Foam Dressing For Leg Ulcers

Dressings And Topical Agents For Treating Venous Leg Ulcers

What is the aim of this review?

The aim of this review is to find out which dressings and topical agents are most effective for treating a type of wound known as venous leg ulcers. These are longterm wounds in the lower leg caused by problems with blood flow back up the leg through the veins. Researchers from Cochrane found 78 relevant studies to answer this question. Randomised controlled trials are medical studies where patients are chosen at random to receive different treatments. This type of trial provides the most reliable evidence. We evaluated these studies using a method known as network metaanalysis , which allowed us to compare treatments across different studies and to rank them in terms of complete ulcer healing.

Key messages

We cannot be certain which dressings and topical agents are most effective for healing venous leg ulcers: over all studies there were not enough participants per treatment and there was high risk of bias this means that many of the studies were conducted or reported in a way that means we cannot be sure if the results are accurate. The main treatment for venous leg ulcers is compression bandages or stockings and the choice of additional dressings or topical treatments should take into account the review findings and their uncertainty, alongside factors such as patient preference and cost.

What was studied in the review?

What are the main results of the review?

How up to date is this review?

Process Outcomes Evaluation And Reporting

During the EBP realization, the information about cost-efficiency, time of healing, and the overall patient outcomes should be collected. The evaluation will be carried out based on the objective patient data and nursesâ self-reports regarding the compliance with the specifically designed care protocols. The information will be collected on a daily basis and, by the end of week 11, evaluated by the nurse epidemiologist and the project leader. A comprehensive report on the project outcomes will be submitted to the hospital management and discussed at the collective meeting of the involved stakeholders.

Treating An Infected Ulcer

An ulcer sometimes produces a large amount of discharge and becomes more painful. There may also be redness around the ulcer.

These symptoms and feeling unwell are signs of infection.

If your ulcer becomes infected, it should be cleaned and dressed as usual.

You should also elevate your leg most of the time. Youll be prescribed a 7-day course of antibiotics.

The aim of antibiotic treatment is to clear the infection. But antibiotics do not heal ulcers and should only be used in short courses to treat infected ulcers.

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Curavance Foam Ag Bordered Dressings

CuraVance Foam Ag Dressings are indicated for the management ofmoderate to heavily exuding, acute and chronic wounds including: diabetic foot ulcers, venous leg ulcers, pressure ulcers, graft and donor sites, trauma wounds, second-degree burns, and post-operative wounds and skin abrasions.

The semipermeable polyurethane film outer layer acts as a liquidand microbial barrier to prevent contamination, while delivering balanced oxygen and moisture vapor transfer for a moist wound healing environment.

Non-adherent foam absorbs and retains exudate and ensures atraumatic dressing removal to deliver optimal patient outcomes.

Laboratory testing has demonstrated that CuraVance Foam Ag Dressingsprovide broad-spectrum antibacterial activity against the most commonpathogens associated with wound infections for up to 7 days.

CuraVance Foam Ag Dressings are available withand without adhesive border.

• Absorbent foam absorbs excess wound fluid to maintain the optimal moist wound healing environment.
• Non-adherent foam reduces pain and trauma during dressing changes.
• Broad spectrum antibacterial activity protects against the most common pathogens associated with wound infection.
• High MVTR semi-permeable PU film provides low coefficient of friction and extends wear time
• Transparent film serves as a physical barrier to prevent fluid and microbial contamination

Determine Responsibility Of Team Members

Stakeholders are selected from different organizational levels and professional backgrounds because, in this way, it will be easier to integrate changes throughout the hospital. The Director will participate as a co-leader and will provide managerial support. The nurse epidemiologist will be responsible for monitoring and evaluation of the results. The charge nurse will co-manage and ensure the program follow-up.

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How Does It Happen

Gravity works well at getting the blood down to the feet, but when it comes to getting the blood back up the leg towards the knee and thigh, the ankle area becomes most vulnerable. The blood is pushed up the veins when your heart pumps and by your blood pressure. When it cant make it upwards, it pools and collects in the veins, expanding them like a small balloon. The valves in the veins cant open and close properly due to this distention. Tissues inside the skin depend upon the circulatory system to bring nutrients, and to remove waste products from the cells. When the circulation reduces the tissues discolor, devitalize and die. This causes an opening in the skin called ulceration.

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Cleaning And Dressing The Ulcer

The first step is to remove any debris or dead tissue from the ulcer and apply an appropriate dressing. This provides the best conditions for the ulcer to heal.

A simple non-sticky dressing will be used to dress your ulcer. This usually needs to be changed once a week.

Many people find they can manage cleaning and dressing their own ulcer under the supervision of a nurse.

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Criteria For Considering Studies For This Review

Types of studies

We included published and unpublished randomised controlled trials , irrespective of language of report. We only included crossover trials that reported outcome data at the end of the first treatment period and prior to crossover. We excluded studies using quasirandom methods of allocation . We highlighted trials in which three or more interventions were randomised and included all relevant arms.

Types of participants

We included trials recruiting adults described as having venous leg ulcers, managed in any setting. We accepted study authors definitions of venous leg ulcers. Where wounds were described only as leg ulcers without information as to aetiology, we assumed that they were venous in origin. Trials in which a minority of leg ulcers are described as having a mixed or arterial pathology were included provided that these were fewer than 25% of participants. Trials including other types of mixed wound populations were not included. We included participants at any stage of their treatment process for example, participants with or without ulcers described as being hard to heal or clinically infected.

Types of interventions

* combination dressings means two or more dressings applied sequentially over time , or a product containing two or more types of dressing material .

Some of the interventions we considered are as follows we used the categories listed below as the basis for grouping the treatments used in individual studies:

Data synthesis

Evaluating The Efficacy Of An Absorbent Foam Dressing Containing Silver Versus The Same Dressing Without Silver Used On Subjects With Venous Leg Ulcers Or Mixed Ulcers

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Indications And Contraindications For Foam Dressing Use

Foam dressings are excellent for wounds which are exuding, whether minimally or heavily. Generally, foam dressings are meant for partial- or full-thickness wounds. Wounds which benefit from the use of foams dressings include:

• wounds needing negative pressure wound therapy
• tracheotomy and gastrostomy tubes

Foam dressings can be used on wounds that have softened necrotic tissue. They are also flexible and can be cut to fit specific body parts like toes, fingers, or ears. Because of their thermal properties, foam dressings can be used on a wound which needs insulation to keep it warm. Additionally, foam dressings can be helpful in protecting the skin on top of bony prominences or high friction areas on the skin.

Non-draining wounds and third-degree burns are generally not good candidates for foam dressings. These dressings are also not effective on wounds which have dry eschar because with no exudate, the wound bed may be too dry for a moist wound healing environment . Excessive exudate can be a contraindication if the foam is being soaked through quickly, possibly allowing external bacteria to enter the wound. In addition, excessive exudate can require too many dressing changes and cause maceration of the periwound area. In such cases, a more absorbent foam or another dressing type is indicated.

Activheal Foam Adhesive Is An Absorbent Foam Dressing Ideal For Moderate To High Exuding Wounds

FEATURESEXCELLENT ABSORPTION OF EXUDATE // VERSATILE // PROMOTES HEALING THROUGH A MOIST WOUND ENVIRONMENT // REDUCES THE RISK OF MACERATION // WATERPROOF // BACTERIAL BARRIER // SOFT AND COMFORTABLE //

ActivHeal® Foam Adhesive is a two layer dressing indicated for moderate to heavily exuding wounds. Each layer of the ActivHeal® Foam Adhesive contributes to the performance of the dressing.

The dressing comprises of a polyurethane absorbent foam pad and a polyurethane membrane. The core of the dressing is a layer of absorbent polyurethane foam which absorbs wound exudate vertically into the dressing. The absorbent pad retains the exudate within the dressing preventing the exudate from re-entering the wound and preventing maceration to the peri wound and surrounding skin. The polyurethane membrane provides an effective barrier function and is waterproof whilst allowing the transpiration of exudate which aids the total fluid handling capacity of the dressing.

Indicated for moderate to heavily exudating wounds. The dressing offers a pressure sensitive acrylic adhesive border ensuring the dressing remains in place allowing the patient to continue everyday activities confidently. The dressing conforms to the contours of the body which reduces the risk of rucking or catching on clothing and bedding.

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Proper Foam Dressing Application Instructions

The procedure for applying a foam dressing is as follows:

The flexibility of foam dressings allows for a wide variety of clinical applications with wounds that have from moderate to heavy exudate. Because they are easy to use and can be easily cut to fit irregular wound areas, they are a good dressing choice for many situations.

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of IncontinenceSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.

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Foam Dressings For Venous Leg Ulcers

Venous leg ulcers are a common and recurring type of chronic wound. Compression therapy is used to treat venous leg ulcers. Dressings that aim to protect the wound and provide a moist environment to aid ulcer healing are applied beneath compression devices. Foam dressings are one of several types of dressing available. We evaluated the evidence from 12 randomised controlled trials that either compared different types of foam dressings, or compared foam dressings with other types of wound dressings. We found no evidence to suggest that polyurethane foam dressings are significantly better or worse than hydrocellular foam dressings in venous leg ulcer healing. Similarly, we found no evidence to suggest that foam dressings are significantly better or worse than other types of dressings , for the healing of venous leg ulcers. We found insufficient evidence to draw any conclusions regarding: adverse events, quality of life, costs, pain, or dressing performance. Overall, the current evidence is of low or unclear methodological quality. This limits the making of any specific recommendations regarding the use of foam dressings. Further, good quality evidence is required before definitive conclusions can be made regarding the role of foam dressings in the management of venous leg ulcers.

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How Often Should Unna Boots Be Changed

An Unna Boot can be left on for up to 7 days before it needs to be changed. Patients usually return to the clinic to have their boot changed once or twice per week until the wound or ulcer has healed.

At each clinic visit, the state of the wound will be assessed to determine if another Unna Boot needs to be applied.

Patients may need to use Unna Boots for a few weeks until their wound fully heals and stops draining. Usually, the Unna Boot needs to be applied multiple times until the patient can be transitioned to a dry compression wrap or graded compression stocking.

Venous Leg Ulcers: 6 Things To Know When Treating Venous Disease

Lower extremity venous disease affects millions of Americans and may ultimately lead to open, draining wounds that adversely affect quality of life. However, there are exciting developments in early diagnosis, prevention and treatment of venous leg ulcers . On the treatment side, there are more choices now than ever before in compression products, which is greatly improving the patient experience. But proper treatment also comes from a better understanding of venous leg ulcers, and better understanding comes from more education. Luckily, were here to help provide education and support for you and your team, so here are six things to know when treating VLUs.

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What You Need To Know

• The cornerstone of treatment for venous leg ulcers is compression therapy, but dressings can aid with symptom control and optimise the local wound environment, promoting healing

• There is no evidence to support the superiority of one dressing type over another when applied under appropriate multilayer compression bandaging

• When selecting a dressing, look at the wound bed, edge and surrounding skin and decide on the goal of the dressing: for example, if there are signs of localised infection consider an antimicrobial dressing, if there is heavy exudate consider an absorbent dressing

A 65 year old man presents with a two month history of a wound in the gaiter area of his left leg. He has a history of a left leg deep vein thrombosis after a long flight but is otherwise fit and well. He had been self-managing with dressings bought over the counter, but the wound has gradually increased in size. The wound is not painful but is weeping serous fluid, causing irritation of the surrounding skin. Examination shows a 4×3×0.1cm wound above the left medial malleolus. There is haemosiderin deposition, venous flare, and moderate oedema in the limb. The ankle-brachial pressure index is normal at 1.0. He is diagnosed with a venous leg ulcer, which is managed with dressings and compression bandaging.

About 1% of the adult population in Westernised countries are affected by venous ulcers on the leg or foot.2 The prevalence increases with age to 1.7% in

Data Collection And Analysis

Two review authors independently performed study selection, Risk of bias assessment and data extraction. We conducted this NMA using frequentist metaregression methods for the efficacy outcome the probability of complete healing. We assumed that treatment effects were similar within dressings classes . We present estimates of effect with their 95% confidence intervals for individual treatments focusing on comparisons with widely used dressing classes, and we report ranking probabilities for each intervention . We assessed the certainty of the body of evidence using GRADE for each network comparison and for the network as whole.

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How Can These Ulcers Be Prevented

Once an ulcer has developed, statistics show that another one will develop within 3-5 years. You know that preventing ulcers is well worth the effort if you have experienced the pain and frustration associated with healing wounds. Many patients will continue to wear some type of compression stocking every day while they are on their feet to help the circulation. While a Venous Stasis ulcer may have healed the poor circulation which caused the ulcer has not been corrected. Use AMERIGEL Care Lotion on your lower legs, particularly around the ankles daily. This helps the skin retain its natural moisture, promoting healthier skin that is less prone to problems.

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AMERX®, AMERIGEL®, HELIX3®, EXTREMIT-EASE®, Where Compression Meets Compliance®, Turn-Key DME®, and Oakin®, are registered trademarks of AMERX Health Care Corporation.