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Objective: To compare the clinical efficacy of a collagen dressing covered with a foam dressing with the same foam used as a primary dressing in stagnating granulating pressure ulcer patients. Method: Patients were randomised to receive either a foam dressing (Suprasorb P; Lohmann & Rauscher) as a primary dressing (group A), or a combination of a collagen dressing (Suprasorb C; Lohmann & Rauscher) covered with the same foam dressing (group B). Wound fluid was collected and evaluated prior to treatment (day 0), and on days 3, 7, 14 and 21. The level and expression of matrix metalloproteinases (MMPs) MMP-2 and MMP-9, and tissue inhibitors of metalloproteinases (TIMPs) TIMP-1 and TIMP-2, as well as elastase content in wound fluid and angiogenesis, were evaluated, comparing results on day 0 and day 21. Time to ulcer healing, reduction in ulcer area, safety of treatment, patient-reported ulcer pain and comfort of the dressing regimen were evaluated as secondary outcomes. Patients received standard preventive measures, in line with the pressure ulcer prevention guidelines. Results: Ten patients were included in the pilot; five were treated with the foam dressing (group A) and five patients received the collagen dressing, using the foam as a secondary dressing (group B). Wound fluid from group B displayed a significant positive effect on angiogenesis (p < 0.05) compared with group A. In the collagen and foam group TIMP-1 and -2 increased faster and levels were higher than in group A. Furthermore, MMP-2, MMP-9 (p < 0.04) and elastase in group B showed faster and greater decrease in levels, compared with group A, indicating a faster and superior reduction of inflammation. In both groups the ulcers started to heal, with a faster onset of healing for group B. Conclusion: The results of this pilot support published data on the use of collagen dressings compared with foam for stagnating wounds, shown in clinical studies. Declaration of interest: This study was supported with an educational grant by Lohmann & Rauscher GmbH. Apart from Dr Abel, the sponsors had no role in the design or conduct of the study, in the collection, analysis and interpretation of the data, or in the preparation, review or approval of the manuscript. Dr Abel gave input to the study design from a scientific perspective. None of the authors received administrative, technical or material support for the conduct of this study. The authors have no other relevant financial interests to declare. [ABSTRACT FROM AUTHOR]

Objective: Effective and comfortable debridement is an important part of managing complex wounds. This user test evaluated a monofilament-fibre pad (with handle) (Debrisoft Lolly, Lohmann & Rauscher GmbH & Co. KG) in the debridement of various hard-to-reach wounds., Method: The multicentre, international user test was performed by experienced physicians and nurses in Germany and the UK, who used the monofilament-fibre pad in their clinical practice. After debridement, using the monofilament-fibre pad, the clinicians completed an evaluation questionnaire. The assessment comprised of performance, usability, tolerability, safety and suitability of the device for debridement, comparing it with standard methods used in the clinicians' centres., Results: A total of 23 clinicians in 20 centres each treated between six and 10 patients with the monofilament-fibre pad (a total of 155 wounds of different aetiologies). Most participating patients had deep wounds (n=63 (41%)) or cavity (n=31 (20%)) wounds. When compared with the standard debridement method used at the centres, the tested device was scored as 'easier' or 'equally easy' to use in all cases. When comparing the standard debridement procedure with the monofilament-fibre pad, debridement duration was reported as equal to or shorter than the standard method in 90% of cases when using the monofilament-fibre pad. Debridement efficacy was scored by the clinician as 'better' or 'equal' for the monofilament-fibre pad in 67% of cases. Overall, patients reported that the study device was comfortable., Conclusion: The monofilament-fibre pad effectively, easily and safely removed slough and debris from wounds of various aetiologies and was effective in wounds of different shapes, such as in cavity wounds and those in hard-to-reach locations.

Objective: Exudate control is an important aspect of wound management in both acute and chronic wounds. Exudate can be an indicator of the wound bed condition, specifically inflammation and infection. This study aimed to evaluate the performance, in terms of usability, handling properties, exudate management, user satisfaction and patient comfort, in daily clinical practice, of a superabsorbent dressing, Vliwasorb Pro (Lohmann & Rauscher), suitable for the management of moderate-to-very high exudate levels., Method: The user test was conducted between September 2016 and July 2017, with clinicians from different specialisms in 55 centres across Germany. Both the dressing and user test were supplied by the sponsor. The superabsorbent dressing was used for at least three dressing changes, with frequency dependent on the patient and wound condition., Results: A total of 55 clinicians recruited 171 patients with various wound types. The clinicians rated dressing application as 'easy' for 163 (95.3%) of the patients. The dressing was rated as easy to remove (168 (98.3%) and, according to clinicians, did not soil patients' clothing in 165 (97.1%) of cases. The dressing demonstrated a 'good absorbent capacity', as noted by clinicians in 167 (98.2%) of cases. Clinicians also commented that the dressing reduced foul odour, maceration and improved periwound skin condition., Conclusion: The evaluated dressing was easy to use, comfortable and reliable for patients with moderate-to-very high exuding wounds. In view of these results, superabsorbent dressings seem to be interesting for both clinicians and patients. Clinical studies are required to confirm these results.

In the western industrial nations the proportion of old people (according to WHO definition people over 75 years) has been rising for many years and with it the amount of surgical treatment on this group of the population. High age does not automatically mean a risk too high for surgical treatment. Very often the reasons for this age group being high-risk patients are hospital admission in an advanced stage of illness or complications due to the illness. Old people are biologically younger than they were years ago. Often they express their perfectly understandable wish for suitable treatment. New treatments and strategies in surgery such as minimal-invasive surgery, endoluminal techniques for heart and vascular surgery, fast-track-concepts, anaesthetising techniques like spinal anaesthesia or the use of better controllable narcotics, improves alleviation of pain, quick mobilisation and early oral nutrition contribute to a minimisation of the risk. Age-related multimorbidity defines the risks of major operations and requires an individual weighing up of benefit and risk. The decision for or against an operation must take the elderly patient's wishes into account. The most important aspect is not only to help the people survive but to enable them to participate in life. In this paper we try to give an overview of geriatric surgery with all its aspects relevant to insurance.