- Email: [email protected]
Recent new products or product changes
PRODUCT NEWS
Recent additions to the Drug Tariff MONTH
PRODUCT
SIZE(S)
PRICE (£) (MAR 05)
Jan 2005
Vacuskin
6 x 7cm 10 x 12cm 10 x 12cm 15 x 20cm
0.40 1.06 2.06 2.19
Jan 2005
Urgotul
10 x 12cm
2.86
Jan 2005
Activa Leg Ulcer Hosiery Kit - Medical Stocking & Compression Liner (1 stocking, 2 liners) - Liner Pack (3 liners)
19.99 14.99
Feb 2005
Tegaderm + Pad
5 9 9 9 9 9
Feb 2005
Tegasorb Sacral
17.1 x 16.1cm
4.59
Feb 2005
Versiva Oval
11 x 19cm
4.00
Feb 2005
Vacunet - square - rectangular
10 x 10cm 10 x 15cm
1.93 2.86
Feb 2005
Cadesorb
20g
7.98
Feb 2005
Contreet Foam - Heel - Sacral
19 x 20cm 23 x 23cm
15.95 16.95
Ulcertec - Short - Long
(small, medium or large) (small, medium or large)
27.10 27.10
Mar 2005
Neosport
15cm
1.22
Mar 2005
Medisafe
6 8 8 9 9 9
0.12 0.13 0.23 0.29 0.34 0.36
Mar 2005
C-View
12 x 12cm
1.18
Mar 2005
Catrix
19
3.80
Mar 2005
ActivHeal (with adhesive border)
20 x 20cm
4.34
Mar 2005
ActivHeal (without adhesive border)
5 x 5cm 20 x 20cm
0.72 3.78
Mar 2005
Contreet Foam (without adhesive border) - square - rectangular - circular
20 x 20cm 10 x 20cm 5cm diameter.
19.95 12.95 2.95
1.25cm 2.5cm 5cm 7.5cm
0.52 0.86 1.64 2.40
Feb 2005
Mar 2005
VOL 15 NO.2 MAY 2005
Scanpor
x x x x x x
x x x x x x
7cm 10cm 15cm 20cm 25cm 35cm
8cm 10cm 12cm 15cm 20cm 25cm
0.24 0.60 0.88 1.29 1.45 2.45
31
PRODUCT NEWS
Recent new products or product changes ACT/VA LEG ULCER HOSIERY KIT (Activa Healthcare)
• A venous ulcer compression system similar to Jobst Ulcer Care, SurePress Comfort Pro Graduated Compression System and Ulcertec • Available in small, medium, large, extra large and extra extra large packs • Medical stocking and compression liner (pack contains one stocking and two liners) • Liner pack (pack contains three liners)
• Apply powder evenly on the entire wound surface • Re-apply as needed, usually one or two times weekly (additional applications if needed) • For difficult to reach areas, powder can be mixed with glycerin (2-5ml) or saline solution (4-1 Oml) to form a paste • Due to its natural origin, the powder completely degrades within seven days (or powder can be removed by irrigation) • Do not use in patients with known adverse reactions to bovine products • Available in sachets of Ig
APPEEL (CliniMed)
• • • •
A no-sting medical adhesive remover There is no need to wash the area after use Contains moisturiser to care for the skin Available on prescription as aerosol and wipes
CONTREET FOAM (Coloplast)
• A silver impregnated polyurethane foam film dressing with an adhesive border • Used for medium to heavily exuding chronic wounds • Available in heel and sacral dressings
CADESORB (S & N)
• A sterile protease modulating matrix similar to Promogran • Consists of a matrix of cross-linked starch • Suitable for all chronic wounds healing by secondary intent that are clear of necrotic tissue and infection • When present in appropriate concentrations, proteases promote cell migration and activate growth factors • Normally, protease levels rise in response to wounding then decrease in acute wounds. Sometimes levels remain elevated in chronic wounds and this prolongs inflammation and reduces fibroblast proliferation. Lowering the acidity of the wound to around pHS dramatically reduces protease activity • Cadesorb lowers the pH of the wound environment by ion exchange - the reduced pH inhibits protease activity without causing permanent protease deactivation • Promotes slough removal and is absorbent • Can be applied via a sterile dressing or directly to the wound • Ointment should be changed at least every three days • Can be removed by irrigation with saline or sterile water • The starch based polymer is biodegradable so any residual ointment will be naturally broken down over time CATRIX (Valeant Pharmaceuticals Ltd)
• Sterile, micronised, collagen wound healing powder • Contains approximately 73.5% protein, 18.1 % carbohydrate, 4.9% other cartilage components, 3.3% inert material and 0.2% lipids • Used on chronic wounds of more than six weeks duration or those likely to be difficult to heal • Stimulates the formation of granulation tissue • Each gramme of the powder can absorb approximately 3-4ml fluid
DERMASURE (ADI Medical Ltd)
• A wound management pouch capable of adhering to the skin • Consists of a wafer of hydrocolloid material and an integral collection system • Used to collect exudate from large wounds, fistulae or sinuses • Inlet and outlet ports allow fluid instillation and remote drainage • The wound area can be accessed for cleaning and dressing using a large zip-lock access window running the length of the pouch • Available in small, medium, large and starter packs • The small and medium sizes are available on prescription EpiFLOSD (Ogenix Corporation USA)
• A small disposable oxygen concentrator weighing 57g and a long sterile cannula (tube) • Extracts pure oxygen from ambient air and delivers transdermal oxygen through the cannula directly to the wound site, using a standard occlusive dressing to blanket the wound • Patient can be treated 24 hours per day for seven days while continuing with normal daily activities • Has received FDA approval JOBST ULCER CARE (BSN Medical Ltd)
• A venous ulcer compression system similar to Activa Leg Ulcer Hosiery Kit, SurePress Comfort Pro Graduated Compression System and Ulcertec • Available in small, medium, large and extra large packs • Medical stocking and compression liner (pack contains one stocking and one liner) • Compression liner pack (pack contains three liners)
© 2005 Tissue Viability Society 32
VOL 15 NO.2 MAY 2005
MAGNO-PULSE LEG-WRAP (Magnopulse Ltd.)
TEGASORB SACRAL (3M)
• A drug-free magnetic leg-wrap that improves circulation in the leg, from the foot to the hip • The small, powerful, therapeutic magnets are designed and positioned to work in harmony with the body to improve blood flow • To achieve maximum benefit, should be worn as often as possible (including overnight) • Cost is £29 + £3 p+p
• A hydrocolloid dressing with adhesive border similar to Hydrocoll Border and Ultec Pro
MEDISAFE
• Absorbent, perforated dressing with adhesive border similar to Cosmopor E, Mepore and Primapore
ULCERTEC (Bauerfeind UK)
• A venous ulcer compression system similar to Activa Leg Ulcer Hosiery Kit, Jobst UlcerCare and SurePress Comfort Pro Graduated Compression System • A medical stocking and compression liner (pack contains one stocking and two liners) available as: • Short (small, medium, large) • Long (small, medium, large) VACUNET (Shiloh Healthcare)
NEOSPORT (Neomedic)
• Cotton, Polyamide and Elastane Bandage • All bandages are not less than 4.5m in length when fully stretched • Used for support or compression
• A hydrogel-coated polyester weave non-adherent contact dressing without adhesive border • Used on low exuding wounds • Requires a secondary dressing that can be changed without disturbing the non-adherent contact layer
SCANPOR
VACUSKIN (Shiloh Healthcare)
• Permeable non-woven synthetic adhesive tape similar to Micropore
• A vapour-permeable adhesive film dressing
SKINLINK (Advanced Medical Solutions)
Healthcare)
• • • •
• • • • •
VACUTEX ADVANCED WOUND CARE SYSTEM (Shiloh
• • •
• • •
Non-invasive wound closure product consisting of: Perforated wound strips (hypoallergenic adhesive) N-butyl cyanoacrylate anchoring adhesive Intended for use in A&E departments and operating theatres For larger traumatic topical wounds, wounds under tension/stress and wounds over joints For wounds not appropriate for glue closure Strips are placed across the wound ensuring that the wound is central to the strips; the adhesive is applied to the holes in the strip allowing 15 seconds to set and two minutes to dry Stronger than sutures and strips No need for clinical removal - can be removed using acetone wipes Available as large and small skin strip formats
Consists of: Vacunet - wound contact layer Vacutex - rapid capillary action wound dressing Vacuskin - semi-occlusive film dressing Vacutex can be placed directly onto the wound bed of moderate and highly exuding wounds • Vacunet should be used on low exuding wounds VENOUS ULCER COMPRESSION SYSTEMS
• See Activa Leg Ulcer Hosiery Kit, Jobst Ulcer Care and SurePress Comfort Pro Graduated Compression System • Available in a variety of different size packs VERSIVA (ConvaTec)
• A hydrocolloid dressing with an adhesive border similar to Alione and CombiDERM
SUREPRESS COMFORT PRO GRADUATED COMPRESSION SYSTEM (ConvaTec Ltd)
WOUND DRAINAGE POUCHES
• A venous ulcer compression system similar to Activa Leg Ulcer Hosiery Kit, Jobst Ulcer Care and Ulcertec • Available in pack sizes A to E, each containing one stocking and one liner
• See Biotrol Draina S Fistula (Biotrol), Convatec Wound Manager (Convatec), Dermasure (ADI Medical Ltd), Oakmed Option Wound Manager (Oakmed) • The Wound Manager products are wound drainage pouches - ConvaTec for high volumes of exudate and Oakmed for low volumes.
TEGADERM
+ PAD (3M)
• A vapour-permeable adhesive film dressing with absorbent pad similar to Alldress, Mepore Ultra and Opsite Plus • Combines the features of Tegaderm dressing with an absorbent pad to form an island dressing (contact pad plus border)
VOL 15 NO.2 MAY 2005
Other wound care news ALLEWN PLUS CAVITY: the 1.5 x 20cm cavity dressing has
been deleted from the February Drug Tariff.
33
PRODUCT NEWS
BIOLOGICAL DRESSINGS AND CONSENT: In a survey of attitudes towards the use of biological dressings, concerns included unwillingness to use products obtained by cruelty or deliberately killing animals (Methodists, Buddhists); a ban on pig products unless there was no other alternative (Muslim); and unacceptability of products derived from human prepuce (Quakers). All considered that fully informed consent was essential'.
WOUND CARE (modern and conventional): In a hospital survey in Switzerland comparing 1998 and 2003 practice, in 86% of all treatments a modern wound care procedure theoretically costs 20% of a traditional one. More modern dressings are being used. Traditional procedures relying on frequently changing wound dressings using ointments, enzymes and antibiotics/disinfectants are becoming more and more obsolete 9 •
FOOT ULCERS AND DIABETES: Substantial evidence supports screening all patients with diabetes to identify those at risk for foot ulceration. These patients might benefit from certain prophylactic interventions, including patient education, prescription footwear, intensive podiatric care, and evaluation for surgical interventions'.
Further dressings information can be found in the 9th edition (September 2004) of the FonnulalY of Wound Management Products, written by David Morgan arid available for £9.95 (including P+p) from: Euromed Communications Ltd, The Old Surgery, Liphook Road, Haslemere, Surrey Gun INL (Tel: 01428 656665). Updates to this edition are regularly posted on the Euromed website at: www.euromed.uk.com/formulary.
HYPERBARIC OXYGEN THERAPY: A recent Cochrane review concluded that there was not sufficient evidence to support or refute the effectiveness of hyperbaric oxygen therapy for the management of thermal burns'. MAGGOTS: The University of York is looking for 600 leg ulcer sufferers to test the effectiveness of maggots. The £750,000 trial will compare the clinical and costeffectiveness of larval therapy with conventional hydrogel treatment as well as the effect on patients' quality of life over a period of one year (BBC News, 11 January 2005)'. SCARS: The causes of and treatment options for abnormal scar tissueS. SKIN GRAFTS: Their definition, use and care of donor sites are described in a recent publication from the Wound Care Society6. SKIN GRAFTS: A meta-analysis of clinical efficacy and a review of cost-effectiveness of artificial skin grafts in chronic wound care reported: • More frequent and rapid healing of chronic diabetic foot ulcers compared with standard therapy • Same benefit of wound healing is not seen in venous leg ulcers • No significant effect on adverse events such as infection, cellulitis and osteomyelitis • Increased costs in the short term. By one year there may be net cost savings'. WOUND BED PREPARATION: Proteolytic activity is sensitive to the environmental pH. Decreasing the pH level could thus be a simple and effective way of reducing protease activity and promoting healing, although clinical studies are needed to test this hypothesis8 (see Cadesorb above).
34
Information on new products or changes to existing products should be sent to: David Morgan Consultant in Pharmaceutical Public Health National Public Health Service for Wales, Preswylfa, Hendy Road, Mold, Flintshire CH7 IPZ. email: [email protected]
References 1. Enoch S, Shaaban H, Dunn KW. Informed consent should be obtained from patients to use products (skin substitutes) and dressings containing biological material. loumal 0/ Medical Ethics 2005 31: 2-6. 2. Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. lAMA 2005 293: 217-28. 3. Villanueva E, Bennett MH, Wasiak J, Lehm JP. Hyperbaric oxygen therapy for thermal burns. The Cochmne Database 0/ Systematic Reviews 2004 Issue 2. 4. http://news.bbc.co.uk! 5. Beldon P. The use of skin grafts in wound management. Educational leaflet. 2004 Hartford, Huntingdon: The Wound Care Society. 6. Smith FR. Causes of and treatment options for abnormal scar tissue. lournal a/Wound Care 2005 14: 49-52. 7. Ho C, Tran K, Hux M, Sibbald G, Campbell K. Artificial skin grafts in chronic wound care: a meta-analysis of clinical efficacy and a review of cost-effectiveness (Technology report no 52). 2005 Ottawa: Canadian Coordinating Office for Health Technology Assessment. 8. Greener B, Hughes AA, Bannister NP, Douglass 1. Proteases and pH in chronic wounds. loumal a/Wound Care 2005 14: 59-61. 9. Jenzer H, Bastos Bettencourt Al, Maillard S. Modern wound care is cost-effective and amounts to merely 20% of conventional wound care cost. European loumal Hospital Pharmacy 2004 10(4): 48-55.
VOL 15 NO.2 MAY 2005
Recent additions to the Drug Tariff MONTH
PRODUCT
SIZE(S)
PRICE (£) (MAR 05)
Jan 2005
Vacuskin
6 x 7cm 10 x 12cm 10 x 12cm 15 x 20cm
0.40 1.06 2.06 2.19
Jan 2005
Urgotul
10 x 12cm
2.86
Jan 2005
Activa Leg Ulcer Hosiery Kit - Medical Stocking & Compression Liner (1 stocking, 2 liners) - Liner Pack (3 liners)
19.99 14.99
Feb 2005
Tegaderm + Pad
5 9 9 9 9 9
Feb 2005
Tegasorb Sacral
17.1 x 16.1cm
4.59
Feb 2005
Versiva Oval
11 x 19cm
4.00
Feb 2005
Vacunet - square - rectangular
10 x 10cm 10 x 15cm
1.93 2.86
Feb 2005
Cadesorb
20g
7.98
Feb 2005
Contreet Foam - Heel - Sacral
19 x 20cm 23 x 23cm
15.95 16.95
Ulcertec - Short - Long
(small, medium or large) (small, medium or large)
27.10 27.10
Mar 2005
Neosport
15cm
1.22
Mar 2005
Medisafe
6 8 8 9 9 9
0.12 0.13 0.23 0.29 0.34 0.36
Mar 2005
C-View
12 x 12cm
1.18
Mar 2005
Catrix
19
3.80
Mar 2005
ActivHeal (with adhesive border)
20 x 20cm
4.34
Mar 2005
ActivHeal (without adhesive border)
5 x 5cm 20 x 20cm
0.72 3.78
Mar 2005
Contreet Foam (without adhesive border) - square - rectangular - circular
20 x 20cm 10 x 20cm 5cm diameter.
19.95 12.95 2.95
1.25cm 2.5cm 5cm 7.5cm
0.52 0.86 1.64 2.40
Feb 2005
Mar 2005
VOL 15 NO.2 MAY 2005
Scanpor
x x x x x x
x x x x x x
7cm 10cm 15cm 20cm 25cm 35cm
8cm 10cm 12cm 15cm 20cm 25cm
0.24 0.60 0.88 1.29 1.45 2.45
31
PRODUCT NEWS
Recent new products or product changes ACT/VA LEG ULCER HOSIERY KIT (Activa Healthcare)
• A venous ulcer compression system similar to Jobst Ulcer Care, SurePress Comfort Pro Graduated Compression System and Ulcertec • Available in small, medium, large, extra large and extra extra large packs • Medical stocking and compression liner (pack contains one stocking and two liners) • Liner pack (pack contains three liners)
• Apply powder evenly on the entire wound surface • Re-apply as needed, usually one or two times weekly (additional applications if needed) • For difficult to reach areas, powder can be mixed with glycerin (2-5ml) or saline solution (4-1 Oml) to form a paste • Due to its natural origin, the powder completely degrades within seven days (or powder can be removed by irrigation) • Do not use in patients with known adverse reactions to bovine products • Available in sachets of Ig
APPEEL (CliniMed)
• • • •
A no-sting medical adhesive remover There is no need to wash the area after use Contains moisturiser to care for the skin Available on prescription as aerosol and wipes
CONTREET FOAM (Coloplast)
• A silver impregnated polyurethane foam film dressing with an adhesive border • Used for medium to heavily exuding chronic wounds • Available in heel and sacral dressings
CADESORB (S & N)
• A sterile protease modulating matrix similar to Promogran • Consists of a matrix of cross-linked starch • Suitable for all chronic wounds healing by secondary intent that are clear of necrotic tissue and infection • When present in appropriate concentrations, proteases promote cell migration and activate growth factors • Normally, protease levels rise in response to wounding then decrease in acute wounds. Sometimes levels remain elevated in chronic wounds and this prolongs inflammation and reduces fibroblast proliferation. Lowering the acidity of the wound to around pHS dramatically reduces protease activity • Cadesorb lowers the pH of the wound environment by ion exchange - the reduced pH inhibits protease activity without causing permanent protease deactivation • Promotes slough removal and is absorbent • Can be applied via a sterile dressing or directly to the wound • Ointment should be changed at least every three days • Can be removed by irrigation with saline or sterile water • The starch based polymer is biodegradable so any residual ointment will be naturally broken down over time CATRIX (Valeant Pharmaceuticals Ltd)
• Sterile, micronised, collagen wound healing powder • Contains approximately 73.5% protein, 18.1 % carbohydrate, 4.9% other cartilage components, 3.3% inert material and 0.2% lipids • Used on chronic wounds of more than six weeks duration or those likely to be difficult to heal • Stimulates the formation of granulation tissue • Each gramme of the powder can absorb approximately 3-4ml fluid
DERMASURE (ADI Medical Ltd)
• A wound management pouch capable of adhering to the skin • Consists of a wafer of hydrocolloid material and an integral collection system • Used to collect exudate from large wounds, fistulae or sinuses • Inlet and outlet ports allow fluid instillation and remote drainage • The wound area can be accessed for cleaning and dressing using a large zip-lock access window running the length of the pouch • Available in small, medium, large and starter packs • The small and medium sizes are available on prescription EpiFLOSD (Ogenix Corporation USA)
• A small disposable oxygen concentrator weighing 57g and a long sterile cannula (tube) • Extracts pure oxygen from ambient air and delivers transdermal oxygen through the cannula directly to the wound site, using a standard occlusive dressing to blanket the wound • Patient can be treated 24 hours per day for seven days while continuing with normal daily activities • Has received FDA approval JOBST ULCER CARE (BSN Medical Ltd)
• A venous ulcer compression system similar to Activa Leg Ulcer Hosiery Kit, SurePress Comfort Pro Graduated Compression System and Ulcertec • Available in small, medium, large and extra large packs • Medical stocking and compression liner (pack contains one stocking and one liner) • Compression liner pack (pack contains three liners)
© 2005 Tissue Viability Society 32
VOL 15 NO.2 MAY 2005
MAGNO-PULSE LEG-WRAP (Magnopulse Ltd.)
TEGASORB SACRAL (3M)
• A drug-free magnetic leg-wrap that improves circulation in the leg, from the foot to the hip • The small, powerful, therapeutic magnets are designed and positioned to work in harmony with the body to improve blood flow • To achieve maximum benefit, should be worn as often as possible (including overnight) • Cost is £29 + £3 p+p
• A hydrocolloid dressing with adhesive border similar to Hydrocoll Border and Ultec Pro
MEDISAFE
• Absorbent, perforated dressing with adhesive border similar to Cosmopor E, Mepore and Primapore
ULCERTEC (Bauerfeind UK)
• A venous ulcer compression system similar to Activa Leg Ulcer Hosiery Kit, Jobst UlcerCare and SurePress Comfort Pro Graduated Compression System • A medical stocking and compression liner (pack contains one stocking and two liners) available as: • Short (small, medium, large) • Long (small, medium, large) VACUNET (Shiloh Healthcare)
NEOSPORT (Neomedic)
• Cotton, Polyamide and Elastane Bandage • All bandages are not less than 4.5m in length when fully stretched • Used for support or compression
• A hydrogel-coated polyester weave non-adherent contact dressing without adhesive border • Used on low exuding wounds • Requires a secondary dressing that can be changed without disturbing the non-adherent contact layer
SCANPOR
VACUSKIN (Shiloh Healthcare)
• Permeable non-woven synthetic adhesive tape similar to Micropore
• A vapour-permeable adhesive film dressing
SKINLINK (Advanced Medical Solutions)
Healthcare)
• • • •
• • • • •
VACUTEX ADVANCED WOUND CARE SYSTEM (Shiloh
• • •
• • •
Non-invasive wound closure product consisting of: Perforated wound strips (hypoallergenic adhesive) N-butyl cyanoacrylate anchoring adhesive Intended for use in A&E departments and operating theatres For larger traumatic topical wounds, wounds under tension/stress and wounds over joints For wounds not appropriate for glue closure Strips are placed across the wound ensuring that the wound is central to the strips; the adhesive is applied to the holes in the strip allowing 15 seconds to set and two minutes to dry Stronger than sutures and strips No need for clinical removal - can be removed using acetone wipes Available as large and small skin strip formats
Consists of: Vacunet - wound contact layer Vacutex - rapid capillary action wound dressing Vacuskin - semi-occlusive film dressing Vacutex can be placed directly onto the wound bed of moderate and highly exuding wounds • Vacunet should be used on low exuding wounds VENOUS ULCER COMPRESSION SYSTEMS
• See Activa Leg Ulcer Hosiery Kit, Jobst Ulcer Care and SurePress Comfort Pro Graduated Compression System • Available in a variety of different size packs VERSIVA (ConvaTec)
• A hydrocolloid dressing with an adhesive border similar to Alione and CombiDERM
SUREPRESS COMFORT PRO GRADUATED COMPRESSION SYSTEM (ConvaTec Ltd)
WOUND DRAINAGE POUCHES
• A venous ulcer compression system similar to Activa Leg Ulcer Hosiery Kit, Jobst Ulcer Care and Ulcertec • Available in pack sizes A to E, each containing one stocking and one liner
• See Biotrol Draina S Fistula (Biotrol), Convatec Wound Manager (Convatec), Dermasure (ADI Medical Ltd), Oakmed Option Wound Manager (Oakmed) • The Wound Manager products are wound drainage pouches - ConvaTec for high volumes of exudate and Oakmed for low volumes.
TEGADERM
+ PAD (3M)
• A vapour-permeable adhesive film dressing with absorbent pad similar to Alldress, Mepore Ultra and Opsite Plus • Combines the features of Tegaderm dressing with an absorbent pad to form an island dressing (contact pad plus border)
VOL 15 NO.2 MAY 2005
Other wound care news ALLEWN PLUS CAVITY: the 1.5 x 20cm cavity dressing has
been deleted from the February Drug Tariff.
33
PRODUCT NEWS
BIOLOGICAL DRESSINGS AND CONSENT: In a survey of attitudes towards the use of biological dressings, concerns included unwillingness to use products obtained by cruelty or deliberately killing animals (Methodists, Buddhists); a ban on pig products unless there was no other alternative (Muslim); and unacceptability of products derived from human prepuce (Quakers). All considered that fully informed consent was essential'.
WOUND CARE (modern and conventional): In a hospital survey in Switzerland comparing 1998 and 2003 practice, in 86% of all treatments a modern wound care procedure theoretically costs 20% of a traditional one. More modern dressings are being used. Traditional procedures relying on frequently changing wound dressings using ointments, enzymes and antibiotics/disinfectants are becoming more and more obsolete 9 •
FOOT ULCERS AND DIABETES: Substantial evidence supports screening all patients with diabetes to identify those at risk for foot ulceration. These patients might benefit from certain prophylactic interventions, including patient education, prescription footwear, intensive podiatric care, and evaluation for surgical interventions'.
Further dressings information can be found in the 9th edition (September 2004) of the FonnulalY of Wound Management Products, written by David Morgan arid available for £9.95 (including P+p) from: Euromed Communications Ltd, The Old Surgery, Liphook Road, Haslemere, Surrey Gun INL (Tel: 01428 656665). Updates to this edition are regularly posted on the Euromed website at: www.euromed.uk.com/formulary.
HYPERBARIC OXYGEN THERAPY: A recent Cochrane review concluded that there was not sufficient evidence to support or refute the effectiveness of hyperbaric oxygen therapy for the management of thermal burns'. MAGGOTS: The University of York is looking for 600 leg ulcer sufferers to test the effectiveness of maggots. The £750,000 trial will compare the clinical and costeffectiveness of larval therapy with conventional hydrogel treatment as well as the effect on patients' quality of life over a period of one year (BBC News, 11 January 2005)'. SCARS: The causes of and treatment options for abnormal scar tissueS. SKIN GRAFTS: Their definition, use and care of donor sites are described in a recent publication from the Wound Care Society6. SKIN GRAFTS: A meta-analysis of clinical efficacy and a review of cost-effectiveness of artificial skin grafts in chronic wound care reported: • More frequent and rapid healing of chronic diabetic foot ulcers compared with standard therapy • Same benefit of wound healing is not seen in venous leg ulcers • No significant effect on adverse events such as infection, cellulitis and osteomyelitis • Increased costs in the short term. By one year there may be net cost savings'. WOUND BED PREPARATION: Proteolytic activity is sensitive to the environmental pH. Decreasing the pH level could thus be a simple and effective way of reducing protease activity and promoting healing, although clinical studies are needed to test this hypothesis8 (see Cadesorb above).
34
Information on new products or changes to existing products should be sent to: David Morgan Consultant in Pharmaceutical Public Health National Public Health Service for Wales, Preswylfa, Hendy Road, Mold, Flintshire CH7 IPZ. email: [email protected]
References 1. Enoch S, Shaaban H, Dunn KW. Informed consent should be obtained from patients to use products (skin substitutes) and dressings containing biological material. loumal 0/ Medical Ethics 2005 31: 2-6. 2. Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. lAMA 2005 293: 217-28. 3. Villanueva E, Bennett MH, Wasiak J, Lehm JP. Hyperbaric oxygen therapy for thermal burns. The Cochmne Database 0/ Systematic Reviews 2004 Issue 2. 4. http://news.bbc.co.uk! 5. Beldon P. The use of skin grafts in wound management. Educational leaflet. 2004 Hartford, Huntingdon: The Wound Care Society. 6. Smith FR. Causes of and treatment options for abnormal scar tissue. lournal a/Wound Care 2005 14: 49-52. 7. Ho C, Tran K, Hux M, Sibbald G, Campbell K. Artificial skin grafts in chronic wound care: a meta-analysis of clinical efficacy and a review of cost-effectiveness (Technology report no 52). 2005 Ottawa: Canadian Coordinating Office for Health Technology Assessment. 8. Greener B, Hughes AA, Bannister NP, Douglass 1. Proteases and pH in chronic wounds. loumal a/Wound Care 2005 14: 59-61. 9. Jenzer H, Bastos Bettencourt Al, Maillard S. Modern wound care is cost-effective and amounts to merely 20% of conventional wound care cost. European loumal Hospital Pharmacy 2004 10(4): 48-55.
VOL 15 NO.2 MAY 2005