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Poland is a country of around 38 million people. The ageing population is growing and thus chronic wounds are causing lots of problems to patients and generating high expenses to health care system. Unfortunately, physicians in Poland are still influenced by traditional methods of managing wounds, although there are many activities taken to move awareness of medical professionals towards modern wound healing. Doctors associated with modern wound management in Poland are mostly specialists – dermatologists and surgeons. Surgeons involved in vascular diseases management are also focusing recently on problems of managing chronic venous ulcers.

Twelve years ago Polish physicians established the Polish Phlebological Society (PPS). This is an intraspeciality association of medical professionals (vascular surgeons, angiologists, internal medicine) who are focused on modern standards and modern therapeutic methods in treating various venal disorders. The Polish Phlebological Society has always been very active body on a ground of organizing conferences and trainings for medical professionals. The present chairman of the PPS, Dr Zbigniew Rybak, has always tried to ensure a high scientific level at every conference the society has organized. Following this trend, in 2003 PPS decided to organize a conference focusing on a problem that still needed to be properly recognised in Poland – Managing Venous Leg Ulcers.

The conference took place in February 2003 in Krynica, a lovely venue in the Tatra Mountain in southern Poland. Dr Rybak and the head of the organizing committee, Dr Mariusz Kozka, have both put in lots of effort to bring the most up-to-date messages to the audience of the conference. The title – Venous Leg Ulcers – showed very clearly how the conference was designed to detail the issues on a particular topic. It is, although, a common standard for the PPS to organize conferences focused on one topic, and to present all materials on that subject.

In order to fulfil the demands of specialists who gathered for the conference, the organizing committee, supported by one of the two main sponsors – ConvaTec, part of Bristol-Myers Squibb in Poland, managed to organize a session on Modern Management of Venous Leg Ulcers. This was a great success expressed in the number of parti-cipants and interest among listeners after the programme was completed. The key success factor for that event was the presence of very experienced professionals who are well known in the international wound healing arena, i.e., Dr George Cherry and Professor Finn Gottrup. They both presented the current standards in wound management of various wounds with particular focus on leg ulcers. They also referred to cost effectiveness data which proved that modern therapeutic approach is also saving money, both on patients and medical service payers (Sick Funds).

The two lectures presented by the above speakers were accompanied by a very interesting lecture from Dr John Chen of the ConvaTec Global Development Centre, who clearly showed the impact of modern dressing materials on wounds. He also detailed modes of wound deterioration, resulting from use of traditional dressing materials that not only delay healing but also promote conditions for wound development. Finally, at the end of the session, the audience had a chance to get some most up-to-date information regarding the real cost of treatment in terms of pharmcoeconomic analyses. Not only was a strict comparison of cost of traditional dressing materials – gauze and modern dressing – Granuflex (calculated for a period of time) presented but also the real economic approach to that subject was discussed. It was possible because a group of experts from Poland run a pharmcoeconomic analysis based on work of Harding, et al, but relating to Polish conditions. The results were presented by Wojciech Stras, the ConvaTec Product Manager responsible for wound dressings in Poland. He showed clearly that taking into account the cost of dressing, how often it is changed, the cost of medical service, and the clinical effectiveness of modern dressing (Granuflex™), these products are much more cost effective in management of chronic venous ulcers than traditional gauze dressings.

Together, all the presentations showed a clear and consistent way of managing Venous Leg Ulcers. It seems that experienced medical professionals are going to bear that in mind and spread the modern approach to wound healing among medical societies in Poland. Especially encouraging is the fact that Poland has finally managed to gather physicians and nurses to work together towards establishing new standards in wound healing in Poland. As a result of comprehensive agreement in the field of wound healing, Polish medical professionals fully supported the idea of establishing a Polish Wound Management Association (PWMA). The aim of this organization will be introducing modern therapeutic methods into medical practice in Poland, continuous training of physicians and nurses and following the standards in wound management in well-developed wound healing markets. The registration of the PWMA is underway, and is expected in forthcoming weeks. One of the most important further aims is to become a part of European Wound Management Association.

Not surprisingly, the core of members establishing the PWMA are also members of the PPS, who would like to increase the awareness of wounds, and their proper treatment, throughout medical society and patients.

The short abstracts below summarize the lectures presented during the 14th Conference of Polish Phlebological Society in Krynica, in the session entitled: Management of Venous Leg Ulcers.

Dr George Cherry, from the Oxford Wound Healing Institute, Churchill Hospital, Oxford, England, presented the first lecture:

The Oxford Management Programme of Venous Ulcers – Utilising Modern Wound Dressings

Background
In a number of countries in Europe, as well as other parts of the world, the most common type of lower leg ulceration is due to venous insufficiency accounting for up to 80–90% of all lower extremity ulcers. In the UK the financial cost of venous disease has been estimated between £294 million and £650 million per year. In the USA costs are estimated between $2.5 and 3 billion with a loss of 2 million workdays per year.

At Oxford we have had a dedicated leg ulcer programme since 1982 which consists of hospital and community based treatment to deal with the logistics of treating venous ulcers. In our hospital assessment clinic collaboration between vascular surgery, plastic surgery and pain specialist physicians plays an important part in the management programme. In addition after the patients are healed they enter a healed ulcer programme which has shown that with such a programme the incidence of venous ulcer recurrence can significantly be reduced by providing patients with support stockings and long term monitoring.

Vascular assessment
A treatment flow chart has been established which incorporates the following major factors: physical and social history, arterial assessment including screening, vascular assessment with resting ultrasound Doppler, to measure ankle pressure index values, venous valvular incompetency screening assessed using light reflection rheography and verified by colour Duplex scanning. Patients with superficial venous disease are offered appropriate venous surgery to correct the insufficiency if they so desire. The above assessment regime is mandatory for diagnosis of venous disease before treatment to the wound and surrounding skin can be initiated. The major therapy that is used for dealing with the venous insufficiency which results in venous hypertension and localised microcirculatory abnormality followed by tissue breakdown is either support or compression bandages. Both of these control venous hypertension as well as limb oedema formation.

Treatment-utilisation of hydrocolloid dressings
With regard to improving healing of the ulcers with dressings after the underlying pathophysiology has been corrected, the use of hydrocolloid dressings, particularly Granuflex has been part of our treatment regime since 1982. The results of this first trial in UK in patients with venous ulcers was published in 1984. An added feature of Granuflex is its ability to stimulate angiogenesis and this has been shown in both experimental and clinical studies. The rationale for using modern dressings, such as hydro-colloids is based on the concept of moist wound healing. Although these dressings improve localised healing and are looked upon today as the gold standard of wound healing, there were both clinical and experimental studies as early as the 1940s but it was not until Dr George Winter’s work, which was published in Nature in 1962, that it was scientifically accepted. Since then there have been a number of papers published on Granuflex as well as other related products such as Hyalofill which supports that these advanced wound care dressings can enhance and improve healing. These dressings have essentially replaced gauze by their numerous clinical benefits when compared to the latter.

In summary, it is imperative that in managing venous ulcers the underlying pathophysiology is adequately assessed and that treatment such as bandaging or surgical correction of superficial venous disease is carried out. After this is done then the treatment regime should include dressings that improve the healing as well as improving quality of life. The hydrocolloid dressing Granuflex based on modern wound healing concepts as well as clinical and scientific evidence and other similar dressings should be part of such a treatment protocol.