Cutimed® Sorbact® in combination with hyperbaric oxygen therapy ...

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Cutimed® Sorbact® in combination with hyperbaric oxygen therapy ...

Cutimed ® Sorbact ®

physical

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


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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

work.”

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.”

DACC technology

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 ® .”


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CASE: RADIONECROTIC NECK WOUND

Day 1

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

area.

Day 17

(After 16 days of Cutimed ® Sorbact ® and 10x

HBOT)

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.

Dressing change

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.

Day 29

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.


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ANNEX: IVHG

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

((osteo) radionecrosis)

• 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.

Author

Tiana Mollet (Medical Advisor, BSN Medical BV) in cooperation with Institute for Hyperbaric Medicine (IvHG),

Brielselaan 69e, 3081 AA Rotterdam, Netherlands

70550-00562-00 02/2012

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