some time now, it has been accepted that compression workshops in clinics are beneficial and should be ongoing. The author's clinic hosted two workshops in 2010 and will be repeating them next year. These were organised in collaboration with the department of physical therapy and were composed of a lecture on the theoretical basics of compression bandaging (based on case studies), followed by a practical session in which the participants themselves were able to apply bandages. After those workshops, an improvement


in outcomes was observed, as compression bandages applied by staff in the clinic stayed in place more efficiently, especially on mobile patients. When teaching and applying compression therapy the clinic follows the World Union of Wound Healing Societies (WUWHS) recommendations[1]


. These workshops will be repeated in 2012.


In each workshop, bandage pressure will be assessed with a special device (PicoPress®


,


Microlab Elettronica), which uses a sensor placed under the bandage to measure pressure exerted by compression in both static and dynamic conditions. Afterwards this data can be downloaded and analysed. Bandages that have visual indicators, (such


as ProGuide® [Smith & Nephew] or K-Two® [Urgo Medical]) may help with applying adequate tension. In a study in 2008[2]


it was


shown that compression bandages with visual indicators were applied more accurately than bandages without indicators. In the author's hospital, feedback from colleagues demonstrated that they now feel more secure in applying the correct amount of compression since these bandages have been introduced. These types of bandages are also self-adherent, which means they stay in place more easily.


DRESSINGS UNDER COMPRESSION Another challenge of compression and leg ulcer management is providing appropriate wound management. This involves choosing appropriate dressings that fit underneath the compression and which can absorb excessive exudate and protect the surrounding skin. In recent years, the development of wound


products that incorporate superabsorbers, such as dressing pads (ie Sorbion® Sachet S, Sorbion) and silicon laminated foam dressings (ie Cutimed® Siltec®, BSN Medical) has been a notable advance. These dressings help to manage and absorb exudate effectively,


References


1.WUWHS. Principles of Best Practice: compression in venous leg ulcers. A consensus document. 2008; MEP Ltd, London.


2. Hanna R. A comparison of interface pressures of three compression bandage systems. Br J Nurs (Tissue Viability Supplement) 2008; 17(20): S16–24.


3. Phillips PL, Wolcott RD, Fletcher J, Schultz GS. Biofilms Made Easy. Wounds International 2010. Available at: http://www.woundsinternational. com/made-easys/biofilms-made-easy (accessed 19, January, 2012)


4. Dissemond J, Assadian O, Gerber V, et al. Classification of Wounds at Risk (W.A.R.Score) and their antimicrobial treatment with Polyhexanide – a practice-oriented expert recommendation. Skin Pharm Physiol 2011; 24: 245–55.


5.Wang XO, Kempf M, Mott J, et al. Silver absorption on burns after the application of Acticoat: data from pediatric patients and a porcine burn model. J Burn Care Res 2009; 30(2): 341–48.


Author: Astrid Probst


www.woundsinternational.com


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