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We advise you to upgrade to a newer and safer browser, either Internet Explorer 9, Mozilla Firefox or Google Chrome. Wound healing is determined by the general health of your patient, so a comprehensive assessment of your patient is crucial when planning and evaluating treatment. Diagnosing the underlying cause of a wound is an essential part of wound assessment – and you can only treat the wound once this has been determined. In many countries Coloplast offers training in wound assessment and management for health care professionals. Venous leg ulcers are caused either by dysfunction of the venous valves or an inadequate calf muscle pump. Arterial leg ulcers are caused by insufficient blood supply to the leg or feet due to arteriosclerosis. Mixed venous and arterial leg ulcers are ulcers caused by both venous and arterial disease.
Wound dressings for leg ulcers should offer superior absorption and exudate management properties that enable them to absorb and retain exudate under compression bandages (venous leg ulcers). A silver-releasing dressing, such as Biatain Ag, can help prevent or resolve wound infection.If the wound is painful, a moist wound healing foam dressing containing ibuprofen such as Biatain Ibu is a good option. Successfully managing a diabetic foot ulcer requires a comprehensive understanding of the wound: its cause, progression, risk, and treatment. Neuropathy is the most common diabetic foot condition and is caused by damaged nerves in the lower extremity.
Responsible for a two-fold increase in mortality rates (1), pressure ulcers demand timely, effective treatment. Intact skin with non-blanchable erythema of a localised area, usually over a bony prominence.
Suitable wound dressings for pressure ulcers are foam or alginate dressings with superior absorption and exudate management properties, such as  Biatain Adhesive foam dressing or Biatain Alginate dressing.
Foreign objects should be removed from the wound and necrotic tissue debrided, as it can function as a base for infection and delay wound healing. Exudate production is part of the natural wound healing process (1), but the exudate needs to be managed appropriately. With appropriate care, smaller acute wounds will normally close within days or weeks depending on the size, depth and position of the wound. Suitable dressings for acute wounds are dressings with superior absorption and exudate management properties that support a moist wound healing environment. If a wound contains dead (necrotic) tissue, it’s a sign that the wound is not healing normally.
Purilon gel is ideal for gentle and effective autolytic debridement of tissue in both dry and moist necrotic wounds, when used in combination with a secondary dressing such as Comfeel or Biatain.
Exudate leaked from ulcers can cause maceration, a softening or sogginess and breakdown of the skin that results from on-going contact with excessive moisture.
As we grow older, the texture of our skin changes and our skin becomes thinner, weaker and less protective. The Biatain dressing range offers dressings with superior absorption and exudate management properties for all types of skin conditions.
If the skin is very fragile, consider using a non-adhesive dressing such as Biatain Non-adhesive or Biatain Alginate. Whether a wound is low-, medium- or high-exuding, superior absorption and control of exudate are essential for optimal healing.
If wound exudate is not properly controlled, it can leak from the dressing and result in the peri-ulcer skin being exposed to the exudate (1).
Maceration is a softening or sogginess and breakdown of the skin caused by on-going contact with excessive moisture. It is therefore very important that excess exudate is removed from the wound by an absorbent dressing.
Control of exudate, removal of unhealthy tissue by debridement and management of bacterial load are all part of good wound bed preparation.
We recommend the Biatain dressing range, which provides superior absorption - faster healing (5,6) of low to high exuding wounds. Wounds that are not healing normally may have a bacterial imbalance resulting in local infection of the wound.
Additional clinical symptoms may arise if the infection spreads to the healthy tissue surrounding the wound. Please remember that diabetic foot ulcers do not always present with the classical signs of local infection.
If a wound is healing normally, a foam dressing with superior absorption such as Biatain is ideal.
Studies show that more than 80% of patients with chronic wounds are in constant pain and half of them classify the pain as moderate to severe.
Local pain management is an important first step for persistent wound pain and for painful procedures, such as dressing changes and debridement. You should consider systemic treatment if the pain does not improve with local pain management. Biatain Ibu is the first and only dressing to combine moist wound healing with local release of ibuprofen (1,2). See how the use of Biatain® Non-Adhesive foam dressings led to a 95% reduction in ulcer area after four weeks’ treatment of a venous leg ulcer.
The patient – an 85-year-old woman – had been suffering from a venous leg ulcer on the lateral part of her lower left leg. Prior to inclusion, the ulcer had been treated with alginate dressings and compression therapy for ten weeks.
See how treatment of a heavily infected ulcer with Biatain® Ag Non-Adhesive foam dressing and Biatain Alginate® Ag prevented amputation of a foot.
This patient suffered from heart failure, coronary heart disease, arterial hypertension and venous insufficiency in both lower limbs, as well as Alzheimer’s. For four months, she had a very deep diabetic foot ulcer on the right foot with erythema, oedema, crepitation and heat in the surrounding tissues. The family was opposed to this treatment, and the patient was returned to her home for monitoring by her family doctor and out-patient care and dressing by home nursing.
The objective set was to prevent amputation of the foot, ensure the well being and comfort of the patient and of the family. See how a one-month treatment of a heavily exuding sacral pressure ulcer with Biatain® Ag effectively eliminated signs of local infection. The patient was an 88-year-old woman with a highly exuding Stage III sacral pressure ulcer. The ulcer had several signs of local infection, a significant odour, and was heavily exuding. During the one-month treatment period Biatain Ag effectively eliminated signs of local infection and supported healing of this heavily exuding sacral pressure ulcer.
This quick guide on Pressure ulcers – prevention and treatment contains general guidelines as well as important information and advice for prevention and treatment of pressure ulcers.
This quick guide on Diabetic foot ulcers – prevention and treatment is a general guideline to help diagnose, assess and treat diabetic foot ulcers in clinical practice. This pocket-sized application and cutting guide provides general guidelines and practical aid to cut and apply wound dressings to many different difficult-to-dress wounds. The number of dressings available on the market can make it difficult and confusing to choose the correct dressing.
This innovative case report presents the management of a patient with two infected pressure ulcers, one on the heel and one on the sacrum, using a granulated sugar dressing. Washing an open wound with soap and water should be the first step to prevent an infection.
When dealing with scrapes, which may also be called abrasions, most times people won’t need stitches and might not need medical care unless the abrasion is very large, is in addition to injury under the skin, such as potential bone fracture, or has matter in it like glass, wood or chemical irritants that cannot be thoroughly cleaned.

The other thing that could be necessary with an abrasion is pressure on the wound to make it stop bleeding. Animal and human bites can contain a variety of infectious elements including diseases like rabies or high levels of bacteria. Puncture wounds may also require hospital care, particularly if the puncture appears very deep. One of the reasons that doctor care is required to treat an open wound in many cases is because risk of infection tends to multiply as the hours pass. Care of the wound after it receives appropriate treatment could vary depending on what that treatment is. Smith & Nephew is the world-leading provider of wound care treatment and prevention products used to treat hard-to-heal wounds.
Increased blood sugar levels in Diabetes, leads to nerve damage due to toxic products called aldoses and aldehydes. Testing a patient for neuropathy involves testing for vibration, touch, temperature and blood flow. This test helps to determine vibration and touch sensation in the feet which are affected early in diabetic neuropathy. Computerized foot pressure testing is done to give an idea of pressure distribution in the feet and thereby allow design of effective footwear. The foot scan is not only useful to know pressure distribution but also useful in diagnosing flat feet, and thereby advising corrective footwear. Latest blood flow studies of the feet are done to understand severity of blood flow reduction on progression of disease. Blood flow studies are important in diabetics as the very small blood vessels are involved early in the disease and are responsible for ulcer formation. ABPI and vascular studies indicate not only the severity of vascular compromise in diabetic feet, but also in allowing one to predict gangrene level and the level of amputation. AT HAPPY FEET we have got LEDs (Light emitting diodes) to increase blood flow and improve symptoms of tingling & numbness and burning. Diabetics are more prone for foot ulcers due to reduced skin sensation in the feet and narrowing of blood vessels in the feet. Avoid using open sandals with thongs, as thongs can cause ulcers especially if not padded well.
Repeatedly washing your feet several times a day can lead to drying and cracking, leading to infection. Using narrow fronted shoes can give rise to a variety of problems like fungal infections between toes, and corns and ulcers on adjacent toes. In whichever stage, early, small or badly infected and gangrenous, requires planning and an established approach. They have to be used based on organism isolated and sensitivity to the particular antibiotic.
One of the most neglected but important aspects of ulcer treatment is the need for customized footwear. Growth factors are normally present in tissues which help wounds to heal normally after injury. The best way to treat these is to clear the infected matter in wound with an operation called debridement. Using blood vessels in a reverse technique due to a existence of perforators connecting superficial and deep vessels, a large 'flap'-meaning skin with fat, fascia and blood vessels is transported to the ulcer area.
Point-Counterpoint: Are Static Measurements Of Foot Morphology Necessary To Create Custom Foot Orthoses? HMP Communications LLC (HMP) is the authoritative source for comprehensive information and education servicing health care professionals. You will not get an optimal browsing experience using Internet Explorer 6 to view this site. The condition reduces the supply of oxygen and nutrients to the cells, resulting in tissue death and, eventually, ulcers.Patients with arterial ulcers should not be treated with compression therapy, but will often need vascular surgery.
The majority of patients diagnosed with mixed venous ulcers have ulcers of venous origin and develop arterial insufficiency over time.
The use of Biatain Ibu for leg ulcers is supported by several randomized controlled studies (1-3). Diabetic ulcers have a considerable negative impact on patients’ lives, and are highly susceptible to infection that all too often leads to amputation.
Ischemia is caused by impaired circulation, which can be due to arteriosclerosis or occlusion of tissue.
Not only are the feet more prone to infection, it’s also harder to get rid of an infection once it’s there.
A silver-releasing dressing such as Biatain Ag or Biatain Alginate Ag can help prevent or resolve wound infection. Exudate levels are often high during the inflammatory phase of wound healing, and leakage of exudate under the dressing can damage the surrounding skin.
Chronic wounds are often defined by the underlying condition that prevents wound healing, such as venous leg ulcers, arterial leg ulcers, diabetic foot ulcers or pressure ulcers.
This may be associated with age, disease processes or exposure of the skin to wound exudate or dressing adhesives. Maceration can lead to skin breakdown, causing the ulcer to grow or creating satellite ulcers.
If a wound is surrounded by fragile skin, dressings are more likely to cause skin irritation.
With proper wound treatment and use of dressings with superior absorption and exudate management, the skin surrounding a wound may be perfectly healthy and suitable for adhesive dressings such as Biatain Adhesive or Biatain Super, Adhesive. Non-healing, or chronic, wounds are often stuck in the inflammatory phase and may produce large amounts of exudate. Macerated tissue looks white and maceration can cause an ulcer to grow or create satellite ulcers. The optimal wound dressing keeps the wound moist and absorbs exudate, locking it inside the dressing to prevent maceration. Depending on the type of bacteria, the wound exudate may become more pus-like, and the peri-ulcer skin may be tender, red and painful. If the wound is infected or there is risk of wound infection, we recommend silver dressings such as Biatain Ag, or Biatain Alginate Ag.
Persistent or chronic wound pain not only affects patients’ quality of life, it can also be a major barrier to wound healing.
The method used began to bear fruit already seven days after the treatment started, with visible changes in the development of the wound.The wound closed ten months after the treatment was started.
Elimination of odour and a significant increase in healthy granulation tissue was observed already after one week. These include chronic wounds such as leg, pressure and diabetic foot ulcers as well as burns and post operative wounds. This testing is important not only to diagnose early changes in the diabetic feet, but also to monitor the response to treatment.
In diabetics and also especially in people over the age of 50, foot pressures increase and are unevenly distributed, pre-disposing to ulcer formation.
All diabetic foot testing should involve not only foot testing but also pressure measurement of the arm as well. If you have diabetes you have an increased risk of developing narrowing of the arteries (peripheral vascular disease). Because diabetic patients have lessened sensation on their feet, they are more prone for ulceration. The cause is poor blood flow and lack of sensation due to neuropathy (or loss of normal sensory function of the nerves). All dead and decaying tissue is removed including involved bony infection for healing to take place.

As the name implies, taking the weight off the involved area, lets healing to progress rapidly and is used as a routine in our centre.
In diabetes several cellular changes lead to abnormal growth factor function on the cells, leading to delay in healing. In chronic wounds oxygen given at a higher concentration, called hyperbaric oxygen accelerates wound healing. Once there is red granulation tissue and wound is no longer infected, then a secondary split skin graft or either local or regional full thickness graft is used. The skin closure after harvest is in such a way that there is no requirement for split skin grafts.
The donor area is usually closed on it's own, or wound sometimes require a split skin graft taken from the thigh. The advantage compared to supra-malleolar is that a relatively large distance is covered with the flap, mitigating flap loss due to tension on the flap.
Diabetes affects about 20 % of Indians, and the complications like vascular disease and neuropathy are about 30%.
HMP’s products include peer-reviewed and non-peer-reviewed medical journals, national tradeshows and conferences, online programs and customized clinical programs. Impaired circulation causes reduced pulse – the foot is cold and blue – and this leads to tissue death and the eventual development of an ulcer. So it’s crucial that you assess the patient regularly to prevent and react quickly to infections.
The pressure prevents the blood from circulating properly, and causes cell death, tissue necrosis and the development of ulcers. Wound exudate must be absorbed and managed by a dressing with moist wound healing properties. Necrotic tissue can contain bacteria – and if the bacteria grow, the wound will become infected.
For optimal moisture balance in the wound, the hydrocolloid Comfeel dressing and the unique properties of the Biatain foam dressing both support the natural autolytic debridement process. You must examine the skin carefully before deciding to use either an adhesive or a non-adhesive dressing. Composition and viscosity varies, from thin and clear plasma fluid to thick yellow secretion containing high concentrations of white blood cells and bacteria. Furthermore, the app holds information on the high quality product solutions within Coloplast’s Wound Care portfolio as well as the latest news. Nerve damage leads to loss of sensation of touch and pain causing pins & needles sensation, numbness and burning.
Existing, large non-healing, chronic and infective wounds shrink to a small and manageable size.
Depending on the location of the ulcer, a front off-loading or a back off-loading is available. Growth factors based on platelet cell and epidermis (normal top layer of skin) have been proven to work on diabetic wound healing. Generally several sessions may be required for the wound to granulate and become normal skin. Wheelchair users or people confined to a bed (for example, after surgery or an injury) are especially at risk. The safety and performance of Biatain Ibu is supported by evidence from the largest randomised, comparative clinical trials ever performed on a wound dressing(1-3). This can help closure of wounds using split skin graft or full thickness local or distant flap. The incidence of diabetes increased 40 percent over a period of eight years for people 40 and over. This is of serious concern when you consider the resulting complications that may be prevalent earlier in life and the exuberant medical care costs that run from $10,000 to $12,000 annually for the remainder of the patient’s life. Many studies have shown the per capita medical costs for a patient with diabetes are three times that of those for a person without diabetes. With the increased risk of complications and the increase in care costs, effectively diagnosing and treating diabetic infections has become more important than ever. Key Diagnostic Pointers And Early Treatment Considerations Early recognition of diabetic foot infections goes a long way toward treatment success. It is caused by the lack of normal protective sensation, which allows unrecognized trauma or microtrauma to cause tissue edema, inflammation and necrosis. Early in the treatment plan of a diabetic foot infection, you must answer two important questions: • Is hospitalization required? A simple way to summarize widely practiced surgical and medical therapies is the 4-D approach for abscess: decompression, drainage, debridement and drugs. Exploring Alternative Therapies In addition to traditional antibiotic and surgical decompression, there are many emerging adjunctive modalities to aid in the treatment of diabetic foot infections. Maggot debridement therapy is an inexpensive and efficient adjunct for treating diabetic foot wounds.4 Researchers have found that maggots are useful in debriding wounds, controlling wound odor and reducing bacterial burden in wounds, even in wounds infected by antibiotic resistant organisms. Randomized placebo-controlled trial of granulocyte-colony stimulating factor in diabetic foot infections. Maggots are fly larvae and are available in medical grade from commercial laboratories in the United States and Europe. This treatment is currently used in several centers, but requires proper staff training and patient acceptance. Evidence-based trials are also needed to appropriately define what type of infections would benefit from this therapy. Surveying The Antibiotic Possibilities Antibiotic-impregnated calcium sulphate pellets have been used for the local treatment of deep, infected, diabetic foot wounds with or without osteomyelitis. A randomized prospective controlled trial of granulocyte-colony stimulating factor (G-CSF) in limb-threatening diabetic foot infections.
The qualities of biocompatibility and biodegradability along with a slow release of high levels of a locally concentrated antibiotic make the pellets a beneficial therapy. This product is now commercially available in a kit that consists of the powdered calcium sulfate and a curing solution. The one time use kit is prepared under sterile conditions in the operating room and a powdered antibiotic (i.e. The mixture is then placed into a formation template to fabricate pellets of various sizes from 3 to 6 mm. The pellets are resorbed completely over approximately six weeks and deliver a steady state antibiotic concentration directly to the wound site.
Controlled studies are necessary to determine the efficacy of this modality in treating diabetic foot infections, but early clinical results have been impressive. Empiric antibiotic therapy should include broad spectrum antibiotics capable of covering the most common pathogens found in diabetic infections. Empiric treatment of moderate to severe infections should include agents active against Staph, Strep, gram-negatives, bacilli and anaerobes.
Combination therapy often includes clindamycin in addition to the previously mentioned antibiotics. The current challenge is to not only continue to develop new treatments but to master existing ones in a cost-effective, evidence-based and multidisciplinary manner.
Not only should we collaborate with various medical specialists, we must also recognize that the patient is the most important member of the team in order to win the battle of saving limbs.
Jones is a first year resident at the University of Texas Health Science Center in San Antonio, Texas.

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