References

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Reg. Toscana – SNLG 3. Lesioni da pressione, prevenzione e ttratamento. 2013. http://bit.ly/1QeDLBu (accessed February 2016)

European Wound Management Association (EWMA). Position Document: Management of wound infection. 2006. http://bit.ly/1m9Rnji (accessed February 2016)

Jones C., Kennedy J. Treatment options to manage wound biofilm. Adv Wound Care (New Rochelle). 2012; 1:(3)120-126

Strohal R., Apelqvist J., Dissemond J. EWMA Document: Debridement. J Wound Care. 2013; 22:S1-S52

Percival S.L., Cutting K.F. Biofilms: possible strategies for suppression in chronic wounds. Nurs Stand. 2009; 23:(32)64-72

James G.A., Swogger E., Wolcott R. Biofilms in chronic wounds. Wound Repair Regen. 2008; 16:(1)37-44

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Eberlein T., Fendler H., Hoffman M. Expert assessment on the benefits of systematic application of Prontosan solution in wound treatment with particular focus on cost-efficacy when compared to current standard treatment (saline/Ringer). Die Schwester Der Pfleger 45 Jahrg. 2006; 9/06:2-4

Biofilms Made Easy, Wounds International. 2010. http://bit.ly/1CJUTUX (accessed February 2016)

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Pressure ulcers
Leg ulcers
Hard-to-heal wounds
Clinical/pre-clinical research

Effect of a wound cleansing solution on wound bed preparation and inflammation in chronic wounds: a single-blind RCT

02 October 2017
Research
02 October 2017
Volume 1 · Issue 4

Abstract

Objective:

Research into surfactant solutions for the debridement of chronic wounds suggests that surfactants may support wound bed preparation (WBP) in chronic wounds, however their efficacy has not been evaluated in randomised controlled trials (RCTs). Our aim was to assess the clinical efficacy of a propylbetaine-polihexanide (PP) solution versus normal saline (NS) solution in WBP, assessing inflammatory signs and wound size reduction in patients with pressure ulcers (PUs) or vascular leg ulcers.

Method:

In a single-blinded randomised controlled trial (RCT) patients were randomly allocated to two groups and treated with either propylbetaine-polihexanide (PP) solution (Prontosan) or NS. Wounds were assessed using the Bates-Jensen wound assessment tool (BWAT). Assessments took place at inclusion (T0), day 7 (T1), day 14 (T2), day 21 (T3), and day 28 (T4). Outcomes were analysed using a two-tailed Student's t-test.

Results:

A total of 289 patients were included. Both groups had similar demographics, clinical status, and wound characteristics. Data analysis showed statistically significant differences between T0 and T4 for the following outcomes: BWAT total score, p=0.0248; BWAT score for inflammatory items, p=0.03; BWAT scores for wound size reduction (p=0.049) and granulation tissue improvement (p=0.043), all in favour of PP. The assessment of pain did not show any significant difference between the two groups.

Conclusion:

The study results showed significantly higher efficacy of the PP solution versus NS solution, in reducing inflammatory signs and accelerating the healing of vascular leg ulcers and PUs. This evidence supports the update of protocols for the care of chronic wounds.

Hard-to-heal ulcers are frequently due to the presence of debris and tissue that allows the heavy growth of bacteria and the development of biofilm. Cleaning and debridement of the wound bed as well as control of exudate and bacterial load1 are principles that apply to wound management.2 Since 20053 international and national guidelines2,4,5 have incorporated the principles of wound bed preparation (WBP), to promote tissue repair through evidence-based clinical decisions.

Debridement has been traditionally assimilated to WBP. Debridement refers to removing necrotic material, eschar, devitalised tissue or any other type of bioburden from a wound, including wounds with tunnels and/or cavities, to promote wound healing.1,2,3,4,5 The most important clinical challenge regarding debridement is to select the appropriate debridement method for each individual, maintaining the balance between respecting viable tissue and the speed at which non-viable tissue is removed.5

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wound debridement
inflammation
leg ulcers
pressure ulcers
propylbetaine
polihexanide