Original publication by: E. Andersson Klinik Magazin 1991; 12: 20-22

This case study describes the use of CUTINOVA ^◊ Hydro for the treatment of varicose leg ulcers. One of the patients described is a 42 year old man who has had an ulcer on his lower left leg for more than six months associated with grade IV varicosis of the long saphenous vein.

The photographs below show a painful varicose leg ulcer as it appeared on initial presentation and completely healed after 45 days treatment with CUTINOVA Hydro.

Summary

The initial practical experience collected with CUTINOVA Hydro is positive, not least because it saves treatment time and is readily accepted by the patients. The results of the Tübingen study show that 5.3 million people in Germany are suffering from chronic venous insufficiency, and more than 800.000 are suffering from a leg ulcer. These numbers will be increased by about 25% by the inhabitants of the five new states of the federation, although accurate data are not yet available. Varicose leg ulcers are wounds which tend to heal poorly, if at all, and then by second intention. This is the reason for the wide range of local therapeutic procedures. Successful use of local therapies is based on the compression bandage.

However, it has to be recognized that this type of therapy is discontinued more often than others. Only about 50% of patients display good compliance. It is, therefore, important for successful therapy that the compression bandage is combined with a suitable and straightforward local therapy which is not painful and speeds up the healing process. In this connection, it should be remembered that 30-85% of ulcer patients in various populations display polyvalent sensitization in a patch test.

The local treatment must also be matched to the phase of wound healing, i.e. absorb exudate during the exudative or cleaning phase, stimulate granulation during the proliferative phase and not prevent epithelialization during the repair phase.

A new dimension was added to the principle of moist wound treatment in the early 1980s when the hydrocolloid dressings were introduced. A new wound dressing (CUTINOVA Hydro) has recently been launched. This takes the form of a self-adhesive polyurethane gel matrix in which "superabsorbers" are embedded. The entire matrix is covered by a polyurethane film which is permeable to water vapor and oxygen. Experience has shown that the sensitization associated with such polyurethane wound dressings is negligible, which is a great benefit to patients with leg ulcers.

We have collected initial experience on this form of treatment in our patients, who comprise a negative selection with long-standing and poorly healing ulcers. CUTINOVA Hydro was placed on the ulcer. A compression bandage was then employed for all the patients. The dressings were changed at intervals of 2-3 days. Changing CUTINOVA Hydro was quick and painless, without serious adhesion to the bed or edges of the wound and without additional odor development. This made the dressing very acceptable to our patients.

The ease of use is regarded as good because the nursing staff were able to change the dressing very quickly and easily without additional work. The absorption of exudate by the wound dressing was evident from the swelling which took place, although without any dissolution or tearing, which is pleasing.

However, if there is heavy exudate, it is important to have a margin about 2 cm wide beyond the edges of the wound in order to prevent detachment of the dressing and the associated maceration of the ulcer surrounding. If an eczematous reaction around the ulcer made painting or zinc paste treatment necessary, this was easily combined.

It was occasionally found at the first changing of the dressing that the ulcer had apparently enlarged and, at the same time, the edges had become flatter and the depth had decreased. In some of the patients there was complete granulation but inadequate epithelialization so that it was necessary to have recourse to other local measures (e.g. temporary skin substitute).

In the remaining cases, CUTINOVA Hydro could be used until epithelialization was complete.

Details of 2 cases are given as examples:

Case 1 42-year old man, ulcer on lower left leg for more than six months associated with grade IV varicosis of the long saphenous vein (Figures 1-3).

Case 2 54-year old man, post traumatic ulcer of lower left leg for about one year associated with post thrombotic syndrome (Figures 1-3).