Promogran and Promogran Prisma made easy
25/05/10 | Complex wounds, Infection | Cullen B, Ivins N
STEP-BY-STEP GUIDE TO APPLICATION
Step 1: Prepare the wound bed
Before any application of Promogran or Promogran Prisma, the wound bed should be prepared according to local policy. This will usually involve removal of necrotic or sloughy tissue and any previous dressings.
Note: if there are signs and symptoms of an infection, this should be treated appropriately and the use of Promogran Prisma considered.
Step 2: Assess the level of exudate
The products are supplied pre-packed and packaged in a tray. This can be used to hold saline to pre-wet the dressing if the wound has a low exudate level. Alternatively, a small amount of saline can be added to the surface of the dressing once it has been applied to the wound bed. This helps to initiate the breakdown of the dressing and its ability to modify the wound environment.
Note: the choice of the secondary dressing is dependent on the level of exudate.
Step 3: Apply the dressing
Place the dressing in the wound bed. If the patient has multiple small wounds the dressing can be broken into smaller pieces with a gloved hand.
Note: if there is any depth to the wound the dressing should be layered to fill the wound.
Step 4: Dressing review
Based on instructions of use, the dressing should be changed every 72 hours or more frequently if the exudate level is high. If the gel has not biodegraded the dressing should be left in place until the next dressing change, minimising disturbance to the wound. If there is no residue of gel in the wound bed or traces left on the secondary dressing and the wound bed is clean and granulating, the dressing has fully biodegraded. Both products can be used under compression bandaging and do not cause indentation, skin irritation or maceration, even when the dressing is overlapped at the wound edge.
WHAT FACTORS INDICATE THIS IS THE RIGHT DRESSING CHOICE?
From personal experience, during the first few dressing changes there should be a change in the colour of the wound bed and a reduction in the amount of sloughy tissue present. Following two weeks of treatment there should be a marked reduction in the level of exudate. Often the first change is that patients report a reduction in the level of pain experienced.
WHEN SHOULD TREATMENT BE DISCONTINUED?
There is no need to stop Promogran or Promogran Prisma if the wound is progressing well. However, if the wound is epithelialising and there is no exudate, it may be more appropriate to change to a simple non-adherent dressing.
WHEN IS TREATMENT CONTRAINDICATED?
Neither product should be used on patients with full-thickness burn injuries, active vasculitis or a known hypersensitivity to either collagen or ORC . If infection is present or suspected, it should be treated according to local policy. Promogran Prisma can be used with systemic antibiotics to treat infection.
WHAT ARE THE ECONOMIC ARGUMENTS FOR USING THIS TREATMENT?
A case for using these products can be made if they can be shown to accelerate healing and reduce the number of dressing changes. This may be supported by evidence from clinical trials [50,51]. In addition, it is important to consider factors such as reduction in pain because many patients may experience high levels of pain, which can affect all aspects of daily life and may cause poor sleeping patterns .
Furthermore, Phillips et al  have reported that many patients with leg ulcers experience negative financial, social and psychological effects, which are resolved once the ulcer is healed.
Often decisions about which dressing to use are based on limited clinical experience. Patients may see a number of practitioners and be prescribed different dressings by each. This may lead to a lack of continuity of care with poor rationale for treatment choice, which may negatively impact on costs. It is therefore important that clinicians understand when and how to use these products appropriately to ensure optimum outcomes for patients.
Promogran and Promogran Prisma are designed to provide an optimum wound healing environment and to modify the wound biochemistry, by reducing excessive protease activity to promote healing. These dressings can be considered in a wide range of wounds to 'kick start' healing.
Cullen B, Scientific Programme Manager, Systagenix Wound Management, Skipton, UK
Ivins N, Research Nurse, Wound Healing Research Unit, Cardiff University, UK
Supported by an educational grant from Systagenix. The views expressed in this 'Made Easy' section do not necessarily reflect those of Systagenix.