Absorption of exudate

Here we distinguish
1.) the application as a wound dressing: LIGASANO® white has contact only to one side of the wound. The absorptivity depends on the viscosity of the exudate (our measures were made with water) and amounts to approximately 30 volume per cent and 1500 weight per cent respectively; alternatively 0.3 ml/3.
2.) the application as a wound insert: LIGASANO® white has contact to all sides of the wound, the absorptivity here amounts to about 90 volume per cent and 4500 weight per cent respectively; alternatively 0.9 ml/cm3.

 
 
Absorpitve capacity
See wound cleaning
 
 
Adhesion with the wound

Basically LIGASANO® doesnīt adhere to wounds, because itīs always a moist wound care (see also Promotion of blood flow ). Sometimes it can happen in practice though, that LIGASANO® adheres to wounds persistently. In the following you get a chart about the causes known to us and their countermeasures:

 
Causes Remedial measures

The LIGASANO® padding is thinner than 2 cm, therefore too much air comes to the wound, the exudate evaporates too fast and dries up.

LIGASANO® should be at least 2 cm thick, as measured from the bottom of the wound, to ensure a moist and warm environment.

LIGASANO® has partly no wound contact, exudate cantīt be absorbed and adheres on the one hand to the wound and on the other hand to LIGASANO®.

Please keep always an eye on wound contact on the whole surface. Therefore insert LIGASANO® with slight compression into the wound. Donīt fear compression! (see Pressure tension)

In the case of wounds which discharche only less, as superficial burns or abrasions, the issued blood resp. exudate may dry up.

In most cases it is helpful to moisten LIGASANO® on the side of the wound, e.g. by Ringerīs solution, to increase the moisture content.

Additional ointments, gel or drugs which are drying out, are used at wound treatment. They adhere with skin resp. wound and LIGASANO®:.

In single cases this adhesion is desired. By the adhesive effect of the gel an accelerated debridement shall obtain.>br>If this adhesive effect is not desired, please examine whether ointment, gel or drug is really neccessary or whether an other preparation is on-hand.

Additional ointments, gel or drugs are used, that have a desiccant effect on the wound itself. A moist and warm wound environment canīt develop.

Please examine if ointment, gel or drug is really neccessary or whether another preparation, that isnīt desiccative, is on-hand.

During the granulation phase LIGASANO® was too long into the wound; regenerated tissue is sprouted into the cell structure of LIGASANO®.

At the treatment with LIGASANO® wounds often granulate surprisingly quick and vigorous. In such cases please shorten the interval of dressing change reasonable.

 

Generally: should LIGASANO® adhered to a wound, please dry it from the outer side and press the wet with pumping movements into the material, so that it softenes the dehydrated blood or exudate as far as LIGASANO® can be removed easily.

 
 
Air permeability

LIGASANO® white is partly permeable to air. Therewith from a thickness of 2 cm on a sufficient thermical isolation is guaranteed, without hindering the exchange of gas during the wound treatment.

LIGASANO® green is nearly completely permeable to air. There is no thermical isolation, regarless whether the thickness.

 
 
Allergy

By the present knowledge LIGASANO® white is allergy neutral. However skin reaction appear occasionally.

  • Reddening of the skin is a typical side effect of a better blood circulation.
  • Vesiculation is rare seen, always in connection with heavy perspiration. Counter measures see Perspiration on LIGASANO®.
  • Sore skin can come into being, if there is heavy friction (caused by movements) between LIGASANO® and the skin.
    Counter measure: Save LIGASANO® toward displacing with skin, fix it at the body. See also
    Fixation of LIGASANO®.
  • Cutaneous manifestations by simultaneous use with other preparations, see Ointments, interaction with LIGASANO®.

 
 
Application forms
Please klick here.
 
 
Azo dye
In LIGASANO® not contained.
 
 
Change of dressing

During the phase of wound cleaning the wound mostly weeps strong - and thatīs the way it should be! The fluency of exudate cleans the wound from the depth through the pores of the wound ground, even dry necroses are dissolved and flushed out.

  • During the phase of wound cleaning the LIGASANO® dressing must be changed at the latest when exudate appears at the outside. On the average two times daily, but differs individually.
  • The cleaner the wound the less more it weeps. Now it donīt need to clean itsself, but only stay clean. Change of dressing one time daily up to one time all 2-3 days.
    (Our recommendation is one time daily. So you can ensure that granulation tissue canīt grow in LIGASANO®)

See also Repose of the wound - disturbation of the wound by change of dressing
 
 
Chronic wounds

Wounds which donīt clean or only badly. The cause are wound healing impairments (see also Wound healing impairments) that must be treatened, to reach the wound healing.

 
 
Contra-indications

LIGASANO® is neutral to allergies, stimulates the blood flow in the skin-to-skin contact through its mechanical stimulus; it has a controlled absorption effect and a quickly reducing compressive stress. These effects have to be considered in every application. In the case of carcinoma the promotion of blood flow could have a negative effect; but real contra-indications are not known to us.

 
 
Cost

You have to differ between

  1. pure product costs per piece
  2. product costs per application
  3. product costse per day
  4. product costs per therapy until success
  5. total costs incl. personell cost until success of therapy.
    In the case of clinical accomodation the determining expense factor might be the timer after which the patient can leave the hospital.

All in all the items 1 to 4 are meaningless if the balance in item 5 comes out positive. A real serious comparison is certainly only possible at item 1 to 3, because item 4 and 5 is dependent decisively upon the general environment and the condition of the patient. There is a endless number of different preconditions, two real comparable patients are hard to find.
An example of an investigation regarding to cost and success of the LIGASANO® - Therapy in comparison is drawn up by Dr. med Carola Zemlin. Please click
here to get more.

 
 
Deep wound with narrow opening

Deep wounds with narrow opening, e.g. fistlulae or wounds with pockets, tender to heal superficial and to encapsulate an infection. The after-effect is, that the wound bursts open after a short time, possibly at another point of the body surface. The goal is, that the wound really granulates from bottom to top resp. from the inside to the outside. Therefore the wound dressing always has to reach down to the bottom of the wound.
This kind of treatment is often very painful because during tamponing and removing of the dressing a lot of friction arises, that can also hurt the granulation tissue. Differently the LIGASANO® - wound band.

 
 

Completely fill out the wound with the LIGASANO® - wound band (art. 15370) with slight compression.

Firstly explore direction and depth of the wound, so that you can reliable reach the bottom of the wound. Generously cover the wound environment with a LIGASANO® sheet, 1-2 cm thick.

The wound strip should assume a zigzag pattern in the wound.

Changing the wound dressing is quick and simple. A premature, superficial closure of the wound will prevented.

 
 
Durability of LIGASANO®

It is almost the same as in the case of salt and pepper; they also need a durability date. Theoretically LIGASANO® would be durable endless, if it is reliable protected against UV radiation and moist. From the production date on we guarantee a durability of 5 years, if it is stored in an appropriated way. Donīt apply LIGASANO®, if it is yellowed or if it crumbles.

 
 
Exsudate management

At the moment an often used term that sounds good but says nothing but exudate is absorpted by a suitable wound dressing. The earlier term for this was absorption ability or effect. In connection with LIGASANO® we speak about controlled absorption effect (see Wound cleaning ).

 
 
Fistulae

Fistulae are best treated with the LIGASANO® (white) wound band. The sterile wound strip with the size 300 x 2,5 x 0.4 cm can easily applicated with a pair of forceps and it assumes a zigzag pattern in the wound. If the fistula isnīt ramified too much, you can treat the wound without chirurgical intervention.
The especially advantages of the treatment with the wound band you can find under Deep wounds with narrow opening

Schematic description of an exemplary fistula treatment with LIGASANO® (white) wound band sterile (art. 15370) 300 x 2,5 x 0.4 cm.

Illustration 1:
The wound strip is applicated in the deeper canal of the fistula by a pair of foreceps, until the end of the branch.

Illustration 2:
Roll off a part of the wound band (ca. as long as the second canal of the fistula is deep) and move it until the branch. Fill out the canal of the fistula as described in illustration 1.

Illustration 3:
At last fill off the common canal.

Procedure otherwise as described in
Deep wounds with narrow opening. Please pay attention to our users manual.

 
 
Fixation
In every case the fixation of LIGASANO® (white) must be permeable to air, never occlusive.
Here are some possibilities, with the autorīs subjective assessment.
 
 

Practice score D


Fixation with adhesive plaster strips

Poor adhesion, may exert traction on small areas of skin.
Even "skin-friendly" plaster strips place stress on the skin on removal.
 
 
 

Practice score C


Large-area, air-permeable adhesive plaster
e.g. Fixomull stretch


Relatively expensive, good adhesion, stress on skin on removal.
 
 
 

Practice score B


Stretch net pants, fixation pants, tubular net bandage, tubular bandage

No stress on skin, simple to change, can be reused.

Disadvantage: Generates traction on textiles; when the patient moves in bed, fixation and LIGASANO® may shift.
 
 
 

Practice score A


Nylon stockings or parts of it

Very low-priced (-.40 to -.90 €), may be reused.
The cheapest nylons are the best quality for this application, because they are wide-meshed and air-permeable. May be cut as required, thus replacing any fixation pants and tubular bandages.
Advantage: The nylon material slides smoothly over textiles, but adheres to LIGASANO®. Even when the patient moves around in bed, LIGASANO® remains in place.
 
 
Foam

Foamed (=expanded) plastics (EPS, EPP, PVC, PVA, PUR, etc.) are usually named foam. Other foamed (expanded) materials are in language use named e.g. "foam rubber" (=latex), "cellular caoutchouc" resp. "cellular rubber". At bakerīs ware, for example bread, rolls, pastries, etc. it concerns foamed (=expanded) dough.

 
 
Foam for wound dressings

For wound dressings made of foam, for the most part polyurethane (abbrev. PUR) has become accepted. PUR foam has the outstanding advantage that it can be produced in endless many variations (density, elasticity, cell size, cell structure, hydrolysis properties, etc.). Mainly used are are in continuous processes made polyurethane- and polyesterurethane soft foams.
Favourable basic properties the most of the various preparations have common, although in different weighting: lightweight, easily cut to fit, good mechanical and thermic protection, absorptivity, permeable to air.
Despite this common ground the various preparations are hardly comparable concerning the effect, because the various vendors pursue different aims with their product offer and their product properties (this shall often get at material combinations).
LIGASANO® white and LIGASANO® green are mono products with clear defined but each with completely different properties.

 
 
Gel and LIGASANO®
See below Ointments
 
 
GREEN CLIMATE GRID®

An alternative Term for LIGASANO® green

 
 
History LIGAMED®, LIGASANO® white, LIGASANO® green

LIGASANO® was developed from the then medical superintended of the Dermatological department of the Klinikum Nuremberg and his assistant medical director Dr. Karl-Heinz Galli. This was at the end of the 7th decade in the last century.
Since 1985 LIGASANO® is developed of the LIGAMED® medical Produkte GmbH. Up to this day there is no comparable product on the market, neither with regard to effectiveness nor with regard to the wide and poor-risk applicability.

 
 
Latex
LIGASANO® is free of latex.
 
 
LIGASANO® green

Main field of application: ventilation of the skin, air-conditioning of the skin, patient positioning
Chemically full cross-linked polyurethane (PUR) with the following main properties

  • almost completely permeable to air
  • no temperature insulation
  • properties are similar to a three-dimensional sieve
  • durable elasticity
  • washable, disinfectable, sterilisable
  • medical product regarding to MDD 93/42 EWG class IIb

 
 
LIGASANO® white

Main field of application: wound healing, prevention, care of the skin
Chemically full cross-linked polyurethane (PUR) with the following main properties

  • local promotion of blood-flow in contact with wound or skin (see Promotion of blood flow )
  • wound care easy and quick by fast decrease of pressure tension (see Pressure tension )
  • controlled absorption effect. Surplus of exudate is absorbed reliably, the wound stay moist-warm at every ime.
  • no adhesion with the wound
  • protection against environmental effects as temperature, germs, push, pressure
  • moderate permeable to air
  • available low-germ or sterile, sterilisable at place with steam at 134°C / 3 minutes
  • neutral to allergies
  • medical product regarding to MDD 93/42 EWG appendix 2, class IIb

 
 
Mechanical stimulus (see also Promotion of blood flow )

While LIGASANO® white is in contact with wound and skin it produces by its surface properties and the involuntary motions of the body a mechanical stimulus that promotes the blood flow.

 
 
Modern wound care

A modern term used for wound dressings with additional properties. Example: Hydrocolloides, alginates, activated charcoal dressings, etc. Especially in the case of chronic wounds this term diverts from the really necessary measures. It seem like the "modern wound care" in fact could heal wounds. but this is naturally incorrect. (see Wound healing impairments ). Fact is that you have to make the patientsīorganism able to heal the wound. On chronic wounds you have to give your special attention to remove the wound healing impairments.
This "modern wound treatment" that is placed into the foreground, fulfils in the process of wound healing only a secondary task.

 
 
Moist wound care (see also Adhesion with the wound )

The LIGASANO® wound treatment is always a moist wound care. The moist isnīt brought in from outside, as many other preparations do, but is generated in the wound itsself.
See also
Promotion of blood flow.

 
 
MRSA - Methicillinresistant Staphylococcus aureus

Staphylococci, Staphylococcus aureus too, belong to the normal colonists of skin and mucous membranes. About 20 to 60% of the people take in this germ in a relatively great number in the nasal and pharynx area. In the case of medical stuff you have to proceed even greater carrier rates. On the other hand staphylococcus aureus can under certain circumstances cause life-threatening infections. As a typical pyogenic germ it can take part in the developement of abscesses, furuncles, wound infections and impetigo contagiosa. Moreover this germ can cause osteomyelitis (inflammation of the bone marrow), pneumonia (inflammation of the lungs), sepsis (blood poisoning) and endocarditis (inflammation of the heart muscle).
When during the fifties penicilline wasnīt applicable for the therapy of staphylococcus aureus infections because of the occurence of penicillase-developing strains, at the beginning of the sixties there are available effective substances (e.g. Oxacillin, Methicillin) again. But already at the beginning of the sixties was reported about methicillin-resistant strains from England. In the sequel it came to many similar announcements worlwide.
In Germany now we must proceed that around 5% of the inhabitants is colonised with such a strain - with an evident spreading at seniors. In nursery homes you have to expect a much more higher carrier rate.
The problem of methicillin-resistant staphylococcus aureus strain doesnīt lie with its especially dangerousness in comparison to sensitive strains, but therein that there are only a few antibiotics (e.g. Vanomycin or Teicoplanin) for the therapy of serios infections.
Healthy persons, which are only colonised with methicillin-resistant staphylococcus aureus strains or have contact to respective carriers, arenīt threatened themselves. On this account there is no reason to refuse accomodating MRSA carriers in a nursing home or to deny the return of a hospitalised patient from the hospital back to nursering home. At any rate tracheostoma patients need a special attention: you have to clarify a possible MRSA carrier state. It is of greatest interest, that sanitary measures at the care of all inhabitants will consequently carried out for hindering the dissemination of these resistent germs.
Several measures that are recommended for the hospital, canīt practice in nursery homes, because its inhabitants do permanent live in the facility and not only for a short time. Present studies have shown that a durable sanitation of hospitalised MRSA carriers can probably only be achieved by very special requirements. As the local health department of Stuttgart (Germany) takes it, a routinely screening of all inhabitants of a nursing home is for this reason not suggestive and should only be made in the case of epidemic appearance.
However it is indispensable to protect a dissemination of these potential pathogenes in the nursery homes by adequate sanitary measures. Also the mutual information about such patients helps to defuse the problem.

Source: health department
 
 
Nutrition

A dietetic treatment that is abounding in nutrients esp. in albumines, may help to dam up bed sores, reports Marion Hönig, a oecotrophologist of the German society for nutrition medicine and dietetics in Bad Aachen, Germany. According to an topical study of the Humboldt University in Berlin (Germany), 37% of the patients in the contacted hospitals and even 65% of the inhabitants of nursery homes are endangered to get a pressure ulcer.1
Specific therapy measures, among other things a protein-rich food, counteract the disturbed wound healing. An optimal nutrition during the therapy or prophylaxis of a decubitus consists of food rich in albumin, sufficient hydration, dose of zinc, vitamin B12 and if necessary a multivitamin preparation, explains Hönig. Also expedient is the application of immuno nutrients, that contains immunological effective nutrients as arginine, RNS-nucleotides and omega-3-fatty acids. Furthermore are recommended balanced diets as drinking fluids, which are developed especially for persons with pressure ulcers; they contain nutrients that are indispensable for the wound healing. The deficiencis of nutrients can be asserted by laoratory parameters in blood and urine. First of all the proteine albumin is essential for the healing of wounds.2 As soon as a balance of the deficit takes places, it has an positive effect on the wound healing.


1 http://www.charite.de/ch/pflege/forschung
2 http://www.hartmann.info/shortcuts/literatur.html
 
Leaflet Appropriate Diet
 
 
Ointments, change of potency of LIGASANO®

Ointment or gel can constipate the pores of LIGASANO® and change the nature of its surface. The controlled capillar effect and the desired mechanical stimulus may influenced negatively or even abolished.

 
 
Ointments, durability of LIGASANO® against

By the concurrent use of ointments, liquors, etc. you have to check if LIGASANO® is persistant against it.
Apply ointment or liquor on LIGASANO®, pack it shut tight in a foil and store it warm. If there is no visible change on LIGASANO® after 24 hours, you can draw the conclusion that LIGASANO® is durable against these preparate.
Normally the durability of LIGASANO® against preparates that are used on the skin, is given. At least we havenīt got any other information, yet.

 
 
Ointments, solutions, drugs: interaction with LIGASANO®

As a matter of principle there are no interactions of ointments, solutions and drugs with LIGASANO®. However ointments or liquors may cause different effects by different circumstances.
There is a difference whether the preparate is applicated to skin that is exposed to the air or the patient lies onto the treated body region. In the first case no accumulation of heat, sweat and evaporated active substances comes into beeing; but in the second case there is an accumulation that maybe could change or strengthen the effects of the preparate up to an undesirable degree.
If a preparate is used in the resting area, LIGASANO® green is very helpful, because it can avoid or at least reduce accumulation of heat and moist.
!! Gel, ointments and some drugs tend to run dry, if applicated on skin or wound and therefore promote the drying out of wounds. This can lead to adhesion of LIGASANO® with the wound.

 
 
Perspiration on LIGASANO®

By skin contact with LIGASANO® white the local blood flow is promoted; in the case of lying patients this leads to a normalisation of the body temperature. (At lying position the blood circulation doesnīt need to overcome gravity, because heart and circulation are at the same level. The blood pressure is falling, especially peripheral the body temperature declines for about 1° C.)
This local promotion of blood flow is one of the therapeutical basic approaches by the use of LIGASANO® to enable a better supply with nutrients, oxygene etc.
As everyone knows, sweating is the bodyīs air-conditioning system. The flowing-out moist shall evaporate at the surface of the skin to produce the cooling effect. Naturally this can only function, if enough (with moist unsaturated) air reaches the skin. It also functions in the seating and resting areas quite good, if
LIGASANO® green is laid between, because this material is almost completely permeable to air; imagine a three-dimensional sieve.

 

For an optimal effect please pay attention to the following:

  1. LIGASANO® green shall not compressed completely, therewith air can circulate.
  2. LIGASANO® green shall not covered lateral, therewith air in the area of application can exchange itself with the ambient air.

 
 
Polyurethane

One of the "silver bullets" in the plastics industry with nearly unlimited possibilities in variation and use. LIGASANO® white and LIGASANO® green are polyurethanes.

 
 
Prescription of LIGASANO®

In Germany LIGASANO® white, LIGASANO® green and LIGASANO® black are dressings able to prescribe, if they are prescribed and used as such ones.
According to § 31 section 1 phrase 1 SGB V insurants have the right to be supplied with pharmacons, obtainable only at the chemistīs, as far as these pharmacons are not excluded according to § 34 or by directives according to § 92 section 1 phrase 2 no. 6, and to be supplied with dressings and test strips for urine and blood.
LIGASANO® white, LIGASANO® green and LIGASANO® black are neither pharmacons nor medical products similar to pharmacons, but medical products, which are used as a dressing.
According to the above named § 31 dressings are able to prescribe and arenīt subject to the preclusion rule according to § 34.
The insurants have to remit an additional payment for dressings, that is calculated according to § 61 phrase 1.

 
 
Pressure tension

"Pressure causes an identical counter-pressure", accordingly Newton says. If an elastic material is deformed under pressure, it presses back with the same counter-pressure. This is called pressure tension.
LIGASANO® (white) has the property to get used to the new form, that is created by the pressure. To say it in a technical way: LIGASANO® (white) looses a lot of its pressure tension.
If you apply LIGASANO® with compression (max. 50% deformation) into the wound, the greater part of compression gets lost after short time. What remains is the contact to skin resp. wound.
Thus you can dress wounds quick and easy.

 
  Wound care quick and easy
  Always cut LIGASANO® (white) somewhat larger than the wound diameter and somewhat thicker than the wound depth and insert it into the wound with slight compression.
 
  
  The goal: wound contact on the complete surface
  
 
  
 Compression is reduced rapidly, the required contact remains.
 
 
Promotion of blood flow
 

Poor blood circulation is the most frequent cause for the development of chronic wounds and simultaneous the main cause, why this kind of wounds heal not or only badly. See also Wound healing impairments.
If a region of the body is not or not enough supplied with blood, it becomes necrotic or a wound developes, that doesnīt heal up.
LIGASANO® white causes a local promotion of blood flow where it has contact to skin resp. wound and therefore reduces the risk to develope a wound caused by poor blood flow or promotes its healing in all phases of wound healing. By the size of application beyond the wound resp. risked area the effect of the local measure is added. The supply of the wound with nutrients, oxygene and antitoxines is improved, products of metabolism are carried off. The cleaning of the wound from germs, coats and even dry necroses is achieved by a naturally strengthen sectretion of the wound. See also
Wound cleaning.
The effect to stimulate the blood flow is achieved by a mechanical stimulus, that results from the special surface properties of LIGASANO® white in contact with wound or skin and from the involuntary body movements (muscle reflexes, breathing, heart beat).

 
 
PUR
Abbrevation for polyurethane.
 
 
PVC (polyvinyl chloride)
LIGASANO® is free of PVC.
 
 
Repose of the wound - disturbation of the wound by change of dressing

The wound shall be disturbed as less as ever possible, to promote an unhindered healing process. That is absolutely correct, but nevertheless for the LIGASANO® wound therapy we recommend also in the granulation phase a daily change of dressing. How can fit this together?
Letīs comprise, what strictly speaking is meant with repose of the wound resp. its opposite, the disturbation of the wound. Typical disturbations of the wound in case of the classical, but also the modern wound care are

  • The wound is open for a long time. The wound cools down within minutes, the vessels become constricted and therefore the provide of the wound is reduced. The wound stays passive and defenceless adainst germs for hours.
    During the long open time germs have time enough to colonise the wound resp. to penetrate the body.
  • Washing and douching of the wound. This wound cleaning measures also coole down the wound with the consequences described above. During the lavage of the wound beside unwelcome coats and germs, but also endogenous antitoxines and nutrients are mobilised.
    A real wound cleaning doenīt take place by lavaging or douching, the measure is superficial, deeper located germs and pathogenes arenīt reached.
During the LIGASANO®-treatment the wound is completely spared of this disturbations:
  • The complete wound therapy consists exclusively of th wound dressing at the right time. At practice it was shown that additional measures as lavaging, antiseptica, ointments, etc. are superfluous.
  • During the change of the dressing there is no need to clean or treat additionally.
  • The dressing change is very quick (see Pressure tension), during the proper dressing change the wound is open for mostly less than half a minute. By that the wound is spared from wound disturbations, that hinder the healing process.
By a proper use of the LIGASANO® wound therapy there are no wound disturbations at any time, the process of wound healing is never interrupted. For that reason: donīt be afraid of frequently dressing changes!

 
 
Softener
LIGASANO® doesnīt contain any softener.
 
 
Stock-keeping

Protect LIGASANO® against UV radiation, moist, fire, glowing fire and temperatures over 70°C, see also our userīs manual.

 
 
Ulcus cruris
Lars Koschorrek, physician
What is leg ulcer?

Leg ulcer is a poor healing (chronic) deep wound at the lower legs and feet.
Colloquial is often spoken of open legs. Open legs develope in about 80% of the cases by disturbations of the venous blood circulation, above all by varicose veins. More rarely these wounds come into being by narrowing of the leg arteries.
In Germany more than one million people suffer under ulcus cruris, with increasing tendency.

 
How do leg ulcers come into being?
Venous disorders

Venous leg ulcer run to ca. 80% of all leg ulcers. They are the consequence of a chronic venous weakness (chronic venous insufficiency). Often the predisposition to a venous weakness runs in a family. The veins enlarge and elongate themselves and constitute varices. These dilatation effects, that the valves of the venous system donīt function (close) properly. By this blood can flow back and accumulates in the veins. This congestion leads to a oedema (accumulation of water in the tissue) and after a certain time to an induration of the connective tissue (sclerosis). Both changes lead to an undersupply of the tissue with blood and nutrients, particularly at the inner side of the ankles and the front of the lower leg. Later this can lead to leg ulcers.
A further cause of the chronic venous insufficiency are blood clots in the deep veins of the legs and the pelvis (thrombosis). The dilatation of the veins is also called post-thrombotic syndrome.

Arterial disorders

More rare leg ulcers develope by disturbations of the arterial blood circulation. The arteries transport the blood from the heart to the tissues of the body to provide them with oxygen and nutrients. If the blood circulation is considerable weakened for example by a heavy arterial calcification (arteriosclerosis), leg ulcers may develop.
A high-risk factor for arterial leg ulcers is a arteriosclerosis of the legs, caused by e.g.

  • diabetes: diabetics can evolve leg ulcers. Often it comes to infections of these leg ulcers.
  • smoking
  • increased blood pressure (hypertension)
  • hyperlipoidaemia

How to become aware of leg ulcers?
Venous leg ulcers

  • appear mostly in the ankle region, especially at the inner side of the legs
  • are often moist and weeping wounds, that are many times infected with bacteria and then smell decomposed
  • cause normally a feeling of tension and no pain
  • develop frequently from a swollen and chronic inflamed leg (stasis eczema). By emigration of red blood cells and deposition of their catabolic products (Hämosiderin) skin changes color to brownish.

Arterial leg ulcers

  • appear mostly at feet, toes and ankles
  • go along with cold and pale feet and legs
  • normally they cause pain, in particular at corporal movement and by elevation of the legs

How leg ulcers are diagnosed?

To diagnose a leg ulcer isnīt difficult for an physician. But is is important for the therapy to know the triggered cause.
Normally it is sufficient for the skilled physician to inspect the ulcer and to ask for the case history for estimating the cause of the leg ulcer.
By Dopplerīs sonography you can visualise both venous and arterial circulatory conditions. A X-ray examination with contrast medium of the veins shows possible existing blood clots (thrombosis). An examination of the blood uncovers a possible existing diabetes or a thrombpoathy. In singular cases an epithelioma spinocellularis (a form of cancer of the skin) may be the cause of a leg ulcer. By help of a biopsy of the tissue you can preclude this.

 
How to treat leg ulcers?
Venous leg ulcers
  • Compressing bandages:
    A consequent realisation of this treatment is the most important measure. Many venous leg ulcers heal completely by a correct executed compression measure!
  • Cleaning of the ulcer:
    This takes place either fibrinolytic, i.e. with specified ointments, which can dissolve coats. Another method is to remove the coats by means of a sharp spoon (curettage).
  • compresses with antiseptic active substances, i.e. substances that make the wound free of germs, or in the case of heavy exudating wounds with compresses saturated with saline solution.
  • Antibiotics at massive bacterial invasion, also in form of infusions.
  • Varices that lead to the ulcer may removed by an operation or to sclerose them (obliteration).
  • Often an allergic contact dermatitis exists additionally. Many ulcers are pretreatened with various ointments; by time this can cause an allergy. Then a local therapy with cortisone may be suggestive.
  • A rather unsavory but very effective treatment is the so-called bioenzymatic wound cleaning with maggots. Therefore 100 to 200 maggots are applicated to the ulcer for 2 to 3 days. Durinbg this time the maggots subsist on the necrotic tissue, they partly have digested by their spittle. Living tissue isnīt attacked by the maggots.
Arterial leg ulcers
  • In the case of arterial leg ulcers a chirurgical treatment in form of a bypass operation can be adviseable. A bypass is the bridging-over of a stenosed resp. occluded vessel section by means of an artery or a vein. Some ulcers may brought to healing more quickly by an operative skin transplantation.

If you treat an ulcer the topmost goal must be to eliminate all factors that caused the development of the ulcer and hinder its healing.

 
What can you do by yourself?
Venous leg ulcers
  • Wear compression stockings. Compression is the most important measure!
  • Walk and move yourself regularly to activate the muscles of the calf.
  • Donīt sit with crossed legs; this restrains the venous pump.
  • Please take care that you always change your posture during work and move yourself.
  • If possible, sit with elevated legs (higher than the heart region).
  • Reduce your weight, if you are overweight.
Arterial leg ulcers
  • Stop smoking!
    That is the most important measure. By the motto: Stop smoking, keep walking!
  • Move yourself also in seating position. First make circumductions with your feet and move the heels up and down. Move until pain occurs; then make a break. Continue the training not before you are free of pain.
  • Reduce your weight if you are overweight.
  • Eat less fat but more fruits and vegetables.
  • Examine your feet and lower legs regularly on change of color and wounds. This matters especially for diabetics.
  • Dontīt wear shoes that are too small or to large. Buy shoes in which your feet feel good.
  • Please pay attention during pedicure (cutting nails) to avoid every (also little) hurt.
And the prognosis?

By the correct treatment leg ulcers heal completely mostly during a few month.
Unfortunately a lot of the older patients are exposed to several high-risk factors. At this age group the healing of a leg ulcer can last several years.
Venous leg ulcers heal better than arterial caused. Almost never they are threated by amputation. Indeed every second completely healed ulcer occurs once more during one year. By a consequent after-care, particularly the compression therapy, the rate may improved.
Arterial leg ulcers and the so-called "shop window disease" (intermittend claudication) are very serious danger signals, that without treatment may lead to the black gangrene (necrosis) and therefore to the amputation of toes, foot and later the leg. The risk for an amputation increases with the dimension of the arteriosclerosis of the arteries in leg or pelvis, as well as the number and dimension of the risk factors mentioned above. In patients with a badly stabilised blood sugar and hypertension, they additionally smoke, an amputation is more likely.

 
References
Leitlinien der Deutschen Gesellschaft für Phlebologie
Braun-Falco: Dermatologie und Venerologie
Herold: Innere Medizin

Editor
Dr. med. Katharina Larisch
 
 
Water vapour permeability

The water vapour permeability is measured only at relatively impermeable materials, as for example foils. For this, it is not possible to specify a reasonable value for LIGASANO®.
LIGASANO® is almost completely permeable to vapour. The usual measuring methods, e.g. according to DIN 53122, ISO 11092, DIN 31092 are non-applicable.
This is the reason why LIGASANO® always shall have a thickness of at least 2cm (measured from the ground of the wound). In order that not too much air comes to the wound, that a temperature-insulating effect results, that exudate does not dry out and that LIGASANO® does not adhere to the wound.

 
 
Wound cleaning
  • Effective wound cleaning and reduction of germs without any further help


  • No need for irrigation of the wound, antiseptics, ointments, etc.


  • The surplus of exudate is absorbed of LIGASANO® white without drying up the wound


  • The wound edges donīt flow over


  • The wound environment stays always moist-warm


  • No adhesion to the wound


  • Change of dressing is very quick, because there is no need for an additional treatment beside the change of dressing.
 
 
Wound healing impairments

Wound healing impairments impede the wound healing and are the cause for chronic wounds.
Typical and frequent wound healing impairments are deficiency of blood flow, malnutrition, metabolic disturbance, sepsis and additional inflammations. See also
Chronic wounds .
A further wound healing impairment is improper treatment. In fact it is relatively simple to hinder a wound to heal by wrong treatment.
See also
Repose of the wound - disturbation of the wound by change of dressing.

 
 
Wound management

A modern term that - especially in the case of chronic wounds - takes off from the really required measures. It sounds like the treatment of a wound could heal the wound, but this is not true.
Fact is that the patientīs organism has to place into the position to heal the wound. In chronic wounds you have to get rid of wound healing impairments (see
Wound healing impairments). The "wound management" or "wound treatment" that is placed into the foreground, only fulfils a secondary task in the process of wound healing.