A retrospective study to evaluate the effect on an activated carbon dressing on chronic wounds S Young. In Control Cambridge & S. Gray. & S Hampton Wound Care Consultants. Eastbourne

The results of the wound bed scans show that as treatment progresses the wound area moves towards a more normal skin profile as inflammation starts to subside. Figures below shows a typical example of this.

Figure 2. Scans comparing the patient’s normal skin with the wound site

Introduction

This was a retrospective and observational clinical evaluation reviewing changes that occur in wounds treated with an activated carbon dressing (Zorflex®) applied over a 5 week period. Each patient had an initial assessment then another 5 weeks later to establish that it was non healing. Zorflex was then applied and assessments carried out 2weeks, 5 weeks and then a 12 week follow up.

20 patients were initially evaluated on Zorflex with the objectives being to collate and record nurse / carer / subject feedback on product use; Identify wound changes through assessment, high definition ultrasound, planimetry and photographs; Monitor progress through the wound healing continuum.

Zorflex® activated carbon cloth adsorbs a large volume of organic or inorganic molecules from various gases and liquids and acts as a high purity filter, a method of separation or as a protective layer.

In vitro tests, undertaken by UK Health Protection Agency, demonstrated that long fibre activated carbon, used in uniforms and in dressings, was both antiviral and virucidal, with virus kill rates of up to 98%. Long fibre activated carbon (LFAC) has been used against bacterial and chemical warfare for armed forces uniforms for many years.

The evaluation had a strict inclusion/exclusion criteria and complied with the Declaration of Helsinki. Every subject consented to take part and the subjects were drawn from GP clinics and nursing homes.

uninjured skin Initial Visit

Wound at 2 weeks Wound at 12 weeks

Fig 1 Photograph indicating typical region where scans were made

Note that at initial visit the wound area is shown predominantly in red pixels (Low Echogenic Pixels – LEP’s), whereas at the end of the study there is an increase in blue pixel number, which is more typical of the uninjured tissue state. Results of the wound scan analysis (figure 3) shows that the ratio of LEP’s to total pixel count is reducing back towards normal uninjured skin levels.

This evaluation was supported by Chemviron Carbon Cloth Division.

Time period comparison Significant p-value

Normal vs. Initial YES <0.00001

Initial vs. Time 0 NO =0.06966

Time 0 vs. 2 weeks YES <0.00001

2 weeks vs. 5 weeks YES =1.6E-05

5 weeks vs. 12 weeks YES <0.00001

12 weeks vs. Normal YES <0.00001

Table1. Statistical analysis of ultrasound data

Conclusion This was an evaluation of the product Zorflex and designed to explore the experience and findings of Tissue Viability Nurses using Zorflex within the GP clinics and nursing homes where it was evaluated.

The evaluation demonstrated excellent healing results, reduction of pain and patient quality of life was increased in each case.

Wound closure at 90.7% was far greater than national healing rates for wounds.

Results

Ultrasound Assessment

Figure 3. Graph showing Pixel Ratio Data

The benefit of including ultrasound as an assessment tool is that it provides quantitative information about what is happening beneath the wound surface, i.e. the wound bed where healing is initiated. Combining this information with that gained from the clinical data which looks at surface characteristics we can get the whole picture of what’s happening.

National healing rates are 61%3 healing in a year. This evaluation saw a total healing of all wounds of 90.7% in the 5 week period of treatment. All the wounds were non healing prior to application of the activated carbon as shown by the ‘run in’ period of 5 weeks prior to application. Therefore, the conclusion must be that Zorflex actually provided the ideal wound healing environment that assisted or stimulated the healing process.

The following wounds in the photographs are a typical example of all wounds in the evaluation. In each case a chronic wound became a healing wound within a very short period of time. Average wound width = 3.1cms with largest being 5 cms in width. Average length = 2.6 cms with largest being 5 cms in length. Average wound area = 8.8 cm2. With largest being 20cms2. The following photographs are all first and last visits.

References 1. Quintavalle P, Lyder CH, Mertz PJ, et.al. Use of high-resolution, high

frequency diagnostic ultrasound to investigate the pathogenesis of pressure ulcer development. Adv. Skin & Wound Care 2006; 19(9):498-505

2. Gniadecka M. Localization of dermal edema in lipodermatosclerosis, lymphedema, and cardiac insufficiency: high-frequency ultrasound examination of intradermal echogenicity. J Am Acad Dermatol. 1996; 35:37-41.

3. Guest, JF., Ayoub, N., McIlwraith, T., Uchegbu, I., Gerrish, A., Weidlich, D., Vowden, K., Vowden, P. (2015). Health economic burden that wounds impose on the National Health Service in the UK BMJ; Dec 7;5(1).

Clinical Observations

18 wounds achieved full closure. One wound was a category 4 heel pressure ulcer which remains in the healing phase. Not all subjects had leg wounds but those who did had Ankle Brachial Pressure Index (ABPI) undertaken with Dopplex Ability. The Highest ABPI was 1.04 and lowest was 0.79. Two subjects had monophasic sounds with the majority being bi-phasic. Those with suspected arterial deficiency were referred to the vascular team.

All nurses, carers and patients said they were amazed at the results produced by this product.

The wounds were all chronic wounds of more than six weeks and an average length of duration was 15.75 months duration.

Pain Assessment Pain judged on scale 1 -10 (1 = none 10 = worst ever). First assessment – Mean score = 6.4 Last assessment – Mean score = 1.4

Exudate Levels Judged on scale 1 – 4 (1=dry 4 = dressing leaking exudate) First assessment – Mean score = 2.7 Last assessment – Mean score = 1

Odour Levels Judged on scale 1 – 5 (1 = no odour 2 = Slight 3 = Moderate 4 = Strong 5 = Very strong) First assessment – Mean score = 2.85 ( 8 patients at level 4/5) Last assessment – Mean score = 1

ZOR004-1