Roberto Brambilla1, Daniele Aloisi2, Iris Weingard3, Marco Fioruzzi4, Thomas Heisterkamp5, Edith Janthur6, Peter Kurz7, Katrin Will8 1 Instituti Clinici Zucchi (Monza, Italy) 2 Poliambulatotio Mengoli (Bologna, Italy) 3 Venenzentrum Freiburg (Freiburg, Germany) 4 Policlinico San Marco (Zingonia, Italy) 5 Dermatologische-Phlebologische Praxis GESCHER, (Gescher, Germany) 6 Venenzentrum SAARLOUIS,(Saarlouis, Germany) 7 Wund Pflege Management GmbH (Bad Pirawarth, Austria) 8 BSN medical GmbH (Germany)

1. PROBLEMATIC WOUNDS UNDER COMPRESSION
EXPERIENCES IN TREATING LARGE AND/OR INFECTED VENOUS
LEG ULCERS WITH A COMPREHENSIVE THERAPY APPROACH
Roberto Brambilla1, Daniele Aloisi2, Iris Weingard3, Marco Fioruzzi4,
Thomas Heisterkamp5, Edith Janthur6, Peter Kurz7, Katrin Will8
1 Instituti Clinici Zucchi (Monza, Italy)
2 Poliambulatotio Mengoli (Bologna, Italy)
3 Venenzentrum Freiburg (Freiburg, Germany)
4 Policlinico San Marco (Zingonia, Italy)
5 Dermatologische-Phlebologische Praxis GESCHER, (Gescher, Germany)
6 Venenzentrum SAARLOUIS,(Saarlouis, Germany)
7 Wund Pflege Management GmbH (Bad Pirawarth, Austria)
8 BSN medical GmbH (Germany)
EWMA Conference 2013,
16 – 17 May, Copenhagen, Denmark

2. PROBLEMATIC WOUNDS UNDER COMPRESSION
Participants
EWMA Conference 2013,
16 – 17 May, Copenhagen, Denmark
Dr. I. Weingard
Veins center
Dermatologist,
Phlebologist
Freiburg
Dr. E. Janthur
Veins center
Dermatologist,
Phlebologist
Saarlouis
Dr. T. Heisterkamp
Dermalogical-phlebological
center
Dermatologist, Phlebologist
Gescher
Dr. R. Brambilla
Instituti Clinici Zucchi
Monza
Dr. D. Aloisi
Poliambulatotio Mengoli
Bologna
Dr. M. Fioruzzi
Policlinico San Marco
Zingonia
P. Kurz
Wund Pflege Management GmbH
Bad Pirawarth

3. PROBLEMATIC WOUNDS UNDER COMPRESSION
Venous leg ulcers represent the most important group within the family of chronic wounds.
Among them are quite large wounds or multiple smaller wounds with high microbial load.
To find treatment options applicable even for patients with multiple or larger sometimes
infected wounds, various wounds were treated according to a comprehensive therapy
conceptof compression therapy and moist wound care in daily medical practice.
Aim
EWMA Conference 2013,
16 – 17 May, Copenhagen, Denmark

4. PROBLEMATIC WOUNDS UNDER COMPRESSION
Methods
Large oedema
• Phase-adapted moisture management
and antimicrobial treatment without antibiotics by using a hydrophobic
wound dressing
• Reduction of oedema by short stretch bandages with high stiffness
characteristics
Reduced oedema
• Phase-adapted moisture management
and antimicrobial treatment without antibiotics by using
a hydrophobic wound dressing
• Control of oedema by a compression stocking system with
high stiffness characteristics, high working pressure during walking &
comfortably low resting pressure)
Treatment time: 2-12 weeks depending on the wound status EWMA Conference 2013,
16 – 17 May, Copenhagen, Denmark

5. PROBLEMATIC WOUNDS UNDER COMPRESSION
Methods
65 cases of venous leg ulcers in in Germany, Italy, Austria were treated with compression
therapy and moist wound care: oedema reduction by stiff short-stretch compression
bandages, followed by oedema control using a stiff two-layer compression stocking
system*** (40 mmHg) in combination with phase-adapted, moist wound healing** and
antimicrobial control using a hydrophobic wound dressing***.
*JOBST® UlcerCARE Compression System, BSN medical GmbH
**Phase-adapted, moisture management Cutimed® Siltec® /L/B, BSN medical GmbH
***Antimicrobial control using a microbe-binding wound dressing Cutimed® Sorbact, BSN
medical GmbH
EWMA Conference 2013,
16 – 17 May, Copenhagen, Denmark

6. PROBLEMATIC WOUNDS UNDER COMPRESSION
Methods
Compression therapy
Compression stocking
system consisting of an
inner and outer stocking
delivering 40 mmHg in total.
Antimicrobial treatment
without antibiotics by using
a hydrophobic wound
dressing*
Phase-adapted moisture
management**
Compression therapy
(Short stretch
compression bandage)
EWMA Conference 2013,
16 – 17 May, Copenhagen, Denmark
*Cutimed® Sorbact, BSN medical GmbH
**Cutimed® Siltec®/B, BSN medical GmbH
***Comprilan, BSN medical GmbH
****JOBST® UlcerCARE, BSN medical GmbH

7. PROBLEMATIC WOUNDS UNDER COMPRESSION
Results
82 % of all wounds reduced in size significantly,
54 % of all wounds healed completely.
Also larger wounds and multiple smaller wounds were treated successfully.
Very large ulcer could be stabilized but were subsequently mesh grafted to speed up the
healing process.
As the majority of patients had not experienced any progress in healing for extended
periods of time due to their complicated health situation (e.g. underlying diseases, obesity,
signs of infection, skin problems) or inadequate treatments, the healing results were rated
very positively by patients and physicians.
The patients’ well-being was substantially improved leading to high patient compliance.
EWMA Conference 2013,
16 – 17 May, Copenhagen, Denmark

8. PROBLEMATIC WOUNDS UNDER COMPRESSION
August 9 2012
August 9 2012
August 9 2012
October 3 2012
September 26 2012
September 26 2012
68 years, male, smoker, ABPI 1, multiple ulcers around the leg, since 3
months, slough.
EWMA Conference 2013,
16 – 17 May, Copenhagen, Denmark
Multiple Venous Leg Ulcers

9. PROBLEMATIC WOUNDS UNDER COMPRESSION
August 8 2012
April 19 2011
October 12 2012
June 31 2011
EWMA Conference 2013,
16 – 17 May, Copenhagen, Denmark
59 years old, male, adipositas, inhibited perfusion, since 3 months, disturbed
wound healing, signs of infection
82 years, male, hypertension, inhibited perfusion of the leg, ulcer since 3
months, ABPI 1
Large Venous Leg Ulcers

10. PROBLEMATIC WOUNDS UNDER COMPRESSION
Conclusion
EWMA Conference 2013,
16 – 17 May, Copenhagen, Denmark
Even multiple or larger venous leg ulcers can successfully be treated, if a clear
comprehensive treatment concept, consisting of phase adapted moist wound healing,
anti-microbial wound treatment and compression is followed.