Volume

7
Number 1
January 2007
Published by
European
Wound Management
Association
FO

CU
O

SO G D
NW K I N
OUN T E D
DC ARE IN THE UNI
 The EWMA Journal
ISSN number: 1609-2759
EWMA Council
Volume 7, No. 1. January, 2007

The Journal of the European

Wound Management Association
Published three times a year

Editorial Board
Carol Dealey, Editor

E. Andrea Nelson
Finn Gottrup
Michelle Briggs Marco Romanelli Peter Franks Peter Vowden Finn Gottrup
President Elect & President Immediate Past President Recorder
Peter Franks Treasurer
Peter Vowden
Sue Bale
Zbigniew Rybak

EWMA web site

www.ewma.org

For membership application,

correspondence,
prospective publications
and advertising
please contact: Sue Bale Judith Darzcy Carol Dealey Katia Furtado Luc Gryson
EWMA Business Office EWMA Journal Editor
Congress Consultants
Martensens All 8
1828 Frederiksberg C Denmark.
Tel: (+45) 7020 0305
Fax: (+45) 7020 0315
ewma@ewma.org

Layout:

Birgitte Clematide
Deborah Hofman Christina Lindholm Christine Moffatt Zena Moore E. Andrea Nelson
Position Document Editor
Printed by:
Kailow Graphic A/S, Denmark
Copies printed: 13,000

Prices:
Distributed free of charge to members of
the European Wound Management
Association and members
of co-operating associations.
Individual subscription per issue: 7.50 Patricia Price Zbigniew Rybak Salla Seppnen Javier Soldevilla Carolyn Wyndham-White
Libraries and institutions per issue: 25

The next issue will be published

May 2007. Panel Members
Prospective material for publication
must be with the editors Editorial Board Members Scientific Review Panel
as soon as possible and Dr. E. Andrea Nelson, UK Luc Gryson, Belgium
no later than 15 March 2007 Dr. Carol Dealey, UK Zena Moore, Ireland
Professor Finn Gottrup, Denmark Marco Romanelli, Italy
The contents of articles and letters in
Dr. Michelle Briggs, UK Jos verdu Soriano, Spain
EWMA Journal do not necessarily
reflect the opinions of the Editors Professor Peter Franks, UK Carolyn Windham-White, Switzerland
or the European Wound Professor Peter Vowden, UK Professor Peter Franks, UK
Management Association. Dr. Sue Bale, UK Deborah Hofman, UK
Copyright of all published material Dr. Zbigniew Rybak, Poland Dr. E. Andrea Nelson, UK
and illustrations is the property of Professor Patricia Price, UK
the European Wound Management Educational Panel Madeleine Flanagan, UK
Association. However, provided prior Madeleine Flanagan, UK Ass. Professor Gerald Zch, Austria
written consent for their reproduction
M.D. Milada Francu, Czech Republic
obtained from both the Author and Co-operating Organisations Board
EWMA via the Editorial Board of the Professor Ralf-Uwe Peter, Germany
Journal, and proper acknowledgement Rokas Bagdonas Anbal Justiniano Salla Seppnen, Finland
and printed, such permission will Pauline Beldon Aleksandra Kuspelo Ass. Professor Rytis Rimdeika, Lithuania
normally be readily granted. Claudia Caula M.A. Lassing-Kroonenberg Dr. Caroline Amery, UK
Requests to reproduce material Senior Lecturer Mark Collier, UK
Mark Collier Gubjrg Plsdttir
should state where material is to
be published, and, if it is abstracted, Rodica Crutescu Martin Koschnik
summarised, or abbreviated, then Blent Erdogan Helena Peric
the proposed new text should be sent Milada Francu Vivianne Schubert
to the EWMA Journal Editor Marie Gamlem Maciej Sopata
for final approval. Sheila Gilmartin Jos Verd Soriano
Peter Hanga Luc Tot
Mria Hok Deborah Thompson For contact information,
Lydia Jack Gerald Zch see www.ewma.org

 EWMA Journal 2007 vol 7 no 1

 3 Editorial
Carol Dealey
Editorial
Scientific Articles
5 Self-care activities of venous leg ulcer

W
patients in Finland
Salla Seppnen elcome to the first issue of the EWMA Journal for 2007.
17 Smoking is not contra-indicated in maggot As you will have seen from the cover, the focus for some
debridement therapy in the chronic wound
Pascal Steenvoorde of the background articles in this issue is on the UK,
23 Effectiveness of non-alcohol film forming skin in anticipation of the EWMA Conference being held in Glasgow
protector on the skins isles inside the ulcers this year. We saw it as an opportunity to showcase the activities of
and the healing rate of venous leg ulcers
Tanja Planinsek Rucigaj some of the organisations who are partnering EWMA in planning
26 Wound measurement: the conference. I would also draw your attention to the Call for
the contribution to practice
Georgina T. Gethin Abstracts and the details of the EWMA Awards, especially the First
31 Improving education in wound care: crossing Time Presenter Award to be found on pages 40-41. More details
he boundaries of interprofessional learning
Caroline McIntosh about the conference can be found on the EWMA website:
32 Waterjet debridement of deep and www.ewma.org/ewma2007.
indeterminate depth thermal injuries
Mayer Tenenhaus

EBWM
We look forward to an exciting event in what looks to be stunning
34 Abstracts of recent Cochrane reviews
venue.
Sally Bell-Syer

EWMA However, the whole of the journal does not focus on activities in
35 Brian Gilchrist: thank you the UK and the scientific papers and abstracts reflect the fact that
Peter J Franks
36 EWMA Education Development Project:
the EWMA Journal is a European journal and draws upon readers
what is it and what does it do? from many countries. There is also a growing recognition across
Zena Moore
Europe of the impact that chronic wounds have upon the lives
38 EWMA 2007 Glasgow, United Kingdom
40 EWMA 2007 Abstract Submission
of individuals and importance of providing them with effective
41 EWMA 2007 Awards
wound care services. There is still much to understand about all
42 LUF, The Leg Ulcer Forum aspects of wound healing and management and great opportuni-
43 National Association of Tissue Viability ties for research, particularly collaborative research across Europe.
Nurses (Scotland) Sadly, although there are now opportunities for funded studies on
44 TVNA, Tissue Viability Nurses Association
a national level in many countries, there is still a lack of interest at a
45 TVS, Tissue Viability Society
European level. There is no mention of chronic wounds within the
46 EWMA Journal previous issues
46 International Journals topics listed in the Health Theme for the FP7 Research Programme
48 EWMA Corporate Sponsors Contact Data funded by the European Commission, despite lobbying from the
50 EWMA welcomes new Corporate B Sponsors European Pressure Ulcer Advisory Panel. Maybe we all need to get
Conferences political and lobby our relevant local representatives to the EU in
52 EPUAP conference in Berlin, 2006 order to get their attention
54 6th scientific meeting of the DFSG
54 The 1st national congress of WMAT Carol Dealey, Editor
55 Conference calendar
Organisations
56 HWMS/MSKT, Hungarian Lymphoedema
and Wound Managing Society
57 The hungarian SEBINKO association
58 Co-operating organisations

EWMA Journal 2007 vol 7 no 1 

Making the Choice Clear
AQUACEL Ag dressing is the only
antimicrobial with all the benefits
of Hydrofiber ConvaTec Technology
Gels on contact with exudateabsorbs and retains fluid 1
and locks away harmful components contained within exudate*,2-4
as demonstrated in in vitro testing
Effective antimicrobiallow concentration of ionic silver kills
a broad range of wound pathogens in the dressing including MRSA 5
as demonstrated in in vitro testing
Enhances patient comfortsoft and conformable for ease
of application
Allows for non-traumatic removalwithout damaging newly
formed tissue
Supports healingby providing a moist environment
*AQUACEL dressing has the same composition and Hydrofiber Technology as AQUACEL Ag dressing.
References: 1. Parsons D, Bowler PG, Myles V, Jones S. Silver antimicrobial dressings in wound management: a comparison of antibacterial,
physical, and chemical characteristics. Wounds. 2005;17(8):222-232. 2. Walker M, Hobot JA, Newman GR, Bowler PG. Scanning electron
microscopic examination of bacterial immobilisation in a carboxymethyl cellulose (AQUACEL) and alginate dressings. Biomaterials. 2003;24:883-890.
3. Bowler PG, Jones SA, Davies BJ, Coyle E. Infection control properties of some wound dressings. J Wound Care. 1999;8(10):499-502. 4. Walker
M, Cochrane CA. Protease sequestration studies: a comparison between AQUACEL and PROMOGRAN in their ability to sequester proteolytic
enzymes. WHRI 2494 WA139. May 27, 2003. Data on file, ConvaTec. 5. Jones SA, Bowler PG, Walker M, Parsons D. Controlling wound bioburden
with a novel silver-containing Hydrofiber dressing. Wound Rep Reg. 2004;12:288-294.
/TM The following are trademarks of E.R. Squibb & Sons, L.L.C.: AQUACEL Ag and Hydrofiber. ConvaTec is an authorised user.
www.aquacelag.com
2006 E.R. Squibb & Sons, L.L.C. July 2006 GO-06-1047.1

Self-care activities of venous
leg ulcer patients in Finland
Abstract
The aim of the study was to describe the health-
deviation of self-care activities of venous leg ulcer
patients in Finland. The self-care activities were
studied using WAS-VOB (Panfil/Evers), which
is a catalogue containing propositions for self-care
activities for venous leg ulcer patients. It includes
59 propositions of self-care activities describing
them in eight sections: general compression, wear-
ing compression bandages, wearing compression
hosiery, mobility, temperature, overloading of the
venous system, prevention of skin damage and
wound healing. For this study the WAS-VOB
was translated in to Finnish and culturally modi-
fied. The background information of patients
concerned
1) independency and social aspects,
2) medical and wound history and
3) current situation of wound.
The data were collected in the years 2003-2004
and analysed by SPSS 11.0. The study involved
88 venous leg ulcer patients, 75% of whom were
female. Most of the patients (80%) were over 65
years old. All the patients had a medical diagnosis
of venous leg ulcer and 74 of them had an ulcer
or ulcers at the time of study. The general com-
pression treatment was implemented every day
by 72% of the patients either using compression
bandages or hosiery. One third of patients (29)
applied compression therapy on themselves. The
three best implemented self-care activities were
skin care, avoidance of venous system overload
and avoidance of high temperatures. The least
implemented self-care activities were mobility,
wound healing and implementation of compres-
sion therapy. Only 35.4% of the patients reported
that they implemented compression therapy even
when a wound was not present. Health-care pro-
fessionals need to motivate venous leg ulcer pa-
tients to continue compression therapy after the
wound is healed. In addition, mobility activities
and asepsis in wound treatment need more at-
EWMA Journal 2007 vol 7 no 1
Scientific Article
tention in supervision of self-care. WAS-VOB
assesses the self-care deficits of venous leg ulcer
patients and it can also be recommended for use
as a tool for health professionals in the area of
preventive care.
Background of the study
It is estimated that in Finland there are about Salla Seppnen, RGN,
15,000 people who suffer from venous leg ulcers Specialist in Medical-
Surgical Nursing, MNSc,
and 400,000 people who suffer from venous in- Principal Lecturer,
sufficiency, which it is estimated, for 12-14% of Oulu University of Applied
them, will turn into leg ulcers.1 The incidence of Sciences,
Oulainen Department of
venous leg ulcers among the Finnish population Health Care
is very much the same as in other European coun- Finland
tries, 0.12-0.19%.2,3,4,5,6 When those leg ulcer pa- salla.seppanen@pp.inet.fi
tients who are not involved in professional health
care are included within the incidence of venous
leg ulcer patients, the numbers are estimated to be
around 2%. In the future the number of venous
leg ulcer patients will increase in all European
countries, because of the aging population. The
incidence of venous leg ulcers in the over 65s age
group is 1.0-3.3%.8
Poor rates of healing and high rates of re-ulceration
are typical characteristics of these chronic wounds.
The statistics show that around 50-72% of venous
leg ulcer patients have had an ulcer for at least one
year and 12-29% of patients have had an ulcer for
over 2 years. Venous leg ulcers recur in 67-80%
of patients, and 25% of venous leg ulcer patients
have had at least four wound episodes.7
The cooperation of patients is very important for
the successful treatment and prevention of venous
leg ulcers. Within the framework of the Theory of
Self-Care Deficit, venous leg ulcer patients have
self-care requisites caused by the medical diagno-
sis and its treatment. Also the pain, discomfort
and frustration of the slow healing of ulcers create
requisites for self-care to bring relief. The self-care
deficit refers to the relationship between self-care

agency and therapeutic self-care demands of individuals in
which capabilities for self-care because of existent limita-
tions are not equal to meeting some or all components of
their therapeutic self-care demands.9 The special health-
deviation self-care propositions in the case of venous leg
ulcer patients are maintaining and supporting the venous
system, promoting wound healing and preventing re-ul-
ceration.10 The implementation or knowledge of self-care
activities among venous leg ulcer patients is not much
studied, so we can just assume that the self-care is not all
that well implemented.
Implementation of the study
The aim of this study was to describe the health-devia-
tion self-care activities of venous leg ulcer patients in Fin-
land.
The study was carried out through structured interviewing
of leg ulcer patients and structured assessment of patients
ulcers by professional nurses. The patients for the study
were selected by the nurses. Criteria for inclusion were that
a patient had a medical diagnosis of venous leg ulcer and
a patient was able to communicate reliably. Also patients
with a history of leg ulcers were accepted in to the study,
even if they did not have an ulcer at the time of the study.
Also, the self-care activities among the leg ulcer patients
were continued as normal in a preventive perspective.
The study proposal was accepted by the ethical committee
of Helsinki University Hospital. All the hospitals, health
care centres and nursing homes where the data were col-
lected accepted the study proposal and gave permission
for the implementation of study. Also each patient was
individually informed of the study and he/she decided on
his/her participation in the study.
The self-care activities were studied by WAS-VOB (Pan-
fil/Evers), which is a catalogue containing propositions
of self-care activities for venous leg ulcer patients.11 The
measurement was developed by professors E-M Panfil and
GCM Evers and tested in the German population with
234 venous leg ulcer patients. The test and retest-coef-
ficient were between 0.53 and 0.67. Cronbachs alpha
was between 0.63 and 0.82.12 WAS-VOB includes 59
propositions of self-care activities describing them in eight
sections; general compression, wearing compression band-
ages, wearing compression hosiery, mobility, temperature,
overloading of the venous system, prevention of skin dam-
age and wound healing. The propositions are assessed by
patients with a four point Likert scale; definitely yes, pos-
sibly yes, possibly no, definitely no.11
 EWMA
Table 1. The Sections of WAS-VOB (Panfil/ Evers)
PART 1.
General compression
1a Activities for implementation of compression
(7 propositions)
1 b Wearing compression bandages (6 propositions)
1 c Wearing compression hosiery (4 propositions)
PART 2.
I. Self care activities
2. Mobility (13 propositions)
3. Temperature (5 propositions)
4. Overloading of the venous system (10 propositions)
II Self-care activities to avoid skin damages
(6 propositions)
III Self-care activities in wound management
(8 propositions)
For this study the WAS-VOB was translated in to Finnish
and culturally modified; at the end of WAS-VOB four
propositions concerning of self-care activities related to
sauna were included.
Table 2. The self-care activities related to sauna
SELF-CARE ACTIVITIES RELATED TO SAUNA
(4 propositions)
I bathe weekly in sauna.
I do not bathe in hot sauna.
I do not raise my legs up in sauna.
I put wet and cool towels on the wound to keep it cooler in sauna.
The background histories of patients were collected by
questionnaire, which included three items:
1) independency and social aspects,
2) medical and wound history and
3) current situation in leg ulceration.
The wound assessment was done by the nurses with spe-
cial charts that included the size of wound, tissue type,
amount, colour and smell of exudation and assessment of
peri-wound. Because the pain is a problem with leg ulcer
patients13,14,15 the patients experience of pain was also
measured on a numeric scale (0-10). The data was collect-
ed in the years 2003-2004 by registered nurses who were
specialists in wound management in Oulu and Mikkeli
Polytechnics. The nurses assessed the wound, amount of
oedema in legs and filled patients charts with the medical
information that was needed. The self-care activities of ve-
nous leg ulcer patients were studied using the WAS-VOB
proposition catalogue and by interviewing the patients.
The data was analysed by SPSS 13.0 for statistics.
Journal 2007 vol 7 no 1

Background information of venous
leg ulcer patients
The study involved 88 venous leg ulcer patients, of whom
75% were female. Most of the patients (80%) were over
65 years old.
Picture 1. The age of venous leg ulcer patients (N= 88)
Most of the patients 75.8% (86) lived at home or in nurs-
ing homes and 54.6% (47) of them lived with family or
spouse. Two patients were cared for in a geriatric ward of
a health care centre. 73% of patients (64) coped inde-
pendently or with minor help with their daily activities.
43.2% of patients (38) used some aid for mobility. Most
of the patients (85.2%, n= 75) were mentally active. Only
9.1% (8) of patients had some problems with memory and
5.7% (5) had more serious memory problems concerning
difficulties in coping with daily activities
For most of the patients (69.3%, n=61) the wound man-
agement was implemented at home either by health visi-
tors (25 patients) or by non-professional persons, such as
the patients themselves or a relative (36 patients). For some
of the patients the wound management was implemented
in primary health care, in a ward 6.8% (6 patients) or in an
outpatient clinic10.2% (9 patients). Ten patients (11.4%)
had their wounds managed in specialised hospital units.
Two of the patients lived in a home for the elderly and
their wound management was done by the nurses who
worked there.
The wound history of 86 patients was described. Of those,
37.6% (32) had just one episode of leg ulcers, while 42.4%
(36) had 2-3 episodes and 20% of the patients (17) had
had more than three wound episodes. Also the time period
that a patient has suffered venous leg ulcers was long. The
longest history of wounds was 60 years while 14 patients
(16.3%) reported that they had had venous leg ulcers for
over 20 years and 48 patients (55.8%) reported suffering
venous leg ulcers for five years or less.
EWMA Journal 2007 vol 7 no 1
Scientific Article
Current situation in leg ulceration
Of the patients, 74 (84%) had an ulcer or ulcers at the
time of study and 24 (32.4%) of those had more than
one ulcer. The total number of ulcers was 112. While the
ulcers were mainly superficial, five wounds extended into
muscle. The size of wounds varied a lot, ranging between
height 2mm-379 mm and length 2 mm-170 mm. All
wounds had granulation and fibrin tissue and two wounds
displayed necrotic tissue.
At the time of study, 55 patients had oedema in one or
both legs and 47 patients reported pain. The patients as-
sessed the pain on a numeric scale 0-10. (See Table 3)
Table 3. Numeric value of venous leg ulcer patients
experience of pain
Numeric value of pain Number of venous leg ulcer patients
0 10 patients
1-3 23 patients
4-7 29 patients
8 5 patients
Self-care activities of venous leg
ulcer patients
The self-care activities of venous leg ulcer patients are
described in two main categories -compression therapy and
other self-care activities. The first main category, compres-
sion therapy, is divided in to sub-categories general ac-
tivities in the implementation of compression therapy,
wearing compression bandages and wearing compression
hosiery. The second category, other self-care activities, is
divided in to six sub-categories: mobility, temperature,
overloading of the venous system, preventing skin damag-
es, wound management and activities related to sauna.
Compression therapy
Patients activities for applying the compression therapy
were studied by 17 propositions of which seven concerned
general activities for compression therapy and six proposi-
tions related to wearing compression bandages and four
to wearing hosiery.
However, 41.8% of patients reported that they do not
implement compression therapy if there is no wound.
Only 35.4% of patients said that they definitely would
implement the compression therapy while the skin is intact
and the rest, 32.8%, said possibly yes or possibly no. (table
2). While implementing compression therapy 72.2% of
the patients said that they did it daily, but only 53.2% of
the patients said definitely yes that they put compression
bandages or hosiery immediately when they wake up. Most

 Contreet / Biatain - Ag
Sustained silver release and
absorption in one dressing

Contreet / Biatain - Ag reduces the ulcer

area by 45-56% within 4 weeks1-3

Contreet / Biatain - Ag kills MRSA faster

than other silver dressings4

Contreet / Biatain - Ag provides excellent

exudate management1-3

Contreet / Biatain - Ag is a cost-effective

treatment5

Contreet / Biatain - Ag
Sustained silver release and
absorption in one dressing

Visit
1 Mnter K-C et al. Effect of a sustained silver-releasing dressing on ulcers www.woundcare.evidence.coloplast.com
with delayed healing: the CONTOP study. Journal of Wound Care 2006,
15(5), 199-206. to find all peer-reviewed clinical, laboratory
2 Jrgensen B et al. The silver-releasing foam dressing, Contreet Foam,
promotes faster healing of critically colonised venous leg ulcers: a and health-economic evidence for Coloplast wound dressings.
randomised, controlled trial. International Wound Journal 2005, 2(1), 64-73.
3 Rayman et al. Sustained silver-releasing dressing in the treatment of
diabetic foot ulcers. British Journal of Nursing 2005, 14(2), 109-114.
4 Ip M et al. Antimicrobial activities of silver dressings: an in vitro comparison.
Journal of Medical Microbiology 2006, 55, 59-63
5 Scanlon E et al. Cost-effective faster wound healing with a sustained
silver-releasing foam dressing in delayed healing leg ulcers - a health-
economic analysis. International Wound Journal 2005, 2(2), 150-160.

Faster wound healing

, Biatain and Contreet are registered trademarks of Coloplast A/S. by reducing the barriers
2007-01/dkcht. All rights reserved Coloplast A/S, 3050 Humlebk, Denmark.
to wound healing

of the patients (59%) reported that they wear compression
only in the daytime. The other self care-activities related to
general compression were not so well implemented; only
19.7% of patients reported that they definitely yes raised
the swollen foot, just 16.9% of patients said definitely yes
to exercise after putting on compression and only 27.8%
of the patients replied definitely yes to keeping the leg
raised several times during the day.
Table 4. Venous leg ulcer patients answers for WAS-VOB propositions concern on wearing of compression bandages
propositions concern on the general activities of implementation
of compression therapy
Proposition Likert scale Valid %
I wear compression bandages - definitely yes 35.4
or hosiery even when I have - possibly yes 6.3
NO wound. (n=79) - possibly no 16.5
- definitely no 41.8
The first thing what I do when - definitely yes 53.2
I wake up is that I put on hosiery - possibly yes 13.0
or compression bandages. - possibly no 10.4
(n=77) - definitely no 23.4
I wear compression bandages - definitely yes 72.2
or hosiery everyday. (n=79) - possibly yes 10.2
- possibly no 3.8
- definitely no 13.9
I wear compression only in - definitely yes 59.0
daytime. (n=78) - possibly yes 10.3
- possibly no 3.8
- definitely no 26.9
I raise up the swollen foot. - definitely yes 19.7
(n=76) - possibly yes 17.2
- possibly no 19.7
- definitely no 43.4
I do exercise for at least 20 - definitely yes 16.9
minute after putting on the - possibly yes 19.5
compression bandages or - possibly no 23.4
hosiery. (n=77) - definitely no 40.3
I raise up my legs several times - definitely yes 27.8
during the day. (n=79) - possibly yes 29.1
- possibly no 24.1
- definitely no 19.0
The second sub-category under the main category com-
pression therapy was wearing compression bandages.
While 22.2% of patients who wear compression band-
ages reported that they definitely yes did the bandaging
themselves, 64.8% of patients reported that they definitely
no put on the compression bandages themselves. The an-
swers to the other propositions of this item showed that
the technique of bandaging is not that good when done by
professionals or non professionals; only 41.5% of patients
reported definitely yes for using two bandages, just 42.5%
EWMA Journal 2007 vol 7 no 1
Scientific Article
of patients reported definitely yes to the use of padding
under the bandage and 54.9% of patients reported defi-
nitely yes to taking care that the pressure is strongest in the
ankle. Only 43.4% of patients reported definitely yes to
confirming that the bandages will stay up and only 29.4%
of patients reported definitely yes to re-doing bandaging
when the bandages loosen. (See table 5).
Table 5: The venous leg ulcer patient answers for WAS-VOB
Proposition Likert scale Valid %
I put on the compression - definitely yes 22.2
bandages by myself. (n=54) - possibly yes 11.1
- possibly no 1.9
- definitely no 64.8
I use two bandages for the com- - definitely yes 41.5
pression. (n= 53) - possibly yes 7.5
- possibly no 11.3
- definitely no 39.6
I use the padding under the - definitely yes 42.6
bandage. (n=54) - possibly yes 7.4
- possibly no 9.3
- definitely no 40.7
I take care that the pressure is - definitely yes 54.9
strongest in the ankle.(n=51) - possibly yes 15.7
- possibly no 11.8
- definitely no 17.6
I confirm that the bandages will - definitely yes 43.4
stay up. (n=53) - possibly yes 26.4
- possibly no 18.9
- definitely no 11.3
When the bandages loosen/slack- - definitely yes 29.4
en off, I take it off and do the - possibly yes 23.5
bandaging again. (n=51) - possibly no 15.7
- definitely no 31.4
Reasons the patients reported for not using the compres-
sion bandages were pain, discomfort and family tradi-
tion.
I feel unwell when I wear the compression bandages.
Bandages hurt; I feel pain while wearing them.
My brother and sisters have also had a history of venous
leg ulcers and they never used compression bandages and
everything went OK for them.
The third sub-category under the main category com-
pression therapy was wearing compression hosiery. The
answers show that the implementation of compression
therapy by hosiery was not too good: only 42.6% of the
patients who wear hosiery reported that they definitely yes
do change to clean hosiery every second day. Also the con-
dition of hosiery was not inspected nor was new hosiery
bought every 6 months as recommended. (table 6).

Table 6. The venous leg ulcer patients answers for WAS-VOB Table 7. The venous leg ulcer patients answers for WAS-VOB
propositions concerning the wearing of compression hosiery. propositions concerning mobility
Proposition Likert scale Valid % Proposition Likert scale Valid %
I change to clean compression - definitely yes 42.6 I avoid standing for a long time - definitely yes 55.7
hosiery every second day. (n= 54) - possibly yes 22.2 period. (n= 88) - possibly yes 27.3
- possibly no 11.1 - possibly no 13.6
- definitely no 24.1 - definitely no 3.4
I do not wear loose hosiery - definitely yes 32.1 I avoid sitting down for a long - definitely yes 29.5
(without stretch). (n= 53) - possibly yes 26.3 time period. (n=88) - possibly yes 30.7
- possibly no 20.8 - possibly no 26.1
- definitely no 20.8 - definitely no 13.6
I inspect my hosiery every 6 - definitely yes 22.0 I walk often. (n=84) - definitely yes 44.0
months. (n= 50) - possibly yes 8.0 - possibly yes 23.8
- possibly no 12.0 - possibly no 22.6
- definitely no 58.0 - definitely no 9.5
I buy new hosiery after 6 months. - definitely yes 30.0 I raise my feet during the day- - definitely yes 30.2
(n = 50) - possibly yes 14.0 time, as often as possible.(n=86) - possibly yes 32.6
- possibly no 10.0 - possibly no 24.4
- definitely no 46.0 - definitely no 12.8
I raise my feet during the evening - definitely yes 36.5
as often as possible. (n=85) - possibly yes 25.9
The patients comments relating to not wearing compres- - possibly no 24.7
- definitely no 12.9
sion hosiery were that the hosiery was too expensive.
I raise my feet above the heart - definitely yes 22.1
The hosiery are so expensive I do not have extra level. (n=86) - possibly yes 17.4
money for them! - possibly no 30.2
- definitely no 30.2
Other Self-Care Activities I have raised up the foot of my - definitely yes 25.3
bed. (n= 87) - possibly yes 5.7
The other self-care activities of venous leg ulcer patients - possibly no 20.7
were studied in sub-categories: mobility; temperature; - definitely no 48.3
overloading of the venous system; preventing skin damage; I stretch and twist my feet several - definitely yes 27.9
wound management; and activities related to sauna. times a day. (n=86) - possibly yes 30.2
- possibly no 27.9
- definitely no 14.0
The sub-category mobility included 13 propositions re- I stretch and twist my toes several - definitely yes 19.8
lated to physical exercise, sitting down, raising the legs, times a day. (n=86) - possibly yes 37.2
sleeping position and type of shoes (table 7). About half of - possibly no 25.6
- definitely no 17.4
the patients reported that they walk often. However, only
I exercise my calf muscles, at - definitely yes 12.8
22.7% of the patients reported that that they definitely least 15 minutes per day. (n=86) - possibly yes 15.1
yes walk at least half an hour everyday. Over half of the - possibly no 29.1
patients reported that they do avoid standing for a long - definitely no 43.0
time and 30% of the patients said that they definitely Before falling asleep I exercise my - definitely yes 16.5
feet so that the venous circulation - possibly yes 10.6
yes avoid sitting down for a long time. The other physi- is supported. (n=85) - possibly no 25.9
cal activities were not so well implemented; only 12.8% - definitely no 47.1
of the patients reported that they definitely yes do daily I walk at least 30 minutes a day. - definitely yes 23.3
gymnastic exercises for 15 minutes (see table 7). (n=86) - possibly yes 11.6
- possibly no 29.1
- definitely no 36.0
I buy new shoes in the afternoon - definitely yes 6.1
or evening. (n=82) - possibly yes 13.4
- possibly no 31.7
- definitely no 48.8

10 EWMA Journal 2007 vol 7 no 1

 Scientific Article

The section temperature included five propositions con- Table 9. The venous leg ulcer patients answers for WAS-VOB
propositions concern on avoiding overloading the venous system
cerning the temperature inside the house, tap water while
Proposition Likert scale Valid %
washing feet and wearing socks and shoes (table 8). Just
I wear stockings and socks that - definitely yes 0.0
32.6% of the patients said definitely no they do not wash are tight. (n=76) - possibly yes 3.4
their feet in very warm water and 65% of patients reported - possibly no 10.2
that they definitely no use socks or shoes that make their - definitely no 86.4

feet sweat. I wear a tight girdle. (n=84) - definitely yes 0.0

- possibly yes 0.0
- possibly no 2.4
Table 8. The venous leg ulcer patients answers for WAS-VOB - definitely no 97.6
propositions concerning temperature
I wear tight underpants or pants. - definitely yes 3.4
Proposition Likert scale Valid % (n=81) - possibly yes 3.4
In the winter I usually keep my - definitely yes 28.7 - possibly no 1.1
room temperature very warm. - possibly yes 25.3 - definitely no 92.0
(n=87) - possibly no 16.1 I prefer sitting so that my legs are - definitely yes 10.3
- definitely no 29.9 crossed. (n=87) - possibly yes 6.9
I wash my feet with very warm - definitely yes 25.6 - possibly no 23.0
water. (n=86) - possibly yes 25.6 - definitely no 59.8
- possibly no 16.3 I carry heavy things like firewood - definitely yes 9.1
- definitely no 32.6 and water from the well. - possibly yes 2.3
I wear socks that make my feet - definitely yes 2.3 (n=88) - possibly no 12.5
sweat. (n=86) - possibly yes 8.1 - definitely no 76.1
- possibly no 23.3 I carry heavy shopping bags. - definitely yes 10.5
- definitely no 66.3 (n=86) - possibly yes 3.5
I wear shoes that make my feet - definitely yes 2.3 - possibly no 24.4
sweat. (n=86) - possibly yes 4.7 - definitely no 61.6
- possibly no 27.9 I carry heavy laundry baskets. - definitely yes 3.4
- definitely no 65.1 (n=87) - possibly yes 4.6
While I sleep I prefer a very warm - definitely yes 21.6 - possibly no 18.4
blanket. (n=88) - possibly yes 21.6 - definitely no 73.6
- possibly no 13.6 I carry heavy things in my work. - definitely yes 6.0
- definitely no 43.2 (n=83) - possibly yes 2.4
- possibly no 8.4
- definitely no 83.1
The section overloading the venous system included 10 I lift up heavy items. (n=85) - definitely yes 5.9
propositions concerning socks, sitting position, carrying - possibly yes 2.4
heavy bags and other heavy items (table 9). Many patients - possibly no 16.5
- definitely no 75.3
reported definitely no to wearing tight socks (86.4%) or
For physically heavy tasks I ask for - definitely yes 60.0
trousers (92.0%) and do not cross their legs when sitting help from other people. (n=85) - possibly yes 16.5
down. (59.1%). They definitely do not carry heavy bags - possibly no 11.8
or other heavy items; 60% of the patients also reported - definitely no 11.8
that they definitely yes ask for help with physically heavy
tasks. The section avoiding skin damage included six proposi-
tions concerning self-protection of intact skin (table 10).
Only 63.6% of the patients reported that they definitely
yes try to avoid hurting themselves, 55.7% of patients
said that they definitely yes cream their feet regularly and
43.2% of patients said that they definitely yes protect the
skin of their feet and legs against grazes and cuts. In ad-
dition, 46.6% of the patients said that they definitely yes
inspected their feet daily and 25.3% of them said that
that they definitely use padding on the bone prominence
under the compression bandages.

EWMA Journal 2007 vol 7 no 1 11

 Natural HydroBalance.
Simple. Unique!
Suprasorb X controls the moisture content
of lightly to moderately exuding wounds.
Suprasorb X is able to absorb and release moisture.
Exactly as required. Independently. Simultaneously.
Through its unique structure of biosynthetic HydroBalance fibres.

For infected wounds:

Suprasorb X + PHMB

Suprasorb X
Lohmann & Rauscher
The intelligent one
32097/1206/e

GmbH & Co. KG

P.O.Box 23 43 among the wound dressings.
D-56513 Neuwied
www.lohmann-rauscher.com

HEALING PROTECTING PROVIDING CARE

 Scientific Article

Table 10. The venous leg ulcer patients answers for WAS-VOB Table 11. The venous leg ulcer patients answers for WAS-VOB
propositions concerning avoiding skin damages propositions concern on wound management
Proposition Likert scale Valid % Proposition Likert scale Valid %
I pay attention to avoid hurting - definitely yes 63.6 I inspect a wound every time the - definitely yes 56.6
myself. (n=88) - possibly yes 29.5 bandages are changed to be sure - possibly yes 12.0
- possibly no 4.5 that there are no signs of infec- - possibly no 9.6
- definitely no 2.3 tion (n=83) - definitely no 21.7
I cream my feet regularly. (n=88) - definitely yes 55.7 I regularly measure the length - definitely yes 11.3
- possibly yes 23.9 and the width of the wound - possibly yes 7.5
- possibly no 12.9 (n=80) - possibly no 8.8
- definitely no 8.0 - definitely no 72.5
I protect my skin under hosiery or - definitely yes 43.2 I wash my hands every time be- - definitely yes 59.0
compression bandages. (n=81) - possibly yes 28.4 fore changing the dressing - possibly yes 12.8
- possibly no 9.9 (n=78) - possibly no 5.1
- definitely no 18.5 - definitely no 23.1
I inspect my feet every day to be - definitely yes 46.6 When I remove the dressing I take - definitely yes 55.8
sure that there is no skin damage - possibly yes 20.5 care not to damage surrounding - possibly yes 16.9
(n=88) - possibly no 19.3 skin or new tissue in the wound - possibly no 2.6
- definitely no 13.6 (n=77) - definitely no 24.7
I use padding on the bone promi- - definitely yes 25.3 I take care to ensure the wound - definitely yes 34.2
nence under the compression - possibly yes 15.7 has enough humidity (n=76) - possibly yes 27.6
bandages (n=83) - possibly no 20.5 - possibly no 10.5
- definitely no 38.6 - definitely no 27.6
If I feel unwell I check if my feet - definitely yes 32.2 I go to see my GP immediately if I - definitely yes 73.3
are swollen or if there are any - possibly yes 21.8 see any signs of wound infection - possibly yes 9.3
signs of ulcers (n=87) - possibly no 26.4 (n=76) - possibly no 10.7
- definitely no 19.5 - definitely no 6.7
I use a clean towel every day for - definitely yes 36.4
drying my feet (n=77) - possibly yes 18.2
The section wound management included eight propo- - possibly no 20.8
sitions concerning asepsis and assessment and treatment - definitely no 24.7
of ulcer (table 11). Only 56.6% of the patients reported I always have wound care prod- - definitely yes 34.7
that they definitely yes inspected the wound every time ucts and dressings with me - possibly yes 21.3
(n=75) - possibly no 13.3
the wound was treated. Also, while 59% of the patients - definitely no 30.7
reported that they definitely yes wash their hands before
treating the wound and 55.8% of the patients said that
they are definitely careful while taking off a dressing to Table 12. The venous leg ulcer patient responses to the
propositions concern on the self-care activities related to sauna
avoid causing damage to a wound, only 34.2% of patients
Proposition Likert scale Valid %
reported that they definitely take care that the wound has
I do not bath in hot sauna (n= - definitely yes 43.9
enough humidity and just 34.7% of the patients reported 82) - possibly yes 29.3
that they definitely yes always carried with them dressings - possibly no 7.3
and wound management products. - definitely no 19.5
I do not raise my legs up in sauna - definitely yes 65.4
(not over heart) (n= 78) - possibly yes 10.3
Self-care activities related to sauna - possibly no 3.8
Almost half of the patients reported that they go to sauna - definitely no 20.5
once a week and 13.3% of the patients had sauna often I protect the wound with a wet - definitely yes 24.7
but seldom more than once a week. For 32.5% of the and cool towel while I am in sau- - possibly yes 11.0
na (n= 73) - possibly no 9.6
patients it was not possible to go to sauna at all because - definitely no 54.7
of their physical condition or because there was not sauna
available. For example, I live in a home for the elderly and
there is no sauna. The patients also reported extra information on self-care
activities related to sauna.
The patients were very well aware of that they should avoid
very hot sauna and not keep their legs raised in sauna While I have an open wound I do not go to sauna.
because the hot sauna will enlarge veins and cause extra I put cool water on my wound while I am in sauna
oedema. Only 24.7% of patients protected the wound I keep my foot in cool water while I sit down in sauna
from heat with a cold and wet towel (table 12). and throw water on the rocks
I do not cover the wound, while I am in sauna.

EWMA Journal 2007 vol 7 no 1 13

Scientific Article
Conclusions
The deficits in the self-care activities of venous leg ulcer
patients were very strongly related to prevention of oedema
and implementing of compression therapy. According to
the study, general compression was implemented daily by
72% of the patients but 13.9% of the patients said that
they definitely do not use compression therapy daily. There
are some patients who are not cooperative enough with the
implementation of compression therapy, this is especially
a problem when the wound is healed and skin is intact.
Only 35.4% of the patients reported that they continue to
implement compression therapy when a wound does not
exist. Similar results were reported in Panfils and Evers
study.12
Also the techniques of bandaging and wearing of hosiery
were not carried out according to the recommendations:
apply compression on the morning before getting out of
bed, use the padding on the ulcer as well on the bone
prominence of leg under the compression bandages and
use two bandages. In addition, the checking of the fitting
of hosiery and buying new after 6 months wear were not
implemented well. Also, only one third of the patients
applied the bandages themselves, this presents a challenge
to nurses to supervise relatives and non-professional car-
egivers, who are implementing the compression therapy
for the patient more carefully to ensure it is carried out
efficiently and effectively.
The best implemented self-care activities reported by pa-
tients were avoiding of overloading the venous system, skin
care and avoiding of very high temperatures. The less well
implemented self-care activity was mobility. The physi-
cal exercises recommended to support venous circulation
and muscles in the legs were not well implemented. The
reason for this might be that patients are not aware of the
importance of physical exercise, and they do not know
what to do or how to do it.
According to the results of the study the most demanding
challenge for health professionals is to motivate venous leg
ulcer patients to apply compression therapy. To achieve
this it will be necessary to develop community-based care
models for venous leg ulcer patients and offer education
for health professionals. According to the previous studies,
these two activities can significantly improve the healing
of the ulcers as well as the cost-effectiveness of care of
venous leg ulcer patients.16, 17. In the Harrison study the
implementation of new community-based approach to
the treatment of leg ulcer patients led to better healing
rates and improved the efficiency of care. The proportion
of patients receiving the appropriate treatment (compres-
14
sion bandages) nearly doubled, the average number of
care visits per person declined, and the healing rates nearly
tripled.17. I do believe that the specialist nurse-led care
model is likely to be a key issue in the promotion of self-
care activities of venous leg ulcer patients while the wound
exists and also when the wound is healed and skin is intact.
In Finland there is a deficit in the health care system; while
a patient does not have a wound episode the supervision
of venous leg ulcer patients is minimal. Preventative care
should be included as an integral part of the care of venous
leg ulcer patients.
This study also gave an opportunity to test WAS-VOB
in a clinical situation. The results of the study as well as
the experience of the nurses who interviewed the patients
for the study showed that WAS-VOB is a suitable tool
for the assessment of self-care deficits of venous leg ulcer
patients and it can be recommended for use as a tool for
health professionals caring for venous leg ulcer patients.
WAS-VOB helps nurses to identify the key issues of self-
care. The limit of WAS-VOB is that it does not take into
consideration weight and nutrition, which also are part of
the self-care activities of venous leg ulcer patients. m
References
1. Lehtola A, Hietanen H, Srihaava. In book Hietanen H, Iivanainen A,
Seppnen S, Juutilainen V. Haava. 2003. WSOY. Porvoo: 136-157.
2 Baker S, Stacey M, Singh G et. al. 1992. Aetiology of chronic leg ulcers.
Eur J Vasc Surg 6:245-51.
3 Fowkes F, Evans C, Lee A. 2001. Prevalence and risk factors of chronic venous
insufficiency. Angiology 52:5-15.
4 Malanin G, Jansen C. 1990. Srihaavat I. Kuka sairastaa, kuka hoitaa,
mit maksaa? Suomen Lkrilehti 45:11-13.
5 OBrien, Perry I, Burke P.2000. Prevalence and aetiology of leg ulcers in Ireland.
Irish Journal of Medical Science 169:110-112.
6. ien R, Hkansson A, Hansen B. 2000. Leg ulcer epidemiology and care in a
well-defined population in southern Sweden. Scandinavian Journal of Primary Health
Care 18:220-225.
7. Leach M. J. 2004. Making sense of the venous leg ulcer debate: a literature review.
Journal of Wound Care. 13 (2): 52-56.
8. Margolis D, Bilker W, Santanna J et al. 2002. Venous leg ulcer: Incidence and
prevalence in the elderly. Journal of American Academic Dermatology 3:381-6.
9. Orem D. Nursing concepts of practice. 1985. McGraw-Hill Book Company. USA.
10. Panfil E-M. Health-deviation self-care of people with venous leg ulcer.
Paper presented at the 7th International Self-Care Deficit Nursing Theory
Conference in Atlanta/ USA. November 1-3, 2002.
11. Panfil E-M, Evers GCM. Krankheitsbedingte Selbstpflege von menschen mit einem
vens bedingten offenen Bein. WAS VOB (Panfil Evers). Private Universitt Witten/
Herdecke gGmbH, Instiut fr Klinische Plflegeforschung, Stockumer STR 12,
D-58453 Witten.
12. Panfil E-M. 2002. Health-deviation self-care of people with venous leg ulcer.
Paper presented at 7th International Self-Care Deficit Nursing Theory Conference in
Atlanta/USA. November 1-3.2002.
13. Charles, H. Does leg ulcer treatment improve patients quality of life?
Journal of Wound Care 2004, 13 (6): 209-213.
14. Clay, C.S. & Chen W.Y.J 2005. Wound pain: the need for a more understanding
approach. Journal of Wound Care 2005, 143 (4):181-184
15. Hareendran ym 2005 Measuring the impact of venous leg ulcers on quality of life.
Journal of Wound Care 2005 154(2):53-57
16. Moffat C, Franks P. 2004. Implementation of a leg ulcer strategy.
British Journal Dermatology 151:857-867.
17. Harrison M, Graham I, Lorimer K et al. 2005. Leg-ulcer care in the community,
before and after implementation of an evidence-based service.
CMAJ 172 (11):1447-52.
EWMA Journal 2007 vol 7 no 1
 Find out more at www.kci-medical.com
2006 KCI Licensing, Inc. All Rights Reserved. All trademarks designated herein are property of KCI, its affiliates and licensors. Those KCI trademarks designated with the or TM symbol are registered
in at least one country where this product/work is commercialized, but not necessarily in all such countries. Most KCI products referenced herein are subject to patents and pending patents.
 Progressive Strength

S 02 04 - * Trademark of Johnson & Johnson - X-STATIC is a registered Trademark of Noble Fiber Technologies Inc

SILVERCEL* dressing uses new hydro-alginate technology to complement the effectiveness of silver release. It is a dressing that becomes stronger as it
absorbs, facilitating removal from the wound. Clinically tested, SILVERCEL* dressing encourages healing even in very wet wound situations by providing
an optimal moist wound environment. The sustained and balanced release of silver ions kills a broad spectrum of microorganisms associated with the
bacterial colonization and infection of wounds, including MRSA, MRSE and VRE.

Smoking is not contra-indicated
in maggot debridement therapy
in the chronic wound
Based on a study of 125 wounds in 109 patients
Abstract
Smoking has demonstrated negative effects on
acute wound healing. However, the effect on
healing of chronic sloughy or necrotic wounds
is less clear. Patients that were treated with Mag-
got Debridement Therapy (MDT) from 1 August
2002, and who were finished with MDT on the
first of March 2006 were included in the present
study. The patient group consisted of a total of
109 patients, who were treated with MDT for
125 infected chronic wounds. In the current study
there were 37 smokers and 72 non-smokers. The
overall results of MDT were comparable in both
groups (success rate of MDT is 67.7% in smokers
versus 70.8% in non-smokers; a statistically non-
significant difference). In our opinion, although
smoking has been proven to have negative effects
on acute wound healing, it does not seem to influ-
ence healing in the chronic sloughy or necrotic
wound. Smoking should therefore not be regarded
as a (relative) contra-indication for MDT.
Keywords: Maggot debridement smoking
outcome
Introduction
The negative effects of smoking on acute wound
healing were first reported in 1977, in a smoker
with impaired healing of a hand-wound.1 Ciga-
rette smoke contains over 4000 different compo-
nents with different effects on a variety of tissues
in the body.2;3 There is a vast amount of litera-
ture describing the negative effects of smoking
on acute wound healing.4 There is also evidence
that5 6-9 smoking cessation programs improve
healing rates, compared to patients that continue
to smoke.10 These effects are, however, less clear
in the chronic wound.3 Maggot debridement
therapy (MDT) is effective in the debridement
of chronic sloughy or necrotic wounds, with suc-
cess percentages of around 80%.11 Patients with
cutaneous ulcers should be instructed to refrain
EWMA Journal 2007 vol 7 no 1
Scientific Article
from smoking12, but this is not always feasible in
a chronic wound population. Also, there are many
other factors besides smoking that influence the
healing of chronic wounds.13 We questioned our-
selves whether MDT-healing rates were influenced
by smoking, because smoking is considered as a
(relative) contra-indication for MDT in another
hospital in the Netherlands. We believe this could Pascal Steenvoorde
MD MSc*1,2,
be important in traumatic acute wounds, but be-
Catharina E. Jacobi Phd3,
lieve this should be reconsidered in the chronic Louk P. van Doorn MA2,
wound care group in whom amputation some- Jacques Oskam MD Phd1,2
times seems to be the only alternative. We believed
From the department of
MDT in smokers would be a better alternative Surgery1 Rijnland Hospital
to the standard surgical debridement that was Leiderdorp,
performed in our clinic before the introduction the Rijnland Wound Clinic
Leiderdorp2 and
of MDT. Here we report MDT-results on 125 the department of Medical
wounds in 109 patients, with special emphasis on Decision Making3,
Leiden University Medical
the possible detrimental effects of smoking. Center,
all in the Netherlands
Methods
Corresponding author*:
In the period August 2002 to March 2006, patients P. Steenvoorde, MD MSc.
who presented with chronic wounds with signs of Rijnland Hospital
gangrenous or necrotic tissue at our surgical de- Leiderdorp,
Simon Smitweg 1.
partment and seemed suited to MDT were treated Postbus 2300
with MDT. This is a descriptive consecutive case- RC Leiderdorp,
series. Chronic wounds were arbitrarily defined as The Netherlands
wounds existing for more than four weeks. The Phone: 0031-715828282
accepted definition of a chronic wound relates to psteenvoorde@zonnet.nl
and/or
any wound that fails to heal within a reasonable
p.steenvoorde@rijnland.nl
period. There is no clear-cut definition that points
to how chronic a wound is.12 Three physicians,
three nurses and one nurse practitioner were in-
volved in the actual maggot therapy. Patients were
not eligible for the study if the treating surgeon
believed an urgent amputation could not be post-
poned (for example in case of severe sepsis) or if
life expectancy was shorter than a few weeks. All
patients gave informed consent for MDT. Patient
characteristics like age and sex were also reported.
The patient was recorded as a non-smoker if they
had never smoked or had been non-smoking for
more than three months.
17
Maggot debridement therapy
At the start of this study, maggots were not commer-
cially available. We were able, however, to get them at
the nearest university medical center. Currently, maggots
can be ordered up to 24 hours before start of the clinic
(BiologiQTM, Apeldoorn, The Netherlands). The maggot
applications are performed in our outpatient department
twice a week. MDT was performed until thorough debri-
dement was achieved. Each maggot application remained
on the wound for three to four days. The free-range tech-
nique is more effective14 and is our preferred technique.
However, with reference to patient preference15, painful
wounds16, coagulation problems in the patient17 and
problems with ensuring an adequate barrier for prevent-
ing maggot escape the contained technique was chosen.
In total 65/125 (52%) wounds were treated with the con-
tained technique.
Outcome
Maggots are debriding agents; if the wound is clean from
bacteria, necrosis and slough maggots are no longer use-
ful in the wound, and other wound-treatments must be
followed in order to close the wound. In this study we
defined eight different outcomes of MDT, based on out-
come definition in the literature.11;18-21 and our own ex-
perience14;16;22;23
Effect of MDT observed (beneficial outcome)
1) Wound fully closed by second intervention Of the 125 wounds treated with MDT, 76 (69.7%) had
(for example split skin graft);
2) Wound spontaneously fully closed;
3) Wound free from infection and <1/3 of original
wound size;
4) Clean wound (free from infection/necrosis/slough),
but same as initial size or up to 1/3 smaller.
No effect of MDT observed (unsuccessful outcome)
5) No difference observed between the pre- and
post-MDT-treated wound;
6) The wound is worse;
7) Minor amputation
(for example partial toe amputation);
8) Major amputation
(for example below knee amputation).
9) Unknown outcome.
The woundteam,
from left to right:
Louk van doorn, nurse practioner
Geertje Abrahamse, woundcare nurse
Pascal Steenvoorde, resident surgery
Nicolette hof, nurse practioner
Franca Hallebeek, woundcare nurse
Jacques Oskam, vascular surgeon
18
In this study outcomes 1-4 are arbitrarily determined
beneficial outcomes and outcomes 5-9 are determined
unsuccessful outcomes. They are arbitrary because in
some patients a fully debrided wound does not offer any
advantages for the patient (for example he/she still needs
wound care) and for another patient only a partial toe
amputation (which is defined as non-successful) could
mean the difference between being in a wheelchair and
being fully ambulatory.
Statistical analyses
To study the impact of smoking on the outcome of MDT,
a univariate analysis using Chi-square statistics was per-
formed.
Results
From August 2002 until March 2006, 109 patients with
125 wounds were treated with MDT in our hospital. In
total 110 patients were offered MDT, one alcoholic pa-
tient, with a psychiatric history refused. For one patient the
outcome was not known, due to the patients death during
maggot treatment. The patient died in another hospital,
due to a myocardial infarction, which was unrelated to
the MDT. There were 59 male (54.1%) and 50 female
patients treated. The average age was 71 years (range: 25-
93 years). The wounds existed on average seven months
before starting with MDT (range 1 week-11 years).
beneficial outcomes (Table 1). MDT resulted in complete
debridement and epithelialization, leading to a stable and
pain-free scar with no subsequent breakdown in 64 of the
125 wounds (51.2%), while 14 wounds (11.3%) were
free from necrosis, slough and infection and the wound
dimensions were less than one third of original wound size.
A major amputation was needed in 28 patients (22.4%).
In the current study there were 37 smokers and 72 non-
EWMA Journal 2007 vol 7 no 1
 Scientific Article

Table 1. Results of MDT in 109 patients with 125 wounds, divided by smokers and non-smokers
All wounds* All patients**
Smokers Non-smokers Smokers Non-smokers
N (%) N (%) N (%) N (%) N (%) N (%)
Total 125 (100) 41 (32.8) 84 (67.2) 109 (100) 37 (33.9) 72 (66.1)

Beneficial outcome 85 (68.0) 29 (70.7) 56 (66.7) 76 (69.7) 25 (32.9) 51 (67.1)

1. Wound fully closed by second intervention 23 (18.4) 9 (22.0) 14 (16.7) 23 (21.1) 9 (24.3) 14 (19.4)
(for example split skin graft)
2. Wound spontaneously fully closed 41 (32.8) 16 (39.0) 25 (29.8) 34 (31.2) 13 (35.1) 21 (29.2)
3. Wound free from infection and <1/3 of original 14 (11.2) 2 (4.9) 12 (14.3) 13 (11.9) 2 (5.4) 11 (15.3)
wound size
4. Clean wound (free from infection/necrosis/slough), 7 (5.6) 2 (4.9) 5 (6.0) 6 (5.5) 1 (2.7) 5 (6.9)
but same as initial size or up to 1/3 smaller
Unsuccessful outcome 40 (32.0) 12 (29.3) 28 (33.3) 33 ((30.3) 12 (36.4) 21 (63.6)
5. There is no difference between before and after MDT 5 (4.0) 2 (4.9) 3 (3.6) 3 (2.8) 2 (5.4) 1 (1.4)
6. The wound is worse 1 (0.8) 0 (0.0) 1 (1.2) 1 (0.9) 0 (0.0) 1 (1.4)
7. Minor amputation (for example toe) 5 (4.0) 2 (4.9) 3 (3.6) 5 (4.6) 2 (5.4) 3 (4.2)
8. Major amputation (below knee amputation or above 28 (22.4) 8 (19.5) 20 (23.8) 23 (21.1) 8 (21.6) 15 (20.8)
knee amputation)
9. Unknown result 1 (0.8) 0 (0.0) 1 (1.2) 1 (0.9) 0 (0.0) 1 (1.4)
* Chi-square: smokers/non-smokers wounds vs. 2-group outcome:X2=0.209 (df=1), P-value=0.647
(via Fishers Exact correction: P-value=0.688)
** Chi-square: smoking/non-smoking patients vs. 2-group outcome: X2=0.123 (df=1), P-value=0.725
(via Fishers Exact correction: P-value=0.826)

smokers. Of the smokers 25 (67.7%) had a good result,
compared to 51 (70.8%) in the non-smokers group. This
difference was non-significant (Table 1). The same result
was true if success was defined only as a closed wound
(outcome 1 or 2). Nor did smokers have a higher chance
of amputation (outcome 7 and 8).
Discussion
Smoking is a risk factor for complicated wound healing;
it is a systemic risk factor in line with diabetes and mal-
nutrition. It seems to be one of the most important (pre-
ventable) risk factors for impaired healing, considering
more than 25% of the adult population smokes.3 Smoking
causes damage to blood vessels, there is decreased collagen
production24, increased aging of collagen25 and keratinoc-
ytes show impaired migration.26 Nicotine has been shown
to impair wound contraction from the sixth to the tenth
day in a rabbit-ear model.27 Tobacco smoke contains over
4000 different compounds of particles or gases. There are
many toxic components like nicotine, carbon monoxide,
cyanide, heavy metals, additives and numerous different
chemical compounds known as condenate.3 The effect of
the cigarette smoke is a thrombogenic state through an
effect on the blood constituents, vasoconstricting prostag-
landins and an effect on the dermal microvasculature.28
Eventually all these factors lead to tissue hypoxia.
There is a vast amount of literature describing the negative
effects of smoking on acute wound healing. Sternal wound-
healing4, hip and knee arthroplasty5, ankle arthrodesis29,
spinal fusion6, intra-oral implant placement7, skin flaps8,
incisional hernia30, leg amputation31 and breast reduc-
tion9 are all examples of acute wounds that have delayed
healing in smokers. For example, delayed healing after
breast reduction was significantly associated with smoking.
In a study on 179 patients undergoing breast reduction
surgery; 22% had delayed healing in the smoking group
versus 7.7% in the non-smoking group (p=0.03)9; thus
demonstrating a relatively strong effect. Evidence of the
negative effect of smoking is not only seen in (skin-)wound
healing, there is also evidence, in the fields of (for example)
fracture healing32 and bowel anastomosis33 where it has
been shown that smoking negatively affects healing. There
is a dose-response association in heavy smokers with all
cause higher morbidity, however it is not clear if this is
also the case for wound healing.34 One study found that
high-level smokers (> 1 pack per day) had developed tissue
necrosis three times more frequently compared to low-level
smokers (<1 pack per day).35 In literature we could find
no reports describing the differences between cigarette and
cigar smokers, nor on passive smoke. Almost all smokers
in the current study were cigarette smokers, there was one
cigar smoker.
In patients undergoing elective hip or knee replacement,
a smoking intervention study (with smoking cessation or
at least a 50% reduction in smoking) led, in a randomised
controlled trial (n=120), to a reduction in the wound-re-
lated complications from 31% to 5% (p=0.001).10 This
effect was found if the patients had been subject to a six-
eight week program. In experimental rat studies, Kaufman
and others found that exposure to tobacco smoke seven
days prior to the flap procedure affected flap survival more

EWMA Journal 2007 vol 7 no 1 19

Scientific Article
adversely than did smoking postoperatively. They, how-
ever, did not find cessation of smoking to greatly improve
flap survival.36 Others found a critical time period of seven
to 14 days of preoperative cessation of smoking before
this increase in flap survival occurred.37 It seems there-
fore that pre-operative smoking is more important than
post-operative smoking. However, all these reports relate
to acute wound healing, and we are dealing with patients
with chronic wounds. In our study many patients claimed
they would stop smoking during the MDT, but we clas-
sified them as smokers, because the duration of MDT is
shorter than the time needed before healing rates would
be comparable to non-smokers.
In this type of study, with relatively small sample sizes,
one should always be careful interpreting the results. In
this study we found no indications that smoking should
be considered a contra-indication in MDT of chronic
wounds. It is always possible that there is an effect, but
one not shown by the statistics. Regarding our study, how-
ever, it is not very likely a negative effect of smoking in
chronic wound therapy was missed as even a somewhat
larger percentage of smokers had beneficial outcomes as
compared to non-smokers.
References
1. Mosley LH, Finseth F. Cigarette smoking: Impairment of digital blood flow and
wound healing in the hand. Hand. 1977;9:97-101.
2. Peto R, Lopez AD, Borehain J. Mortality from tobacco in developed countries:
indirect estimation from national statistics. Lancet. 1992;339:1268-1278.
3. Sorensen LT. Smoking and wound healing. EWMA Journal. 2003;3:13-15.
4. Golosow LM, Wagner JD, Feeley M et al. Risk factors for predicting surgical salvage
of sternal wound-healing complications. Ann Plast Surg. 1999;43:30-35.
5. Moller AM, Pedersen T, Villebro N, Munksgaard A. Effect of smoking on early com-
plications after elective orthopaedic surgery. J Bone Joint Surg Br. 2003;85:178-181.
6. Glassman SD, Anagnost SC, Parker A, Burke D, Johnson JR, Dimar JR. The effect
of cigarette smoking and smoking cessation on spinal fusion. Spine. 2000;25:2608-
2615.
7. Jones JK, Triplett RG. The relationship of cigarette smoking to impaired intraoral
wound healing: a review of evidence and implications for patient care. J Oral Maxil-
lofac Surg. 1992;50:237-239.
8. Nolan J, Jenkins RA, Kurihara K, Schultz RC. The acute effects of cigarette smoke
exposure on experimental skin flaps. Plast Reconstr Surg. 1985;75:544-551.
9. Cunningham BL, Gear AJL, Kerrigan CL, Collins ED. Analysis of breast reduction
complications derived from the Bravo study. Plast Reconstr Surg. 2005;115:1597-
1604.
10. Moller AM, Villebro N, Pedersen A, Tonnesen H. Effect of preoperative smoking
intervention on postoperative complications: a randomised clinical trial. Lancet.
2002;359:114-117.
11. Wolff.H., Hansson C. Larval therapy - an effective method for ulcer debridement.
Clin Exp Dermat. 2003;28:137.
12. Shai A, Maibach HI. Wound Healing and Ulcers of the Skin. Diagnosis and Therapy - The
practical approach. Heidelberg: Springer-Verlag; 2005:1-268.
13. Hunt TK, Hopf H, Hussain Z. Physiology of wound healing. Adv Skin Wound Care.
2000;13:6-11.
14. Steenvoorde P, Jacobi CE, Oskam J. Maggot Debridement Therapy: Free-range or
contained? An In-vivo study. Adv Skin Wound Care. 2005;18:430-435.
15. Steenvoorde P, Oskam J. Use of larval therapy to combat infection after breast-con-
serving surgery. J Wound Care. 2005;14:212-213.
16. Steenvoorde P, Budding TJ, Oskam J. Pain levels in patients treated with maggot
debridement therapy. J Wound Care . 2005;14:485-488.
17. Steenvoorde P, Oskam J. Bleeding complications in patients treated with Maggot
Debridement Therapy (MDT). Letter to the editor. IJLEW. 2005;4:57-58.
18. Wollina U, Liebold K, Schmidt W-D, Hartmann M, Fassler D. Biosurgery supports
granulation and debridement in chronic wounds - clinical data and remittance
spectroscopy measurement. Int J Dermatol. 2002;41:635-639.
19. Church JCT, Courtenay M. Maggot debridement therapy for chronic wounds. Lower
extremity Wounds. 2002;1:129-134.
20
In this study on maggot debridement therapy on chronic
wounds, we could not observe any statistically significant
difference between smokers and non-smokers in outcome.
Tissue hypoxia is the end-result of the detrimental effects
of smoking, which occurs through different pathways.28
It has been shown in the acute wound that smoking has
negative effects, and we hypothesize that this is due to
tissue hypoxia in the smokers group. The patients in our
study were a selection of many worst-case scenarios. We
could postulate that all these wounds had tissue hypoxia
at presentation, caused by different mechanisms, such as
arterial insufficiency, diabetes mellitus or smoking. It could
be that, because all wounds were in some sort of tissue
hypoxia at the start of MDT, that is the reason why we
didnt observe any difference between the smokers and the
non-smokers in outcome.
Conclusion
Smoking has an adverse effect on acute wound healing,
but in chronic wound care this effect has been less proven.
In this study, smoking was not found to affect the results
of maggot debridement therapy in chronic wounds, and
smoking should, therefore, not be a contra-indication for
maggot debridement therapy in these wounds. m
20. Courtenay M, Church JC, Ryan TJ. Larva therapy in wound management. J R Soc
Med. 2000;93:72-74.
21. Mumcuoglu KY, Ingber A, Gilead L et al. Maggot therapy for the treatment of
intractable wounds. Int J Dermatol. 1999;38:623-627.
22. Steenvoorde P, Budding TJ, Engeland Av, Oskam J. Maggot therapy and the YUK
factor; an issue for the patient? Wound Repair Regen. 2005;13:350-352.
23. Steenvoorde P, Jacobi CE, Doorn Lv, Oskam J. Maggot Debridement Therapy of
infected ulcers: patient and wound factors influencing outcome. Ann Royal Coll Surg
Eng accepted for publication. 2006.
24. Jorgensen LN, Kallehave F, Christensen E, Siana JE, Gottrup F. Less collagen
production in smokers. Surgery. 1998;123:450-455.
25. Rickert WS, Forbes WF. Changes in collagen with age- II Modification of collagen
structure by exposure to gaseous phase of tobacco smoke. Exp Geront. 1972;7:99.
26. Zia S, Ndoye A, Lee TX, Webber RJ, Grando SA. Receptor-mediated inhibition of
keratinocyte migration by nicotine involves modulations of calcium influx and intrac-
ellular concentration. J Pharmacol Exp Ther. 2000;293:973-981.
27. Mosely LH, Finseth F, Goody M. Nicotine and its effect on wound healing. Plast
Reconstr Surg. 1978;61:570-575.
28. Chang LD, Buncke G, Slezak S, Buncke HJ. Cigarette smoking, plastic surgery, and
microsurgery. J Reconstr Microsurg. 1996;12:467-474.
29. Cobb TK, Gabrielsen TA, Campbell DC, Wallrichs SL, Ilstrup DM. Cigarette smoking
and non-union after ankle arthrodesis. Foot Ankle Int. 1994;15:64-67.
30. Sorensen LT, Hemmingsen UB, Kirkeby LT, Kallehave F, Jorgensen LN. Smoking is
a risk factor for incisional hernia. Arch Surg. 2005;140:119-123.
31. Lind J, Kramhoft M, Bodtker S. The influence of smoking on complications after
primary amputations of the lower extremity. Clin Orthop Relat Res. 1991;211-217.
32. Schmitz MA, Finnegan M, Natarajan R, Champine J. Effect of smoking on tibial
shaft fracture healing. Clin Orthop Relat Res. 1999;184-200.
33. Sorensen LT, Jorgensen T, Kirkeby LT, Skovdal J, Vennits B, Wille JP. Smoking and
alcohol abuse are major risk factors for anastomotic leakage in colorectal surgery. Br
J Surg. 1999;86:927-931.
34. Sorensen LT, Horby J, Friis E, Pilsgaard B, Jorgensen T. Smoking as a risk fac-
tor for wound healing and infection in breast cancer surgery. Eur J Surg Oncol.
2002;28:815-820.
35. Goldminz D, Bennet RG. Cigarette smoking and flap and full-thickness graft necro-
sis. Arch Dermatol. 1991;127:1012.
36. Kaufman T, Eicheulaub EH, Levin M. Tobacco smoking: impairment of experimen-
tal flap survival. Ann Plast Surg. 1984;13:468.
37. Hardesty R.A., West SS, Schmidt S. Preoperative cessation of cigarette smoking and
its relationship to flap survival. Presented at the 69th Annual Meeting, American Associa-
tion of Plastic Surgeons, Hot Springs, VA, USA. 1990.
EWMA Journal 2007 vol 7 no 1
 H087510701
Secure xation when
you and your patients
need it most

We believe that you are quite happy with Mepore. But we just want you to kn
We believe that you are quite happy with Mepore. But we just want you to kno

For decades, the Mepore name has been synonymous with trusted, easy-to-use dressings that
Even better than you think
are gentle to the skin. Now we are introducing Mepore IV the latest addition to the Mepore range.
It is a high performance self-adhesive lm dressing, designed specically for secure xation of
intravascular catheters.
Mepore IV gives you a cost-effective solution that you can rely on. Whats more, it is easy to apply.
For non-ported catheter xation, use Mepore Film (formerly known as Melm). Together,
Mepore IV and Mepore Film give you a complete xation solution for most of your IV/catheter needs.
The symbol and the word mark are both registered trademarks or trademark pendings of Mlnlycke Health Care.
Mlnlycke Health Care AB (publ.), Box 13080, SE-402 52 Gteborg, Sweden. Phone + 46 31 722 30 00. www.molnlycke.com
 Biatain - Ibu
Exudate management
and release of ibuprofen

y Begg
Stanle atient
p
wound Canada
n t o ,
Toro

Exudate management
and release of ibuprofen
Biatain - Ibu is a unique combination of excellent exudate management
and continuous release of ibuprofen1,2

Biatain - Ibu may reduce wound pain caused by tissue damage1,3,4

Biatain - Ibu releases ibuprofen locally with no observed systemic effect1

www.biatain-ibu.coloplast.com

1 Jrgensen, B.; Friis, G. J.; Gottrup, F. Pain and quality of life for patients with venous leg ulcers: Proof of concept of the
efcacy of Biatain - Ibu, a new pain reducing wound dressing. Wound repair and regeneration 2006, 14 (3), 333-339.
2 Steffansen, Bente and Herping, Soe Paarup Kirkeby. Novel wound models for characterizing the effects of exudates levels
on the controlled release of ibuprofen from foam dressings. Poster, EWMA 2006, Czech Republic.
3 Sibbald, R. G., Coutts, Patricia, and Fierheller, Marjorie. Improved Persistent Wound Pain With A Novel Sustained Release
Ibuprofen Foam Dressing. Poster, Symposium for Advanced Wound Care, San Antonio, Texas, USA, 2006.
4 Flanagan, M.; Vogensen, H.; Haase, L. Case series investigating the experience of pain in patients with chronic venous leg
ulcers treated with a foam dressing releasing ibuprofen. World Wide Wounds 2006, April.

and Biatain are registered trademarks of Coloplast A/S. 2006-09. All rights reserved Coloplast A/S, 3050 Humlebk, Denmark.

Effectiveness of non-alcohol
Extended Abstract PragUE 2006
film forming skin protector on
the skins isles inside the ulcers
and the healing rate of venous
leg ulcers Randomized clinical study
Abstract:
The tender islands of epithelium inside venous leg
ulcers are exposed to copious moisture from ulcers
and tape trauma from frequent adhesive dressing
changes. Protecting them with non-alcohol film
forming skin protector will entail a faster healing
rate of venous leg ulcers.
INTRODUCTION
Epithelialization is the migration of new cells and
begins from wound edges and hair follicles1. The
main reason for delayed healing is copious exu-
dates at the chronic wound maceration and skin
breakdown of peri-wound surface. At the same
time the chronic exudates cause the breakdown
of extracellularmatrix proteins and growth fac-
tors, inhibit cell proliferation and lead to poor
angiogenesis. In addition the exudates cause the
degradation of tissue matrix and non-migration of
epithelial cells from wound margin2,3. However,
the presence of islands of epithelium originating
from hair follicles is an indicator of healing4.
To protect the skin isles and aid healing, film
forming skin protectors are applied to the skin.
These leave a protective polymer behind on the
skin when the carrier solvent evaporates off. The
film forming skin protector has to be:
1. non-cyto-toxic: because it is used near
wounds and must not interfere with wound
healing; like alcohol free skin protectors;
2. moisture barrier effective, and
3. have the ability to protect vulnerable skin
from frequent adhesive dressing changes that
can cause tape trauma5, 6.
The protector which has all those abilities is a non-
alcohol film forming skin protector Cavilon* from
3 M a protective polymer (Acrylates Copolymer)
dissolved into a fast drying carrier solvent (Hex
methyl Disiloxane)3.
EWMA Journal 2007 vol 7 no 1
Scientific Article
AIM
In a randomized clinical study we compared the
speed of formation of skin isles inside the ulcers
when using and not using non-alcohol film form-
ing skin protector.
METHODS
Adult patients older than 18 years with venous Tanja Planinsek Rucigaj
leg ulcers C6s, Ep, As/Ad/Ap, Pr on CEAP clas- MD, dermatovenerologist
sification7, ABPI > 0,8, with skin isles inside the Dermatovenerological
ulcers, in bed stage B 1-2 by the V. Fallanga classi- clinic, Clinical centre,
Ljubljana, Slovenia
fication of wound bed8 were included in a precise
randomized clinical study. Additional inclusion Correspondance to:
Tanja Planinsek Rucigaj
criteria were: no recidive ulcer, ulcer duration of
C. na Brod 20 b
less than 10 years, and the maximum size of ulcer 1231 Ljubljana
300 cm2. Slovenia
Tel: 0038641511806
Fax: 0038615612295
Acute wound contamination was an excluding cri-
rucigaj.janko@siol.net
terion. Other exclusion criteria were severe disease
like insulin dependent diabetes mellitus, rheuma-
toid arthritis, carcinoma, cardiac decompensation,
uncontrollable hypertension and immobility. Pa-
tients were selected and placed into one of two
groups by closed numbered envelopes. The study
protocol conformed to the ethical guidelines of
the 1975 Declaration of Helsinki and received
hospital permission. The ulcer area and skin isles
were drawn onto film and then measured by using
a digital planimeter*. This was carried out both
before and at the end of the study. Each ulcer
was measured three times and the investigator
calculated the average value of the ulcer area and
isles. The study was run for three months and all
the patients were in hospital. At first assessment
patients were placed into two groups, the ulcus
was measured and photos taken. The same nurse
and doctor-investigator carried out the dressing
changes and compression. The control was as-
sessed after 17 days when the study was closed.
23
Before study Patient no.1 Sprinkle with film-forming skin protector. End of study Patient no.1
Patient no.1

Table 1

Twenty-seven venous leg ulcers were included in the

study:
group 1: 14 patients, duration of ulcers average 9.7
years; average 16.6 days of therapy and
group 2: 13 patients, duration of ulcers average four
years; average 18.7 days of therapy.
In the first group we treated the ulcers with non-alcohol
film forming skin protector over the whole area of the
ulcers (including isles, wound bed and peri-wound skin)
at every change of dressing and then we covered the ulcers
with hydrocolloid dressings. The hydrocolloid dressings
were changed every two to five days, depending on secre-
tion from the ulcers. In Slovenia, hydrocolloid dressings
are usually applied on wounds when granulation tissue
starts to grow2. The selection of those dressings simulated
the tape trauma of adhesive dressings. The compression
therapy was performed with long-stretch bandages.
In the second group we used the hydrocolloid dressings
Table 2 only along with the long-stretch bandages.

There were no adverse events and all patients completed

the study.

RESULTS
Group 1: At the beginning the ulcers with skin isles, treat-
ed with non-alcohol film forming skin protector measured
an average of 151.8 cm2, and an average of 128.2 cm2 at
the end. The skin isles averaged 7.6 cm2 at the beginning,
and 14.9 cm2 at the end of the study.
Group 2: At the beginning the ulcers with skin isles,
which were treated without non-alcohol film forming skin
protector, were on average 186.7 cm2, and at the end of
the study averaged 188.8 cm2. The skin isles measured an
average of 14.5 cm2 at the beginning, and 12.5 cm2 at the
end (Table 1, 2).

24 EWMA Journal 2007 vol 7 no 1

 Scientific Article

DISCUSSION frequent adhesive dressing changes which can cause

The whole ulcer area was reduced by an average of 15.55%
of the ulcers treated with non-alcohol film forming skin
protector and on average enlarged by 1.12% on those
other ulcers where skin protectors were not used. The isles
were on average approximately two times larger with the
use of non-alcohol film forming skin protector therapy and
reduced by nearly an average of 13.8% on the ulcers with-
out skin protectors. It seems that non-alcohol film forming
skin protector saves skin isles from the harm of different
traumas inside venous leg ulcers. In our case faster growing
isles were already seen after two days in those ulcers where
we used non-alcohol film forming skin protector.
CONCLUSIONS
1. In our cases the prevalence of skin isles treated with
non-alcohol film forming skin protector increased
significantly and the ulcers healed faster than skin
isles and ulcers treated without non-alcohol film
forming skin protector.
2. It seems that non-alcohol film forming skin protec-
tor is not cyto-toxic, is moisture barrier effective
and has the ability to protect vulnerable skin from
tape trauma. However, larger studies including cellu-
lar level studies are needed to evaluate the effective-
ness of this non-alcohol film forming skin protector.
m
References
1. Shai A, Maibach HI. Wound Healing and Ulcers of the Skin. Springer-Verlag Berlin
Heidelberg 2005.p.10-12.
2. Aubck J. Synthetic Dressings. In: Hafner J, Ramelet AA, Schmeller W, Brunner UV
(eds). Current problems in dermatology.Management of Leg Ulcers. Basel: Kager.
1999; p.28-32.
3. Hampton S, Stephen-Haynes J. Skin Maceration: Assessment, Prevention and treat-
ment. In: White R. Skin Care in Wound Management: Assessment, Prevention and
treatment. Aberdeen: Wounds UK limited, 2005. p. 87-106.
4. Moffatt C, Morison MJ, Pina E.Wound bed preparation for venous leg ulcers. In
EWMA Position document: Wound bed preparation in practice. London: MEP Ltd,
2004.p. 14-5.
5. Lutz JB, et al. Comparison of the barrier properties of four film forming skin protect-
ants. Abstract/poster The Symp. On Adv. Wound Care. April 30-May 4,1995.
6. Wallace J.et al.Film forming skin protectant products: preventing skin breakdown.
Abstract/poster The Symp. On Adv. Wound Care. April 28-30,1994.
7. Ramelet AA, Kern P, Perrin M. Varicose veins and teleangiectasias. Elsevier SAS
2004, p. 6-8.
8. Falanga V.Classification for Wound Bed Preparation and Stimulation of chronic
Wounds. Wound repair and Regeneration; 8(5):347-52.
*Placom KP-90N(Japan)

DMS 1205-6 Intern.PressMap.EWMAad 2/24/06 2:07 PM Page 1

Pressured to Prevent Heel Ulcers?

Choose Heelift Suspension Boot
The Pressure-Free Solution
Now theres proof that Heelift Suspension Boots provide a pressure-
free environment to help eliminate the onset of pressure ulcers and
to help heal existing ulcers. Using a 16-sensor force sensing pad
affixed to the heel of the subject patient, pressure was mapped
using various pressure reduction products. In all tests, Heelift
provided a pressure-free solution!
Heelift Suspension Boot
Heelift has added design features for more
comfort, support and easier, one-handed
closure.
Pressure Reduction Mattress Extended stitching along the top rim narrows
the forefoot, increasing support to protect against
foot drop, equinus deformity or heel cord contracture
Two non-abrasive, soft straps with D-ring closures permit
Heel Protector
easy adjustment of strap tension

Heel Pillow
Darco (Europe) GmbH
Gewerbegebiet 18 82399 Raisting
Tel: +49-8807-9228-0 Fax: +49-8807-9228-22
info@darco-europe.com
www.darco-europe.com
Heelift Original and Smooth Patent No. 5449339 Additional patents pending
Moorings Mediquip
Mobility & Independent Living Centre
51 Slaght Road Ballymena
Co Antrim BT42 2JH N.Ireland
Tel: +44 28 2563 2777 Fax: +44 28 2563 2272
e-mail: sales@mooringsmediquip.co.uk
2006 DM Systems, Inc.
 Extended Abstract PragUE 2006
Georgina T. Gethin
RGN, HE Dip Wound Care
(PhD student)
HRB-Research Fellow
Faculty of Nursing
Royal College of Surgeons, mates size and should only be used as an estimate
Dublin, Ireland
Prof. Seamus Cowman,
PhD, MSc, FFNMRCSI,
RGN, RNT, PGCEA,
Dip N.
Head of Department
Faculty of Nursing
Royal College of Surgeons
Dublin, Ireland
Corresponding Author:
ggethin@eircom.net
Tel: 00 353 86 8560053
Wound Measurement:
the contribution
to practice
Abstract
The routine assessment of a wound is limited
to what is visible to the naked eye and is both
knowledge and skill based process dependent on
objective and subjective interpretation. Wound
measurement represents a simple, objective contri-
bution to this process. However, clinicians should
be aware of the reliability and validity of various
methods used.
Studies, which have compared methods, have
reported a high degree of intra-rater reliability for
each method but ruler based method over esti-
of wound size compared to acetate or planimetry.
Acetate tracing and digital planimetry are well
suited to routine clinical practice and no statis-
tically significant differences in size are seen for
wounds less than 10cm2 when both methods are
used. For wounds > 10cm2 a statistically signifi-
cant difference has been reported. Studies have
concluded that acetate provides accurate measure-
ment but planimetry is deemed more precise.
Monitoring of wound size over a 4 week period
and calculation of percentage change from base-
line can aid in prediction of healing. In addition,
it may indicate the need for further investigation,
provide objective information, and can improve
cost justification, communication and patient
care.
Introduction
The progress or deterioration in the condition
of a wound represents a complex physiological
process occurring at a molecular and cellular level
with the end result only visible to the naked eye.
It is reasonable to suggest that often wounds are
visualized as a one time event represented in an
assessment of what is seen at a point in time rather
than as changes over time. The fundamental ques-
tion posed when assessing a wound is whether
the wound is the same, better or worse than be-
fore? One method of answering this question
is by measuring the wound. This paper reviews
various approaches to wound measurement and
examines the benefits of each.
Advantages of
measuring wounds
Wound measurement serves a numbers of purpos-
es: it provides an objective component of assess-
ment and re-evaluation; lack of change in size or
unusual patterns in wound size may indicate the
need for further investigation; provides reassur-
ance to both patient and clinician; aids cost justi-
fication; enhances communication; slow progress
with standard treatment could aid selection of
more advanced treatment modalities.1,2 While
many methods are available to determine wound
size they vary in terms of contact or non-contact
methods; cost; availability; skill required and ease
of use. For most clinicians the ruler technique and
acetate methods are the most commonly used .3 In
addition, digital planimetry is easy to use and rela-
tively low in cost.4 Given the range of approaches
to wound measurement a vital aspect in the de-
termination of the suitability of an individual ap-
proach for use in practice is whether inter-rater
reliability and validity has been established.
Ruler method
The ruler method requires measuring the greatest
length of the wound by the greatest perpendicular
width and is deemed to be the most reliable of
ruler methods.5 However, this method requires
subjective interpretation and lacks clarity as to
the exact points to be measured.4 In addition, this
method can overestimate the size of the wound
by up to 44% compared to other methods.6,7,8
As Majeske argues one is applying the area of a
rectangle that is length x breath to an irregular
shape such as a wound.6 Indeed when this method
is used the length and width of the wound may
not change but new areas of epithelization may
develop in the wound bed which cannot be ac-
counted for. Therefore length x width should be

26 EWMA Journal 2007 vol 7 no 1


regarded as an estimation of size rather than true reflection
of size and thus the contribution of the ruler method for
wound assessment and evaluation is questionable.9
Acetate method
The acetate method involves tracing the circumference of
the wound onto a two layered 1cm2 preprinted acetate
tracing (single layer may still be available in certain areas).
The contact layer is discarded and the area of the wound
is calculated by counting each square that is more than
half within the border of the wound as 1cm2.10 Acetates
are still available in mm2 but less commonly used than
the 1cm2 and are more time consuming to count. The
acetate method of wound measurement requires subjec-
tive interpretation, as each square within the border of the
wound margin must be interpreted for inclusion or not.
Acetates have the advantage of being easily stored within
patient notes, can be dated and areas of epithelization
or slough can be marked on the tracing. This method
has high inter-rater reliability.6,11 However, when this
method is used it is important to have the patient in the
same position at each measurement as the main source of
error is the ability of observers to define precisely the edge
of the wound.12
Digital planimetry
Digital planimetry for wound measurement requires plac-
ing the acetate tracing on a digital tablet, retracing the
border using a stylus and the underlying sensor calculates
area. This method is more objective and precise and has
high inter-rater and intra-rater reliability but still depends
on the accuracy of the initial wound tracing.4,6,11
Other methods include structured light technique, col-
our reflective analyzer, ultrasound and magnetic resonance
imaging but are more suited to specialized centers and
do not lend themselves to routine use within the clinical
environment.12,13
Comparing methods of treatment the patient received and concluded that %
wound measurement
A recent study compared the area of 50 superficial wounds
using acetate tracing and square counting with digital
planimetry (Visitrak, Smith & Nephew).4 25 wounds less
than 10cm2 and 25 wounds greater than 10cm2 were
measured. They reported for wounds less than 10cm2
no statistically significant difference (p = 0.330) but for
the larger wounds a statistically significant difference was
demonstrated (p=0.008).4 The results of this study support
the finding of Oien et al (2000) where the differences in
methods increased with the increased size of the wound.11
The authors attempted to determine if any difference ex-
isted in % change in wound size after 4 weeks using both
methods but insufficient tracings were available for mean-
EWMA Journal 2007 vol 7 no 1
Scientific Article
ingful statistical analysis, however for the 13 tracings that
were available the results were very similar.4
A comparison of 4 methods of wound measurement
including diameter, square counting, digital and mechani-
cal planimetry of 50 wounds of 20 patients reported a high
degree of agreement with each other at least for wounds
with an area up to 10cm2.11 This supports the findings
of Majeske.6 In addition it should be noted that different
measurement methods cannot be used interchangeably,
as studies report different wound size with each meth-
od.4,6,11
Measuring cavity wounds is difficult as even some ad-
vanced measurement techniques such as structured light
are inaccurate as these technologically advanced techniques
cannot precisely account for the 3D aspect of the wound
and thus are unsuitable for undermined or very deep and
very large wounds.12,14 Melhuish suggested that the cir-
cumference of a wound can be used to monitor progress
of healing in cavity wounds.15 A study by Melhuish et al
(1994) of 14 surgical wounds over 10 weeks or until heal-
ing demonstrated a direct correlation between area and
wound circumference (0.90, p <0.001) and volume and
circumference (0.70, p < 0.001).15 The authors conclude
that circumference could be used to follow the progress
towards healing when measurement devices cannot probe
the depths of the cavity.15
Clinical application
The clinical impact of measuring wounds over time is
demonstrated in studies which used change in wound area
as a prognostic indicator to healing.2,16,17 Sheehan et al
(2003) monitored percentage change in Wagner grade 1
and 2 diabetic foot ulcers of 203 patients over 12 weeks as
part of a randomised controlled trial. This study reported
that the mean percentage reduction in wound area was
82% in those DFU that healed by week 12, versus 25%
of those that did not heal.17 The results were statistically
significant (p<0.02) and were independent of the wound
change at 4 weeks was a robust predictor of healing. 17
A further study of 104 venous leg ulcer patients receiving
optimum care and in whom wound area was measured
over a 4 week period as a prognostic indicator to healing at
24 weeks was conducted.16 The percentage change in area
at week 2, 3, 4 and between weeks 1 and 2, and weeks 3
and 4 all distinguished between wounds that healed at 24
weeks and those that did not.16 This was in contrast to the
rate of healing (area healed per week) which did not dif-
ferentiate between the healed and non-healed groups.16
The instability in wound healing over time has been re-
ported and chronic wounds have been described as becom-
27
Scientifi c Article

ing inert or static at any stage along the healing proc- knowledge and skill. The use of accurate yet simple wound
ess.2,18 However, in reviewing studies of wound healing measurement such as acetate and planimetry supports
and wound measuring rate of healing appears less reliable the use of objective information which can aid wound
than percentage change in area over a defi ned period of monitoring. The pace of change in wound management
time as a useful predictor to healing.16 However, a mean is placing an emphasis on the development of more objec-
adjusted healing rate formulae by Tallman et al (1997) tive tools by which to assess and evaluate wound healing,
reported that for venous ulcers early negative healing rates measuring can contribute to this. Whereas it is diffi cult to
indicate a poor prognosis for healing and that this method make strong pronouncements on individual approaches
accurately predicts healing as early as the third week of it is clear that the inter-rater reliability of many methods
treatment.2 such as acetate and planimetry is high, and other meth-
A review by Flanagan (2003) further supports the use ods need to be used with caution for example ruler based
of percentage reduction in wound size as a means of ef- methods have been shown to overestimate size and should
fective wound monitoring.19 It concluded that a percent- only be regarded as an estimate.
age reduction at 2-4 weeks of between 20-40% is a good
predictor of healing.19 Indeed Margolis et al (2000) uses Monitoring of wound size over a 4 week period and calcu-
wound size as one of two parameters to predict healing of lation of percentage change in area can assist in prediction
venous ulcers when fi rst line management such as com- of healing and provides objective, factual information on
pression therapy is used, wound duration is the second which to base treatment decisions. m
parameter.20 In their study patients received one point
for wounds larger than 5 cm2 and one point for duration
longer than 6 months.20 93% of those with a score of 0
References
healed at 24 weeks compared with 13-37% of those with a 1. Vowden, K. Common problems in wound care: wound and ulcer measurement.
score of 2.20 The authors state as an advantage of this scor- British Journal of Nursing, (1995) 4(13), 775-779.
2. Tallman, P., Muscare, E., Carson, P., Eaglstein, H. and Falanga, V. Initial rate of
ing system that patients can be selected for more advanced healing predicts complete healing of venous ulcers. Arch Dermatology, (1997) 133,
1231-1234.
treatment modalities and further investigation at an early
3. Charles, H. wound assessment: measuring the area of a leg ulcer.
stage of management. In this regard ruler measurements British Journal of Nursing, (1998), 7(13), 765-772.

are unsuited to wound monitoring, as they consistently 4. Gethin, G. and Cowman, S. Wound measurement comparing the use of acetate
tracings and VisitrakTM digital planimetry. Journal of clinical Nursing, (2006),
overestimate size. 6,7,11 15, 422-427.
5. Keast, D., Bowering, C., Evans, A, Mackean, G., Burrows, C. and DSouza, L.
The time frame of 4 weeks from the commencement MEASURE a proposed assessment framework for developing best practice recom-
mendations for wound assessment. Wound Repair and Regeneration, (2004) 12(3),
of a treatment regime is useful for clinicians during which S1-S17.
effi cacy of treatment can be monitored objectively. Wound 6. Majeske, C. Reliability of wound surface area measurements.
Physical Therapy, (1992) 72(2), 138-141.
measuring can further aid planning of appropriate treat- 7. Brown, D. Comparing different ulcer measurement techniques:
ment strategies and avoid shifts in treatment regimes.2 a pilot study. Primary Intention, (2003), 11(3), 125-134.
8. Schultz, G., Mozingo, D., Romanelli, M. and Claxton, K. Wound healing and TIME:
Such regular reassessments using wound measuring are new concepts and scientific applications. Wound Repair and Regeneration, (2005)
currently the only way to determine treatment effi cacy, 13(4), S1-S11.
9. Gethin, G. The importance of continuous wound measuring. Wounds UK, (2006),
quantify and document progress and guide further treat- 2(2), 60-68.
ment decisions and aid early identifi cation of factors delay- 10. Harding, K. Methods for assessing change in ulcer status. Advanced wound care,
(1995), 8, 28-42.
ing healing.5,9,19 In addition validated predictors of healing 11. Oien, R., Hakansson, A., Hansen, B. and Bjellerup, M. Measuring the size of ulcers
by planimetry: a useful method in the clinical setting. Journal of Wound Care, (2002)
could serve as surrogate end points in the evaluation of 11(5), 165-168.
new treatment and allow more effi cient design of clinical 12. Plassmann, P. Measuring wounds. Journal of Wound Care, (1995) 4(6), 269-272.
13. Romanelli, M. Technological advances in wound bed measurements. Wounds
trials.17 (2002), 14(2): 58-66.
14. Mani, R. and Ross, J. Morphometry and other measurements In: Mani, R., Falanga,
V., Sherman, CP., Sandeman, D. eds. Chronic Wound Healing, WB Saunders,
CONCLUSION London, (1999) 81-98.
Wound measurement is essential in ensuring best practice 15. Melhuish, J., Plassman, P. and Harding, K. Circumference, area and volume of the
healing wound. Journal of Wound Care, (1994) 3(8), 380-384.
approaches to wound management. There are multiple 16. Kantor, J. and Margolis, D. A multicentre study of percentage change in venous
leg ulcer area as a prognostic index of healing at 24 weeks. British Journal of
approaches to measuring wounds and some are more reli- Dermatology, (2000), 142(5), 960-964.
able and valid than others such as acetate and planimetry. 17. Sheehan, P., Jones, P., Caselli, A., Giurini, J., Veves, A. Percent change in wound
area of diabetic foot ulcers over a 4-week period is a robust predictor of complete
Healthcare practitioners must at all times adopt the most healing in a 12-week prospective trial. Diabetes care, (2003) 26(6), 1879-1882.
appropriate and validated methods of measurement in the 18. Enoch, S. and Price, P. Should alternative endpoints be considered to evaluate
outcomes in chronic recalcitrant wounds? World Wide Wounds,
management of patients/clients wounds. www.worldwidewounds.com (2004) October.
19. Flanagan, M. wound measurement: can it help us to monitor progression to
healing? Journal of Wound Care, (2003), 12(5), 189-194.
It is the case that many elements of wound management 20. Margolis D., Berlin, J. and Strom, B. Which venous leg ulcers will heal with limb
compression bandages? American Journal of Medicine, (2000) 109(1), 15-19.
require subjective interpretation based on varying levels of

8 EWMA Journal 2007 vol 7 no 1

 H086040701
Improved

Neither patients nor nurses need to suffer from poor fluid handling. Mepilex Border
with improved fluid handling is even better than before as it reduces the risk of
leakage and maceration.
Thanks to its unique and patented Safetac soft silicone adhesive technology, Mepilex
Border minimises trauma to the wound, the surrounding skin and pain to the patient.
Try new Mepilex Border with Safetac technology an improvement almost as
important as the double straw.
Mlnlycke Health Care AB (publ), Box 13080, SE-402 52 Gteborg, Sweden, Phone + 46 31 722 30 00, www.molnlycke.com, www.safetac.com
The symbol and the word mark are both registered trademarks or trademark pendings of Mlnlycke Health Care
Prontosan

... the solution for chronic wound irrigation

optimal wound conditioning

fast and effective removal of wound
coating
absorption of wound odours
can be used up to 8 weeks after opening

B. Braun Medical AG OPM Division Seesatz Sempach 6204 Switzerland Tel +41 58 258 5000 www.bbraun.com
 Scientific Article

Extended Abstract PragUE 2006

Improving education in
wound care: crossing the boundaries
of interprofessional learning

Introduction on current best evidence and research. Users will

Despite a plethora of evidence and clinical guide-
lines the management of complex chronic wounds
is a challenging area of clinical practice for all
practitioners involved in tissue viability. Nurses
and podiatrists are frequently involved in the as-
sessment and management of complex wounds
on the lower extremities. Despite evidence dem-
onstrating the benefits of inter-professional team
working, the reality remains there is often little
collaboration between nurses and podiatrists in
the care of patients with chronic wounds on the
lower extremity. This partly stems from a lack of
awareness of each others roles and inconsistent
educational strategies at pre-registration and post-
registration levels. The University of Hudders-
field, United Kingdom, has begun to address this
issue by developing an inter-professional strand
to undergraduate/ pre-registration wound care
education.
Aim
To develop an IT-based learning resource to con-
vey evidence-based concepts and best practice in
wound care to undergraduate/ pre-registration
nursing and podiatry students.
Methods
A CD-Rom has been developed utilising a prob-
lem based learning format bringing theory to
life with the use of real life case scenarios centred
on the assessment and management of common
wound types; diabetic foot ulcers, pressure ulcers,
leg ulcers and infected wounds. This format allows
students to select care options in a virtual envi-
ronment and receive generated feedback based
be encouraged to interpret findings from clinical
investigations, test their knowledge at the start
of the quiz and again at the end of the CD, ad-
ditionally students will be encouraged to consider
the role of different professions in the virtual case.
Qualitative statements from experienced nurses
and podiatrists are included that highlight per- Caroline McIntosh
MSc BSc (Hons) MChS
ceived perceptions on the benefits and barriers to Senior Lecturer in Podiatry
interprofessional collaboration in wound care. Centre for Health &
Social Care Research,
Purpose University of Huddersfield,
Queensgate, Huddersfield,
The CD-Rom will provide an innovative approach West Yorkshire,
to wound care education that will bridge the the- HD1 3DH, UK
ory to practice gap, highlight the importance of Tel: 01484 473224,
Fax 01484 472380
interdisciplinary working and raise awareness of
c.mcintosh@hud.ac.uk
each others roles.
Karen Ousey RGN, ONC,
Conclusion DPPN, PGDE, BA, MA,
Principal Lecturer,
This initiative aims to introduce an IT resource Department of Nursing,
to undergraduate nursing and podiatry students Centre for Health & Social
Care Research,
to encourage students to embrace evidence based
University of Huddersfield,
concepts, appreciate the importance on an inter- Queensgate, Huddersfield,
professional approach and better prepare students West Yorkshire, UK
for independent practice.
The CD-Rom will be formally evaluated after
12 months to assess whether the anticipated learn-
ing outcomes have been achieved by students of
both disciplines. m
Funding: This project was funded, following a
successful bid for School of Human and Health
Sciences, University of Huddersfield innovation
funding.
Declaration of interest: None

EWMA Journal 2007 vol 7 no 1 31

 Scientific Article
ABSTRACT
STUTTGART GERMANY 2005
1Mayer
Tenenhaus, M.D.,
2OliverRennekampff, M.D.,
1Dhaval Bhavsar, M.D.,
3Bruce Potenza, M.D.
1Division
of Plastic Surgery,
UCSD, San Diego, CA
2Division
of Plastic Surgery,
Tbingen University,
Tbingen, Germany flap reconstruction with its resultant stigmata.
3Division of Trauma and
Burn Surgery, UCSD Medi-
cal Center, San Diego, CA
rennekampff@
bgu-tuebingen.de
Please note:
Dr. Rennekampff and
Dr. Tenenhaus contributed
equally to this work.
32
Waterjet debridement
of deep and indeterminate
depth thermal injuries
ABSTRACT
Deeper and indeterminate depth thermal injuries
often prove to be particularly challenging and dif-
ficult to manage. Protracted management strate-
gies can lead to prolongation of the inflammatory
phase of wound healing and result in compro-
mised aesthetic and functional results. Conversely,
overaggressive attempts at excisional debridement
might condemn the site to skin graft closure or
tion that develops on thermal injury surfaces treat-
Recently, a waterjet debriding tool has been advo-
cated for surgical wound debridement and wound
bed preparation and has shown particular promise
in the field. The benefits of this therapeutic mo-
dality include controlled depth precision, rapid
debridement, evacuation of debris as well as the
elimination of an additional sharp cutting edge
from the surgical field. In this abstract we describe
our clinical experience with the use of the Versajet
SystemTM, a fluid jet technology in the treatment
of deep and indeterminate depth burns.
A high pressure jet stream of saline is oriented
parallel to the working plane and tangential to
the tissue. In traversing the working aperture,
this stream creates--by Venturi effect--a vacuum
which evacuates debris. A vertical orientation
to the working head promotes cutting while a
more tangential or oblique application facilitates
debridement. Increasing the power setting both
increases its cutting and debriding abilities and
augments the evacuation of debris. The Versajet
SystemTM employs disposable hand-pieces in
varied angulations and debriding apertures fa-
cilitating the treatment of areas like the fingers
and nose, which are often difficult to contour or
reach with traditional excisional modalities.
To date, at our institutions, twenty patients with
burns to the face, neck, extremities, and torso have
undergone debridement using the water jet pow-
ered surgical tool. The Versajet SystemTM was able
to precisely debride these wounds for immedi-
ate closure with either skin grafts or biosynthetic
dressings. All grafted wounds demonstrated suc-
cessful take and all sites treated in biosynthetic
dressings epithelialized within 5 to 16 days post
application.
Pseudoeschar, the proteinacious exudative collec-
ed with topical antimicrobials, has been shown
to inhibit epithelialization as well as skin graft or
biosynthetic biointegration. The waterjet rapidly
removes this layer affording accurate assessment
of the depth of injury. Deeper thermal injuries are
successfully debrided of nonvital tissue and debris.
Limitations to the present form of this technology
include the difficulty of addressing full thickness
eschars, particularly when overlying superficially
located fatty collections as seen in the malar re-
gions of the face. This is a cutting and debriding
tool and judicious application and care in use as
with all surgical instruments must be employed.
Ex-vivo experiments on discarded abdominoplasty
skin demonstrate that the adjustable power set-
tings of the Versajet SystemTM allow for precise and
controlled debridement of the surgical planes of
skin while preserving adnexa, critical for epitheli-
alization. Concomitant application of biosynthet-
ics like Transcyte and Biobrane complement this
approach. As opposed to conventional excisional
surgical knives like the Goulian, Braithwaite, and
scalpel, the absence of additional sharp cutting
edges on the surgical field yields an additional
extra measure of protection to both patient and
staff. m
EWMA Journal 2007 vol 7 no 1
97 different instruments.
1 cutting-edge technology.
VERSAJET significantly expands your surgical debridement and excision options.

The VERSAJET Hydrosurgery System enables surgeons to Debridement of traumatic wounds, chronic wounds, burns
simultaneously grasp, cut and remove damaged tissue and and other soft tissue lesions is achieved in a single step,
contaminants precisely-without the collateral tissue trauma with a single instrument, and single-handedly.
associated with current surgical modalities. Call us today for a demonstration.

EU Authorised Representative: Manufactured for: www.smith-nephew.com/wound

Wound Management, Smith & Nephew Medical Ltd, 101 Hessle Road, Hull HU3 2BN Smith & Nephew, Inc. 11775 Starkey Road, Largo, FL 33773 USA www.versajet.info
T 44 (0) 1482 225181 F 44 (0) 1482 673106 T (1) 800 876 1261
Trademark of Smith & Nephew
 EBWM
ABSTRACTS OF RECENT
COCHRANE REVIEWS
Wound drains after incisional Authors conclusions: There is insufficient evidence to
hernia repair
Gurusamy KS, Samraj K
The Cochrane Database of Systematic Reviews
Copyright 2005 The Cochrane Collaboration.
Published by John Wiley & Sons, Ltd.2007 Issue1.
ABSTRACT
Background: Incisional hernias are caused by the fail-
Sally Bell-Syer, MSc
ure of the wall of the abdomen to close after abdomi-
Review Group Co-ordinator nal surgery, leaving a hole through which the viscera
Cochrane Wounds Group
protrude. Incisional hernias are repaired by further
Department of surgery. Surgical drains are frequently inserted during
Health Sciences hernia repair with the aim of facilitating fluid drainage
Area 4 and preventing complications. Traditional teaching has
Seebohm Rowntree recommended the use of drains after incisional hernia
Building
repair other than for laparoscopic ventral hernia repair.
University of York
York, More than 50% of open mesh repairs of ventral hernias
United Kingdom have drains inserted. However, there is uncertainty as
sembs1@york.ac.uk to whether drains are associated with benefits or harms
to the patient.
Objectives: To determine the effects on wound infec-
tion and other outcomes, of inserting a wound drain
during surgery to repair incisional hernias, and, if pos-
sible, to determine the comparative effects of different
types of wound drain after incisional hernia repair.
Search strategy: We searched the Cochrane Wounds
Group Specialised Register (last searched March
2006), the Cochrane Central Register of Controlled
Trials (CENTRAL)(The Cochrane Library Issue 1,
2006), EMBASE (1974 to March 2006), PubMed
(1951 to March 2006), and Science Citation Index
Expanded (1974 to March 2006). We also searched
the meta-register of controlled trials.
Selection criteria: We considered all randomised trials
performed in adult patients who underwent incisional
hernia repair and that compared using a drain with
nodrain. We also considered trials that compared
different types of drain.
Data collection and analysis: We extracted data on
the characteristics of the trial, methodological quality of
the trials, outcomes (e.g. infection and other wound
complications) from each trial. For each outcome we
calculated the risk ratio (RR) with 95% confidence in-
tervals (CI) and based on intention-to-treat analysis.
Main results: Only one trial was eligible for inclusion in
the review with a total of 24 patients randomised to an
electrified drain (12 patients) compared with a corru-
gated drain (12 patients). There were no statistically
significant differences between the groups for any of
the outcomes (a variety of measures of infection).
34
determine whether wound drains after incisional hernia
repair are associated with better or worse outcomes
than no drains.
________
Plain language summary: No recommendations can
be made about whether drains should be used after
incisional hernia repair because of a lack of trial
evidence. Incisional hernias are caused by the failure
ofthe wall of the abdomen to close after abdominal
surgery. This leaves a hole through which the viscera
(guts) protrude. Hernias are repaired with further sur-
gery, during which the insertion of a drain to remove
excess fluid is common practice. It is not known
whether or not these drains help the wounds to heal.
Drains may produce undesired results such as an in-
creased risk of infection, pain, and an increased length
of hospital stay after surgery. We reviewed all the avail-
able trial evidence to see whether drains help or hinder
recovery after operations for incisional hernia repair.
We found that no trials that compared people who had
drains inserted for this type of surgery against those
who didnt. One trial compared two types of drain
against each other, and both models of drain per-
formed similarly well. Further trials need to be carried
out before being able to answer the question about the
benefits, or otherwise, of drains inserted during repair
of incisional hernias.
Topical silver for treating infected wounds
Vermeulen H, van Hattem JM, Storm-Versloot MN,
Ubbink DT
The Cochrane Database of Systematic Reviews
Copyright 2005 The Cochrane Collaboration.
Published by John Wiley & Sons, Ltd. 2007 Issue1
ABSTRACT
Background: Topical silver treatments and silver dress-
ings are increasingly used for the local treatment of
contaminated or infected wounds, however, there is a
lack of clarity regarding the evidence for their effective-
ness.
Objectives: To evaluate the effects on wound healing
of topical silver and silver dressings in the treatment of
contaminated and infected acute or chronic wounds.
Search strategy: We sought relevant trials from the Co-
chrane Central Register of Controlled Trials (CEN-
TRAL), the Cochrane Wounds Group Specialised Reg-
ister in March 2006 and in MEDLINE, EMBASE,
CINAHL, and digital dissertations databases up to Sep-
EWMA Journal 2007 vol 7 no 1
 EWMA

tember 2006. In addition, we contacted companies, man-

ufacturers and distributors for information to identify rele-
vant trials.
Selection criteria: Randomised controlled trials (RCTs) as-
sessing the effectiveness of topical silver in the treatment
of contaminated and infected acute or chronic wounds.
Data collection and analysis: Eligibility of trials, assess-
ment of trial quality and data extraction were undertaken
by two authors independently. Disagreements were re-
ferred to a third author.
Main results: Three RCTs were identified, comprising a to-
tal of 847 participants. One trial compared silver-contain-
ing foam (Contreet) with hydrocellular foam (Allevyn) in
patients with leg ulcers. The second trial compared a sil-
ver-containing alginate (Silvercel) with an alginate alone
(Algosteril). The third trial compared a silver-containing
foam dressing (Contreet) with best local practice in pa-
tients with chronic wounds.
The data from these trials show that silver-containing foam
dressings did not significantly increase complete ulcer
healing as compared with standard foam dressings or best
local practice after up to four weeks of follow-up, although
a greater reduction of ulcer size was observed with the sil-
ver-containing foam. The use of antibiotics was assessed
in two trials, but no significant differences were found.
Data on pain, patient satisfaction, length of hospital stay,
and costs were limited and showed no differences. Leak-
age occurred significantly less frequently in patients with
leg ulcers and chronic wounds treated with a silver dress-
ing than with a standard foam dressing or best local prac-
tice in one trial.
Authors conclusions: Only three trials with a short follow-
up duration were found. There is insufficient evidence to
recommend the use of silver-containing dressings or topi-
cal agents for treatment of infected or contaminated
chronic wounds.
________
Plain language summary: Using dressings and topical
agents which contain silver for treating infected wounds.
Brian Gilchrist: Thank you
Many of you will know Brian Gilchrist
who has been Secretary of EWMA
since its inception in 1991. Originally
a native of New Zealand, Brian has
worked for many years in the Nightin-
gale School of Nursing at Kings College
in London where he has just resigned as
Head of Pre-Registration Education. Brian has left the UK
(and Europe) to return to his native New Zealand where
he has recently taken up an appointment as Director of
Nursing Education at the Universal College of Learning
in Palmerston North. Because of this move he is no longer
able to act as the EWMA Secretary. However, all is not lost
as there is a flourishing wound care society in New Zealand
which Brian has already been invited to join. Although not
part of Europe, the New Zealand Wound Care Society is
one of our unofficial Co-operating Organisations and as
members receive copies of the EWMA Journal, I am sure
we will not lose touch.
Brian has been a stalwart of the EWMA Council, and
as Secretary has dealt with membership issues, organized
the agendas for all Council meetings and Annual General
Meetings. Much of his time working for EWMA has been
taken up liaising with the UK Charity Commission on
points of procedure when the EWMA Constitution has
had to be amended. As president of EWMA I would like
to thank Brian for all his hard work over the last 16 years.
I hope that his new appointment will offer him plenty of
new challenges that I am sure he will relish.
Peter J Franks, EWMA President

People with chronic wounds such as foot ulcers and leg ul-
cers and acute wounds such as surgical wounds often find
their wound becomes infected. Healing the wound can be
delayed by the amount of bacteria on the wound surface.
Wound care involves frequent dressing changes. Silver is
an antimicrobial and dressings which contain silver have
been developed. The authors of this Cochrane review
wanted to find evidence on whether silver based dressings
reduced infection and encouraged wound healing.

Three studies looking at people with chronic wounds were Are you interested in
included in the review and found that silver-containing
foam dressings did not result in faster wound healing after
submitting an article or paper
up to four weeks of follow-up. One study did find that the for EWMA Journal?
overall size of the ulcer reduced more quickly when dressed
with a silver-containing foam.
Read our author guidelines at
There is no enough evidence to recommend the use of sil-
ver-containing dressings or topical agents for treating in- www.ewma.org/english/authorguide
fected or contaminated chronic wounds.

EWMA Journal 2007 vol 7 no 1 35

 EWMA
EWMA
Educational Panel
EWMA Education Development Project:
what is it and what does it do?
Background
In order to meet EWMAs education goal, the
educational development project was established
in October 2000. The broad aims of this project
are to increase the knowledge and skills of health
care professionals involved in the management
of individuals with wounds of varying aetiolo-
gies, thereby enabling them to provide optimum
Zena Moore wound care. In order to achieve this goal, the
RGN, MSc, FFNMRCSI
project aims to provide quality standards against
Lecturer, which other organisations can evaluate existing
Faculty of Nursing wound management programmes. For those
& Midwifery,
RCSI,
groups who do not have existing education, the
Dublin 2, project aims to provide contemporary interdis-
Ireland ciplinary wound management education that is
zmoore@rcsi.ie
endorsed by organisations affiliated to EWMA.
The project group have worked hard at achieving
their aims. Thus far, two very successful aspects of
the work of the project group have been:
The development of curricula exploring a
variety of wound aetiologies
The establishment of an endorsement proc-
ess for existing education programmes
Wound Management Modules
A modular curricula framework has been designed
that incorporates various aspects of wound man-
agement, for example Diabetic Foot Ulcers, Man-
agement of Oncology Wounds and Principles of
Wound Care. Modules on Wound Assessment and
Infection are due for completion in early 2007. A
full list of modules is available on the EWMA web
site. All of the modules are available for members
of EWMA through the EWMA office.
Endorsement Process
The project group acknowledged that there are a
large number of existing programmes of educa-
tion on different aspects of wound management
currently available. Many of the groups or organi-
sations who have developed those programmes
expressed an interest in having EWMA endorse-
ment of their programmes. To this end, the
project group developed an endorsement proc-
ess in order to work collaboratively with colleges
36
and universities and other groups or institutions.
EWMA approval for existing wound education
programmes provides a large number of advan-
tages, for example, having the course added to the
EWMA approved course list makes the institution
more visible and thereby improves the marketing
of courses to potential students. Furthermore,
through the endorsement of the speciality wound
healing content of courses, educational excellence
is demonstrated. The interest in this endorsement
process has been enormous, and to date, there are
50 courses approved by EWMA. Further informa-
tion about the endorsement process is available
from the EWMA web site (www.ewma.org).
New developments
The members of the project group have been
aware for some time that health professionals are
seeking alternative approaches to professional
development and have created a unique model
that combines attendance at the annual EWMA
Conference with academic study at a university of
their own choice. This model is called the Univer-
sity Conference Model (UCM) and is headed up
by Madeline Flanagan, past chair of the Educa-
tion Development Project. The module is due to
be piloted at the EWMA meeting in Glasgow in
May 2007. Further information is available from
Madeleine Flanagan at m.flanagan@herts.ac.uk.
Other work underway is a Teach the Teachers
education programme, aimed at standardising the
training of those who teach wound care across
Europe. The project group will continue with the
development of further modules on other aspects
of wound care and the development of an endorse-
ment process for other teaching resources.
The education group are committed to achiev-
ing their project aims and we are grateful to all
those who have worked with us to date. We look
forward to further collaboration from those in-
terested in the work of the group so that together
we may assist in the development of high quality,
easily accessible, wound management education
across Europe. m
EWMA Journal 2007 vol 7 no 1
COPA
Ultra-soft foam wound dressing

Super absorbency
Ultra Softness and superior feel
Maximum protection
Fluid capacity (cc/cm2)
1.5
1.24
1.25

1
0.74
0.75

0.5 0.43

0.25

0
COPA Allevyn Polymem

COPAs fluid capacity outperforms the leading competition

www.copadressing.com
Tyco Healthcare UK Limited - 154 Fareham Road - GOSPORT - HAMPSHIRE
UK - PO13 0AS - Tel: +44 (0) 1329 224 411 - Fax: +44 (0) 1329 224 390

Allevyn is a trademark of Smith & Nephew. Polymem is a trademark of Fleming Medical Limited.
Trademark of Tyco Healthcare Group LP or its affiliate 2006 Tyco Healthcare Group LP. All rights reserved. P-WC-A-Copa/GB
 Evidence,
Consensus and
Driving the Agenda
forward
EWMA2007 GLASGOW
EWMA 2007
2-4 MAY 2007
WWW.EWMA.ORG/EWMA2007

17th Conference of the European Wound Management Association 2-4 May 2007

GLASGOW
United Kingdom

EWMA was founded in 1991 at a conference in From 1999, EWMA decided to have only one
Cardiff with the aim of addressing clinical and main conference every year and as the need for
scientific issues associated with wound healing EWMA to become truly pan-European was
and representeding medical, nursing, scientific evident, the conferences have since then been
and pharmaceutical interests. One of the objec- heldina variety of countries across Europe.
tives of this meeting was to draw on expertise
Over the years, since the last time EWMA was in
from professionals throughout Europe and a
the UK in 1999, it has been a standing wish from
council was formed with members from the UK
many council members to return to UK and now
and mainland Europe, so that EWMA would be
is the time. With the EWMA 2007 Conference
able to have direct links with the wound healing
being held in Glasgow, EWMA is very pleased to
societies in these countries.
be back in the UK, where it all started.
Initially, EWMA had its annual conference in the
The conference is organised in cooperation with
UK, but in 1994, EWMA had its first conference
the Leg Ulcer Forum (LUF), the National Associa-
outside the UK in Copenhagen, Denmark. From
tion of Tissue Viability Nurses (NATVNS),
1994-1998 EWMA maintained its position in the
the Tissue Viability Nurse Association (TVNA)
UK with an annual conference in Harrogate, UK,
and the Tissue Viability Society (TVS).
but also had conferences in different European
countries.

EWMA Conference History

Year City Country Theme
Next conferences
2007 Glasgow United Kingdom Evidence, Consensus and Driving the Agenda forward
2008 Lisbon Portugal
2009 Helsinki Finland

Previous conferences
2006 Prague Czech Republic Innovation, Education, Implementation
2005 Stuttgart Germany From the Laboratory to the Patient:
Future Organisation and Care of Problem Wounds
2003 Pisa Italy Team-work in Wound Care The Art of Healing
2002 Grenada Spain Chronic Wounds and Quality of Life
2001 Dublin Ireland Back to the Future
2000 Stockholm Sweden Advances in Wound Management
1999 Harrogate United Kingdom Taking Wound Care into the 21st Century
1998 Madrid Spain Acute and Chronic Wounds: Is there a Difference?
1998 Harrogate United Kingdom Patient Centred Wound Care
1997 Milano Italy New Approaches to the Advancement of Chronic Wounds
1997 Harrogate United Kingdom Improving Clinical Outcomes through Education
1996 Amsterdam Holland Wound Healing Therapy:
a critique of current practice and opportunities for improvement
1995 Harrogate United Kingdom Advances in Wound Management
1994 Copenhagen Denmark Advances in Wound Management
1993 Harrogate United Kingdom Advances in Wound Management
1992 Harrogate United Kingdom Advances in Wound Management
1991 Cardiff United Kingdom Advances in Wound Management

38 EWMA Journal 2007 vol 7 no 1


The Scottish Exhibition and Conference Centre (SECC) is designed by Norman Foster, who named it the Armadillo.
How did the Thistle
become a National Emblem?
The prickly purple thistle was adopted
as the Emblem of Scotland during
the reign of Alexander III (1249 -1286).
Legend has it that an Army of King Haakon of
Norway, intent on conquering the Scots
landed at the Coast of Largs at night to surprise
the sleeping Scottish Clansmen. In order to
move more stealthily under the cover of
darkness the Norsemen removed their footwear.
As they drew near to the Scots
it wasnt the only thing hiding under
the cover of darkness. One of Haakons men
unfortunately stood on one of these spiny little
defenders and shrieked out in pain, alerting
the Clansmen of the advancing Norsemen.
Needless to say the Scots won the day.
From that day, the thistle has been adopted as
Scotlands National Emblem.
Nowadays, the Thistle is widely used
to signify the Scottishness of
countless products, services, organisations, etc.,
and can be seen everywhere.
www.scotshistoryonline.co.uk/thistle/thistle.html
EWMA Journal 2007 vol 7 no 1
EWMA
The theme of the conference is:
Evidence, Consensus and
Driving the Agenda forward
The venue for the conference is the Scottish Exhibition
and Conference Centre (SECC), which is located on
thebanks of the River Clyde in Glasgow,
There are many good reasons for choosing Glasgow
andthe SECC. Glasgow has been transformed in recent
years and has become one of Europes most cosmo
politan, culturally dynamic and exciting conference
destinations.
As Glasgow is a city in the midst of a cultural and eco-
nomic renaissance, participants at EWMA 2007 will not
only benefit from an interesting scientific programme,
but also from the beautiful city of Glasgow.
The conference venue, the SECC, is Britains largest
integrated exhibition and conference centre, which can
host specialist events for up to 25,000 people. It opened
in 1997 and is designed by Norman Foster, who named
it the Armadillo very appropriate looking at its shape.
Throughout the complex, the style is light and airy,
themood professional and the atmosphere dynamic.
The64acre site is a ten minute walk from Glasgow city
and only 11miles from the citys international airport.
The SECC even has its own railway station, bus termi-
nus and heliport.
The EWMA 2007 Conference Evening will be at the
Glasgow Science Centre. It is located directly opposite
the SECC and with its three landmark titanium-clad
buildings and several exciting attractions, it offers a
variety of exhilarating and unusual experiences.
For more information, please go to:
www.ewma.org/ewma2007 www.secc.co.uk
www.glasgowsciencecentre.org www.seeglasgow.com
39
 Evidence,
Consensus and
Driving the Agenda

EWMA 2007 Abstract Submission

forward
EWMA2007 GLASGOW
2-4 MAY 2007
WWW.EWMA.ORG/EWMA2007

Submit an Abstract Contents of your Abstract

1. To submit an abstract for EWMA 2007 1. Abstracts should briefly and clearly state the
please go to www.ewma.org/ewma2007. purpose, method, results, and conclusion of
Detailed information on how to submit the work:
the abstract will be provided online. Aim: Clearly state the purpose of the abstract
2. If you wish to submit an abstract and have Methods: Describe your selection of observa-
no access to the internet, please contact the tions or experimental subjects clearly.
Conference Secretariat: Results: Present your results in a logical
sequence in text, table and illustrations.
EWMA Business Office
Discussion: Emphasize new and important
Congress Consultants
aspects of the study and conclusions that are
Martensens All 8
drawn from them.
DK-1828 Frederiksberg C
2. All abbreviations must be defined in first use.
Denmark
3. Use generic drug names.
ewma2007@ewma.org
4. Statements such as results will be discussed
Tel: +45 70 20 03 05
or data will be presented cannot be accepted.
Fax: +45 70 20 03 15
5. Papers will not be accepted if previously pre-
For further information, please visit the website: sented at a EWMA meeting unless there is a
www.ewma.org/ewma2007 substantial increase in data.

Practical information Reviewing

1. Abstracts are required for all oral
presentations and posters
2. Abstracts must be submitted in English
3. Abstracts must be submitted before to the conference.
24.00 GMT 15 February 2007
4. The title should be as brief as possible but
long enough to clearly indicate the nature
ofthe study. Write the abstract title in
CAPITAL LETTERS.
No full stop at the end.
5. A blind selection process will be used. submitted abstract, which is believed to violate
No identifying features such as names of au-
thors and hospitals, medical schools, clinics or
cities may be listed in the title or abstract text.
You will be asked to enter the names of au-
thors and their institutions, when you submit
your abstract online.
WWW.EWMA.ORG/EWMA2007
1. The scientific committee will review the
abstract.
2. Notification can be expected two months prior
3. It is the responsibility of all investigators that
all studies are performed with respect to both
national and international legislations and
ethical guidelines both with regards to humans
and animals. The EWMA 2007 Scientific
Committee reserves the right to reject any
these principles.
Conditions
1. The presenting author must register as an
active participant at the Conference. EWMA
2007 reserves the right to not publish any
abstracts that are not followed by a participant
registration a minimum of one month prior to
the conference.
2. Abstracts will be published on the web site and
in the final programme for the conference.
By submitting an abstract you consent to
giving EWMA 2007 permission to publish your
abstract.
3. If you wish to withdraw an abstract, please
contact the Conference Secretariat in writing,
and await confirmation of your withdrawal.

40 EWMA Journal 2007 vol 7 no 1


EWMA 2007 Awards
Poster Prizes
These awards are designed to reward the
considerable work that goes into preparing
aposter for presentation at the conference. when registering for the EWMA Conferences.
To be eligible for consideration you must have
a paper accepted for poster presentation at the
EWMA 2007 conference. Posters that have
been submitted/presented elsewhere are not
eligible for a poster prize. A panel of judges
will attend the poster session, and authors are
strongly encouraged to be present at these
sessions in order to answer questions concern-
ing their work. Thepanel will award 3-5
poster prizes.
Value of poster prizes: The value of each
oster prize will be E 200.
p 75 King William Street, London EC4N 7DT, UK
How to apply: Your accepted poster will
automatically be considered for this award,
provided that it has not previously been
submitted elsewhere.
First Time Presenter Prize
This award is designed to encourage people
who have not previously presented their work
at an international conference. To be eligible
for this prize you must have submitted your
abstract to EWMA and you must be a novice
presenter. That is, you should not have
presented previously at an international
conference. Posters that have been submitted
elsewhere are not eligible for this prize.
A panel of judges will attend the presentation
sessions.
Value of prize: The value of the First Time
Presenter prize will be E 450.
How to apply: Please confirm that you are
applying for this award when submitting your
abstract online. Furthermore, you should send
a letter tothe Scientific Secretariat stating that
this is your first presentation at aninterna-
tional conference, and you should enclose a
letter from your employer/supervisor/manager
confirming that you have not presented previ-
ously at an international conference. m Please return form and enclose cheque to:
EWMA Journal 2007 vol 7 no 1
EWMA
EWMA Membership
Become a member of the European Wound Management
Association and you will receive EWMA position documents
annually and EWMA Journal three times a year.
In addition, you will also have the benefit of obtaining the
membership discount, which is normally 15%,
The most important aspect of becoming a member of EWMA
is the influence this membership can give you. As a EWMA
member you can vote and even stand for election for the
EWMA Council, which will give you direct influence on future
developments within European woundhealing.
Please register as a ewma member at www.ewma.org.
A membership only costs 25 EUR a year.
You can pay by credit card as well as bank transfer.
Existing members of EWMA can also renew their membership online.
EWMA Business Office
Danske Bank, London Cash Management
Account No: 93406336. IBAN: GB69DABA30128193406336
BIC/SWIFT: DABAGB2L. Sort code 301281
EWMA Membership application
Please use CAPITAL letters
Surname:
First name(s):
Profession:
Physician Surgeon Dietician Nurse Pharmacist Other
Work Address:
Address for Correspondence (if different from above):
Tel: Fax:
E-mail:
I enclose a cheque of 25e. Please indicate cheque no.: ___________________________________
Please make cheques payable to: European Wound Management Association
Or: Please debit my account by 25e:
Credit Card type: (Delta, Master Card or Visa). Credit card no:
Expiry Date:
Exact name and initials on the credit card:
_____________________________________
EWMA Business Office, Congress Consultants
Martensens all 8, DK-1828 Frederiksberg C, Denmark
41
 THE LEG ULCER FORUM

The Leg Ulcer Forum (LUF) aims to
support health care professionals who Scotland and the Executive members of
care for people with leg ulcers and
related conditions. The LUF has been in
existence for 13 years and is committed
to facilitating discussion, debate, reflective
practice and the dissemination of new evidence
and research. TheLUF also has a political voice
particularly in relation to DoH and PASA initi-
atives in compression therapies and dressings.
The LUF is equally concerned with the contin-
uing professional development of those new to
leg ulcer management as well as the specialist
practitioner.
The benefits of membership (which costs 15
annually) includes a welcome pack with LUF
resources, mailings of educational material pro-
duced by the LUF and the Wound Care supple-
ments from Nursing Times. In addition you will
be entitled to a discounted delegate fee at LUF
educational events.
The LUF has affiliations in Ireland and
all 3 teams are committed to offering
members support and encouragement to
advance the care of patients and develop-
ment of staff working in this field. Events
this year include a summer conference on the
12th July in the South of England, events and
workshops in Ireland and an August conference
in Scotland. This year we are pleased to be a
co-operating society for the EWMA conference
in may 2007 and look forward to meeting as
many of you as possible there.
Please contact us via our administrative address
if you have any queries and if you are interested
in becoming a member or a commercial spon-
sor.
Irene Anderson (Chair)
legulcer.forum@btopenworld.com
or telephone: 01480 494842
www.legulcerforum.org

17TH CONFERENCE OF THE EUROPEAN WOUND MANAGEMENT ASSOCIATION

Evidence, Consensus and

Driving the Agenda forward
EWMA2007 GLASGOW
2-4 MAY 2007

WWW.EWMA.ORG/EWMA2007

42 EWMA Journal 2007 vol 7 no 1


NATIONAL ASSOCIATION OF
TISSUE VIABILITY NURSES (SCOTLAND)
The National Association of
Tissue Viability Nurses (Scotland)
was established in the early 1990s
bythefirst couple of Tissue Viability
Nurses who were appointed in Scotland. Since
then the number of members has steadily
increased. The group meets four times ayear
and provides an opportunity for members to
network, to share ideas and to discuss ways to
improve patient care. The group is very pro-ac-
tive and have created various documents such as
the Tissue Viability Competency Framework,
Skin Excoriation tool and a Wound Assessment
Chart. All these documents can be downloaded
from our website www.natvns.com
The National Association of Tissue Viability
Nurse Specialists (Scotland) continues to be a
proactive group and the past year has seen our
members involved in several projects.
The work of the wound debridement sub-
group, in collaboration with Stirling University,
has resulted in the first Scottish wound debride-
ment course which will be held in Stirling
University during January 2007.
The wound assessment form will be included in
a development from the Scottish Executive. It is
their intention to publish the form as a clinical
template, which will allow all areas of Scotland
to have access to it.
Work on the mentorship framework is progress-
ing with a sub group working on the implemen-
tation of the competency framework.
Production of the best practice statement on the
treatment of pressure ulcers and review of the
best practice statement on prevention of pres-
sure ulcers.
EWMA Journal 2007 vol 7 no 1
EWMA
The Best Purchasing Initiative has
evolved over the past year into
National Procurement (NP). Our
members are working closely with
National Procurement in relation to specialist
equipment and wound management products.
The next year will be a challenge for the associa-
tion as the work on projects continues. Our
involvement with National Procurement will
include many of our members who will work
tirelessly to ensure the products which are in the
final selection allow clinicians across Scotland
tobe able to choose the care that individual
patients require.
An exciting opportunity has arisen to collabo-
rate with the European Wound Management
Association (EWMA) during the next year to
help organize their conference to be held in
Glasgow in May 2007.
Ultimately the work of the NATVNS is about
establishing and maintaining high standards of
patient care. I am sure our members will contin-
ue to work together to achieve this aim.
Liz McMath, Chair person
(Amended chair persons report)
Committee
Chair Lydia Jack
Vice Chair Anne Ballard Wilson
Secretary Joy Bell
Secretary Fiona Russell
www.natvns.com
43
 TISSUE VIABILITY NURSES
ASSOCIATION
Tissue Viability Nurses (TVNs) in the The TVNA is the only UK association
UK are facing their biggest challenge within wound care that is exclusive to
yet as we move into 2007. The current nurses. Full membership is reserved
UK population is 59.8 million, 16% for registered nurses in post whose
of which are aged 65 years and older, within primary responsibility is the provision of tissue
which the proportion of those aged 85 years and viability services or who have the lead
older is now 12% (Office for National Statistics, responsibility for tissue viability issues within a
2004). Bythe year 2007 there will be more of trust or other care-giving organisation. Associate
the population aged over 65 years than under membership is open to any registered nurse
18 years (NSF Older People, 2006). These sta- with a specialist interest in tissue viability.
tistics no doubt reflect the wider picture within
Europe, although not all countries are as densely The primary objective of the TVNA is to pro-
populated as the UK. vide its members with professional and political
representation by acting as the primary point of
This steep rise in the elderly population is contact for government and other agencies.
accompanied by changes with the NHS with Anincreasingly significant objective is that of
the emphasis of care moving primarily to the promoting the integration of quality assurance
community setting. While this might be logical, into tissue viability and supporting the clinical
many primary care trusts have not yet organised governance agenda.
themselves to be able to accommodate this shift
in care. As a consequence many Tissue Viability Pauline Beldon, Chair TVNA
Nurses (TVNs) are being urged to spread their
pauline.beldon@epsom-sthelier.nhs.uk
service with reduced resources.
www.tvna.org
The Tissue Viability Nurses Association
(TVNA), believes it is time that government
and the Department of Health realised the
extent of the problem and the worth of TVNs.
A submission has been made to the Health Care
Committee in Parliament by Jacqui Fletcher
(TVN, University of Hertfordshire) containing
information gathered from TVNs across the UK
with the aim of raising the governments aware-
ness of the issues involved within the speciality
of Tissue Viability.

44 EWMA Journal 2007 vol 7 no 1


ABOUT
TVS
The Tissue Viability Society (TVS) is
probably the world's oldest society dedi
cated to all tissue viability issues. Formed
in 1981 and a UK registered charity since
1996 the Society attracts members from all
health care professions involved with tissue
viability.
Our mission statement includes our goals
to disseminate information, promote research
and increase awareness of all aspects of good
clinical practice in wound prevention and
management essentially we want to pro-
vide expertise in wound management.
What is tissue viability?
This is a growing speciality that primarily
considers all aspects of skin and soft tissue
wounds including acute surgical wounds,
pressure ulcers and all forms ofleg ulcera-
tion. However tissue viability is not just
wound management for it also covers a
wide range of organisational, political and
socioeconomic issues as well as professional
relationships and education.
The Tissue Viability Society has over 1500
members drawn from the various profes-
sions involved in tissue viability; primarily
nurses but with many doctors, engineers,
scientists, pharmacists, podiatrists and
other professions also represented. There is
a Council elected by members who serve to
guide the strategic direction of the Society
and a Business Office and Professional
Adviser to conduct the day-to-day actions
of the Society.
Please visit www.tvs.org.uk to find out
more details of the Society and its
activities.
EWMA Journal 2007 vol 7 no 1
EWMA
There was considerable
disappointment among
Tissue Viability Society
members and support-
ers that the one-day symposium on wound
inflammation scheduled for late October 2006
had to be cancelled due to the low number of
delegates who booked places! The shortage of
delegates was probably a direct consequence of
the low profile of the meeting where the event
organizers did not reach out to non-TVS mem-
bers. The Trustees of the TVS would like to
thank all those who did book places and espe-
cially note the support given by the companies
who booked exhibition space.
In 2007 there will be no separate Tissue Viabil-
ity Society conference with the TVS partnering
with the European Wound Management Asso-
ciation at the EWMA conference to be held in
early May in Glasgow. The AGM of the TVS
will be held during the Glasgow meeting and
we look forward to welcoming members at the
TVS stand during the EWMA event. There will
be a TVS conference in the spring of 2008 and
future society news will bring details of this
forthcoming event.
The TVS will be issuing monthly updates of its
activities through an electronic newsletter.
Members and non-members alike can sign up to
receive this communication at the TVS web-site
www.tvs.org.uk
Michael Clark
Tissue Viability Society,
1 Lancaster Place,
London WC2E 7HR
tvs@mcmslondon.co.uk
www.tvs.org.uk
45
 EWMA Journal International Journals
Previous Issues
Volume 6, no 2, Fall 2006 The section on International Journals is part of
The number of leg ulcers increases a 20-year-questionnaire
study in Pirkanmaa Health Care in Finland EWMAs attempt to exchange information on
Anna L Hjerppe
wound healing in a broad perspective.
An ex-vivo model to evaluate dressings & drugs for wound healing
Johanna M. Brandner, Pia Houdek, Thomas Quitschau,
Ute Siemann-Harms, Ulrich Ohnemus, Ingo Willhardt, Ingrid Moll
Compression therapy of venous ulcers Italian Acta Vulnologica, vol. 4, no 3, 2006
Hugo Partsch Reconstructive surgery in chronic ulcers of the lower limbs
Seasonal variation of onset of venous leg ulcers with the use of Integra Derma Regeneration Template
Marian Simka Campitiello F., Della Corte A., Fattopace A., Mancone M.
Determinants and estimation of wound healing achievement after Assessment of the use of Prontosan, a detergent solution,
minor amputation in patients with diabetic foot as an adjuvant in the treatment of ulcers
Robert Bm, A. Jirkovsk, V. Fejfarov, J. Skibov, B. Sixta, P. Herdegen Forma O.
Leg ulcer prevalence in the Czech Republic: Efficacy of hyperbaric oxygen therapy in the healing of ulcers
Omnibus survey results 2006 Brustia P., Crespi A., Renghi A., Fassiola A., Villaraggia A.
Zdenek Kucera Vacuum-assisted sternal closure after a depression induced
ischaemic test in a case of severe mediastinitis
Cappuccio G., Patan F., Comoglio C., Zingarelli E.,
Volume 6, no 1, Spring 2006 Sansone F., Ceresa F.
Focus on silver Clinical methodology in wound care. The scientific basis for
Jean-YvesMaillard, Stephen P Denyer the correct local therapy
Som K., Furlini S.
Factors that influence the frequency of rebandaging
Una Adderley
Microengineered hydrogel as a vehicle for grafting
human skin cells English Advances in Skin & Wound Care, vol. 20 January 2007
Stephen Britland, Annie Smith www.aswcjournal.com
Wound Care in Anatolia Certification and Education:
Ali Barutcu Do They Affect Pressure Ulcer Knowledge in Nursing?
Implementation of a Leg Ulcer Strategy in Central & Eastern Europe Karen Zulkowski, Elizabeth A. Ayello, Sharon Wexler
Peter J. Franks The Role of Moisture Balance in Wound Healing
Post Graduate Wound Healing Course Modena, Italy Denis Okan, Kevin Woo, Elizabeth A. Ayello,
Deborah Hofman R. GarySibbald
From The Laboratory to the Patient: Future Organisation and Determining Differential Diagnosis by Practical
Care of Problem Wounds. A New Experience Observation
Finn Gottrup Cynthia A. Fleck
Wound Care Challenges Faced in Iran
Afsaneh Alavi
Update Charge Encounter Sheets and Charge
Volume 5, no 2, Fall 2005
Description Masters
Retrospective analysis of topical application of Kathleen D. Schaum
factor XIII in patients with chronic leg ulcers
The Role of Nutritional Therapy in Palliative Care
Mirjana Ziemer, Claudia Scheumann, Martin Kaatz, Johannes Norgauer
Mary Ellen Posthauer
An overview of surgical site infections:
aetiology, incidence and risk factors
Finn Gottrup, Andrew Melling, Dirk A. Hollander
Regulating research and associated activity in the UK English The International Journal of Lower Extremity Wounds
Sue Bale vol. 5, no 4, 2006
Article Review The effectiveness of a hyperoxygenated fatty http://ijlew.sagepub.com
acid compound in preventing pressure ulcers Achieving Goals in Wound Healing
Joan-Enric Torra i Bou, T. Segovia Gmez, J. Verd Soriano, Raj Mani
A. Nolasco Bonmat, J. Rueda Lpez, M. Arboix i Perejamo
What Price Wound Care?
Article Review Extended commentary on a trial Paul Trueman and John Posnett
E. Andrea Nelson
Role of Hyperbaric Oxygen Therapy in the Management
UK Lymphoedema Framework Project of Lower Extremity Wounds
Philip A. Morgan, Christine J. Moffatt, Debra C. Doherty, Peter J. Franks D. Mathieu
German Wound Surgeons 1450-1750 Do Clinical and Social Factors Predict Quality of Life
Carol Dealey in Leg Ulceration?
Peter J. Franks and Christine J. Moffatt
An Assessment of the Disease Burden of Foot Ulcers
Volume 5, no 1, Spring 2005 in Patients With Diabetes Mellitus Attending a Teaching
Wound Healing and Wound Treatment 2004 the current state Hospital in Lagos, Nigeria
Stephan Coerper A. O. Ogbera, O. Fasanmade, A. E. Ohwovoriole, O. Adediran
Vascularized Bone Replacement for the Treatment of Chronic Thermography and Thermometry in the Assessment of
Bone Defects Initial Results of Microsurgical Solid Matrix Diabetic Neuropathic Foot: A Case for Furthering the
Vascularization Role of Thermal Techniques
Ulrich Kneser M. Bharara, J. E. Cobb, and D. J. Claremont
The Importance of Family and Domiciliary Treatment of Immobile Is There Evidence-Based Guidance for Timing of
Patients with Chronic Wounds Soft Tissue Coverage of Grade III B Tibia Fractures?
F. Petrella Corstiaan C. Breugem and Simon D. Strackee
After TIME: wound bed preparation for pressure ulcers Necrotizing Fasciitis: A Common Problem in Darwin
Marco Romanelli, Madeleine Flanagan Jennifer M. Byrnes
Selected abstracts from 2nd World Union of Wound Healing
Societies meeting

The EWMA Journals can be downloaded free of charge from www.ewma.org

46 EWMA Journal 2007 vol 7 no 1

 EWMA

Spanish Helcos 2006, vol 17, no 4 English Journal of Tissue Viability, Nov 2006, vol. 16 no 4
www.tvs.org.uk/standard.asp?id=104
Legal aspects related to pressure ulcers
J.Javier Soldevilla Agreda, Sonia Navarro Rodriguez Antiseptics, iodine, povidone iodine and traumatic wound
cleansing
Assesment of the satisfaction and effectiveness of the
MN Khan, AH Naqvi
hydrocoloid dressing Sureskin II in the treatment of acute
and chronic wounds Optical assessment of skin blood content and oxygenation
J.C. Modenes ; J.M. Porras; M. Pelet; S. Cmara; E. Jovet; JC Barbanel, F Gibson, F Turnbull
I. Santal; J.L. Palacio The effect of pressure loading on the blood flow rate in
human skin
CH Daly, JE Chimoskey, GA Holloway, D Kennedy
Optimal method for isolation of human peritoneal
mesothelial cells from clinical samples of omentum
M Riera, P McCulloch, L Pazmany, T Jagoe
Finnish Haava, vol. no 4, 2006
www.suomenhaavanhoitoyhdistys.fi
Knowledge of Wound Management in Journals and
Internet English Journal of Wound Care, July issue, vol. 16, no 1, 2007
Helvi Hietanen www.journalofwoundcare.com; jwc@emap.com
Wound Surgery under Unwanted Conditions Economics of pressure-ulcer care: review of the literature
Erkki Tukianen, Virve Koljonen on modern versus traditional dressings
Working in the Kingdom of Saudi Arabia L. San Miguel, J-E. Torra i Bou, J. Verd Soriano
Marja Sirkeinen Dressing remedies: a concept for improving access to and
International Experience of Wound use of dressings in nursing homes
Marianne Olander A. Clarkson
Wound Management in Switzerland Bacterial resistance to silver in wound care and medical
Christina Falk devices
A. Lansdown
Wound Management in England, Ireland and Norway
Minna Tikkanen Our motivation to improve patient care wills us to succeed
A. Brown, H. Middleton, C. Curry, J. Geraghty, C. Rivers
A Survey of Wound Care in Ireland
Zena Moore, Seamus Cowman Venous leg ulcer treatment and practice part 1: the
causes and diagnosis of venous leg ulcers
EWMA, European Wound Management Conference in S. Rajendran, A.J. Rigby, S.C. Anand
Prague
Ansa Iivanainen, Tiina Pukki, Salla Seppnen, Nina Pulkkinen An educational intervention for district nurses:
use of electronic records in leg ulcer management
Pressure Ulcer Know-how in Practice A. Lagerin, G. Nilsson, L. Trnkvist
Tiina Pukki
Role of topical negative pressure in pressure ulcer
Learning Wound Management in France management
Niina Tasaranta A. Mandal
European Pressure Ulcer Advisory Panel ( EPUAP) Use of porcine dermal collagen graft and topical negative
Helvi Hietanen pressure on infected open abdominal wounds
EWMA European Wound Management Association K.S. Jehle, A. Rohatgi, M.K. Baig
Salla Seppnen A review of the effect of tap water versus normal saline on
The Nordic Burn Conference in Kuopio infection rates in acute traumatic wounds
Pivi Mntyvaara, Pivi Virkki S. Hall
Pressure Ulcer Prevention Protocol adult The successful management of a dehisced surgical wound
Marja-Leena Isoaho with TNP following femoropopliteal bypass
Guide for A Novice Visitor in Wound Management A. Dee
Conference
Tiina Pukki

English Touch Briefing: European Dermatology Review

www.touchbriefings.com/cdps/cditem.cfm?nid=2003&cid=5
English International Wound Journal, Dec. 2006, vol. 3, Issue 4
www.blackwellpublishing.com European Dermatology Review 2006 brings together leading
industry experts in each specialized sector within the dermatologi-
Negative-pressure wound therapy: a snapshot of the evidence
cal field, in order to create a market-leading platform to provide
Derick A Mendonca, Remo Papini, Patricia E Price
the most comprehensive information on the latest innovations and
The management of deep sternal wound infections using developments within dermatology.
vacuum assisted closure (V.A.C.) therapy
Tatjana Fleck et al.
Silver dressings: their role in wound management
David J Leaper
Reimbursement of dressings: a WUWHS statement
Luc Tot et al.
Does dermal thermometry predict clinical outcome in diabetic
foot infection? Analysis of data from the SIDESTEP* trial Scandinavian Wounds (SR) vol. 14, no 4, 2006
David G Armstrong, Benjamin A Lipsky, Adam B Polis, www.saar.dk
Murray A Abramson Testing of Sorbion Sachet in the primary sector
In vitro diffusion bed, 3-day repeat challenge 'capacity' test for Susan F. Jrgensen
antimicrobial wound dressings New treatment of dry skin on the diabetic foot
John Greenman, Robin MS Thorn, Saliah Saad, Andrew J Austin Marita Jonsson, Anett Chramer, Jan Apelqvist,
Inflammatory inert poly(ethylene glycol)protein wound dressing Christel Nelson Zimdal
improves healing responses in partial- and full-thickness Amelogenin (Xelma), Norwegian experiences after using it
wounds for 9 years
Kirill I Shingel, Liliana Di Stabile, Jean-Paul Marty, Theis Huldt-Nystrm, Jon Helge Bonesrnning, ystein Vatne,
Marie-Pierre Faure Ada Steen, Nathalie Dufour, Kirsti Espeseth, Runbjrg Buner,
Estimating the risk of pressure ulcer development: Kirsten M Nilsen, Erlend Tolaas, Malene Johnsrud,
is it truly evidence based? Marcus Grgen, Anne Lise Westmo
Catherine A Sharp, Mary-Louise McLaws
Prognosis of stage I pressure ulcers and related factors
Miwa Sato, Hiromi Sanada, Chizuko Konya, Junko Sugama,
Gojiro Nakagami
The potential of microscopic sterile sponge particles to induce
foreign body reaction
Alper Sari, Yavuz Basterzi, Tuba Karabacak, Bahar Tasdelen,
Ferit Demirkan

EWMA Journal 2007 vol 7 no 1 47

 EWMA Corporate Sponsor Contact Data
Corporate A Corporate B

3M Health Care
Morley Street, Loughborough
Coloplast Lohmann & Rauscher LE11 1EP Leicestershire
Holtedam 1-3 P.O. BOX 23 43 Neuwied United Kingdom
DK-3050 Humlebk D-56513 Tel: +44 1509 260 869
Denmark Germany Fax: +44 1 509 613326
Tel: +45 49 11 15 88 Tel: +49 (0) 2634 99-6205 www.mmm.com
Fax: +45 49 11 15 80 Fax: +49 (0) 2634 99-1205
www.coloplast.com www.lohmann-rauscher.com

Activa Healthcare Ltd

1 Lancaster Park
Newborough Road
ConvaTec Europe Needwood
Harrington House Mlnlycke Health Care Ab Burton on Trent
Milton Road Box 13080 Staffordshire
Ickenham, Uxbridge 402 52 Gteborg, DE13 9PD
UB10 8PU Sweden Tel: +44 (0) 8450 606 707
United Kingdom Tel: +46 31 722 30 00 Fax: +44 (0) 1283 576808
Tel: +44 (0) 1895 62 8300 Fax: +46 31 722 34 08 www.activahealthcare.co.uk
Fax: +44 (0) 1895 62 8362 www.molnlycke.com
www.convatec.com

B. Braun Medical
204 avenue du Marchal Juin
Smith & Nephew 92107 Boulogne Billancourt
Ethicon GmbH Po Box 81, Hessle Road France
Johnson & Johnson Wound Management HU3 2BN Hull, Tel: +33 1 41 10 75 66
Oststrae 1 United Kingdom Fax: +33 1 41 10 75 69
22844 Norderstedt Tel: +44 (0) 1482 225 181 www.bbraun.com
Germany Fax: +44 (0) 1482 328 326
Tel: +49 40 52207 230 www.smith-nephew.com
Fax: +49 40 52207 823
www.jnjgateway.com

Comvita UK Ltd
Unit 3, 55-57 Park Royal Road
London NW10 7LP
United Kingdom
Tel: +44 208 961 4410
KCI Europe Holding B.V. Tyco Healthcare
Fax: +44 208 961 9420
Parktoren, 6th floor 154, Fareham Road
www.comvita.co.uk
van Heuven Goedhartlaan 11 PO13 0AS Gosport
1181 LE Amstelveen United Kingdom
The Netherlands. Tel: +44 1329 224479
Tel: +31 - (0) 20 - 426 0000 Fax: +44 1329 224107
Fax: +31 (0)20 426 0097 www.tycohealthcare.com
www.kci-medical.com

48 EWMA Journal 2007 vol 7 no 1

 EWMA

EWMA Position Document 2006

Management of wound infection

The 2006 European Wound Management

Ferris Mfg. Corp. Association (EWMA) position document on
16W300 83rd Street Management of wound infection continues
Burr Ridge, last years exploration of the criteria for wound
Illinois 60527-5848 U.S.A. infection by tackling the complex clinical
Tel: +1 (630) 887-9797 challenges healthcare professionals face when
Toll-Free: +1 (630) 800 765-9636 making decisions about how to treat wound
Fax: +1 (630) 887-1008 infection.
www.polymem.com
With the recent escalating prevalence of
EWMA Position Document bacterial resistance there has been renewed
Editor: Christine Moffatt interest in the use of topical antimicrobials
The document is available particularly silver, iodine, honey and maggot
from www.ewma.org as a therapy. However, injudicious use and the
Paul Hartman AG downloadable pdf. limited clinical evidence to support their use
Paul-Hartmann Strasse For further details contact has led to further problems and controversies.
D-89522 Heidenheim MEP Ltd, 53 Hargrave Road, In producing this position document, EWMA
Germany London N19 5SH. pays particular attention to the appropriate
Tel: +49 (0) 7321 / 36-0 www.mepltd.co.uk use of topical antimicrobials and provides
Fax: +49 (0) 7321 / 36-3636 practical recommendations for clinicians.
www.hartmann.info or
EWMA Business Office, This position document, the fifth in the series,
Congress Consultants, was launched at Prague, 18-20 May 2006.
Martensens All 8, The document comprises four seminal papers:
1828 Frederiksberg, Denmark. An integrated approach to managing
ewma@ewma.org wound infection
Sorbion AG P Vowden and RA Cooper
Tel: +45 7020 0305
Hobackestrae 91 Demystifying silver
Fax: +45 7020 0315
D-45899 Gelsenkirchen J-Y Maillard and SP Denyer
Tel: +49 (0)2 09-95 71 88-0 Topical management of infected grade 3
Fax: +49 (0)2 09-95 71 88-20 and 4 pressure ulcers
www.sorbion.com Z Moore and M Romanelli
Topical antimicrobials and surgical site
infection
A Melling, FK Gould and F Gottrup

Management of wound infection has been

Laboratoires Urgo supported by an unrestricted educational
42 rue de Longvic grant from ConvaTec and is available in
B.P. 157 English, French, German, Italian, Spanish and
21300 Chenve Japanese.
France
Tel: (+33) 3 80 44 70 00 Previous Position Documents:
Fax: (+33) 3 80 44 71 30
www.urgo.com

Use
the EWMA Journal
to profi le your company
Deadline for advertising in the
next issue is 26 March 2007

EWMA Journal 2007 vol 7 no 1 4

 EWMA
EWMA welcomes new Corporate B Sponsors
B. Braun
T F
he B. Braun Group stands for competence in
healthcare. For more than 165 years, the
company has been developing, producing and
distributing products and services for medicine, and it
has developed into a worldwide group of companies.
In2005, almost 31,000 B. Braun employees in 50
countries achieved a turnover of EUR 3.03bn.
The product spectrum ranges from infusion solutions,
injection pumps and accessories for infusion therapy,
intensive medicine and anesthesia to surgical instru-
ments, sterile containers and sutures, hip and knee
endoprostheses, power systems and accessories for extra
corporeal blood treatment and products for wound care
and infection control. The complete range encompasses
more than 160,000 different products.
B. Braun Wound Excellence Center
B. Braun Centers of Excellence in Wound Care.
B.Braun has focused its know-how in wound care
through specialized, dedicated Centers of Excellence
(CoE) and offers a range of products under brand
names likes Askina, Calgitrol Ag and Prontosan.
The wound care centers of excellence have close
relationships with other CoEs, leading to innovative
synergies and development of new products aimed at
bringing significant patient benefits.
The full range of products offered respond to basic
needs for moist treatment, but complex wounds and
non healing wounds require novel approaches for
wound repair. B. Braun is actively involved in providing
better solutions for local care of the wound and thereby
aims at bridging the gap between clinical use and basic
research.
For more information, please go to www.bbraun.com
50
Ferris Mfg. Corp.
erris Mfg. Corp., with head office in Burr Ridge
(Chicago), USA, was founded by Robert W. Ses-
sions, a former director of biomedical research at
Chicagos Rush-Presbyterian St. Lukes Medical Center.
In his craving to add science to the art of wound care
Sessions had realized that traditional therapies discourage,
even inhibit, healing. Responding to this problem, he
began his quest for a truly wound-friendly dressing. After
researching thousands of different formulations, he dis-
covered a drug-free and irritant-free blend that creates an
ideal warm, moist healing environment and in 1988, his
PolyMem formulation was patented and introduced to
the professional wound care market. What was truly
unique with this formulation was that it contained three
wound-friendly components each providing patient
benefits; a cleanser (F68), a moisturizer (glycerol), and a
super- absorber. PolyMem dressings now belong to an
innovative class of adaptable wound care dressings called
QuadraFoam that effectively cleanse, fill, absorb, and
moisten wounds throughout the healing continuum.
Even if Ferris Mfg. Corp. is most known for PolyMem
wound dressings, Sessions is also responsible for numer-
ous other inventions, including: one of the first implant-
able cardiac pacemakers; disposable electrocardiogram
electrodes; a disposable bone marrow aspiration needle;
asuture-less cannula for open heart surgery; the Hunter-
Sessions Vena Cava Occluder (an implant to prevent
blood clots in the lungs); BabySmooth diaper rash pads,
and RhinoPak nasal surgery dressings. Sessions died in
April of 2005 and Ferris Mfg. Corp. is now led by his
nephew, Dr. Roger Sessions.
Due to the work of Bob Sessions, the company has
received numerous awards and recognitions for excellence
in medical product design and contributions to the medi-
cal profession. These awards include the Illinois Gover-
nors Export Award (1998 and 1999), the Medical Device
and Diagnostic Industrys Medical Design Excellence
Awards (2000), the WOCN Case Study Merit Award
(2006), and the Frost & Sullivan 2006 North-American
Product Differentiation Innovation Award. This latest
reward was won for its its most recent line, Shapes by
PolyMem a large range of pre-cut, easy-to-use dressings
that reduce the need to manually cut dressings to size.
For more information, please go to www.polymem.com
EWMA Journal 2007 vol 7 no 1
Conferences

A stimulating and successful conference

for the EPUAP in Berlin
With over 500 delegates and more than 35 speakers,
this conference provided ample opportunity for networking
and to hear about developments in pressure ulcer care.

D
elegates from Europe, the US (boosted by a group. However, the mattresses were associated with lower
delegation from the National Pressure Ulcer overall costs.
Advisory Board Panel, NPUAPD), Australia, Jeannie Donnelly announced the results of a RCT
Japan, Korea and China met together in september 2006 comparing leg elevation with therapy mattresses in the
in Berlin at the ninth European Pressure Ulcer Advisory prevention of pressure ulcers on the heels of people with
Panel (EPUAP) open meeting. fractured hips. She set out to further investigate the theory
The conference theme was Pressure Ulcers: putting that offl oading is an effective measure in preventing heel
knowledge into practice, and included a host of stim- pressure ulcers. All patients with a hip fracture admit-
ulating presentations with topics such as technological ted to the Royal Hospitals Trust, Belfast, were recruited
advances in pressure ulcer prevention, microbiology, the if they had a fractured hip, were aged 65 or over, and
patients experience of living with a leg ulcer, tissue refl ect- gave informed consent. Patients whose fractures had oc-
ance spectroscopy and the development of test methods for curred 48 hours previously or had existing heel damage
support surfaces. Given the large number of presentations were excluded. Patients were randomised to receive one of
it would be impossible to describe them all here, but I two treatment options: heels elevated or heels down. The
would like to focus on a few that caught my eye. primary outcome was development of a grade I or above
pressure ulcer. Assessments were verifi ed by an experienced
Papers tissue viability nurse blinded to the intervention. Patients
Dan Bader highlighted the need for objective monitoring in the control group developed more pressure damage than
to identify at-risk individuals and the conditions, such those in the intervention group. The results were so pro-
as the patient-support interface, that can lead to tissue nounced that the study was stopped half way through on
breakdown. New technologies being developed can image ethical grounds.
the entire soft-tissue composition down to the underlying
bony prominences, evaluate damage at the cellular level Other events
and predict the local mechanical environment within the The EPUAP also announced the formation of the Shear
tissue. Such techniques may have the potential to pro- Force Initiative Group, comprising the EPUAP, the NP-
vide new monitoring systems for practitioners. Dr Bader UAP and the Japanese Pressure Ulcer Society. The group
reminded us that a better understanding of the physiol- has two goals: to identify the clinical signifi cance of shear
ogy of pressure ulceration is the key to prevention and force (and agree on a defi nition), and explore how best
management. to monitor shear. The group fi rst met in Aberdeen at EP-
Jane Nixon reported on the PRESSURE trial: a ran- UAP open meeting 2005, and held a follow-up meeting
domised controlled trial (RCT) that compared alternating in Berlin.
pressure mattresses and overlays in 11 hospitals (including Industry were represented both in the exhibition, and
six NHS trusts). Its objective was to determine whether by sponsored symposia, with KCI supporting a session on
there are any differences between the two, with a primary a holistic approach to pressure ulcer management, Nutricia
end point of the development of a grade 11 or above pres- a symposium on nutrition and healing, Smith & Nephew
sure ulcer. The sample consisted of 1972 patients aged a session on adapting to the complexity in wound manage-
55 or over admitted in the previous 24 hours to vascular, ment, Gaymar one on deep tissue injury and Gerromed
orthopaedic, medical or elderly acute care wards, either one on electrical stimulation in healing.
as acute or elective admissions. Of the sample, 990 were EPUAP will celebrate its tenth anniversary open meet-
randomised to overlays and 982 to mattresses. Intention- ing in Oxford from 30 August to 1 September 2007. m
to-treat analysis found no difference in the proportion Tracy Cowan,
of patients who developed new pressures ulcers in either Deputy Editor/Production Editor, Journal of Wound Care

 EWMA Journal 2007 vol 7 no 1

 We call it QuadraFoam because

Healing-Cleansing-Absorbing-
Moisturising-Comfortable-Easy-
Fast-Acting Dressing just
didnt seem as catchy.

QuadraFoam. The first 4-in-1 dressing formulation.

PolyMem, the only QuadraFoam dressing, simplifies your work and improves
healing by effectively cleansing, filling, absorbing, and moistening wounds
throughout the healing continuum. Finally, a dressing that lives up to its name.

Contact us to receive a complimentary case study along with a set of PolyMem

samples. Find your local distributor at www.PolyMem.eu.

www.PolyMem.eu
PolyMem and QuadraFoam are trademarks of Ferris Mfg. Corp., registered or pending in the US Patent and Trademark
Office and in other countries. 2006 Ferris Mfg. Corp. All rights reserved. 16W300 83rd St., Burr Ridge, IL 60527
MKL-218,0706
6th Scientific Meeting of the The 1st National Wound Care Congress

Diabetic Foot Study Group of WMAT

(of the EASD)
10-13 September 2006, Elsinore, Denmark

F
rom 10 September to 13 September 2006 the
Scientific Meeting of the Diabetic Foot Study
Group (DFSG) of the European Association for
the Study of Diabetes (EASD) took place in Elsinore (close
to Copenhagen), Denmark. The 13th of September was
dedicated to the Diabetic Foot Symposium with the theme
Treatment and Organisation, which was mainly for local
participants and was held in Danish.

The DFSG meeting supports an interdisciplinary col-

laboration between diabetologists, podiatrists, specialist
nurses, orthopaedic and vascular surgeons and all other
specialists with an interest in caring for diabetic patients
with foot problems. Board members of WMAT with EWMA Council members
Finn Gottrup, Sue Bale and Brian Gilchrist.
The main themes of the conference were:
Diabetic foot infection Diagnosis and management

T
Biomechanics of the Diabetic Foot he 1st National Wound Care Congress was
Charcot Osteoarthropathy held 15-18 November 2006 at Silence Beach
Standard and adjunctive therapies Resort Hotel, Side-ANTALYA, Turkey.
Surgical management

Structures of Diabetic Foot Care
Extra sessions covered the following topics:
The Eurodiale project
21st Century Wound Care Making the DFU
disappear (KCI Symposium)
Improving Diabetic Foot Care in the Developing
EWMA council members Sue Bale, Brian Gilchrist
and Finn Gottrup attended this conference and
found that WMAT, the Turkish Wound Management
Association had arranged a very interesting scientific
programme. m

World (Novo Nordisk Symposium) Link to the scientic programme:

www.yarabakimikongresi.com/eng/kongreprogrami.
Future meetings php
The 5th International Symposium on The Diabetic Foot
will be held 9-12 May 2007 in Noordwijkerhout, the
Netherlands. It is a 4-day symposium and the meeting
aims at providing up-to-date information on prevention
and management of the diabetic foot. For more informa-
tion please go to www.diabeticfoot.nl

The next Scientific Meeting of the Diabetic Foot Study

Group (DFSG) of the European Association for the Study
of Diabetes (EASD) will be held in September 2008 in
Pisa, Italy.
For more information please go to www.dfsg.org m

54 EWMA Journal 2007 vol 7 no 1

 Conferences

Conference Calendar
International Conferences Theme 2007
17th Conference of the European Wound Evidence, Consensus and Driving the May 2-4 Glasgow UK
Management Association (EWMA 2007) Agenda forward
EADV 16th Congress European Dermatology and Venereology May 16-20 Vienna Austria
Strong Past, Stronger Future
EPUAP 10th European Meeting Aug/Sep 30-1 Oxford UK
ETRS 17th Annual Meeting Measurements in wound healing the con- Sep 26 -28 Southampton UK
duit between the laboratory and the clinic
ILDS 21st World Congress of Dermatology Global Dermatology for a globalized world Oct 1-5 Buenos Aires Argentina
2008
18th Conference of the European Wound May Lisbon Portugal
Management Association (EWMA 2008)
WUWHS 3rd Congress of the World Union of Jun 4-8 Toronto Canada
Wound Healing Societies
Diabetic Foot Study Group (DFSG) of the EASD Sep Pisa Italy
National Conferences Theme 2007
Finnish Wound Care Meeting Feb 1-2 Helsinki Finland
DGfW 10th Annual Congress Wundbehandlung in der Schrglage?! Mar 9-10 Berlin Germany
Seminar and annual meeting in NIFS Diabetic Foot Mar 15-16 Oslo Norway
17th Annual Meeting of WHS and SAWC Apr/May 28-01 Tampa US
5th international symposium on the Diabetic Foot May 9-12 Noordwijkerhout The Netherlands
SAfW 4th Congress May 24 Morges Switzerland
12th Congress of the ESDaP Jun 14-17 Wroclaw Poland
Wounds UK summerconference Jun 22 Warwickshire UK
SiSS National Congress Sep 24 Sweden
APTFeridas 2007 Congress Nov 7-9 Porto Portugal
Wounds UK Nov

For web link please visit www.ewma.org

17TH CONFERENCE OF THE EUROPEAN WOUND MANAGEMENT ASSOCIATION

Evidence, Consensus and

Driving the Agenda forward
EWMA2007 GLASGOW
2-4 MAY 2007

WWW.EWMA.ORG/EWMA2007
 Activity of the Hungarian Lymphoedema
and Wound Managing Society
HWMS/MSKT Background: In Hungary chronic wound assess-
ment and treatment is carried out by general
Hungarian practitioners, dermatologists and surgeons.
There are no standards of care and there is no
Lymphoedema and consensus within the levels of professional care
Wound Managing providers general practice, hospital, rehabilita-
Society tion, etc. concerning their participation in that
care. The only professional center for the treat-
Prof. Dr. Judit Darczy ment of chronic peripheral lymphoedema in
Hungary is in the department of Dermatology
Department of Dermatology and and Lymphology of the Saint Stephan Hospital,
Lymphology
Saint Stephan Hospital Budapest. In Hungary dermatologists provide
Budapest treatment for chronic lymphoedema. The medi-
H-1096, Nagyvrad tr 1. cal staff of Saint Stephan Hospital has estab-
Tel/Fax: 36-1-280-1368 lished the accepted and published guideline for
complex oedema relief. As skin lesions of lym-
daroczy@istvankorhaz.hu
judit@daroczy.net phoedema patients (especially those with com-
plications) need dermatological care, it seems
to be a good idea to link the care of lymphoe
dema, wounds and dermatological diseases.
Goals:
to acquaint GPs and specialists with the
established standards of care;
to stress the importance of the levels of care
(each patient should receive the appropriate
treatment according to his status) otherwise
the care can be too expensive;
to educate wound care nurses and establish
provision of a recognized training pro-
gramme with diploma;
to establish provision of information and
support for patients and their relatives;
to establish a specialized nursing unit for
chronic wound treatment.
In 2007 basic changes will happen because of
the reform of the national healthcare system
inHungary. Parallel to the diminution of the
number of active hospital beds the number of
rehabilitation and chronic beds will increase.
With this in mind, the Hungarian Wound Man-
aging Society (MSKT) submitted an application
for a specialized nursing unit for chronic wound
treatment with 40 beds that could be set up in
Saint Stephan Hospital.
Methods and activities:
1. Every year the Hungarian Wound Managing
Society (MSKT) organizes a congress on a cur-
rent topic. In 2006 the topic was the guideline
of chronic wound treatment. This guideline was
handed in to the Ministry of Health. We also
discussed the competency and training of
wound care nurses.
56
2. Involvement of nursing directors: In Hungary
there are no centers for wound treatment; care
of chronic wounds is performed in dermatology
and surgery outpatient clinics and departments.
For this reason, wound care presents a problem
for those hospital departments (internal medi-
cine, diabetology, gastroenterological surgery)
where patients with chronic wounds are usually
treated. In 2006 we organized a national meet-
ing for the nursing directors of hospitals and the
decision was made that the training of nurses
inwound treatment will be supplemented and
supported with a license exam.
3. Institute of Nursing Postgraduate Diploma:
Twice a year we organize a 54-hour long
training programme for nurses in chronic
wound treatment incorporating both theory
andpractice. Until now this training did not
give a license for the nurses to work independ-
ently (only a diploma).
4. Nurses working in chronic wound treatment
would need a license to be able to independ-
ently treat patients referred to the communal
centers by doctors. To address this, the first half
of 2007 is to be spent defining the competen-
cies of the nurses role. This is going to be done
in cooperation with representatives of different
specialties: surgery, infectology, hygiene, diabe-
tology, traumatology, dermatology, internal
medicine, angiology, and vascular surgery to
ensure an all disciplines approach to wound
care.
5. Specialized nursing unit for chronic wound
treatment: we have started to establish the op-
erational conditions and the quality assurances
required for the activity/operation of a special-
ized nursing unit. Within the healthcare reform
programme, the opening of the unit is planned
for the second half of 2007.
Summary and problems:
1. The guideline for chronic wound treatment
appropriate for the Hungarian healthcare, hos-
pital and insurance system has been accepted
by a professional board and has been officially
published.
2. The guideline has to be accepted by other
medical specialties and the drain on the
resources of the other levels of care has to
bemonitored.
3. The treatment of lymphoedema and chronic
wounds has to be integrated with the dermato-
logical care system.
4. For training and education we need financial
support.
EWMA Journal 2007 vol 7 no 1

SEBINKO
Hungarian
Association for the
Improvement of Care
of Chronic Wounds
and Incontinentia
Dr. Maria Hok
Independent consultant
Nursing education,
Nursing research,
Nursing management and
Quality of Nursing Care
Hungary
Budapest 1085
Maria Street 5.
SEBINKO Association Hungary
hokmaria42@t-online.hu
www.sebinko.hu
In Glasgow 2007
at the EWMA
Evidence, Consensus
and Driving the Agenda
Congress, we hope that by
sharing our experiences
we will learn a lot of
interesting information
and will be able to count
this congress as one of
our great moments to
come.
EWMA Journal 2007 vol 7 no 1
Moments = Years
The Life Of The 10 Year Old Hungarian SEBINKO Association
The Hungarian SEBINKO Association was
e stablished in 1996 to improve the care of in-
continent people and patients with chronic or
problem wounds. At the beginning its mem-
bers were nurses, today it includes doctors and
whole institutions amongst its members.
In the first years the main challenges were
those of finding the way forward; we used the
first three years to establish the aims and the
mission of our organisation, and to ensure our
values became known and accepted.
Our mission statement is as follows:
The aim of the SEBINKO Association is to
develop a wide scope, nationwide co-operation
and consensus in the fields of chronic wound
prevention and treatment and the improve-
ment of the treatment of incontinence.
This we support by developing, teaching and
training scientific methods.
We are striving to reach our goals by con-
tinuous information flow through the SEBINKO
publications, conferences, correspondence,
training programmes, tenders etc. We are
achieving our goals through wide-scale co
operation and support from professional care
givers including doctors, nurses, scientists and
the medical industry who work in the field of
chronic wounds and incontinence.
We support the wound treatment and in-
continence treatment programmes developed
by medical institutes and the development of
responsible, reliable nursing care in the fields
of wound treatment and healing. We place
special emphasis on the importance of unified
documentation and data processing and the
training of institutional coordinators for decubi-
tus and incontinence.
Our association is actively supporting the
following values of professional help and care:
preservation or reestablishment of the self-
care of the patients,
security
minimising pain,
infection-free surroundings,
cost effectiveness in wound treatment.
Since 1999, when these values were intro-
duced at our first consensus conference, these
values have also been supported by our associ-
ates.
A big moment for us was in 2003 when we
accepted, by consensus, the management
principles of the client-oriented wound treat-
ment process. At the heart of this consensus
were unified documentation, data collection
and processing, with an emphasis on decubitus.
Organisations
The most important details of the consensus
were the competencies of the members of the
multidisciplinary team, the details and docu-
mentation of the continuous wound, and pa-
tient observation. In 2006 these were accept-
ed by the National Health Financial Institute
and made compulsory another three years
and another great moment for us!
Of the resources necessary for effective wound
treatment, we find evidence, knowledge and
use of different techniques, and product infor-
mation and presentation by medical industry
sales people as important as the training of
the wound treatment team, the patients, their
relatives and their involvement in the treat-
ment. Not forgetting treatment cost-effective-
ness.
Since 2003 we have built a strong relationship
with the founders and acceptors of the nation-
wide consensus. Amongst them one can find
professional politicians, members of Parlia-
ment, members of medical and nursing col-
leges, leaders of professional and civil organi-
sations, health industry organisations, universi-
ties, practitioners and practicing teams.
Of our Big Moments we mustnt forget our
annual conferences that take place in October
every year. At our 10th Anniversary Confer-
ence in 2006 we identified The development
of clinical validity and best practices require-
ments as the professional task facing our
members and us for the following year. In this
the most important areas will be the develop-
ment of everyday best practice, continuous
evaluation, renewal of nursing research meth-
ods, and the development of training and evi-
dence research. All the details of this work
may take up to three years each before they
also become some of our Big Moments!
One of the greatest moments came in 2006
with the acceptance of our organisation in to
the cooperating bodies of EWMA. We believe
that our organisation, upon developing its
solid national base, will be able to share our
experiences and learn from the international
experience offered by EWMA.
Based on the above it is understandable that,
for us, the 2006 EWMA Congress: Innovation,
Education, Implementation was very impor-
tant, and, therefore, it was also one of our
great moments.
57
 Co-operating Organisations

ABUSCEP FWCS
Wound Management Finnish Wound Care Society
Association in Belgium www.suomenhaavanhoitoyhdistys.fi

AISLeC GAIF
Associazione Infermieristica
Grupo Associativo de
per lo Studio Lesioni Cutanee
Investigaco em Feridas
Italian Nurse Association for
www.gaif.net
the Study of Cutaneous
Wounds GNEAUPP
www.aislec.it Grupo Nacional para el
Estudio y Asesoramiente en
AIUC Ulceras por Presin y Heridas
Associazione Italiana
Crnicas
Ulcere Cutanee.
www.gneaupp.org
Italian Association for
Cutaneous Ulcers GWMA
www.aiuc.it Greek Wound Management
Association
APTFeridas
Portuguese Wound HWMS/MSKT
Management Association Hungarian Lymphoedema
www.aptferidas.com and Wound Managing
Society
AWA
Austrian Wound Association
www.a-w-a.at IWHS
Iceland Wound Healing
Society
CNC/BFW www.sums-is.org
Wound Management
Organisation LBAA
www.befewo.org Latvian Wound Treating
www.wondzorg.be Organisation

CSLR
Czech Wound Management LF
Society Lymphoedema Framework
www.cslr.cz www.lymphoedemaframe-
work.org
DGfW
Deutsche Gesellschaft fr LSN
Wundheilung The Lymphoedema Support
www.dgfw.de Network
www.lymphoedema.org/lsn
Danish Wound
DWHS
Healing Society Danish Wound Healing LUF
Society The Leg Ulcer Forum
www.dsfs.org www.legulcerforum.org

LWMS
Lithuanian Wound
Management Society

58 EWMA Journal 2007 vol 7 no 1

 Organisations

NATVNS TVNA
National Association of Tissue Viability Nurses
Viability Nurse Specialists Association
(Scotland) www.tvna.org
www.natvns.com
TVS
NIFS Tissue Viability Society
Norwegian Wound Healing www.tvs.org.uk
Association
www.nifs-saar.no WMAI
Wound Management
NOVW Association of Ireland
Dutch Organisation of www.wmaoi.org
Wound Care Nurses
www.novw.org WMAS
Slovenian Wound
PWMA Management Association
Polish Wound Management
Association
WMAT
QN Wound Management
Qualitts Netzwerk Association Turkey

ROWMA
Romanian Wound
Management Association

SAfW
Swiss Association for
Wound Care
www.safw.ch

SEBINKO Present your national

Hungarian Association for
wound management
the Improvement of Care of
Chronic Wounds and organisation
Incontinentia or write a report about
www.sebinko.hu your organisations
SFFPC latest meeting.
La Socit Franaise et
Francophone de Plaies et ewma@ewma.org
Cicatrisations
www.sffpc.org

SISS Deadline
Swedish Wound Care Nurses
for incoming material for
Association
www.sarsjukskoterskor.se the next issue is
15 March 2007.
SWHS
Svenskt Srlkningssllskap
www.sarlakning.com

EWMA Journal 2007 vol 7 no 1 59

 3 Editorial
Carol Dealey

Scientific Articles
5 Self-care activities of venous leg ulcer
patients in Finland
Salla Seppnen
17 Smoking is not contra-indicated in maggot
debridement therapy in the chronic wound
Pascal Steenvoorde
23 Effectiveness of non-alcohol film forming skin
protector on the skins isles inside the ulcers
and the healing rate of venous leg ulcers
Tanja Planinsek Rucigaj
26 Wound measurement:
the contribution to practice
Georgina T. Gethin
31 Improving education in wound care: crossing
he boundaries of interprofessional learning
Caroline McIntosh
32 Waterjet debridement of deep and
indeterminate depth thermal injuries
Mayer Tenenhaus

EBWM
34 Abstracts of recent Cochrane reviews
Sally Bell-Syer

EWMA
35 Brian Gilchrist: thank you
Peter J Franks
36 EWMA Education Development Project:
what is it and what does it do?
Zena Moore
38 EWMA 2007 Glasgow, United Kingdom
40 EWMA 2007 Abstract Submission
41 EWMA 2007 Awards
42 LUF, The Leg Ulcer Forum
43 National Association of Tissue Viability
Nurses (Scotland)
44 TVNA, Tissue Viability Nurses Association
45 TVS, Tissue Viability Society
46 EWMA Journal previous issues
46 International Journals
48 EWMA Corporate Sponsors Contact Data
50 EWMA welcomes new Corporate B Sponsors
Conferences
52 EPUAP conference in Berlin, 2006
54 6th scientific meeting of the DFSG
54 The 1st national congress of WMAT
55 Conference calendar
Organisations
56 HWMS/MSKT, Hungarian Lymphoedema
and Wound Managing Society
57 The hungarian SEBINKO association
58 Co-operating organisations