Article 1

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" colspan=2 height=88 BGCOLOR="#006699" TEXT="#080000"> <div> carbonics GmbH  -  <FONT SIZE="4" COLOR="#FFFFFF" FACE="Tahoma" >Carbon Wound Dressings</FONT></div> <div> <A HREF="anfang98.htm" TARGET="_top" TITLE="Medical"><U>Medical</U></A>   ·   <A HREF="id153.htm" TARGET="_top" TITLE="Products"><U>Products</U></A>   ·   <A HREF="id154.htm" TARGET="_top" TITLE="Case Studies / Publications"><U>Case Studies / Publications</U></A>   ·   <A HREF="id155.htm" TARGET="_top" TITLE="Contact"><U>Contact</U></A></div> <div> <A HREF="id156.htm" TARGET="_top" TITLE="Case Study 1: Lower Leg"><U>Case Study 1: Lower Leg</U></A><FONT SIZE="2" COLOR="#FFFFCC" FACE="Tahoma" >   ·   </FONT><A HREF="id157.htm" TARGET="_top" TITLE="Case Study 2: Face"><U>Case Study 2: Face</U></A><FONT SIZE="2" COLOR="#FFFFCC" FACE="Tahoma" >   ·   </FONT><A HREF="id158.htm" TARGET="_top" TITLE="Case Study 3: Legs"><U>Case Study 3: Legs</U></A><FONT SIZE="2" COLOR="#FFFFCC" FACE="Tahoma" >   ·   </FONT><A HREF="id159.htm" TARGET="_top" TITLE="Case Study 4: Stump Infection"><U>Case Study 4: Stump Infection</U></A><FONT SIZE="2" COLOR="#FFFFCC" FACE="Tahoma" >   ·   </FONT><A HREF="id172.htm" TARGET="_top" TITLE="Varicose Ulcers"><U>Varicose Ulcers</U></A><FONT SIZE="2" COLOR="#FFFFCC" FACE="Tahoma" >   ·   </FONT><B>Article 1</B><FONT SIZE="2" COLOR="#FFFFCC" FACE="Tahoma" >   ·   </FONT><A HREF="id161.htm" TARGET="_top" TITLE="Article 2"><U>Article 2</U></A><FONT SIZE="2" COLOR="#FFFFCC" FACE="Tahoma" >   ·   </FONT><A HREF="id162.htm" TARGET="_top" TITLE="Article 3"><U>Article 3</U></A></div> </td> </tr><tr> <td valign="top" width=20,625% BGCOLOR="#006666" TEXT="#080000"> <bR> <div> <IMG SRC="20b4f610.gif" border=0 width="79" height="97" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> Dr. Cordula Krawehl-Nakath</div> <div> <I>was born on Feb. 18, 1950 in Peine (Lower Saxony, Germany) and attended school there. 1969-1971: one year of voluntary social work followed by a nursing course in Berlin. From 1971 until 1973 she studied biology at the University of Tübingen and completed her pre-diploma work. From 1973-1978 she studied medizine at the University of Frankfurt. From 1978-1981, Dr. Krawehl-Nakath worked in Frankfurt hospitals as a medical assistant in the departments of general and traumatic surgery. After receiving the rank of ambulance service officer in the German Armed Forces in 1981, she continued her professional educcation in surgery, first for one year in the GAFCH in Koblenz and then in the Evangelic Hospital in Bad Godesberg until 1985. Until 1993, she worked as a medical assistant in the Department for Traumatic Surgery and Burn Care of the GAFCH, and received her doctorate in 1990 from the University of Bonn. During 1993-1995, she completed her professional education in plastic surgery in various clinics in Cologne. In 1996, she received recognition in the area of plastic and hand surery. Since 1996, Dr. Krawehl-Nakath is a Senior Medical Assistant to the Department Director at the GAFCH in Koblenz.</I></div> </td> <td valign="top" height=392 BGCOLOR="#FFFFFF" TEXT="#080000"> <div>      <FONT SIZE="3" COLOR="#000000" FACE="Arial" ><IMG SRC="179b0210.jpg" border=0 width="176" height="33" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></FONT></div> <bR> <div> <B>The Treatment of Burns with a Carbon Fibre Dressing , </B></div> <div> <B>Sorusal, Legius - A New Method of Treatment</B></div> <bR> <div> Department XIV - Trauma Surgery / Plastic Surgery / Burns Unit</div> <div> (Chief Medical Officer: Dr. G. Gritze) German Armed Forces Central Hospital Koblenz</div> <div> (Chief Medical Officer: Prof. Dr. H. Frößler)</div> <bR> <div> <B>C. KRAWEHL-NAKATH, S. GOEBBELS, N. SEIDENSTICKER, </B></div> <div> <B>P. MARKOWSKI-WONG, S. SCHOLTEN</B></div> <bR> <div> <TABLE BORDER="2" CELLPADDING="2" CELLSPACING="1" WIDTH="583" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#111111" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" BGCOLOR=#C0C0C0 > <tR> <tD VALIGN=TOP HEIGHT= 194 WIDTH="571"><div> <B>Summary</B></div> <div> Antiseptic treatment of burn injuries is carried out with the aim of protecting the burn wounds against infection until the healing process is complete. As a rule, such treatment is performed with the use of antiseptic solutions and ointments.</div> <bR> <div> The development of the carbon fibre dressings, Sorusal and Legius, has resulted in a new medical treatment concept which is especially effective in the treatment of burn injuries. this treatment method consists of the removal of burn blisters, disinfection of the wound and application of a carbon fibre wound dressing.</div> <bR> <div> This method of treatment was implemented in our clinic in 1996.</div> </tD> </tR> </TABLE></div> <bR> <bR> <div> Topical wound treatment of burn injuries is a standardised procedure and consists mainly of disinfection of burned surfaces, followed by application of antiseptic solutions or ointments with or without the use of bandaging material. In most hospitals, the treatment is performed with sulfadiazine or iodine. At the Department of Burn Care of the German Armed Forces Central Hospital in Koblenz, we have been using carbon wound dressings for treatment of patients with 2nd degree burn injuries (a and b) since 1996. These dressings, impregnated with antiseptics, are an exceptional wound dressing. We call this method of treatment the "Koblenz Model". </div> <bR> <div> <B>Material</B></div> <div> The production of wound dressings manufactured from carbon fiber fabrics was strongly influenced through the treatment of radiation burns after the breakdown of the nuclear reactor in Tschernobyl in 1985. Sterile gauze, easy to handle and suitable for treatment of the burn injuries was needed.</div> <bR> <div> These requirements were met by the wound dressing Sorusal and Legius, manufactured from pine cellulose through a carbonisation process. The carbon content of Sorusal and Legius is 99,9% and 98,0% respectively. The dressings differ in their woven structure. Sorusal has a higher porosity than Legius; one gram of Sorusal has a surface of 1200-1500 m², which allows for high absorption. In contrast to the Sorusal dressing, the Legius dressing can be impregnated with antiseptic solutions and used for long-term disinfection.</div> <bR> <bR> <div> <B>Mechanism</B></div> <div> Because of their soft pliability, the carbon fiber wound dressings Sorusal and Legius comfortably cover the wound surface without adhering. Sorusal dressings should be used during the exudative phase of treatment, due to their outstanding hygroscopic properties. The Legius dressing, after impregnation with antiseptica, should be used for long-term disinfection of burn injuries as a "wet wound dressing".</div> <bR> <div> The carbon fibre dressings protect the wound surface against mechanical damage and against bacteria. Due to their soft consistence, they do not chafe or rub the wound and are well tolerated by patients.</div> <bR> <div> The highly absorbent Sorusal dressing results in a quick drying out of the burn injuriy and, at the same time, facilitating the evaluation of the depth and extent of the damage to the tissue. Because of their chemical inertness, the application of the Legius dressing promotes the quick healing of superficial burn injuries.</div> <bR> <div> <B>Method</B></div> <div> Since January 1996, the carbon fiber wound dressings Sorusal and Legius have been used for topical treatment of burn injuries in the German Armed Forces Central Hospital in Koblenz. This method of treatment, also known as the "Koblenz Model", includes the following steps:</div> <bR> <div> After debridement, the wound is disinfected with Betaisodona (povidone-iodine) or, in case of iodine allergy with Lavasept (silver sulphadiazine). The wound is then covered with a dry, steril Sorusal, fixed with a mull bandage. Because the burn injury tends toward extreme exudation during the 24-48 hours post trauma, the Sorusal dressing is the proper dressing to use. As soon as the dressing becomes soaked (usually after 6-8 hours) it should be changed under sterile conditions. The wound is then again disinfected and rebandaged with a new, dry Sorusal dressing.</div> <bR> <div> As soon as the wound is no longerin the exsudative phase, the <B>dry stage of treatment</B> is complete and the <B>wet stage of treatment</B> with the Legius dressing follows. The disinfection of the wound is carried out as described above. After disinfection, a Legius dressing should be soaked with diluted povidine-iodine (1:5) solution and placed on the wound, again fixed with sterile mull bandage.</div> <div> Thereafter, the dressing should be soaked with the antiseptic solution every 6 hours; a complete dressing change takes place every other day. Through this method, a long-term disinfection of burn injuries is achieved, which minimises the risk of infection. </div> <bR> <div> Should the dressing dry out on the wound, it can easily be removed through the application of saline solution.</div> <bR> <bR> <div> This method of treatment has the following advantages:</div> <bR> <div> Because the burn injury dries out quickly, usually within two days post trauma, the assessment of the depth and of the extent of tissue damage is easier. After 3-5 days, a reliable differentiation between surface injury and deep injury is possible. Consequently, this facilitates the determination of the optimum point in time for surgical intervention in the case of deep burns.</div> <bR> <div> Treatment of superficial 2nd degree burns with Sorusal and Legius results in a quick and spontaneous epithelisation of the damaged tissue within 10-12 days. In the case of superficial and deep 2nd grade burns, spontanous healing sets on after 10-20 days. In some cases, operative debridement can be necessary during the healing phase in order to remove fibrinous residue.</div> <bR> <div> In case of infection of severe burn injuries (for example, bei pseudomonas eruginosa stems), antiseptic treatment with Legius dressings impregnated with 1% acetic acid solution has proven to be effective.</div> <bR> <div> The following photographs illustrate the "Koblenz Model" method of treatment.</div> <bR> <div> <B>Example 1</B></div> <bR> <div> <IMG SRC="20fa2f60.jpg" border=0 width="162" height="246" ALIGN="BOTTOM" HSPACE="0" VSPACE="0">  <IMG SRC="214abf70.jpg" border=0 width="171" height="247" ALIGN="BOTTOM" HSPACE="0" VSPACE="0">  <IMG SRC="210c1f90.jpg" border=0 width="193" height="249" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> <I><B>Fig. 1                                      Fig.  2                                         Fig. 3</B></I></div> <bR> <div> <I><B>Fig. 1</B></I>: 2nd degree burns of the face, treatment with Sorusal after disinfection<I><B>(Fig. 2)</B></I>. After the exudation phase on the second day post trauma, Legius is applied to the wound. After 7 days,  the healing process and reepithelisation  is in progress.</div> <div> <I><B>Fig.  3 </B></I> shows the patient one year post trauma.</div> <bR> <div> <B>Example 2</B></div> <bR> <div> <IMG SRC="1b61fb10.jpg" border=0 width="287" height="177" ALIGN="BOTTOM" HSPACE="0" VSPACE="0">   <IMG SRC="1b705b10.jpg" border=0 width="261" height="177" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> <I><B>Fig. 4                                                                         </B></I>     <I><B>Fig. 5</B></I></div> <bR> <div> Burn injury to the hand after a car fire, grade 2a-2b. After disinfection, the injury was treated with Sorusal and Legius (<I><B>Fig. 4</B></I>). After 11 days of treatment according to the "Koblenz Model", a dry eschar has formed, under which the reephitelisation takes place. The dressing can easily be removed from the injury (<I><B>Fig. 5</B></I>) and makes an assessment of the status of the wound possible.</div> <bR> <bR> <div> <IMG SRC="1b868f40.jpg" border=0 width="360" height="244" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> <I><B>Fig. 6</B></I>  9 months post-trauma.</div> <bR> <bR> <div> <B>Summary</B></div> <div> Topical treatment of burn injuries according to the "Koblenz Model" is easy to handle, time and material saving method. </div> <bR> <div> In treating burn injuries with carbon fiber dressings, the assessment of the extent and depth of the wound is made possible, and is not distorted through ointments remaining on the wound. Surface burns heal quickly; the determination of the optimum point in time for surgical intervention in the case of deep burns is facilitated. Due to the painless dressing change, the dressings are tolerated very well by patients.</div> <bR> </td> </tr></table></body>