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Evaluating the effectiveness of Tegapore wound-contact material

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VOL: 100, ISSUE: 04, PAGE NO: 66

Wendy Jones, BSc, RGN, DNDip, is research liaison nurse

Nicola Ivins, RGN, is clinical trials facilitator;Patricia Price, PhD, BA, AFBPsS, CHPsychol, is director; all at Wound Healing Research Unit, University of Wales College of Medicine, Cardiff

During wound healing, new-forming granulation tissue is often extremely fragile and can be easily disrupted during dressing changes. This can lead to a delay in the completion of wound healing and increased pain and discomfort for the patient (European Wound Management Association, 2002; Fear, 2002).

During wound healing, new-forming granulation tissue is often extremely fragile and can be easily disrupted during dressing changes. This can lead to a delay in the completion of wound healing and increased pain and discomfort for the patient (European Wound Management Association, 2002; Fear, 2002).

Modern wound dressings are generally designed to exhibit low adherence to wound tissue, but this is not always the case clinically, especially when the wound is allowed to dry.

The introduction of advanced wound-contact materials, which can be left in place while absorbent secondary dressings are changed, has meant that wounds can be allowed to heal with minimal disruption (Fear, 2002).

This study uses Tegapore Wound Contact Material. This is a woven, nylon fabric with sealed edges that is a lint-free, non-adherent, non-toxic, non-irritating and hypoallergenic material.

It allows wound exudate to pass through to an absorbent outer dressing and clinical studies have shown that it can be left on the wound for up to seven days (Fear, 2002; Mulder et al, 1991). The wound-contact material can be used under gauze or other absorbent dressings.

Methodology
This study was initiated to gather information on the clinical experiences of nurses and patients who are using the wound-contact material. Twelve patients with painful ulcers or who experienced significant pain during dressing changes were selected for inclusion in the two-week study.

Informed consent was obtained from the patients, their details were recorded, and a photograph and a tracing of their wounds were taken.

Each patient was asked to rate their ulcer pain using a 10-point scoring scale (Price et al, 1994) and to consider three specific areas:

- Level of wound pain over the previous seven days (before treatment with Tegapore);

- Level of wound pain experienced during changing of the dressing;

- Level of wound pain over the subsequent seven days (for a wound treated with Tegapore).

The patients continued with their existing dressing regimen for the first seven days, after which time their ulcers were examined: they were retraced, rephotographed and the pain level was reassessed.

Tegapore was applied on day seven, with an appropriate secondary dressing to manage the exudate. On day 14, a final assessment of the wound was made, which again comprised photographs, tracings and pain scores. An appropriate dressing was then applied and the patient was referred back to his or her community nurse.

Results
The following case studies detail patients' experiences with Tegapore.

Several patients were unable to assign appropriate pain scores. Of the remainder, the following five case studies best illustrate the benefits of the dressing.

Patient one

Patient one was a 67-year-old woman who had had a wound on her left lateral malleolus for the previous six months. Mixed disease (arterial and venous disease) was confirmed in December 2002 following a duplex scan (used to measure blood flow). Before involvement in the study, she complained of continuous severe wound pain that was not relieved with analgesia.

The patient was taking co-proxamol and ibuprofen, supplemented by buprenorphine 200mcg as required for severe pain (Fig 1).

Effectiveness of dressing

At day zero the wound was dressed with a fibrous hydrocolloid dressing and gauze with light compression. At day seven Tegapore was introduced, covered with a fibrous hydrocolloid dressing and gauze with light compression. At day 14 of the study, the patient requested the continuation of treatment with Tegapore.

During the study period, her pain reduced to being moderate and intermittent and was tolerated easily without any changes to her regular analgesia. She found the dressing to be comfortable and easy to remove.

Patient two

Patient two was a 52-year-old woman who had had a wound on her left medial malleolus for the previous 18 months. Venous disease was diagnosed following a comprehensive assessment, which included ankle brachial pressure index (ABPI) measurement.

ABPI is a simple non-invasive method of identifying arterial insufficiency.

Before taking part in the study, the patient complained of moderate intermittent pain, which was most acute when her dressing was being changed. She had taken no specific analgesia for this (Fig 2).

Effectiveness of dressing

At day zero the wound was dressed with knitted viscose primary dressing and four-layer compression bandages. At day seven Tegapore was introduced with light compression. At day 14 a knitted viscose primary dressing and light compression were applied. Wound pain remained intermittent, but became mild in nature. The patient found Tegapore to be comfortable and easy to remove.

Patient three

Patient three was a 72-year-old man with a long history of leg ulcers. The current wound on his right medial malleolus had been present for 10 months. Venous disease was diagnosed after a comprehensive assessment, which included ABPI measurement. Before enrolment on the study, the patient complained of moderate intermittent pain that was controlled by regular doses of diclofenac 50mg (Fig 3).

Effectiveness of dressing

At day zero the wound was dressed with knitted viscose primary dressing and four-layer compression bandages. The wound-contact material was applied at day seven. At day 14, the patient requested the continuation of this treatment and the four-layer compression bandages.

Although the wound pain increased initially, it had decreased by day 14 when the Tegapore was first changed. The patient found the dressing was comfortable and easy to remove.

Patient four

Patient four was a 66-year-old man who had had a half-circumferential wound on the gaiter area of his left leg for the previous year before the study took place. Venous disease was diagnosed following a comprehensive assessment, which included ABPI measurement. Before enrolling onto the study, the patient had complained of moderate pain during dressing changes.

The patient was taking paracetamol and also morphine sulphate continuous-release tablets 100mg for his acute arthritic pain. He was not taking any specific analgesia for his wound pain (Fig 4).

Effectiveness of dressing

At day zero the wound was dressed with knitted viscose primary dressing and four-layer compression bandages. At day seven Tegapore was introduced with four-layer compression. At day 14 the patient made a request for Tegapore to be re-applied with four-layer compression.

During the study period the patient's wound pain increased. This coincided with a particularly cold spell of weather that inflamed his arthritis and restricted his movements.

However, the patient found that the last dressing change on day 14 was much less painful because the dressing was far easier to remove and caused less trauma.

Patient five

Patient five was a 50-year-old woman with a history of leg ulcers since 1973. The present wound on her right medial malleolus developed 10 years before the start of the study, and venous disease was confirmed by duplex scan two years before the study began.

Before enrolment onto the study, the patient had complained of severe continuous pain that was not relieved by taking effervescent co-codamol 16mg/1g (Fig 5).

Effectiveness of dressing

At day zero the wound was covered with a knitted viscose primary dressing, an elasticated tubular bandage and three-layer compression bandages.

At day seven Tegapore was introduced with an elasticated tubular bandage and three-layer compression. At day 14 the wound was dressed with a knitted viscose primary dressing, an elasticated tubular bandage and three-layer compression.

The wound on day 14 was smaller in size, but an offensive odour was present, with increased maceration and spreading erythema indicating an infection requiring treatment with antibiotics.

The wound pain remained unchanged during the period of the study, but the patient felt that there was a small reduction in pain during the final change of dressing in spite of the actual worsening condition of her wound.

Conclusion
In common with other studies, such as Mulder et al (1991), the nursing staff involved in this evaluation reported that patients with leg ulcers frequently reported pain from their wounds.

The 12 patients who used the Tegapore wound-contact material were recruited from both the Wound Healing Research Unit in Cardiff and the local community leg-ulcer clinics.

Most wounds treated had been present for more than two years, only four had developed within the previous year, and three of them were particularly long-standing.

Of the 12 patients who consented to take part in the study, eight felt that Tegapore had been beneficial to their wounds, particularly with respect to its comfort and ease of removal.

Four of the patients requested the continuation of treatment with Tegapore after completion of the study, because they felt that the dressing had assisted in reducing their wound pain.

During the study, two patients' wounds became infected and required antibiotics.

Another patient was referred to the Wound Healing Research Unit for further investigations. Two patients found it difficult to assign appropriate pain scores.

The results from these case studies suggest that Tegapore is an easy-to-use, comfortable and effective advanced wound-contact material that can minimize the patient's experience of pain at dressing changes.

FOOTNOTE
This study was sponsored by 3M Health Care

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