Wound Bed Preparation - A Practical Perspective
Katie Bennett shares her experiences of using the Prontosan® wound bed preparation system for lower limb wound care.
This is adapted from an article originally printed in Practical Patient Care (NS Media Group) Vol 25, 2020.
What are your main objectives in leg ulcer care and why would you recommend wound cleansing?
A thorough, holistic assessment of a patient with a leg ulcer needs to be undertaken to determine an accurate diagnosis and plan of care. My main objectives in leg ulcer care are that wounds need to be free from infection or biofilm, exudate needs to be managed and any slough/necrotic tissue to the wound bed needs to be debrided. Cleansing ulcers avoids cross infection from contamination, by using a solution such as Prontosan Irrigation Solution I have found a reduction in reoccurring infections.
Can you explain a bit about wound bed preparation and why it’s important to your clinical practice?
A wound that has slough or necrotic tissue is difficult to assess as the true extent of the wound cannot be seen and also slows down the healing process, therefore it is very important that this type of tissue is removed. Infection causes pain to the patient and can delay or deteriorate a wound, it also can increase moisture levels which in turn can cause maceration and excoriation to the peri-wound. The edge of a wound bed will not epithelise unless it is well prepared. Care of the surrounding skin is equally as important, to promote comfort and skin health.
Several methods of wound debridement are available to you as a specialist - how does mechanical debridement suit leg ulcer care?
Leg ulcers as with all chronic wounds can get stuck in a particular phase of healing, usually the inflammatory phase; to enable a wound to move to the proliferation phase of healing it is essential to remove any dead tissue or biofilm. Mechanical debridement physically removes devitalised tissue from the wound bed, without damaging any healthy tissue.
What have been your experiences of the Prontosan Debridement Pad? Do you have any tips on how to use it?
Prontosan Debridement Pad is my go-to for mechanical debridement. It is very quick and easy to use, with instant results, and requires no specialist training. For patients that have wound debris or a possible biofilm present, I will cleanse the ulcer with a moistened pad, using a circular motion. I have found patients find it comfortable and they also like to see the immediate results of the removal of dead tissue. It can also be used on the whole leg to remove dry skin plaques(hyperkeratosis) as a build-up of dry skin can crack, allowing bacteria to enter which can then lead to infection. The round end of the pad, I use on the larger areas and tapered end is great for harder to reach areas such as in between toes or a wound with some depth to it.
I can use the Pad with an emollient, which does not alter the effectiveness. I feel it allows the emollient to penetrate the patient’s skin and wound better. Patients have a positive experience of their leg having ‘a good wash’ – it gives them a greater sense of well-being.
Why do you use Prontosan Gel X and what benefits have you seen with using it between dressing changes?
I use Prontosan Gel X on acute and chronic wounds. It is easy to use, applied directly on to the wound, great for cavities or wounds that are undermining. Patients find dressing changes comfortable as the gel keeps the wound bed moist, so there is no adherence of dressing to wound bed. Odour from leg ulcers due to the presence of bacteria and devitalised tissue can be distressing for patients, I have found that Prontosan Gel X helps to reduce odour thereby improving patient care.
Have you found any extra benefits from using the Prontosan products in combination? How have they come together to make things better and easier for you and your patients?
I have found that using all 3 products in combination works particularly well on patients with chronic leg ulcers, these may have the presence of a biofilm. The Pad removes debris, slough and bioburden. The Irrigation Solution continues to reduce the bacterial burden and the Gel X, along with autolytic debridement will continue to debride, whilst offering an antimicrobial effect and providing a moist environment for the ulcer to heal. The 3 in combination stop the biofilm from re-forming, reduce healing time and help prevent infection.
Katie Bennett works as a Wound Care Nurse with special interest in Tissue Viability (NSI) which enables her to provide evidence based, quality assured knowledge for all clinical staff with particular reference to complex and challenging wounds.