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PubMed2002

Wound blisters post hip surgery: a prospective trial comparing dressings.

INTRODUCTION: Wound blisters are formed in the epidermis adjacent to surgical incisions and are a significant cause of morbidity following hip surgery. This study was designed to compare two commonly used primary dressings, namely a nonadherent absorbable (NAA) dressing and paraffin tulle gras (PTG). Monitoring for the subsequent development of wound blisters in the epidermis adjacent to the surgical incision was then undertaken. METHODS: The present study was performed in the setting of a prospective, randomised trial of 50 consecutive patients undergoing hip surgery. It was assumed there would be no difference in the development of blisters between the dressing groups. The alternative hypothesis was that PTG would, because of its properties, provide less friction in the epidermis and contribute to fewer wound blisters. RESULTS: A statistically significant difference (P = 0.0028) between the two dressing groups was observed with the NAA group developing blisters in 17 (64%) patients and the PTG group in only two (8%) of the patients. CONCLUSION: The present study would suggest that PTG produces fewer wound blisters following hip surgery when compared to the NAA type as a primary dressing.

Aged↗
PubMed2001

Tolerability and efficacy of hydrocolloid dressings in the treatment of venous leg ulcers under tropical conditions: an open prospective study.

In the Western world, hydrocolloid dressings are widely used in wound treatment. However, little is known about their tolerability and efficacy under tropical conditions. The purpose of this study was to assess the tolerability and efficacy of a hydrocolloid dressing in combination with short stretch compressive bandages under tropical conditions. Seventeen patients with venous leg ulcers attending an outpatient clinic in Surinam were enrolled in the study for a period of 6 weeks. Swabs for bacterial cultures were taken at the beginning and end of the study. All ulcers showed a good healing tendency. Percentage of granulation tissue in the ulcers improved from mean 27% at start to 92% at the end. Mean circumference at start was 9.9 cm, at the end 4.9 cm. Exudation diminished from moderate in six and severe in eight ulcers, to moderate in 10 and almost none in two ulcers. In general, the dressing was very well accepted, pain was never reported. Leakage was noticed 39 times in the 164 dressing changes. This study revealed no differences in the rate of bacterial infections or colonization of wounds compared with studies performed in temperate regions. Our data indicate that hydrocolloid dressings can be used under tropical conditions.

Colloids↗
PubMed2000

Delayed infections following full-face CO2 laser resurfacing and occlusive dressing use.

BACKGROUND: Carbon dioxide (CO2) laser resurfacing has become an increasingly popular procedure for the treatment of facial rhytides and solar damage. Yet despite ongoing advancements in laser technology, CO2 laser resurfacing is still a risk-laden procedure that may lead to complications such as infection. Occlusive dressings increase the healing rate and decrease pain intensity in patients who receive full face laser resurfacing. It has been said that the use of occlusive dressings in postresurfacing patients may increase the risk of infection, which typically presents 2-10 days after the procedure. OBJECTIVE: The purpose of this article is to report the incidence of infection following full-face CO2 laser resurfacing of 354 patients who were treated with occlusive dressings. In addition, factors which may have contributed to the delayed onset in three of the four infections are discussed. METHODS: Three hundred fifty-four patients received full-face CO2 laser resurfacing. Either a continuous wave CO2 laser with a computer-generated scanner (396 microseconds dwell time, 18 W) or a pulsed CO2 laser (500 mJ pulse energy, 90 microseconds pulse duration) were used in all cases of resurfacing. Postoperatively all patients were treated with occlusive dressings and empiric oral cephalexin. Postoperatively patients were monitored at weekly intervals during the first month and then at 3 and 6 months. RESULTS: Of the 354 patients who received full-face laser resurfacing, there were 4 cases of culture-proven infection, which translates to an infection rate of 1.13%. Three of the four infections developed 3-5 weeks after the procedure. CONCLUSION: This study reports an infection rate of 1.13% following full-face CO2 laser resurfacing and occlusive dressing use in 354 patients. Because infection may develop many weeks after the procedure, patients should be educated to maintain proper wound care hygiene and to avoid "double dipping" of wound care products until wounds are completely healed.

Aged↗
PubMed2002

Treatment of soft tissue defects with exposed bone in the head and face region with alginates and hydrocolloid dressings.

PURPOSE: In cases of soft tissue defects with exposed bone surfaces in the head and face region, there is the option of treating the defect with free split-thickness skin grafts following appropriate wound granulation. Secondary granulation on free bone surfaces is often a lengthy process, as granulation primarily occurs from the edges of the wound. Hydrocolloid dressings are gaining increasing attention in this context. The question arises as to whether the positive properties of hydrocolloid dressings can bring about rapid and positive conditioning of the base of the wound in soft tissue defects with exposed bone in the head and face region, with a view to subsequent split-thickness skin graft transplantation. MATERIALS AND METHODS: In the period from 1997 to 2000, a total of 25 patients with soft tissue defects with exposed bone surfaces in the head and face region were treated with hydrocolloid dressings in the framework of a prospective clinical study. RESULTS: The average time taken for complete granulation of the bone surface was 39.44 days (minimum, 10 days; maximum, 72 days). As a rule, this necessitated 12.8 changes of dressing (minimum, 3; maximum, 26). The granulation tissue was of good quality, generously vascularized, and occasionally exuberant at the edges of the wound CONCLUSION: On the whole, the combination of hydrocolloid dressing and alginate compress was found to have significant advantages as regards conditioning the exposed bone surface.

Adult↗
PubMed2001

A study to evaluate primary dressings for the application of cultured keratinocytes.

Despite the recent improvements in cell culture and dermal regeneration methods, tissue engineering of skin has yet to receive widespread acceptance in the management of burn injuries. The reasons for this are complex and include not only the inherent costs of (particularly) setting up and running such a system but also the continuing difficulties in achieving successful engraftment of the neoepidermis. The latter has previously been addressed in a number of ways, including improving the recipient bed and using pre-confluent delivery systems to allow earlier application of cells to that wound bed. One area that has received little attention is that of the optimal wound dressing to use with this technology; the cells are very poorly attached at early time points, and, in this context, the traditional dressing of paraffin gauze has never been formally assessed in comparison with newer materials. Using a porcine acute wound chamber model, we performed a prospective randomised trial to assess four different wound dressings with reference to the amount of epidermal cover gained and the histological quality of the regenerated skin after 3 weeks. Out of the four materials tested, polyurethane foam (Allevyn) was superior histologically (although equal in take rate with paraffin gauze), whilst polythene sheet (Opsite) and silicone sheet were substantially inferior. We conclude that the traditional dressing used with this technology should be compared with polyurethane foam in a clinical trial. In the future, novel dressings should be formally tested against traditional methods before being adopted.

Animals↗
PubMed2006

[Abdominal dressing -- a new standard in therapy of the open abdomen following secondary peritonitis?].

INTRODUCTION: The management of patients with a laparostoma due to peritonitis is a challenge for every surgeon and intensivist. The goal of this study was to compare the different treatment strategies for the open abdomen: Abdominal Dressing (AD), the classic V.A.C. therapy (CV) and conventional open therapy (CT). METHODS: Between 2001 and 2005 we identified 62 patients in 4 surgical departments in Austria who had to be treated with a laparostoma due to peritonitis. 27 patients were conventionally treated, 16 with the Classic V.A.C. therapy and 19 patients with V.A.C. abdominal dressing. RESULTS: The mortality was 3/16 (14 %) in the AD group vs. 4/12 (21 %) patients in the CV group and 18/9 (59 %) in conventional therapy. There was no significant difference for survivors in the length of ICU stay: 26.6 +/- 23.0 days in the CT group, 34.6 +/- 30.2 days in the CV group and 38.9 +/- 27.2 days in the AD group. Apache II Score and Mannheimer Peritonitis Score showed no difference between the groups. CONCLUSION: We found a reduction of mortality in the V.A.C. Abdominal Dressing group by approximately 40 % (AD: 14 %, CT: 59 %). Although we could identify a difference in age in our retrospective study we believe that V.A.C. Abdominal Dressing is the important factor for the different clinical outcome. These first results indicate the need for further prospective evaluation of the V.A.C. Abdominal Dressing therapy, to prove if a new standard in the therapy of the open abdomen is created.

APACHE↗
PubMed2000

Effect of hydrocolloid dressings on healing by second intention after excision of pilonidal sinus.

OBJECTIVE: To assess the efficacy of hydrocolloid dressings in wound management after excision of pilonidal sinus. DESIGN: Prospective randomised trial. SETTING: District hospital, Spain. PATIENTS: 38 patients with chronic pilonidal sinus. INTERVENTIONS: Open excision with healing by second intention. Divided into three groups: conventional gauze dressing (control, n = 15), Comfeel (n = 12) and Varihesive (n = 11). MAIN OUTCOME MEASURES: Median healing time, infection rate, intolerance, pain, comfort, ease of management, leakage, and recurrence. RESULTS: Median healing time was 68 days (range 33-168) in the control group, compared with 65 days (range 40-137) in the two hydrocolloid groups combined. There were no differences between the hydrocolloid groups. There were no recurrences during the 74 months of follow-up. A third of the postoperative cultures in the control group grew pathogens compared with 1/23 of the patients treated with hydrocolloid dressings (p = 0.03). This was of no clinical relevance. 14/23 in the hydrocolloid group developed leaks. Pain was significantly less in the first four postoperative weeks among the patients in the hydrocolloid group than in the control group (p < 0.05). CONCLUSIONS: Hydrocolloid dressings lessen pain and increase comfort for patients after excision of pilonidal sinus, though time to healing is no shorten than when a conventional gauze dressing is used.

Adolescent↗
PubMed2005

Effectiveness of eutectic mixture of local anesthetic cream and occlusive dressing with low dosage of fentanyl for pain control during shockwave lithotripsy.

BACKGROUND AND PURPOSE: To investigate the effect and usefulness of Eutectic Mixture of Local Anesthetic (EMLA) applied with an occlusive dressing and used simultaneously with a low dose of fentanyl during shockwave lithotripsy (SWL). PATIENTS AND METHODS: One hundred sixty patients with kidney stones, aged between 19 and 68 years, were randomly divided into seven groups that were treated as follows: group 1: fentanyl 1 microg/kg by intravenous infusion (IV); group 2: IV fentanyl 0.25 microg/kg; group 3: occlusive dressing and IV fentanyl 0.25 microg/kg; group 4: placebo cream and IV fentanyl 0.25 microg/kg; group 5: EMLA cream and IV fentanyl 0.25 microg/kg; group 6: placebo cream and IV fentanyl 0.25 microg/kg with an occlusive dressing; and group 7: EMLA cream and IV fentanyl 0.25 microg/kg with an occlusive dressing. The mean arterial pressure (MAP), heart rate, ventilatory rate, and oxygen saturation (SpO(2)) were recorded on all patients. A visual analog scale 0-100 mm (VAS) was used for the evaluation of pain. The skin integrity was inspected to detect any lesions after SWL. RESULTS: The SpO(2) in group 1 was lower statistically than in the other groups. The VAS score in group 7 was clearly lower than in the others in the first, tenth, and twentieth minutes and at the end of SWL. In groups 6 and 7, additional fentanyl doses were lower than in the other groups, but only in group 7 was the total fentanyl dosage low. Skin lesions were not seen only in groups 3, 6, and 7. CONCLUSION: Use of EMLA and an occlusive dressing with low doses of fentanyl during SWL provides appropriate analgesia with minimal morbidity.

Administration, Topical↗
PubMed2000

The "stegosaurus" dressing: a simple and effective method of securing skin grafts in the burn patient.

Skin grafts are vulnerable to shear stress, infection, and hematoma formation during the postoperative period, all of which reduce graft survival. Various methods of dressing application and materials have been described in the literature to try and prevent graft loss. The authors report the use of the "stegosaurus dressing" (Eggcrate Pad) in 6 patients to secure skin grafts. Patients chosen were those who were either noncompliant or who sustained burns in unfavorable anatomic sites. All grafts demonstrated complete take without infection and hematoma formation. This foam dressing provides an even pressure to the recipient bed, absorbs drainage, and protects the graft from shearing. It also demonstrates the versatility to be used in difficult nonburn skin graft areas. The stegosaurus dressing is easy to apply, inexpensive, and provides a very secure dressing over the skin graft.

Burns↗
PubMed2001

Negative-pressure dressings in the treatment of hidradenitis suppurativa.

Negative-pressure dressings have been used in the treatment of a variety of open wounds, and as a bolster for skin grafts. The benefits of these dressings include increased oxygen tension in the wound, decreased bacterial counts, increased granulation formation, and the prevention of shear force on wounds. Also, by virtue of the diminished need for daily dressing changes, there are the additional advantages of enhancing patient comfort, decreasing nursing work, and diminished cost of wound care. Hidradenitis suppurativa (HS) is a chronic infection of the apocrine sweat glands. Treatment options range from oral isotretinoin to radical excision. Wound closure may be achieved by secondary intention, skin grafting, or flap closure. Complications may still arise and include disease progression and squamous cell carcinoma. Radical excision yields the best results in terms of disease eradication. The authors describe using the negative-pressure dressing in two cases of bilateral axillary HS to secure skin grafts firmly to the wound bed after radical excision of all involved tissues. Patient comfort and acceptance was high, and skin graft take was excellent. The dressings themselves are simple to apply and are highly effective.

Adult↗
PubMed1990

Collodion as a safe, cost-effective dressing for central venous catheters.

Catheter-related sepsis continues to be a major problem with the use of central venous catheters. Controversy exists with respect to dressing material and frequency of dressing changes. Collodion is a solution of pyroxylin in a solution of 75% ether and 25% alcohol. Camphor and castor oil are added to create a flexible noncontracting dressing when applied to the skin. We retrospectively reviewed the charts of 34 patients requiring central venous catheters between 1986 and 1988. All catheters were placed via the subclavian approach. Collodion was used as a dressing on all patients. Dressings were not routinely changed. The catheters remained in position an average of 16.5 days. No insertion site became infected; one episode of catheter-related sepsis occurred, and two catheters were inadvertently dislodged. The overall incidence of catheter-related sepsis was 2.9%.

Bacterial Infections↗
PubMed1993

Fibrin cuff lysis in chronic venous ulcers treated with a hydrocolloid dressing.

BACKGROUND: Pericapillary fibrin cuffs (PFC) are a recognized part of the pathology of venous stasis ulcers. A hydrocolloid dressing capable of lysing wound surface fibrin was tested in venous ulcers for its capacity to lyse pericapillary fibrin below the wound surface. METHODS: Tissue biopsies from the rims of 19 venous ulcers were evaluated for thickness of shallow and deep dermal PFCs before and after treatment with DuoDERM covered by Unna's boot and a compression bandage (DD+UB; n = 9) versus the same treatment without the hydrocolloid dressing (UB; n = 10). Frozen sections of all biopsies were stained with an immunofluorescent antibody to fibrin for rating of PFC thickness. Separate sections were stained with hematoxylin and eosin to assess capillary frequency, histopathology, and inflammation. All ratings and pathology assessments were performed blinded to treatment conditions. RESULTS: Both deep and shallow PFCs were reduced in 89% of ulcers treated with DD+UB versus 40% of ulcers treated with UB (alpha < 0.04). No other significant differences in inflammation, histopathology, or capillary frequency were observed. CONCLUSIONS: Treatment with DD+UB reduced PCFs in twice the number of ulcers than UB alone in 1 week. This is the first scientific documentation that a topical wound dressing could reduce the pathophysiology associated with venous ulcers, beyond the known beneficial effect of graduated compression. Not all hydrocolloid dressing are fibrinolytic, so this effect may not generalize to other dressings.

Bandages↗
PubMed1982

The effect of two new dressings on epidermal wound healing.

The effects of a Polyethylene oxide hydrogel dressing and a co-polymer starch hydrogel dressing upon the rate of re-epithelization were evaluated in a study using Yorkshire pigs. The polyethylene oxide hydrogel dressing significantly promoted re-epithelization by 44% as compared to untreated control wounds, while the copolymer starch hydrogel dressing significantly promoted epidermal healing by 24%. A possible mechanism of action is presented for the quicker healing induced by these dressings.

Animals↗
PubMed1992

Histological evaluation of surgically treated oral tissues after application of a photocuring periodontal dressing material. An animal study.

At present no information is available about biological effects on oral tissues of the photocuring periodontal dressing Barricaid. This animal study examines histologically the tissue responses of surgical areas covered during 7 days with either Barricaid, the eugenol-containing dressing Ward's Wondrpak or the bionert control gel Carboxyl Methyl Cellulose. One group was studied immediately after the removal of the dressings; in the other group, further healing was permitted for another week. Results after 7 days indicate acute inflammatory reactions in the test areas without significant differences between the 2 periodontal dressing materials. The control areas showed to a lesser degree basically the same tissue response. In the 2nd week, generally all areas healed. After 14 days, no differences between test- and control sites could be detected. From a biological point of view, these findings suggest no contra-indication for application of this photocuring dressing material after periodontal surgery.

Animals↗
PubMed2005

Periodontal dressing (Vocopac) influences outcomes in a two-step treatment procedure.

OBJECTIVES: It is not clear if periodontal dressing influences the long-term results in a non-surgical treatment procedure. MATERIAL AND METHODS: The periodontal parameters (pre-baseline) of 36 patients with aggressive periodontitis were obtained before the patients were treated initially (1st step) by a dental hygienist, who completely removed the supra- and subgingival concrements. Baseline parameters were raised 3 weeks after the 1st step, before the 2nd therapy step was conducted. It consisted of a non-surgical procedure, which comprised a closed full-mouth manual root curettage (root planing), immediate systemic application of metronidazole, and the placement of a periodontal dressing (Vocopac, Voco). The patients were randomized to two test groups having their periodontal packs removed after 3-4 days (group 1, n=12) and 7-8 days (group 2, n=12), respectively and a control group (n=12) without periodontal dressing. Clinical parameters were raised again after 6 and 24 months. RESULTS: Six and 24 months later, changes in probing pocket depth (PPD) and probing attachment level (PAL) were observed in all three groups compared with baseline, but the difference was significant in group 2 only. In addition, group 2 showed a greater reduction in mean PPD and also a significantly greater gain of attachment in comparison with the controls. CONCLUSION: Wound dressing has a positive effect on clinical long-term results using a two-step non-surgical procedure. Moreover, removing the dressing after 7-8 days leads to clearly better results than removing it earlier.

Administration, Oral↗
PubMed2004

A dressing history.

Over the past 30 years as caregivers, clinicians have been exposed to a plethora of new advanced wound dressings. The moist wound care revolution began in the 1970s with the introduction of film and hydrocolloid dressings, and today these are the traditional types of dressings of the advanced dressing categories. Wound-healing science has progressed significantly over the same period, as a result of intense clinical and scientific research around these product introductions. Today, the clinician understands moist wound healing, occlusion, cost effectiveness, wound bed preparation and MMP activity to name but a few of the many concepts in wound care that have flourished as a result of technology and product advancement. This review article presents a condensed history of dressing development over the past 30 years. However, in addition, such advancement is discussed in respect to its adoption in different parts of the world. The largest single markets of the world are generally the United States of America and Europe; as such, the development of both practice and technology generally begins there. Much has been written about these markets in previous review articles. For the purposes of this review, the development of wound care and the maturing of practice is discussed in respect to Canada, Japan and Australia representing smaller geographical areas where the development has been more recent but nonetheless significant.

Alginates↗
PubMed1994

A comparison of a modified form of Granuflex (Granuflex Extra Thin) and a conventional dressing in the management of lacerations, abrasions and minor operation wounds in an accident and emergency department.

A clinical study of 96 patients compared a new hydrocolloid dressing (Granuflex Extra Thin) with a non-adherent dressing (perforated film absorbent dressing) in the management of lacerations, abrasions and minor operation incisions at the Accident and Emergency (A&E) Department of the University College Hospital, Galway. While time to heal was similar for both groups, the patients using Granuflex Extra Thin experienced less pain (P < 0.001), required less analgesia (P = 0.0154) and were able to carry out their normal daily activities including bathing or showering without affecting the dressing or the wound. Patient satisfaction with the new dressing appeared to be very high especially in those patients who pursued an active lifestyle.

Adolescent↗
PubMedDate not supplied

Toxicity and antimicrobial activity of a hydrocolloid dressing containing silver particles in an ex vivo model of cutaneous infection.

In the present study we examined the effects of two hydrocolloid wound dressings (conventional silver-free Comfeel, silver-incorporating Contreet-H) on uninfected and Candida albicans- or methicillin-resistant Staphylococcus aureus-infected reconstituted human epithelium (RHE). The morphological alterations of the keratinocytes caused by infection and by treatment were analysed with light and electron microscopy. As a measure of epithelial cell damage the release of lactate dehydrogenase from epithelial cells into the surrounding medium was monitored. Application of Contreet-H or Comfeel to uninfected RHE induced no major morphological effects on epithelial cells. Both wound dressings reduced the growth of micro-organisms. Specific alterations of the infected epithelium (vacuoles, spongiosis, oedema, detachment of keratinocytes) and invasion of the epithelium were significantly reduced only by treatment with Contreet-H. At the ultrastructural level release of silver by Contreet-H and superior antimicrobial efficacy could be verified. In summary, treatment with both wound dressings reduced the number of pathogens, with the silver-based wound dressing providing a more effective antimicrobial activity. This resulted in a strong decrease of pathogen-specific alterations of the infected epithelium. We present evidence that delivering silver to infected keratinocytes in a moist healing environment improves the benefit/risk ratio as compared to silver-free wound dressings.

Anti-Bacterial Agents↗