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Is pressure dressing necessary after ear surgery?

Compressive bandages carry intrinsic risks and complications. The purpose of this study was to assess whether compressive head bandages are necessary after ear surgery to prevent complications such as hematoma or wound infection. A prospective, randomized, controlled study was conducted from August 1, 1993, to June 1, 1999. We randomly assigned 420 consecutive middle ear or mastoid operations to either a pressure bandage group or to a no-pressure bandage group. A careful follow-up was planned, and complications were recorded. In the pressure bandage group, 3 patients had bruising over the pinna and 70 patients had minor skin erythema when the dressing was removed. No patient had bruising or erythema in the no-pressure bandage group. No patient had hematoma, wound infection, or any other wound complication in either group. As a result of this study, we have decided to abandon the use of compression bandages after uncomplicated ear surgery.

Adolescent↗

Enzymatic chemical modification of human amniotic membrane and skin as a means for the preparation of biological dressing.

A non-antigenic biological dressing of amniotic membrane and skin was prepared by treatment with the enzyme ficin and dialdehyde starch. The dressing was tested in experimental animals for the coverage of full-thickness skin defects. The healing process was studied, as well as the durability of the biological dressing. Testing for flexibility, adherence and antigenicity, there was no change in the ficin-treated dressing when used even after being stored for a period of up to 2 years. The enzyme treatment did not result in a superior biological dressing.

Amnion↗

The use of silver nitrate-incorporated amniotic membrane as a temporary dressing.

Human amniotic membrane is one of the most effective biological dressings used in burn treatment. Since 1978, we have been using human amniotic membrane incorporating 0.5 per cent silver nitrate. Studies in 96 patients using this method showed that the silver-incorporated membranes gave a better therapeutic effect than plain amniotic membranes. It was noted that 0.5 per cent silver nitrate incorporated into the membranes increased their manageability, provided easier application to the burned area and created a bactericidal effect, therefore reducing the risk of contamination and infection. One of the main advantages of wound coverage with amniotic membrane is that it does not appear to discourage re-epithelization, reduces fluid, protein, heat and energy loss, increases mobility and most important this may be the ideal wound cover next to the patient's own skin. Therefore, we highly recommend the use of 0.5 per cent silver nitrate-incorporated amniotic membrane, since it is readily available and freely obtainable, has low preparation and storage costs that make it an ideal dressing to use, especially in countries where economic factors prevent the purchase of other types of dressings.

Adolescent↗

Comparison of calcium sodium alginate (KALTOSTAT) and porcine xenograft (E-Z DERM) in the healing of split-thickness skin graft donor sites.

In a controlled, prospective study, calcium sodium alginate and porcine xenograft were compared in the treatment of split-thickness skin graft donor sites on 20 patients. Half of each donor site was dressed with each material. Time to complete healing, quality of regenerated skin and patient comfort were assessed. Time to healing was 8.1 days with alginate and 11.3 days with porcine xenograft (P less than 0.001). Quality of healed skin was consistently good with the alginate, and better than under the xenograft in 95 per cent of patients (P less than 0.001). Hypertrophic scarring was not observed under alginate dressings but occurred in 25 per cent of xenograft-dressed sites (P less than 0.01). In addition, evidence was found that allergic reactions to porcine xenograft could occur. Alginate was preferred by 75 per cent of patients and none preferred porcine xenograft (P less than 0.01); the remainder had no preference. It was concluded that porcine xenograft is inferior to calcium sodium alginate as a dressing for split-thickness skin donor sites.

Alginates↗

A factorial, randomized trial of pentoxifylline or placebo, four-layer or single-layer compression, and knitted viscose or hydrocolloid dressings for venous ulcers.

OBJECTIVES: We evaluated the effectiveness of pentoxifylline, knitted viscose or hydrocolloid dressings, and single-layer or four-layer bandaging for venous ulceration. METHOD: A factorial randomized controlled trial with 24-week follow-up was conducted in leg ulcer clinics in Scotland with blinded allocation to pentoxifylline (1200 mg) or placebo, knitted viscose or hydrocolloid dressings, and single-layer or four-layer bandages. The study enrolled 245 adults with venous ulcers. The main outcome measure was time to complete healing. Secondary outcomes included proportions healed, withdrawals, and adverse events. Analysis was by intention to treat. RESULTS: There was no evidence of interaction between the drug, bandages, and dressings. Pentoxifylline was associated with nonsignificant increased ulcer healing (62% vs 53%; P = .21). Four-layer bandages were associated with significantly higher healing rates (67% vs 49%; P = .009). There was no difference in healing between knitted viscose and hydrocolloid dressings (58% and 57%; P = .88). Cox regression models increased the significance of the pentoxifylline effect (relative risk of healing, 1.4; 95% confidence interval, 1.0 to 2.0). CONCLUSIONS: Pentoxifylline increased the proportion healing compared with placebo to the same extent as shown in recent systematic reviews, although this finding was only statistically significant when a secondary adjusted analysis was conducted. Four-layer bandaging produced higher healing rates than single-layer bandaging. There was no difference in time to healing between knitted viscose and hydrocolloid dressings.

Administration, Oral↗

How long should ears be bandaged after otoplasty?

A firm head dressing is usually applied after otoplasty. Some surgeons recommend that the patient should wear the bandage for up to 10 days after surgery. However, these bandages are frequently displaced or come off. Patients complain of reduced hearing, itch and the smell of old blood in the bandages. A case series of 52 patients undergoing bilateral otoplasty who had a head bandage on for only 24 hours was audited prospectively. Minor complications occurred in two patients. A head bandage does not need to remain on for more than 24 hours after otoplasty.

Adolescent↗