Glossary

Glossary

Please select from the menu above

Accelerate range

Leg ulcers, pressure ulcers and diabetic foot ulcers are common wound types and part of the day-to-day reality for healthcare professionals. In response to this problem, Urgo has developed the Accelerate range which is clinically proven to accelerate the wound-healing process, once the wound is clean and prepared for healing.

The TLC-NOSF neutralises the excess proteases present in chronic wounds. This rebalances the wound equilibrium and promotes faster healing. TLC (Technology Lipido-Colloid) creates a moist environment, promotes fibroblast proliferation and ensures non-adherence and pain-free dressing change.

The key benefits of the accelerate range dressing are:

  • Promotes faster healing
  • Is cost-effective
  • Improves patients’ quality of life

This range is indicated in leg ulcers, pressure ulcers, diabetic foot ulcers and longstanding acute wounds

Acute wounds

Acute wounds can be defined as wounds of sudden onset and of short duration. They include surgical wounds and traumatic wounds that may include:

  • Burns
  • Abrasions
  • Bites and scratches

Alginates – Hydrofibres – Hydro-desloughing dressings

These are highly absorbent dressings which are indicated for the debridement of wet slough and necrosis.

The new-generation hydro-desloughing fibres are composed of polyacrylate polymers surrounding an acrylic core for removal of the dressing in one piece.

Ankle-brachial pressure index (ABPI)

Measures the arterial blood supply to the lower limb it is used to help determine the aetiology of a leg ulcer:

abpi

This measurement easily performed as an ambulatory test using a continuous Doppler probe or Doppler ultrasound blood flow detector:

  • In a healthy individual, the ABPI is 1.1.
  • If the ABPI is between 0.9 and 1.3: there is no arterial disease:
    • If an ulcer is present, it is of purely venous origin.
  • If the ABPI is between 0.7 and 0.9: there is concurrent arterial disease.
    • However the ulcer is predominantly venous in origin.
  • If the ABPI is less than 0.7:
    • the ulcer is of predominantly arterial origin.
  • In the event of an ABPI greater than 1.3, the measurement is not significant since this reflects an artery incompressibility problem.

Arterial ulcer

Arterial ulcers occur less frequently than venous ulcers, they arise distally (below) an area of external damage (knock, scrape or other injury) that often goes unnoticed by the patient:

  • On the foot, away from the ankle, heel or ball of the foot
  • Other pressure points

They occur in patients with:

  • peripheral arterial disease, arteriosclerosis, diabetes etc. as a result of poor arterial circulation.

Main clinical characteristics are:

  • round, smooth edges
  • deep “punched out” appearance with necrotic tissue
  • no odour
  • the foot often turns to a pale white/yellow colour when the leg is elevated
  • painful, especially at night exacerbated by raising the limb to a horizontal position (e.g. when in bed)
  • exposure of underlying structures

Assisted desloughing by negative pressure

Assisted desloughing using negative pressure therapy is a method to eliminate exudate and organic waste using pressure lower than atmospheric pressure. This continuous or discontinuous aspiration pressure is exerted through a polyurethane foam or a pad. It is performed using an aspirating motor. The pressure can be adjusted on the basis of wound type: from 50 mm Hg for burns to up to 175 mm Hg for surgical wounds.

It is indicated in the desloughing of difficult-to-heal wounds and to speed up granulation.

Autolytic desloughing

Autolytic desloughing consists in promoting the elimination of waste by softening necrotic tissue and/or absorbing exudate and slough using dressings.

Its indications differ depending on the type of necrosis encountered:

  • dry necrosis: hydrogels
  • moist necrosis: alginates, hydrofibres and hydrodesloughing fibres.

Each one of these dressings has its own specific action depending on the type of necrosis

Average 40mmHg

The recommended treatment for venous leg ulcers requires the application of effective compression therapy. Research has shown that graduated pressure, with a high sub-bandage pressure of 40 mmHg at the ankle is necessary to achieve optimum results (EWMA 2003).

Biofilm

Biofilms are complex microbial communities containing bacteria and fungi. The microorganisms synthesise and secrete a protective matrix that attaches the biofilm firmly to a living (e.g. wound) or non-living surface. Biofilms are dynamic heterogeneous communities that are continuously changing. They may consist of a single bacterial or fungal species, or may be contain multiple diverse species.

A biofilm can be described as bacteria embedded in a thick, slimy barrier of sugars and proteins. A typical example of a biofilm is the yellow slimy film that can be seen on the teeth if left unbrushed. The biofilm barrier protects the microorganisms from external threats. Biofilms can be found in wounds and are suspected to delay healing in some cases.

(adapted from  : http://www.woundsinternational.com/made-easys/biofilms-made-easy)

Biological desloughing

This method results from the observation that some maggots only feed on necrotic tissue. In addition, their movements on the wound are thought to mechanically stimulate healing.

This method can be used on both dry and moist necrosis.

Burns

A burn is an injury to the skin, and sometimes to underlying tissues, caused by contact with heat, electricity, chemicals, light, radiation or friction. Severe loss of skin can lead to infection and loss of the skin’s functions such as thermoregulation and immunity.

Charcoal dressings

Charcoal dressings are odour-absorbing, deodorising the wound by absorbing bacteria and bacterial spores away from the wound.

Chronic wounds

A chronic wound is one that does not heal in the expected time frame (~21 days to a month). An almost permanently inflammatory environment established in the lesion does not allow healing to follow the normal staged procedure. They include:

  • Ulcers
  • Pressure ulcers
  • Diabetic foot ulcers
  • Longstanding acute wounds

Clean range

The procedure of desloughing a wound, can be difficult for clinicians (removing slough without pain and avoiding bleeding) but also unpleasant and painful for patients (manual debridement, bleeding…). For this reason, Urgo Medical has developed UrgoClean, an innovative solution, which prepares sloughy and exuding wounds effectively and efficiently to improve healing.

When in contact with exudate, the hydro-desloughing polyacrylate fibres gel, swell and bind to the sloughy residue within the wound, absorbing and draining it to aid elimination (autolytic debridement). The creation of this gel in contact with the wound, maintains a moist environment, which promotes the healing of desloughed areas and traps exudate preventing any lateral diffusion.

The key benefits of the clean range dressing are:

  • Absorbs and drains slough and bacteria
  • Is removable in one piece
  • Provides atraumatic and painfree dressing changes

This range is indicated for exuding and sloughy wounds (leg ulcers, pressure ulcers, diabetic foot ulcers, burns, skin abrasions, traumatic wounds, postoperative wounds…)

Close range

The UrgoTul range is the first range of dressings to benefit from the exclusive TLC technology (Technology Lipido-Colloid). It combines efficacy, tolerance and acceptability for the optimal healing of wounds regardless of exudate level. The overall objective being to optimise wound healing.

When in contact with wound exudate, Urgotul dressings gel and create a moist environment. This stimulates fibroblast proliferation, ensures non-adherence and pain-free dressing changes which promotes the healing process.

The key benefits of the close range dressing are:

  • Optimises wound healing
  • Ensures pain-free and atraumatic dressing change
  • Promotes fibroblasts proliferation

This range is indicated for wounds in the epithelialization stage (burns, abrasions, traumatic wounds, post-operative wounds, leg ulcers, pressure ulcers, diabetic foot ulcers, epidermolysis bullosa).

Colonisation

Colonisation is the presence of bacteria within a wound without this leading to an inflammatory response.

Most colonisation of acute wounds is by bacteria such as streptococci and staphylococci which are already present on normal healthy skin (commensal organisms).

The bacterial population in chronic wounds is much more varied, including commensal skin bacteria such as Staphylococcus (S. aureus, coagulase-negative staphylococci), Corynebacteria and α-haemolytic streptococci. Following multiplication of microorganisms within the wound and adherence to epithelial cells, an equilibrium is set up between the patient and their microbial flora. The microorganisms remain at the surface of the wound and can form a biofilm.

Contact layers

Interfaces composed of a tight mesh of a synthetic material, coated with a special substance, recommended for use at the end of the granulation and epithelialisation phases.

Debridement/Desloughing

The desloughing phase is the phase that occurs after wound cleaning and once bleeding has stopped.

It eliminates all foreign waste and/or necrotic tissue. Once this elimination phase is complete, tissue reconstruction can begin. In a chronic wound, the desloughing phase is often the healing phase that obstructs tissue reconstruction. The term “desloughing” covers 2 concepts:

  • natural desloughing, which is achieved thanks to our own cells. This is the cleaning process performed by the body itself thanks to our white blood cells or proteolytic enzymes produced by our white blood cells.
  • assisted desloughing is essential when the body’s own cleaning capacities are unable to cope with the quantity of tissue damage (exudate, slough).

Dehisced wounds

Dehiscence means the breaking down, or splitting open of all or part of a wound healing by first intention. This can be caused by systemic factors or local factors e.g. wound closure technique (e.g. suturing too tightly so affecting the vascularity of the skin edges causing necrosis) or infection. The management of any infection in dehisced wounds is vital and the wound is often allowed to heal by secondary intention.

Delayed primary closure

This method of wound closing is used when there has been bacterial contamination. The wound will be left slightly open to allow the free drainage of pus.

After a few days the wound will be closed and then allowed to heal by primary closure. Sometimes wound drains are used to assist the drainage of fluid from the wound. Cavity dressings may be appropriate to pack this type of wound, e.g. alginate rope for absorbency. When dressing this type of cavity wound it is important to manage any exudate and also keep the wound bed moist to protect and aid the process of granulation and healing.

Dermabrasions

These lesions result from scraping the surface layer of the skin, generally this is the result of a fall onto a hard surface and are common sports injuries.

Dermis

The dermis is the living layer of the skin. Highly vascularised, its role is as supporting connective tissue. It is rich in fibres that make the skin elastic and strong. In this living layer there are:

  • Blood and lymph vessels: ensure the movement of the nutrition and oxygen needed by living cells, removal of waste and migration of antibodies.
  • Hair follicles: produce the hairs that protect the skin surface.
  • Sweat and sebaceous glands: sweat glands help remove waste but also are essential for temperature regulation. Sebaceous glands produce sebum that lubricates and softens the skin.
  • Collagen and elastin fibres: provide respectively the strength of the skin and its movement.
  • Fibroblasts: these cells are the major cell type in the dermis producing and secreting procollagen and elastic fibres to form the skin’s structure.
  • Nerves: enable the sensory role of the skin, reacting to heat, cold and pain etc.
  • Macrophages: phagocytic white blood cells that form part of the innate immune system, form part of the body’s primary defence to infection.

Diabetes

Diabetes is a state of hyperglycaemia (high blood glucose) resulting from both genetic and environmental factors. There are two main types of diabetes:

  • Type I Diabetes (10% of diabetics). This form of diabetes is characterised by the complete or almost complete disappearance of insulin secretion by the pancreas. This lack of insulin is responsible for serious hyperglycaemia and will have a fatal outcome if not treated by frequent insulin injections.
  • Type 2 Diabetes (90% of cases) This form of diabetes is characterised by insulin resistance, frequently accompanied with obesity. Sometimes during a long period of time there is no need for insulin treatment if diet is controlled and glucose lowering drugs such as metformin are used. Unfortunately, insulin becomes necessary after several years of evolution.

In both types of diabetes, chronic hyperglycaemia is responsible for long-term complications that explain the high morbidity and mortality associated with the disease.

Enzymatic desloughing

This consists in using proteolytic enzymes to compensate for the concentration of our own enzymes.
This method is indicated for local adjuvant treatment of wounds, skin ulcers and pressure sores during the desloughing phase.

Epidermis

The outermost layer of the skin, the epidermis forms the body’s external barrier, providing the functions of protection and waterproofing. The thickness of the layer varies depending on the area of the body concerned. On average it is 0.5mm thick but can be as much as 5 mm thick on the soles of the feet.

The epidermis is composed of:  

  • stratum corneum or horny layer
  • stratum germinativum
  • basal layer (basement membrane)

Epidermolysis Bullosa

Epidermolysis Bullosa is a rare hereditary disease affecting ~500 000 people worldwide. It is the result of a failure of connection between the epidermis and the dermis. Epidermolysis Bullosa is characterised by the fragility of the epithelium leading to the formation of blisters at the slightest knock or rub.

Epithelisation

Epithelialisation is the last phase of the healing process. Once granulation is complete and lost dermis has been replaced, terminal epithelialisation can begin.
There is no longer a basement membrane so epithelialisation will take place from skin edge to skin edge.
Marginally, the basal cells slide over the surface of the granulation buds through multiplication and generate a neo-epidermis on the surface of the healed wound.
The final scar is not the same as normal skin there are no hair, sebaceous glands, or sweat glands and sensitivity is impaired.

Extracellular Matrix

The extracellular matrix serves many functions, including providing support, segregating tissues from one another and regulating intercellular communication.

Fistula

A fistula is an abnormal track between internal organs (such as between the intestine and the bladder or vagina), between two loops of the intestine, or between an organ and the skin. Care of the surrounding skin is important as exudate may excoriate and irritate surrounding skin. Infection may need to be treated. Fluid drainage and fluid loss will need to be managed, monitored and corrected.

Friction

These are forces applied between two surfaces in contact with each other and moving relative to each other. These forces are often responsible for the initial skin abrasion.

Glycaemia

Glycaemia: level of glucose in the blood.

  • Normal glycaemia in a healthy subject, on an empty stomach, is between 0.7 and 1.1g/l.
  • Hypoglycaemia: below 0.7 g/l.
  • Hyperglycaemia: above 1.1 g/l.
  • Diabetes: above 1.26 g/l.

Granulation

The granulation phase can begin quickly with the proliferation of endothelial cells and fibroblasts leading to the formation of new blood vessels (angiogenesis) and the synthesis of a new extracellular matrix (ECM). As the new ECM is re-modelled, the existing matrix is degraded by a number of proteases, enzymes known as Matrix Metallo-proteinases (MMPs), the MMPs help with autolytic debridement (cleansing) of the wound and cell migration. Their levels increase within the wound after injury and decrease when inflammation subsides.

Fibroblasts then acquire the morphology and biochemical characteristics of smooth muscle cells to become myofibroblasts.

Myofibroblasts are responsible for synthesis of the extracellular matrix and contribute to reorganisation of the ECM as the wound contracts. Re-epithelialisation occurs to close the wound with the migration of epithelial cells starting from the edges of the wound and skin appendages. Differentiation of keratinocytes then helps to restore the barrier function of the epidermis.

Greasy gauzes and impregnated pads

These are composed of a loose mesh of cotton impregnated with a fatty substance and are used mainly in the epithelialisation phase.

Healing by primary intention

First-line healing concerns surgical wounds or surgically sutured traumatic wounds. The first healing phase is reconstruction of skin continuity and corresponds to the time during which the surgeon leaves the suture in place. The sutures are removed after a period of 5 to 15 days. The duration of this period depends on the skin thickness and the tension applied to the edges.

Healing is still not complete when the sutures are removed, because an inflammation phenomenon is observed that can last for up to two months. After two or even three months, the scar will progressively reduce although it will not disappear entirely.

Healing by second intention

The wound is left open. This method may be used when there is considerable tissue loss, the surface area is shallow but large, or where there may have been an infection or a risk of infection (bites). Debridement (desloughing) is nearly always necessary as the first step towards successful healing. Wound healing progresses by granulation, contraction and epithelialisation.

Hydrocellular/foam dressings

Hydrocellular/foam dressings are absorbent, semi-permeable/impermeable polyurethane dressings indicated for the treatment of exuding wounds. There is a broad range of hydrocellular/foam dressings available which are used in the epithelialisation stage (lite hydrocellular/foam dressings).

Hydrogels

Hydrogels release water. They contain more than 80% water and are cohesive so that do not run and stay on the wound. They facilitate the debridement phase for dry fibrin and dry necrosis.

They come in the form of a gel, sheets or impregnated pads. They act by moistening and softening the tissues to make them easier to eliminate.

Infection

The term infection is used when the presence of micro-organisms leads to a local, regional or general inflammatory response with clinical symptoms. Infection will not only delay wound healing it and can also lead to severe systemic complications. Infection always requires treatment with antiseptic or antibiotics.

Local infection or critical colonisation (with signs such as pus, redness, increased exudate or odor) must be differentiated from infection with regional signs (cellulitis) or systemic signs (ie fever.)

Leg ulcer

Leg ulcers may be defined as an open lesion on the lower limb due to full thickness skin loss resulting in chronic wound progression. The ulcer may be surrounded by hard or discoloured tissue with reduced circulation, the state of the skin surrounding the ulcer is extremely important to the outcome, the healthier the surrounding area the greater the success of healing.

Ulcers tend not to heal spontaneously and often reoccur. This can be very incapacitating, especially if complications ensue.  Treating leg ulcers has a high societal cost both in terms of healthcare expenditure and psychological burden upon the patient.

Mechanical desloughing

This is performed using a variety of surgical instruments, such as a scalpel, tweezers, scissors or curette.It consists in excising devitalised tissue from the centre of the wound towards the margins.

Mechanical desloughing is often employed in addition to the use of dressings. It is also used for trimming blisters.

MMPs

MMPs help with autolytic debridement (cleansing) of the wound and cell migration. Their levels increase within the wound after injury and decrease when inflammation subsides.

NOSF

TLC-NOSF (Nano-OligoSaccharide Factor) is a unique technology designed to neutralize excess MMPs (Matrix MetalloProteases), promoting faster healing. The efficacy of TLC-NOSF has been proven in the first double blind RCT in the wound care arena (1), demonstrating that healing is twice as fast with UrgoStart than with a neutral foam dressing.

Perforating diabetic foot ulcer

This is a chronic, painless and clean ulceration that develops because of vascular, neurological and metabolic disorders in diabetes. Diabetic foot ulcers are usually located under the head of the 2nd or 3rd metatarsal bone or on any other point of normal or abnormal pressure on the underside of the foot. They can be readily complicated by infections, abscesses or osteitis and frequently result in amputation if untreated.

Pressure

Pressure is a perpendicular force applied to a specific area of living tissue. This pressure is applied particularly on bony prominences, where soft tissues between the bone relief and the underlying support are compressed. These forces correspond to the distribution of the body weight over the contact surface area.

Pressure system

The PresSure system is bandage application technology exclusive to UrgoMedical, which aids the application of the two layer compression bandage system, UrgoK2 enabling healthcare professionals achieve the correct, recommended therapeutic pressure (average 40 mmHg) every time, from the first application.

Pressure ulcers

A pressure ulcer is caused by unrelieved and prolonged vascular compression on a specific area of the body, usually a bony prominence, from a supporting item such as a bed or chair. The ulcer forms when there is ischaemic necrosis (lack of blood supply) of the skin and subcutaneous tissue.

Pressurised jet desloughing

This is performed using water jets of variable pressures depending on the type of system. The level of wound desloughing varies according to the pressure delivered: the wound can be cleaned at low pressure or the tissue trimmed at high pressure.

Pressurised jets are used in addition to other desloughing methods.

Primary closure

The skin edges are held together using sutures, clips or tapes. This allows the skin edges to seal with fibrin and epithelialise very quickly providing a barrier to the entry of bacteria.

Usually a simple island dressing to keep the wound free from infection will be appropriate.

Proliferation of fibroblasts

On contact with wound exudate, the hydrocolloid particles hydrate and swell to form a lipido-colloid gel, creating a moist environment in the wound bed. This moist environment offers optimal conditions for cell multiplication.

During skin repair, fibroblasts (key cells in the wound healing process), within the wound area, proliferate and synthesise the extracellular matrix to form new granulation tissue.

The fibroblasts are then differentiated in situ into myofibroblasts which bring the edges of the wound together, due to their contractile properties.

The unique physicochemical properties of TLC encourage fibroblast proliferation which supports the healing process.

Proliferation of fibroblasts

On contact with wound exudate, the hydrocolloid particles hydrate and swell to form a lipido-colloid gel, creating a moist environment in the wound bed.

During skin repair, fibroblasts (key cells in the wound healing process), migrate within the wound area, proliferate and synthesise the extracellular matrix to form new granulation tissue.

The fibroblasts are then differentiated in situ into myofibroblasts which bring the edges of the wound together, due to their contractile properties.

The unique physicochemical properties of TLC encourage fibroblast proliferation which supports the healing process.

Purify range

Preparation of the wound bed is necessary to ensure healthy healing. The silver ion has a broad spectrum antimicrobial activity with a mode of action which minimises the risk of resistance. In this context, Urgo has developed a wide range of silver dressings to manage wounds at risk of infection, clean the wound bed and ensure that healing progresses without the risk of infection from pathogens.

When in contact with wound exudate, TLC-Ag (Technology Lipido-Colloid with silver) dressings gel, creating a moist environment. This promotes the healing process and ensures non-adherence and pain-free dressing change. The silver salt is broken down in contact with wound exudate, and the TLC Ag acts as a reservoir which continuously releases a bactericidal concentration of silver ions whilst in contact with the wound.

The key benefits of the purify range dressing are:

  • Broad spectrum antibacterial efficacy, including MRSA, when in contact with the wound bed
  • 99.9% removal of biofilm after 24 hours (Pseudomonas Aeruginosa, Staphylococcus Aureus)
  • Pain-free dressing change

This range is indicated for wounds at risk of infection: chronic wounds (pressure ulcers and leg ulcers) and acute wounds (partial-thickness burns, dermabrasions, traumatic wounds, surgical wounds, etc).

Randomised controlled trial

A Randomised Controlled Trial is the best type of evidence required by Heath Authorities.
  • “Randomised” means that patients are chosen at random to be in one group or the other.
  • “Controlled” means that the treatment is tested against another treatment that has proven efficacy.

Shear

These are forces that cause slip and torsion of the subcutaneous layers. They exist especially in an unstable semi-seated position in which subcutaneous layers are subject to a kneading type force.

Silver

The Ag+ ion reacts rapidly with the DNA of the bacteria by replacing the hydrogen atoms which connect the two nitrogen atoms belonging to two opposite bases on the DNA molecule chains of the bacteria.
This replacement by silver blocks duplication and bacterial replication.
The bacteria are then unable to reproduce, and protein synthesis is blocked.

Silver salts

Silver salts are used in the treatment of wounds with high bacterial colonisation due to their antibacterial and local anti-inflammatory properties.

Silver is only active in its Ag+ ionic form. It is unique in this classification since it is neither a genuinely antiseptic nor a genuinely antibiotic treatment and for this reason it is classified as an antibacterial agent. The silver ion has a broad spectrum of activity that covers most micro-organisms associated with the colonisation of chronic wounds. It acts on numerous targets and is bactericidal at very low concentrations, thereby minimising the potential risk of resistance:

  • bactericidal action of the Ag+ ion
  • many actions targeted at bacteria
  • inhibits the bacterial DNA replication process
  • reduces the bacterial-cell wall strength
  • increases the permeability of the bacterial cytoplasmic membrane
  • inhibits the respiratory enzymes causing asphyxia of the bacteria

It is important to note that silver has no cytotoxicity that hinders the healing process.

Sinus

A sinus is a track to the body surface from an abscess or another irritant such as suture material and can be a focus for infection. Sinuses can become chronic and it is difficult to identify the root of the problem. A wide excision of the sinus is often the most appropriate treatment to allow any drainage of pus.

Skin grafts

Skin grafts are widely used in reconstructive surgery often following trauma or burns. Skin grafts may also be used to repair chronic wounds e.g. pressure ulcers or leg ulcers. Skin grafting is a technique that transfers a portion of skin from one part of the body to another part of the body.

There are several classifications of skin grafts:

  • Autografts- graft of the patient’s own skin
  • Allografts- graft taken from another individual
  • Xenografts- graft taken form another species

It is important that a graft ‘vascularises’ or ‘takes’, non-adherent dressings to protect the graft, manage pain, and manage any initial exudate are necessary.

Standard hydrocolloids

Hydrocolloids are the pioneers of moist wound healing and are composed mainly of carboxymethylcellulose. They have the characteristics of absorbing, swelling and then gelling.

They are recommended for use in the granulation and epithelialisation phases (thin hydrocolloids).

Sulphadiazine

Sulphadiazine plays an important role in the topical efficacy of silver sulphadiazine. By virtue of its pyrimidine nucleus, sulphadiazine facilitates the movement of the Ag+ ion through the bacterial membrane. It induces cell changes: distortion, weakening of the cell membrane, and permeability problems.

Surgical cavities

A surgical wound is a skin incision made with the objective of eliminating a skin lesion or creating a path for reaching deep organs under the sterile conditions of the operating theatre.

Surgical cavities are generally clean wounds with a healthy bed that should heal without complication. They are created at the time of surgery when the surgeon has decided that healing should be by secondary intention. Normally undertaken when there is extensive tissue loss which would prevent primary closure of the wound, or because the wound is heavily contaminated, or was infected at the time of surgery.

Reference: Pudner R. Managing cavity wounds Journal of Community Nursing March 1998

Surgical desloughing

Surgical desloughing is a surgical procedure.It makes it possible to remove all necrotic tissue in the event of difficult wounds. If the wound is infected, it can be used to eliminate all infected tissue. In general, it is used for wounds for which desloughing is impossible using a gentler method.

The indications for this method are all necroses that cannot be eliminated using easier methods.

Tangential removal

To remove Algoplaque/Algoplaque Thin, stretch the dressing by pulling each side and it will lift slowly and gently from the wound.

TLC

TLC is a healing matrix incorporating hydrocolloid and fatty substances. It creates a favourable moist environment for healing wounds, encourages the natural proliferation of fibroblasts and optimizes skin cell organization. The TLC healing matrix enables harmonious reconstruction of the dermis and epidermis. TLC dressings do not adhere to the wound, enabling atraumatic treatment and painfree removal. The benefits of TLC dressings have been clinically proven in more than 36, 000 patients.

TLC

TLC is a healing matrix incorporating hydrocolloid particles and fatty substances. It creates a favourable moist environment for healing wounds and optimizes skin cell organization. The TLC healing matrix enables harmonious reconstruction of the dermis and epidermis. TLC dressings do not adhere to the wound, enabling atraumatic treatment and painfree removal. The benefits of TLC dressings have been clinically proven in more than 36, 000 patients.

TLC-Ag

TLC-Ag is the combination of Urgo Medical’s unique Technology Lipido-Colloid (TLC) with the antibacterial action of silver salts for the management and prevention of infection.

The benefits of TLC-Ag Technology are:

  • Broad spectrum antibacterial efficacy, including MRSA
  • 99.9% removal of biofilms after 1 day (Pseudomonas aeruginosa, Staphylococcus aureus)
  • All the benefits of TLC Technology

TLC-Ag dressings are indicated for the local treatment of acute and chronic wounds at risk of infection.

TLC-NOSF

TLC-NOSF is the combination of Urgo Medical’s unique Technology Lipido-Colloid (TLC) with NOSF (Nano-Oligo Saccharide Factor), a compound with a chemical structure derived from the oligosaccharide family with known anti-proteinase properties. Combined with the other ingredients in the TLC healing matrix, NOSF preferentially binds to the damaged zones, exerting its anti-metalloproteinase activity.

The benefits of TLC-NOSF Technology are:

  • Faster wound healing
  • Cost-effective treatment
  • Improvement of patients’ quality of life

TLC- NOSF dressings are indicated for the local treatment of leg ulcers, pressure ulcers, diabetic foot ulcers and longstanding acute wounds.

TLC-NOSF Start

TLC-NOSF is the combination of Urgo Medical’s unique Technology Lipido-Colloid (TLC) with NOSF (Nano-Oligo Saccharide Factor), a compound with a chemical structure derived from the oligosaccharide family with known anti-proteinase properties. Combined with the other ingredients in the TLC healing matrix, NOSF preferentially binds to the damaged zones, exerting its anti-metalloproteinase activity.

The benefits of TLC-NOSF Technology are:

  • Faster wound healing
  • Cost-effective treatment
  • Improvement of patients’ quality of life

TLC- NOSF dressings are indicated for the local treatment of leg ulcers, pressure ulcers, diabetic foot ulcers and longstanding acute wounds.

The efficacy of TLC-NOSF has been proven in the first double blind RCT in the wound care arena (1) , demonstrating that healing is twice as fast with UrgoStart than with a neutral foam dressing.

Traumatic wounds

Types of acute trauma involve a variety of wounds depending on the cause. These wounds can have an impact on bodily systems and incur massive skin loss or they can on the other hand, have little effect. Examples of traumatic wounds are skin tears, fingertip injuries, abrasions, lacerations, blisters, gunshot wounds, stabbing and nail avulsions.

Type 1 Diabetes

The type I Diabetes (10% of diabetics) is characterised by the complete or almost complete disappearance of insulin secretion by the pancreas. This lack of insulin is responsible for serious hyperglycaemia and will have a fatal outcome if not treated by frequent insulin injections.

Type 2 Diabetes

The type 2 Diabetes (90% of cases) is characterised by insulin resistance, frequently accompanied with obesity. Sometimes during a long period of time there is no need for insulin treatment if diet is controlled and glucose lowering drugs such as metformin are used. Unfortunately, insulin becomes necessary after several years of evolution.

Ulcer of mixed aetiology

Mixed ulcers are the result of a combination of both venous and arterial disease. They are complex and can change their character rapidly e.g. when the arterial disease is rapidly progressive. If the arterial disease is left untreated because it is progressive the arterial problem will eventually be the major factor to consider when making treatment decisions.

Venous ulcer

Venous ulcers are the most common type of vascular ulcer.They occur predominantly on the lower limb above or in the vicinity of the malleolus (ankle).

The main clinical characteristics of venous leg ulcers are:

  • Shallow with irregular wound margins:
    • the skin around the ulcer is frequently discoloured
    • the presence of oedema may cause skin shininess and tightness of the surrounding skin
    • the skin temperature may be elevated to  touch
  • The ulcer itself may be:
    • red coloured with or without fibrin.
    • infected, the presence of discharge is suggestive of bacterial colonisation.
    • have significant exudate.

Important signs to look for include; lack of necrosis, non-deepening nature, presence of peripheral pulse.

  • 30 to 50% of all venous ulcers are post-thrombotic. Here the deep venous trunks (deep veins) are affected, unlike varicose ulcers, post-thrombotic syndrome develops gradually and will continue to deteriorate without treatment.

This type of ulcer is becoming less frequent due to improved prevention of phlebitis (vein inflammation) over the past 15 years.

Wallace’s Rule of Nines

The extent of burns to the total skin surface can be estimated fairly accurately in adults using the Wallace’s Rule of Nines where each body part is considered to account for 9% of the skin’s surface area:

  • head and neck total for front and back: 9%
  • each upper limb total for front and back: 9%
  • thorax and abdomen front: 18%
  • thorax and abdomen back: 18%
  • perineum: 1%
  • each lower limb total for front and back: 18%

In children body proportions are different from those of adults, so the Rule of Nines has to be adapted depending on the age of the child.

Last update : October 20, 2017