Infection, tissue temperatures, and dressings.
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OBJECTIVES: To compare the functional outcome associated with the use of Unna semirigid dressings (SRD) and elastic bandage soft dressings (ED) for adults with lower limb amputation. DESIGN: Experimental design. SETTING: Inpatient rehabilitation unit of an urban academic medical center. PARTICIPANTS: A successive series of adults with vascular disease who had lower limb amputation surgery. Subjects were randomly assigned to the SRD (12 patients with 12 recent amputations) or the ED (9 patients with 10 recent amputations) group. Subjects in each group were not significantly different except for age; those in the SRD group were somewhat older. INTERVENTION: Subjects in the SRD group had Unna dressings applied to the amputation limb by physical therapists trained in the technique. Those in the ED group had elastic bandaging by therapists, nurses, family, and themselves, all of whom were trained in the technique. RESULTS: Sixty-seven percent of the SRD group and 20% of those in the ED group were discharged from the rehabilitation unit ambulating with prostheses. Of those who received prostheses, time from admission to the rehabilitation unit to readiness for fitting averaged 20.8 days for the SRD group and 28.7 days for the ED group. Comparison of survival curves shows that the time from surgery to fitting in the SRD group was almost half that of the ED group; 30% of the SRD group was fitted within 34 days, whereas it took 64 days for the same percentage of the ED group to be fitted. CONCLUSIONS: Unna semirigid dressings are more effective in fostering amputation limb wound healing and preparing the amputation limb for prosthetic fitting. Subjects treated with SRDs were more likely to be fitted with prostheses and to return home walking with a prosthesis.
At present the following guidelines for treatment of venous leg ulcers from our department are: Check the patients' general health--special attention to heart incompensation with oedema of the legs and the peripheral circulation. The most relevant laboratory tests are haemoglobin and urine-glucose. Routine bacterial cultivation is not necessary in non-diabetic patients as the result will generally not influence diagnosis, treatment or prognosis. Furthermore, treatment with topical antibiotics should be avoided. It is not only unnecessary, wasteful and sensitizing, but it also involves a risk of causing antibiotic resistance. Systematic antibiotic therapy is indicated only when obvious inflammatory signs in the tissues surrounding the ulcer are present, e.g. erysipelas or cellulitis. Non-sensitizing topical remedies should be applied. Avoid wool, alcohols, parabens, topical antibiotics and oxiquinolines. When eczema occurs use a hydrocortisone preparation in an inert base. Epicutaneous testing might be indicated. Bandages to be recommended are double-layer bandages consisting of an inner zinc oxide impregnated stocking and an outer elastic bandage and hydrocolloid dressing plus compression bandage.
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OBJECTIVE: To determine whether pentoxifylline 400 mg (Trental 400) taken orally three times daily, in addition to ambulatory compression bandages and dressings, improves the healing rate of pure venous ulcers. DESIGN: Randomised, double blind placebo controlled trial, parallel group study of factorial design, permitting the simultaneous evaluation of alternative pharmaceutical, bandaging, and dressings materials. SETTING: Leg ulcer clinics of a teaching and a district general hospital in southern Scotland. PARTICIPANTS: 200 patients with confirmed venous ulcers and in whom other major causal factors were excluded. INTERVENTIONS: Pentoxifylline 400 mg three times daily or placebo. MAIN OUTCOME MEASURE: Complete healing (full epithelialisation) of all ulcers on the trial leg. RESULTS: Complete healing occurred in 65 of the 101 (64%) patients receiving pentoxifylline and 52 of the 99 (53%) patients receiving placebo. CONCLUSIONS: The difference in the healing rates between patients taking pentoxifylline and those taking placebo did not reach statistical significance.
Post cardiac catheterization puncture site care is usually done with a tight pressure dressing by an elastic adhesive bandage (Tensoplast) due to the belief that it should prevent bleeding. The practice is uncomfortable to the patients. The authors compared a new way of dressing using light transparent tape (Tegaderm) to the conventional tight pressure one. 126 post coronary angiography patients were randomized to have their groins dressed either with Tensoplast or with Tegaderm. Patients ambulated 8 hours after the procedures. The groin was evaluated for pain, discomfort and bleeding complications. 49 per cent in the Tensoplast vs 26.9 per cent in the Tegaderm group experienced pain (p value of 0.01). 55.5 per cent in the Tensoplast group vs 11.1 per cent in the Tegaderm group reported discomfort. 4.7 per cent in the Tensoplast vs 1.6 per cent in the Tegaderm group developed bleeding or hematoma. Dressing of the puncture site after cardiac catheterization with Tegaderm was more comfortable than the conventional Tensoplast without any difference in bleeding complications.
A technique is described to prevent the shift in position of dressing materials by applying a double-sided adhesive tape between the skin and the elastic bandage. This technique also prevents a shift in position of a pressure garment, especially when applied around joints on the extremities.
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A bulky compression dressing (the Robert Jones bandage) is often used by orthopaedic surgeons. We have reviewed its history and monitored intramuscular compartment pressure under it after total knee replacement. We found that it increased compartment pressure and helped to reduce bleeding, tissue oedema and the size of effusions and haemarthroses.
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An important factor in the healing of superficial and moderate partial thickness burn is early and effective coverage with a dressing that protects the wound from trauma and dessication and is non-adherent. In our country cost is also a very important factor. Disturbed by the pain and anxiety experienced by the patients during and after dressing changes, search for a new dressing material was begun for partial thickness burn wounds and the banana leaf dressing (BLD) was subsequently developed and optimised by June 1996. An open controlled study was carried out to compare banana leaf dressing and boiled potato peel bandage (BPPB), the dressing being used in our Burn Unit since 1994. Thirty patients all less than 40 years of age, with burn size less than 50% TBSA, involving comparable body areas with partial thickness burn, were included in the study. BLD along with a topical agent was applied over the right sided extremity while BPPB was applied with the same topical agent on the left sided extremity. Dressing was changed every day. The pain during dressing change, feeling of comfort and ease of handling dressing was assessed by awarding scores by the patients and care givers for each type of dressing. Analysis of the scores revealed that both BLD and BPPB caused easily tolerable, minimal pain during dressing change in majority of the patients. The days taken for epithelialisation, eschar formation and the need for skin grafting over deep partial thickness burns, did not reveal any significant difference between the areas treated by BLD and those by BPPB. So both the dressings were observed to have equal efficacy in protecting the wounds and aiding healing. Thus, the efficacy of BLD and BPPB was parallel in all respects. But BLD is 11 times cheaper than BPPB. Banana plants can be easily grown, the leaves are easily available throughout the year. The leaves of banana are large thus offering larger surface area and the surface is non-adherent, waxy and cool. The dressing can be prepared very easily with little training. It is also the cheapest dressing available today. We strongly recommend the use of banana leaf dressing for all partial thickness burn wounds in our environment.
OBJECTIVE: Very little research has explored patients' experience of pain with different cleansing agents and dressings. We therefore undertook a longitudinal study of their impact on leg ulcer pain. METHOD: Patients with leg ulcers referred to community nurses were eligible to participate. They were followed up for six months, completing questionnaires about the impact on pain of each wound treatment used. A treatment episode was defined as the use of a wound cleansing agent, primary dressing and bandages. When one aspect of treatment changed, a new treatment episode began. RESULTS: There were 210 treatment episodes for 96 leg ulcer patients. In 206 episodes cleansing agents were used. Cleansing caused pain in 22% of episodes and relieved pain in 27%. Of the five most commonly used dressing types, low-adherent dressings were the least likely to cause pain. Only 56% of patients were able to tolerate full compression bandaging and pain was the most common reason for non-compliance. CONCLUSION: A substantial proportion of patients felt that leg ulcer treatments caused pain. A greater emphasis on the impact of treatment on pain and healing is warranted both clinically and in research.
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