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. 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? 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
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, 45-55. 2 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):24-51. 3 Cotton, C. (1996). Compression Therapy in the management of leg ulcers. Canadian Association for Enterostomal Therapy (CAET) Journal, 15(1), 8-9. 4
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 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. 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 being addressed with compression, adequate local wound care is required to offer optimal healing conditions. Local Wound Care Debridement Infection Control Moisture Balance Cutimed Gel Cutimed Sorbact Hydroactive Cutisorb Ultra Cutimed Sorbact dressing / pad Cutimed Sorbact gel 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. 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. Exudate level Wound depth Wound phase Dry to low Shallow Sloughy Low to medium Shallow + deep Infected Medium to high Necrotic 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 Cutisorb Ultra is a super-absorbent dressing for high to very high levels of exudates. Super-absorbent particles not only absorb exudates, but reliably bind the fluid, even under compression. 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
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 Sorbact Hydroactive combines Sorbact antimicrobial therapy with reliable exudate management, even under compression. Cutimed Sorbact dressing Primary wound dressing for deep or superficial wounds Cutimed Sorbact pad provides an additional absorbent core for exudates handling Cutimed Sorbact gel combines Sorbact antimicrobial therapy with hydrogel component that helps cleansing the leg ulcer from slough and fibrin layers 10
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. JOBST has a complete range of fashionable compression stockings ready-to-wear and custom-made. JOBST UltraSheer Unparalleled sheerness for stylish leg therapy NEW Now available in elegant pattern! JOBST Opaque Softness and ease of donning for exceptionnaly comfortable leg therapy JOBST ActiveWear Effective leg therapy in an energizing athletic sock JOBST formen Casual Effective leg therapy in a high-quality dress or casual sock For complete line of products and ordering information, please contact your BSN representative or Customer Service 11
Ordering Information Code Dimensions Qty/Box Cutimed Sorbact Hydroactive 7264603 7 cm x 8,5 cm (5 x 6,5) 10 dressings 7264604 14 cm x 14 cm (10 x 10) 10 dressings 7264605 19 cm x 19 cm (15 x 15) 10 dressings 7264606 24 cm x 24 cm (20 x 20) 05 dressings 7264607 14 cm x 24 cm (10 x 20) 10 dressings Cutimed Sorbact pad 7216101 7 cm x 9 cm 05 dressings 7216100 7 cm x 9 cm 40 dressings 7216201 10 cm x 10 cm 05 dressings 7216200 10 cm x 10 cm 40 dressings 7216300 10 cm x 20 cm 20 dressings Cutimed Sorbact dressing 7216401 4 cm x 6 cm 05 dressings 7216400 4 cm x 6 cm 40 dressings 7216501 7 cm x 9 cm 05 dressings 7216500 7 cm x 9 cm 40 dressings Cutimed Sorbact gel 7261100 7,5 cm x 7,5 cm 10 dressings 7261101 7,5 cm x 15 cm 10 dressings Tensopress 7172301 7.5 cm x 3 m 10 rolls 7172300 10 cm x 3 m 10 rolls JOBST UlcerCARE TM Stocking and Liners Size Color No Zipper Left Zipper Right Zipper Qty/Box S Beige 7363021 7363121 7363161 1 stocking & 2 liners M Beige 7363022 7363122 7363162 1 stocking & 2 liners L Beige 7363023 7363123 7363163 1 stocking & 2 liners XL Beige 7363024 7363124 7363164 1 stocking & 2 liners 2XL Beige 7363025 7363125 7363165 1 stocking & 2 liners 3XL Beige 7363026 7363126 7363166 1 stocking & 2 liners 4XL Beige 7363027 7363127 7363167 1 stocking & 2 liners S Black 7363041 7363141 7363171 1 stocking & 2 liners M Black 7363042 7363142 7363172 1 stocking & 2 liners L Black 7363043 7363143 7363173 1 stocking & 2 liners XL Black 7363044 7363144 7363174 1 stocking & 2 liners 2XL Black 7363045 7363145 7363175 1 stocking & 2 liners 3XL Black 7363046 7363146 7363176 1 stocking & 2 liners 4XL Black 7363047 7363147 7363177 1 stocking & 2 liners JOBST UlcerCARE TM Replacement Liners Size Color Code Qty/Box S White 7363221 3 liners M White 7363222 3 liners L White 7363223 3 liners XL White 7363224 3 liners 2XL White 7363225 3 liners 3XL White 7363226 3 liners 4XL White 7363227 3 liners Code Dimensions Qty/Box Cutimed Gel 7261000 8 g 10 tubes 7261001 15 g 10 tubes 7261002 25 g 10 tubes Cutisorb Ultra 7263900 10 cm x 10 cm 20 dressings 7263901 10 cm x 20 cm 20 dressings 7263902 20 cm x 20 cm 20 dressings 7263903 20 cm x 30 cm 20 dressings Comprilan 7718700 4 cm x 5 m 1 roll 0102600 6 cm x 5 m 1 roll 0102700 8 cm x 5 m 1 roll 0102800 10 cm x 5 m 1 roll 0102900 12 cm x 5 m 1 roll 7718800 10 cm x 10 m 1 roll 7718900 12 cm x 10 m 1 roll Easifix Cohesive 7143609 4 cm x 4 m* 10 rolls 7143610 6 cm x 4 m* 10 rolls 7143611 8 cm x 4 m* 10 rolls 7143612 10 cm x 4 m* 10 rolls 7143613 12 cm x 4 m* 10 rolls 7143614 4 cm x 20 m* 1 rolls 7143615 6 cm x 20 m* 1 roll 7143616 8 cm x 20 m* 1 roll 7143617 10 cm x 20 m* 1 roll 7143618 12 cm x 20 m* 1 roll Gelocast 105200 7.5 cm x 9 m 1 box 105300 10 cm x 9 m 1 box JOBST Comprifore LF 7266101 4-layer 1 kit 7266103 3-layer (lite version) 1 kit *Stretched Sizing chart S 18 21 cm (7 8 1/4 ) 29 35 cm (11 1/2 13 3/4 ) M 21 24 cm (8 1/4 9 1/ 2 ) 34 41 cm (13 1/4 16 ) L 24 27 cm (9 1/2 10 3/4 ) 40 47 cm (15 3/4 18 1/2 ) XL 27 30 cm (10 3/4 12 ) 46 54 cm (18 21 1/4 ) 2XL 30 33 cm (12 13 ) 48 56 cm (19 22 ) 3XL 33 36 cm (13 14 ) 50 58 cm (19 3/4 23 ) 4XL 36 39 cm (14 15 1/4 ) 52 60 cm (20 1/2 23 3/4 ) PE1110912VLU R4 BSN Medical Inc. 4455 Autoroute Laval West, Suite 255 Laval (QC) Canada H7P 4W6 Tel. 1-877-978-5526 Fax 1-877-978-9703