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PubMed1990

Histological and bacteriological studies of burn wounds treated with boiled potato peel dressings.

Histological and clinical studies have been made on comparable burn wounds covered with either boiled potato peels affixed to gauze bandages or gauze dressings alone; both dressings were applied over a thin layer of 5 per cent silver sulphadiazine. Compared with treatment with plain gauze dressings, the application of the potato peel dressing reduced or eliminated dessication, permitted the survival of superficial skin cells and hastened epithelial regeneration. Bacteriological studies showed that the potato peels had no intrinsic antibacterial activity, the wounds beneath both dressings showing either no growth or, on most occasions, the same bacterial species. The easy availability of potato peels and gauze bandages on to which they can be affixed, the simplicity of the preparation of this dressing, the ease of sterilization and its low cost of production make this the dressing of choice for burn wounds in our developing country.

Adolescent↗

PubMed2005

Visualisation of bacterial sequestration and bactericidal activity within hydrating Hydrofiber wound dressings.

The fluid handling and microbiological properties of a non-antimicrobial Hydrofiber(NAH) wound dressing have been compared with those of a silver salt-containing Hydrofiber (SCH). Fluorescent dyes (BacLight, Live/Dead Kit) were added to fresh cultures of two wound pathogens (Pseudomonas aeruginosa and Staphylococcus aureus), and used to visualise their viability. Live bacteria stained green and dead/dying bacteria turned red. When inoculated into samples of the NAH and SCH dressings, the viability of the bacteria could be effectively monitored over time using a rapid form of confocal laser scanning microscopy (RCLSM--Leica UK). When the NAH dressing was hydrated with stained bacterial culture, its fibres swelled quickly, reducing interstitial spaces between the fibres, resulting in the formation of a cohesive gel. Bacteria became immobilised in the gel, forming characteristic clumps, but remained largely green (viable) for more than 20 h with no apparent increase in numbers. The SCH initially behaved in a similar manner, however, using 3-D data from RCLSM time-lapse sequences P. aeruginosa was observed to turn progressively red (i.e. died) within 1.5-3 h and S. aureus similarly turned red within 5-7 h of contact with the SCH dressing. The ability of both Hydrofiber dressings to sequester and immobilise potentially pathogenic wound micro-organisms has been demonstrated. Additionally the SCH dressing was shown to kill immobilised bacteria, as a consequence of the ionic silver bactericide. These properties of the Hydrofiber dressings may contribute to providing an environment that is supportive to wound healing.

Anti-Bacterial Agents↗

PubMed2005

Nanocrystalline silver dressings as an efficient anti-MRSA barrier: a new solution to an increasing problem.

The emergence of multi-drug-resistant strains of bacteria represents a particular challenge in the field of wound management. The aim of the current study was to investigate whether nanocrystalline silver dressings possess the physical properties to act as a barrier to the transmission of methicillin-resistant Staphylococcus aureus (MRSA) in the laboratory setting and in a clinical setting. Initially, MRSA suspension and colony culture experiments were performed showing that nanocrystalline silver dressings act as potent and sustained antimicrobial agents, efficiently inhibiting MRSA penetration. Subsequently, a double-centre clinical trial was initiated using nanocrystalline silver dressings as a cover for 10 MRSA colonized wounds in a total of seven patients. By delineating the MRSA load on the upper side of the dressing and the wound bed each time the dressing was changed (i.e. after 1, 24, 48 and 72 h), nanocrystalline silver dressings were found to provide a complete, or almost complete, barrier to the penetration/spread of MRSA in 95% of readings. In addition, 67% of all wound observations showed a decrease in the MRSA load with an eradication rate of 11%. We believe that nanocrystalline silver dressings may become an important part of local MRSA management, with cost benefits to both patients and the healthcare system.

Bandages↗

PubMed2002

Use of skin staples to fix film dressings on scalp donor wounds in patients with burns.

Split-thickness skin grafts (STSGs) from the scalp have been used in large burns. The donor site wounds are usually covered using occlusive dressings, such as film dressings because they contribute to reduce donor site pain and infection under exudative crust and to enhance re-epithelialization. However, it is not always easy to fix such film dressings to the scalp because of the presence of hair. In this paper, we report the use of skin staplers to fix the film dressings. Eight donor sites in four patients were dressed in this way. The patients had 50-78% of the body burned, all of them survived. The mean healing time for the donor sites was 6.8 days. Three patients had their scalps re-harvested several times (range two to three times). There were no infections nor secondary skin ulcers at the donor sites. The technique of this dressing is very simple and speedy, thus we recommend the use of skin staplers to fix the film dressing to scalp donor wounds in patients with burns.

Adult↗

PubMed2002

Less frequent catheter dressing changes decrease local cutaneous toxicity of high-dose chemotherapy in children, without increasing the rate of catheter-related infections: results of a randomised trial.

Cutaneous lesions caused by catheter dressing changes can be serious and generate local pain in children undergoing high-dose chemotherapy followed by bone marrow transplantation. One hundred and thirteen children entered a randomised trial to compare two catheter dressing change frequencies (15 days vs 4 days). Skin toxicity was classified according to the following scale: grade 0: healthy skin, to grade 4: severe skin toxicity. A qualitative culture of the skin at the catheter entry site was taken whenever the dressing was changed. Of the 112 evaluable children (56 in each group) 32 developed grade > or = 2 local skin toxicity (eight in the 15-day group and 24 in the 4-day group; P = 0.001). Although higher in the 4-day group, the proportions of children experiencing pain during and between dressing changes were not statistically different between the two groups. The proportion of patients with one or more positive skin culture(s) at the catheter entry site during hospitalisation were similar in the two groups (27% in the 15-day group and 23% in the 4-day group) as were the proportions of documented nosocomial bloodstream infections (11% and 13%; NS). Whereas the planned frequency was maintained in the 4-day group (mean = 4 days, s.d. = 1), it was usually shortened in the 15-day group (mean = 8 days, s.d. = 4), mainly because dressings had loosened. Decreasing the catheter dressing change frequency proved efficient in reducing cutaneous toxicity without increasing the risk of local and systemic infection. In our unit, catheter dressings are changed every 8 days since this analysis.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed2000

The use of a target-controlled infusion of alfentanil to provide analgesia for burn dressing changes A dose finding study.

Burn dressing changes require profound analgesia for a short duration. This study aimed to determine whether an operator-adjusted target-controlled infusion of alfentanil could provide effective analgesia for burn dressing changes. Ten patients with a burn of between 5 and 50% of body surface area were studied. Pain scoring was performed before, during and following the dressing change. Target and effect site concentrations of alfentanil were recorded during and for 15 min after the dressing change. Median baseline visual analogue pain score (VAS) was 22 mm. Median (range) duration of dressing change was 35 (20-75) min. Median (range) VAS during the dressing change was 30 (14-66) mm. All patients were satisfied with their pain relief. There was no respiratory depression or cardiovascular instability. No patient became sedated and there were no episodes of nausea or vomiting. Median (range) total dose of alfentanil was 2.6 (1-10.7) mg. This study supports the efficacy of an operator-adjusted target-controlled infusion of alfentanil to provide analgesia for burn dressing changes.

Adult↗

PubMed1998

Effect of calcium hydroxide as an intracanal dressing on apical leakage.

In this in vitro study, we investigated the effects of the use of two different calcium hydroxide (Ca(OH)2) preparations as an intracanal dressing on the sealing ability of two different sealers were investigated. Eighty-eight freshly extracted, single-rooted maxillary anterior teeth were used. After the root canals were hand-instrumented, they were divided into six groups of 10 each. The root canals were dressed with Ca(OH)2 paste, either mixed with sterile water (in groups 1 and 2) or with glycerine (in groups 3 and 4). The dressed root canals were incubated in 100% humidity at 37 degrees C for 7 days. In groups 5 and 6, the root canals were not dressed. After the root canal dressings were removed by irrigation with 5.25% NaOCl and reaming with a K-type file, all canals of the experimental groups were obturated with sealer and gutta-percha using a cold lateral condensation technique. Calciobiotric Root Canal Sealer, (CRCS), (in groups 1, 3 and 5) and Diaket (in groups 2, 4 and 6) were used as sealers. All specimens were placed in India ink for 7 days, and the amount of apical leakage was scored. Eight further prepared specimens were dressed with Ca(OH)2 plus water or Ca(OH)2 plus glycerine and examined with scanning electron microscopy (SEM) following the removal of dressings. There was a statistical difference in the leakage patterns amongst the 6 experimental groups (P < 0.05). Specimens in group 2 exhibited less leakage than the other experimental groups, except group 4 (P < 0.05). There were no other significant interactions. SEM examination revealed that Ca(OH)2 crystals were present on the surface of smear layer in both groups where Ca(OH)2 paste had been placed, but they did not penetrate into the dentinal tubules.

Analysis of Variance↗

PubMed1999

Analysis of pressure achieved by various materials used for pressure dressings.

BACKGROUND: To minimize the risk of complications, pressure dressings are frequently applied to wounds. The actual pressures yielded by different dressing materials and application techniques have not been documented. OBJECTIVE: To measure and compare pressures produced using various types of dressing tapes with and without a gauze roll. METHODS: An infant blood pressure cuff was adapted for use in a pressure dressing model. Investigators independently applied four strips of each of five different types of tape to the cuff when it was located in three settings: a hard inanimate surface, a subject's distal volar forearm, and the subject's forehead. RESULTS: Foam and plastic tapes produced more pressure under a simple dressing than three other commonly used tapes. Higher, more consistent pressures were achieved on the forearm than the forehead. Adding a gauze roll to the dressing consistently increased the pressure. CONCLUSION: The experimental model demonstrated substantial differences in pressures yielded by various pressure dressing materials.

Analysis of Variance↗

PubMedDate not supplied

Effect of oxygen treatment and dressing oxygen permeability on wound healing.

Although it has been shown that both the level of tissue oxygen and its gradient are critical factors in the healing process, optimal conditions for oxygen therapy have not been determined. In this study, both the oxygen level and oxygen gradient for a full-thickness defect were modified on the basis of preceding in vitro studies to determine the effect on the healing process. The goal of this study was to help determine the optimal clinical oxygen treatment protocol. Specifically, the healing of full-thickness defects in a rabbit model as determined by histomorphometric analyses (cell and tissue volume fraction, epithelialization, and contraction) under two types of dressings with or without oxygen treatment (70% O(2)) was investigated. One of the dressings was more oxygen permeable than the other. No significant differences were found in the histomorphometric response between the wounds covered with the oxygen-permeable and oxygen-impermeable dressings in the group without supplemental oxygen. Oxygen treatment, however, seemed to enhance the healing response significantly. According to the histomorphometric response, the wounds covered with the oxygen-impermeable dressings were significantly better than those with the oxygen-permeable dressing in the oxygen-treated group after 1 week, but the wounds covered by the oxygen-permeable dressings were better healed at 3 weeks. Therefore, oxygen-impermeable dressings may be useful only in the early stages of healing, before granulation tissue formation.

Journal Article↗

PubMed2006

Action errors and dressing disability after stroke: an ecological approach to neuropsychological assessment and intervention.

A combination of detailed observation of dressing behaviour and neuropsychological assessment was used to identify the cognitive barriers to independent dressing in a series of eight stroke patients. For those with right hemisphere damage, dressing was disrupted by visuospatial problems or poor sustained attention. Those with left hemisphere damage and ideomotor apraxia were unable to learn the correct procedure to compensate for hemiparesis when dressing. The value of a therapeutic approach based on these observations was assessed in a single-blind randomised multiple-baseline experiment. A baseline phase of conventional dressing therapy which takes no account of individual patterns of cognitive impairment was contrasted with an approach which was formulated for each case. A permutation test demonstrated that there was a significant treatment effect for the right hemisphere cases but there was no therapy-related improvement for those with left or bilateral damage and apraxia. Observation of a naturalistic but controlled task (dressing with a standard item of clothing) appears to allow greater insight into the impact of specific neuropsychological deficits than has been found for more complex naturalistic tasks. The benefits of this ecological approach over conventional approaches to dressing therapy need to be evaluated further in a randomised clinical trial.

Activities of Daily Living↗

PubMedDate not supplied

Comparative evaluation of the antimicrobial activity of ACTICOAT antimicrobial barrier dressing.

This study evaluated the antimicrobial activity of ACTICOAT Antimicrobial Barrier Dressing (Westaim Biomedical Corp, Fort Saskatchewan, Alberta, Canada), a silver-coated wound dressing, and compared it with silver nitrate, silver sulfadiazine, and mafenide acetate. The minimum inhibitory concentrations (MIC), minimum bactericidal concentrations (MBC), zone of inhibition, and killing curves were determined with 5 clinically relevant bacteria. The data indicate that ACTICOAT silver had the lowest MIC and MBC and generated similar zones of inhibition to silver nitrate and silver sulfadiazine. Viable bacteria were undetectable 30 minutes after inoculation with the dressing, whereas it took 2 to 4 hours for silver nitrate and silver sulfadazine to achieve the same result. Mafenide acetate generated the biggest zones of inhibition, but it had the highest MICs and MBCs, and a significant number of bacteria still survived after 6 hours of treatment. The results suggest that ACTICOAT Antimicrobial Barrier Dressing has better antimicrobial performance than either of the existing silver-based products. ACTICOAT dressing killed the bacteria that were tested much faster, which is a very important characteristic for a wound dressing acting as a barrier to invasive infection to have. The study also suggests that a single susceptibility test such as a MIC or zone of inhibition test does not provide a comprehensive profile of antimicrobial activity of a topical antimicrobial agent or dressing. A combination of tests is desirable.

Anti-Infective Agents, Local↗

PubMed1990

Comparison of a hydrocolloid dressing and silver sulfadiazine cream in the outpatient management of second-degree burns.

The purpose of this prospective randomized study was to evaluate the use of an occlusive hydrocolloid dressing (Duoderm hydroactive, Squibb) and silver sulfadiazine (Silvadene, Marion) cream in the outpatient management of second-degree burns. The inclusion criteria consisted of burns less than 15% total body surface area that were evaluated within 24 hours of injury and did not require hospital admission. Fifty patients were randomly assigned after having been screened through a list of seven exclusion criteria. On initial evaluation the burns were photographed and screened for causative agent, location, size, depth, tetanus status, and presence of associated burns and injuries. Patients were seen in followup at least biweekly and evaluated for wound bed healing, wound margin healing, pain, number of dressing changes between visits, and ease of dressing application and removal. On final evaluation the burns were photographed and inspected for appearance of the healed burn, repigmentation, wound contraction, approximate time for dressing change, patient compliance, limitation of activity, overall impression of the treatment, and number of days for complete healing. Results were compared using a two-tailed t-test with p less than 0.01. Both groups were statistically similar in age, sex, and size. Duoderm-treated burns had statistically significantly better wound healing, repigmentation, less pain, fewer dressing changes, less time for dressing changes, and less cost. Duoderm-treated patients had statistically significantly less limitation of activity, better patient compliance, greater patient comfort, better overall acceptance, and felt the treatment was more aesthetically pleasing. The results reveal that the Duoderm Hydroactive dressings are superior to Silvadene cream in the outpatient management of second-degree burns.

Adolescent↗

PubMed1998

Hemostatic efficacy of a fibrin sealant dressing in an animal model of kidney injury.

OBJECTIVE: The purpose of this study is to determine the hemostatic efficacy of a fibrin sealant dressing compared with a standard collagen control dressing in an animal model of kidney injury. METHODS: Twenty adult male Sprague-Dawley rats were administered general anesthesia and underwent partial nephrectomy with heparin anticoagulation (300 U/kg intravenous). Treatment of the cut surface of the kidney was randomized to three groups: group I, no hemostatic agent; group II, collagen dressing; and group III, fibrin sealant dressing. RESULTS: Blood loss was significantly less in group III (3.39+/-0.63 mL) than in group I (8.64+/-2.26 mL) and group II (8.63+/-1.72 mL; p < 0.001). The percentage decrease in the mean arterial pressure was significantly less in group III (34.09+/-15.58%) than in group I (59.66+/-16.19%) and group II (60.35+/-15.66%; p=0.015). CONCLUSION: Fibrin sealant dressings provide effective hemostasis and are superior to collagen dressings in an animal model of kidney injury. Additional development of fibrin sealant dressings for potential clinical use is warranted.

Animals↗

PubMedDate not supplied

Evaluation of a no-dressing intervention for tunneled central venous catheter exit sites.

This study tested whether central venous catheter (CVC)-related sepsis could be reduced by removing a hypothesized reservoir for pathogens, the CVC exit site dressing. Seventy-eight individuals with cancer, stratified for gender (37 men and 41 women) and transplant status, with newly inserted CVCs were recruited and randomly assigned to receive either a gauze dressing or no dressing, once their catheter insertion site had healed (3 weeks). Because there was no difference in CVC-related septic episodes based on gender or transplant status, the stratification was not maintained for remaining analyses. Although there was no significant difference in CVC-related septic episodes (P =.28) or rehospitalization rates (P =.41) because of CVC-related sepsis between the dressing and no-dressing group, individuals in the dressing group developed CVC-related sepsis sooner (P =.02) than did individuals in the no-dressing group.

Bandages↗

PubMedDate not supplied

Comparison of two pressure ulcer preventive dressings for reducing shear force on the heel.

OBJECTIVE: We compared the shear forces exerted over the heel between a pressure ulcer preventive dressing and a thin-film dressing in a clinical setting. Interface pressures were measured as well. DESIGN: Quasi-experimental clinical trial. SETTING AND SUBJECTS: Participants were 30 elderly patients (5 men, 25 women; mean age, 86.4 +/- 8.0 years) hospitalized in a geriatrics hospital in Japan; all had a Braden score of less than 14 (mean, 10.1 +/- 1.1). Informed consent was obtained from all the patients.A shear force and pressure sensor including a strain gauge, and an oval airbag-type pressure sensor were used. METHODS: The sensor was attached to one heel using double-sided tape; then the target dressing was applied over the sensor and on the opposite heel to avoid the influence of the opposite heel on the shear force measurement. Interface pressures were measured with the patient in a stationary supine position; shear force was then measured at 0.2-second intervals, while the sheet was manually pulled at a velocity of around 5 cm/second. Shear force was determined by averaging the stable shear force lasting for 10 measurement points. RESULTS: The mean interface pressures with the PPD and the film dressings were 70.7 +/- 16.5 and 70.2 +/- 15.2 mmHg, respectively; this difference was not statistically significant. The shear force produced during the pulling of the sheet was 2.2 +/- 1.4 and 11.7 +/- 5.8 N, respectively (P < .001, Wilcoxon signed-rank test). CONCLUSIONS: The results of this study suggest that a dressing with a low-friction external surface (such as the pressure ulcer preventive dressing) can significantly reduce shear force. However, results also suggest that external dressings do not significantly reduce interface pressures and cannot be used as a substitute for heel elevation in an immobile patient.

Bandages, Hydrocolloid↗

PubMedDate not supplied

Therapeutic efficacy of three silver dressings in an infected animal model.

The organic salt AgNO3 has been available as a topical armamentarium to the medical arena for centuries and for burns for the past 60 years. Thirty-five (1968) years later, Charles Fox introduced and popularized a new topical agent known as silver sulfadiazine. More recently, several new slow-release silver dressings came to the forefront. Acticoat (Smith & Nephew, Largo, FL) Silverlon (Argentum, Lakemont, GA) & Silvasorb (Medline Industries, Inc, Mundelein, IL). Because the standard of care is to change dressings daily, our study focused in on weekly dressing changes as a cost-containment issue. Sprague-Dawley rats received a standard contact burn (20% TBSA). On day 3, the wound was excised and infected with Pseudomonas aeruginosa and Staphylococcus aureus at 5.0 x 10 cfu/ml. The animals were divided into four groups (n = 5 each group): untreated control, Acticoat group, Silvasorb group, and Silverlon group. The dressings remained on the wounds for 10 days when the wounds were quantitatively assessed. Mean wound counts of the control ranged from 1.2 x 10(5) to 6.5 x 10(5) for P. aeruginosa and S. aureus, respectively. Acticoat dressing counts for both organisms were 0 and 1.8 x 10(3) (median alpha); Silvasorb was 0 and 6.3 x 10(3) and Silverlon was 1.5 x 10(4) x 7.4 x 10(4) (median), Acticoat and Silvasorb were both significantly lower (P < .05) than the control for P. aeruginosa, and Acticoat was significantly lower (P < .05) than the control for S. aureus. Although counts for Silvasorb (M) appear significantly lower than the controls for S. aureus, the numbers were not sufficient to be significant. However, Silverlon did achieve a slight significance. These preliminary data suggest that weekly dressing changes with these new silver dressings are feasible and economically and medically congruous.

Administration, Topical↗

PubMed2003

Comparison of 10 different hemostatic dressings in an aortic injury.

BACKGROUND: Uncontrolled hemorrhage is the leading preventable cause of death on the battlefield. Similarly, hemorrhage accounts for 80% of all deaths within the first 48 hours of injury in civilian trauma patients. New methods of hemostasis are required to reduce hemorrhagic mortality. The purpose of this study was to compare nine hemostatic dressings for their efficacy in controlling bleeding from an otherwise fatal aortic injury in a pig model. Each hemostatic dressing was compared with the current standard U.S. Army field gauze dressing for a 1-hour period. METHODS: Fifty-nine anesthetized pigs were instrumented with catheters and splenectomized. Nine test dressings (n = 5 per group) and two control groups (gauze, n = 9; suture, n = 5) were applied to a 4.4-mm aortotomy through the spraying jet of blood, and direct pressure was held for 4 minutes and then released. Survival, blood loss, and other variables were measured over a 1-hour period. RESULTS: All animals with fibrin dressing and those receiving suture repair (five of five in both groups) survived the 1-hour observation period with minimal bleeding in the postocclusion period (< 37 mL). Those in the other dressing groups exsanguinated within 10 minutes, except for two animals in the gauze group surviving 1 hour. CONCLUSION: With one 4-minute application, a single fibrin dressing stopped bleeding from an aortotomy, which was equivalent to sutured repair. No other test group exhibited any evidence of significant hemostatic efficacy.

Animals↗

PubMed2006

Antimicrobial activities of silver dressings: an in vitro comparison.

A range of silver-coated or -impregnated dressings are now commercially available for use but comparative data on their antimicrobial efficacies are limited. The antibacterial activities of five commercially available silver-coated/impregnated dressings were compared against nine common burn-wound pathogens, namely methicillin-sensitive and -resistant Staphylococcus aureus (MRSA), Enterococcus faecalis, Pseudomonas aeruginosa, Escherichia coli, Enterobacter cloacae, Proteus vulgaris, Acinetobacter baumannii and a multi-drug-efflux-positive Acinetobacter baumannii (BM4454), using a broth culture method. The rapidity and extent of killing of these pathogens under in vitro conditions were evaluated. All five silver-impregnated dressings investigated exerted bactericidal activity, particularly against Gram-negative bacteria, including Enterobacter species, Proteus species and E. coli. The spectrum and rapidity of action, however, ranged widely for different dressings. Acticoat and Contreet had a broad spectrum of bactericidal activities against both Gram-positive and -negative bacteria. Contreet was characterized by a very rapid bactericidal action and achieved a reduction of > or =10,000 c.f.u. ml(-1) in the first 30 min for Enterobacter cloacae, Proteus vulgaris, Pseudomonas aeruginosa and Acinetobacter baumanii. Other dressings demonstrated a narrower range of bactericidal activities. Understanding the characteristics of these dressings may enable them to be targeted more appropriately according to the specific requirements for use of a particular dressing, as in for prophylaxis in skin grafting or for an infected wound with MRSA.

Bandages↗