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PubMed2004

Chitosan delivery systems for the treatment of oral mucositis: in vitro and in vivo studies.

Oral mucositis is a frequent and potentially severe complication of radiation or chemotherapy for cancer. Associated with atrophy and ulceration of the oral mucosa is an increased risk of infection, and the most common pathogenic agent is Candida. Chitosan is an excellent candidate for the treatment of oral mucositis. Its bioadhesive and antimicrobial properties offer the palliative effects of an occlusive dressing and the potential for delivering drugs, including anti-candidal agents. The aim of this study was to develop an occlusive bioadhesive system for prophylaxis and/or treatment of oral mucositis. Gel and film formulations were prepared using chitosans at different molecular weights and in different solvents. Nystatin, which is considered as a prophylactic agent for oral mucositis was incorporated into the formulations. The in vitro release of nystatin from the formulations was decreased with the increasing molecular weight of chitosan. The effect of the formulations was investigated in vivo in hamsters with chemotherapy-induced mucositis. Mucositis scores in groups treated with nystatin incorporated into gel and suspension formulations were significantly lower (p < 0.05) than those treated with the chitosan gel alone. Survival of animals in the treated groups was higher than that in the control group. The retention time and distribution of the gels in the oral cavity were investigated in healthy volunteers. A faster distribution of nystatin in the oral cavity was obtained using the suspension compared to the gels, but the nystatin saliva level decreased rapidly as well. A drug concentration above the minimum inhibitory concentration (MIC) value for Candida albicans (0.14 microg/ml) was maintained for longer periods of time at the application site (90 min) than at the contralateral site (45 min) in the oral cavity.

Adult↗
PubMed1990

Methods of arterial site skin preparation and dressing.

Before an arterial line is inserted, the skin at the site is prepped typically with the traditional iodophor-based preps. The arterial site is then covered with an occlusive dressing. When arterial lines are maintained for even a few days, it is not uncommon that some form of complication develops at the arterial site, such as redness, inflammation, positional problems, or even infection. Unfortunately, due to the nature of this traditional preparation and dressing method, the site is obscured constantly and complications are not always detected before a resulting infection occurs. This prospective study was designed to examine the efficiency and effectiveness of a new transparent prep, used with a transparent dressing at the arterial site. Sixty patients' arterial line sites were evaluated to determine the incidence of complications of the two arterial site prep and dressing methods. The effectiveness that the dressings may serve in securing the arterial lines in place was also evaluated. There were no complications in this study directly related to either skin preparation or dressing method, thus, there were no statistically significant differences. However, the transparent prep and transparent dressing method provided constant visual access to the arterial site and required fewer steps, clearly significant advantages not provided by the traditional method.

Catheterization, Peripheral↗
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↗
PubMed1998

A controlled subatmospheric pressure dressing increases the rate of skin graft donor site reepithelialization.

The ability to increase the rate of skin graft donor site reepithelialization significantly in a cost-effective manner has important implications for the patient undergoing major reconstructive procedures. In this study the effect of externally applied reduced pressure (the V.A.C.) on the rate of healing of donor site wounds was initially investigated using a porcine model (N = 4), then repeated on humans (N = 10). Split-thickness skin grafts were harvested from the backs of pigs using standard technique. Half of the donor sites were treated with subatmospheric pressure (125 mmHg) and half were treated with an OpSite dressing. Biopsies taken every 48 hours demonstrated that sites exposed to reduced pressure healed at a much faster rate than sites treated with a standard occlusive dressing. Similarly, donor sites in humans reepithelialized faster in 7 of 10 patients, the rate was the same in 2 of 10 patients, and OpSite was faster in 1 of 10 patients. We believe this technology has the potential to be a relatively simple and cost-efficient method for increasing the rate of donor site healing.

Adult↗
PubMed1975

The use of Opsite, a vapour permeable dressing, on skin graft donor sites.

A trial of a moisture vapour permeable dressing (Opsite) on split-skin graft donor sites of 53 patients has been carried out. The main advantages were freedom from pain, early healing and lack of bulky dressings. The disadvantages were post-operative leakage of fluid from under the Opsite and fragility of the newly healed donor site for the first few days. An occlusive dressing for the first 48 hours post-operatively is suggested to help overcome the leakage problem, and care of the healed donor site, with particular emphasis on not removing Opsite that is adherent to it, is stressed.

Bandages↗
PubMed1991

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↗
PubMed1988

Topical spironolactone inhibits dihydrotestosterone receptors in human sebaceous glands: an autoradiographic study in subjects with acne vulgaris.

The interaction between spironolactone and dihydrotestosterone (DHT) receptors was evaluated with an autoradiographic technique. The inhibition of DHT receptors by spironolactone was found to be related to the decrease of tritiated DHT granules in the sebaceous glands of the treated site. 6 male patients affected by acne vulgaris entered the study. The acute study was performed by applying to 25 cm2 of the back a cream containing 5% spironolactone under occlusive dressing. The dosage of spironolactone applied was 4 mg/cm2 for 48 h. The long-term study was performed by applying the same amount to the entire back, without occlusion, twice daily for 1 month. Skin biopsies were taken at the end of the treatment, incubated with tritiated DHT and processed for autoradiography. Both the acute and the long-term study revealed a decrease of the autoradiographic granules in the treated site. This effect is related to the binding of spironolactone with dihydrotestosterone receptors in the sebaceous glands. Our study demonstrates that 5% topical spironolactone cream acts as an antiandrogen in human sebaceous glands, competing with DHT receptors and producing a decrease of labelled DHT. At the concentrations used the effect has been only local. No side-effects were recorded during both studies.

Acne Vulgaris↗
PubMed1988

Action of topically applied arachidonic acid on the skin of patients with psoriasis.

Concentrations of arachidonic acid ranging from 0.1% to 2% were applied under occlusive dressings to psoriatic plaques in 45 patients. Alleviation of the clinical symptoms of psoriasis including complete clearing in some cases was obtained with the use of 0.5% to 2% arachidonic acid applied under occlusion every 24 to 48 hours five to seven times. Histologic examination showed polymorphonuclear leukocytes penetrating into the stratum corneum and formation of microabscesses or wide-spread accumulations of polymorphonuclear leukocytes in the stratum corneum, with its eventual destruction. The parakeratotic horny layer became detached; this was followed by restoration of the granular layer and an apparently normal stratum corneum. While arachidonic acid metabolites can be proinflammatory and proproliferative, they may also be important in the healing process for psoriasis.

Administration, Topical↗
PubMedDate not supplied

Glycosaminoglycan hydrogels as supplemental wound dressings for donor sites.

Chemically crosslinked glycosaminoglycan (GAG) hydrogel films were evaluated as biointeractive dressings in a porcine model for donor-site autograft wounds. Multiple 5 x 5 x 0.03 cm wounds were created on the dorsum of pigs. Half of the wounds were treated with a GAG film plus an occlusive dressing (Tegaderm), whereas the other half were treated with Tegaderm alone. At 3, 5, or 7 days after surgery, the partially healed wounds were excised and evaluated histologically for three animals at each time point. By day 3, epithelial cells had proliferated and migrated from wound edges and from epithelial islands associated with residual hair follicles to begin to cover the wound bed. A statistically significant increase in coverage was observed for GAG + Tegaderm-dressed wounds than for those with Tegaderm alone at day 3 and day 5 post-surgery. By day 7, all treatment groups were completely healed. Thus, GAG hydrogels accelerated wound healing by enhancing re-epithelialization.

Animals↗
PubMed1992

Characterization of biologic properties of wound fluid collected during early stages of wound healing.

The clinical effects of occlusive dressings on wound healing are well documented. However, the underlying biologic mechanisms associated with moist healing are not well understood. Experimental studies and clinical experience have shown enhanced eschar and clot removal, re-epithelialization, and collagen synthesis under occlusion, suggesting the possibility of elevated activities of proteinases and other effectors, e.g., growth factors, in the moist wound environment. To gain an insight into the biology of early wounds under occlusion, we have carried out biologic and biochemical analyses on fluids from occluded full- and partial-thickness wounds. Metalloproteinase activities were detected in the wound fluid samples. When applied to cultured dermal fibroblasts, mitogenic activity was observed with fluids from full-thickness wounds. Wound fluid-stimulated accumulation of urokinase-type plasminogen activator by fibroblasts was also observed in a time-dependent manner. Stimulation of metalloproteinase accumulation by fibroblasts was also observed. We have further demonstrated the presence of platelet-derived growth factor-like and basic fibroblast growth factor-like factors in wound fluid by antibody neutralization of their biologic activities. Proteinase presence and proteinase stimulatory activity of wound fluid retained in the occluded wound may contribute to an enhanced proteolytic environment in these wounds in comparison to non-occluded "dry" wounds. The presence of growth factors and the potential abilities of proteinases to activate latent growth factors and generate chemotactic peptides through connective tissue breakdown may also contribute to the enhanced healing of occluded wounds.

Animals↗
PubMed1992

Early and late radiation-induced skin alterations. Part II: Nursing care of irradiated skin.

Teaching patients how to care for irradiated skin during and after a course of radiation therapy is a major concern of oncology nurses. Part I of this two-part article (ONF 19(5):801-807) focused on the mechanisms of skin injury. Many topical preparations are available for skin care. When these substances are applied, both the active ingredient and the vehicle must be appropriate for the condition being treated. Preparations may be applied to the skin as liquids (e.g., lotions, solutions, tinctures used in wet dressings, soaks, baths) or solids (e.g., powders, creams, ointments). As skin reaction progresses during a course of radiation therapy, recommendations for skin care will change. Healing of injury occurs in three stages: inflammation, proliferation, and maturation. Wound healing proceeds more rapidly in a moist environment, and a variety of occlusive dressings can be used with moist desquamation.

Dermatologic Agents↗
PubMedDate not supplied

[Knowledge and problems regarding the topical treatment of leg ulcers: survey among general practitioners in the Indre-et-Loire area].

INTRODUCTION: The quantity of topical treatments for leg ulcers has increased over the last 15 years. OBJECTIVE: To determine the prescriptions for topical treatments and the problems in the management of leg ulcers using a questionnaire sent to general practitioners. MATERIAL AND METHODS: A questionnaire in 3 parts was sent to 95 general practitioners in the area working in 36 different districts with an explanatory letter. The first part was composed of 29 closed questions regarding prescription of topical treatment for leg ulcers. The second part, also closed, included 3 pictures showing a budding, a necrotic and a fibrinous ulcer. The physicians had to choose which treatment they would have prescribed and the frequency of dressings changes. The third part was composed of two open questions regarding the problems encountered. The survey started on May 1st and was closed on June 30th 2002. No reminders were sent. RESULTS: We received 52 replies, 49 of which were exploitable. Forty-five percent (43/95) did not reply. Occlusive dressings were widely prescribed (mainly hydrocolloid 38/49 and hydrocellular 28/49). Vaseline impregnated gauze were less prescribed (14/49). Dressings with balsam of Peru were prescribed often by 10 and occasionally by 27 general practitioners. Alginate or charcoal dressings were not always used appropriately. Antiseptics were prescribed by 10 physicians. Mechanical debridement of fibrinous or necrotic wounds was rarely used even for necrotic ulcers. Topical anesthetics were prescribed in 21 out of 33 cases of mechanical debridement. Some physicians referred care (n=4), others complained about lack of compliance (n=15), cost (n=14), local intolerance (n=10) and the excessively wide variety of dressings (n=10). We drew-up a synopsis with guidelines for treatment, which was sent to all the general practitioners who had participated in the survey. CONCLUSION: Forty-three of the 95 physicians approached did not reply. This poor response rate, which is common in this type of survey, may include physicians who are not at ease in the management of ulcers and this may bias the results. The physicians who replied to the survey knew the subject well but complained of the costs and variety of dressings. They were all eager to receive further information and guidelines.

Administration, Topical↗
PubMed1997

Cutaneous aspergillosis.

The authors present a patient with advanced acquired immunodeficiency syndrome who developed a cutaneous lesion under the transparent dressing of a venous catheter. Histologic examination of the lesion revealed suppurative granulomatous inflammation in the dermis with numerous branching hyphae within the follicular infundibulum. A culture of the biopsy material grew Aspergillus fumigatus. Aspergillus must be considered in the differential diagnosis of cutaneous lesions in patients infected with the human immunodeficiency virus, especially when the lesion occurs under an occlusive dressing.

AIDS-Related Opportunistic Infections↗
PubMed1991

Vascular skin ulcers of limbs.

On clinical grounds, ulcers of the leg of vascular origin can fairly easily be separated into venous and arterial origins; 85% of ulcers of the leg are caused by venous insufficiency. The ulcers occur mainly around the medial malleolus, are covered by moist granulation tissue, and are surrounded by varying degrees of stasis dermatitis and brown hemosiderin pigmentation. The limb is usually edematous and improves with elevation. In contrast, arterial ulcers of the leg develop more distally on the toes or feet, severe pain is a prominent feature, and the dry crusted ulcers usually lack granulation tissue. Elevation of the leg aggravated the pain of ischemic ulcers, whereas dependency of the limb provides some relief. Both types of ulcers heal faster with occlusive dressings that furnish a moist wound environment. Patients with ulcers caused by venous insufficiency can have coexisting peripheral atherosclerosis. Compression elastic stockings used for venous insufficiency should not be so tight that they induce necrosis of the skin in patients with occult arterial disease.

Aged↗
PubMed1993

Topical phenytoin in the treatment of split-thickness skin autograft donor sites: a comparative study with polyurethane membrane drape and conventional dressing.

The effectiveness of topical phenytoin as a wound healing agent was compared with that of OpSite (Smith & Nephew) and a conventional topical antibiotic dressing (Soframycin, Roussel) in a controlled study of 60 patients with partial-thickness skin autograft donor sites on the lower extremities. Mean time to complete healing (complete epithelialization) was 6.2 +/- 1.6 days in the phenytoin-treated group (30 patients), compared to 8.6 +/- 2.2 days with OpSite (15 patients), and 12.6 +/- 3.4 days in the 15 Soframycin-treated patients. The differences between the treatment groups were significant at P < 0.001. Mean pain scores were also lower in the phenytoin-treated group, 0.40 +/- 0.55 vs. 0.66 +/- 0.60 with OpSite (P < 0.05) and 1.4 +/- 0.50 with the conventional dressing (P < 0.001). Both phenytoin and OpSite were superior to the Soframycin dressing with respect to bacterial contamination and wound infection as measured by Gram stains of wound smears, swab and aspirate (OpSite) cultures, and clinical assessments (P < 0.001) carried out on the fifth day of treatment. No local or systemic adverse effects of the three agents used were noted. Phenytoin appears to be an effective, low-cost and safe method for the treatment of partial-thickness skin graft donor sites, comparing very favourably with, and in some aspects superior to, occlusive dressings. Further clinical use and evaluation of topical phenytoin are merited.

Administration, Topical↗
PubMed2004

Octyl-2-cyanoacrylate as a routine dressing after open pediatric urological procedures.

PURPOSE: Octyl-2-cyanoacrylate Dermabond, Ethicon, Inc., Sommerville, New Jersey is a synthetic tissue adhesive that has recently been used for skin closure in the treatment of minor lacerations. We assess its effectiveness as a sole dressing after open pediatric urological procedures. MATERIALS AND METHODS: Between February and August 2003 we prospectively evaluated patients undergoing extragenital open and laparoscopic pediatric urological procedures at our institution. All open incisions were closed in layers using a final layer of self-absorbing subcuticular stitches for the skin before applying Dermabond only at the skin level. In laparoscopic cases Dermabond alone was applied to port sites (3 mm or less) and instrument sites without any sutures beneath the skin. No adjuvant occlusive dressings were applied to any of these wounds. All patients were allowed to bathe and return to activity immediately postoperatively. RESULTS: During the study period 146 patients with 200 incisions were identified (open 146, laparoscopy 54). Of these children 103 (142 incisions) returned for followup during the period of study with only 1 complication identified. This 6-month-old child presented the evening of surgery with omental prolapse through the umbilical port (3 mm port) requiring urgent closure. In no case was there an appreciable healing problem on surgeon or parental examination and no wound infections occurred. CONCLUSIONS: Dermabond alone provides a simple coverage for a myriad of pediatric urological surgical wounds. Early bathing and return to activity do not appear to impact negatively on wound healing when a simple skin barrier is used in place of standard dressings.

Adolescent↗