Cutimed ® Sorbact ®
attraction Hands-on Case Report 12
New avenues in wound treatment:
Cutimed ® Sorbact ® in combination
with hyperbaric oxygen therapy (HBOT)
Radionecrotic neck wound
Institute for Hyperbaric Medicine (IvHG), Rotterdam
New avenues in wound treatment:
Cutimed ® Sorbact ® in combination with
hyperbaric oxygen therapy (HBOT)
Radionecrotic neck wound
TIANA MOLLET (MEDICAL ADVISOR, BSN MEDICAL BV) IN COOPERATION WITH
INSTITUTE FOR HYPERBARIC MEDICINE (IVHG), ROTTERDAM
“What especially appeals to us at IvHG about Cutimed ® Sorbact ® is the simplicity of the product.
Both in its action and application.” These are the words of Michiel van der Huls, a doctor at the
Dutch Institute for Hyperbaric Medicine (IvHG). Together with surgeon Dr. Boonstra, he now has
experience with Cutimed ® Sorbact ® : “It is a fine addition to the range of products we are already
using for our treatments.”
Oxygen as a medicine
The Dutch Institute for Hyperbaric Medicine
contributes to the recovery of damaged tissues
by administering 100% oxygen to patients under
high pressure. “We use oxygen as a medicine,”
Van der Huls explains. “The treatment of difficult
wounds now comprises about 20% of our total
Restoring blood supply
The treatment with hyperbaric oxygen is based on
the principle that damaged tissues can recover
when the blood supply is restored. Van der Huls:
“With problem wounds hyperbaric administration
of 100% oxygen stimulates, among other things,
the new growth of capillaries. And once these
capillaries are in situ, the healing process can
begin and slowly progress.”
Does Van der Huls think that a dressing which
binds bacteria due to it's hydrophobic DACC
coating is a plausible mode of action? “I think it
is very plausible,” says the doctor emphatically.
“We know that oil slicks at sea float together after
a few days. The same principle applies here. It is
really very simple and that is what appeals to me.”
No chemicals involved
Van der Huls also finds Cutimed ® Sorbact ® very
simple to apply. “You can put it over the wound
edges, you don’t have to cut it ... yes, it really is
very easy to use. But what I think is best of all
about Cutimed ® Sorbact ® is that, without chemicals,
you can still get rid of bacteria [i.e., by binding it
to the dressing and removing it with each dressing
change], giving the wound area a chance to heal.”
Where other treatments failed, progress made
Patients can only be referred to the IvHG by clinical
specialists. The specialists of the IvHG then determine
whether the patient is eligible for hyperbaric
medicine. Van der Huls: “Patients with problem
wounds who come to us have often tried everything
else. They have had TNPWT therapy and
have been treated with a number of specialised
wound treatment products. For instance, you see
people who have had a DM ulcer for months that
has not responded at all and then within a few
weeks it improves enormously.”
Taking over wound treatment
The IvHG can also oversee and administer the
whole wound treatment process, in consultation
with the referring doctor. “In such cases, we not
only use oxygen, but also other wound dressings,”
according to Van der Huls. “We are always
interested in new products. We follow as many
wound congresses, courses etc. as possible to
keep abreast with the latest developments and
knowledge. That is how we became acquainted
with Cutimed ® Sorbact ® .”
CASE: RADIONECROTIC NECK WOUND
Referred by the oral surgeon due to of poor wound
healing, the patient presented with a right-sided
pT4aN1M0 oropharynx carcinoma treated with
ablation, modified right neck dissection and
reconstruction with a free radial artery forearm
flap. Postoperatively, the patient underwent
radiotherapy. He has a past medical history of
neurocranial trauma and hepatitis A.
Postoperative complications: secondary bleeding,
hemiparesis without a clear cause, wound infection
with an exposed mandibular bone and fistula formation
to the neck wound with wound dehiscence.
Question: Is HBOT indicated?
Answer: Yes, to promote wound healing and as
a preventive measure for surgery in the radiated
(After 16 days of Cutimed ® Sorbact ® and 10x
In consultation with the referring doctor, it was
decided that IvHG would oversee wound treatment;
patient admitted to hospital.
Regimen: 20 treatments pre-operatively followed
by 10 treatments post-operatively. Scheduled for
an intraoral reconstruction with a new skin flap.
When treatment began at IvHG, the wound was malodorous with the wound bed covered in thick
slough and some necrotic areas. It was decided to apply Cutimed ® Sorbact ® swabs (7x9 cm folded),
covered with an absorbent dressing. The dressing initially needed to be changed 2-3 times a day
because of the profuse exudate and leakage, but over the course of the treatment this was reduced to
once a day. During this time, the patient underwent 5 HBOT treatments per week.
After 20 treatments with Cutimed ® Sorbact ® plus
hyperbaric oxygen, the wound is showing signs
of healing. The patient is ready for intraoral reconstruction,
by means of a free skin flap (radial
forearm flap). Post-operatively, the new intraoral
skin flap is well attached with no complications.
This patient can now be discharged.
What does IvHG stand for?
The Dutch Institute for Hyperbaric Medicine is a
young, dynamic organisation with a licence from
the Ministry of Health, Welfare and Sport. The
Institute works closely with university hospitals
and has a collaboration agreement with the
University Medical Centre Groningen, University
Medical Centre St. Radboud and Erasmus MC.
The hyperbaric oxygen treatment is carried out by
a specialised team of doctors, nurses and technicians
in a fully certified environment. In collaboration
with national health insurance companies, 10,000-
12,000 treatments are carried out a year.
What is hyperbaric oxygenation (HBO)?
HBO is the abbreviation of hyperbaric oxygenation.
This means breathing in of pure oxygen under
increased atmospheric pressure.
Indications for hyperbaric oxygen therapy
HBOT is an internationally applied, scientifically
proven medical treatment for disorders in which a
lack of oxygen plays a role. In some cases HBOT
can save lives. To determine when HBOT is indicated,
the IvHG follows the European guidelines, as laid
down by the Committee for Hyperbaric Medicine.
Examples of these indications are:
• Air embolism
• Carbon monoxide and flue gas poisoning
• Gas gangrene, serious soft tissue infections
• Crush injuries
• Skin/muscle transplants at risk of rejection
• Tissue damage following radiotherapy
• Problem wounds (e.g. diabetic foot ulcer).
What does HBO do?
Most oxygen is transported to the tissues via the
blood by red blood cells. Only a small amount is
dissolved in the blood plasma. With increased
atmospheric pressure, oxygen saturation also
increases, proportional to the rise in atmospheric
pressure. This increased oxygen pressure has a
number of therapeutic benefits:
• Oxygen can better penetrate the tissues.
Tissues that are in need of oxygen due to
reduced blood supply are reached.
• Cells responsible for the healing process are
stimulated and activated. The growth of new
capillaries is stimulated.
• Oxygen has a detoxifying and germicidal effect
on a number of intracellular processes.
Tiana Mollet (Medical Advisor, BSN Medical BV) in cooperation with Institute for Hyperbaric Medicine (IvHG),
Brielselaan 69e, 3081 AA Rotterdam, Netherlands