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Biomedical subjects

F Gottrup

Publications and source records attributed to F Gottrup.

At least 19 recordsLinked to original sources
PubMed2006

Effect of a new silver dressing on chronic venous leg ulcers with signs of critical colonisation.

OBJECTIVE: To investigate the clinical performance and safety of a new silver-containing wound-contact layer, Physiotulle -Ag (Coloplast), in the treatment of chronic venous leg ulcers with delayed healing and signs of critical colonisation. METHOD: This was an open prospective non-comparative multicentre clinical study. Patients were treated for four weeks with Physiotulle -Ag, which was covered by Alione Hydrocapillary Dressing (Coloplast). RESULTS: Thirty patients were recruited into the study. One ulcer healed after three weeks of treatment. The mean relative ulcer area reduced by 55% after four weeks. Over the study period the mean amount of healthy granulation tissue increased from 26% to 62%, and the mean amount of fibrin decreased from 63% to 32%. The ratio of malodorous wounds was 50% at inclusion, 20% after one week and 3% after four weeks. The dressing was considered easy or very easy to apply in 100% and easy to remove in 89% of dressing evaluations. The dressing combination showed good exudate-management properties. Incidence and severity of maceration, erythema and eczema decreased during the study and no device-related adverse events were recorded. CONCLUSION: Physiotulle -Ag is safe and easy to use in chronic venous leg ulcers in which healing is delayed and with signs of critical colonisation.

Aged↗
PubMed2006

Biophysical effects of repetitive removal of adhesive dressings on peri-ulcer skin.

OBJECTIVE: To study the effect of repeated removal of four different adhesive dressings on peri-ulcer skin using quantitative non-invasive techniques. METHOD: Forty-five patients with open (n = 29) or healed (n = 16) venous leg ulcers were included. Peri-ulcer skin was treated for 14 days with patches of two different hydrocolloid-based adhesive dressings, one polyurethane adhesive and one soft silicone adhesive dressing. Normal skin of the patients' ventral forearm was also treated identically. Adhesive patches of the dressings were replaced every second day. The skin barrier function was assessed by measuring transepidermal water loss and stratum corneum hydration by measuring electrical conductance. RESULTS: Thirty-nine patients completed the study. The hydrocolloid adhesives increased transepidermal water loss and conductance while the polyurethane and soft silicone adhesives did not influence these parameters significantly compared with adjacent non-treated peri-ulcer skin. For normal forearm skin, similar relative effects among the four adhesives were found. CONCLUSION: Repetitive treatment with hydrocolloid-based adhesive dressings induced major functional alterations of the stratum corneum. In contrast, a polyurethane adhesive and a soft silicone adhesive dressing did not alter transepidermal water loss or conductance of peri-ulcer skin.

Adhesives↗
PubMed2005

Management of the diabetic foot: surgical and organisational aspects.

Most patients are older, but increasing numbers of young patients also develop diabetic foot ulcer (DFU). A third of the patients are under 50 years of age. The prevalence in the Western countries is 4-10% and the incidence 2-6%. Only 10-60% of patients are healed after the first three months and the recurrence rate is 44%, 61%, and 70% after one, two and three years, respectively. DFU results in extensive treatment costs, and the hospital treatment cost of DFU counts towards 25-30% of the total hospital expenses of treatment of patients suffering of diabetes. Recent progress in the treatment of patients with DFU has reduced the number of low-extremity amputation (LEA) cases. These improvements have been achieved through an increasing understanding of the importance of the multifactorial background of DFU, and that there should be a multidisciplinary organized structure behind the treatment of DFU. This used to be a topic of interest, but especially focused on the international Consensus on the Diabetic Foot from 1999. Our understanding of the importance of surgery in DFU has increased over the last 30 years. A simple classification based on presents or absents of neuropathy, open wound or infection has been suggested. Treatment is dependable of the type and classification group of the wound. Various surgical correction techniques are available. The team approach and collaboration between all healthcare professionals is required to facilitate good quality holistic care. Recognition of the talent and creativity of all employees in the multidisciplinary team will increase the chance of success in establishment of the concept. This article is based on a presentation focusing on the surgical and organisational aspects in thr treatment of DFU.

Adult↗
PubMed2005

Evaluation of the quality of venous leg ulcer care given in a multidisciplinary specialist centre.

OBJECTIVE: To determine the quality of venous leg ulcer care given in a multidisciplinary, specialist wound-healing centre and to identify problem areas that might affect it. METHOD: The case records of 90 consecutive patients with venous leg ulcers, diagnosed and treated at the Copenhagen Wound Healing Centre, Denmark, were retrospectively audited by a Scandinavian cross-sectional and multidisciplinary expert panel. Quality of care was audited in each case using implicit criteria. The experts then formulated key recommendations for good clinical practice for patients with venous leg ulcers. RESULTS: Quality of care was satisfactory in 74 patients (82%). The one-year healing rate was 77% (69/90), with a three-month recurrence rate of 12% (11/90). Identified problem areas included the lack of systematic assessment of patients' suitability for surgery; lack of systematic, duplex-verified diagnoses of venous aetiology; and the lack of systematic examination of distal arterial pressure. The recommendations include the need for venous diagnosis, differential diagnosis, compression therapy, surgery, systemic treatment, access to venous leg ulcer care and better communication. CONCLUSION: The quality of venous leg ulcer care given in this multidisciplinary centre was satisfactory.

Adult↗
PubMed2005

Use of a hydrocapillary dressing in the management of highly exuding ulcers: a comparative study.

OBJECTIVE: To evaluate the safety and performance of Alione Hydrocapillary dressing (Coloplast A/S) in the management of highly exuding chronic venous leg ulcers and compare it with two hydropolymer dressings,Tielle and Tielle Plus (Johnson & Johnson). METHOD: A comparative clinical trial was conducted on 97 patients with an ankle brachial pressure index > or = 0.8 and a highly exuding leg ulcer. Ulcer duration was at least four weeks. Treatment continued until healing or for a maximum of 12 months. RESULTS: There was no statistically significant difference in healing time or wound area reduction between the two treatment protocols. The test dressing (Alione Hydrocapillary) had better absorption capacity and was more comfortable for the patients than the comparator dressings (Tielle/Tielle Plus) and adhered less to the wound bed.Also, more patients preferred the test dressing to their previous treatment. Although severe leakage and maceration were observed more frequently in the comparator group compared with the test group, this was not statistically significant. CONCLUSION: Both treatment protocols were safe and effective in treating highly exuding chronic venous leg ulcers. The test dressing performed as well as or better than the comparator dressings for all study parameters and more patients preferred the test dressing to their previous dressing compared with the comparator dressings.

Adult↗
PubMed2004

Safety and performance of a new non-adhesive foam dressing for the treatment of diabetic foot ulcers.

OBJECTIVE: This study aimed to document the safety and performance of a new non-adhesive foam dressing (Biatain Non-adhesive Dressing, Coloplast A/S) in the treatment of established foot ulcers in patients with diabetes. METHOD: This was an open non-comparative prospective study. Participants had an ankle brachial pressure index score of over 0.4 (neuro-ischaemic) and an ulcer bigger than 1 cm2 and less than 8 cm2 in any direction. The treatment period was six weeks. RESULTS: Thirty-five out of 37 patients completed the study. The mean wound area reduced from 5.4 cm2 to 2.5 cm2. Relative wound area reduced from 100% at baseline to 40% at week 6. 'Wearing comfort' improved throughout the study (p = 0.039). Maceration remained stable or improved. None of the four reported adverse events were device related. CONCLUSION: This study demonstrates that treatment of diabetic foot ulcers with Biatain Non-adhesive Dressing results in considerable wound area reduction and prevents any deterioration in maceration. The dressing is safe and effective in the management of these ulcers.

Activities of Daily Living↗
PubMed2003

Does the pattern of venous insufficiency influence healing of venous leg ulcers after skin transplantation?

AIMS: this study aimed to investigate the influence of venous insufficiency on results in venous leg ulcers treated with ulcer excision, meshed split-skin transplantation and correction of superficial venous insufficiency in the wound area. DESIGN: retrospective cohort study. SETTING: Copenhagen Wound Healing Center. METHODS: in 113 patients with venous leg ulceration, examined preoperatively with colour Duplex scanning (CDS), prognostic factors of healing and recurrence within 1 year were analysed using logistic regression. RESULTS: cumulative 1-year healing rate was 65% (73 patients) and 13 (12%) had recurrence of ulceration 1 year postoperatively. Initial ulcer size (OR: 0.97(95% CI: 0.96-0.99)), minor local superficial venous surgery (OR: 2.38 (95% CI: 1.04-5.46)), sufficient popliteal vein (2.97 (1.05-8.42)) and non-compliance with compression therapy (OR: 0.27 (95% CI: 0.11-0.71)) influenced the prognosis of healing positively. No statistically significant differences in healing and recurrence between patients with isolated superficial and mixed superficial/deep venous insufficiency was found. CONCLUSION: non-healing venous leg ulcers can be treated with ulcer excision, meshed split-skin transplantation and correction of superficial venous insufficiency in the wound area with beneficial results irrespective of underlying pattern of venous insufficiency as determined by CDS.

Aged↗
PubMed2002

An intraluminal prosthesis may improve healing of a one-layer colonic anastomosis: an experimental study in pigs.

OBJECTIVE: To compare healing of one-layer colonic anastomoses with or without a soluble intraluminal prosthesis (* SBS-tube). DESIGN: Randomised, partly blinded controlled study. SETTING: University hospital, Denmark. SUBJECTS: 16 female Danish country strain pigs, of which 8 had the SBS tube inserted and 8 acted as controls. INTERVENTIONS: One-layer colonic anastomoses either hand-sewn (n = 8, controls) or hand-sewn onto an SBS tube (n = 8). MAIN OUTCOME MEASURES: Macroscopic evaluation, leakage test, breaking strength, histology, oxygen tension in and near the anastomosis peroperatively and 4 days postoperatively. RESULTS: Three quarters of the tubes (n = 8) dissolved in less than 2 hours. Histological examination showed significantly better structured layers and more mucosal epithelial covering in the SBS group. The other histological variables examined were: tissue gap (p < 0.08), inflammation (p < 0.10), breaking strength (p < 0.46) and amount of granulation tissue (p < 0.71), but the last findings were not significant. Oxygen tension at the anastomotic line was better in the SBS tube group, but not significantly so. CONCLUSIONS: We conclude that the SBS tube facilitates the sewing of the anastomosis and may improve healing, possibly because of better apposition of the cut ends and reduced tension in the sutures.

Anastomosis, Surgical↗
PubMed2002

Evaluation of chronic venous disease in the lower limbs: comparison of five diagnostic methods.

To compare the usefulness of five diagnostic methods in ensuring deep vein patency, and in demonstrating site(s) of incompetence, 39 patients with clinical signs of chronic venous disease of a leg were included in a study of deep, superficial and perforator veins using triplex ultrasound (TUS), ascending phlebography (AP), descending phlebography (DP), continuous wave Doppler (CWD) and ambulatory strain gauge plethysmography (ASGP). One patient withdrew from the study. It was not possible to use all five methods in all 38 cases, and the methods could only be used partly in some cases. TUS, which allows anatomical, morphological and functional evaluation of the venous system, was chosen as the reference method. There was poor agreement between TUS and AP, and no agreement between TUS and ASGP, in the diagnosis of venous occlusion. AP demonstrated reflux (abnormal valves) in 7 of 22 patients with competent veins at TUS, and missed reflux in 13 of 15 patients with incompetent veins. Similarly, CWD overdiagnosed reflux in 13 of 20 patients and missed the reflux in 3 of 14 patients. DP was only technically possible in 11 patients. ASGP diagnosed venous reflux in all patients with incompetent deep veins, but also indicated deep vein or perforator vein reflux in all but one patient with competent deep veins. The agreement between TUS and the other methods in evaluating reflux in the deep veins was not better than that expected to occur by chance, Cohen's kappa being less that 0.20. It is concluded that AP, CWD and ASGP are of little value in the work-up of patients with deep venous insufficiency.

Adult↗
PubMed2001

A new concept of a multidisciplinary wound healing center and a national expert function of wound healing.

HYPOTHESIS: An independent, multidisciplinary wound healing center in an accepted national expert function of wound healing is the optimal way to improve prophylaxis and treatment of patients with problem wounds. DESIGN: A clinical perspective analysis. SETTING: An independent, multidisciplinary wound healing center focusing on all types of problem wounds, organized as a university hospital department, and integrated in an expert function in the national health care organization of Denmark. PATIENTS AND METHODS: Patients with all types of problem wounds referred to and treated in the center during the first years of its existence provided a model for a new multidisciplinary structure for treatment of wound patients in the health care system. RESULTS: During the first 3 years of the fully functioning wound healing center, a total of 23 802 patient consultations were performed in the outpatient clinic, and 1014 patients with problem wounds were hospitalized in the inpatient ward. The surgical concept of the center has resulted in improved healing rates in patients with leg ulcers and decreased rates of major amputations. The outpatient function has resulted in a decrease in the number of patients transported in beds to the center. This structure provides better opportunities for basic and clinical research as well as for establishing expert education for all types of health care personnel. The center's structure has been the background for establishing an expert function in wound healing, allowing the wound healing area area to be fully integrated in the Danish National Health Care System. Overall, the concept and structure of the center have enhanced the knowledge and understanding of wound problems and increased the status of wound healing and patient care. CONCLUSIONS: Establishing multidisciplinary centers integrated into an accepted national expert function of wound healing is an optimal way to improve the clinical outcome of prophylaxis and treatment of all types of problem wounds. This model, with minor adjustments, may be applicable for both industrialized and developing countries.

Algorithms↗
PubMed2001

Powder-free, non-sterile gloves assessed in a wound healing centre.

OBJECTIVE: To investigate the relative importance of features of gloves for medical staff working with problem wounds. DESIGN: Prospective, consecutive, crossover, open questionnaire investigation. SETTING: University hospital, Copenhagen, Denmark. SUBJECTS: 38 doctors, nurses, and podiatrists. INTERVENTIONS: Two types of powder-free, non-sterile gloves (No powder Ansell Medical and Skinsense Biogel coated examination glove) were evaluated in the outpatient clinic and the ward of the Copenhagen Wound Healing Center. MAIN OUTCOME MEASURES: Features of gloves regarded as important in the treatment of wounds and a comparison of the features based on the following criteria: much better = 2, better = 1, no difference = 0, worse = -1, much worse = -2. RESULTS: The first questionnaire showed that 84% of the respondents needed a new type of non-sterile glove, and for 66% the price of the glove was a main feature. The study of individual features of gloves showed that "protection" was ranked highest followed by "durability" and "sensitivity". Least important was the "length of the gloves" (p <0.01). The gloves were tested in two different time periods. The Skinsense Biogel glove was evaluated better or much better for "durability" (82%-92% (period 1, 2), p <0.001), "protection" (76%-80%, p <0.001) and "ease of donning" (68%-71%, p <0.001). The Ansell Medical glove was evaluated as better or much better for "tactile sensitivity" (77%-79%, p <0.001). The Skinsense Biogel glove showed more positive changes in skin condition than the Ansell Medical glove. The quality of packing of the Ansell Medical glove in the containers also resulted in more gloves being unusable when unpacked. CONCLUSION: The powder-free, non-sterile gloves were useful in a wound healing department. The Skinsense Biogel glove showed more advantageous features, less changes for the worse in the skin condition, and was better packed in the containers.

Ambulatory Care Facilities↗
PubMed2000

Incidence of glove perforations in gastrointestinal surgery and the protective effect of double gloves: a prospective, randomised controlled study.

OBJECTIVE: To investigate the incidence of glove perforations during various types of gastrointestinal surgery, to record the incidence of blood contamination of the hands, and to evaluate the protective effect of double gloving. DESIGN: Randomised prospective trial. SETTING: University hospital, Denmark. MATERIAL: 566 pairs of gloves tested on surgeons, assistants, and scrub nurses. INTERVENTIONS: The participants were allocated to wear either single gloves or Indicator double gloves. MAIN OUTCOME MEASURES: The number of glove perforations and the incidence of blood contamination of the hands. RESULTS: The perforation rate in single gloves was 53/306 (17%), and that of both outer and inner Indicator gloves at corresponding sites was 6/260 (2%) (p < 0.0001). Double gloving reduced the rate of blood contamination of the hands among surgeons from 15/115 (13%) to 2/98 (2%) (p < 0.005). CONCLUSION: The use of Indicator double gloves is recommended in gastrointestinal surgery because of the appreciable protection against blood contamination that they offer.

Digestive System Surgical Procedures↗
PubMed1999

[Interobserver variation in the Red-Yellow-Black wound classification system].

Communicating wound descriptions between disciplines for treatment and wound care necessitates a simple and unequivocal classification system. The Red-Yellow-Black (RYB) system has been suggested to comply with these demands. The reliability of the RYB-system has, however only been investigated in small studies. The aim of this study was to determine interobserver homogeneity (group Kappa a.m. Schouten) of the RYB-system and further to examine whether interobserver homogeneity was dependent on educational level. One-hundred-and-twenty photo-slides of non-healing ulcers of various etiologies were shown to 21 observers who recorded their assessments in an entry form without discussing their assessments with the other observers. Eighty-nine percent of the possible assessments were completed. Observed agreement for all observers = 0.65; Kappa = 0.47. Kappa-coefficient in subgroup of nurses = 0.49, subgroup of physicians with less than three years of experience with wound treatment = 0.46 and for physicians with more than 10 years of experience with wound healing = 0.48. In conclusion, we demonstrated moderate interobserver agreement for using the RYB-characteristics. The RYB-system is useful for communication about wound care and treatment. However, continuous education and consensus meetings are advisable to increase agreement.

Humans↗