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PubMed2003

From the roots of rhinology: the reconstruction of nasal injuries by Hippocrates.

The goal of this report is to describe the therapeutic methods and surgical techniques used by Hippocrates (5th century BC) in the treatment of nasal injuries. We studied the original Greek texts of the (generally considered genuine) Hippocratic book Mochlicon and, especially, the analytical On Joints. We identified the treatments and techniques applied to the restoration of injured noses. We found that Hippocrates classified nasal injuries, from simple contusions of soft tissues to complicated fractures. Hippocrates provided detailed instructions for each case, from poultice application and bandaging to reconstruction and reshaping of the nasal bones in cases of fractures and deviation. Hippocrates' texts reflect the interest of the classical period in nasal injuries, a common enough accident in athletics. Hippocratic conservative and surgical management for each form of injury was adopted by later physicians and influenced European medicine.

Bandages↗
PubMedDate not supplied

Cytotoxicity testing of wound-dressing materials.

A method was developed for testing the cytotoxicity of various bandage-like wound dressings and gel wound dressings. In this method, the ability of human polymorphonuclear neutrophils (PMNs) to initiate a respiratory burst after exposure to the various wound dressings is used as a marker of cytotoxicity. Luminol-amplified chemiluminescence stimulated with opsonised zymosan or phorbol 12-myristate 13-acetate (PMA) is used to measure the degree of activation of the respiratory burst, i.e. the NADPH oxidase activity, after exposure to wound dressings. Opsonised zymosan (material from yeast cell walls) is a phagocytic stimulus that activates the NADPH oxidase by binding to FC-receptors and complement receptors, and functions as an artificial bacterium, whereas PMA activates the NADPH oxidase by direct activation of protein kinase C. NADPH oxidase activity was inhibited by several wound dressings. The down-regulation of the respiratory burst is detrimental to the bactericial effect of PMNs, and can be used as a marker for the cytotoxicity of wound dressing materials.

Bandages↗
PubMed1986

Spandra: a sustained release battlefield wound dressing.

In 1981, our laboratories developed a family of elastomers which could be cured by ultraviolet (UV) radiation. Curing by UV radiation was a significant advance in chemistry, since it allowed ultra-fast curing of elastomers in a matter of seconds, as compared to several hours at 110 degrees C for conventional heat curing. We applied for a patent based on this technology, and the patent was allowed in mid-1984 [29]. Based on this technology, Thermedics submitted a proposal to the US Army for the development of a sustained-release battlefield wound dressing containing antibiotics and coagulants. The drugs were evenly distributed in the oligomer matrix, and subsequently cured in seconds under UV illumination, without the use of heat, organic solvents or water. Because delicate drugs are not subjected to heat, organic solvents or water, the pharmacological activity of the drugs is insured. Therefore, theoretically any drug may be incorporated into our dressing. Sustained release dressings were first developed at Thermedics in 1983, spurred by a contract from the US Army Medical Research and Development Command. Under this contract, the Company developed a new type of wound dressing capable of accelerating the healing process, retarding infection, and minimizing pain. Based on our TECOFLEX materials technology, the dressing performs like temporary artificial skin. Its transmission properties for oxygen, carbon dioxide, and water vapor are similar to those of intact skin. Thus, while excluding bacteria from the wound site, the dressing maintains an optimal moist environment for the promotion of rapid healing. The new drawing shown in Figure 10 minimizes pain during healing by preventing dehydration and shrinkage in the wound. Patient comfort is also enhanced by the incorporation of a special fabric which imparts flex properties to the bandage that are almost identical to those of human skin, with greater stretch in one direction than in another. This also facilitates application to complex body contours by only one attendant, an important feature in both hospital and emergency situations. Materials currently in use in hospitals are difficult to handle, requiring two or three nurses to apply large dressings. Thermedics' military wound dressing not only has the significant advantage of ease of application, but this dressing can also be used for delivery of drugs to a specific site.(ABSTRACT TRUNCATED AT 400 WORDS)

Administration, Cutaneous↗
PubMed1998

A systematic review of compression therapy for venous leg ulcers.

The aim of the study was to determine the relative effectiveness of compression therapies used in the treatment of venous leg ulcers. Randomized controlled trials (RCT) were sought using a search strategy that aimed to identify relevant RCT by searching eight electronic databases (including Medline, Embase and CINHAL), conference proceedings and hand searching key journals. In addition, citations within papers were scrutinized to identify any relevant studies. Suitability for inclusion in this review was determined by a critical appraisal of key determinants of the quality of the trials. Trials that included patients of mixed ulcer aetiology were excluded unless the results of patients with venous disease were reported separately. Data was extracted independently by two reviewers and synthesized quantitatively and qualitatively. Losses to follow-up/withdrawals were assumed to be failures of treatment. A total of 132 articles were identified, and of these eight fulfilled the inclusion criteria. The remaining 126 trials were excluded due to trial design flaws, the inclusion of mixed/arterial aetiology ulcers or because they were non-RCT. Meta-analysis using a random-effects model showed the benefits of multi-layer and elastic compression bandages. It was concluded that more high-quality trials are required and that more emphasis should be placed on economic and quality of life data to try to ascertain the cost-effectiveness and utility of the treatment options available.

Bandages↗
PubMed2006

Mobilization versus immobilization in the treatment of acute proximal deep venous thrombosis: a prospective, randomized, open, multicentre trial.

OBJECTIVE: The aim of prescribing strict bed rest for acute deep venous thrombosis is to reduce the risk of pulmonary embolism and pain in the legs, as well as swelling. This study was performed in order to compare outcome of mobilization against 5 days of strict bed rest in patients with acute proximal deep venous thrombosis (DVT). METHODS: 103 in-patients with proximal DVT or patients admitted to the hospital because of proximal DVT were recruited to a randomized study. All patients were treated in hospital and given a lower leg and thigh compression bandage as well as therapeutic doses of the low molecular weight heparin, dalteparin-sodium (Fragmin). RESULTS: Seven of 52 patients (13.5%) in the mobile group versus 14 of 50 patients (28.0%) in the immobile group suffered at least one of the outcomes defined under the combined primary endpoint (clinically relevant pulmonary embolisms, pulmonary embolisms detectable by scintigraphy or computer tomography, progression of thrombosis or new thrombosis, nosocomial infections and/or serious adverse events) (p = 0.088), whereby serious adverse events occurred once in the mobile group and three times in the immobile group. New pulmonary embolisms over the course were seen in 10 of 50 patients (20%) with a perfusion disorder at baseline scintigraphy, while such was ascertained only in one of 52 patients (1.9%) without a perfusion disorder at baseline scintigraphy. Leg pain was reduced from 54.1 (+/-30.4) to 20.7 (+/-19.2) in the mobilized group and from 41.0 (+/-26.8) to 14.0 (+/-11.1) in the immobilized patients. Leg pain was assessed using the visual analogue scale (0 = no pain, 100 = maximum pain). More immobilized patients complained of increasing back pain (23% versus 6%) and disturbed micturition (10% versus 2%) as well as defecation (13% versus 6%) on day 5. More patients in the mobile group reported increased stress from the thrombosis and its treatment (15% versus 6%). CONCLUSIONS: No benefit of prescribing bed rest in patients with deep venous thrombosis could be detected in this study. Based on data available, strict bed rest for at least 5 days is not justified if adequate therapy with low molecular weight heparin and adequate compression is assured. It remains open whether patients with initial signs of pulmonary embolism might profit from a brief immobilization.

Anticoagulants↗
PubMed1992

Pentoxifylline in the treatment of venous leg ulcers.

A double-blind, placebo-controlled study was carried out in 12 patients suffering from chronic venous insufficiency and persistent leg ulcers to assess the efficacy of pentoxifylline treatment as an adjunct to compression bandaging in the conservative management of venous leg ulcers. Six patients were allocated at random to receive twice-daily infusions of 200 mg pentoxifylline intravenously and 400 mg pentoxifylline orally 3-times daily for 7 days then 400 mg oral doses 3-times daily for a further 60 days. The control group received matching placebo in an identical regimen. Treatment outcome was assessed by changes between the start and end of the study in venous ulcer surface area, and continuous wave Doppler ultrasound was used to monitor ankle/arm systolic pressure ratio, venous pressure at the ankle, valvular competence and possible venous reflux at intervals throughout the study period. The results showed that in the patients treated with pentoxifylline complete ulcer healing took place in 4 out of 6 and there was a significant reduction in mean ulcer surface area. In the control group, complete ulcer healing was recorded in 1 out of 6 patient only and the ulcer area was only moderately reduced in the others. There was no statistically significant differences between the two groups in the variables monitored by Doppler ultrasound but the difference between treatment outcome was significant. Treatment was well-tolerated.

Aged↗
PubMed2002

Use of sugar in the treatment of infected leg ulcers.

Mrs R is an 84-year-old retired shop-keeper with a 17-year history of recurrent leg ulceration. She has received treatment in both primary and secondary care settings, including specialist dermatology and vascular clinics. Mrs R has a long history of non-compliance to treatment regime, removing bandages and rucking them down causing compression injuries that almost resulted in amputation of her right leg. On assessment by the author, she had two partial thickness ulcers to each leg, signs of venous insufficiency and malnutrition, and swabs cultured positive for a range of bacteria. Resistance to topical antimicrobials and allergy to systemic antibiotics meant that another solution had to be tried to relieve the bacterial load on Mrs R's wounds.

Administration, Cutaneous↗
PubMed2002

Randomised, comparative study of three primary dressings for the treatment of venous ulcers.

In this article, we describe a randomised trial in which two established primary dressings - Comfeel (Coloplast, UK) and Granuflex improved formulation (Convatec, UK) - were compared to Cutinova foam (Beiersdorf Medical, UK) in the management of venous leg ulcers. Patients that met the study trial criteria were randomised to receive one of the three primary dressings. All ulcers were secondarily bandaged with Comprilan (Beiersdorf Medical, UK) short-stretch compression. The three dressings were compared in terms of their ability to promote ulcer healing (closure rate and healing rate) and reduce the prevalence and severity of ulcer-associated pain, over a 12-week period. The ease with which dressings could be used in a busy outpatient clinic setting was also considered. On enrollment, groups were well matched in terms of all of the patient and ulcer parameters studies. Six patients were withdrawn for reasons unrelated to study dressings or trial procedures. Following non-parametric analysis of the study data, the three dressings were found to be equally effective at promoting ulcer healing and alleviating ulcer-associated pain. Study personnel rated Cutinova Foam as easy, if not easier, to use than Comfeel or Granuflex. This study suggests that Cutinova Foam is as safe and effective as both Comfeel and Granuflex, in the treatment of venous leg ulcers.

Aged↗
PubMed2003

Jobst UlcerCARE compression hosiery for venous leg ulcers.

Chronic venous insufficiency affects the productivity and well-being of millions of people worldwide and is the most common cause of leg ulcers. Treatment of leg ulcers accounts for 22% of district nurses' time and places a major financial burden on NHS resources. Compression bandaging has been recognized as the optimum approach for venous ulcers but is not always applied effectively. It is also costly and may lead to non-compliance. Compression hosiery is an alternative treatment approach. Review of relevant research shows JOBST UlcerCARE to be an effective treatment that is easy to apply, thereby maintaining patient independence. It also provides a major potential for cost savings to the NHS.

Bandages↗
PubMedDate not supplied

Identification and healing of leg ulcers with impaired circulation.

Leg ulcers may fail to heal because inaccurate assessment has resulted in inappropriate treatment. This article suggests a more accurate method of assessment and describes the use of zinc oxide paste bandage to heal leg ulcers where there is impaired arterial circulation.

Aged↗
PubMedDate not supplied

Allevyn adhesive.

Allevyn Adhesive is a development of Allevyn Hydrocellular produced by Smith & Nephew Healthcare. Allevyn Adhesive comprises three layers and has the same absorbency as Allevyn Hydrocellular. The dressing is waterproof and requires no secondary dressing, tape or bandages. It is able to conform to the most awkward body areas such as the sacrum, heels and elbows. It is suitable for use on a variety of exuding wounds and can be used in conjunction with a hydrogel for sloughy wounds.

Aged↗
PubMedDate not supplied

Interface pressure measurements in leg ulcer management.

Interface pressure measurements are undertaken in health care as a useful tool to assist in understanding the pressures that exist between the skin surface and another surface. Pressure monitors are utilized to measure pressures under compression bandages and pressure garments and in determining pressures between patients and support surfaces such as pressure-reducing mattresses and cushions. This literature review identified that many studies using these measurements are inadequately described, and that there are many variables such as the effect of time, posture and temperature associated with such measurements that may lead to misinterpretation of results. Studies utilizing interface pressure measurements should be interpreted with caution and measurement techniques could be improved.

Bandages↗
PubMedDate not supplied

The use of intermittent pneumatic compression in venous ulceration.

Even with the application of four-layer bandaging, the recommended treatment for venous leg ulceration, patients with reduced mobility have delayed ulcer healing. Intermittent pneumatic compression (IPC) has an established role in deep vein thrombosis prophylaxis and has been shown to influence fibrinolysis, tissue oxygenation, oedema and venous return. It has also been suggested, but not yet proven, that IPC may improve the healing of venous leg ulcers. An extensive review of the literature has demonstrated that the use of this treatment on patients with reduced mobility has not been previously studied; yet, analysis of difficult-to-heal ulcer patients would indicate that this method of treatment may be appropriate and requires further study.

Activities of Daily Living↗
PubMed1995

The cost of wound care in the community.

As part of a project examining expenditure on all wound management materials currently prescribed by general practitioners in Wales, the cost of bandages and surgical tapes was analysed. Changes to prescribing patterns are suggested which could result in significant financial savings and improvements in patient care.

Adhesives↗
PubMed1996

Treating venous leg ulcers in the community.

Standardisation was necessary to improve the treatment of venous leg ulceration in the community and reduce costs. A study was conducted to assess the performance of a compression bandage with orthopaedic wool and patient compliance with this system. Patients were assessed weekly, and photographs taken to monitor progress. Nine out of 11 patients healed in an average time of eight weeks, and the total cost for 12 weeks' treatment was estimated at 130.02 pounds.

Bandages↗
PubMed1998

A leg ulcer clinic: audit of the first three years.

This study documents the establishment in 1994 of a leg ulcer clinic in Hobart, Tasmania. Information relating to patient demographics, results of treatment and costs required to successfully operate the clinic were studied prospectively. Over a 40-month period, 345 patients attended the clinic on 1154 occasions. Ulcers were classified as venous (59%), arterial (19%), mixed venous and arterial disease (13%), pressure injury (3%), traumatic injury (2%) or rheumatoid disease (1%). A wide range of dressings and bandages were used during treatment. The clinic cost an average of A$42,683 per annum to run. This information has the potential to be of use as a guide for any organisation planning to open a similar clinic.

Adult↗
PubMed1999

A follow-up study of leg ulcer patients in south Stockholm.

The objective of this study was to follow up patients with leg ulcers, previously identified in an epidemiological study in South Stockholm. Rate of healing, non-healing, recurrence, amputation and mortality were recorded. A total of 254 patients were identified for follow-up after 18 months, 217 of whom were included. The use of a questionnaire revealed that, during this period, 43 (20%) of the patients had died; of the remaining 174 patients, 61% had healed, 29% were unhealed, 8% had recurring ulceration after healing; 2% had required amputation. Venous aetiology was found to be more common than arterial aetiology. However, among those who had died, arterial disease was found to be more common than venous insufficiency. A further objective was to investigate 21 patients with non-healed venous leg ulcers who had been treated in community care. They were assessed by means of a standardised form and given a triple-layer bandaging treatment for a three-month period. Two ulcers had healed and nine ulcers had improved and were healing. In the group of patients with healed or improved ulcers, five had normal mobility.

Adult↗

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