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Studies on the repopulation of Langerhans cells in partial-thickness wounds. Air exposed and occlusively dressed.

BACKGROUND AND DESIGN: The use of occlusive dressings on partial-thickness wounds has been shown to promote early epithelization and connective tissue regeneration. Because Langerhans cells (LC) have been implicated in epidermal homeostasis we studied the rate of repopulation of LC in air-exposed vs occlusively dressed wounds. Partial-thickness wounds on the backs of pigs were treated with occlusive dressings (Tegaderm) for 3 days or left air exposed. On days 3, 5, 7, and 11 after keratome wounding, epidermal sheets from the regenerating wounds were isolated and stained for LC using indirect immunofluorescence. The LC populations were quantified in the interfollicular regions and expressed as average number of cells per square millimeter of epidermis. RESULTS: Normal skin control had 1024 +/- 93 LC/mm2 distributed uniformly. On day 3 after wounding occlusive-dressing-treated wounds had an LC repopulation of 46% of the original value. Langerhans cells in air-exposed skin could not be evaluated until epithelization occurred at day 5. Langerhans cells in both air-exposed and occlusive-dressing-treated wounds were 46% to 51%, 65% to 71%, and 91% of normal value, respectively, on days 5, 7, and 11. CONCLUSIONS: We conclude that at least in regenerating epidermis, the degree of repair of the new epidermis apparently plays a limited role in the migration of LC, as does the earlier growth of blood vessels.

Air↗

Evaluation of bacterial growth with occlusive dressing use on excoriated skin in the premature infant.

This study evaluated the effects of an occlusive (OpSite Flexigrid) dressing on bacterial growth over excoriated and the surrounding intact skin of eight premature infants. Cultures were obtained before placement and four days after dressing placement. An analysis of variance demonstrated significant increases in coagulase-negative Staphylococcus and overall total skin. No significant differences in bacterial growth occurred between intact skin underneath the dressing and that on the opposite side of the body post-dressing placement. Significant increases were found in bacterial concentrations for both intact and excoriated skin post-dressing placement. Small sample size and no between-subject design hinder generalization to the neonatal population.

Analysis of Variance↗

Allergic contact dermatitis from hydrocolloid dressings.

BACKGROUND: Hydrocolloid wound dressings have been in use for nearly two decades, and have rarely caused allergic contact dermatitis. DuoDERM E (DuoDERM CGF) is a newer version of DuoDERM (ConvaTec Ltd, a division of Bristol-Myers Squibb Co, Princeton, NJ) that contains a sensitizing derivative of colophony. OBJECTIVE: We describe three patients who developed eczematous lesions under this type of wound covering. METHODS: The patients were patch tested to the European standard series, to a glues and adhesives series, and to pieces of various adhesive dressings. RESULTS: The patients displayed positive patch tests to colophony and to DuoDERM E or DuoDERM CGF hydrocolloid dressings. CONCLUSION: These dressings contain the pentaerythritol ester of hydrogenated rosin as a tackifying agent, and this substance retains the sensitizing potential of colophony. The addition of this compound is an important change that may negatively alter the good safety record of ConvaTec dressings.

Adult↗

[Evaluation of the usefulness of dressings made from chitosan and lyophilized human placenta on wound healing].

The goal of this study is evaluation in experimental and clinical circumstances of biological dressings obtained form lyophilized human placenta and chitosan. The therapeutic specificities of human placenta where confirmed in the course many years' observation in The Department of Surgery of the Digestive Tract. The reservation arose only because of inconvenience in using placenta fragile after lyophilization. The product was obtained in the course of studies which were performed in common with The Chemical Fibres Institute in Lódź. This product (which was a combination of placenta and chitosan) was free of defects considering defects of lyophilized placenta. The experimental part of study was performed on 50 female rats of Wistar strain. It was compared healing of wound 2 cm2 area provided with tested dressing and the other controlled wound. The result was evaluated on the ground of postoperative survival and the macroscopic and microscopic evaluation. In the clinical part of the study the experimental model was made by wounds provided by sutures passed by all layers on special "small drains" which under drains make bedsores placed symmetrically on both sides of incision line. The evaluation was performed randomly putting on one of these sides of tested dressing. There was evaluated the speed of demarcation, growth of granulation tissue and epithelialization. The evaluation was compared with standard dressing. Combination of therapeutic specificities of lyophilized human placenta with proper mechanical specificities of chitosan made possible to obtain comfortable and efficient dressing. In the clinical part of the study on the ground of macroscopic evaluation it was found that the process of the healing in tested group becomes shorter of about 48 hours.

Aged↗

Unna's boot vs polyurethane foam dressings for the treatment of venous ulceration. A randomized prospective study.

Recent reports have suggested that polyurethane foam dressings provide a more rapid and comfortable healing of venous stasis cutaneous ulcerations than standard semirigid impregnated gauze dressings. This multi-institutional study consists of a randomized, prospective comparison of 36 consecutive patients who were treated with either polyurethane foam dressings (group 1, n = 17) or Unna's boot (group 2, n = 19) for venous ulceration of the lower extremities. Ulcer size ranged from 6.0 to 270 cm2 (mean, 32.2 cm2) for group 1 and 0.2 to 600 cm2 (mean, 76.0 cm2) for group 2. Nine (52.9%) of 17 group 1 patients withdrew from the study due to wound odor, while there was 100% compliance in group 2. Overall wound healing was superior in group 2 (18 [94.7%] of 19) as compared with group 1 (7 [41.2%] of 17) (chi 2 = 8.2). The rate of healing was also better in group 2 (0.5 cm2/d) than in group 1 (0.07 cm2/d). Contrary to published European trials, impregnated gauze dressings exhibited superior treatment results when compared with polyurethane foam dressings in the current study.

Bandages↗

Wound dressing with sustained anti-microbial capability.

To overcome current limitations in wound dressings for treating mustard-burn induced septic wound injuries, a nonadherent wound dressing with sustained anti-microbial capability has been developed. The wound dressing consists of two layers: the upper layer is a carboxymethyl-chitin hydrogel material, while the lower layer is an anti-microbial impregnated biomaterial. The hydrogel layer acts as a mechanical and microbial barrier, and is capable of absorbing wound exudate. In physiological fluid, the carboxymethylated-chitin hydrogel swells considerably, imbibing up to 4 times its own weight of water and is also highly porous to water vapor. The moisture permeability of the dressing prevents the accumulation of fluid in heavily exudating wounds seen in second-degree burns. The lower layer, fabricated from chitosan acetate foam, is impregnated with chlorhexidine gluconate. From the in vitro release studies, the loading concentration was optimized to deliver sufficient anti-microbial drug into the wound area to sustain the anti-microbial activity for 24 h. The anti-microbial activity of the dressing against Pseudomonas aeruginosa and Staphylococcus aureus was tested using the Bauer-Kirby Disk Diffusion Test.

Anti-Infective Agents↗

The management of the open perineal wound using a foam elastomer dressing: a prospective clinical trial.

In an attempt to improve the management of the perineal wound after abdominoperineal excision of the rectum we have assessed the value of foam elastomer, a catalysed silicone polymer dressing. The substance has already been used successfully in the treatment of open, granulating wounds at other sites (1). On the fourteenth postoperative day 50 patients with open perineal wounds were randomized to receive either conventional gauze packing or treatment with a foam elastomer dressing. Patients were received weekly until healing occurred. When no cavity remained, a dry dressing alone was used. Initial wound volume was calculated in all patients by forming a foam dressing the volume of which was measured by displacement of water. Healing times were shorter in patients who received foam elastomer, but not significantly so. However, less analgesia (P less than 0.01) and fewer district nurse visits (P less than 0.001) were required by patients in the foam elastomer group. This study suggests that foam elastomer dressing is a more comfortable alternative to a gauze pack in the management of the perineal wound and substantially reduces the amount of nursing supervision which is required. We recommend its routine use in the management of the open perineal wound particularly in the young and cooperative patient.

Adult↗

Use of negative pressure dressings in head and neck reconstruction.

BACKGROUND: Head and neck microvascular surgery commonly requires management of complex wounds of the upper aerodigestive tract and donor sites. Negative pressure dressings have been reported to promote healing in compromised wounds. METHODS: Between February 2001 and June 2004, data were collected in a retrospective manner on 23 patients who underwent treatment with negative pressure dressings at two tertiary care institutions. RESULTS: Twenty-three patients underwent negative pressure wound treatment for donor site complications (n = 9) or head and neck wounds (n = 14) with a minimum of 5 months follow-up. Average duration of treatment was 6.5 days. Indications for use in wound complications included wound breakdown (n = 3), fistula with carotid exposure (n = 4), tendon exposure of donor site (n = 6), and others (n = 3). On average, granulation tissue was promoted in across 93% of the wound bed over the course of treatment. Two patients with anterior mandibular hardware exposure were managed successfully with negative pressure dressings. Large split-thickness skin grafts (average size, 135 cm2) at mobile sites were bolstered with negative pressure dressings in seven patients with an overall take rate of 74%. CONCLUSION: Although of limited use as a bolster for split-thickness skin grafts, negative pressure dressings are safe and effective in the management of complex head and neck wounds and in the treatment of donor site complications.

Bandages↗

Flexible chitin films as potential wound-dressing materials: wound model studies.

Chitin films possessing increased flexibility, softness, transparency, and conformability have been prepared. These attributes enable the potential application of chitin films as occlusive, semipermeable film wound dressings similar to commercial products such as Opsite trade mark. The chitin films are generally nonabsorbent, exhibiting a total weight gain of only up to 120-160% in physiological fluid. Dry chitin films transpire water vapor at a rate of about 600 g/m(2)/24 h, similar to commercial polyurethane-based film dressings, but rises to 2400 g/m(2)/24 h, when wet, which is higher than the water vapor transmission rate of intact skin. The chitin films are nontoxic to human skin fibroblasts, maintaining 70-80% cell viability. Wound studies using a rat model showed no signs of allergenicity or the high inflammatory response associated with biodegradable biomaterials. The chitin films displayed accelerated wound-healing properties. Based on histological examination, wound sites dressed with the chitin films stabilized and healed faster, and appeared stronger than those dressed with Opsite trade mark and gauze dressings after 7 days of healing.

Animals↗

The effect of a collagen dressing on contaminated surgical wounds in rats.

In maintaining the rat, the collagen dressings, Aviderm Amine and Aviderm, are as effective as skin in low bacterial levels in contaminated surgical wounds. In the scald-burn wound in the rat the effect of skin dressing is confirmed. Also, 48 h after collagen dressing in the wound the bacterial contamination was the same as that seen under autograft dressings. We have elsewhere suggested that skin and some other dressings modify the local host defense by their effect on the accumulated white blood cells. We believe that collagen, as well as some synthetics, can alter the local environment permitting the destruction of invading bacteria by the accumulated white blood cells.

Animals↗

[Silicone rubber dressing in wound healing disorders].

This report deals with new dressing method using silastic foam which was used on 55 patients with good success. Silastic foam dressings are indicated in cases of badly healing and infected wounds, especially caused by diabetes and arteriosclerosis. On account of the physical quality of the silastic foam the wounds were cleaned and healed quickly. The treatment with silastic foam dressing is a good alternative to conservative dressing methods. Two cases will demonstrate the success of the silastic foam dressing in surgery.

Bandages↗

The healing of below-knee amputations: a comparison of soft and plaster dressing.

To evaluate the effect of wound dressing upon wound healing, fifty-one patients undergoing below-knee amputation using a long posterior myocutaneous flap technic were randomly allocated into a soft or plaster dressing group. Neither wound dressing technic proved superior, as wounds healed in 85.2 per cent of the plaster dressing group and 83.3 per cent of the soft dressing group.

Adult↗

Toxicity testing of wound dressing materials in vitro.

There is a bewildering array of dressing materials available for wound coverage. The choice of dressing is often by local custom or practical experience. We wished to investigate if different dressings varied in their ability to either stimulate or inhibit proliferative activity and differentiation in an in vitro test system. We have used a number of test systems for this study. Human dermal fibroblast and keratinocyte cultures were used to screen for proliferative and cytotoxic effects. A more complex "organotypic" method involving fibroblast-impregnated collagen gels overlaid with epidermal keratinocytes was used to investigate effects on differentiation. Dressings were selected from each of the major types available, from simple gauze to hydrocolloids. Of the dressings tested, some reduced cell growth rates but the majority showed no major effect on proliferation or differentiation. Of those displaying an effect, only one could be attributed to cytotoxicity.

3T3 Cells↗

Silicone foam dressing for penis after reconstructive pediatric surgery.

Although silicone foam has been used abroad as an effective means to dress the penis after hypospadias surgery, its use has not been widespread in the United States. We have modified the method to apply the foam in order to facilitate its use. We used this method to dress the penis with silicone foam in 50 boys after reconstructive surgery. The dressing appeared to be effective in restricting edema and hematoma formation. Also, the dressing stabilized the indwelling urethral catheter thereby preventing disruption of the glansplasty. The urethrocutaneous fistula rate (10%) was not reduced by use of the foam. The dressings uncommonly fell off prematurely. The boys appeared to experience little discomfort while the foam was in place and during its removal.

Bandages↗

Use of patient-controlled analgesia with alfentanil for burns dressing procedures: a preliminary report of five patients.

The use of patient-controlled analgesia with alfentanil (PCA-alfentanil) as a form of pain relief for dressing procedures in patients during the acute phase of their burn injuries was investigated. Five ASA 1 and 2 patients with 10-30 per cent total body surface area (TBSA) thermal burns, had PCA-alfentanil for their dressing procedures after standard fluid resuscitation. One patient who did not receive a loading dose and a background infusion of alfentanil had unsatisfactory pain relief. Four patients had good pain relief after a loading dose of IV alfentanil 1 mg followed by a continuous background infusion of 200-800 micrograms/h. Demand dose ranged from 200 to 400 micrograms and lockout time ranged from 1 to 3 min. The total dose of alfentanil delivered ranged from 0.8 to 4.48 mg and duration of the dressings ranged from 30 to 60 min. All patients were mildly sedated, calm, communicative and cooperative during dressing procedures. None of them experienced hypotension or respiratory depression. One patient experienced nausea but no vomiting, no other adverse effects of alfentanil were noted. From the pilot study, PCA-alfentanil may be an effective form of pain relief for dressing procedures in patients during their acute phase of burn injuries. The optimal PCA-alfentanil setting has yet to be determined.

Adolescent↗

A graduated guidance procedure for teaching self-dressing skills to multihandicapped children.

The effectiveness of a graduated guidance procedure for increasing independence in dressing was examined in a multiple baseline analysis across behaviors. Two multihandicapped children were trained to dress in socks, pants, and shirt. In training sessions, subjects completed the entire sequence of steps involved in putting on the training garment on each trial. Trainer assistance was provided as necessary, but was faded systematically according to a hierarchy of intrusiveness. Positive reinforcement was delivered contingent on dressing with increased independence. Assessment of independent responses followed each training session. Dependent measures were derived from a task analysis of each dressing behavior. Results showed that both children learned dressing skills, although rates of acquisition varied considerably. Generalization of treatment effects to similar garments was observed; maintenance of skills was evident at follow-up probes conducted at 36 weeks for one child and 18 weeks for the other.

Activities of Daily Living↗

[Non pharmacological treatment of severe cutaneous infections: hyperbaric oxygen therapy, dressings and local treatments].

Beside conventional therapy, the management of necrotizing cellulitis and fasciitis is based on non-pharmacological treatments. Hyperbaric oxygen therapy and dressings are the most frequently used techniques. The usefulness of hyperbaric oxygen therapy is clearly demonstrated in experimental studies while the efficacy of this technique is poorly assessed in clinical practice. The French consensus conference has concluded to an adjuvant role of hyperbaric oxygen therapy combined to intensive care management, surgery and antibiotic therapy. Occlusive conventional dressings using humid or vaseline gauze dressings are largely used. Calcium alginate or silver coated dressings might be useful. In addition, vacuum-assisted closure therapy could be proposed in replacement of conventional dressings.

Bandages↗

[Oxcarbazepine and DRESS syndrome: a paediatric cause of acute liver failure].

Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome, also called hypersensitivity reaction, is a severe idiosyncratic reaction to drugs, especially to anti-epileptic drugs. Clinical features associate cutaneous eruption, fever, multiple peripheral ganglions, and potentially life-threatening damage of one or more organs. DRESS syndrome is well described in adults treated with aromatic anti-epileptic drugs, such as phenytoin, phenobarbital, and carbamazepine, but also with other drugs. The new anti-epileptic drugs, such as oxcarbazepine also induce various cutaneous eruptions, but with less report of DRESS syndrome. In children, DRESS syndrome is rare and probably underdiagnosed. We report on the case of a 11-year-old girl hospitalised with an acute severe hepatitis revealing an oxcarbazepine-induced DRESS syndrome.

Acute Kidney Injury↗