Dramatically reduce wound pain with Hydrosorb® Hydrogel dressing ...
Dramatically reduce wound pain with Hydrosorb® Hydrogel dressing ...
Dramatically reduce wound pain with Hydrosorb® Hydrogel dressing ...
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Case Study 1David Gray Tissue Viability Nurse, Grampian University Hospitals Trust, AberdeenManaging Highly Exuding Leg WoundsOccasionally <strong>wound</strong>s present <strong>with</strong> highlychallenging symptoms, which require afresh approach to their management. Themanagement of infected <strong>wound</strong>s on thelower limbs, which present <strong>with</strong> high exudatelevels, are one such example. In the two casestudies on this page, the level of exudateproduced by the <strong>wound</strong>s over a 12 hourperiod far exceeded the moisture handlingcapabilities of modern foam <strong>dressing</strong>s.It was clear that in both cases moist <strong>wound</strong>healing was not an achievable aim until thetwo underlying pathologies, oedema in study1 and infection in study 2, were removed.The clinician is then left <strong>with</strong> the problem ofmanaging the symptom until the underlyingpathology is removed and healing can proceed.During this time the level of exudate producedwould involve many <strong>dressing</strong> changes <strong>with</strong>the potential for adhesives to irritate thesurrounding skin and maceration to develop.In these cases the management of the two casesinvolved the use of a non-adherent contactlayer, Atrauman and a secondary-<strong>dressing</strong> pad,Zetuvit. These <strong>dressing</strong>s were held in place<strong>with</strong> light tubular bandages. This combinationallowed the <strong>wound</strong> bed to be left undisturbedand the pad to be changed regularly <strong>with</strong>outtrauma to the surrounding skin. The ease <strong>with</strong>which the <strong>dressing</strong> could be changed allowedregular pad changes, thus reducing the risk ofmaceration around the <strong>wound</strong>.Study 1Image 1 and 2 portray a gentleman <strong>with</strong>widespread lymphodema of both lower limbsdue to a malignant condition. There are twopuncture <strong>wound</strong>s, one on the left foot andone on the right leg.These <strong>wound</strong>s were leaking approximately50mls per 2 hours and elevating the limbsproved difficult due to his condition.These <strong>wound</strong>s were being treated usingfoam <strong>dressing</strong>s that were being changed2-4 times per day, <strong>with</strong> large amounts ofleakage observed.As it was impossible to quickly <strong>reduce</strong> theoedema in the legs, the patient faced manydays/weeks of fluid leaking from his limbsand regular <strong>dressing</strong>s changes. Even <strong>with</strong>these <strong>dressing</strong>s changes, it was not possibleto prevent fluid leaking across the healthyskin at the <strong>wound</strong> margins. The decision wastaken to dress the <strong>wound</strong>s <strong>with</strong> Atrauman,a non-adherent contact layer, covering <strong>with</strong>Zetuvit, a <strong>dressing</strong> pad and securing <strong>with</strong> atubular bandage, applied from toe to knee.This combination allowed the patient to havethe oedema absorbed from the <strong>wound</strong>s intothe <strong>dressing</strong> pads. When the <strong>dressing</strong>s padsneeded changing the tubular bandagewas rolled down and the pads changed.The presence of the Atrauman on the<strong>wound</strong> surface meant that the <strong>wound</strong> itselfwas not disturbed.Study 2Image 3 and 4 show a resolving case of cellulitusto the lower limbs. Both limbs have sufferedsuperficial skin loss due to blistering, associated<strong>with</strong> soft tissue infection. Due to the oedemapresent in the legs the application of a standardmoist <strong>wound</strong> <strong>dressing</strong> was contraindicated,due to the high levels of exudate and the needfor frequent <strong>dressing</strong> changes.Due to these factors the patient’s legs weremanaged <strong>with</strong> the same <strong>dressing</strong> regimeas that in study 1 (Atrauman, Zetuvit,tubular bandage).This regime was continued until the oedemain the legs and the leakage from the <strong>wound</strong>s<strong>reduce</strong>d. At this point, a new moist <strong>wound</strong>healingregime was introduced as the needfor regular [4-6] daily <strong>dressing</strong> was nolonger necessary.Image 3Image 4Image 1Image 2These <strong>wound</strong>s were unlikelyto heal until the oedema hadresolved, this was not likely tohappen for some days, possiblyweeks. The decision was takento manage the main symptom,oedema leakage, using thecombination described.ConclusionThese case studies demonstrate how theuse of relatively simple <strong>wound</strong> managementtechniques can <strong>reduce</strong> trauma to thesurrounding skin, manage high exudate levelswhile being economically effective. Using moreexpensive <strong>dressing</strong>s to manage the exudatein the cases described could have resulted ingreater costs <strong>with</strong> no greater clinical outcome.It should be noted that due to the underlyingpathologies present at the time no healingcould have been reasonably expected.HARTMANN Wound Forum 5
Clinical Study 1Holger Kapp Department Clinical Application Studies, PAUL HARTMANN AG, HeidenheimClinical performance of a hydrogel <strong>dressing</strong>in the management of chronic <strong>wound</strong>s –a prospective application study in 81 patientsSUMMARYIn a prospective, multicentre, ambulantapplication study, 81 patients (average age67 years) were treated <strong>with</strong> the Hydrosorbcomfort hydrogel <strong>dressing</strong>. The majorityof the patients had chronic <strong>wound</strong>s,which were one year old on average. Atthe beginning and end of the study, thephysicians evaluated the condition of the<strong>wound</strong>s and the <strong>pain</strong> experienced by thepatients. They were treated <strong>with</strong> <strong>Hydrogel</strong>comfort for an average of twelve days andthe <strong>dressing</strong> was changed every 4 days.The <strong>wound</strong> status improved markedly inthe course of the study. The proportionof the <strong>wound</strong> surface that was covered<strong>with</strong> slough fell from 62.7% to 23.1%.At the same time, the area covered bygranulation and epithelial tissue increasedby 11.9 and 15.1 percentage points,respectively. The <strong>wound</strong> area decreasedfrom 4.7 x 2.9 cm at the start to 3.7 x2.3 cm. Other parameters that improved<strong>with</strong> the Hydrosorb treatment were thedegree of exudation and the conditionof the perilesional skin. The patients alsoreported markedly less <strong>pain</strong>. Whereas29.6% of the patients reported no <strong>pain</strong> atthe beginning of the study, this proportionincreased to 56.3% at the final assessment.As the treating physicians emphasised,the documentation sheet provided <strong>with</strong>Hydrosorb comfort proved to be helpful inmonitoring and documenting the course of<strong>wound</strong> healing.Conclusion: chronic <strong>wound</strong>s can be treatedeffectively <strong>with</strong> Hydrosorb comfort. Thehydrogel <strong>dressing</strong> promotes the <strong>wound</strong>healing process, <strong>reduce</strong>s <strong>wound</strong> <strong>pain</strong> andthus improves the patients’ quality of life.IntroductionWhen the skin is injured, the body initiatesa cascade of processes that eventually leadto a re-epithelialisation of the <strong>wound</strong> areaand re-establishment of the skin’s barrierfunction (1). If the precisely coordinatedinterplay of inflammatory cytokines, mitogenicgrowth factors, extracellular componentsand enzymes such as proteases is disturbed,stagnation of the repair process can occur.The result is a chronic <strong>wound</strong>. The mostchronic <strong>wound</strong>s such as leg ulcers, pressureulcers and diabetic foot ulcers have anunderlying systemic disease process, whichpersistently interferes <strong>with</strong> biochemical andphysiological processes in the <strong>wound</strong> area.As a result, the healing process ceases in theinflammatory phase and becomesdeadlocked (2).Chronic <strong>wound</strong>s are of various origins andhave different aetiologies. Vascular causessuch as venous insufficiency, arterial occlusivedisease, diabetic angiopathy and neuropathy- sometimes in combination – are the mostcommon systemic disorders. At the local level,infections, and the presence of a foreignbody in the <strong>wound</strong> can delay <strong>wound</strong> healing.In addition, prevailing systemic diseasesinclude malnutrition, malignant cachexia,autoimmune diseases and systemicco-medication (3).Taking a systematic and disease-specificdiagnosis of these local and systemic factors isa prerequisite for successful <strong>wound</strong> treatment(4). Because of the complex pathophysiologyof a chronic <strong>wound</strong>, therapy should not bedirected only toward isolated local factors.Rather, a more holistical approach totreatment should be taken. The basis of everytherapy is causal treatment or ameliorationof the underlying disease, for instance,treatment of venous hypertension in chronicvenous insufficiency. Furthermore, only whendeficits of the macro- and microcirculationin the <strong>wound</strong> area are eliminated and blood,oxygen, and nutrient supply are optimallycorrected, can a <strong>wound</strong> <strong>dressing</strong> successfullysupport the healing process of an ulcer (5).Several parameters of the <strong>wound</strong> stateinfluence the choice of the appropriate <strong>wound</strong><strong>dressing</strong>. Important parameters include sizeand location of the <strong>wound</strong>, the degree ofexudation, presence of slough, necrosis, andpossible signs of infection as well as thehealing phase of a <strong>wound</strong> at any given time.No single <strong>wound</strong> <strong>dressing</strong> can deal <strong>with</strong> allof these different parameters. Therefore,a number of different hydroactive <strong>wound</strong><strong>dressing</strong>s are available to the <strong>wound</strong> careprofessionals, most specifically tailored toensure a physiologically moist <strong>wound</strong> milieu,which promotes the repair process. During thetreatment, the condition of the ulcer shouldbe inspected regularly and the local andsystemic treatment should be adjusted if anychanges are diagnosed (6).<strong>Hydrogel</strong> <strong>dressing</strong>s are indicated forchronic <strong>wound</strong>s which exhibit only slightexudation. Because of the high water contentof up to 90% of these <strong>dressing</strong>s, they areable to keep granulation tissue and freshepithelial tissue moist and protect them fromexternal mechanical stress and provide abarrier to secondary infection fromthe environment (7).The present application study investigatedthe clinical efficacy and tolerability of theHydrosorb comfort hydrogel <strong>dressing</strong> on<strong>wound</strong> healing in patients who sufferedmainly from chronic ulcers that weredifficult to address therapeutically.6 HARTMANN Wound Forum
Table 1 Patient characteristics (n =81)Women 42 (51.9%)Men 39 (48.1%)Age66.8 years(±15.1 years;median 68.4 years;range 31.2 to97.7 years)Age of <strong>wound</strong>365 daysHydrosorb comfort is a transparenthydrogel <strong>dressing</strong> made of absorbentpolyurethane polymers containing about60% water. When applied to the <strong>wound</strong>,Hydrosorb supplies the tissue <strong>with</strong>moisture. At the same time, the hydrogelabsorbs excess <strong>wound</strong> exudate and locksit into the gel structure. This ensuresmoisture balance in the <strong>wound</strong> andpromotes the production of epithelial andgranulation tissue.Because of the high proportion of water,Hydrosorb comfort is also indicatedwhen dry slough or necrosis has to beseparated from the base of the <strong>wound</strong>.The Hydrosorb comfort employed in thestudy is surrounded by a hypoallergenicadhesive film. The transparency of thehydrogel enables the condition of the<strong>wound</strong> to be inspected at any time. Theuser can also document changes in the<strong>wound</strong> size during treatment <strong>with</strong> a foil.After the <strong>wound</strong> <strong>dressing</strong> has been placedon the <strong>wound</strong>, the <strong>wound</strong> size can betraced on the film using a pen and the filmis then removed and stored in the patientfile. After several <strong>dressing</strong> changes, thetreating doctor can track the course ofhealing by comparing the respective<strong>wound</strong> sizes.Material and methodsOutpatients <strong>with</strong> chronic or acute <strong>wound</strong>s ofdifferent aetiologies in 15 German medicalcentres (eight surgeons, four generalphysicians, one internal medicine office andtwo teaching hospitals) were eligible toparticipate in the prospective, multicentreapplication study. The requirement forincluding the patients in the study was thattreatment <strong>with</strong> the hydrogel <strong>dressing</strong> wasclinically indicated. One <strong>wound</strong> per patientwas treated in the study. No patients wereexcluded, in line <strong>with</strong> chronic <strong>wound</strong>sencountered mostly in daily practice. Theattending physicians were free to treat anypatient <strong>with</strong> chronic <strong>wound</strong>s, irrespective ofage, sex or comorbidities or the origin of the<strong>wound</strong>. Each patient was treated individuallyin the study according to their medicalhistory and diagnosis. Overall, three <strong>dressing</strong>changes were documented. At the initialexamination, the investigators recorded thepatients’ age, sex, general health state andcomorbidities, age and size of the <strong>wound</strong>s aswell as previous local and systemic treatmentsand co-medications using a standardisedquestionnaire. At the beginning and endof the study, the investigators evaluatedthe condition of the <strong>wound</strong> by recordingthe proportion of slough, granulation andepithelial tissue, the extent of exudate, thecondition of the perilesional skin and patientreported<strong>pain</strong>. At the final examination,the <strong>wound</strong> care professionals assessed theclinical efficacy, tolerability, and the handlingof Hydrosorb comfort. The patients werealso asked about their experiences <strong>with</strong> thehydrogel treatment.ResultsThe investigators documented the course oftreatment of 81 patients. 39 patients (48.1%)were male and 42 (51.9%) were female(table 1). The average age was 66.8 years(±15.1 years, range 31.2 to 97.7 years). Thegeneral health was assessed as very good in16 patients (20%) and age-appropriate in45 patients (55%). 20 patients (25%) had a<strong>reduce</strong>d physical state due to comorbidities.According to the attending physicians’Table 2 Aetiology of the <strong>wound</strong>s (n= 81Cause proportion in %Venous leg ulcer 19.8Arterial leg ulcer 7.4Mixed leg ulcer 12.3Decubitus ulcer 9.9Diabetic pressure ulcer 9.9Diabetic gangrene 7.4Acute traumatic <strong>wound</strong> 7.4Burn 8.6Other 17.3Wound conditionFig. 1 Condition of the <strong>wound</strong> before and after treatment <strong>with</strong> Hydrosorb comfort (n = 81)HARTMANN Wound Forum 7
description, 44 of the patients (54%) wereincluded in the study because previoustreatment of the <strong>wound</strong> had failed to achieveimprovement. For 30 (37%) the treatment<strong>with</strong> the hydrogel <strong>dressing</strong> was the firsttreatment of the <strong>wound</strong>. 6 patients (7.4%)were treated <strong>with</strong> the hydrogel because thephase of <strong>wound</strong> healing had changed.8 of the 81 patients <strong>with</strong>drew from thestudy prematurely, two of them at the first<strong>dressing</strong> change and 6 further patients at thesecond <strong>dressing</strong> change. The reasons weremaceration, in particular, and other adversereactions in the region of the <strong>wound</strong> margins.Aetiology of the <strong>wound</strong>sThe <strong>wound</strong> care professionals treated <strong>wound</strong>s<strong>with</strong> Hydrosorb that had arisen mainly becauseof vascular diseases (table 2). Venous andarterial ulcers were the most common <strong>wound</strong>types <strong>with</strong> 40%. The patients had suffered fromtheir ulcers for an average of 365 days (range 0days to 20 years, median 92 days).Fig. 2 Change in the degree of exudation in the course of the study (n = 81)ExudationPainPreviously used local <strong>wound</strong> <strong>dressing</strong>sTopical <strong>wound</strong> care consisted of foam<strong>dressing</strong>s, silver-containing <strong>wound</strong> <strong>dressing</strong>s,<strong>wound</strong> <strong>dressing</strong>s <strong>with</strong> antiseptic and antibioticagents, ointment <strong>dressing</strong>s and hydrocolloids,sometimes in combination, were mostcommonly applied in 46 patients prior toinclusion in the study.Co-medication and therapyAt the start of the study, 35 patients (43%)were on systemic medication. The patientswere taking anticoagulants, antibiotics,oral antidiabetic regiments, steroids andanalgesics in particular. In 8 patients (9.9%),the treating physicians combined the hydrogel<strong>dressing</strong> <strong>with</strong> another <strong>wound</strong> <strong>dressing</strong>: 3patients had an amorphous hydrogel, 2patients an alginate <strong>dressing</strong> and 3 patientshad a <strong>wound</strong> <strong>dressing</strong> containing silverapplied to their <strong>wound</strong>s. To treat the chronicvenous insufficiency, compression therapy waspre scribed for 24 patients. In 22 patients,measures to relieve the pressure on the <strong>wound</strong>were employed and in a further 16 patientsthe doctors documented accompanyingmeasures such as <strong>wound</strong> debridement orelevation of the treated limb.Wound outcomesThe patients were treated <strong>with</strong> the hydrogel<strong>dressing</strong> for an average of 12.1 days and<strong>dressing</strong>s were changed every 4 days. In thecourse of the study <strong>with</strong> the hydrogel theproportion of the <strong>wound</strong> area covered <strong>with</strong>Fig. 3 Change in <strong>pain</strong> felt by the patients in the course of the study (n = 81)slough fell from 62.6 to 23.1%. At the sametime, the area covered <strong>with</strong> granulation andepithelial tissue markedly increased (fig. 1). The<strong>wound</strong> size (length x width) fell from 4.7x 2.9 cmto 3.7 x 2.3 cm. Five <strong>wound</strong>s were completelyre-epithelialised at the end of the study.Apart from the condition of the <strong>wound</strong>, thedegree of exudation also improved (fig. 2).Table 3 Condition of the perilesional skin before and after treatment<strong>with</strong> hydrogel <strong>dressing</strong> (multiple nominations possible)The proportion of patients whose <strong>wound</strong>swere not exuding increased from 0% atbaseline evaluation to 22%. At the same time,the proportion of moderately and heavilyexuding <strong>wound</strong>s fell by more than half from47% to 23%. Fewer pathological symptomswere also diagnosed in the perilesionalskin (table 3).Diagnosis Initial examination Final ExaminationNo pathological findings 33 47Signs of inflammation 46 23Erythema 16 8Hyperthermia 11 3Oedema 10 8Infection 9 4Perilesional maceration 20 18Maceration 8 5Eczema 1 6Hyperkeratosis 10 7Blisters 1 0Other 2 88 HARTMANN Wound Forum
Assessment of Hydrosorb comfort treatment by the patientsFig. 4 Assessment of the <strong>wound</strong> treatment by the patients (n = 70)Patient-reported <strong>pain</strong>The number of patients reporting <strong>wound</strong><strong>pain</strong> decreased markedly in the course of thethree <strong>dressing</strong> changes. Whereas 29.6% ofthe patients reported no <strong>pain</strong> at the start, thisproportion rose steadily to 56.3% at the finalevaluation (fig. 3). The number of patients<strong>with</strong> severe <strong>pain</strong> was almost halved from11.1% to 6.3%.Dressing performance ratings byphysicians and patientsThe investigators assessed the hydratingcharacteristics, the ease of removal and thegood contact <strong>with</strong> the base of the <strong>wound</strong>as very good or good in over 90% of thetreatments (table 4). Good or very good skintolerability was recorded in over 90% of thetreated patients. The physicians had a goodor very good overall impression of thetreatment <strong>with</strong> the hydrogel in 83% ofthe treatment.In the opinion of the treating physicians,the condition of the <strong>wound</strong>s had improvedor markedly improved in over 85% of thepatients. The condition did not change in8.6% of the patients and it worsened in 6.1%.70 of the 81 patients assessed the tolerabilityand wearing comfort of the hydrogel (fig. 4).The overall impression was graded as verygood or good by over 85% and as satisfactoryby 5.7%.Documentation aid to assess the courseof healingThe investigators used the Hydrosorb comfortdocumentation aid at each <strong>dressing</strong> change in15 patients (18.5%). The documentation aidwas used partially in a further 40 treatments(49.4%). In every third <strong>wound</strong> treatment(32.1%), the aid was not used as otherdocumentation methods were preferred.If the documentation aid was used, its usewas de scribed in 54 of the 55 cases as veryeasy or easy and in one case as satisfactory.In 43 cases, the doctors assessed thedocumentation aid as helpful or very helpfulin assisting <strong>wound</strong> documentation.DiscussionThe prospective and multicentre applicationstudy showed that the hydrogel <strong>dressing</strong>promotes production of granulation andepithelisation. Because this was a smallnonrandomised and non-comparative clinicalobservational trial, it can only give some firstinformation about the clinical performanceand tolerance of the treatment <strong>with</strong> thehydrogel <strong>dressing</strong>. It is not a proof of efficacy,but provides a real-world outcome evaluationof the <strong>wound</strong> care provided by medicalund nursing staff, in an unselected panelof patients, mostly reflecting non-healing,intractable <strong>wound</strong>s encountered in dailypractice. During the local treatment <strong>with</strong> thehydrogel, the proportion of the <strong>wound</strong> areaTable 4 Assessment of Hydrosorb comfort treatment by the physicians (results in %)very good good satisfactory adequate poor not assessableContact <strong>with</strong> the <strong>wound</strong> base 43.2 49.4 4.9 1.2 1.2 0.0Adjustment to the body modellability 45.7 49.4 13.6 2.5 1.2 0.0Exudate management 28.4 54.3 9.9 1.2 4.9 2.5Hydrating characteristics 54.3 40.7 1.2 2.5 0.0 1.2Skin tolerability 60.5 30.9 1.2 0.0 6.2 1.2Separation of necrosis 29.6 23.5 1.2 0.0 1.2 44.4Adhesion 46.9 32.1 12.3 1.2 6.2 1.2Removability 64.2 32.1 2.5 0.0 1.2 1.2Overall impression 46.5 37.0 6.2 3.7 6.2 0.0HARTMANN Wound Forum 9
covered <strong>with</strong> granulation tissue increasedfrom 25% to 37% and the proportion covered<strong>with</strong> epithelial tissue from 12% to 28%.These results are consistent <strong>with</strong> other studiesin which the local treatment <strong>with</strong> hydrogel<strong>dressing</strong>s promotes the healing process ofchronic <strong>wound</strong>s (8, 9).Chronic <strong>wound</strong>s cause <strong>pain</strong> in many patients,which can interfere <strong>with</strong> quality of life (10,11).To relieve <strong>wound</strong> <strong>pain</strong>, the choice of a suitablehydroactive <strong>wound</strong> <strong>dressing</strong> is of crucialimportance (12). <strong>Hydrogel</strong> <strong>dressing</strong>s hydrateand cool the <strong>wound</strong> and therefore have ananalgesic effect. This was shown by numerousstudies in which burn <strong>wound</strong>s, venousulcers and dermabrasions were treated <strong>with</strong>hydrogels (13). As they can also be removed<strong>with</strong>out traumatising the <strong>wound</strong> bed, thecell vitality of the newly formed granulationand epithelial tissue remains intact (14). The<strong>pain</strong>-reducing effects were also observed inthe patients who were treated <strong>with</strong> Hydrosorbcomfort in the current study. The number of<strong>pain</strong>-free patients <strong>with</strong>out <strong>pain</strong> increasedfrom 30% to over 56% while at the same timethe proportion <strong>with</strong> severe <strong>pain</strong> decreasedfrom 11% to 6%. The attending physiciansconfirmed that the hydrogel <strong>dressing</strong> can beremoved from the <strong>wound</strong> <strong>with</strong>out difficultywhen the <strong>dressing</strong> is changed. They assessedthe removability as very good or good in over96% of the treatments.Another advantage of hydroactive comparedto traditional <strong>wound</strong> <strong>dressing</strong>s is their costeffectivenessin the treatment of chroniculcers. Hydroactive <strong>wound</strong> <strong>dressing</strong>s canbe left on the <strong>wound</strong> longer compared totraditional <strong>dressing</strong>s and therefore haveto be changed less frequently. In thepresent application study, the <strong>wound</strong> careprofessionals changed the hydrogel <strong>dressing</strong>every 4 days on average. Since the hydroactive<strong>dressing</strong> also provides a physiologicallymoist milieu, the <strong>wound</strong>s heal faster, whichagain shortens the treatment time. This alsoimproves the quality of life of the patients,who are often troubled by their chronic<strong>wound</strong> for months or even years. If the totaltreatment costs are compared (materialfor <strong>dressing</strong>s and other aids, frequency of<strong>dressing</strong> changes, staff costs etc.), hydroactive<strong>wound</strong> <strong>dressing</strong>s are more cost-effective than,for instance, gauze <strong>dressing</strong>s (15).In the treatment of chronic ulcers <strong>with</strong>hydrogel <strong>dressing</strong>s, maceration in the <strong>wound</strong>area can occur because of the constantwater release especially in the case of moreexudative <strong>wound</strong>s. The ability to absorbexcessive exudate is much lower compared<strong>with</strong> other hydroactive <strong>dressing</strong>s such ashydrocolloids or foams (7). According to theinvestigators, this was also the main reasonfor discontinuation of the treatment <strong>with</strong> thehydrogel <strong>dressing</strong>. To avoid maceration, it istherefore important to inspect the <strong>wound</strong> andalso the perilesional skin regularly in order toidentify pathological changes promptly andadjust the local <strong>wound</strong> treatment accordingly(16, 17). Adequate care of the <strong>wound</strong> marginsmust also be ensured. Especially in elderlypatients, the skin around the ulcer is veryfragile and susceptible to maceration, oedemaand erythema (18). Closure of the defect ispossible only when the perilesional skin is alsointact as the proliferation and migration ofcells from which the epithelial and granulationtissue is produced are initiated by the skinsurrounding the <strong>wound</strong> (19). Skin protectioncreams have been proven as effective skincaremeasures (20). Nevertheless, hydrogel<strong>dressing</strong>s have clear advantages when little<strong>wound</strong> exudate is produced and the <strong>dressing</strong>change intervals become longer. Here theirtransparency allows <strong>wound</strong> bed inspection<strong>with</strong>out the necessity to remove the <strong>dressing</strong>.This unique property avoids traumatic <strong>dressing</strong>changes and adds cost benefits.ConclusionThe non-randomised, non-comparative trial inan unselected panel of 81 patients, who arecharacteristic for internist and general medicalpractices and outpatient clinics, suggeststhat chronic <strong>wound</strong>s, especially those ofvenous origin, can be treated effectively <strong>with</strong>Hydrosorb comfort. By providing a moist<strong>wound</strong> environment, the hydrogel <strong>dressing</strong>promotes the healing process, <strong>reduce</strong>s <strong>wound</strong><strong>pain</strong> and thus improves the patients’ qualityof life.References1 Martini P. Wound healing – aiming forperfect skin regeneration. Science 1997;276: 75-812 Scheithauer M, Riechelmann H. 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Wounds UK 2008HARTMANN are pleased to be attendingWounds UK 2008 in Harrogate. This year, theconference takes place between 10th – 12thNovember at the Harrogate InternationalConference Centre.Please come and visit our stand to see theHARTMANN range of modern and traditional<strong>wound</strong> care products including the newHydrofilm range and enter our daily free prizedraw to win an authentic Steiff Teddy Bear.Your partner in <strong>wound</strong> managementpartnership professionalism passionTell us how we can improve the Forum& you could win a Nintendo WiiPlease complete all 3 sectionsto qualify for entry into the prize draw1. Please highlight any suggestions you may have on howHARTMANN can improve Wound Forum3. Recommend a colleagueNameOrganisation / TrustAddress2. Please give details of clinical subject matter you would like tosee covered in a future edition of Wound ForumTelephoneEmailYour detailsNameOrganisation / TrustAddressPostcodePlease return this FREEPOST card today!TelephoneEmailProfessional Addresses OnlyPostcode