Surgical removal of necrotic tissue Particularly suitable for treatment under compression
If the patient's medical situation allows, surgical debride- bandages is the hydroactive foam dressing PermaFoam.
ment should be performed to remove necrotic and inade- This dressing has a high vertical wicking effect for rapid
quately perfused tissue and fibrinous necrotic slough as regulation of wound exudate as well as high retention for
completely as possible. This results in a “fresh”, bleeding reliable fluid binding, thereby protecting the wound mar-
wound. Wound healing can then commence, as in an gins and minimising the risk of maceration. Detailed
acute wound, with hemostasis followed by the release of product description from page 50.
growth factors and migration of sufficient inflammatory
The healing tendency of a venous
cells into the wound, and can then reorganise itself into For moderately exuding ulcers which still have a relatively
leg ulcer improves dramatically
the chronologically correct sequence of events. This intact peri-ulcer area, the absorbent hydrocolloid dressing
when necroses and tissue inade-
quately supplied with blood are
approach should be considered especially for therapy- Hydrocoll can be used, which because of its semi-perme-
removed as completely as possi-
refractory ulcers; after wound conditioning, there may be ability is particularly effective in supporting the autolytic
ble.
an indication for wound closure by split-thickness skin processes of wound cleansing. The principle of action of
grafting. Hydrocoll is described in detail starting on page 53.
Ulcers with a severely damaged
peri-ulcer area require particularly
gentle wound treatment, for
For care of the surgically debrided ulcer and subsequent Infection prophylaxis and control
example with TenderWet com-
wound conditioning, wound coverage with the Sorbalgon The problem of infection prophylaxis and control is most
presses.
calcium alginate dressings, whose principle of action is likely to arise in the cleansing phase, which is often
described from page 49 onwards, should be performed. fraught with uncertainties. In most cases, the ulcer can
be assumed to be colonized with microorganisms,
Cleansing by moist wound treatment although the contamination – especially in the case of
If surgical debridement is impracticable, physical debride- purely venous ulcers – relatively rarely leads to a clinically
ment by moist wound treatment may be substituted. overt infection. The rather low susceptibility to infection
Hydroactive wound dressings with different modes of generally observed with older wounds thus also seems to
action are available for this purpose and are to be used apply to venous leg ulcers. Prophylactic disinfection of
selectively depending on the condition of the wound. the ulcer or topical antibiotic therapy is therefore not
advisable in most cases, especially considering the poten-
For ulcers with pronounced fibrinous and/or slimy coats tial of many of these substances to inhibit wound healing
(infected or non-infected), moist therapy with TenderWet and the high risk of sensitization.
24 active is recommended. The principle of action of this
“absorbent-rinsing dressing” is described from page 44 One treatment option for infected and infection-prone
onwards. TenderWet is especially suitable in cases in wounds is the silver-containing ointment dressing
The silver-containing ointment
which the ulcer environment is extremely sensitive due to Atrauman Ag. It has a broad spectrum of action and a
dressing Atrauman Ag with
reliable bactericidal action is indi-
eczematous lesions. sustained bactericidal action combined with proven good
cated for infected wounds.
tissue tolerability and only low toxicity. Details about
Atrauman Ag from page 56.
Phase-specific wound management [38.39]
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