Presentation on theme: "The role of Vascular Surgery and wound care treatment"— Presentation transcript:
1The role of Vascular Surgery and wound care treatment Dr. W. AmannDivision of General- and Vascular SurgeryLKH Villach, AustriaXV. Educational seminar for doctors; Nov. 11, 2011 University Medical Center( UMC ), Ljubljana
2Chronic wound and vascular disease majority of patients in vascular medical unitsmajority of hospital stay dayscost intensive
15TIME - principles of wound bed preparation Tissuerevascularizationremoval of non-viable or deficient tissueInfectioncontrol of infection or inflammationlocal antisepticsystemic antibioticsMoistureExsudate managementEdge of woundexcavationhyperceratosismacerationepitheliasation
28Foams – polyurethane Moderate exsudating wound Keeps wound moist sometimes adheres to wound bedpainful dressing changealterates wound bed
29Superabsorberhighly exsudating woundsavoids macerationprimary and secondary dressing
30VAC – vaccuum assisted closure large excavated woundsGood exsudate controlimproves granulationexpensivedifficult for outpatient
31Summary conventional wound dressings Dressings have different characteristicsUse of many different dressings in each phase of wound healing process is possibleNeed for high expertise to choose the best one in a certain situationNeed for different combinations increases costs
32PolyMem® Multifunctional dressings These multifunctional dressings promote:Gentle autolytic debridementRapid debriding and wound healing resultsReduction of pain and inflammation around the woundNon-adherence of dressings to the wound bedQuick, simple and pain-free dressing changesMight look and feel like foam dressings but due their composition they have an entirely different mode of action.
33PolyMem® Multifunctional dressings All PolyMem dressings have the same core technologyHydrophilic Polyurethane (carrier)Wound cleanser - F-68 SurfactantMoisturizer – GlycerinSuperabsorbent ( Copolymer )absorbs fluids 10 ( Polymem ) to 16 fold ( Polymax ) of own weightSemi-permeable backing film ( not on cavity products)Application of PolyMem on wound, wound fluid is immediately absorbed into the dressing.Wound fluid absorbed into the dressing making it swell and fill the wound contours.Release of wound-cleanser and glycerine onto the wound bed.Surfactant and glycerine stimulate autolytic debridement. Exudate retained in the dressing due to superabsorbents.
34PolyMem ® Silver ™All the advantages of PolyMem dressings, plus the antimicrobial benefits of silver!In vitro testing demonstrates kill of at least 99.9% of all bacteria and fungi populations*Nano-crystalline silver particles are equally distributed throughout and bound into the membrane.Unlike other silver dressings - Non cytotoxic!No skin staining*Organisms tested – Klebsiella pneumoniae, Staphylococcus aureus, Pseudominas aeruginosa, Enterococcus faecalis, Staphylococcus aureus, Candid albicans
35Example of effect after 24 hours 24/7Example of effect after 24 hoursStagnating (4 months) wound on tibia after trauma.PolyMem has reduced the hypergranulation, odour and pain in only 24 hours.Note the clean wound surface and absence of the slimey film and slough that had previously covered the wound.25/7No need for additional cleansing!
36How does PolyMem reduce pain? Inhibits the actions of the pain-sensing nerve endings under the dressings*. (“nociceptors”)These same nerves, when activated, create the series of events that result in; - bruising - swelling - edema - pain.Evidence suggests that the dressing might absorb sodium ions, by capillary action, from the skin and from the subcutaneous tissues.If this is true, then this local decrease in sodium ions would result in reduced nociceptor nerve conduction, which could account for the observed pain relief.Inflammation
37An incisional study on a rodent model The coming slide demonstrates how PolyMem reduces the spread of inflammation (and pain which is linked to inflammation) in the tissue surrounding the trauma (in this case, inscisions/cuts)The inscisions on the animals were either:- left uncovered - covered with gauze (earlier study showed same result with gauze and a placebo foam) - covered with PolyMemFollowing slide show histological photos of the inflammatory reaction of surrounding tissue.Note that there is no reduction in the robust localized inflammatory response required for healing the injury!20Suppression of the spread of the inflammation and swelling cascade into the surrounding, uninjured tissues helps accelerate the healing process. 16,20Photos courtesy of Dr. Alvin J. Beitz, University of Minnesota
38An incisional study on a rodent model The vertical lines measure the extent of the inflammation, which is dramatically more localized with Polymem®.Note that there is no reduction in the robust localized inflammatory response required for healing the injury!20Suppression of the spread of the inflammation and swelling cascade into the surrounding, uninjured tissues helps accelerate the healing process. 16,20Photos courtesy of Dr. Alvin J. Beitz, University of Minnesota
39Blunt trauma animal model Uniform blunt trauma to both legs on 14 anesthetized animalsPolyMem® dressing plus a compression wrap applied to one legOnly the compression wrap was applied to the other legTwo independent observers evaluated swelling (0 – 4 scale)PMD + wrapwrapPMD+wrapwrapData courtesy of Dr. Alan R. Kahn, University of Minnesota
40Charcot foot treated with PolyMem® 4,5 months to closure with PolyMem Silver WIC + PolyMem (without silver). The wound was NOT debrided or cleansed in-between dressing changes.Poster presented at EWMA 2008
41Heel ulcer 1. treated with PolyMem® 3 months to closure with PolyMem Silver WIC + PolyMem. The wound was NOT debrided or cleansed in-between dressing changes.Poster presented at EWMA 2008
42Heel ulcer 2. treated with PolyMem® 8 months to closure with PolyMem + PolyMem WIC. The wound was NOT debrided or cleansed in-between dressing changes.Poster presented at EPUAP 2009
43PolyMem® Wic Silver Rope Main indication is tunneling wounds/fistulasReinforced with a surgical mesh (top and bottom)Can be cut in half lengthwise (use slits as guide)Absorbs up to 6x its own weight (will swell up to 1/3)One piece removal.
45Local treatment – summary Optimum: one product for all optionsMonotherapyFactors for cost effectivenesspricenursing timeneed for hospital stayneed for additional treatment ( pain, cleansing etc )storage costshealing timeFirst line local treatment