Glossary

All entries at a glance

Allergies

LIGASANO® white is allergy neutral according to today's state of knowledge. Nevertheless, skin reactions sometimes occur.

  • Skin redness is a typical side effect of better blood circulation.
  • Blistering is rarely observed, always in connection with heavy sweating. For countermeasures see Sweating on LIGASANO®.
  • Rubbed skin can occur if there is strong friction between LIGASANO® and the skin as a result of movement.
  • Countermeasure: Secure LIGASANO® against slipping against the skin, fix to the body. See also Fixation of LIGASANO®.
  • Skin symptoms with simultaneous use of other preparations, see ointments, interactions with LIGASANO®.

How strong is the exudate absorption of LIGASANO® white?

Here we distinguish

1) the application as wound covering: LIGASANO® white has wound contact only from one side, the absorbency is, depending on the viscosity of the exudate (our measurements were made with water), at about 30 % by volume or 1500 % by weight or 0.3ml/cm3

2) application as wound dressing: LIGASANO® white has wound contact on all sides, the absorbency here is up to 90 % by volume or 4500 % by weight or 0.9ml/cm3

AZO colours

Not included in LIGASANO®.

Chronic wounds

Wounds that heal badly or not at all. The cause is wound healing disorders (see also wound healing disorders) which must be treated in order to achieve successful wound healing.

Dosage forms

Please click here.

THE GREEN CLIMATE GRID

Alternative designation of LIGASANO® green.

Pressure tension

"Pressure creates identical counterpressure," Newton says. When an elastic material is deformed under pressure, it pushes back with the same counterpressure. This is called pressure tension.

LIGASANO® has the ability to quickly adapt to the new shape created by the pressure. Technically speaking, LIGASANO® loses a large part of its pressure tension.

If LIGASANO® is applied to the wound with compression (max. 50% deformation), most of the compression is lost after a short time. What remains is contact with the skin or wound.

This allows wounds to be perfectly treated quickly and easily.

Wound care simple and fast

Always cut LIGASANO® slightly larger than the wound diameter and slightly thicker than the wound depth and insert into the wound with light compression.

The goal: full-surface wound contact

The initial compression decreases rapidly and the required wound contact remains.

Blood flow stimulation

Lack of blood circulation is the most frequent cause for the development of chronic wounds and at the same time the main reason why such wounds do not heal or heal only poorly. See also Wound healing disorders.
If an area of the body is not or not sufficiently supplied with blood, it dies or a non-healing wound develops.
LIGASANO® white causes a local increase in blood circulation in the contact area with skin or wound and thus reduces the risk of the development of wounds caused by insufficient blood circulation or promotes their healing in all phases. With the size of the application beyond the wound or risk area, the sphere of influence of the local measure increases. The supply of nutrients, oxygen and defence substances to the wound or risk area is improved and metabolic products are removed. The cleaning of the wound from germs, coatings and even dry necroses is achieved by natural increased secretion of the wound, without further action. See also wound cleansing.
The circulation-promoting effect is achieved by a mechanical stimulus, which is caused by the special surface quality of LIGASANO® white in contact with the wound or skin and by involuntary body movements (muscle reflexes, breathing, heartbeat).

Nutrition

A nutrient-rich, in particular protein-rich nourishing therapy can help to dam up the bedsores, reports Marion Hönig, Dipl. Oecotrophologin of the society for nourishing medicine and Diätetik in Bad Aachen. After a current study of the Humboldt university Berlin 37% of the patients in the contacted hospitals and even 65% of the inhabitants of nursing homes are decubitus-prone.1

Targeted therapy measures among other things by protein-rich food work against the disturbed wound healing. An optimal nutrition with the decubitus therapy and - prophylaxis consists of protein-rich food, sufficient liquid supply, the administration of zinc, Vitamin B12 and if necessary multivitamin preparation, explains Hönig. It also makes sense to use immunonutrition, which contains immunologically effective nutrients such as arginine, RNA nucleotides and omega-3 fatty acids. In addition, balanced diets such as drinking foods are recommended, which have been specially developed for decubitus patients and contain nutrients that are indispensable for wound healing. The nutrient deficits can be determined by laboratory parameters in blood and urine. The albumin protein in particular is essential for healing wounds.2 As soon as the deficits are balanced, this has a positive effect on wound healing.

1 http://www.charite.de/ch/pflege/forschung

2 www.hartmann.info/shortcuts/literatur.html

 

Click here for the information sheet on suitable nutrition

Exudate absorption

Here we distinguish

1) the application as wound covering: LIGASANO® white has wound contact only from one side, the absorbency is, depending on the viscosity of the exudate (our measurements were made with water), at about 30 % by volume or 1500 % by weight or 0.3ml/cm3

2) application as wound dressing: LIGASANO® white has wound contact on all sides, the absorbency here is up to 90 % by volume or 4500 % by weight or 0.9ml/cm3

Exudate management

A fashionable term that should sound good in the first place, but says nothing else than that exudate is absorbed by the wound dressing in a suitable form. The earlier term for this was absorbency or absorbency. In connection with LIGASANO® we speak of controlled absorbency (see wound cleaning).

Moist wound care

(see also sticking to the wound )

LIGASANO® wound treatment is always a moist wound treatment. However, the moisture is typically not introduced from the outside, as is the case with many other preparations, but is generated in the wound itself.
See also "Promoting blood flow".

Fistulas

Best treated with LIGASANO® white Wound Stip. The sterile wound dressing measuring 300 x 2.5 x 0.4 cm can simply be inserted with a pair of tweezers and lies leporello-like on the wound surface. If the fistula is not too branched, it can be treated without surgical intervention.
The special advantages of the Wound Band application can be found under Deep Wounds with Narrow Entrance.

 

Fixation

The fixation of LIGASANO® white must always be open to air, never occlusive.
Below are some options, with subjective evaluation by the author.

 

Practice grade inadequate

Fixation with adhesive plaster strips

Does not hold very well and can exert small traction on the skin. Even "skin-friendly" plasters strain the skin during peeling.

 

Practice mark satisfactory

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

Relatively expensive, holds quite well, skin stress during peeling.

 

Practice mark good

Net pants, fixing pants, net hose, tubular bandage

No skin stress, easy to change, may be reusable.

Disadvantage: Brakes compared to textiles. When the patient slips around,
the fixation and LIGASANO® can slip as well

 

Practice mark very good

Women's nylon pantyhose or parts thereof

Very inexpensive (-,40 to -,90 €), possibly reusable.
The cheapest product is the best quality for this application because it is wide meshed and permeable to air. Can be cut up at will and thus replace any fixing panties and any tubular bandage.

Advantage: The nylon material glides well over textiles, but slows down compared to LIGASANO®. Even if the patient slides around in bed, LIGASANO® remains in place.

Gel and LIGASANO®

See under ointments

Shelf life of LIGASANO®

It is almost the same as salt and pepper, for which a sell-by date must also be specified. Theoretically, LIGASANO® would have an endless shelf life if it was reliably protected against light and moisture. We guarantee a shelf life of 5 years from the production date, if stored properly. LIGASANO® should no longer be used if it is heavily yellowed or crumbles.

History of LIGAMED®, LIGASANO® weiß, LIGASANO® grün

LIGASANO® was developed by Prof. Dr. Gerhard Weber, then chief physician of the Dermatology Clinic Nuremberg, and his senior physician Dr. Karl-Heinz Galli. That was at the end of the 70s.
LIGASANO® has been further developed by LIGAMED® medical Produkte GmbH since 1985. To date, there is no comparable product on the market, neither in terms of efficacy nor in terms of broad and low-risk applicability.

Contraindications

LIGASANO® is allergy neutral, stimulates the blood flow in skin contact due to its mechanical stimulus, has a controlled absorbency and rapidly falling pressure tension. These effects must be taken into consideration with every application. In carcinomas, for example, the stimulation of blood flow could have a negative effect, but we are not aware of any real contraindications.

Costs

A distinction must be made between the following costs

  1. pure product costs per unit
  2. Product costs per application
  3. Product costs per day
  4. Product costs per therapy until success
  5. Total costs incl. personnel costs until the therapy is successful.

In clinical care, the decisive cost factor is likely to be the time after which the patient can leave the clinic.
Points 1 to 4 are meaningless if the balance at point 5 is positive. A real comparison, however, is only possible with respect to points 1, 2 and 3, since the success of points 4 and 5 depends decisively on the general environment and the condition of the patient. There is simply an infinite number of different prerequisites, two really comparable patients are difficult to find.

Storage, conditions

Store away from light, moisture, open fire, embers and temperatures above 70°C, see also package information.

Latex

LIGASANO® is latex-free.

LIGASANO® white

Main fields of application: wound healing, prevention, skin care

Chemically fully crosslinked polyurethane (PUR) having the following main characteristics

  • Local stimulation of blood circulation in skin and wound contact (see stimulation of blood circulation)
  • Wound care simple and fast due to rapidly decreasing compressive stress (see compressive stress)
  • Controlled suction effect. Excess exudate is reliably absorbed, the wound always remains moist and warm.
  • no sticking to the wound
  • Protection against environmental influences such as temperature, approach germs, shock and pressure
  • slowed air-permeable - gas exchange
  • available low-germ or sterile, can also be sterilized on site with steam at 134°C / 3 minutes
  • allergy-neutral
  • Medical device according to MDD 93/42 EWG Annex 2, Class IIb

LIGASANO® green

Main fields of application: skin aeration, skin climate control, patient positioning

Chemically fully crosslinked polyurethane (PUR) having the following main characteristics

  • unimpeded air permeable
  • no temperature insulation
  • behaves like a sieve
  • permanently elastic like foam rubber
  • washable, disinfectable, sterilizable
  • Medical device according to MDD 93/42 EWG Class IIb

Air permeability

LIGASANO® white is slowed air-permeable. This ensures sufficient thermal insulation from a thickness of 2 cm without hindering gas exchange during wound treatment.

LIGASANO® green is almost unhindered permeable to air. There is no thermal insulation, regardless of thickness.

Mechanical stimulus

(see also blood flow promotion)

LIGASANO® white exerts a mechanical stimulus in wound and skin contact through its surface texture and the involuntary movements of the body which promotes blood flow.

Modern wound care

A fashionable term used for wound dressings with additional properties. Examples: Hydrocolloids, alginates, activated carbon dressings, etc. Especially in the case of chronic wounds, the term distracts from the measures actually required. It sounds as if "modern wound care" could actually heal wounds, but this is of course not true (see wound healing disorders ). The fact is that the patient's organism must be enabled to heal the wound. In the case of chronic wounds, the main focus must be on eliminating the wound healing disorders.
The emphasis on "modern wound care" essentially fulfils secondary tasks in the wound healing process.

MRSA - Methicillin Resistant Staphylococcus aureus

Staphylococcae - also called Staphylococcus aureus - belong to the normal colonizers of skin and mucous membranes. Approximately 20 - 60% of the people harbor this germ in relatively large numbers in the nasopharyngeal area. Even higher carrier rates must be assumed for medical personnel. On the other hand, Staphylococcus aureus can also cause life-threatening infections under certain circumstances. As a typical pyogenic pathogen it can be involved in abscesses, furuncles, wound infections and impetigo contagiosa. Osteomyelitis (inflammation of the bone marrow), pneumonia (pneumonia), sepsis (blood poisoning) and endocarditis (inflammation of the heart muscle) can also be caused by this germ.
After penicillin was no longer suitable for the therapy of Staphylococcus aureus infections in the 1950s due to the occurrence of penicillinase-forming strains, penicillinase-resistant penicillins (e.g. oxacillin, methicillin) became available again in the early 1960s. But already at the beginning of the 60's methicillin resistant strains were reported from England. In the following time there were numerous similar reports worldwide.
In Germany it must be assumed today that about 5% of the population is populated with such a strain - with a clear accumulation in old people. In nursing homes, even higher carrier rates are therefore to be expected.
The problem with methicillin-resistant Staphylococcus aureus strains is not that they are particularly dangerous compared to sensitive strains, but that very few antibiotics (such as vanomycin or teicoplanin) are available for the treatment of life-threatening infections.
Healthy persons who are only colonised with methicillin-resistant Staphylococcus aureus strains or who are only in contact with the corresponding carriers are therefore not themselves at risk. There is therefore no reason to refuse to admit MRSA carriers to a nursing home from the outset or to refuse the return of a hospitalised nurse from the hospital to the home. However, tracheostoma patients should be given special attention. In these cases, a possible MRSA carrier should be clarified. However, it is of utmost importance to prevent the spread of these resistant germs in the nursing home by consistently implementing hygiene measures in the care of all residents.
Various measures recommended for the hospital sector cannot be applied in the nursing home for the elderly because its residents live permanently in this facility and are not only temporarily accommodated here. Recent studies have shown that the permanent rehabilitation of hospitalised MRSA patients can only be achieved under very specific conditions. In the opinion of the Stuttgart Health Office, routine screening of all nursing home residents is therefore not advisable and should only be carried out in the event of an epidemic.
However, it is indispensable to prevent the spread of these potential pathogens in the nursing home through appropriate hygiene measures. Also the mutual information about corresponding patients contributes to defuse the problem.

Source: Health Office

Polyurethane

One of the "wonder weapons" in plastics chemistry with almost unlimited variation and application possibilities. LIGASANO® white, LIGASANO® orange and LIGASANO® green are polyurethanes.

PUR

Abbreviation for polyurethane.

PVC (polyvinyl chloride)

LIGASANO® is PVC-free.

Ointments, resistance of LIGASANO®

If ointments, solutions etc. are used at the same time, it may be necessary to check whether LIGASANO® is resistant to them.
Apply ointment or solution to LIGASANO®, pack tightly in a foil bag and store warm. If after 24 hours there is no noticeable visible change in LIGASANO®, it can be assumed that LIGASANO® is resistant to the preparation.
Normally the resistance of LIGASANO® is given for products applied to the skin. At least to this day we have not heard anything to the contrary.

Ointments, solutions, medications: Interactions with LIGASANO

Basically no interactions of ointments, solutions, medicines and LIGASANO®. However, ointments or solutions can trigger different effects on the skin under different conditions.
It makes a difference whether a product is applied to the skin exposed to air or to the treated body area. In the first case there is no accumulation of heat, sweat and evaporating active substances, in the second case there is no accumulation, which could even change or intensify the effect of a product to an undesirable degree.
LIGASANO® green can provide valuable services if a preparation is used in the overlying area, because it prevents or at least greatly reduces heat and moisture build-up.
! gels, ointments and some medications tend to dry out or promote the drying out of wounds when applied to the skin or wound. This can lead to LIGASANO® sticking to the wound.

Ointments, change of effect of LIGASANO®

Ointments or gels can clog the pores of LIGASANO® and change the surface texture. The controlled absorbency and the desired mechanical stimulus can be negatively affected or even eliminated.

Absorbency

Foams

Foamed (=expanded) plastics (EPS, EPP, PVC, PVA, PUR, etc.) are commonly referred to as foams. Other foamed (expanded) materials are called "foam rubber" (=latex), "cellular rubber" or "cellular rubber". Bakery products such as bread, rolls, pastries etc. are foamed (expanded) dough.

Foams as wound dressings

For foam wound dressings, polyurethane, also known as PUR in short, has become widely accepted. PUR foam has the outstanding advantage that it can be produced in countless variations (density, elasticity, cell size, cell structure, hydrolysis properties, etc.). Mainly used are polyurethane and polyester urethane flexible foams produced in continuous processes.
The various preparations usually have favourable basic properties in common, albeit with different weights: light, easy to cut to size, good mechanical and thermal protection, absorbency, air permeability. Despite these similarities, however, it is difficult to compare the effects of the various preparations because the different suppliers pursue very different goals with their product range and product properties, which are often to be achieved with the aid of material combinations.
LIGASANO® white, LIGASANO® orange and LIGASANO® green are both monoproducts with clearly defined but very different properties.

Sweating on LIGASANO®

Skin contact with LIGASANO® white promotes local blood flow, leading to a local normalisation of body temperature in lying patients. (When lying down, the blood circulation does not have to overcome gravity because the heart and circulation are on the same level. Blood pressure decreases, especially peripheral body temperature drops by about 1° C).
This local blood flow stimulation is one of the therapeutic approaches in the LIGASANO® application to enable a better supply of the body part with nutrients, oxygen, etc. to enable.
Sweating is, as is generally known, the air conditioning system of the body. The penetrating moisture should evaporate at the skin surface to produce cooling. Of course, this can only work if sufficient (moisture-unsaturated) air reaches the skin. This also works quite well in the sitting, leaning and lying area, if LIGASANO® is placed green in between, because this material is almost unhindered air-permeable, imaginable like a three-dimensional sieve.

Please note for an optimal effect:

LIGASANO® green should not be completely compressed so that there is room for air to circulate.
LIGASANO® green should not be covered on the side, so that air in the application area can exchange freely with the ambient air.

Sterilisation

LIGASANO® white is available both sterile and non-sterile.

LIGASANO® orange is available both sterile and non-sterile.

LIGASANO® green is available both sterile and non-sterile.

Those three products can also be sterilized on site with steam. Below is our Technical Information: Sterilization 15243 / Status 27 Jan. 2006 / LH.

Description of the routine sterilization of LIGASANO® white and LIGASANO® green in a validated procedure:

  • The products LIGASANO® white, LIGASANO® orange and LIGASANO® green are PUR foams with special properties for medical applications.
  • The products are offered by LIGAMED® medical Produkte GmbH (hereinafter referred to as LIGAMED®) non-sterile and partly also sterile.
  • In our experience, sterilization with moist heat in steam sterilization is very suitable for LIGASANO® white, LIGASANO® orange and LIGASANO® green. The procedure is safe and the material properties of the products are not influenced by the validated sterilisation procedures with moist heat used by us.
  • Several years ago we also gained experience with sterilization by cobalt irradiation (gamma sterilization) with a minimum dose of 25kGy. During this procedure, LIGASANO® white showed a slight discoloration, which can also be observed under UV radiation. The material properties also remained unchanged here, it was a purely cosmetic defect.
  • If the products are purchased from LIGAMED® in sterile form, these products are individually packaged in sterile packaging and sterilized with moist heat in a validated sterilization cycle. Sterilisation takes place in "large steam sterilisers" in accordance with DIN 58946-6 and DIN EN 285.
  • Validation and routine monitoring for sterilisation with moist heat in accordance with the requirements of DIN EN 554 and the DGKH recommendation for validation and routine monitoring of sterilisation with moist heat for products used in hospitals and other medical facilities in the health care sector. Other applicable standards according to current status, e.g. DIN EN 285, DIN EN ISO 10993-1 Biological evaluation of medical devices.
  • The packaging materials for sterile goods packaging are selected in accordance with DIN EN 868 and their marking has been carried out in accordance with DIN EN 980.
  • The packaging of the products into the sterile goods packaging and the introduction of the packed products into the steam sterilizer is carried out in clean rooms of ISO class 8 (corresponds to class 100,000). The quality of these clean rooms is regularly qualified in accordance with DIN EN ISO 14644.
  • Quantitative determinations of the bioburden are carried out for each production batch. DIN EN 1174 part 1-3 and LAL tests according to USFDA LAL-Guideline 1987. These tests and investigations were carried out in external laboratories accredited by the ZLG.
  • Steam sterilization is carried out at the factory for 5 minutes at 134 °C under validated conditions. In our experience, these standardized parameters best meet the requirements for adequate product safety and economy, and there is no measurable effect on the properties of LIGASANO® white, LIGASANO® orange and LIGASANO® green.
  • Other variants tested in validated procedures and their effects on LIGASANO®:
  • 121 °C / 15 minutes - without measurable effects on the properties of LIGASANO® white and LIGASANO® green
  • 134 °C / 20 minutes - low loss of hardness with LIGASANO® white, no measurable effects on the properties of LIGASANO® green.

Legal requirements and applicable standards have been complied with until 27.01.2006.

Deep wounds with narrow entrance

Deep wounds with a narrow entrance, e.g. fistulas or wounds with pockets, tend to heal superficially and encapsulate an infection. The consequence is that the wound breaks open again after a short time, possibly also at other places on the body surface. The aim is that the wound actually granulates from bottom to top or from inside to outside. For this purpose, the wound care must always extend to the wound bed.
Such treatments are often very painful because a lot of friction occurs when tamponing and removing the wound care material, which can also injure granulation tissue. The LIGASANO® wound dressing is different.

Fill the wound completely, under light pressure, with the LIGASANO® Wound Strip (Art. 15370).

To do this, first explore the direction and depth of the wound so that you can reliably reach the wound bed. The wound area is generously covered with a LIGASANO® plate, 1-2 cm thick.

The wound dressing lies leporello like in the wound. There is hardly any friction during removal.

The change of supply is relatively painless and quick and easy. Premature, superficial closure of the wound is avoided.

Ulcus cruris

Lars Koschorrek, Doctor
What are leg ulcers?
Leg ulcers (Ulcus cruris) are poorly healing (chronic), deep wounds on the lower legs and feet.
Colloquially they are often referred to as open legs. In about 80 percent of cases, they are caused by disturbances in the venous blood circulation, especially varicose veins. These wounds are rarely caused by narrowing of the leg arteries (PAOD).
In Germany, more than one million people suffer from ulcus cruris. The trend is rising.

How do leg ulcers develop?
Venous disorders
Venous leg ulcers, i.e. those caused by venous disorders, account for about 80 percent of all leg ulcers. Leg ulcers are the result of chronic venous insufficiency. The disposition to venous insufficiency is often inherited. The veins expand and lengthen and form varicose veins. This widening causes the valves of the venous system to no longer function properly (close). As a result, blood can flow back and accumulate in the veins. This congestion leads to oedema (accumulation of water in the tissue) and, after a longer period of time, to hardening of the connective tissue (sclerosis). Both changes lead to an insufficient supply of blood and nutrients to the tissue, especially in the area of the inside of the ankles and on the front of the lower leg. This can later lead to leg ulcers.
Blood clots in the deep leg and pelvic veins (thrombosis) are another cause of chronic venous insufficiency. The dilatation of the veins is also called postthrombotic syndrome.


Arterial disorders
More rarely, leg ulcers develop due to disturbances in the arterial blood circulation. The arteries transport the blood from the heart to the tissues of the body to supply them with oxygen and nutrients. If blood circulation is considerably weakened, e.g. due to severe arteriosclerosis, leg ulcers can develop.
Risk factors for arterial leg ulcers are arteriosclerosis of the legs, e.g. due to

Diabetes:
Diabetics may develop diabetic leg ulcers. These leg ulcers are often infected.
Smoking
Elevated blood pressure (hypertension)
High blood lipid levels (hyperlipidemia)
How do you notice leg ulcers?
Venous leg ulcers
mostly occur in the ankle area, especially on the inside of the leg
are often moist and weeping wounds, which often become infected with bacteria and then smell rotten.
usually cause a feeling of tension and no pain
often develop on the basis of a swollen and chronically inflamed leg (stasis eczema). The emigration of red blood cells and deposition of their degradation products (hemosiderin) causes the skin to turn brownish.
Arterial leg ulcers
mostly occur on feet, toes and heels
go along with cold and pale feet and legs
are usually painful, especially during physical exercise and elevation of the leg
How are leg ulcers diagnosed?
It is not difficult for the doctor to diagnose a leg ulcer. However, it is important for the therapy to know the triggering cause.
As a rule, a thorough examination (inspection) of the ulcer and an inquiry of the medical history (anamnesis) is sufficient for the experienced physician to assess the cause of a leg ulcer.
Doppler sonography can be used to visualise both venous and arterial blood circulation conditions. A contrast medium X-ray examination of the veins (phlebography) reveals any blood clots (thromboses). A blood test reveals a possible diabetes or coagulation disorder. In rare cases, a spinalioma (a form of skin cancer) can be the cause of a leg ulcer. This can be ruled out with the help of a tissue sample (biopsy).

How can leg ulcers be treated?
Venous leg ulcers
Compressing bandages:
Consistent implementation of this treatment is the most important measure. Many venous leg ulcers heal under a correctly performed compression measure!
Cleaning of the ulcer:
This is done either fibrinolytically, i.e. with certain ointments that can dissolve firmly adhering coatings. Another method is to remove the deposits with a sharp spoon (curetage).
Envelopes with antiseptic agents, i.e. substances that make the wound sterile or, in the case of heavily weeping wounds, moist envelopes with saline solution.
Antibiotics for massive bacterial colonisation, also in the form of infusions
In the case of varicose veins leading to the ulcer, surgical removal or sclerosing therapy (obliteration) of these varicose veins is helpful.
Frequently, allergic contact dermatitis is also present. Many ulcers are pre-treated with various ointments to which the body can react allergically over time. In these cases a local cortisone therapy can be useful.
A somewhat unappetising, but very effective treatment is a so-called bioenzymatic wound cleansing with fly larvae. Here, 100 to 200 fly larvae are applied to the ulcer for two to three days. During this time, the larvae feed on dead tissue that they have previously accumulated through their saliva. Living tissue is not attacked by the larvae.
Arterial leg ulcers
In the case of arterial leg ulcers, surgical treatment in the form of bypass surgery may be appropriate. A bypass is the bridging of a constricted or closed vascular section with the help of an artery or vein. Some ulcers can be healed more quickly by surgical skin transplantation.
However, the primary goal of ulcer treatment must be to eliminate all factors that have caused the ulcer to develop and hinder healing.

What can they do for themselves?
Venous leg ulcers
Wear fitted compression stockings. Compression is the most important measure!
Walk and move regularly to activate the calf muscles.
If you do not sit with your legs crossed, this will inhibit the vein pump.
When sitting or standing, make sure that you regularly change your working posture and move.
Whenever you have the opportunity, sit with your legs supported (above heart level).
Take them off when they are overweight.
Arterial leg ulcers
Stop smoking!
This is the most important measure. According to the motto: Stop smoking, keep walking!
Move even when you are sitting. First make circular movements with your feet and move your heels up and down. If you move until pain occurs, then take a break. Do not continue with training until you are free of pain again.
Lose weight if you are overweight.
Eat less fat and more fruit and vegetables.
Check your feet and lower legs regularly for colour changes and wounds. This is especially true for diabetics.
Do not wear shoes that are too small or too big. Buy shoes in which your feet feel comfortable.
When taking care of your feet (nail cutting), make sure you avoid any injuries, no matter how minor.
What is the prognosis?
With the right treatment, leg ulcers usually heal within a few months.
Unfortunately, many older patients are exposed to several risk factors. In this age group, the healing of a leg ulcer can take several years.
Venous leg ulcers heal better than arterial ulcers. They are almost never threatened by amputation. However, every second healed ulcer reappears within a year. This rate can be improved by consistent follow-up treatment, especially compression therapy.
Arterial leg ulcers and "shop window disease" (Claudicatio intermittens) are very serious danger signals, which without treatment can lead to a black burn (tissue destruction) and thus to amputation of toes, feet and later legs. The risk of amputation increases with the extent of arteriosclerosis of the leg or pelvic arteries and with the number and severity of the above risk factors. Patients with poorly controlled blood sugar and high blood pressure who also smoke are more likely to have an amputation.

Sources
Guidelines of the German Society of Phlebology
Braun-Falco: Dermatology and Venerology
Herold: Internal Medicine
editorial office
Dr. med. Katharina Larisch

Dressing changes

In the wound cleaning phase, the wound usually moists heavily - and it should! The exudate flow cleans the wound from the depth through the pores of the wound bed, even dry necroses are dissolved and washed out.

  • In the wound cleansing phase, the LIGASANO® dressing must always be changed at the latest when exudate becomes visible on the outside. On average twice a day, but can vary greatly from person to person.
  • The cleaner the wound, the less it will moist. Now it no longer has to clean itself, but only keep clean. Change of dressing 1x daily to 1x every 2-3 days.
    (Our recommendation is 1x daily. This ensures that granulation tissue cannot grow into LIGASANO®).

See also "Relaxation of wounds - Wound disturbance due to change of supply

Sticking to the wound

In principle, LIGASANO® does not stick in wounds, because it is always a moist wound treatment (see also blood circulation promotion). Nevertheless, it sometimes happens in practice that LIGASANO® still sticks stubbornly in wounds. Below is an overview of the causes known to us and their countermeasures:

The LIGASANO® wound dressing is thinner than 2 cm, therefore too much air reaches the wound, the exudate evaporates too quickly and dries out. Measured from the wound bed, LIGASANO® should always be at least 2 cm thick to ensure a moist and warm wound environment.
LIGASANO® has no contact with the wound in places. Exudate cannot be absorbed and dries on the one hand on the wound and on the other hand on LIGASANO®. Always pay attention to full-surface wound contact. Always apply LIGASANO® to the wound with light compression. Do not be afraid of compression! (see compression stress)
In wounds that in principle only wet very little, such as superficial burns or abrasions, the leaked blood or exudate can dry out. It is usually helpful to moisten LIGASANO® on the wound side, e.g. with Ringer's solution, in order to increase the moisture content.
In addition, ointments, gels or medicines are used in wound treatment which dry out and thus combine with the skin/wound on the one hand and LIGASANO® on the other. This sticking is desired in individual cases. The adhesive effect of the gel should accelerate the debridement process. If the adhesive effect is not desired, please check whether ointment, gel or medication is really necessary or whether another, non-drying preparation with the desired effect is available.
Additional ointments, gels or medicines are applied to the wound, which have a drying effect on the wound itself. A moist, warm wound environment cannot develop. Please check whether an ointment, gel or medication is really necessary or whether another, non-drying preparation with the desired effect is available.
LIGASANO®: was too long in the wound during the granulation phase, newly formed tissue has sprouted into the cell structure. When LIGASANO® is used, wounds often granulate surprisingly quickly and strongly. In such cases, it makes sense to shorten the interval between the change of supply.

As a general rule, if LIGASANO® is stuck to a wound, please moist it from the outside and press the wetness into the material with pumping movements so that the dried blood or exudate softens to such an extent that LIGASANO® can be easily removed.

Prescribability of LIGASANO®

LIGASANO® white, LIGASANO® orange and LIGASANO® green are dressing materials that can be prescribed in Germany if they are prescribed and used as such.
According to § 31 paragraph 1 sentence 1 SGB V, insured persons are entitled to the supply of pharmacy-prescribed drugs, insofar as the drugs are not excluded according to § 34 or by guidelines according to §92 paragraph 1 sentence 2 no. 6, and to the supply of bandages, urine and blood test strips.
LIGASANO® white, LIGASANO® orange and LIGASANO® green are not drugs or pharmacy-like medical devices, but medical devices used as dressings.
Dressings are prescribable according to the above mentioned § 31 and are not subject to the exclusion regulation according to § 34.
Dressing materials are subject to copayment according to the amount resulting from § 61 sentence 1.

Water vapour permeability

Water vapour permeability is only measured for relatively impermeable materials such as films. A meaningful measurement value for LIGASANO® can therefore not be given, it is almost unhindered water vapour permeable. The usual measuring methods, e.g. according to DIN 53122, ISO 11092, DIN 31092, are not applicable.
This is also the reason why LIGASANO® should always be at least two centimetres thick when treating wounds (measured from the wound bed). So that too much air does not get to the wound, so that a temperature-insulating effect is created, so that exudate does not dry out and LIGASANO® does not stick to the wound.

Plasticizers

LIGASANO® does not contain any plasticizers.

Wound healing disorders

Wound healing disorders hinder wound healing and are the cause of chronic wounds.
Typical and frequent wound healing disorders are circulatory deficiency, malnutrition, metabolic disorders, sepsis and additional inflammation.
Another not uncommon wound healing disorder is mistreatment. In fact, it is relatively easy to prevent a wound from healing by incorrect treatment.
See also "Relaxation of wounds - wound disorders due to change of supply".

Wound management

A fashionable term that distracts from the measures actually required, especially in the case of chronic wounds. It sounds as if the treatment of wounds could actually heal wounds, but this is not true.
The fact is that the patient's organism must be able to heal the wound. In the case of chronic wounds, the main focus must be on eliminating the wound healing disorders (see Wound healing disorders). The "wound management", i.e. the direct treatment of wounds, which is placed in the foreground, only fulfils secondary tasks in the wound healing process.

Wound cleaning

  • Effective wound cleaning and germ reduction without further intervention
  • Wound rinses, antiseptics, ointments etc. are unnecessary
  • The excess exudate is absorbed by LIGASANO® white in a controlled manner without drying out the wound.
  • The wound edges do not overflow
  • The wound environment always remains moist and warm
  • No sticking to the wound
  • Very fast change of supply, as no additional wound treatment other than the change of supply itself takes place.

Wound calm - Wound disturbance due to change of supply

The wound should be disturbed as little as possible in order to promote an unhindered healing process. We consider this to be perfectly correct, however, with LIGASANO® wound therapy, a daily change of dressing is also suggested during the granulation phase. How does this fit together?

Let us summarise what is actually meant by calm or the opposite, the wound disorder. Typical wound disorders in classical wound care, but also in modern wound care, include

  • Long open time of wound. The wound cools down within minutes, the vessels constrict, blood circulation and thus the wound care is reduced. The wound remains passive and defenceless against approach germs for hours. During the long open time, approach germs also have plenty of time to settle on the wound or penetrate the body.
  • Rinse or shower the wound. These wound cleansing measures also cool the wound with the consequences described above. In addition, when the wound is rinsed or showered out, the body's own defence and nutrients that have been laboriously transported to the wound are washed out in addition to the undesirable coatings and germ colonisations. A real wound cleansing does not take place during rinsing or showering, the measure remains superficial, deeper-seated germs and pathogens are not reached.

These disturbances are completely spared the wound during the LIGASANO® treatment:

  • The entire wound therapy consists exclusively of changing the dressing at the right time. Practical experience has shown that additional measures such as rinsing, antiseptics, ointments etc. are unnecessary.
  • When changing the dressing, the wound does not have to be cleaned or treated additionally.
  • The dressing is changed very quickly (see pressure tension), the wound is usually open for less than half a minute during the proper change of dressing. This means that the wound is spared any wound disturbances that could prevent healing when the LIGASANO® dressing is changed.

If LIGASANO® wound therapy is applied correctly, there will never be any wound disturbances at any time and the wound healing process will never be interrupted. Therefore: No fear of frequent dressing changes!