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Human amniotic membrane: a versatile wound dressing.

Human amniotic membrane proved to be a versatile and useful temporary biologic dressing in studies involving 120 patients. Wounds, both traumatic and nontraumatic in origin, responded to a protocol that allowed coverage of tissues as diverse as exposed bowel, pleura, pericardium, blood vessels, tendon, nerve and bone. Wounds unresponsive to usual therapeutic measures responded to membrane application. Ease of availability, negligible cost and facilitated wound healing make this temporary biologic dressing generally superior to either cadaver skin allograft or pigskin xenograft. Human amniotic membrane dressings are therefore a useful adjunct in the care of the complicated wound.

Amnion↗

An overview of the topical management of wounds.

Wounds in animals are a common and frequent reason for seeking veterinary attention. The way in which wounds are managed affect the rate of healing, the time to return to normal function, the final cosmetic appearance, and hence the satisfaction of customers. The management of wounds depends on the stage of wound healing and can include irrigation, mechanical and chemical debridement, the use of antiseptics and antimicrobials, adherent and nonadherent dressings, and miscellaneous topical applications such as aloe vera, honey and live yeast cell derivative. The advantages, disadvantages and indications for initial wound management, topical applicants and dressings are discussed.

Administration, Topical↗

Some effects of sustained compression on ulcerated tissues.

Sustained leg compression is the first line of treatment for patients with chronic venous ulcers. The success rates of this treatment vary, and the mode(s) of action are not well understood. In this study, tissue oxygen tension (TcPO2), surface pH, and reactive hyperemia measurements were made to observe changes associated with sustained compression in patients with chronic venous ulcers. Patients with chronic venous ulcers (n = 20, 13 F, 7 M, median age 65.5 years, median ulcer size 13.9 cm2) were assigned to the same treatment, wound dressings, and 4-layer bandaging during a 24-week period. Duplex ultrasound, venous refilling time, skin tissue oxygen, and ulcer surface pH were measured at defined time points. Ulcer areas were calculated from contour traces done at regular dressing changes. The difference between ulcer surface pH and control values measured proximally on the same leg diminished with healing (p = 0.02), which occurred despite the evidence of deep venous reflux. Ulcers with smaller initial areas healed quicker (p = 0.003). A greater likelihood of healing was observed in women (p = 0.017). Sustained compression may potentiate healing by acting on the microcirculation in ulcerated tissues.

Aged↗

Clinical trials of amniotic membranes in burn wound care.

Four test conditions of increasing complexity were used to evaluate the clinical efficacy of amniotic membranes as biologic dressings on donor sites and burn wounds in children. These were the clean-skin donor-site wound, the uncontaminated shallow partial-thickness burn wound, the bed of freshly excised full-thickness wounds, and the granulating surface of colonized burn wounds. The rate of epithelialization under amniotic membranes was the same as that under 5% scarlet red ointment or 0.5% silver nitrate solution dressings. Preservation of a healthy excised wound bed and maintenance of a low bacterial count in contaminated wounds paralleled the experience with human allograft dressings despite technical difficulties and the absence of vascularization of amniotic membrane and its fragile structure. Tentative conclusions are drawn as to the mechanisms by which biologic dressings exert their beneficial effects.

Bandages↗

Management of acute and chronic open wounds: the importance of moist environment in optimal wound healing.

The history of wound care and management closely parallels that of military surgery which has laid down the principles and dictated the practices of wound cleansing, debridement and coverage. From a treatment standpoint, there are essentially two types of wounds: those characterized by loss of tissue and those in which no tissue has been lost. In the event of tissue loss it is critical to determine whether vital structures such as bone, tendons, nerves and vessels have been exposed. It is also important to determine the amount of soft tissue contusion and contamination. In any case primary wound healing by early closure either primarily or with the help of grafts or flaps is preferred to secondary healing and wound contraction with subsequent contractures which interfere with range of motion and function. Whether the wound is acute or chronic, essential principles of wound care must be observed in order to avoid wound sepsis and achieve rapid and optimal wound healing. - Tissues must be handled gently. - Caustic solutions capable of sterilizing the skin should never be applied to the wound. It is desirable never to put anything in the wound that cannot be tolerated comfortably in the conjunctival sac. - All devitalized tissues must be debrided either hydrodynamically, chemically, mechanically or surgically. - All dead space must be obliterated. - Exposed vital structures must be covered by well vascularized tissues. An essential part of any wound management protocol is wound dressing. It cannot be too strongly emphasized that a wound dressing may have a profound influence on healing particularly of secondary type healing, a critical feature being the extent to which such dressing restricts the evaporation of water from the wound surface. A review of available dressing materials is reported with emphasis on the newly developed concept of moist environment for optimal healing. a practical guide for dressing selection is also proposed.

Acute Disease↗

Amniotic membranes as a temporary wound dressing in necrotizing fasciitis.

A diabetic patient was seen at Magee-Womens Hospital with a vulvar abscess extending to the abdomen. Necrotizing fasciitis was diagnosed at operation, and the involved tissue was widely excised. The authors describe the successful use of amniotic membranes as a temporary wound dressing. The benefits of this method over conventional gauze dressings are easy availability, better adherence to the wound, less pain, and negligible cost to the patient.

Abscess↗

The treatment of donor sites with cultured epithelial grafts.

In a significant number of elderly patients, the healing of split skin donor sites can be delayed. The cultured allogenic epithelial graft (CAG) has been reported to heal leg ulcers. The mechanism of action may be to improve the healing environment and thus stimulate the host skin cells. A clinical trial was undertaken to compare the healing rate of the donor sites of elderly patients using CAGs and two commercially available dressings. Compared to Jelonet, CAGs (p = 0.008) and OpSite (p = 0.013) significantly reduced the number of patients with delayed healing. There was no significant difference between CAGs and the occlusive dressing, OpSite.

Aged↗

Coverage of the open sternotomy wound with Biobrane dressing.

Massive edema accumulated after prolonged cardiopulmonary bypass for coronary grafting such that neither the sternum nor the presternal skin could be closed after insertion of a left ventricular assist device. To protect the mediastinum from infection, we applied Biobrane synthetic temporary wound dressing and placed a moist gauze dressing over it. When the dressing was removed 4 days later, the wound was pink, granulating, free from infection, and suitable for closure. Use of Biobrane biologic dressing should be considered when the mediastinum must remain exposed after median sternotomy.

Bandages↗

Wound repair: advanced dressing materials.

Georgina Casey examines the process of wound healing and describes the roles of the main cells and biologically active molecules found in the wound bed.

Bandages↗

Use of dry human and bovine amnion as a biological dressing.

A new method of drying and sterilizing the amnion extends the life of the product to more than nine months and enables it to be stored at room temperature. The bovine amnion is unique and the first of its kind, there being no comparable series in the literature, to our knowledge. Bovine amnion has a large surface area and can provide bulk supplies. The membrane as prepared has been tested in 12 rabbits experimentally and in 70 patients of different ages with a variety of surgical lesions, mainly burns. More than 150 applications of the dried amnion have been made as the sole dressing for these patients. The results indicate that amnion, both human and bovine, is quite safe and effective as a biological dressing. The dried material retains all the physical and biological characteristics of the fresh membrane.

Adolescent↗

Principles of burn dressings.

Throughout history burn wounds have been treated by covering with dressings of many different materials. The successful application of a burn dressing remains an objective for biomaterial development. This paper examines how the burn wound differs from other skin injuries, the requirements of the ideal burn wound dressing, and reviews the type of dressings available. The dressings in common use in the treatment of burns are compared with the 'ideal' dressing, in so far as it can be defined.

Bandages↗