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PubMed2002

A new dressing for laser-treated areas.

Contemporary studies and observations have left no doubt that occlusive dressings are superior to open treatment after laser resurfacing. The currently available occlusive dressings, however, are time-consuming to apply, often dislodge shortly after application, and most require reapplication. The authors report a cross-sectional observational study of patients who were treated with a new dual silicone-based dressing (DiamondSeal) after full-face laser resurfacing, with or without rhytidectomy. Patients who previously underwent similar surgeries and who were treated with a popular occlusive tape dressing (Flexzan) acted as historic controls. A combination of two silicones produced a gel-like silicone admixture that was spread evenly over the laser-treated areas. The silicone gel solidified into a flexible membrane and remained on the patient's face for 5 days. Questionnaires were sent to patients who were treated with the silicone dressing and those who were treated with a currently popular occlusive dressing. When the attributes of these dressings were compared, the superiority of the silicone dressing approached statistical significance ( = 0.08). The majority of patients treated with the silicone dressing (71 percent) had a positive experience with this dressing, stating they would repeat the experience if necessary. Only 54 percent of patients with a tape dressing were willing to repeat their experience ( = 0.18). The major advantages of this dressing, noted from the surgeon's perspective, were the speed with which the mask was applied; the ease of application, without the need for templates; the acceptable cure duration, allowing spontaneous contouring of the silicone along facial contours; the simple tailoring of the dressing; the reduced need for and minimal time for reapplication; and the paucity of complications.

Adult↗
PubMed2003

Hydropolymer dressings in the management of wound exudate.

In the UK the so-called 'foam' dressings are currently the most widely used absorbent dressings. They can, in certain cases, be particularly useful for the management of exuding wounds. One type of foam dressing--the Tielle hydropolymer adhesive dressing family (by Johnson & Johnson Wound Management)--is a range of five types of hydropolymer dressings: Tielle Original dressing, Tielle Lite dressing. Tielle Plus dressing, Tielle Borderless dressing and Tielle Packing dressing. The Tielle range shares a common basic composition that gives each dressing bacterial barrier properties and the capability of managing exudate by the combined process of absorption and moisture vapour transmission. Each type except Packing can be used as either a primary or as a secondary dressing. The choice should be based on the characteristics of the primary dressing, if any, on the degree of exudate that the wound is producing and on the condition of the surrounding skin. This article aims to give an overview of the Tielle range and a review of research-based clinical and scientific evidence to support the management of differing levels of exuding wounds in everyday clinical practice.

Absorption↗
PubMed2006

Predicting recovery of upper-body dressing ability after stroke.

OBJECTIVE: To identify predictors of the recovery of independent dressing ability after stroke. DESIGN: Prospective cohort study. SETTING: Rehabilitation unit at a university hospital. PARTICIPANTS: Sixty-three consecutive stroke patients were enrolled in the study. Twelve patients were not able to complete the study because they were discharged or transferred to another hospital before study completion. INTERVENTION: Fifty-one patients underwent and completed 15 days of dressing training based on the time-delay method, which included the 10 component actions of upper-body dressing and 4 cues given by therapists. MAIN OUTCOME MEASURES: The dressing item of the FIM instrument, Brunnstrom motor recovery stages, presence or absence of deep and tactile sensation, Rey-Osterrieth complex figure test, Kohs block design test, body image test, Weintraub cancellation task, and presence or absence of the visual extinction phenomenon and the motor impersistence phenomenon. RESULTS: The FIM upper-body dressing item score and the cancellation task score at the start of training were significantly better in patients who achieved independence in dressing within 15 training days than in patients who did not (P < .05). The motor impersistence phenomenon was found less frequently among patients who achieved independence in upper-body dressing than among patients who did not (P < .05). However, logistic regression analysis showed that only the FIM score for upper-body dressing on the first day of training was a significant independent predictor of dressing ability at the end of training (odds ratio, 4.33; 95% confidence interval, 1.51-12.37). The receiver operating characteristic curve indicated that a cutoff score of 3 would provide the best balance between sensitivity and specificity for the FIM upper-body dressing item. The positive predictive value of this cutoff score was .90, and the negative predictive value was .70. CONCLUSIONS: Our findings indicate that the FIM upper-body dressing score on the first day of dressing training is an independent predictor of recovery of upper-body dressing ability after stroke.

Activities of Daily Living↗
PubMed2006

A special report on the chitosan-based hemostatic dressing: experience in current combat operations.

BACKGROUND: Hemorrhage remains a leading cause of death in both civilian and military trauma patients. The HemCon chitosan-based hemostatic dressing is approved by the US Food and Drug Administration (FDA) for hemorrhage control. Animal data have shown the HemCon dressing to reduce hemorrhage and improve survival. The purpose of this article is to report preliminary results of the hemostatic efficacy of the HemCon dressing used in the prehospital setting on combat casualties. METHODS: A request for case information on use of HemCon dressings in Operation Iraqi Freedom and Operation Enduring Freedom was sent to deployed Special Forces combat medics, physicians, and physician assistants. RESULTS: Sixty-eight uses of the HemCon dressing were reported and reviewed by two US Army physicians. Four of the 68 cases were determined duplicative resulting in a total of 64 combat uses. Dressings were utilized externally on the chest, groin, buttock, and abdomen in 25 cases; on extremities in 35 cases; and on neck or facial wounds in 4 cases. In 66% of cases, dressings were utilized following gauze failure and were 100% successful. In 62 (97%) of the cases, the use of the HemCon dressing resulted in cessation of bleeding or improvement in hemostasis. There were two reported dressing failures that occurred with blind application of bandages up into large cavitational injuries. Dressings were reported to be most useful on areas where tourniquets could not be applied to control bleeding. The dressings were reported to be most difficult to use in extremity injuries where they could not be placed easily onto or into the wounds. No complications or adverse events were reported. CONCLUSION: This report on the field use of the HemCon dressing by medics suggests that it is a useful hemostatic dressing for prehospital combat casualties and supports further study to confirm efficacy.

Bandages↗
PubMed2000

Alginate dressings in surgery and wound management--Part 1.

Large quantities of alginate dressings are used each year to treat exuding wounds, such as leg ulcers, pressure sores and infected surgical wounds. Originally these dressings were a loose fleece formed primarily from fibres of calcium alginate. More recently they have been developed so that the fibres have been entangled to form a product with more cohesive structure, which increases the fabric's strength when it is soaked with exudate or blood. Some products also contain a significant proportion of sodium alginate to improve the gelling properties of the dressing in use. Other dressings have been produced from freeze-dried alginate. Once in contact with an exuding wound, an ion-exchange reaction takes place between the calcium ions in the dressing and sodium ions in serum or wound fluid. When a significant proportion of the calcium ions on the fibre have been replaced by sodium, the fibre swells and partially dissolves forming a gel-like mass. The degree of swelling is determined principally by the chemical composition of the alginate, which depends on its botanical source. Although it is recognised that the differences between the various brands of dressings may influence their handling characteristics--particularly when wet--it is generally assumed that these differences are of limited relevance to the dressing's performance clinically or at a cellular level. There is some evidence to suggest, however, that these assumptions may be wrong and that alginates may influence wound healing in a number of ways not yet fully understood. This three-part review of the literature encompasses the history, origin, structure, chemistry and clinical applications of alginates and alginate dressings. This review reveals that, despite their widespread use, alginates have been the subject of very few well-controlled clinical studies. There is fairly convincing evidence, however, that they do offer advantages over more traditional dressings for at least some clinical indications. It has also become obvious that there is a general lack of understanding about the importance of secondary dressing systems that must be used in with alginate dressings. Careful examination of the design and outcomes of the published studies suggests that the choice of both the primary alginate dressing and the secondary dressing can play a major role in determining treatment outcomes.

Alginates↗
PubMed2002

Nurses' views about pain and trauma at dressing changes: a central European perspective.

OBJECTIVE: This study investigated nursing and medical practitioners' perceptions of pain and trauma at dressing change in three German-speaking European countries: Austria, Germany and Switzerland. It follows a similar study by Hollinworth and Collier conducted in the UK. METHOD: A total of 3300 questionnaires were posted to practitioners in the three countries. All of the practitioners had attended at least one educational event on wound management organised by the researchers. The questionnaire contained closed questions about the participants' experience of dressing change and pain, their place of work and their freedom to select wound management products. RESULTS: A 15.1% response rate was achieved. The main aim at dressing change was to prevent trauma to the wound (30%) and to prevent infection (29%) and pain (21%). Dressing removal (51%) and wound cleansing (41%) were cited as the phases of dressing pain most likely to cause pain. Factors perceived to cause pain during dressing changes included dressings that adhere to the wound area (35%), particularly direct adherence to the wound (29%) and dried-out dressings (28%). Techniques used to prevent pain included rehydrating dressings. The responses also pointed to insufficient knowledge about low-adherent or non-adherent dressings among some respondents. CONCLUSION: The respondents perceived dressing removal and wound cleansing to be the most painful wound-care interventions. Their key objectives were to prevent pain and trauma at dressing changes. Lack of information on low- and non-adherent dressings needs to be addressed. DECLARATION OF INTEREST: This study was funded by Mölnlycke Health Care AG, Switzerland.

Austria↗
PubMed2005

Evaluation of 2-methacryloyloxyethyl phosphorylcholine (MPC) polymer-coated dressing on surgical wounds.

The ideal dressing material is bio-inert and keeps the wound site moist. It is equally important that no regenerative tissue is peeled off on the removal of the dressing. 2-Methacryloyloxyethyl phosphorylcholine (MPC) has a phospholipid polar group that mimics a biomembrane. We prepared poly [MPC-co-n-dodecyl methacrylate (DMA)] (PMD), using conventional radical polymerization with 2,2'-azobisisobutyronitrile as an initiator, and coated it on polyurethane (PU; Tecoflex 60 Thermedics Inc.) membrane. Full-thickness surgical wounds were made on the dorsal skin of rats and wound healing was compared under the following three conditions: air-exposed control (no dressing), PU dressing, and PMD dressing. At 3, 4 and 7 days after the operation, the wound sizes of the PMD dressings were smaller than the non-dressed wound, and at 6 and 7 days after the operation, the wound sizes of PU dressing were smaller than that of the air-exposed group. But there were no significant difference between the PMD dressing group and PU dressing group. Histologically, scab formation was not observed on the PU or PMD-dressed wounds. However, in the air-exposed control, a scab was formed and re-epithelialization of the wound site was prevented. Additionally, no damage was observed in the histological section of PMD dressed wound after the wound was cured. These results indicate that PMD dressing (PMD-coated PU membrane) has the potential to provide an inert environment for wound healing as well as PU.

Animals↗
PubMed2000

Review of closed dressings after laser resurfacing.

BACKGROUND: Laser skin resurfacing has become an accepted technique for the treatment of facial rhytides and associated solar skin damage. Achieving a successful result is directly related to proper postoperative wound care during the reepithelialization process. There are open and closed approaches to the treatment of the post-laser resurfacing patient with distinct advantages and disadvantages. OBJECTIVE: To review the most commonly used closed dressings after facial laser skin resurfacing and compare their advantages and disadvantages. To compare clinical findings with a group of patients treated exclusively with an open technique. METHODS: Review of composite foams, polymer film, polymer mesh, and hydrogel products and prospective observations of clinical outcomes of patients treated with each dressing category after facial laser skin resurfacing. We perform a retrospective chart review of a group of patients treated exclusively with an open technique comparing crust formation, comfort, and pruritus with the prospective group of patients treated with closed dressings. RESULTS: The closed dressings available today each have unique structural configurations and adhesive properties intended to maintain an occlusive wound environment. Patient acceptance of these dressings was favorable, with improved comfort compared to the open dressing group. Complications of bacterial infections and contact dermatitis were not observed when closed dressings were used with a protocol for dressing changes performed at 48 hours. Rates of reepithelialization did not vary according to dressing category. Crust formation and postoperative pruritus occurred less frequently when closed occlusive dressings were worn by patients. CONCLUSIONS: When used properly, these dressings improve patient comfort, simplify their postoperative wound care, and do not increase the risk of infection or contact dermatitis. Overall satisfaction was highest with perforated mesh and polymer dressings for full-face wounds.

Adult↗
PubMedDate not supplied

A comparison of three wound dressings in patients undergoing heart surgery.

Two hundred fifty patients undergoing heart surgery were randomized in a prospective comparative study of a semiocclusive hydroactive wound dressing, an occlusive hydrocolloid dressing, and a conventional absorbent dressing. The wounds were evaluated during the 4 weeks after surgery. Color photographs were used for a blind evaluation of wound healing. The conventional absorbent dressing was more effective in wound healing, compared with the hydroactive dressing. Further, there were fewer skin changes and less redness in the wounds with the conventional dressing than with the hydroactive dressing; the differences were not significant with the hydrocolloid dressing. The conventional dressing was less painful to remove than the hydroactive and hydrocolloid dressings. More frequent dressing changes, however, were needed when using the conventional dressing. Despite this, it was the least expensive alternative.

Absorption↗
PubMed1989

Effect of periodontal dressings on human gingiva fibroblasts in vitro.

In vitro cytotoxicity studies of periodontal dressings have not generally produced a result consistent with in vivo observations. These prior in vitro studies have not used human intraoral cell lines. We tested the effects of two eugenol containing and two non-eugenol periodontal dressings on cultured human gingival fibroblasts (HGF) (ATCC #1292). Replicate HGF cultures grown in microtiter plates were exposed to stock, 1:4 and 1:16 dilutions of extracts made from each of the four periodontal dressings. The HGF cultures were pulse labelled with tritiated thymidine (3HTdR) after 24, 48, and 72 hours. Incorporations of the labelled thymidine were measured using liquid scintillation counting and expressed as counts per minute. The results showed that undiluted extracts from all four periodontal dressings totally inhibited 3HTdR uptake (P less than 0.05). The 1:4 dilution of eugenol dressings inhibited 3HTdR uptake significantly more than non-eugenol dressings (P less than 0.05). Interestingly, at 72 hours the 1:16 dilution of the non-eugenol dressings caused significantly increased 3HTdR uptake which was not observed with the eugenol dressings. The present results suggest that the use of a human fibroblastic cell line for testing the effects of periodontal dressings may provide information about the relative biological effects of these dressings. Using this cell line, we have found that eugenol dressings inhibit fibroblast proliferation to a greater extent than non-eugenol dressings.

Cell Line↗
PubMed2006

Umbilical hernia repair in children: is pressure dressing necessary.

The use of pressure dressing to cover the sutured surgical wound is usually considered a routine conclusion to the repair of umbilical hernias in children. The wound is usually left dressed for a minimum of 5-7 days. The main purpose of pressure dressing is prevention of a hematoma formation. The aim of this study was to compare the surgical outcome after umbilical hernia repair in children when the wounds were covered using pressure dressing or left exposed without dressing after the completion of wound closure. Ninety-six patients with umbilical hernia repair were prospectively randomized to receive pressure dressing (n=52) or have their wounds left exposed without any dressing (n=44) after the completion of wound closure. None of the hernias were huge umbilical hernia and none required an umbilicoplasty. In the group who received pressure dressing, one patient developed wound infection 1.9% while no patients developed wound infection in the group who had their wounds exposed without any dressing. In children, there was no significant difference in terms of wound infection, hematoma or seroma formation and recurrence rate after applying pressure dressing or leaving the surgical wounds exposed without any dressing after completion of wound closure. Pressure dressing after umbilical hernia repair may be unnecessary.

Bandages↗
PubMed2004

Pediatric clean surgical wounds: is dressing necessary?

BACKGROUND/PURPOSE: The covering of the sutured surgical wound with a sterile dressing is usually considered a routine conclusion to an aseptic operation. The wound is usually left dressed for a minimum of 3 to 5 days. The main purpose of dressing is protection of the wound against bacterial contamination that remains a significant source of postoperative morbidity. The aim of this study was to compare the infectious local risk when the clean pediatric surgical wounds were dressed or left exposed without dressing after the completion of wound closure. METHODS: Four hundred fifty-one patients with clean surgical wounds were randomized prospectively to receive dressing (n = 216) or have their wounds left exposed without any dressing (n = 235) after the completion of wound closure. RESULTS: In the group that received wound dressing, wound infection developed in 3 patients (1.4%), whereas in the group that had wounds exposed without any dressing, 4 patients (1.7%) developed wound infection. CONCLUSIONS: In children, there was no significant difference in terms of wound infection after applying dressing or leaving the clean surgical wounds exposed without any dressing after completion of wound closure. Dressing clean surgical wounds may be unnecessary.

Adolescent↗
PubMed2000

Healing of porcine donor sites covered with silver-coated dressings.

OBJECTIVE: To compare rates of healing of donor sites in pigs between those dressed with silver-coated dressings and those dressed with petrolatum-impregnated absorbent gauze. DESIGN: Open study with each animal acting as its own control. SETTING: University research facility, Canada. ANIMALS: 6 young specific-pathogen-free domestic pigs. INTERVENTIONS: A total of 72 wounds about 1 cm x 2 cm x 0.4 mm were made in rows of eight on each pig with a dermatome. They were divided into three groups of 24, and dressed with petrolatum gauze, or silver-coated dressings moistened with sterile water either once only or daily for 10 days. All dressings were secured in place with an elastic bandage. MAIN OUTCOME MEASURES: Erythema, infection, epidermal migration, and healing. RESULTS: Wounds dressed with moistened silver-coated dressings re-epithelialised significantly more quickly. This resulted in complete re-epithelialisation within 70% of the time taken by those wounds dressed with petrolatum gauze. CONCLUSION: Silver-coated dressings provide a moist environment for the healing wound combined with an effective antimicrobial agent, and this significantly accelerates healing compared with wounds dressed with traditional petrolatum gauze dressings.

Animals↗
PubMed1995

Managing sacral pressure ulcers with hydrocolloid dressings: results of a controlled, clinical study.

One-hundred and three patients with Stage II and III sacral pressure ulcers were enrolled in a prospective, controlled, multi-center clinical study to evaluate and compare dressing performance, safety and efficacy. Fifty-two patients were randomized to treatment with a triangle-shaped hydrocolloid border dressing and 51 patients were randomized to a different, oval shape, hydrocolloid dressing. The majority of patients (70 percent) utilized a pressure reducing mattress or bed. Most ulcers were Stage II, had existed for < 1 month and exhibited no change utilizing previous treatments. Patients and wounds were similarly distributed among treatment groups. Patients in the oval dressing group were more likely to exhibit a product related adverse reaction resulting in discontinuation of treatment as compared to patients treated with the triangle border dressing (p = 0.057, Fisher's Exact Test). Wear time was longest for wounds dressed with the triangle dressing applied point down. Incontinence reduced the interval between dressing changes in both groups. Healing was more likely to occur in wounds dressed with the triangle border dressing. These ulcers showed a greater reduction in ulcer width as compared to wounds dressed with the oval dressing (p < 0.03, Fisher's Exact Test).

Aged↗
PubMedDate not supplied

Evaluation of a collagen-alginate wound dressing in the management of diabetic foot ulcers.

Efficacy and safety of a collagen-alginate topical wound dressing (FIBRACOL Collagen-Alginate Wound Dressing) in the treatment of diabetic foot ulcers was compared with that of regular gauze moistened with normal saline. Seventy-five patients with foot ulcers were assigned randomly in a 2:1 ratio to the collagen-alginate test dressing or the gauze dressing. At the end of the study, the mean percent reduction of the wound area was 80.6% +/- 6% in the collagen-alginate dressing group and 61.1% +/- 26% in the gauze dressing group (p = .4692). Thirty-nine (78%) patients treated with the collagen-alginate dressing achieved > or = 75% wound area reduction, compared with 15 (60%) of gauze-treated patients. Complete healing was achieved in 24 (48%) of the collagen-alginate dressing group and 9 (36%) of the gauze dressing group. Wound size, when averaged over the 8-week period and with the duration of the ulcer taken into account, was reduced significantly in the collagen-alginate dressing group, as compared with the gauze dressing group (df = 1, p = .0049). It is concluded that the collagen-alginate test dressing is as or more effective and safe as the currently used treatment.

Adult↗
PubMed2001

Evaluation of a silicone occlusive dressing after laser skin resurfacing.

BACKGROUND: Closed dressings are thought to promote postoperative wound healing after laser skin resurfacing; however, quantitative data are lacking. OBJECTIVE: To compare postoperative healing after combination carbon dioxide and erbium:YAG full-face laser skin resurfacing in patients who were treated with a silicone occlusive dressing (Silon-TSR; Bio Med Sciences, Inc, Bethlehem, Pa) vs open-wound care consisting of soaks and ointment application. DESIGN: Thirty-five patients with closed dressings compared retrospectively with 35 control subjects with open-wound care. In a prospective evaluation, 27 patients with closed dressings were then compared with 27 historical controls matched by age, sex, skin type, and treatment technique. Erythema, crusting, swelling, pain, pruritus, purpura, long-term complications, and dressing comfort were evaluated. SETTING: Referral-based academic practice. RESULTS: Prospectively, closed-dressing and open-wound care groups differed significantly in maximum erythema severity (1.8 vs 2.0 on a scale of 0-3; P =.03), noticeable erythema duration (15.4 vs 31.1 days; P =.04), and time until complete erythema resolution (41.8 vs 96.1 days; P =.02). Swelling resolution was more rapid in the dressing group (12.1 vs 29.5 days; P =.02). Crusting was limited to uncovered areas in the dressing group, and crusting duration was shorter (5.0 vs 9.1 days; P<.001). Pain was more likely to be reported prospectively, but severity was mild, in the closed-dressing group. Other short- and long-term complications did not differ significantly. Subjective patient attitudes toward the dressing were positive. CONCLUSIONS: Occlusive silicone dressing application decreases immediate postoperative morbidity with significantly reduced severity and duration of erythema and decreased duration of swelling and crusting. Long-term results and complication rates remain unchanged.

Erythema↗
PubMed1999

Application of an in vitro model to evaluate bioadhesion of fibroblasts and epithelial cells to two different dressings.

The cellular component of a healing wound consists of many cell types and the environment in which these cells grow is important to the rate and quality of healing which can be influenced by the type of dressing used. The most commonly used dressings are traditional gauze-type dressings. In many cases these dressings may adhere to the wound surface, and subsequent removal is often traumatic, causing pain and tissue reinjury. Some modern gelling dressings have been developed to overcome this adherence problem. In order to evaluate in more detail cell-dressing interactions, an in vitro model has been developed utilising wound fibroblasts and epithelial cells. Quantitative evaluation of adherence of cells cultured with a traditional gauze or a new gelling dressing has been undertaken using radiolabel and manual counting techniques. Scanning electron microscopy has been used to visualise the cells adherent to dressings allowing evaluation of their adhesion-morphology. The results show differential attachment of cells to viscose and gelling fibres of the dressings; considerably reduced cell adhesion to the gelling fibre was evident, and it was apparent that cells adhered predominantly to the viscose component of the dressing. This model can be used to investigate and compare the adhesion of cells to different dressings and their components.

Animals↗
PubMed2001

The use of silver coated dressings on donor site wounds: a prospective, controlled matched pair study.

Acticoat, a new silver-coated dressing, produces a moist healing environment along with the sustained release of ionic silver for improved microbial control. These properties suggest that Acticoat might be a useful donor site dressing. However, there are no human studies which assess Acticoat for this use. The purpose of this study was to compare the healing of human skin graft donor sites dressed with Acticoat, to the healing of those dressed with Allevyn, an occlusive moist-healing environment material, which is our standard donor site dressing. In burn patients who had undergone burn excision and grafting, identical side-by-side split thickness donor site wound pairs were dressed with Allevyn and Acticoat. Re-epithelialization was directly assessed daily by a single observer from post-operative day 6 onward, and by four independent observers who rated the extent of re-epithelialization by viewing standardized digital images of the wounds that had been obtained on post-operative days 6, 8, 10,and 12. Donor sites were swabbed for bacterial culture on days 3, 6, and 9. Subsequently, each study donor site scar was rated by a blinded observer using the Vancouver Scar Scale at 1, 2, and 3 months. Sixteen paired sites in 15 patients (3 female, 12 male) were studied. Donor sites dressed with Allevyn were >90% re-epithelialized at a mean of 9.1+/-1.6 days while donor sites dressed with Acticoat required a mean of 14.5+/-6.7 days to achieve >90% re-epithelialization (P=0.004). The Allevyn sites had significantly greater estimated re-epithelialization at days 6, 8, 10 and 12 than the Acticoat sites based on the observations of the digital images. There were no significant differences in the incidence of positive bacterial cultures with either dressing at days 3, 6, and 9. Donor sites dressed with Acticoat had significantly worse scars at 1 and 2 months but this difference resolved by 3 months. Our findings do not support the use of Acticoat as a skin graft donor site dressing.

Adolescent↗