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A concentration gradient of bacteria within wound tissues and scab.

This investigation was designed to evaluate the effect of a synthetic moisture vapor permeable dressing on the size of the bacterial population of superficial wounds. Split-thickness donor sites were created in pig skin and were treated with a synthetic occlusive dressing (Tegaderm), with fine mesh gauze, or with nothing. All wounds became spontaneously infected with a variety of bacteria, predominantly with Staphylococcus epidermidis. The population of the Tegaderm wounds was always greater than that of the untreated controls, while that of the gauze treated wounds was equal to or less than that of the controls. Tegaderm dressed wounds healed more quickly than did the others. A gradient in the concentration of bacteria within the wounds was seen, with a very high concentration in the scab (10(8) cells/g), an intermediate concentration (10(6) cells/g) in the dermal layer, and the lowest concentration (10(4) cells/g) in the hypodermal level of the wound tissue. Such a gradient has not previously been reported. No evidence was seen that the level of infection declined over time for any of the dressings. Apparent bacterial clearing in earlier investigations may be due to the progressive loss of superficial wound tissues with the corresponding exclusion of the high concentration of bacteria within these layers from the tissue sampled.

Animals↗

A randomized controlled trial of hydrocolloid dressing in the treatment of hypertrophic scars and keloids.

BACKGROUND: Silicone gel sheeting has been investigated for use in the treatments of keloids and hypertrophic scars. Its mechanism of action may be related to scar hydration. OBJECTIVE: The purpose of the present study was to evaluate a hydrocolloid occlusive dressing that also acts by promoting a moist environment. METHODS: In a randomized controlled prospective study, patients were allocated to receive hydrocolloid dressing or moisturizer to keloids or hypertrophic scars. Scar size and volume, color, patient symptoms, and transcutaneous oxygen measurements were taken. RESULTS: There was significantly reduced itching (P < 0.03), somewhat reduced pain (P < 0.08) and increased pliability (10%) for both treatments over 2 months. CONCLUSION: Hydration of the scar for 2 months resulted in symptomatic improvement, but no change in physical parameters.

Adult↗

[Principles of primary and secondary wound management].

Wound management includes treatment of injuries, chronically open wounds of various origin, and incisions. Despite successful primary wound healing has good functional and cosmetic results, primarily closure should not be forced by raising wound tension or in wounds with increased risk of infection, respectively. Standards of trauma wound debridement according to location and type of wound are still in force. Anatomically incorrect type of surgical incisions may disturb wound healing. Sutures of the subcutaneous tissue are associated with increased risk of infection and should therefore be avoided. Alternatively, vacuum drainages may be used. Antibiotics should only be given exceptionally and if so, not as a local application. In case of chronically open wounds, underlying diseases should be treated, respectively. Moist wound healing using occlusive dressings has been established successfully in local management of chronic wounds.

Adult↗

Extravasation injuries on regional neonatal units.

This survey of regional neonatal intensive care units determined a prevalence of 38 per 1000 neonates who sustained an extravasation injury that caused skin necrosis. Most injuries occurred in infants of 26 weeks gestation or less, with parenteral nutrition infused through intravenous cannulae. Common treatments were exposing wounds to the air, infiltration with hyaluronidase and saline, and occlusive dressings.

Extravasation of Diagnostic and Therapeutic Materi↗

A prospective controlled trial of Biobrane versus scarlet red on skin graft donor areas.

A prospective trial of Biobrane versus scarlet red as a skin graft donor site dressing was done in 21 burn patients with mean total body surface area burns of 31.9%. Corresponding body areas were randomly selected on each patient to receive one of the dressings. Daily evaluations were made of subjective expression of pain, exudate formation and infection, and time of separation of the dressing from the wound. Biobrane was found to be superior in reducing donor site pain. However, with Biobrane there was a higher incidence of infection (57% v 9.5%) and a significant delay in separation from the wound. Scarlet red was found to be more cost-effective. Occlusive dressings have previously been shown to have a high incidence of complications (30%). In extensive burns, isolating the donor site from the wound is difficult and may lead to increased complications. Scarlet red appears to be superior to Biobrane for skin graft donor sites in this patient population.

Adolescent↗

Toxic shock syndrome associated with use of Biobrane in a scald burn victim.

Biobrane remains an excellent biosynthetic dressing for thermal injury coverage. The present report of a probable case of toxic shock syndrome associated with its use does not question its efficacy as temporary coverage for partial thickness thermal burns. Instead, attention is focused on raising the index of suspicion of toxic shock syndrome in burn patients treated with Biobrane, or other occlusive dressings, who develop early signs or symptoms which may be consistent with the diagnosis.

Biocompatible Materials↗

Risk of vaccinia transfer to the hands of vaccinated persons after smallpox immunization.

Transmission of vaccinia virus after smallpox vaccination is a concern. We conducted a prospective examination of the protection afforded by vaccination-site bandages in recently vaccinated individuals. After smallpox vaccination, inoculation sites were covered with 2 occlusive dressings. Site assessment and bandage changes occurred every 3-5 days until the site was healed. At each visit, specimens from the vaccination site, outer dressing surface, and contralateral hand were obtained for vaccinia culture. For 148 vaccinated subjects, vaccinia was detected from vaccination lesions of every subject on several occasions. Only 6 (0.65%) of 918 dressing (95% CI, 0.24%-1.4%) and 2 (0.22%) of 926 hand (95% CI, 0.03%-0.78%) specimens tested positive for vaccinia. The mean number of bandage changes was 9.6 (95% CI, 9.17-10.0). Vaccinia autoinoculation did not occur. The rate of vaccinia recovery outside occlusive bandages covering smallpox vaccination sites was remarkably low, suggesting excellent protection against inadvertent transmission.

Adult↗

Effect of occlusion on resident flora, skin-moisture and skin-pH.

The effects of a 3-day test of an occlusion dressing of the forearm on the resident flora of the skin, relative skin-moisture and skin-pH were studied in 26 male and female volunteers. The geometrical mean values of coagulase-negative Staphylococci and Corynebacterium species increased five and four logs and decreased 1 day post occlusion only two logs. Relative skin-moisture increased from 20% to 75% under occlusion and decreased to 5% 24h after removal. Skin-pH increased from 4.9 to 7.1 and decreased to pH 5.2. Investigations of the resident flora should be made, if the influence of external, not antimicrobial active agents, is to be examined, because changes in the substrate can cause secondary changes in the resident flora.

Adult↗

[The use of DuoDerm in the surgical wound after surgical treatment of pilonidal fistulae using the open method].

The results of a study on the use of DuoDerm Hydroactive sterile occlusive dressing on the operative wound after simple excision of pilonidal fistula are reported. Two groups of 20 patients were studied: in the first group the wound was treated with traditional medications, in the second group with DuoDerm. Comparing the results obtained from these two groups, the Authors conclude underlining the therapeutic efficacy of the dressing which stimulates granulation and accelerates re-epithelialization with complete healing in 6 weeks on average compared with the 10 needed with traditional medications.

Bandages, Hydrocolloid↗

Hydration and occlusion treatment for hypertrophic scars and keloids.

In 31 patients with hypertrophic scars or keloids, a side by side test was carried out to check the efficacy of an occlusive dressing technique using cream which did not contain silicone oil, versus a simple application of vaseline, used as a control. In all cases, the cream treated areas of scar and keloid demonstrated a remarkable improvement over that of the vaseline treated area. These findings strongly suggest that the mechanisms of hydration and occlusion are the main basis of the therapeutic action of this method in treating hypertrophic scars and keloids.

Adolescent↗

Urea ointment in the nonsurgical avulsion of nail dystrophies.

A nonsurgical and atraumatic method for avulsing dystrophic nails is described. Thirty-five patients with a variety of nail abnormalities were successfully treated using urea preparations under occlusive dressings. The method has many advantages and appears ideal for patients with digital vascular insufficiency and increased susceptibility to infection.

Adult↗

[Percutaneous absorption of triamcinolone 16 alpha, 17 alpha cyclopentylene-dioxy-21-acetate (author's transl)].

The authors try to estimate the percutaneous absorption of a new corticosteroid, derived from triamcinolone: Amcinonide, which is presented as a cream and 0.1% ointment. The study was carried out on 13 patients; cream was applied to 5 of them under occlusive dressings during 48 h, 4 other had ordinary topical applications of the cream, and the 4 remaining patients were treated with the ointment. The parameters studied were 17-ketosteroids and 17-hydroxysteroids in the 24-hour urine, daily sodium and potassium urinary elimination, plasma cortisol levels and ACTH stimulation test before and after treatment. Only extensive occlusive plastic dressings (50--90% of the body area) lead to a temporary decrease in the activity of the pituitary adrenal system (lowering of the 17-hydroxysteroids in the 24-hour urine in all patients, lowering of the normal adrenocortical response after stimulation with exogenous ACTH in 1 patient). On the other hand, the elimination of urinary ions is not significantly modified. With ordinary topical application of cream or ointment no systemic effect could be observed.

Administration, Topical↗

Care of the central venous catheterization site: the use of a transparent polyurethane film.

Studies of care of patients with central venous catheters report a 3-7% incidence of catheter-induced sepsis when sterile gauze and tape are used as an occlusive dressing. The technique requires that the dressing be changed three times each week for catheterization site inspection. From June 1979 to September 1980, a noncomparative evaluation of a transparent, self-adhesive, polyurethane dressing which is permeable to water vapor but not bacteria was performed. This dressing was used for the care of 100 consecutive patients with central venous catheters. Dressing life averaged 5.3 days with silicone rubber catheters and 4.3 days for polyvinyl chloride catheters. One patient developed catheter induced sepsis (incidence 1%). This dressing material: (1) is acceptable for use as a dressing of central venous catheters; (2) continuously permits inspection of the insertion sites; (3) decreases nursing hours; (4) provides a comfortable dressing which secures the catheter to the patient; and (5) is durable even when exposed to high humidity therapy devices, or when possible permits the patient to take showers.

Bacterial Infections↗

Percutaneous absorption of zinc from zinc oxide applied topically to intact skin in man.

The penetration of zinc through normal skin treated with a zinc oxide (25%) medicated occlusive dressing was studied. The mean release rate of zinc to the skin was 5 micrograms/cm2/h. After 48 h of treatment suction blisters were raised by the "Kiistala method." The zinc concentration of the epidermis, blister fluid and dermis was increased beneath the zinc dressing compared to control-treated skin. The study shows that zinc permeates intact human skin from topically applied zinc oxide in vivo.

Administration, Topical↗

The clinical assessment of topical corticosteroid activity.

Glucocorticoid-induced vasoconstriction of human skin has provided a useful guide to topical anti-inflammatory activity. The concentration and base in which a steroid is used influence this activity, and traditional greasy ointments are probably the most effective vehicles. Confirmation of clinical effectiveness should be by double-blind comparison in patients with bilateral skin lesions. Psoriasis provides a more discriminating test of steroidal activity than eczema; the use of occlusive dressings may mask differences between compounds. Short-term trials are informative but in patients with chronic diseases, longer studies should also be done.

Adrenal Cortex Hormones↗

Study of efficacy of urea compound versus emollient cream in avulsive therapy of dystrophic nails.

The efficacy of commercially available urea compound was evaluated in twenty dystrophic nails in ten matched pairs of patients and compared to an emollient cream used under an occlusive dressing for seven days. The results of the study indicate no significant differences between the two treatment modalities. Both procedures provided excellent avulsion of dystrophic nails.

Diabetes Complications↗

A simple and efficient treatment for fingertip injuries.

We have developed a simple, cheap and efficient method of management of fingertip injuries using an occlusive dressing--the fingertip cap (Hyphecan). The results of 156 fingertip injuries treated with this method demonstrate recovery to a near normal fingertip.

Adolescent↗

Effect of topical miconazole in plaque psoriasis.

The aim of this study was the assessment of efficacy and tolerance of topical miconazole in plaque psoriasis. 9 patients aged 23-63 years with diagnosis of plaque psoriasis were enrolled. 2% miconazole cream was applied twice daily from 7 to 12 weeks (under occlusive dressing to obtain optimal penetration of the drug) in the plaque with a minimum diameter of 5 cm. In most patients clinical improvement of the topical miconazole treatment was observed.

Administration, Cutaneous↗