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PubMed1995

Moist wound healing with occlusive dressings. A clinical review.

BACKGROUND: Occlusive dressings have become increasingly popular in the management of wound care. Numerous types of occlusive dressings are presently available for the treatment of acute and chronic wounds. Occlusion enhances wound healing primarily by preventing wound dessication. As a result, epidermal necrosis and eschar formation do not occur, and wounds reepithelialize more quickly. OBJECTIVE: Choosing a dressing to meet the specific needs of the patient can often become confusing for the physician. We review the various types of occlusive dressings and their advantages and disadvantages in the practical management of acute and chronic wounds. METHODS: A literature review of the subject was performed. RESULTS: Occlusive dressings enhance reepithelialization by preventing wound dessication. Lower infection rates are generally achieved despite bacterial proliferation under some occlusive dressings. CONCLUSION: Occlusive dressings simplify wound care and are an excellent choice in the management of most acute and chronic wounds. This review should enable the clinician to choose the best dressing to meet the individual wound of the patient.

Acute Disease↗
PubMed2003

Evaluation study of the properties of two adhesive foam dressings.

The primary objective of this study was to assess the skin stripping of wounds (defined as periwound skin blistering; Fowler, 1990) when treated with an adhesive hydrocellular foam dressing (Allevyn trade mark Adhesive, Smith and Nephew) and a self-adherent soft silicone foam dressing (Mepilex trade mark Border, MöInlycke Health Care). The secondary objectives were to assess wound healing, wound appearance and pain. Data were collected over one year from 403 wounds in 206 patients treated in nursing homes. At follow-up assessment, there was some evidence of skin stripping with both products - 5% (5/106) with the adhesive hydrocellular, and 4% (4/100 with the self-adherent dressing. The results of the study reveal that the closure rates achieved with the two dressings were similar, and that both dressings were equally safe in terms of skin stripping. Independent nurse evaluations highlighted the failure of the self-adherent soft silicone foam dressing to either initially adhere to the wound area, or to remain in contact for more than a few days, and frequently needed the application of additional tape to ensure adhesion. The failure of the self-adhesive soft silicone foam dressing to adhere to the periwound area was a significant deterrent to staff to use this type of dressing routinely.

Adhesives↗
PubMed1999

Infection control properties of some wound dressings.

The ability of some wound dressings to sequester and retain micro-organisms associated with wound fluid is perceived to provide beneficial properties regarding infection control. This study used an in vitro model to investigate and compare such properties in a range of fibrous absorbent dressings (alginate, hydrofibre and hydrophobic). Dressings were challenged with a simulated wound fluid containing common wound pathogens (Staphylococcus aureus or Pseudomonas aeruginosa). Bacterial sequestering and binding levels were monitored over time. A hydrofibre dressing and two calcium alginate dressings were shown to effectively sequester challenge organisms from a simulated wound fluid. However, the hydrophobic and hydrofibre dressings produced statistically significant results in their ability to adsorb and retain challenge organisms (p < 0.05). These investigations have demonstrated that a hydrofibre dressing effectively sequesters and retains micro-organisms upon exposure to simulated wound fluid, and may therefore provide a passive mechanism for reducing the microbial load in wounds and in the surrounding environment. Further in vivo studies are required to investigate these dressing properties.

Alginates↗
PubMed2006

A prospective, randomised, controlled trial comparing wound dressings used in hip and knee surgery: Aquacel and Tegaderm versus Cutiplast.

INTRODUCTION: Cutiplast (absorbent perforated dressing with adhesive border; Smith & Nephew) is commonly used following orthopaedic operation, but complications of its use have been reported. A prospective, randomised, controlled study was performed to compare the efficacy of Cutiplast versus an Aquacel (hydrofibre dressing; ConvaTec) covered with Tegaderm (vapour-permeable dressing; 3M). PATIENTS AND METHODS: Two-hundred patients were randomised to receive one of the two dressings following elective and non-elective surgery of the hip and the knee. We were able to study 183 patients. The condition of the wound and any complications such as skin blistering or signs of infection was noted as was the frequency of dressing changes. RESULTS: The Aquacel and Tegaderm dressing was 5.8 times more likely to result in a wound with no complications as compared to a Cutiplast dressing (odds ratio, 5.8; 95% CI 2.8-12.5; P < 0.00001). CONCLUSION: Aquacel covered by Tegaderm is a superior dressing to Cutiplast following surgery to the hip and knee.

Arthroplasty, Replacement, Hip↗
PubMedDate not supplied

Effects of a normothermic dressing on pressure ulcer healing.

OBJECTIVE: To determine the effects of radiant heat applied through a semiocclusive dressing on periwound skin temperature and wound healing. DESIGN: Before-after trial. SETTING: Spinal cord injury and geriatric units of a VA medical center. PATIENTS: Twenty inpatients with 21 Stage III and IV pressure ulcers. INTERVENTIONS: A semiocclusive, heated dressing was applied to 15 Stage III and IV pressure ulcers for 4.5 hours, Monday through Friday, for 4 consecutive weeks. The dressing emitted heat at 38.0 degrees C for 2 60-minute periods daily. At all other times, the wounds received only standard wound care. Six wounds in a separate control group received only standard wound care during the same 4-week period. MAIN OUTCOME MEASURES: Periwound skin temperature within and adjacent to the dressing and measurements of wound surface area. MAIN RESULTS: Mean skin temperatures inside and outside the heated dressing increased by 0.97 degree C and 1.08 degrees C (P < .05), respectively, from baseline values. Wounds treated with standard care plus the heated dressing underwent a statistically significant reduction in mean surface area of 60.73%. Wounds in the control group underwent a statistically insignificant reduction in mean surface area of 19.24%. CONCLUSION: Wounds treated with a radiant heat dressing healed significantly faster than wounds that received only standard care. There were no adverse effects from the radiant heat dressing.

Adult↗
PubMed1992

Transparent polyurethane film as an intravenous catheter dressing. A meta-analysis of the infection risks.

OBJECTIVE: To obtain a quantitative estimate of the impact on infectious complications of using transparent dressings with intravenous catheters. DATA SOURCES: Meta-analysis of all studies published in the English literature, including abstracts, letters, and reports that examined the primary research question of infection risks associated with transparent compared with gauze dressings for use on central and peripheral venous catheters. Studies were identified by use of the MEDLINE database using the indexing terms occlusive dressings, transparent dressings, and infection and by review of referenced bibliographies. STUDY SELECTION: Seven of the 15 studies (47%) of central venous catheters and seven of 12 studies (58%) of peripheral catheters met our inclusion criteria for analysis. All studies used a prospective cohort design, utilized hospitalized patients, and reported at least one of our defined outcomes. EXTRACTION: Data for each study were abstracted independently by three investigators. At least three studies were used in the analysis of each outcome. DATA SYNTHESIS: Applying a Mantel-Haenszel chi 2 analysis, use of transparent dressings on central venous catheters was significantly associated with an elevated relative risk (RR) of catheter tip infection (RR = 1.78; 95% confidence interval [CI], 1.38 to 2.30). Catheter-related sepsis (RR = 1.69; 95% CI, 0.97 to 2.95) and bacteremia (RR = 1.63; 95% CI, 0.76 to 3.47) were both associated with an elevated RR. Use of transparent dressings on peripheral catheters was associated with an elevated RR of catheter-tip infection (RR = 1.53; 95% CI, 1.18 to 1.99) but not phlebitis (RR = 1.02; 95% CI, 0.86 to 1.20), infiltration (RR = 1.12; 95% CI, 0.92 to 1.37), or skin colonization (RR = 0.99; 95% CI, 0.90 to 1.09). CONCLUSION: The results demonstrated a significantly increased risk of catheter-tip infection with the use of transparent compared with gauze dressings when used with either central or peripheral catheters. An increased risk of bacteremia and catheter sepsis associated with the use of transparent compared with gauze dressings for use on central venous catheters was suggested.

Bacteremia↗
PubMed1997

Release of antibiotics from collagen dressing.

Our new collagen dressing has been developed recently. Three types (A, B, and C) of the dressing were prepared in this study. Each type contained bacitracin, neomycin or colistin. The antibiotic was input into: i. collagen sponge (CS)--type A, ii. layer of limited hydrophobicity (LLH)--type B, and iii. into both CS and LLH layers--type C. The final concentration of the antibiotic that resulted from the loading level was 2 mg/cm2 for the dressings of type A and B and 4 mg/cm2 for the dressing of type C. The antibiotics were then extracted from the pieces of dressings for two days through dialysis membrane. Susceptibility of 54 bacterial strains (S. aureus, P. aeruginosa, and Acinetobacter) isolated from burn wounds were tested to the three antibiotics used for preparation of the dressings. The results of the study evidenced that efficiency of released of antibiotics into the extracts depended on the kind of antibiotic and on the type of dressing. The concentration of the antibiotics proved to be much higher than MIC90 values of the bacterial isolates tested in respect to their susceptibility. The dressing containing mixture of the three antibiotics in two layers--CS and LLH is now considered as potentially effective for care of infected wounds. It may be useful for the treatment of infected wounds or for profilaxis of contaminated wounds, ensuring: i. sufficient antimicrobial activity in wound, and ii. optimal wound environment for the presence of collagenic biomaterial on the damaged tissue.

Acinetobacter↗
PubMed2002

Control of wound infections using a bilayer chitosan wound dressing with sustainable antibiotic delivery.

A novel bilayer chitosan membrane was prepared by a combined wet/dry phase inversion method and evaluated as a wound dressing. This new type of bilayer chitosan wound dressing, consisting of a dense upper layer (skin layer) and a sponge-like lower layer (sublayer), is very suitable for use as a topical delivery of silver sulfadiazine (AgSD) for the control of wound infections. Physical characterization of the bilayer wound dressing showed that it has excellent oxygen permeability, that it controls the water vapor transmission rate, and that it promotes water uptake capability. AgSD dissolved from bilayer chitosan dressings to release silver and sulfadiazine. The release of sulfadiazine from the bilayer chitosan dressing displayed a burst release on the first day and then tapered off to a much slower release. However, the release of silver from the bilayer chitosan dressing displayed a slow release profile with a sustained increase of silver concentration. The cultures of Pseudomonas aeruginosa and Staphylococcus aureus in agar plates showed effective antimicrobial activity for 1 week. In vivo antibacterial tests confirmed that this wound dressing is effective for long-term inhibition of the growth of Pseudomonas aeruginosa and Staphylococcus aureus at an infected wound site. The results in this study indicate that the AgSD-incorporated bilayer chitosan wound dressing may be a material with potential antibacterial capability for the treatment of infected wounds.

Administration, Topical↗
PubMed1994

Women in relationships with cross-dressing men: a descriptive study from a nonclinical setting.

Over a 6-year period, 106 women involved with men who cross-dress (mostly heterosexual transvestites) completed a questionnaire regarding themselves, their male partners, and their relationships. Interview data supplemented these questionnaires for 75% of the respondents. All respondents were recruited from nonclinical settings. The "modal" female partner was a 40-year-old Protestant, Caucasian woman, who was a firstborn child, in her first marriage. She was more likely than other women her age to be childless, and to have earned at least a 2-year college degree. She was no more likely to have had lesbian experiences or substance use problems than comparably aged American women. She had been married to her cross-dressing mate for 13 years and had known of his activities for 9 years. A quarter of women reported at least occasional sexual arousal to their mate's cross-dressing. The two variables associated with low acceptance of cross-dressing were discovery of their partner's cross-dressing after marriage and lack of sexual arousal to cross-dressing stimuli. Low acceptance was unrelated to firstborn status, amount of exposure to cross-dressing activities, or having had children. This group may be more representative of women in relationships with cross-dressing men than previous reports limited to cross-dressers and spouses who are in treatment.

Adult↗
PubMed1991

Inert wound dressing is not desirable.

Four Yorkshire piglets were inflicted with a total of 92 split-thickness wounds 4.8 cm2 in area and 400 microns deep. The wounds were treated with eight dressing regimens under the same experimental design. The rate of reepithelialization of the wound was quantitated by a morphometric method. The magnitude of inflammatory reaction of the wound to the dressing was scored from histological slides. The results indicate a relationship between the rate of reepithelialization of split-thickness wounds and the inflammatory response of the wound to the dressing. Dressings, such as collagen sponge, polyethyleneglycol, Duoderm, and lanolin ointment, induce moderate to severe inflammatory changes when placed on the wounds. These wounds reepithelialize significantly faster than control, gauze-covered wounds. This contrasts with inert dressings, such as hydrated hydrogel membrane, Carbopol 934P, or Silvadene cream, which did not affect the rate of reepithelialization when compared with the healing of control wounds. Simultaneously, these dressings induced no or minimal inflammatory reaction in the wound tissue. Only when the inflammatory reaction to the wound dressing was excessive (methylcellulose) was the rate of reepithelialization of the wounds significantly inhibited in comparison with control wounds. We hypothesize that wound dressings, by inducing inflammatory reaction, enhance healing by activating cells, such as macrophages or fibroblasts, that produce growth factors and other mediators of the repair process.

Animals↗
PubMed1993

A comparison of two transparent film-type dressings in central venous therapy.

A prospective randomized clinical trial has been conducted to compare the clinical performance, with prolonged use, of two film-type transparent dressings used over subclavian and jugular single-lumen venous catheters. 'OpSite', a traditional dressing with a moderate moisture vapour permeability was compared with a new dressing of high moisture vapour permeability, 'OpSite IV3000'. Information was collected daily to assess the nature and incidence of complications, dressing durability and the ease of application and removal. One hundred and one patients provided two well-matched populations receiving a total of 153 dressings for a total of 780 catheter-days. No differences between the two dressings were noted with respect to the incidence of complications, such as moisture accumulation or lifting, and dressing durability. The low incidence of catheter-related sepsis ('OpSite' group three episodes and 'OpSite IV3000' group one episode) suggests that transparent dressings do not increase this risk. This clinical study demonstrated the new 'OpSite IV3000' to be easier to handle, leading to better application, improved catheter fixation and easy removal.

Aged↗
PubMed2004

The effect of semipermeable dressings on smallpox vaccine site evolution.

BACKGROUND: Many hospital systems in the United States are contemplating the implementation of a smallpox vaccination program. The Centers for Disease Control and Prevention and other organizations recommend use of occlusive dressings over the vaccination site of health care workers in contact with patients. Minimal data are available on the impact of an occlusive dressing on the evolution of the vaccinia inoculation site. METHODS: We conducted a prospective observational study in which subjects were instructed to cover their vaccination site with either a semipermeable dressing over gauze or gauze alone. We recorded the duration of semipermeable dressing use and parameters pertaining to vaccination site evolution, to include time until scab separation. RESULTS: The increased use of a semipermeable dressing is associated with increased time until scab separation (n = 41, r =.48, P =.001 by regression analysis). This analysis predicts a 9-day difference in time until scab separation between patients that wore semipermeable dressings 100% of the time versus not at all. No significant correlation was observed between semipermeable dressing use and size of maximum erythema, time until maximum erythema, size of erythema on day 6 or 8, nor time until pustule formation. CONCLUSION: Semipermeable dressing use appears to prolong the time until scab separation and possibly the duration of infectivity and risk of secondary transmission. Health care organizations may wish to consider this information when instituting a smallpox vaccination program.

Adult↗
PubMed2005

Evaluation of a bi-layer wound dressing for burn care I. Cooling and wound healing properties.

Severe burns remain a significant cause of morbidity and mortality despite the availability of numerous therapies. We assessed the wound healing and skin-cooling properties of a DRDC hydrogel/polyurethane wound dressing using different pre-clinical models. Our results show that 85% of partial-thickness, non-contaminated porcine wounds treated with our dressing healed within 6 days. In contrast, 85% of the wounds treated with commercial dressings healed within 8 days. Application of a moist DRDC dressing (to simulate a condition of exudate absorption) on a scald burn covering 25% of the dorsal area in rats reduced skin temperature by 1.70 +/- 0.14 degrees C for 5 min, the skin temperature being comparable to that of control burned rats after 20 min. The application of a moist DRDC dressing did not induce significant differences in body temperatures compared with that of burned animals without dressing coverage throughout the 90-min experiment. While no change in body temperatures were observed when standard dressings (i.e., not pre-moistened) were applied, skin temperature increased gradually. These data show that our dressing is effective in promoting faster healing of the treated wound; and providing a transient, but beneficial cooling effect to the skin contact-site, without the adverse effect of inducing whole-body hypothermia.

Animals↗
PubMed2005

DRESS syndrome in a patient on sulfasalazine for rheumatoid arthritis.

DRESS (Drug Rash with Eosinophilia and Systemic Symptoms) is a drug-induced hypersensitivity syndrome that can mimic malignant lymphoma. We report a case in a 63-year-old woman who had been on sulfasalazine for 2 months to treat rheumatoid arthritis. She was admitted a few days after onset of a flu-like syndrome with a pruriginous maculopapular erythema initially involving the face, trunk, and proximal limbs; a fever of 41 degrees C; and enlargement of the liver, spleen, and several peripheral lymph nodes. Blood tests showed marked eosinophilia (9300/mm3), lymphocytosis, hyperbasophilic cells, and severe inflammation. DRESS syndrome was diagnosed. An indirect immunofluorescence assay for human herpesvirus 6 (HHV6) was positive, supporting recent HHV6 infection. Primary HHV6 infection and HHV6 reactivation have been incriminated in the genesis of DRESS syndrome. DRESS syndrome continues to carry a high mortality rate of about 10%. Drugs previously reported to cause DRESS syndrome include sulfasalazine, hydantoin, d-penicillamine, allopurinol, hydrochlorothiazide, and cyclosporine. A high index of suspicion for DRESS syndrome should be maintained in patients receiving these drugs. Serological tests for HHV6 should be performed routinely in patients with suspected DRESS syndrome, although uncertainty persists about the link between HHV6 infection and DRESS syndrome.

Antirheumatic Agents↗
PubMed2004

A polymeric membrane dressing with antinociceptive properties: analysis with a rodent model of stab wound secondary hyperalgesia.

UNLABELLED: The putative antinociceptive properties of a commercially available polymeric membrane dressing were tested by using a hind limb penetrating stab wound model in which secondary hyperalgesia could be evaluated from the hind paw. We examined the responses to mechanical and thermal stimuli applied to the hind paw remote to 2 small penetrating stab wounds of the calf. Application of the polymeric membrane dressing, but not gauze dressing, significantly reduced the development of both mechanical and thermal hyperalgesia induced by the penetrating stab wounds. In addition, animals with stab wounds showed a significant decrease in cage activity, and this decrease was prevented by application of the polymeric dressing. Analysis of spinal cord Fos expression demonstrated that the polymeric membrane, but not gauze, dressing significantly decreased stab wound-induced Fos expression in laminae I to VI of the ipsilateral L3-L5 cord segments. In addition, application of the polymeric membrane, but not gauze, dressing to the hind limb of naïve animals elicited Fos expression in laminae III and IV of the lumbar spinal cord. The data indicate that this model might be useful for evaluation of the mechanisms underlying deep tissue injury-induced secondary hyperalgesia, but they also demonstrate that the polymeric membrane dressing tested is capable of significantly reducing secondary hyperalgesia. PERSPECTIVE: Surgery and other types of penetrating wounds cause pain that is not always relieved by opioids and/or less potent analgesics. The present results suggest that the polymeric membrane dressing tested here may be used alone or in conjunction with analgesics to relieve pain caused by penetrating tissue injury.

Administration, Topical↗
PubMed1996

Four alginate dressings in the treatment of partial thickness wounds: a comparative experimental study.

Alginate-based absorption materials for wound treatment are meeting with increasing clinical acceptance. The purpose of this study was to compare four different calcium alginate dressings (Algosteril, Comfeel Alginate, Kaltostat and Sorbsan) with respect to wound fluid retaining ability, adherence, dressing residues, epithelialisation and inflammatory cell infiltration using a standardised partial-thickness wound model in domestic pigs. Wound fluid spread laterally onto surrounding normal skin by about 40% more with Sorbsan than with the other alginate dressings after 24 h of treatment (P = 0.026). The corresponding figure after 66 h of treatment was 20% (P = 0.030). Algosteril (mean 1.7 [sem 0.3]) adhered significantly (P = 0.014) more to the wounds than Comfeel Alginate (mean 0.2 [0.2]). Kaltostat (mean 1.8 [0.3]) left significantly (P = 0.038) more dressing residues on the wound surface at dressing removal than the Comfeel Alginate dressing (mean 0.8 [0.2]). In the effect on epithelialisation or dermal inflammation there was no statistically significant difference at significance level 5% among the four alginate dressings, as assessed by light microscopy. In summary, the four alginate dressings showed significant differences in important handling characteristics and did not differ significantly in their effect on epithelialisation.

Alginates↗
PubMed2000

Possibility of wound dressing using poly(L-leucine)/poly(ethylene glycol)/poly(L-leucine) triblock copolymer.

ABA-type block copolymers (abbreviated as LEL) composed of poly(L-leucine) (PLL) as the A component and poly(ethylene glycol) (PEG) as the B component were synthesized by ring-opening polymerization of L-leucine N-carboxyanhydride initiated by primary amino group located at both ends of PEG chain. A silver sulfadiazine (AgSD)-impregnated wound dressing of sponge type was prepared by the lyophilization method. Morphological structure of this wound dressing by scanning electron microscopy was observed to be composed of a dense skin layer and a porous inner layer. Equilibrium water content of LEL wound dressing increased with an increase in PEG content in the block copolymer due to the hydrophilicity of PEG. AgSD release from AgSD-impregnated wound dressing in PBS buffer (pH = 7.4) was dependent on PEG content in the block copolymer. Release of AgSD was increased in proportion to the PEG content in the copolymer. Antibacterial capacity of AgSD-impregnated wound dressing was examined in agar plate against Pseudomonas aeruginosa and Staphylococcus aureus. It was found that the suppression of bacterial proliferation in the wound dressing was dependent upon the PEG content. In cytotoxicity test, cell damage did not occur by the release of AgSD from the LEL sponge matrix of AgSD-medicated wound dressing. In in vivo test, granulous tissue formation and wound contraction for the AgSD- and dehydroepiandrosterone-impregnated LEL-2 wound dressing were faster than for any other groups.

Animals↗
PubMed1993

Colour Duplex imaging through wound dressings.

Colour flow Duplex scanning is becoming the method of choice to determine patency and haemodynamic status in infrainguinal grafts and native arteries. Due to surgical wounds and ulcers, there are often dressings covering the leg above the vessel to be scanned. There is no data as to the effect of different wound dressings on colour flow Duplex signals. Ten normal superficial femoral arteries were scanned by a blinded operator. Initially the artery was visualised to assess the normal image produced for each artery on B-mode and colour flow ultrasound and a Doppler reading was taken. Then each of five commonly used dressings were applied to the skin above the artery, in random order and the blinded operator graded the signal produced on a linear analogue scale. Primapore, an absorbent material dressing and Spyroflex, a bilaminate membrane dressing, did not transmit ultra-sound at all. Granuflex extra thin allowed a clear B-mode image of each artery to be visualised and an adequate Doppler waveform to be obtained. However colour flow mapping was less than optimal although it was possible in each of the arteries. Opsite and Tegaderm, two thin membrane dressings allowed excellent B-mode and colour flow images, in addition to clear Doppler signals. In patients who require dressings and who may require colour flow Duplex scanning of vessels in the same area, we would suggest the use of a product that permits ultrasound transmission, thus saving the necessity of removing the dressing for the assessment.

Adult↗