Flaminal^® and Flaminal^® Hydro –
Frequently Asked Questions (FAQs)

Please note, where the answer applies to both Flaminal^® and Flaminal^® Hydro we have abbreviated to Flaminal^® (Hydro)

How do I use Flaminal^®/
Flaminal^® Hydro?

	Clean and rinse the wound
	Dab the wound and dry carefully
	Apply a thick layer of Flaminal®(Hydro) about 5mm, avoiding the wound edge
	Secure with a secondary dressing
	Renew Flaminal® (Hydro) whenever the gel structure is altered
	Initially the wound may appear larger; this is a normal consequence of the debriding action of Flaminal® (Hydro) which causes dead tissue to be absorbed and removed from the wound
	The colour may change, and there may be a slightly sweetish odour
	Dry wax-like flakes (flakes of alginates) may be seen. This is fine if they are found on the wound borders, as they will protect the wound edges from maceration
	If the flakes appear in the wound itself, consider changing the secondary dressing to one that reduces evaporation, such as gauze, polyurethane film, bandages with or without a central compress such as Opsite® Tegaderm® Opsite® post-op, Tegaderm® pad

When should I use Flaminal^® and when should I use Flaminal^® Hydro?

	Flaminal® and Flaminal® Hydro should be used for moist wound healing, especially on those wounds where there is the potential for an acquired wound infection
	Flaminal® contains a larger amount of alginate and should be used on moderate to heavily exuding wounds
	Flaminal® Hydro contains less alginate and should be used on light to moderate levels of exudate

How does Flaminal^® (Hydro) kill wound pathogens?
Flaminal^® (Hydro) 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. Lactoperoxidase specifically binds to bacterial cell walls.  The reactive oxygen species created then destroy bacteria.

Can I use Flaminal^® (Hydro) on dry necrotic wounds?
In this instance, Flaminal^® Hydro should be used rather than Flaminal^®.
The wound should be washed with saline before applying Flaminal^® Hydro.

Is Flaminal^® (Hydro) active against fungi?
Yes. Flaminal^® (Hydro) has been tested against Aspergillus niger – a fungus – and, in addition, against Candida albicans – a yeast.

Does Flaminal^® (Hydro) have any effect on a wound that is contaminated with MRSA?
There is in vitro evidence to show that Flaminal^® (Hydro) kills MRSA strains.  The antimicrobial activity of Flaminal^® (Hydro) is enzymatic. This is a different mechanism of action compared to other topical antimicrobials and antibiotics and no resistance has been seen.

Does Flaminal^® (Hydro) have any effect on a wound contaminated with Pseudomonas aeruginosa?
There are data demonstrating that Flaminal^® (Hydro) kills Pseudomonas in vitro quickly and effectively and in vivo data shows a marked reduction over 8 days.

Which secondary dressing should be used with Flaminal^® and Flaminal^® Hydro?
The type of secondary dressing will depend on the wound condition. On a wetter wound a more absorbent secondary dressing should be used to prevent maceration, e.g. Foam dressing. On drier wounds a secondary dressing should be selected which will reduce evaporation and prevent the wound drying out e.g. film or hydrocolloid.

When do Flaminal^® and Flaminal^® Hydro need to be changed?

	Flaminal® (Hydro) should be changed when the gel structure becomes altered to the point when it has almost disappeared, or when alginate flakes have appeared, or when the gel becomes too liquid
	When using Flaminal®, if alginate flakes appear, the wound is too dry for Flaminal® and you should switch to Flaminal® Hydro
	When using Flaminal® Hydro, if the gel becomes too liquid, the wound is too wet for Flaminal® Hydro and you should switch to Flaminal®
	In yellow/sloughy wounds Flaminal® (Hydro) can be changed every 1–2 days
	In granulating wounds Flaminal® (Hydro) can be changed every 3-4 days

What should I do when there is no Flaminal^® (Hydro) left in the wound?
The Flaminal^® (Hydro) needs replacing and new dressing applied.

What should I do when Flaminal^® has become too liquid?
Replace the Flaminal^® with a thicker layer and cover with a non-adhesive dressing.

What should I do when there is no Flaminal^® left on the wound and alginate flakes can be observed?
The wound is too dry for Flaminal^® and Flaminal^® Hydro should be used instead as it contains a lower concentration of alginate. 

What should I do when there is no Flaminal^® Hydro left on the wound and alginate flakes can be observed?
The wound is very dry and therefore even the low concentration of alginate in Flaminal^® Hydro is drying out. Replace the Flaminal^® Hydro and cover with a dressing which will reduce evaporation, e.g. a film or hydrocolloid.

Flaminal^® Hydro has become too liquid?
The wound is too wet for Flaminal^® Hydro and should be replaced with Flaminal^® which is more absorbent.

What should I use on wounds with fibrin slough, but no exudate?
Flaminal^® Hydro containing 3% alginates would be well suited; it will eliminate the slough from the wound and thereby debride, encouraging healing.

Can Flaminal^® (Hydro) be painful on application?

	Patients may report pain if the wound is allowed to dry out. With drier wounds, this can be prevented, by using Flaminal® Hydro instead of Flaminal®.
	Patients may also report pain caused by the wound edges becoming macerated. With wetter wounds, this can be prevented, by using Flaminal® instead of Flaminal® Hydro. Maceration can also be reduced by using a more absorbent secondary dressing e.g. foam dressing.
	Patients may report a reduction in pain as Flaminal® Hydro can be used to hydrate then remove slough and necrotic material.
	Pain can be caused by infection; allergies and some ulcers can also be painful.

What is epidermolysis bullosa and can Flaminal^® (Hydro) be used to treat it?
Epidermolysis bullosa is a very rare, congenital skin disease, where the slightest injury will provoke blisters, which are difficult to heal, often causing scarring and functional impediments. Flaminal^® (Hydro) may be used, although it will not prevent injuries and blisters for which there is no treatment.

Are propylene glycol and fenoxyethanol present in Flaminal^® (Hydro)?
No. Flaminal^® (Hydro) does not have any preservatives in its formulation.

What is the shelf life of Flaminal^® (Hydro)?
Flaminal can be used until the expiry date (seen on the tube). This is two years from date of manufacture.

Can antiseptics be used prior to applying Flaminal^® (Hydro)?
Antiseptics are strong antimicrobials, but can harm the key cells involved in wound healing and cause an allergic reaction. Flaminal^® (Hydro) will restore the bacterial balance in the wound without causing any allergic reactions or damaging key cells involved in wound healing. We therefore recommend Flaminal^® (Hydro) is used alone.

Can antibiotics be administered along with Flaminal^® (Hydro)?
Yes. When cellulitis is present, antibiotics are indicated. Infection is caused by the invasion of bacteria into the skin surrounding the wound.

Can Flaminal^® (Hydro) be applied on a recent suture?
Yes, apply Flaminal^® Hydro, in a thick layer. If the suture oozes exudate then use Flaminal^®.

Does Flaminal^® (Hydro) reduce hypergranulation?
No. Flaminal^® (Hydro) restores the bacterial balance in the wound and by continually removing necrotic material allows natural wound healing.
Should the wound, for any reason hyper granulate, stop using Flaminal^® (Hydro) and keep the wound dry to reduce cell growth. Applying local pressure to the wound bed will also help reduce over granulation.

What are the advantages of using Flaminal^® Hydro in treating dermatological surgical wounds?
Flaminal^® Hydro absorbs leaking wound fluid, protects against infection and keeps the wound moist thus avoiding the formation of crusts which may increase the risk of scarring. Flaminal^® Hydro should stay on the wound till the sutures are removed.

Can Flaminal^® (Hydro) be used where a wart has been removed?
Yes. Use Flaminal^® Hydro.

Can the Flaminal^® (Hydro) tube be reused or should it be discarded
once opened?
After use, replace the top and Flaminal^® (Hydro) can be reused as it remains sterile up until its expiry date.  It should only be reused on the same patient.

Is Flaminal^® (Hydro) poisonous
if ingested?
If ingested, Flaminal^® (Hydro) is harmless. Many foodstuffs contain alginates.

Are there any contraindications to using Flaminal^® (Hydro)?
Flaminal^® (Hydro) should not be used where patients have a previous sensitivity reaction to alginate dressings or to polyethylene glycol (Macrogol). Flaminal^® (Hydro) should not be used in full thickness (third degree) burns.

Are there any sites on the body where Flaminal^® (Hydro) should not
be applied?
Flaminal^® (Hydro) cannot be used on the eyelids or in the eye. Should it come into contact with the eye, rinse the eye thoroughly with running water and consult a physician.