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CADESORB

Protease Modulating Ointment

CADESORB

About CADESORB

Restore the Natural Balance with CADESORB

CADESORB OintmentCADESORB is a white, starch based sterile ointment that controls local wound pH and thereby modulates protease activity. CADESORB has been designed specifically to control the pH of its local environment.

By controlling pH levels and modulating protease activity, in addition to managing slough and exudate, CADESORB will help correct the natural balance in chronic wounds and help to stimulate healing.

  • Reduced protease activity can help prevent degradation of the extracellular matrix
  • CADESORB promotes healing in chronic wounds by managing the wound environment

 

CADESORB Mode of Action
What is CADESORB?

Studies have shown that chronic wounds have a typical pH value of around 7–8, There is evidence to suggest that a slightly acidic environment may promote healing of open wounds.  Ex- vivo studies have shown that treating wound fluid with CADESORB lowers this pH value to around pH 5 thus allowing protease activity levels to return to those of a healing wound.

In addition to the benefits of pH control and protease modulation CADESORB promotes slough removal and absorbs wound exudate.

  • Desloughing Properties
    CADESORB is capable of removing slough and debris from the wound.
  • Absorption Capability
    CADESORB will manage exudate from the wound for up to 3 days depending on the level of drainage.

 

Presentations Available

CADESORB is available in 10g and 20g tubes

 

 

References

1 Yager, D.R.,Nwomeh, B. C. The proteolytic environment of chronic wounds. Wound Rep. Reg. 1999 ;7; 433-441

2 Bullen,E.C., Longmaker M.T., Updike, D.L. et al. Tissue inhibitor of metalloprotinases-I is decreased and activated gelatinases are increased in chronic wounds. J invest Dermatology 1995; 104;236-240.

3 Yager D.R., Zhang,L.Y., Liang, H.X., et al. Wound fluids from Human pressure ulcers contain elevated matrix metalloproteinase levels and activity compared to surgical wound fluids. J Invest Dermatology 1996;107; 743-748.

4 Wysocki, A.,Staiano-Coico, L., Grinnell, F. Wound fluid from chronic leg ulcers contains elevated levels of metalloprotinases MMP-2 and MMP-9. J Invest Dermatology 1993;101;64 – 68.

5 Tarnuzzer, R. W., Schultz G.S.,Biochemical analysis of acute and chronic wound environments. Wound Rep. Reg. 1996;4;321 – 325.

6 Proteases and pH on chronic wounds by Greener Hughes, Bannister and Douglass, Journal of wound care 14:2:59- 61

7 Asmussen PD, Söllner B. Principles of Wound Healing. Germany (Stuttgart): Druckerei Kohlhammer.

9 Trengove NJ, Stacey MC, Macauley S, Bennett N, Gibson J, Burslem F, Murphy G, Schultz G. Analysis of the acute and chronic wound environments: the role of proteases and their inhibitors. Wound Rep Reg. 1999;7:442-52.

10 Herrick S, Ashcroft G, Ireland G. et al. Up-Regulation of elastase in acute wounds of healthy aged humans and chronic venous leg ulcers are associated with matrix degradation. Laboratory Investigation 1997, 77; 281-8.

11 Dissemond J, Witthoff M, Brauns TC. et al. pH values in chronic wounds. Evaluation during modern wound therapy (in German). Hautarzt 2003;54: 959-65.

12 Kaufman T, Berger J. Topical pH and burn wound healing: a review. In Ryan TJ (ed) Beyond Occlusion: Wound Care Proceedings. London, RSM Services Ltd. 1988, 55-59.

13 Leveen HH, Falk G, Borek B et al. Chemical acidification of wounds: an adjuvant to healing and the unfavorable action of alkalinity and ammonia. Ann Surg 1973. 178.745-53.

14 Wilson IAI, Henry M, Quill RD, Byrne PJ. The pH of varicose ulcer surfaces and its relationship to healing. Vasa 1979:8 339-342.

15 Dissemond J, Witthoff M, Grabbe S. Investigations on pH values in milieus of chronic wounds during modern wound therapy. Presented at World Congress, Paris 2004.

16 Evaluation of model matrix damaging potential of fresh chronic wound fluids and matrix protecting ability of CADESORB™, S&N Data on File Report 0410020.

17 CADESORB Mode of Action. S&N Data on File Report 0412025.

18 Evaluation of model matrix damaging potential of fresh chronic wound fluids and matrix protecting ability of CADESORB and Promogran, S&N Data on File Report 0410021.

19 In-vitro evaluation of the effect of CADESORB and Promogran on the proliferation of three different microorganisms in the presence of serum. S&N Data on File Report 0410019.

20 Moberg S, Hoffman L, Grennert ML, Holst A. A randomized trial of cadexomer iodine in decubitus ulcers. J Am Geriatr Soc, 1983; 31(8): 462-5.

21 Ormiston MC, Seymour MT, Venn GE, Cohen RI, Fox JA. Controlled trial of IODOSORB in chronic venous ulcers. Br Med J (Clin res Ed), 1985;291 (6491): 308-10.

22 Wound Management and dressings. The pharmaceutical press 1990. Steve Thomas

23 A Koerber, J Freise, S Grabbe, J Dissemond. The lowering of pH values in chronic wounds by the application of CADESORB. Poster presentation EWMA Stuttgart 2005.

24 G Robers, A Chumley, R Mani The Wound Milieu in Venous Ulcers – Further Observations. Oral presentation EWMA Stuttgart 2005

25 Matrix protection ability of Cadesorb vs Promogran Smith and Nephew. Data on file 0510001

26 An in vitro assessment of the impact of CADESORB ointment on the antimicrobial properties of various topical antimicrobial agents and dressings (ACTOCOAT◊ Burn, IODOFLEX◊ dressing, Gentalyn Cream, Gentalyn Ointment and FLAMAZINE◊ Cream). Smith and Nephew. Data on file 0505002

27 Anderson L, Iodphore Gel – in-vitro enzymatic hydrolysis of Iodphore Gel and other modified starch gels by endogenous amylase. Micro Chem Development Laboratory AB. 20/06/1979.

FAQs

Frequently Asked Questions about CADESORB

 

Q. How often do I need to change CADESORB?

A. CADESORB should be changed every 3 days depending on level of exudate. CADESORB is naturally broken down by the body over time, so any remaining ointment does not cause an issue.

Q. How can I tell when the CADESORB needs changing?

A. The time taken for CADESORB to become saturated and reach its absorbent capacity depends on the rate of exudate from the wound. When this happens the excess exudate will usually be visible as strike-through on the secondary dressing.

The number of dressing changes therefore depends on the levels of exudate present in the wound.

Q. Can I use CADESORB underneath compression therapy?

A. Yes CADESORB can be used under compression therapy

Q. Can I use CADESORB on an infected wound?

A. CADESORB is not indicated for infected wounds. It may be used once the infection has been removed.

Q. How do I remove CADESORB from the wound?

A. Remove the secondary dressing. If it is sticking to the CADESORB or the wound, soak with sterile saline or water. To remove CADESORB from the wound, simply flush it away with sterile saline or water.

If there are any small remnants of CADESORB left in the wound, they will be naturally degraded without causing any delay to healing or systemic reaction.

Q. Can I use a secondary dressing to secure CADESORB to the wound?

A. Yes, you can use an appropriate secondary dressing. OPSITE◊ Post-Op may be appropriate for the lower exuding wounds, whereas ALLEVYN◊ will manage additional exudate levels when this is required.

CADESORB may also be used under compression bandages.

Q. For how long can I use CADESORB?

A. CADESORB may be used until the wound has healed, if there are signs wound healing is progressing and exudate is present.

Q. Is there any risk of putting too much CADESORB into the wound? Would it reduce the pH to a level of acidity that would have a deleterious effect?

A. It is unlikely that too much CADESORB could be applied to the wound. The pKa of CADESORB acid (4.75) dictates that local pH will not drop lower than 1 pH unit either side of this value.

It is recommended however that sufficient be applied to cover the wound area (1 – 2mm) and not leave a large excess surrounding the wound.

 

Cadesorb Ointment

References

1 Yager, D.R.,Nwomeh, B. C. The proteolytic environment of chronic wounds. Wound Rep. Reg. 1999 ;7; 433-441

2 Bullen,E.C., Longmaker M.T., Updike, D.L. et al. Tissue inhibitor of metalloprotinases-I is decreased and activated gelatinases are increased in chronic wounds. J invest Dermatology 1995; 104;236-240.

3 Yager D.R., Zhang,L.Y., Liang, H.X., et al. Wound fluids from Human pressure ulcers contain elevated matrix metalloproteinase levels and activity compared to surgical wound fluids. J Invest Dermatology 1996;107; 743-748.

4 Wysocki, A.,Staiano-Coico, L., Grinnell, F. Wound fluid from chronic leg ulcers contains elevated levels of metalloprotinases MMP-2 and MMP-9. J Invest Dermatology 1993;101;64 – 68.

5 Tarnuzzer, R. W., Schultz G.S.,Biochemical analysis of acute and chronic wound environments. Wound Rep. Reg. 1996;4;321 – 325.

6 Proteases and pH on chronic wounds by Greener Hughes, Bannister and Douglass, Journal of wound care 14:2:59- 61

7 Asmussen PD, Söllner B. Principles of Wound Healing. Germany (Stuttgart): Druckerei Kohlhammer.

9 Trengove NJ, Stacey MC, Macauley S, Bennett N, Gibson J, Burslem F, Murphy G, Schultz G. Analysis of the acute and chronic wound environments: the role of proteases and their inhibitors. Wound Rep Reg. 1999;7:442-52.

10 Herrick S, Ashcroft G, Ireland G. et al. Up-Regulation of elastase in acute wounds of healthy aged humans and chronic venous leg ulcers are associated with matrix degradation. Laboratory Investigation 1997, 77; 281-8.

11 Dissemond J, Witthoff M, Brauns TC. et al. pH values in chronic wounds. Evaluation during modern wound therapy (in German). Hautarzt 2003;54: 959-65.

12 Kaufman T, Berger J. Topical pH and burn wound healing: a review. In Ryan TJ (ed) Beyond Occlusion: Wound Care Proceedings. London, RSM Services Ltd. 1988, 55-59.

13 Leveen HH, Falk G, Borek B et al. Chemical acidification of wounds: an adjuvant to healing and the unfavorable action of alkalinity and ammonia. Ann Surg 1973. 178.745-53.

14 Wilson IAI, Henry M, Quill RD, Byrne PJ. The pH of varicose ulcer surfaces and its relationship to healing. Vasa 1979:8 339-342.

15 Dissemond J, Witthoff M, Grabbe S. Investigations on pH values in milieus of chronic wounds during modern wound therapy. Presented at World Congress, Paris 2004.

16 Evaluation of model matrix damaging potential of fresh chronic wound fluids and matrix protecting ability of CADESORB™, S&N Data on File Report 0410020.

17 CADESORB Mode of Action. S&N Data on File Report 0412025.

18 Evaluation of model matrix damaging potential of fresh chronic wound fluids and matrix protecting ability of CADESORB and Promogran, S&N Data on File Report 0410021.

19 In-vitro evaluation of the effect of CADESORB and Promogran on the proliferation of three different microorganisms in the presence of serum. S&N Data on File Report 0410019.

20 Moberg S, Hoffman L, Grennert ML, Holst A. A randomized trial of cadexomer iodine in decubitus ulcers. J Am Geriatr Soc, 1983; 31(8): 462-5.

21 Ormiston MC, Seymour MT, Venn GE, Cohen RI, Fox JA. Controlled trial of IODOSORB in chronic venous ulcers. Br Med J (Clin res Ed), 1985;291 (6491): 308-10.

22 Wound Management and dressings. The pharmaceutical press 1990. Steve Thomas

23 A Koerber, J Freise, S Grabbe, J Dissemond. The lowering of pH values in chronic wounds by the application of CADESORB. Poster presentation EWMA Stuttgart 2005.

24 G Robers, A Chumley, R Mani The Wound Milieu in Venous Ulcers – Further Observations. Oral presentation EWMA Stuttgart 2005

25 Matrix protection ability of Cadesorb vs Promogran Smith and Nephew. Data on file 0510001

26 An in vitro assessment of the impact of CADESORB ointment on the antimicrobial properties of various topical antimicrobial agents and dressings (ACTOCOAT◊ Burn, IODOFLEX◊ dressing, Gentalyn Cream, Gentalyn Ointment and FLAMAZINE◊ Cream). Smith and Nephew. Data on file 0505002

27 Anderson L, Iodphore Gel – in-vitro enzymatic hydrolysis of Iodphore Gel and other modified starch gels by endogenous amylase. Micro Chem Development Laboratory AB. 20/06/1979.

 

Removes barriers to healing

CADESORB absorbs exudate and removes slough to cleanse the wound bed

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