The Debrisoft(®) Monofilament Debridement Pad for Use in Acute or Chronic Wounds: A NICE Medical Technology Guidance

Interactive Skin Wound Segmentation Based on Feature Augment Networks

Skin wound segmentation in photographs allows non-invasive analysis of wounds that supports dermatological diagnosis and treatment. In this paper, we propose a novel feature augment network (FANet) to achieve automatic segmentation of skin wounds, and design an interactive feature augment network (IFANet) to provide interactive adjustment on the automatic segmentation results. The FANet contains the edge feature augment (EFA) module and the spatial relationship feature augment (SFA) module, which can make full use of the notable edge information and the spatial relationship information be-tween the wound and the skin. The IFANet, with FANet as the backbone, takes the user interactions and the initial result as inputs, and outputs the refined segmentation result. The pro-posed networks were tested on a dataset composed of miscellaneous skin wound images, and a public foot ulcer segmentation challenge dataset. The results indicate that the FANet gives good segmentation results while the IFANet can effectively improve them based on simple marking. Comprehensive comparative experiments show that our proposed networks outperform some other existing automatic or interactive segmentation methods, respectively.

An audit to assess the impact of prescribing a monofilament fibre debridement pad for patients with unhealed wounds after six months

A monofilament fibre debridement pad has been found to be a rapid and effective mechanical method of removing dry skin, biofilm and debris from acute and chronic wounds with minimal patient discomfort. Evidence of its impact on prescribing and wound healing, however, has been more limited. The aim of this audit was to show evidence of the monofilament fibre debridement pad's impact on wound treatment costs through an analysis of NHS wound-care prescribing data in England. A dataset for 486 uniquely identified patients who had been newly prescribed the monofilament fibre debridement pad was obtained from the NHS Business Services Authority. All data were anonymised. Costs were identified for the six months before and six months after the month of first prescription of the monofilament fibre debridement pad. The total cost of wound-care prescribing fell by 14% or £101,723 in the six months after the intervention compared with the six months before. The average monthly expenditure per patient fell from £244 before the intervention to £209 (n=486) after. These results indicate that use of the monofilament fibre debridement pad could reduce prescribing costs and the use of antimicrobial and negative pressure therapies. Further research is warranted to investigate the clinical role of the monofilament fibre debridement pad in wound healing.

Use of a monofilament debridement pad in the treatment of acne vulgaris

OBJECTIVE

Acne vulgaris (acne) presents with increased oil-sebum secretion and subsequent formation of comedones, papules, pustules and nodules. Skin cleansing is part of the daily routine to improve skin condition. A monofilament debridement pad has shown to be effective when used for wound debridement and skin cleansing in dermatological conditions. The pad may offer benefits when used for acne affected skin.

METHODS

The in vitro cleansing capacity of the monofilament fibre pad was analysed and compared with commercially available cosmetic pads. For this purpose, a sebum model consisting of glass plates coated with an oil-red-stained layer of artificial sebum was used. To gain clinical experience a case series evaluated cleansing efficacy of the monofilament debridement pad in combination with polyhexanide and sodium-hypochlorite based solutions. Over a period of four months, seven individuals suffering from retentive moderate facial acne who visited the dermatology clinic for their acne used the pad as necessary, ranging from twice weekly to daily, dependent on the sensitivity of the patient's skin condition.

RESULTS

The in vitro study exhibited a significantly better cleansing efficacy of the monofilament debridement pad compared with the cosmetic pads. After single use of the pad subject scores on sebum reduction revealed excellent/very good in 42.9% and acceptable in 57.1% of cases. After repeated use of the monofilament pads scores on sebum reduction of excellent/very good were given in 85.7% and acceptable in 14.3% of cases. Subject scored handling of the pad and comfort during use also received favourable ratings.

CONCLUSION

These initial results show the potential of the monofilament debridement pad for cleansing of acne-prone and acne affected skin. More robust studies are needed to confirm these results.

A comparative study on the cellular viability and debridement efficiency of antimicrobial-based wound dressings

A concentrated surfactant gel containing polyhexamethylene biguanide (CSG-PHMB) (CSG: Plurogel) was evaluated for in vitro cell cytotoxicity using the direct contact, extraction, and cell insert assays, along with its ability to breakdown artificial wound eschar and slough, compared with other clinically available wound gels: a wound gel loaded with 0.13% benzalkonium chloride (BXG) and a highly viscous gel loaded with 0.1% polyhexamethylene biguanide (PXG). Following treatment with CSG-PHMB, BXG, and PXG at day 1, the viability of L929 and HDFa cells sharply decreased to lower than 20% of the culture media control in the direct contact assay; however, cell viability of L929 was 128.65 ± 1.41%, 99.90 ± 2.84%*, and 64.08 ± 5.99%* respectively; HDFa was 84.58 ± 10.41%, 19.54 ± 3.06%**, and 96.28 ± 33.67%, respectively, in the extraction assay. In the cell insert model, cell viability of L929 cells were 95.25 ± 0.96%, 47.49 ± 5.37%**, and 48.63 ± 7.00%**, respectively; HDFa cell viability were 92.80 ± 1.29%, 38.86 ± 4.28%**, and 49.90 ± 2.55%** (*: P < .01; **P < .001 compared with CSG-PHMB; cell viability of culture medium without treatment at day 1 was 100%). The cell extraction model on day 1 indicated that CSG-PHMB had higher viability of L929 cells compared with BXG. In addition, the cellular viability results indicated that CSG-PHMB gel exhibited lower cytotoxicity when compared with BXG and PXG in the cell insert model assay. Within the in vitro debridement model, CSG-PHMB exhibited an ability to potentially increase the loosening of the collagen matrix. The reason for this may be because of the concentrated surfactant found within the CSG-PHMB, which has the ability to lower the surface tension, aiding in the movements of fragments and debris in the fluorescent artificial wound eschar model (fAWE).

Biofilm management using monofilament fibre debridement technology: outcomes and clinician and patient satisfaction

Objective:

Best practice in wound bed preparation and biofilm-based wound management includes debridement to create a clean wound bed and to assist in minimising the redevelopment of biofilm. Biofilm that is not removed inhibits healing and redevelops if not prevented from doing so with topical antimicrobial agents. Monofilament fibre debriding technology (MFDT) is used for effective and rapid mechanical debridement of loose material, slough and biofilm. The objective of this evaluation was to determine the clinical effect and consequential levels of health professional and patient satisfaction with the results of a biofilm pathway that included MFDT to achieve debridement.

Methods:

This non-comparative, open label evaluation was conducted in static and non-static wounds that required debridement. MFDT was used to debride in a two-week evaluation of a biofilm pathway. Wounds were debrided three times in week one and twice in week two. Each debridement was followed by treatment with an antimicrobial dressing. Other care included secondary dressings and compression delivered according to local practice, guidelines and formularies. After the clinical evaluation, health professionals were invited to complete an online survey of the clinical outcomes and their satisfaction with the biofilm pathway.

Results:

There were 706 health professionals who provided answers to the survey questions. Wound types evaluated were leg ulcers (67.4%), pressure ulcers (10%), dehisced surgical wounds (1.7%), diabetic foot ulcers (7.4%) and other wounds (13.4%). Of the wounds, 9% were reported as non-static despite the eligibility criteria. Not all wounds followed the pathway. The most frequently-used antimicrobial was silver. Non-antimicrobial products used included all-in-one dressings, other secondary dressings and compression. There was a change in 77% of wounds overall after two weeks. Change was reported almost equally for both static and non-static wounds. Health professionals who did or did not follow the pathway were ‘completely satisfied’ or ‘satisfied’ with the overall clinical outcome 96% and 95%, respectively. Of the patients, 77% were ‘completely satisfied’ or ‘satisfied’ with healing after following the pathway, as reported by the treating health professional.

Conclusion:

The biofilm pathway that includes MFDT appears effective. Wounds managed on the pathway were debrided effectively and healing progressed to the satisfaction of both health professionals and patients.

Rapid debridement with monofilament fibre debridement technology: clinical outcomes and practitioner satisfaction

Objective:

To determine the clinical effect and consequential levels of health professionals and patient satisfaction with the results of debridement episodes of wounds with visible slough and/or scaly skin using monofilament fibre debridement technology.

Methods:

This was a non-comparative, open label evaluation conducted in static/non-healing acute and chronic wounds with visible slough and/or scaly skin that required debridement. Monofilament fibre debridement technology was applied in 1–2 sequential treatment episodes during normal clinical practice which followed local practice, guidelines or formularies. Following the clinical phase of the evaluation, health professionals were invited to complete an online survey of the clinical outcomes and their satisfaction with them.

Results:

Survey questions were answered by 1129 health professionals. Wounds managed using the monofilament fibre debridement technology during this evaluation included leg ulcers (63%), pressure ulcers (10%), dehisced surgical wounds (3%), diabetic foot ulcers (8%) and other wounds (13%). ‘Other’ wound types included acute dirty wounds, burns, cellulitis, psoriasis, diabetic amputation wounds, dry flaky skin, moisture wounds, trauma, varicose eczema. Of the wounds, 12% were reported as non-static. There was visible change in the wound and/or skin after first use of the monofilament fibre debridement technology in a high proportion of all wound types, and a further increase in the proportion of wounds with visible change after the second use. The visible difference was significant for both static and non-static wounds. User and patient satisfaction with all clinical outcomes were high, whether or not the user and patient had previous experience of monofilament fibre debridement technology.

Conclusion:

Monofilament fibre debridement technology provides rapid, visible and effective debridement of slough and scaly skin after one application and further visible improvement after two applications in static and non-static wounds. Health professionals and patients report high levels of satisfaction with outcomes following application of the monofilament fibre debridement technology.

The Debrisoft(®) Monofilament Debridement Pad for Use in Acute or Chronic Wounds: A NICE Medical Technology Guidance

As part of its Medical Technology Evaluation Programme, the National Institute for Health and Care Excellence (NICE) invited a manufacturer to provide clinical and economic evidence for the evaluation of the Debrisoft(®) monofilament debridement pad for use in acute or chronic wounds. The University of Birmingham and Brunel University, acting as a consortium, was commissioned to act as an External Assessment Centre (EAC) for NICE, independently appraising the submission. This article is an overview of the original evidence submitted, the EAC's findings and the final NICE guidance issued. The sponsor submitted a simple cost analysis to estimate the costs of using Debrisoft(®) to debride wounds compared with saline and gauze, hydrogel and larvae. Separate analyses were conducted for applications in home and applications in a clinic setting. The analysis took an UK National Health Service (NHS) perspective. It incorporated the costs of the technologies and supplementary technologies (such as dressings) and the costs of their application by a district nurse. The sponsor concluded that Debrisoft(®) was cost saving relative to the comparators. The EAC made amendments to the sponsor analysis to correct for errors and to reflect alternative assumptions. Debrisoft(®) remained cost saving in most analyses and savings ranged from £77 to £222 per patient compared with hydrogel, from £97 to £347 compared with saline and gauze, and from £180 to £484 compared with larvae depending on the assumptions included in the analysis and whether debridement took place in a home or clinic setting. All analyses were severely limited by the available data on effectiveness, in particular a lack of comparative studies and that the effectiveness data for the comparators came from studies reporting different clinical endpoints compared with Debrisoft(®). The Medical Technologies Advisory Committee made a positive recommendation for adoption of Debrisoft(®) and this has been published as a NICE medical technology guidance (MTG17).