Wound care and dressing material
Hydroactive wound products
Today, modern dressings allow customized wound treatment. Many products are designed to maintain a moist climate in the wound. This is a prerequisite for
the skin cells can divide and the wound is filled and covered. Some products also have a disinfectant effect to reduce bacterial growth. Other dressings promote the spontaneous detachment of plaque and dead tissue. Many are coated in such a way that they do not stick to the wound. Some are sealed to the outside so that you can shower with them without any problems.
Negative pressure therapy
Particularly large or deep wounds can also be treated initially with a vacuum dressing: Wound therapists pad the wound with foam or a compress, stick an airtight plastic film over it and then create a vacuum in the area of the wound using a suction pump. As a result, harmful substances in the wound secretion are continuously suctioned out and the wound is stimulated to develop strong granulation tissue. This in turn is the prerequisite for slow, spontaneous healing from the edge or for accelerated healing through skin grafting.
Skin grafting
If natural wound healing makes no progress at all, a skin graft can bring about healing in a single step. The wound bed must be well prepared for this (see also negative pressure therapy). A very thin skin graft is then removed from the thigh under local anesthesia and transplanted to the wound on the lower leg. The transplanted skin heals completely within five to ten days. The donor site on the thigh resembles an abrasion that heals completely within two to three weeks. Some people are afraid of possible pain during skin grafting. This fear is understandable, but unnecessary. On the contrary: the wound on the lower leg hurts much less after the skin graft. The donor site on the thigh may burn slightly for a few days and then recovers quickly. As long as good wound preparation is ensured, the success rate of a skin graft is 80-90%. As soon as the transplanted skin on the lower leg has healed, the result must be further stabilized with optimal care and ultimately maintained in the long term.
Skin equivalents
Several biological products have been developed for wounds that are difficult to heal. Among other things, there are products made from human skin cells that are particularly effective in supporting wound healing. These products are expensive and require good specialist knowledge of their application. Many Western European countries – including Switzerland – therefore train wound healing experts in special training courses.
Compression therapy
Continuous compression treatment with elastic bandages or compression stockings enables the venous leg ulcer to heal. The healing rate for medium-sized wounds with a diameter of 1-5 cm is 50-70% after three months and 80-85% after six months. Compression treatment of the legs with elastic bandages or stockings is one of the most important measures in the treatment of leg ulcers and in the prevention of relapses. Unfortunately, it is not always prescribed and carried out correctly. People with venous leg ulcers in particular, but also patients with mixed venous-arterial leg ulcers, benefit from compression treatment.
Compression bandage
Initially, the swollen (edematous) leg is wrapped with elastic bandages until the leg circumference normalizes within a few days.
Before bandaging, the wound is first cleaned and covered with a suitable dressing.
The skin around the wound must be optimally cared for and kept moist. The compression bandage is lightly padded and made up of several layers. This ensures the necessary firmness at rest and when walking, and prevents loosening or slipping. It takes practice and experience to apply a compression bandage correctly.
Compression stocking
Compression stockings are used when the leg is no longer swollen and the leg ulcer is not weeping too much. For patients with venous leg ulcers or mixed venous-arterial leg ulcers, special leg ulcer compression stockings are used, consisting of a slightly weaker lower stocking and a strong upper stocking. Patients can keep the understocking on day and night. They put on the top stocking in the morning when they get up and take it off again in the evening to go to sleep. It is not necessary to compress up to the thigh. Compression stockings that reach below the knee are sufficient to treat an open leg. Thigh stockings are usually not necessary. There are different compression strengths, whereby people with leg ulcers should wear a class II or III. The affected leg should be measured early in the morning either by the doctor, in an orthopaedic specialist store or in a pharmacy so that a well-fitting compression stocking can be ordered. Legs with an unusual shape need a compression stocking made to measure. It is worth practicing putting on and taking off the stocking in a specialist store. Each pack of one pair of compression stockings contains a sliding sock to help you put them on. However, around 40% of all patients have difficulty putting on and taking off the compression stocking. A whole range of different donning aids is available for this frequently occurring situation (see below).
Dressing aids
Compression stockings are often not easy to put on. The industry has therefore developed various aids in recent years that make dressing and undressing much easier. Sliding socks are most commonly used, which make it easier to put on the compression stocking. The sliding socks can be combined with a non-slip floor mat. Rubber gloves generally improve grip when donning and doffing. Patients who cannot bend over easily can stretch the stocking over a metal frame and then step into the stocking. A roll cuff is now also available, which allows the stocking to be rolled onto the leg without any effort. These maneuvers need to be practiced.
Avoidance of relapses
After just one year, around a third of those affected have a new wound – a relapse. Patients with a healed venous or healed mixed venous-arterial leg ulcer are particularly at risk. The most important countermeasure to prevent a relapse is to wear compression stockings consistently throughout the day.
If you are unable to put the stocking on yourself and/or wear it for a whole day, you must check whether the stocking should be adjusted or replaced by another product. It is very important that you do not let up in this situation until you are provided with a suitable product. For people with particularly thin skin, it is advisable to protect the edges of the legs (shins), which are often struck, with foam rubber. If pressure points in the footwear are the cause of the wound, pressure relief must be sought by fitting orthopaedic footwear. In addition, consistent skin care is an important cornerstone in the prevention of new wounds. Skin care products with a small proportion of urea and/or lactic acid are particularly suitable for moisturizing and moisturizing the uppermost layers of the skin. The treatment of chronic eczema may require the short-term use of skin ointments containing cortisone. However, this never replaces a good basic therapy with regular skin care. Your family doctor’s practice, the nearest outpatient wound clinic in your area, your neighborhood Spitex and we, the Dermatology Clinic of the University Hospital Zurich, will be happy to advise you.
