Systemic antibiotics can be used complementary when Flaminal is applied on your wound. When a wound is infected, antibiotics may be indicated. Infection is caused by bacteria infiltrating the deeper tissue layers of the wound. These bacteria are not adequately inhibited or destroyed by your immune system, nor by a topically applied antimicrobial product. However, some chronic wounds have poor blood flow and only small amounts of antibiotics may reach the wound. Ask your doctor or wound clinician for advice.

• Pain may be experienced if the wound is allowed to dry out. With drier wounds this can be prevented by using Flaminal^® Hydro instead of Flaminal^® Forte.
• Pain may be experienced if the wound edges become macerated. With wetter wounds this can be prevented by using Flaminal^® Forte instead of Flaminal^® Hydro. Maceration can also be reduced by using a more absorbent secondary dressing, e. g. foam or superabsorbent dressing. There may be reduction in pain as Flaminal^® (Hydro) can be used to hydrate then remove dead tissue from the wound.
• Pain can be caused by infection; allergies and some ulcers can also be painful.

Yes. Flaminal^® (Hydro & Forte) can be stored in the refrigerator. In fact, if the room temperature where the Flaminal^® (Hydro & Forte) is stored is likely to exceed 25°C, it is preferable to keep Flaminal^® (Hydro & Forte) in the refrigerator. Flaminal^® (Hydro & Forte) should not be stored in the freezer.

Yes. Diabetes patients can use Flaminal^® (Hydro & Forte) on wounds.

Yes. We would advise you to apply Flaminal^® Hydro.

Yes. Flaminal^® contains two enzymes, glucose oxidase and lactoperoxidase. Glucose oxidase converts the available glucose, oxygen and water into peroxide ions. Lactoperoxidase converts the peroxide ions into reactive oxygen species. The reactive oxygen species created will destroy bacteria that are absorbed within the Flaminal^® matrix. The antimicrobial mode of action of Flaminal only takes place in the matrix.

There are data demonstrating that the enzyme system in Flaminal^® (Hydro & Forte) kills Pseudomonas in-vitro quickly and effectively and in-vivo data shows a marked reduction over 8 days.

Flaminal^® (Hydro & Forte) restores the bacterial balance in the wound and by continually removing necrotic material, it allows natural wound healing. Should the wound overgranulate for reasons other than infection or friction, stop using Flaminal^® (Hydro & Forte) and keep the wound dry to reduce cell growth. Applying local pressure to the wound bed will also help reduce overgranulation.

Flaminal^® Hydro is indicated for slightly to moderately exuding wounds, while Flaminal^® Forte is indicated for moderately to highly exuding wounds. (Exuding wounds are oozing/ leaking wounds). Examples of such wounds are:

• leg ulcers
• diabetic foot ulcers
• superficial and deep partial thickness burns (second degree)
• post-surgical wounds
• traumatic wounds
• pressure ulcers (pressure sores)
• skin tears
• wounds from radiotherapy
• oncology wounds By debriding the wound, Flaminal^® (Hydro and Forte) are also indicated to prepare the wound for subsequent surgery such as skin grafting or negative pressure wound therapy (wound bed preparation.)

Step 1: Flaminal^® (Hydro & Forte) absorb exudate pus and bacteria into its structure.

Step 2: The enzyme system consists of two enzymes, glucose oxidase and lactoperoxidase. The first enzyme, glucose oxidase forms a peroxide. The second enzyme, lactoperoxidase immediately captures the peroxide and transforms it into oxygen radicals (ROS, Reactive Oxygen Species). These radicals destroy the bacterial cell wall. Flaminal^® (Hydro & Forte) has been tested in vitro against a wide range of clinically isolated bacteria (such as MRSA, E. coli, E. aerogenes, P. aeruginosa,…). This is a selective process. Only bacteria are destroyed and not human cells, such as keratinocytes and fibroblasts.

Clean the wound with a cleanser such as Flamirins^®. Apply Flaminal^® Hydro (in the case of moderate exudate) or Forte (when there is severe exudation) To dissolve and absorb (remove) fibrin, as the ongoing presence of fibrin slows down wound healing and complicates the diagnosis. To protect the wound from infection with the antimicrobial enzyme system present in Flaminal^® (Hydro & Forte) To maintain a moist and clean wound. To protect the wound borders. Apply a dressing to cover Flaminal^® Hydro or Flaminal^® Forte. The choice of dressing will depend on the amount of exudate from the wound. Inspect the wound daily and change the dressing each day or every two days.

1. Cover Flaminal^® Hydro or Flaminal^® Forte with a passive secondary dressing. The choice of dressing should be based on the type of wound: Slightly to moderately exuding wound: transparent film (polyurethane) or non-adherent dressing fixed by a non-adhesive bandage. For some wounds (such as burn wounds), a wound contact layer could be applied on top of Flaminal Hydro, to avoid sticking in of the secondary dressing. Moderately to highly exuding: absorbent non-adherent dressing fixed by a non-adhesive bandage or by a hypoallergenic, adhesive tape

Flaminal^® (Hydro & Forte) should be kept in a cool dry place (<25°C) and in its original packaging.

• Irrigate and clean the wound and the surrounding area thoroughly.
• Apply a thick layer (e.g. 4-5mm) of Flaminal^®(Hydro or Forte).
• Cover with a secondary dressing.
• Renew Flaminal^® (Hydro & Forte) whenever the gel structure is no longer intact (1-4 days, depending on the amount of exudate).
• Initially the wound may appear larger; this is a normal consequence of the debriding action of Flaminal^®(Hydro & Forte) which causes dead tissue to be absorbed.
• The colour of the alginates (gel) may change slightly due to their natural origin. Colour changes have no effect on the quality of Flaminal^® (Hydro or Forte). • Dry wax-like flakes (flakes of alginates) may be seen. This is OK if they are found on the wound borders as they will protect the wound from maceration.
• If the flakes appear in the wound itself, particularly with Flaminal^® Forte, it might be because the wound is not producing enough exudate and you should change to Flaminal^® Hydro.

Flaminal^® (Hydro & Forte) have been tested against Aspergillus niger (fungus) and against Candida albicans (yeast), mild activity was found. However, Flaminal^® (Hydro & Forte) contains a conservation agent (potassium sorbate) to protect the gel against fungal contamination.