Haemoglobin for wound healing? Case Report Selection 2012-2013 Case 1 31.07.2013 Dr. Peter Engels Case reports Granulox 2012-2013 13 •43 year old male patient •Venous leg ulcer

Granulox®

Dr. Peter Engels Case reports Granulox 2012-2013 131.07.2013

Haemoglobin for wound healing?Case Report Selection

2012-2013

Joint Aetiology

• Different primary diseases lead to a circulatory disorderand often results in a local oxygen deficit (hypoxia)

• Consequence: Almost all chronic wounds are hypoxic !

Tissue formation, division of cells, immunoactivity requiresignificantly more oxygen metabolism activity within a woundthan within intact tissue

Result: Increased oxygen demand !

If the wound is missing oxygen, healing processesare not taking place or are delayed!

Especially wounds need a lot of oxygen!

Hypoxia | Background

Problem: Partial pressure of oxygen is insufficient• Cells need at least 20 mm Hg to survive (minimum)• Complex metabolism activities, especially wound closure / • granulation require a minimum of 40 mmHg

40

20

Partial pressure of oxygen in mmHg

Normal condition

Critical zone,wound healing impossible

Most chronic woundsare in this area.

The tissue dies in most cases

Hypoxia | Treatment Options

• Improvement of oxygen supply due to improvement of bloodcirculation within the frame of an adequate causal therapy

Oxygen is provided from the inside.

• Additional support by oxygen supply from the outside

Oxygen from the air has to be made availablefor cellular activity at the base of the wound.

Oxygen Barrier

• The exudate presents a diffusion barrier for oxygen

• Already a liquid film of 20 micrometer blocks 95% of the diffusion

Even though sufficient oxygen is available within the air, it can‘t get to the base of the wound due to the diffusionbarrier. Therefore the oxygen requirement of the cells can‘t be fulfilled.

Modified equation by Einstein and Smoluchowski

20Distance of source x

Oxygen barrier


Wound exudate is an efficient barrier for oxygen exchange, and prohibitsan external oxygen supply from the air to the wound bed.

Oxygen barrier

Please take Haemoglobin


Substance: haemoglobin

Status: purified, aqueous solution

Function: Binding and Release of oxygen

Question: Can haemoglobin bind and release oxygen outside of erythrocyts?

Yes it can!!! ** Wittenberg 1966, Scholander 1960, Page 1998

Use of a natural oxygen transporter

Transporter takes oxygen from the surface down to the base of the wound

Unloading at the base of the wound

Transporter takes again oxygen from the surface

Rotating procedure

Principle of „facilitated diffusion“!

Principle of Haemoglobin

Principle: Haemoglobin as O2 shuttle


Equably distributed haemoglobin in the wound exudat, binds the oxygen at the surface and release it at the wound ground

Bypass of oxygen barrier

High oxygen partial pressure

Low oxygen partial pressure

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Clinical studies


Case Reports


• Various successful treatments of different wound types are reportedby several users

• Venous leg ulcers• Diabetic foot ulcers• Arterial leg ulcers

• Secundary healing wounds• Burns

Case 1


• 43 year old male patient• Venous leg ulcer

• Wound existed for 8 years, several relapses• Start of treatment February 2012• Start of Granulox application: March 2012• Successful end of therapy: June 2012

Chronic wound management of a venous leg ulcer patient with complication of Budd Chiari Syndrome (paper submitted)

Start of treatment


21.02.2012

Compression therapy


End of therapy after 115 days


Case 2


• 85 year old male patient• Diabetic foot ulcer

• Interdigital DI-II left.• Diabetes mellitus• pAOD• Arterial Hypertension• Wound persisted for 7 months• Treatment with: Iruxol paste, Alginate, Hydrocoloid, Polyurethan foam

Start of Granulox application & Silicone foam


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Case 2


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End of treatment after 73 days & 24 changes of bandages


Case 3 (a&b)


• 62 year old patient• Arterial leg ulcer (right leg)

• pAOD IV, right• lower leg amputation 05/11• Diabetes mellitus• Chronic nicotine abuse• Wound persisted for 7 months• Treatment with : Hydrocolloid, Alginate, Alginate-Ag, Polyurethane Foam

22

Start of treatment with Granulox & non-adhesive foam


23

Case 3


24



Lower leg prothesis pressure mark (3b)


• Wound persisted for 6 weeks• Treatment with : Hydrocolloid, Alginate, Alginate-Ag, Polyurethane Foam

26

Start of treatment




Case 4 a&b


• 72 year old female patient• Venous leg ulcer, left leg

• Persisted for 6,5 years• Varikose at the left leg• Multiple allergies

Lower leg (outer left, 4a)


Case 4a


Treatment successful after 58 days


Lower leg (inner left, 4b)


Successful closure within 114 days

Case 5


• 62 year old patient• Venous leg ulcer (right)

• CVI• Diabetes mellitus• Arterial hypertension• Wound maintained for 6 months• Treatment with: Iruxol, Repithel gel, Hydrocolloid, Alginate,

34

Start of treament


35



36

Case 6


• 68 year old patient• Diabetic foot ulcer (right)

• IDDM• CVI• Nicotine abuse

• Wound existed for 7 months

• Treatment: Hydrocolloid, Hydrogel, Alginate , Alginate-Ag, Foam, Surgicaldebridement

37

Start of treatment with Granulox, Alginate & polyurethane foam dressing


End of treatment after 50 days & 15 changes of bandages (c.o.bds)


39

Case 7


• 85 year old female patient• Arterial leg ulcer (right leg)

pAOD grade II – III Stenosis of A carotis interna (right) Multiple allergies Wound since 7 years

Start of Granulox treatment & non adhesive foam


End of treatment after 169 days & 50 c.o.bds.


Case 8


• 69 year old female patient• Arterial leg ulcer (lateral right leg)

• pAOD Stadium IV (right)• Diabetes mellitus• Two closures of By-passes since 2010• Hodgin – Lymphoma , Polychemotherapy• COPD • C2 –associated liver chirrosis• Wound exists for 28 months• Treatment: everything !!

Treatment result after 67 days


44

Case 9


• 65 year old female patient• Diabetic gangrene at the left big toe

• Diabetes mellitus• pAOD Stadium IV • Obesity• 07/12 Amputation of the left big toe, trans-metatarsal resection• Split-skin graft• Wound persisted 8 weeks

Treatment with Granulox & silicone foam dressing for 59 days


Case 10


• 55 year old male patient• Arterial leg ulcer & diabetic gangrene

• Diabetic gangrene ( Dig. 3.4.5.right foot with necrosis of filament)• foot phlegmone• Diabetic polyneuropathy• Lower leg amputation (left)• Diabetes Mellitus Type II• Obesity

Treatment success within …


42 days (outer wound) & 66 days (inner wound)


Case 11


• 56 year old female patient• Diabetic foot gangrene

• Diabetes mellitus• Colon Ca./ Chemo therapy• MRSA in wound• Amputation D I + II• Negative pressure therapy without success

Therapy result after 98 days


51

Case 12


• 53 year old male patient• Post surgical wound healing dysfunction

• Pre-peritoneal Lipoma• Lipoma-resection 02/12• partial mucosectomy• Nicotine abuse• Depression • Psoriasis• Allergic asthma• Wound existed for 8 months• Therapy before hospital visit: repeated daily shower of the wound

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Successful wound closure after 41 days


53

Case 13


• 44 year old male patient• Neck carbuncle

• Surgery 02/12• Wound persisted for 9 weeks• Therapy before hospital visit: Repeated daily showering of the wound

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Start of treatment with Granulox & silicone foam dressing


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Case 13


End of therapy after 29 days & 9 c. o. b.


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Case 14


• 74 year old male patient• Post surgical impairment of wound healing (after OP)

• Abdominal wall phlegmons• Multiple wound revisions after incisional hernia reparation• MRSA• Wound persisted for 13 months• Therapy: Negative pressure therapy, Alginate , Foam dressings

58

Start of treatment with Granulox & non-adhesive PU foam


End of therapy after 111 days & 37 c.o.bs.

59

Case 15


• 75 year old female patient• Decollement, pretibial left lower leg

• Maligne Melanoma right foot, toe DII• Liver metastases• Radiation• Situation after fall at home• Previous treatment: not known

Successful treatment after 40 days and 12 c.o.bs.


61

Case 16


• 38 year old female patient• Abscess left forearm

Abscess split 01/12 Revision 02/12 Allergic asthma Wound persisted for 2 months Previous Treatment: surgical debridment & dry dressings

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Treatment with Granulox, silicone foam (absorbent dressing pads)


End of treatment after 78 days and 23 c.o.bds.


Case 17


• 64 year old male patient• Circular saw injury

• Laceration and detachment of skin, • left hand, finger D1

Treatment period of two weeks


Case 18


• 25 year old patient• Incised wound

• Right hand, finger D II • Skin necrosis

Two weeks treatment


Case 19


• 84 year old female patient

• Wound infection after:• Radial head implant 05.08.2011• Plate dislocation and Radial head – pseudo arthrosis 8/2011• Wound revision and negative pressure therapy 9/2011

Case 19


Case 20


• 58 year old male patient• Venous leg ulcer

• left lower leg• CVI• Diabetes Mellitus

Case 20


Case 21


• 36 year old male patient• Bacterial secondary infections of the lower leg

• right lower leg (Relapse) • Diabetes mellitus Type 2 • Obesity


Case 21

Case 22


• 28 years old male patient• Burn, Grade 2A

• Right hand• Finger DIII

Finger, DIII


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Case 23 a & b: Burning of both upper legs


• 85 J. Patient • Burn of upper leg

• Diabetes mellitus• pAOD• Arterial hypertension

• Wound persisted for 4 weeks• Treament with: Flamazine

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23a: Start of treatment with Granulox & non-adhesive PU foam dressing


Right leg

End of treatment after 53 days & 17 c.o.bds.


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23b: Start of treatment Granulox & non-adhesive PU foam dressing


Left leg


End of successful treatment after 53 days and 17 c.o.bds.


Thank you for your attention


Documents

Haemoglobin for wound healing? Case Report Selection 2012-2013 Case 1 31.07.2013 Dr. Peter Engels Case reports Granulox 2012-2013 13 •43 year old male patient •Venous leg ulcer