Original publication by: K. Böttcher Klinik Magazin 1991; 2/3. This case study describes the use of CUTINOVA◊ Hydro in the treatment of ulcers of different origins. For example, the photographs below depict a diabetic foot ulcer on hospital admission and after 6 weeks treatment with CUTINOVA Hydro.
In ulcerations of any kind, the formation of granulation tissue and epithelialization begins only after the ulcer has been cleaned of necrotic and sloughy material. In wound cleansing, an interaction often occurs between the infection or bacterial contamination and the extent of necrosis. Bacterial colonization cannot be controlled if necrotic and sloughy materials are present. On the other hand, infections can cause enlargement and deepening of the necrotic areas as in the case of burns. Thus, the most important goal in wound cleansing is the removal of necrotic material. Usually, this is accomplished by use of fibrinolytic ointments or solutions. In such cases, healing is often very slow, particularly in areas with poor blood supply such as those seen in pressure ulcers or leg ulcers.
A new wound dressing (CUTINOVA Hydro) with definite advantages over conventional dressings is now available for the treatment of ulcers of different origin. This material contains highly absorbent particles embedded in a self adhering polyurethane matrix. It is covered by a waterproof, oxygen and water vapor transmitting polyurethane film. By applying the dressing so that it extends far over the surrounding healthy skin, occlusion of the wound surface is attained. The part of the dressing covering the wound surface absorbs moisture and exudate from the wound. This is indicated by a pronounced, cushionlike swelling of the dressing material.
We treated ulcers and sloughy wounds of different origin with CUTINOVA Hydro. The lesions included leg ulcers, pressure ulcers over the sacrum and over the lateral malleolus, poorly cleansing wound cavities after pilonidal sinus surgery, a pretibial, long-neglected, infected hematoma with a heavily coated wound base, sloughy wounds following incision of a deep calf abscess with counterincision and a small ulcer on the back of the foot, caused by a sparkler.
With respect to the handling of the dressing, flat ulcers or ulcers that are only slightly below the level of the surrounding skin present no difficulties. In such cases, the dressing conforms to the wound surface and can thus function in unhindered fashion. For a somewhat deeper wound cavity such as the one resulting from pilonidal sinus surgery or the one in the patient with the infected hematoma over the tibia, the dressing must first be made to conform to the mostly trough-shaped wound until the dressing makes contact with the wound surface. It is important, however, not to wrinkle the bandage when it is applied to the surrounding skin, to prevent the wound exudate from oozing out and contaminating the surroundings. It is a major advantage of these self-adhering, semi-occlusive dressings that when they are correctly applied the surrounding area remains completely dry despite the apparently considerable pressure exerted by the wound exudate. Moreover, it is advantageous particularly for the patient, that the changing of the dressing is practically painless as a result of the fact that the dressing loses its adhesion in the moist wound area. The bandage can be removed in one piece. In contrast to other practices, the material does not liquefy. This in most cases obviates the need for additional washing of the wound.
We changed the dressing daily even if occasionally we could have done so every other day. In most cases, however, the absorbability of the dressing was exhausted after 1 day, as indicated by a considerable swelling of the dressing over the wound. Moreover, exudation from the wound often increased after only 1 day. This seems to be part of the working principle of the dressing. Removing the exudate, which can easily be done with hydrogen peroxide solution, causes wound healing to improve on a daily basis. It is also advantageous that the dressing can be removed in one piece. Whereas with conventional dressings the exudate raises the dressing material, which additionally is impregnated with a fibrinolytic agent, thus rendering it ineffective, the action of the new dressing seems to maintain a steady stream of exudation. In this manner, the necrotic material at the base of the wound is removed quickly. If this material is relatively thin, it will come off within a few days. In the case of thick necrotic layers, removal usually begins at the edges. Well delineated borders are often formed so that removal with scissors and knife is easily accomplished. The speed of wound cleansing depends significantly on the blood supply to the underlying tissue. Necrotic material in pressure ulcers comes off much more slowly than that at the base of wounds located over muscle tissue. Obviously, however, the CUTINOVA Hydro dressings help to remove the necrotic material more quickly than do conventional dressing techniques. In general, with CUTINOVA Hydro, purely fibrinous wound layers can be removed in a few days. From the first day onward, one can see how the blood supply to the wound bed changes. When the blood circulation in the "background" is good, granulation tissue forms rapidly.
We achieved an amazing success in the case of a young man on whose foot a burning sparkler had fallen causing a pfennig-size, 3rd degree burn. For 2 days, conventional dressings with fibrinolytic ointments had been applied without bringing about any change in the necrotic material. After 2 days of treatment with CUTINOVA Hydro, the necrotic material was completely gone, and the wound bed was clean. Under the dressings, the formation of granulation tissue on clean wound surfaces begins quickly even if in other areas of the wound the necrotic material is still present. If treatment with CUTINOVA◊ Hydro is continued after complete wound cleansing, an overabundance of granulation tissue is formed relatively soon. This tissue appears to be of relatively solid consistency. "UNDER THE CUTINOVA◊ Hydro DRESSINGS, NECROTIC MATERIAL IS REMOVED FASTER THAN WITH FIBRINOLYTIC AGENTS"
Experiences with the use of CUTINOVA Hydro dressings on individual wounds covered with necrotic and sloughy material of varying degrees of severity have shown that this dressing technique leads to much faster wound cleansing than do conventional dressing materials. In addition to faster wound cleansing, these dressings bring about the formation of strong granulation tissue with good blood circulation. The handling of the dressings is simple and practical, it does not put too much strain on the patient and it is painless. On the basis of this experience, we can state that with the CUTINOVA Hydro dressing we have at our disposal a new wound dressing material which represents progress in the treatment of problem wounds covered with necrotic and sloughy material.