The Application of Modern Dressings to Buruli Ulcers: Results from a Pilot Implementation Project in Ghana

Abstract

Abstract. Buruli ulcer (BU) is a tropical, infectious skin disease. The resulting ulcer can take a long time to heal, and a high standard of wound care is essential. Currently, the only dressing used for BU wound care is gauze, and its removal causes pain and bleeding. We performed a pilot implementation project using HydroTac ® (HARTMANN, Heidenheim, Germany), a modern dressing combining foam with a hydrogel component. For future BU treatment, we recommend to use a more absorbent dressing than the HydroTac dressing used in the current project. However, we show that modern dressings can be applied to BUs and that HydroTac dressings yield clean, healing wounds, and prevent the pain and bleeding associated with gauze dressings. Wound care is a vital but to date neglected aspect of BU management.

Buruli Ulcer: a Review of the Current Knowledge

“…Some innovative approaches have been piloted for management of BU wounds, including use of absorbent form dressing HydroTac ® (Harmann, Heidenheim, Germany) and negative-pressure wound therapy V.A.C. Therapy System ® (Kinetics Concepts Inc. (KCI), San Antonio, USA) with successful outcomes [ 98 , 99 ]. More of these experiences are needed to be accumulated, together with cost analysis, to address the long-term benefit of such treatments.…”

First-Line Interactive Wound Dressing Update: A Comprehensive Review of the Evidence

“…In general description and physical properties sections, we used information extracted from published articles, books and book chapters. Although we aimed to include publications that arose from research designs providing the highest level evidence (Burns et al, 2011), in their absence, lower levels of evidence were also considered, including descriptive studies, case series, case reports, and pilot projects; for example, a pilot project on the use of hydrogel dressings for management of Buruli ulcers (Velding et al, 2016). Following step five of the Exploratory Phase, we expanded our search to other sources, and included information from the online Wound Care Handbook: The professional's guide to wound product selection (Healthcare Ltd, 2019); for example, information related to HydroTac and HydroTac Comfort dressings.…”

“…The studies included in this systematic review were small trials of poor quality and high risk of bias (Wasiak et al, 2013). HydroTac was piloted in the management of Buruli ulcers and reported the use of foam dressings without a hydrogel component may be more effective (Velding et al, 2016).…”

“…Second, we aimed to focus on the data sources that provide the highest quality evidence, including RCTs and systematic reviews, and therefore, if these data sources were available, information on the effectiveness of first-line dressings based upon the findings from studies that provide lower level of evidence was excluded. Lower levels of evidence, however, were considered in the absence of higher quality evidence, including descriptive studies and pilot projects; for example, a pilot project on the use of hydrogel dressings for the management of Buruli ulcers (Velding et al, 2016). This study inclusion approach is considered appropriate, given the aim of this review was to compile the latest available evidence.…”

Antimicrobial Treatment of Mycobacterium ulcerans Infection

“…During the active phase of the disease adequate wound care is imperative to ensure healing and to prevent disabling scarring. Non-adhesive, absorbent dressing materials have been shown to improve the wound microenvironment and improve time to healing [96,97], and might also play a role to prevent painful dressing changes. While M. ulcerans is generally thought to be a pain-free disease as the toxin mycolactone causes hypoalgesia [98][99][100], later on, as lesions start to heal and the mycolactone is washed out from the lesions and the system, patients report considerable pain especially during wound dressing changes and during physiotherapy needed to prevent and treat contractures and disability [101].…”