Systemic antibiotics can be used complementary when Flaminal^® (Hydro or Forte) 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.

Wounds can hurt for several reasons. When you have a wound, your skin, tissue, and even tiny nerves and blood vessels are damaged. This injury kicks off your body's natural healing process, which includes a phase called inflammation. This is when your body sends extra blood and fluids to the area to start repairing the damage, and it can make the wound feel sore or painful.

• If your wound is very sensitive to pain, we recommend a simple trick. First, apply a thick layer of Flaminal^® (Hydro or Forte) (e.g. 4-5mm) to the secondary dressing (dressing that is chosen to cover Flaminal^® (Hydro or Forte)). Then, gently place this dressing directly onto the wound. This ensures Flaminal^® (Hydro or Forte) is in full contact with the wound and helps to reduce pain and discomfort during dressing changes.
• 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. There may be reduction in pain as Flaminal^® (Hydro) can be used to hydrate then remove dead tissue from the wound.
• 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.
• Pain can be caused by infection; allergies and some ulcers can also be painful. Ask your doctor or wound clinician for advice.

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.

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.¹

¹Vandenbulcke, K. et al. Evaluation of the antibacterial activity and toxicity of 2 new hydrogels: a pilot study. The International Journal of Lower Extremity Wounds. 2006, 5(2): 109-114.

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. Ask your doctor or wound clinician for advice.

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

Step 2: In the gel matrix there is an anti-microbial enzyme system that kills the absorbed bacteria: The enzyme system consists of two enzymes, glucose oxidase and lactoperoxidase. The first enzyme, glucose oxidase forms 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 slightly to moderately exuding wound) or Forte (for moderately to highly exuding wounds):

• To dissolve and absorb (remove) fibrin, as the ongoing presence of fibrin slows down wound healing and complicates the diagnosis.
• To reduce the risk of 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. Check the dressing daily. The dressing with Flaminal^® (Hydro or Forte) can remain in place as long as the gel structure is intact (1 to 4 days, depending on the amount of exudate).

Flaminal^® (Hydro or Forte) tubes and jars can be used until there expiry date. The expiry date (USE BY: Year/Month) is the last day of the indicated month and year. Once opened, and if recapped carefully, a tube of Flaminal^® can be stored at room temperature for 12 months. A jar of Flaminal^® 500g however can be used for one week after its first opening. 

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: non-adherent dressing (contact layer (e.g. paraffin gauze) and a woven or non-woven compress) fixed by a non-adhesive bandage or by a hypoallergenic, adhesive tape (that is air permeable).
• Moderately to highly exuding wound: absorbent non-adherent dressing fixed by a non-adhesive bandage or by a hypoallergenic, adhesive tape (that is air permeable).

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). The wound bed should be irrigated and cleaned with every dressing change. Make sure the remaining of Flaminal^® (Hydro & Forte) are removed.
• Initially the wound may appear larger; this is a normal consequence of the debriding action of Flaminal^®(Hydro & Forte) which causes dead tissue, dirt and exsudate 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. These flakes should be removed. Flakes of alginate are water soluble, thus can be removed easily with water.

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 yeasts and moulds contamination.^1,2

¹De Smet, K. et al. Pre-clinical evaluation of a new antimicrobial enzyme for the control of wound bioburden. Wounds. 2009, 21(3): 65-73.

² Vandenbulcke et al. Evaluation of the Antibacterial Activity and Toxicity of 2 New Hydrogels: A Pilot Study. Lower Extremity Wounds. 2006, 5(2): 109-114.

No, Flaminal^® (Hydro & Forte) is safe to use and not harmful for our skin and wound tissue (keratinocytes & fibroblasts).¹

¹De Smet, K. et al. Pre-clinical evaluation of a new antimicrobial enzyme for the control of wound bioburden. Wounds. 2009, 21(3): 65 - 73.

No, Flaminal^® is not haemostatic, not able to stop bleeding.

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 (wound bed preparation) such as skin grafting or negative pressure wound therapy.

• Flaminal^® Hydro and Flaminal^® Forte keep the wound moist.
• Flaminal^® Hydro and Flaminal^® Forte keep the wound clean/debride the wound continuously.
• Flaminal^® Hydro and Flaminal^® Forte offer antimicrobial protection.
• Flaminal^® Hydro and Flaminal^® Forte are safe for the skin and wound tissue.
• Flaminal^® Hydro and Flaminal^® Forte protect the wound border.

The wound is too wet for Flaminal^® Hydro and should be replaced with Flaminal^® Forte, which is more absorbent. Ensure the secondary dressing is absorbent.

The Flaminal^® (Hydro & Forte) needs replacing: the wound bed should be cleaned thoroughly and a new Flaminal^® layer (e.g. 4-5mm) should be applied.

Flaminal^® Hydro contains 3,5 % alginate which would be well suited to absorb and remover the fibrin. Furthermore, it will aid debridement of slough and thereby promote wound healing.

• Flaminal^® Forte and Flaminal^® Hydro should be used for moist wound healing, to treat acute or chronic wounds that have breached the dermis.
• Flaminal^® Forte contains a larger amount of alginate and should be used on moderately to highly exuding wounds
• Flaminal^® Hydro contains less alginate and should be used on slightly to moderately exuding wounds.

Changing from Flaminal^® Hydro to Flaminal^® Forte: When Flaminal^® Hydro liquefies too quickly (within 24h) or when the secondary dressing is all soaked within 24h, it is recommended that you switch to Flaminal^® Forte.

Changing from Flaminal^® Forte to Flaminal^® Hydro: When a whitish thick layer of alginate appears in the wound, we advise to switch to 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 or superabsorbent. On drier wounds a contact layer is recommended such as a paraffin gauze with on top of that a woven or non-woven compress.