Venous Leg Ulcer. A Complete Solution. Therapy Approach with Adapted Products

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Ethan Walsh
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1 Venous Leg Ulcer A Complete Solution Therapy Approach with Adapted Products

A Complete Solution for Venous Leg Ulcers No two wounds are the same, yet they share one thing: every wound needs the best possible conditions present to allow for its healing.

2 A Complete Solution for Venous Leg Ulcers No two wounds are the same, yet they share one thing: every wound needs the best possible conditions present to allow for its healing. Although the condition of a venous leg ulcer predominantly affects the skin, it actually originates from long-standing venous insufficiency, which causes an impaired exchange of gases and supply of nutrients to the skin. With this therapy approach, BSN Medical provides physicians and caregivers with a full spectrum solution to the challenges of ulcer treatment. BSN Medical offers a full range of compression bandages to help effectively restore venous flow at any stage of wound healing, while the new Cutimed advanced wound care range helps to create ideal conditions for wound healing from autolytic debridement and antimicrobial therapy to exudate management. Once the ulcer is healed, JOBST compression stockings facilitate recurrence prevention. BSN Medical provides you with an easy-to-understand therapy approach and a product range covering all needs for effective treatment. Venous insufficiency is one of the most common diseases among the 50 plus. Chronic wounds resulting from venous insufficiency are a source of much pain and discomfort and, in order to heal, a comprehensive therapy approach is required which is tailored to the indication. 2

Pathogenesis of a Venous Leg Ulcer How do venous leg ulcers develop?

The compromised blood flow to the heart is mainly caused by venous valve incompetence.

Pathologic dilatation and deformation as well as increased extravasation are the consequences.

This causes death of skin tissue and the development of a venous leg ulcer.

Closed valve: Blood cannot flow back towards distal.

The wounds are mostly located on the inside of the lower leg: About 80% of ulcerations are located around the ankle and

3 Pathogenesis of a Venous Leg Ulcer How do venous leg ulcers develop? Venous leg ulcers are the most severe symptom of chronic venous insufficiency. The compromised blood flow to the heart is mainly caused by venous valve incompetence. The resulting reflux leads to an ambulatory venous hypertension which also extends into the capillaries. Pathologic dilatation and deformation as well as increased extravasation are the consequences. Ultimately nutrients and oxygen are unable to diffuse to the skin. This causes death of skin tissue and the development of a venous leg ulcer. Regular function of venous valves Open valve: Blood can flow towards the heart. Closed valve: Blood cannot flow back towards distal. Malfunction of venous valves Deficient valve allows the venous blood to reflux. Where do venous leg ulcers develop? The wounds are mostly located on the inside of the lower leg: About 80% of ulcerations are located around the ankle and behind the malleolus. They can be difficult to heal and require a comprehensive therapeutic approach also tackling the underlying cause. Important: venous or arterial ulcer? Differential diagnosis is the basis for the right therapy: compression would be strictly contraindicated in case of arterial leg ulcers.! In order to exclude an underlying arterial disease, the patient s ABPI (Ankle Brachial Pressure Index) should be assessed. Values below 0.8 may indicate an arterial insufficiency. In the case of values below 0.5, compression would be contraindicated. 3

4 Assessment and Treatment of the Venous Leg Ulcer Treatment Algorithm The Canadian Association of Wound Care has developed Best Practice Recommendations for the Prevention and Treatment of Venous Leg Ulcers 1 and recommends the following treatment algorithm 2 in which implementing appropriate compression therapy is a key component in treating the underlying cause. Person with Venous Leg Ulcer Identify and Treat the Cause Vascular flow Ankle joint mobility Venous reflux Local Wound Care Patient-Centered Concerns Adherence to plan of care Quality of life issues related to lifestyle changes Pain Debridement Support autolytic debridement Inflammation and Infection Control Rule out/treat Moisture Balance Control exudate 1 Cathy Burrows, RN, BScN; Rob Miller, MD, FRCP (c); Debbie Townsend, RN; Ritchie Bellefontaine BSc, RVT; Gerald MacKean, MD, FRCS (c), Heather L. Orsted, RN, BN, ET, MSc; and David H. Keast, MSc, MD, FCFP. Best practice recommendations for the prevention and treatment of venous leg ulcers: Update 2006, Wound Care Canada, vol. 4, Number 1, Sibbald RG, Orsted HL, Schultz GS, Coutts P, Keast D. Preparing the wound bed 2003: Focus on infection and inflammation. Ostomy/Wound Management. 2003;49(11): Cotton, C. (1996). Compression Therapy in the management of leg ulcers. Canadian Association for Enterostomal Therapy (CAET) Journal, 15(1),

Treating the Underlying Cause The importance of

case of venous leg ulcers, as it is the most

pressure and decreases interstitial fluid volume,

No Edema Short Stretch Multi-Layer Long Stretch

Comprifore LF / Comprifore lite LF Tensopress

edema/ Appropriate for mixed ulcer/ When pain is

patients For non-adherent patients/ When rashes

5 Treating the Underlying Cause The importance of compression Adequate compression is compulsory in case of venous leg ulcers, as it is the most effective treatment for the underlying disease: chronic venous insufficiency. Compression therapy increases skin perfusion pressure and decreases interstitial fluid volume, thereby increasing tissue oxygenation, thus promoting tissue healing 3. Treat the Cause Vascular Flow (Compression) Edema No Edema Short Stretch Multi-Layer Long Stretch Zinc Paste Bandage RTW Stocking Comprilan JOBST Comprifore LF / Comprifore lite LF Tensopress Gelocast JOBST UlcerCARE TM To quickly reduce edema/ Appropriate for mixed ulcer/ When pain is an issue Can be left in place 7 days For immobile patients For non-adherent patients/ When rashes are present For patient self-management Prevention/Maintenance: Compression Stockings JOBST UltraSheer JOBST formen Casual JOBST ActiveWear 5

Compression Products There are several options that can provide appropriate sustained compression treatment; short stretch bandage, multi-layer bandage system, long stretch bandage, zinc paste

Short Stretch Bandage Comprilan is a short stretch bandage providing both compression and high resistance to stretch to increase venous return in the management of venous leg ulcers.

6 Compression Products There are several options that can provide appropriate sustained compression treatment; short stretch bandage, multi-layer bandage system, long stretch bandage, zinc paste bandage or ready-to-wear stocking. No matter what your need is, BSN Medical offers a solution! Short Stretch Bandage Comprilan is a short stretch bandage providing both compression and high resistance to stretch to increase venous return in the management of venous leg ulcers. n Provides high working pressure and low resting pressure n Can be worn comfortably, safely and effectively during rest and activity n Can be washed and reused for economical treatment n Cool and light, the open weave 100% cotton fabric allows the skin to breathe n Better tolerated if pain is an issue n Safe for mixed ulcers (0.6 < ABPI < 0.8) To prevent Comprilan bandage from slipping, the use of Easifix Cohesive self-adhesive fixation bandage is recommended. The cohesive coating of Easifix Cohesive ensures that the bandage sticks only to itself and not the patient s skin or clothing, and helps to maintain the bandage in place. Its 20 m roll format and the fact that it can be reused on the same patient make it economical to use. Multi-Layer Compression System JOBST Comprifore LF/Comprifore lite LF are multi-layer compression systems with all the components needed for adequate 40 mmhg compression for the treatment of venous leg ulcers. With the included Cutimed Sorbact WCL (wound contact layer), the set also provides bacteria-binding benefits in infected wounds or to protect wounds at risk of infection. n Provides sustained graduated compression of 40 mmhg for up to 7 days n Safe and easy application to minimize nursing time n Contains Cutimed Sorbact WCL, with micro-binding action and low adherence for atraumatic and pain-free dressing changes n Available in 2 versions: JOBST Comprifore LF for the treatment of VLU (ABPI 0.8) and JOBST Comprifore lite LF for reduced compression for mixed ulcers (0.6 < ABPI < 0.8) 6

Long Stretch Bandage Tensopress is a long stretch compression bandage delivering sustained compression for the treatment of venous leg ulcers, especially for non-ambulatory patients.

repeated washing (up to 20 times) to ensure cost-effective care n Central green line to guide and simplify precise and even application Zinc Paste Bandage Gelocast, the original Unna s boot, is a

n Indicated when rashes are present n Dries quickly n Uniformly impregnated for easy handling and molding to the limb n Available in two sizes: 8 cm and 10 cm Ready-to-Wear Stocking JOBST UlcerCARE

7 Long Stretch Bandage Tensopress is a long stretch compression bandage delivering sustained compression for the treatment of venous leg ulcers, especially for non-ambulatory patients. n Sustained, even and consistent compression for up to eight days n Cotton and viscose mix provides soft edges and reduces the risk of irritation or discomfort n Will retain its performance after repeated washing (up to 20 times) to ensure cost-effective care n Central green line to guide and simplify precise and even application Zinc Paste Bandage Gelocast, the original Unna s boot, is a reliable compression bandage impregnated with zinc oxide and calamine. It provides high working pressure and low resting pressure to reduce edema. n Indicated when rashes are present n Dries quickly n Uniformly impregnated for easy handling and molding to the limb n Available in two sizes: 8 cm and 10 cm Ready-to-Wear Stocking JOBST UlcerCARE is a two-stocking system incorporating a liner and an outer stocking to supply the gradient compression needed for a venous ulcer to heal (40 mmhg), while allowing self-management and normal lifestyle for the patient. n Easy handling n Perfect combination for providing patients with a higher quality of life and maximizing compliance n Liner provides mild compression for non-ambulatory patient to help manage edema during bed rest, and may be worn 24 hours a day n Liner contains silk which increases comfort and facilitates donning of the outer stocking n Outer stocking is available in beige or black, with zipper on left or right side for comfortable closure on the opposite side of the wound, or without zipper 7

Local Wound Care Once the cause of the venous leg ulcer is

required to offer optimal healing conditions.

Siltec / Siltec B Moderate exudate Cutimed Sorbact Hydroactive

8 Local Wound Care Once the cause of the venous leg ulcer is being addressed with compression, adequate local wound care is required to offer optimal healing conditions. Local Wound Care Debridement Infection Control Moisture Balance Cutimed Ultra Sorbact Coming soon! Cutisorb Ultra High exudate Cutimed Siltec Sorbact Cutimed Siltec / Siltec B Moderate exudate Cutimed Sorbact Hydroactive B Cutimed Siltec L Low exudate Cutimed Gel Cutimed Sorbact gel Dry wounds Fixation: Leukomed T, Hypafix transparent 8

Wound Care Products Discover Cutimed advanced wound care products from BSN Medical, an innovative wound management range which reliably covers all wound healing phases.

The Cutimed range features easy to use pictograms to select the appropriate product according to exudate level, wound depth and wound phase.

should be removed from the wound bed as they impair wound healing and hinder the assessment of wound size and depth.

9 Wound Care Products Discover Cutimed advanced wound care products from BSN Medical, an innovative wound management range which reliably covers all wound healing phases. Especially designed to aid in the treatment of chronic wounds such as venous leg ulcers, our new range offers a complete selection of effective and patient-friendly products. The Cutimed range features easy to use pictograms to select the appropriate product according to exudate level, wound depth and wound phase. Wound Phase Necrotic Infected Sloughy Granulation Epithelialization Wound Depth Shallow Deep Shallow + deep Exudate Dry to low Low to medium Medium to high High to excessive Debridement Necroses should be removed from the wound bed as they impair wound healing and hinder the assessment of wound size and depth. Hydrogels provide an effective yet gentle method to dissolve necrotic and sloughy tissue. Cutimed Gel supports autolytic debridement and shows high moisture donation. Moisture Balance In the early stages of wound healing, high amounts of exudate can be experienced. Even more in venous leg ulcers, when effective compression will start to reduce edema in the lower limb which may result in even higher exudate levels. NEW The Cutimed Siltec range of foam dressings has been especially developed for the treatment of chronic wounds. Due to its very evenly perforated silicone layer, Cutimed Siltec ensures most gentle adherence to the skin surrounding the wound without any adhesion in the moist wound, therefore providing painless and atraumatic dressing changes. In addition, super-absorbent particles in the foam core of Cutimed Siltec do not only absorb a multiple of their own weight they reliably bind exudate, even under compression, and ensure vertical absorption to prevent maceration. Cutisorb Ultra is a super-absorbent dressing for high to very high levels of exudates. Cutisorb Ultra is able to absorb four times the amount of exudate in comparison to other absorbent dressings, which means less dressing changes allowing the wound more time to heal and saving time, money and resources. 9

Pathogenic bacteria and fungi are irreversibly bound and inactivated by the wound dressing by a physical principle known as hydrophobic interaction.

10 Wound Care Products Infection Control Wound infection and critical colonization pose a serious barrier to the healing process. Cutimed Sorbact with its unique mode of action, has proved successful as a non-medicated antimicrobial dressing. Pathogenic bacteria and fungi are irreversibly bound and inactivated by the wound dressing by a physical principle known as hydrophobic interaction. Cutimed Sorbact reduces the microbial load and helps to create optimum conditions for the natural wound healing process n Effective against all fungi and bacteria even against MRSA and VRE n No chemical agent: no bacterial resistance n No cytotoxicity and no promotion of bacterial endotoxin release n Pain free dressing changes n No risk of allergies and no contraindications The Cutimed Sorbact range of products offers high flexibility in the antimicrobial therapy of infected wounds. Choose your dressing depending on wound type, exudate level and wound depth. Cutimed Siltec Sorbact combines Sorbact antimicrobial therapy with absorbent foam core for moderately to heavily exuding wounds. Cutimed Sorbact Hydroactive B combines Sorbact antimicrobial therapy with absorbent hydropolymer gel core for fluid management of low to moderately exuding wounds. Cutimed Sorbact gel combines Sorbact antimicrobial therapy with hydrogel component that helps cleansing the leg ulcer in dry wounds. 10

11 Ordering Information Code Dimensions Qty/Box Comprilan cm x 5 m 1 roll cm x 5 m 1 roll cm x 5 m 1 roll cm x 5 m 1 roll cm x 5 m 1 roll cm x 10 m 1 roll cm x 10 m 1 roll Easifix Cohesive cm x 4 m* 10 rolls cm x 4 m* 10 rolls cm x 4 m* 10 rolls cm x 4 m* 10 rolls cm x 4 m* 10 rolls cm x 20 m* 1 roll cm x 20 m* 1 roll cm x 20 m* 1 roll cm x 20 m* 1 roll cm x 20 m* 1 roll Gelocast cm x 9 m 1 box cm x 9 m 1 box JOBST Comprifore LF layer 1 kit layer (lite version) 1 kit Tensopress cm x 3 m 10 rolls cm x 3 m 10 rolls *Stretched JOBST UlcerCARE TM Stocking and Liners Size Color No Zipper Left Zipper Right Zipper Qty/Box S Beige stocking & 2 liners M Beige stocking & 2 liners L Beige stocking & 2 liners XL Beige stocking & 2 liners 2XL Beige stocking & 2 liners 3XL Beige stocking & 2 liners 4XL Beige stocking & 2 liners S Black stocking & 2 liners M Black stocking & 2 liners L Black stocking & 2 liners XL Black stocking & 2 liners 2XL Black stocking & 2 liners 3XL Black stocking & 2 liners 4XL Black stocking & 2 liners JOBST UlcerCARE TM Replacement Liners Size Color Code Qty/Box S White liners M White liners L White liners XL White liners 2XL White liners 3XL White liners 4XL White liners Sizing chart S cm (7 8 1/4 ) cm (11 1/2 13 3/4 ) M cm (8 1/4 9 1/ 2 ) cm (13 1/4 16 ) L cm (9 1/2 10 3/4 ) cm (15 3/4 18 1/2 ) XL cm (10 3/4 12 ) cm ( /4 ) 2XL cm (12 13 ) cm (19 22 ) 3XL cm (13 14 ) cm (19 3/4 23 ) 4XL cm ( /4 ) cm (20 1/2 23 3/4 ) Prevention of Recurrence Living With Venous Insufficiency Once the venous leg ulcer has healed, the underlying disease will need to be addressed to help prevent future ulcers. Recurrent venous leg ulcers are frequent among patients whose venous insufficiency is not treated continuously with compression. Patients therefore have to learn that this condition can be treated with ease, and implemented in daily life. For complete line of products and ordering information, please contact your BSN representative or Customer Service 11

Ordering Information Code Dimensions Qty/Box Cutimed Siltec Sorbact 7992900 7.5 cm x 7.5 cm 10 7992901 12.5 cm x 12.5 cm 10 7992902 15 cm x 15 cm 10 7992903 17.5 cm x 17.5 cm 5 7992904 22.5 cm x 22.

5 cm 10 7993302 14 cm x 14 cm 10 7993303 19 cm x 19 cm 10 7993304 14 cm x 24 cm 10 7993301 24 cm x 24 cm 5 Cutimed Sorbact gel 7261100 7.5 cm x 7.5 cm 10 7261101 7.

7263201 10 cm x 10 cm 10 7263202 10 cm x 20 cm 10 7263203 15 cm x 15 cm 10 7263204 20 cm x 20 cm 5 Cutimed Siltec B 7263100 7.5 cm x 7.5 cm 10 7263101 12.5 cm x 12.

5 cm 5 Cutimed Gel 7261000 8 g 10 tubes 7261001 15 g 10 tubes 7261002 25 g 10 tubes Cutimed Siltec L 7263000 5 cm x 6 cm 10 7263001 10 cm x 10 cm 10 7263002 15 cm x 15 cm 10 The Cutimed range of

12 Ordering Information Code Dimensions Qty/Box Cutimed Siltec Sorbact cm x 7.5 cm cm x 12.5 cm cm x 15 cm cm x 17.5 cm cm x 22.5 cm sacrum 17.5 cm x 17.5 cm sacrum 23 cm x 23 cm 5 Cutimed Sorbact Hydroactive B cm x 8.5 cm cm x 14 cm cm x 19 cm cm x 24 cm cm x 24 cm 5 Cutimed Sorbact gel cm x 7.5 cm cm x 15 cm 10 Cutisorb Ultra Cutimed Siltec Code Dimensions Qty/Box cm x 10 cm cm x 20 cm cm x 20 cm cm x 30 cm cm x 6 cm cm x 10 cm cm x 20 cm cm x 15 cm cm x 20 cm 5 Cutimed Siltec B cm x 7.5 cm cm x 12.5 cm cm x 15 cm cm x 17.5 cm cm x 22.5 cm 5 Cutimed Gel g 10 tubes g 10 tubes g 10 tubes Cutimed Siltec L cm x 6 cm cm x 10 cm cm x 15 cm 10 The Cutimed range of products offers high flexibility in the therapy of chronic wounds. Choose your dressing with the easy-to-use pictograms according to exudate level, wound depth and wound phase: Wound Phase Necrotic Infected Sloughy Granulation Epithelialization Wound Depth Shallow Deep Shallow + deep Exudate Dry to low Low to medium Medium to high High to excessive PE VLU R6 BSN Medical Inc Autoroute Laval West, Suite 255 Laval (QC) Canada H7P 4W6 Tel Fax

Venous Leg Ulcer. A Complete Solution. Therapy Approach with Adapted Products

Venous Leg Ulcer. A Complete Solution. Therapy Approach with Adapted Products Venous Leg Ulcer A Complete Solution Therapy Approach with Adapted Products A Complete Solution for Venous Leg Ulcers No two wounds are the same, yet they share one thing: every wound needs the best possible