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APPLICATION TECHNIQUES AND CASE STUDIES
You can click on the hyper linked applications below for more details and case studies:
- Diabetic wounds
- Burn wounds
- Surgical wounds
- Ulcers
- Bites: animal and human
Bites: venomous
- Digitip (finger and toe) injuries
- Pressure sores
- Emercency Aid
Other successful applications:
- Post-operative wounds
- Post-operative sepsis
- Venous stasis ulcers
- Infective ulcers
- Post-cryotherapy treatment
- Traumatic blisters
- Freshly sutured lacerations
- Traumatic injuries
- Septic wounds
- Dehiscence of wounds
1. DIABETIC WOUNDS
People suffering from diabetes need to be extra careful not to injure themselves as their wounds tend to take longer to heal and often result in complicated or non-healing wounds. Amputations of limbs due to non-healing wounds are not uncommon.
Cerdak has proved to be very useful for diabetics with wounds:
- Early detection of wounds, even a superficial scratch breaking the skin, is very important. The sooner Cerdak treatment is started, the easier wounds will heal. Insignificant wounds will not necessarily heal without any treatment - too many diabetics realise this too late.
- Blood sugar levels must be tested regularly and kept within acceptable limits.
- Before starting treatment with Cerdak, a wound should be cleaned and if necessary, debrided. The wound should be inspected by a professional to determine whether an infection is present, which should then be treated.
- Pressure points should be eliminated to increase blood supply to the wound.
Case study 1: Patient is a 52 year old male with non- insulin-dependent diabetes who presented with a septic ulcer and mild cellulitis surrounding the ulcer. Cerdak Wound Treatment Devices (WTD's) were applied to the wound at home, following the standard treatment protocol. He returned on day 6 of treatment with good signs of healing. The patient finally returned on day16 of treatment with the defect completely closed and no further treatment required.
Case study 2 : The patient is a 45 year old school master with non insulin-dependent diabetes. He presented with a painful ulcer of the right lower leg . His blood sugar was measured at 16.25 mmol/l. Cerdak Wound Treatment Devices were started at the time of initial diagnosis. He was treated with Cotrimoxazole 2 tablets 2 x per day and Diclophenac sodium 25 mg 3 x per day . The inflammation and pain settled within 3 days. By day 10 the ulcer had desloughed and was clearly healing. No further oral treatment was given , but the patient was given fresh dietary advice and was asked to return for follow up measurements of blood sugar . It was still above the 12mm/l level. He returned on day 33 with the wound healed, but as his blood sugar level was still above 15mmol/l , he was referred to a specialist diabetes center for counseling and expert treatment by a team of diabetic healthcare professionals.
2. BURN WOUNDS
- Burn wounds should be cooled down in cold water for two to three hours.
- Cerdak can be used for all degrees of burn, however, third degree burns should first receive surgical treatment to remove eschar (incinerated, dead tissue). Once the 3rd degree burn wound has been cleaned, Cerdak can be applied.
- Should Cerdak stick to the wound, the Cerdak sachet can be soaked with water. When fully saturated the Cerdak can be peeled off easily.
- Chemical burn wounds should be rinsed very thoroughly with clean running water before applying the Cerdak WTD's
- In large burns adequate fluid and protein replacement should be done in the hospital setting.
- Blisters must be de-roofed as soon as possible to create the ideal circumstances for quick re-epithelialisation. Leaving the blisters intact did not contribute to positive healing with Cerdak. Wound treated by de-roofing had a much shorter healing time and less slough to remove once the blister fluid has drained.
Case study 1: The patient is a 7 year old girl who burnt herself whilst playing with a fire poker. She sustained a deep second degree burn on her right shin . She was treated with Cerdak till healed. The skin recovered and she fortunately formed no scar tissue. After the wound had completely healed she applied vitamin A and anti-oxidant cream on the skin.
Case study 2 : The patient is an 36 month old child who sustained second degree burs on most of her back when she accidentally pulled a kettle with hot water onto herself. The blisters were deroofed and healing took place within eleven days with only oral paracetamol and oral rehydration during the first two days. Cerdak was changed every second day and the patient required no analgesics for dressing changes.
3. SURGICAL WOUNDS
Cerdak Surgical is a product designed to be used as a primary surgical dressing by doctors or surgeons at the end of an operation.
The advantage of the Cerdak surgical device is that it reduces the rate of post-operative wound sepsis in high risk cases. It is therefore logical that it will help prevent sepsis in all cases. Sepsis in operation wounds is a serious complication that often results in a much longer stay in hospital, more antibiotic treatment and pain and suffering for the patient. This clearly adds a great deal to the cost of treatment.
The wound is left closed for as long as the outer surface of the Cerdak Surgical device shows less than 50% discolouration of the visible surface. The wound need not be cleaned or disinfected at the time of a change of the Cerdak device. If it does look saturated it is simply removed and replaced by a new device.
Many surgeons are in the habit of opening surgical wounds on day 1 or day 2. This is perfectly acceptable and will not compromise the wound in any way. Practical experience has shown that once Cerdak has been used on a few patients by a particular surgeon, the need to open the wound has become less, as simple inspection of the outer surface will provide adequate evidence of any complication.
One of the key aspects in the action of the Cerdak in this application is the reduction of inflammatory elements in the suture line of the wound by the ceramic. This clearly leads to less production of exudate and less bleeding. This in itself, reduces the risk of sepsis over and above the natural bacteriostatic action of the ceramic, as described above.
This product is envisaged to make a substantial difference in the sepsis rates of operating theatres, save patients and medical insurers money and more importantly, lower the risk in the individual patient of the complications of post-operative sepsis.
Case study 1 : Examples of primary surgical wounds NOT treated with Cerdak primarily. Note the swelling on the wound margin and the presence of wound exudate on the suture line. Clear inflammatory reaction around the staples' entry wounds.
Case study 2 : Examples of wounds treated with Cerdak primarily. Note the absence of wound exudate, swelling at the suture line and completely clean wounds. All of these signs indicate a down-regulation of the inflammatory reaction in the wounds.
4. ULCERS
Cerdak is used for all types of ulcers, acute as well as chronic. It is not a miracle cure for old ulcers though.
NB : Chronic ulcers is the one area where failures might occur. The reason for this is that the biology of some very old ulcers has become so disturbed that healing can not proceed according to the normal orderly healing cascade. Put a little differently, Cerdak can only help wounds heal when the innate ability of the skin to heal is still intact.
- Sepsis is not a contra-indication for the use of Cerdak, it is in fact one of the indications for its use precisely because the ceramic is so bacteriostatic.
- If pain occurs on application of the Cerdak it might be an indicator that the Cerdak will fail to work. Advise the patient to try and bear the pain with the help of analgesics and physical measures. If positive signs of healing is clearly visible after ten days and no other forms of wound treatments have worked in the past, they are advised to try and persist. In our experience patients who fall into this category of very old and disturbed wounds that have failed to heal by any other treatments used, will experience healing in at least 60 % of cases.
- Cerdak can be packed into deep wounds. Placing a single layer of woven gauze in between makes packing and extraction easier.
- In large wounds adequate fluid and protein replacement should be done in the hospital setting.
Case study 1: The patient is a 54 year old war veteran and drug addict who developed necrosis of the skin on his shin due to repeated injections of heroin. The first picture depicts the healing by conventional means after 12 months. Very little progress was visible during the two months prior to the picture. He was treated with Cerdak and the wound healed completely within two and a half months
Case study 2: The patient is a 80 year old female patient who had developed an ulcerated area on the lateral aspect of the right lower leg two weeks before. She had been treating with daily povidone iodine dressings. The ulcerated area was getting steadily bigger. CERDAK WTD's were applied according to the standard treatment protocol. No additional systemic treatment was given. The leg was healed on day 6.
5. BITES: ANIMAL AND HUMAN BITES
VENOMOUS INSECT BITES
VENOMOUS FISH BITES
This is one of the unique application areas of Cerdak, as there are no other specific products marketed in this area. Due to the considerable capillary suction power of Cerdak Wound Treatment Devices, it seems to work well in limiting the effect of venom. We have experience with use in spider bites, limited experience with snake bites and wide experience with animal (including human) bites.
1. Animal bites require thorough cleansing of the wounds to remove saliva, before applying the Cerdak WTD's. Antibiotics and painkillers need to be used at the start of treatment. The Cerdak WTD's are to be used according to normal surgical principles as mentioned above and the sooner the devices are applied the better.
2. Spider venom is well known to show a delayed effect, creating wounds with very large areas of tissue death (necrosis) often with devastating effects. Cerdak WTD's are able to reduce the extent of the damage. It is important not to try and use ONLY the Cerdak WTD's, but to make use of the normal other treatment, especially high doses of cortisone and if necessary, antibiotics. The same principles will apply to the bites of snakes and other venomous insects and fish. Venomous insect bites must be cooled down to slow down local circulation in the injured part and to inhibit the body's reaction to the venom. This limits the damage.
When using Cerdak on an old spider bite (e.g. Violet Spider) where the venom has caused necrosis, it is important to realise that part of the healing process will be the natural removal of necrotic (dead) tissue and Cerdak will most probably have exactly this effect. After initial treatment the wound will look bigger rather than smaller. Surgical debridement and antibiotics will probably be necessary before commencing with Cerdak.
3. Marine venomous bites : The affected body part should be placed in water as warm as the patient can tolerate. Marine venoms evolved in temperatures below 25oC and heat denatures the protein of the venom very quickly, thus limiting tissue damage and relieving pain almost immediately. Dead tissue must be removed surgically before commencing with Cerdak treatment.
Case study 1: The patient is a 45 year old male who was bitten by a spider on his arm. He identified the spider as a violin spider. The wound was clearly very unstable with a lot of marginally necrotic tissue on inspection. He was treated with prednisone 10 mg 2x per day for 5 days, penicillin and Cerdak topically. The wound healed uneventfully with no significant tissue loss and almost no scarring.
6. DIGITIP (FINGER AND TOE TIP) INJURIES :
This application of Cerdak Wound Treatment Devices has produced some unique and astounding results and can be highly recommended in the area of injuries to finger and toe tips.
There are no other products that are specifically marketed for this purpose.
The simple application of Cerdak WTD's onto these injuries and the simple changing of the devices at home, makes it a very cost effective method of treatment for this common type of injury.
Unique features of the digitip treatment has been restoration of a good quality nail bed and good quality nail in many different types of injury. The use of Cerdak WTD's in this application avoids costly and often unsuccessful surgery in a large number of cases. Very good examples are to be seen in the collection of case histories.
Contaminated wounds are to be irrigated very thoroughly with clean water before applying the Cerdak digitip wound treatment devices.
Case study 1: The patient is a 23 year old farm worker who injured his left middle finger when it was caught in a chain used to fasten sugar cane stacks. The chain avulsed the entire soft tissue tip of the finger as can be seen in the first photograph. The avulsed tissue include the complete nail plate and pulp of the tip. As the injury was older than 3 hours and the tip had not been cooled down it was decided not to try and graft it back on. In stead the amputated end of the digit was treated with Cerdak ceramic wound treatment devices. These were initially changed daily for the first week and then every second day for 5 weeks. Unfortunately the patient did not return for follow up photographs until the finger had completely healed. It was healed by 6 weeks, but continued to pigment normally over the next six weeks. Only a small area of hyper-keratotic scarring on the very tip remains visible. He only returned for follow up photographs at the end of three months .
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Day 0
The lost tip not grafted back on. |
Day 0 |
Day 90 |
Case study 2: The patient is a 2 year old toddler who injured the tip of his right index finger with a partial amputation of the finger tip and complete loss of the nail plate. The finger was treated with Cerdak and paracetamol for a short time. The finger shows complete regeneration of the soft tissue after 5 weeks with a flat, normally shaped nail plate.
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| Day 0 |
Day 37 |
7. PRESSURE SORES
- Devitalised tissue must be removed surgically before commencing with Cerdak treatment.
- Cavities in pressure sores must be lined and packed with Cerdak to ensure proper contact with the wound.
- Deep cavities should be redressed fairly often and irrigated with saline between dressings if thick pus is present.
- Minimum pressure should be placed on the wound until it has healed. Removing direct pressure from the wound area is essential for more rapid healing.
- Do not stop treatment with Cerdak until the wound has healed completely.
Cerdak can safely be used to treat the wounds of patients with cancer, but will not heal or cure malignant or pre-malignant wounds. The smell of these wounds is successfully treated by Cerdak. Cerdak will give positive results when applied to the wounds of patients who are HIV positive or who are suffering from AIDS. This irrespective of the general status of the immune system. Naturally it is recommended that these patients should be treated with the appropriate anti-microbial drugs and anti-viral drugs.
Case study: The patient is a 30 year old man who fractured his neck when he dived into a swimming pool. He is partially quadriplegic. Conventional "state of the art" dressings had been applied for a month when the first picture was taken. Cerdak was applied in the normal fashion and the wounds healed uneventfully. Marginal tissue recovered well soon after applying the Cerdak.
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| Day 0 |
Day 45 |
11 Months (no re-infection) |
8. CERDAK IN YOUR FIRST AID KIT
- Emergency treatment aid
The basic action of the ceramic ensures bacteriostasis in new, open wounds.The Cerdak WTD's act as pressure appliances on bleeding wounds. Speed is of the essence, while a protective cover and haemostasis (stopping blood loss) are the important factors to consider to stop bleeding. The Cerdak WTD's can be removed and discarded as soon as the patient is in the emergency room or operating theatre. The unique action and advantages of Cerdak make this the best choice for serious or minor emergency treatment of wounds.
- Spider and other venomous bites
Use Cerdak to limit the effect and spread of venom. Please refer to section on venomous and spider bites.
- Boils
The use of Cerdak on boils give excellent results. The boil should be drained and all necrotic (dead tissue) removed before applying the Cerdak. Signs of deeper infection will require normal antibiotic treatment. Continue with Cerdak WTD's until the skin has healed according to the standard treatment protocol.
- Minor burns, cuts and other injuries
Follow the general instructions for application.
- Nail fold infections
Nail fold infections often lead to small, very painful abscesses. These should be drained, appropriate antibiotics used and Cerdak applied according to the standard treatment protocol.
- Blisters
Remove the lifted layer of skin or de-roof the blister completely before applying the Cerdak WTD. The unique non-sticking membrane will prevent painful dressing changes. Removing the injured upper layer of skin allows for quicker healing time and reduces the risk of infection.
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