Evaluation of different wound dressings in the treatment of children with spoke injuries

In the Netherlands most people ride a bicycle, but there are some risks
entailed. Especially when children are riding along at the front or the back of
the bicycle. It is possible for them to get there foot entamgled between the
spokes of a riding bicycle, a so called spoke injury. Every year aproximately
2800 patients are presented on the emergency departments in the Netherlands. On
the Emergency department in our hospital ecery year around 100 children are
seen with spoke injuries. The treatment usually is a dressing with ointment or
a silicone based wound dressing covered with a casted splint. At check up these
wound dressings have to be removed to evaluate the wound. In the, often very
young, patients this can be experienced as a painful procedure and check-ups
can become a traumatising event.
Treatment with a biodressing impregnated with polyhexamethylene biguanide could
offer some solution. This sort of dressing has been used in chronic and
infected wounds. Treatment of spoke injuries in a small study in Amsterdam
described good healing without infections. An important benefit coudl be a
reduction in pain during treatment because the dressing doesn't have to be
changed an you can see through it to check for any problems. The above
mentioned study mentions a reduction in pain, there has however never been a
study with a control group. Hypothesis is that this biodressing wth
polyhexamethylene biguanide could reduce pain, and the use of this dressing in
the emergency department at the start of the treatment of the spoke injury coud
be of benefit for the patients during the length of the treatment.

To study wether a biodressing impregnated with polyhexamethylene biguanide in
the treatment of spoke injuries in children could give a reduction in pain
during the treatment compared to the standard treatment with wound dressing
impregnated with

Randomised controlled trial, in wich the two treatments are compared: standard
treatment with wound-dressing with ointment to prevent adhesion to the wound
compared to biodressing impregnated with polyhexamethylene biguanide.

wound management with a biodressing impregnated with polyhexamethylene
biguanide (SuprasorbX-PHMB)

Low burden, measurement of pain with pointing to a picture (Faces pain scale)
for the patient and a short questionnaire (FLACC-score) for the
parents/providers
The risk is low, there have been no allergic reactions described, previous
study had no wound infections with the intervention treatment.