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PubMed2005

Evaluation of an in situ forming hydrogel wound dressing based on oxidized alginate and gelatin.

Wound dressings that can be formed in situ offer several advantages over the use of preformed dressings such as conformability without wrinkling or fluting in the wound bed, ease of application and improved patient compliance and comfort. Here we describe such an in situ forming hydrogel wound dressing from gelatin, oxidized alginate and borax. Periodate oxidized alginate rapidly cross-links proteins such as gelatin in the presence of borax to give in situ forming hydrogels that are both non-toxic and biodegradable. The composite matrix has the haemostatic effect of gelatin, the wound healing-promoting feature of alginate and the antiseptic property of borax to make it a potential wound dressing material. The hydrogel was found to have a fluid uptake of 90% of its weight which would prevent the wound bed from accumulation of exudates. The water vapour transmission rate (WVTR) of the hydrogel was found to be 2686+/-124 g/m2/day indicating that the hydrogel can maintain a moist environment over wound bed in moderate to heavily exuding wound which would enhance epithelial cell migration during the healing process. The wound healing efficacy of hydrogel was evaluated in experimental full thickness wounds using a rat model which demonstrated that within 2 weeks, the wound covered with gel was completely filled with new epithelium without any significant adverse reactions. These in situ forming hydrogels fulfil many critical elements desirable in a wound dressing material.

Alginates↗

PubMed2004

The effect of essential oils on methicillin-resistant Staphylococcus aureus using a dressing model.

Patchouli, tea tree, geranium, lavender essential oils and Citricidal (grapefruit seed extract) were used singly and in combination to assess their anti-bacterial activity against three strains of Staphylococcus aureus: Oxford S. aureus NCTC 6571 (Oxford strain), Epidemic methicillin-resistant S. aureus (EMRSA 15) and MRSA (untypable). The individual essential oils, extracts and combinations were impregnated into filter paper discs and placed on the surface of agar plates, pre-seeded with the appropriate strain of Staphylococcus. The effects of the vapours of the oils and oil combinations were also assessed using impregnated filter paper discs that were placed on the underside of the Petri dish lid at a distance of 8mm from the bacteria. The most inhibitory combinations of oils for each strain were used in a dressing model constructed using a four layers of dressings: the primary layer consisted of either Jelonet or TelfaClear with or without Flamazine; the second was a layer of gauze, the third a layer of Gamgee and the final layer was Crepe bandage. The oil combinations were placed in either the gauze or the Gamgee layer. This four-layered dressing was placed over the seeded agar plate, incubated for 24h at 37 degrees C and the zones of inhibition measured. All experiments were repeated on three separate occasions. No anti-bacterial effects were observed when Flamazine was smeared on the gauze in the dressing model. When Telfaclear was used as the primary layer in the dressing model compared to Jelonet, greater zones of inhibition were observed. A combination of Citricidal and geranium oil showed the greatest-anti-bacterial effects against MRSA, whilst a combination of geranium and tea tree oil was most active against the methicillin-sensitive S. aureus (Oxford strain). This study demonstrates the potential of essential oils and essential oil vapours as antibacterial agents and for use in the treatment of MRSA infection.

Anti-Bacterial Agents↗

PubMed2007

A factorial, randomized trial of pentoxifylline or placebo, four-layer or single-layer compression, and knitted viscose or hydrocolloid dressings for venous ulcers.

OBJECTIVES: We evaluated the effectiveness of pentoxifylline, knitted viscose or hydrocolloid dressings, and single-layer or four-layer bandaging for venous ulceration. METHOD: A factorial randomized controlled trial with 24-week follow-up was conducted in leg ulcer clinics in Scotland with blinded allocation to pentoxifylline (1200 mg) or placebo, knitted viscose or hydrocolloid dressings, and single-layer or four-layer bandages. The study enrolled 245 adults with venous ulcers. The main outcome measure was time to complete healing. Secondary outcomes included proportions healed, withdrawals, and adverse events. Analysis was by intention to treat. RESULTS: There was no evidence of interaction between the drug, bandages, and dressings. Pentoxifylline was associated with nonsignificant increased ulcer healing (62% vs 53%; P = .21). Four-layer bandages were associated with significantly higher healing rates (67% vs 49%; P = .009). There was no difference in healing between knitted viscose and hydrocolloid dressings (58% and 57%; P = .88). Cox regression models increased the significance of the pentoxifylline effect (relative risk of healing, 1.4; 95% confidence interval, 1.0 to 2.0). CONCLUSIONS: Pentoxifylline increased the proportion healing compared with placebo to the same extent as shown in recent systematic reviews, although this finding was only statistically significant when a secondary adjusted analysis was conducted. Four-layer bandaging produced higher healing rates than single-layer bandaging. There was no difference in time to healing between knitted viscose and hydrocolloid dressings.

Administration, Oral↗

PubMed2006

Effect of a calcium hydroxide-based root canal dressing on periapical repair in dogs: a histological study.

OBJECTIVE: To compare the periapical repair of teeth with periapical lesion following root canal treatment by using a calcium hydroxide-based intracanal dressing for several time periods or filling in a single visit. STUDY DESIGN: After induction of periapical lesions in 4 dogs, the root canals were prepared using 5.25% sodium hypochlorite for irrigation, and animals were separated into 4 experimental groups; in group I, root canals were filled in a single session; in groups II, III, and IV, a calcium hydroxide-based dressing was kept in place for 15, 30, or 180 days, respectively. Root canals from groups I, II, and III were filled with gutta-percha cones and AH Plus sealer. After 180 days, animals were killed and histological sections were stained with hematoxylin-eosin to evaluate periapical repair. RESULTS: Periapical repair was better in groups II, III, and IV (intracanal dressing) compared with group I (single session; P < .05). CONCLUSION: The use of a calcium hydroxide-based intracanal dressing was important for periapical repair in teeth with periapical lesion. Dressing with calcium hydroxide paste results in better periapical repair than when the root canal is filled in a single-session treatment.

Animals↗

PubMed2003

Wound dressings.

There are currently hundreds of dressings on the market to aid in wound management. Before selecting a dressing for a particular wound, a practitioner must assess carefully the needs of the wound to understand which dressing would provide maximal benefit. Frequently, there is not one clear best choice, and it is crucial that the pros and cons of each dressing modality be understood. This article has provided a framework to assist in dressing assessment.

Bandages↗

PubMed2000

Alginates from wound dressings activate human macrophages to secrete tumour necrosis factor-alpha.

Alginates are used to manufacture a number of wound dressings. Clinical observations indicate that they may initiate or accelerate healing of chronic wounds after treatment of underlying pathology. Wound granulation tissue contains large numbers of macrophages and they are thought to regulate the healing process. As purified alginates have been demonstrated to activate macrophages this study was initiated to determine whether alginates present within wound dressings may interact with wound macrophages. Alginate fibres taken from four commercially available dressings were co-cultured with the human histiocytic lymphoma cell line U937 following its differentiation with PMA. Activation was assessed by measurement of TNFalpha production. Two of the dressings, Seasorb and Tegagen, had a minimal effect whilst Sorbsan at 1 mg/ml induced 302 + 19 pg/ml TNFalpha. This effect was inhibited by polymyxin B indicating that activation was due to endotoxin contamination. Kaltostat induced production of 839 + 36 pg/ml TNFalpha. This effect was induced both by polymyxin inhibitable endotoxin and a direct interaction with the alginate fibres. These data indicate that some alginate containing dressings have the potential to activate macrophages within the chronic wound bed and generate a pro-inflammatory signal which may initiate a resolving inflammation characteristic of healing wounds.

Alginates↗

PubMed2006

[DRESS syndrome related to Hexaquine (quinine and thiamine)].

BACKGROUND: Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS syndrome) is a severe drug eruption defined as an association of a drug reaction, mostly cutaneous, laboratory abnormalities with the presence of hypereosinophilia and/or atypical lymphocytes, and involvement of one or more organs. We report a case of DRESS syndrome associated with quinine or thiamine (which in France are combined in Hexaquine with serious hepatitis and renal failure and associated viral reactivation of Human Herpes Virus 6 (HHV6). OBSERVATION: A twenty-three year-old woman was hospitalized for asthenia, fever, erythroderma, facial edema and painful cervical lymph nodes. Laboratory results showed inflammatory syndrome, hypogammaglobulinemia and the presence of activated atypical lymphocytes. Broad screening for infectious serology showed HHV6 reactivation with marked increase in specific IgG levels within two weeks and detection of circulating DNA in blood by PCR (polymerase chain reaction). Two severe complications subsequently appeared: cytolytic hepatitis and interstitial nephritis. The outcome was favorable with oral corticosteroid therapy. Repeated history-taking did not initially identify any causal agent, but several weeks later, the patient remembered taking Hexaquine (quinine and thiamine) for essential muscular cramps daily for 27 days before the onset of symptoms. The patient had taken no other medication during the previous weeks. One year later, at the end of an enteroviral infection, a skin rash similar to the first episode was seen but in isolation on this occasion, suggesting minor reactivation of DRESS syndrome. DISCUSSION: To our knowledge, ours is the first reported case of DRESS syndrome associated with this drug. Because of the difficulty of identifying the causative drug, even though taken alone, our case once again illustrates the importance of spending adequate time on history taking. Although the physiopathology of DRESS syndrome has not yet been fully elucidated, it is nevertheless probable that it is a multi-factor phenomenon (involving medication and viruses among others).

Adult↗

PubMed1997

Research utilization: adhesive bandage dressing regimen for peripheral venous catheters.

BACKGROUND: This project used the process of research utilization to apply research knowledge to clinical practice for dressing peripheral intravenous (i.v.) catheters. METHOD: The project included (1) the review and synthesis of multiple research studies, (2) transformation of the research-based knowledge into a clinical protocol of use of adhesive bandage (AB) for dressing peripheral i.v. catheters, and (3) evaluation of the proportion of phlebitis as an outcome measure for comparison of peripheral i.v. catheter sites dressed with 2 x 2 inch gauze/tape or AB. Integral to the research utilization process was the use of planned change strategies. RESULTS: The proportion of phlebitis among peripheral i.v. catheters dressed with gauze/tape was 16.7% compared with 14.9% for AB. Antimicrobial ointment applied to the insertion site resulted in a higher proportion of phlebitis when used with an AB. CONCLUSION: This project used a research utilization framework to transfer research knowledge into clinical practice. To assure dissemination and implementation of the new practice, the use of ABs for dressing peripheral i.v.s was incorporated into hospital policy and procedure. In addition, the discontinuation of application of an antimicrobial ointment to peripheral i.v. sites was reinforced.

Adhesives↗

PubMed1999

A prospective, randomized, controlled trial comparing transparent polyurethane and hydrocolloid dressings for central venous catheters.

BACKGROUND: This study was undertaken to determine the frequency of skin colonization, hub colonization, and central venous catheter colonization in transparent hydrocolloid versus standard polyurethane dressings. METHODS: Adult patients requiring the insertion of a multilumen central venous catheter in an intensive care unit were randomized to receive either a standard polyurethane dressing or a transparent hydrocolloid dressing. Cultures were obtained from 125 skin insertion sites, 141 catheter hubs, 128 catheter tips, and blood samples from 132 patients. Extensive data on patient and catheter characteristics were collected. RESULTS: Skin and hub cultures revealed no significant difference in degree of colonization. However, the hydrocolloid group had a significantly higher level of catheter colonization than the polyurethane group (P =.048). Conversely, there was a significantly higher frequency of positive blood cultures in the polyurethane group (P =.03), although the majority were considered to be potential contaminants. There were only 6 cases in which the same species was simultaneously isolated from a positive blood culture and a colonized catheter, 5 from the hydrocolloid group and 1 from the polyurethane group. CONCLUSIONS: The results of this study suggest that an increased risk of catheter colonization is associated with the use of hydrocolloid dressings, despite previous research suggesting that they significantly reduce microbial growth compared with standard polyurethane. The clinical significance of increased numbers of positive blood cultures in the polyurethane group requires further examination, although distinguishing between contamination and true infection in intensive care settings continues to be methodologically challenging. Further studies are required to determine whether these findings are generalizable across different study settings and whether similar outcomes are obtained when different brands of hydrocolloid dressing are used.

Adolescent↗

PubMed2001

Psychological approaches during dressing changes of burned patients: a prospective randomised study comparing hypnosis against stress reducing strategy.

A prospective study was designed to compare two psychological support interventions in controlling peri-dressing change pain and anxiety in severely burned patients. Thirty patients with a total burned surface area of 10-25%, requiring a hospital stay of at least 14 days, were randomised to receive either hypnosis or stress reducing strategies (SRS) adjunctively to routine intramuscular pre-dressing change analgesia and anxiolytic drugs. Visual analogue scale (VAS) scores for anxiety, pain, pain control and satisfaction were recorded at 2-day intervals throughout the 14-day study period, before, during and after dressing changes. The psychological assistance was given on days 8 and 10 after hospital admission. The comparison of the two treatment groups indicated that VAS anxiety scores were significantly decreased before and during dressing changes when the hypnotic technique was used instead of SRS. No difference was observed for pain, pain control and satisfaction, although VAS scores were always better in the hypnosis group. The study also showed that, overall, psychological support interventions reduced pain and increased patient satisfaction. These results confirm the potential benefits of psychological assistance during dressing changes in burned patients.

Adult↗

PubMed2001

The development of a novel technique for predicting the exudate handling properties of modern wound dressings.

Numerous methods have been developed for measuring the absorbency of wound dressings but many are product specific and do not permit comparisons between different dressing types. Existing methods are also of limited value when assessing how a dressing is likely to perform in clinical practice. A new wound model has been developed that overcomes both of these problems. It facilitates direct comparisons between products that are different in structure and composition and provides, perhaps for the first time, a method that may be used to predict the time for which dressings might be expected to remain effective on exuding wounds. The historical background to the introduction of test methods for surgical dressings is briefly reviewed, and the development of the new wound model is described. Some preliminary results that illustrate the potential value of this new technique are also presented.

Absorption↗

PubMed1983

Contaminated first-aid dressings: report of a working party of the PHLS.

In a collaborative study 12 Public Health Laboratory Service laboratories and the Division of Hospital Infection, Central Public Health Laboratory, investigated the degree of contamination of standard dressings produced by manufacturers in India or in England by a comparison of the results of culture of 25 sterilized dressings with those of 25 untreated dressings. Of the 38 batches of dressings made in India 27 (71%) were judged contaminant and another six could be so judged when Bacillus species were examined. In two batches laboratory contamination precluded a judgement and only three batches passed the test. Of the 27 batches made in England, only three gave any evidence of contamination at the lowest level of significance. Repeat investigation of one of these batches gave no evidence of contamination. Organisms of the genus Bacillus and fungi were associated with contamination; micrococci and propionibacteria were laboratory contaminants. There was evidence for both failure and sterilization and of contamination after sterilization during the manufacture of dressings.

Aspergillus niger↗

PubMed2003

Use of irradiated amnion as a biological dressing in the treatment of radiation induced ulcers.

The management of moist skin desquamation (ulceration) following radiation therapy has been a concern since the inception of this therapy. The treatment of skin reactions focuses on promoting healing, improving patient comfort preventing infection and decreasing trauma to the area. Various dressings like topical preparations, hydrocolloid and gentian violet 1 % dressing have been used for its treatment. We present our experience with the use of amnion as a biological dressing in patients with radiation induced ulceration following pelvic radiation using megavoltage beam. The preliminary experience with treatment in 14 patients proved to be cost effective due to a shorter duration of ulcer healing (median of 7 days), fewer dressing changes (median of 4 dressings) and diminished use of analgesics.

Journal Article↗

PubMed2002

An in vitro comparison of pH changes in root dentine following canal dressing with calcium hydroxide points and a conventional calcium hydroxide paste.

AIM: This study aimed to measure and compare pH changes at apical and cervical sites on the external root surface of extracted teeth dressed with calcium hydroxide in two different formulations. METHODOLOGY: Root canals of 45 single-rooted extracted human teeth were accessed and shaped using a step-down technique with rotary instrumentation. Standard cavities were prepared on the external root surface at specific apical and cervical sites. The teeth were randomly allocated to three groups. Teeth in group A were dressed with calcium hydroxide points, those in group B were dressed with an aqueous calcium hydroxide paste and teeth in group C were left unfilled. Following storage in humid conditions, the pH of the dentine at apical and cervical sites was measured at baseline and then at 24 h, 72 h, 1 week, 10 days, 2 weeks and 3 weeks. RESULTS: The pH of the root dentine at both apical and cervical sites was significantly greater (P < 0.001) in teeth dressed with aqueous calcium hydroxide paste compared with those dressed with calcium hydroxide points, when averaged out across all time periods. For all groups, there was a significant difference between the mean apical and cervical pH values for each tooth with lower values for the apical sites (P < 0.001). CONCLUSION: The results of this study indicate that an aqueous calcium hydroxide paste was more effective than calcium hydroxide points at raising the pH on the external root surface of extracted teeth.

Analysis of Variance↗

PubMed2004

The wound dressing supply chain within England's National Health Service: unravelling the context for users.

AIM: To explore the representation of user needs (nurses and patients, both individuals and groups) at the industrial (wound dressing manufacture) and National Health Service interface. MAIN ISSUES: The wound dressing supply chain is outlined, tracking organizational changes. The methods that are used to transfer user information between industries that produce dressings and those using the products are reviewed in terms of their ability to communicate what users need from dressings. Organizational policies and systems are outlined, with the focus on their role in facilitating the communication of user needs. CONCLUSION: Methods for generating user information that can directly inform dressing design are needed together with interactive communication routes within the supply chain, specifically between users, manufacturers, purchasers and suppliers. This will facilitate dual benefits for nursing management through improvements in purchasing decisions and nurses' management of wound care.

Bandages↗

PubMed2001

Interpenetrating polymer network wound dressing versus petrolatum following facial CO2 laser resurfacing: a bilateral comparison.

BACKGROUND: Occlusive dressings increase the speed of epidermal wound healing by decreasing wound adherence, maintaining a moisture barrier, and allowing contact with healing factors. OBJECTIVE: To test whether a thin film of silicone and polytetrafluoroethylene blended into an interpenetrating polymer network (SPIPN) can provide improved healing over petrolatum following CO2 laser resurfacing injury. METHODS: A bilateral comparison of closed SPIPN versus open healing following two different CO2 laser delivery systems for resurfacing was performed. Twenty patients were followed and evaluated at days 1, 2, 3, 7, 14, 30, 60, and 90 for exudate, erythema, rate of epithelialization, pigment changes, postoperative pain, pruritus, cosmetic results, preference, and duration of postoperative complications. RESULTS: Results demonstrated improved healing for SPIPN compared to petrolatum alone. Markedly decreased exudate was seen in 90% of the SPIPN dressing sides. Erythema during the first 72 hours was 1.95 for SPIPN versus 2.6 for open (scale 1-4) (P <.05). Pruritus was 1.67 versus 2.44 (P <.05) for SPIPN versus open during the first 3 days postoperatively. Approximately 75% of the patients preferred SPIPN to control petrolatum. The rate of reepithelialization was also better for the SPIPN dressing, taking only 2 days versus 2.8 days for open control. Approximately 50% of the patients reported decreased pain on the SPIPN side at days 1 and 2. CONCLUSIONS: SPIPN dressing provides an easily applied, easily tolerated dressing for use after laser resurfacing. Many patients benefit from faster healing, reduced exudate, better appearance during the postoperative period, and decreased postoperative discomfort.

Bandages↗

PubMed2001

Silicone versus nonsilicone gel dressings: a controlled trial.

BACKGROUND: Silicone gel dressings decrease scar volume and soften hypertrophic tissue, allowing it to be more easily controlled by other methods. Although silicone does not appear to be an essential component of the treatment, nonsilicone dressings have been reported to cause no change in physical parameters during a 2-month treatment period. OBJECTIVE: To compare silicone and nonsilicone gel dressings in the treatment of keloids and hypertrophic scars, including a control group, and to evaluate the effectiveness of these treatments using two new assessment techniques. METHODS: Patients were randomly chosen to receive silicone or nonsilicone gel dressings in a 4.5-month controlled prospective study. Scar size, induration, and symptoms were evaluated before and after the treatment. Scar color was visually measured using a color palette catalog, and a new device was developed to measure intracicatricial pressure. RESULTS: All of the measured parameters were significantly reduced in both silicone- and nonsilicone-treated groups, as compared to the control, with no significant differences between them. CONCLUSION: Silicone and nonsilicone gel dressings are equally effective in the treatment of keloids and hypertrophic scars.

Adolescent↗

PubMed2001

Intrapartum epidural catheter migration: a comparative study of three dressing applications.

We compared three types of catheter fixation application for their ability to minimize the incidence and magnitude of epidural catheter movement during labour. Patients were randomized to have their epidural catheter secured by a Tegaderm dressing (group T; n = 35), a Tegaderm dressing plus filter-shoulder fixation (group F; n = 39), or a Niko Epi-Fix dressing (group N; n = 37). The length of catheter visible at the patient's skin surface was recorded (to the nearest 0.5 cm) after insertion and before removal; the difference was defined as 'catheter movement'. Outward movement of the catheter was greatest when a Niko Epi-Fix was used (P < 0.01). Concerning minimization of displacement of the epidural catheter per se, only a Tegaderm dressing with additional filter-shoulder fixation proved more effective than using a Niko Epi-Fix dressing (P < 0.05).

Analgesia, Epidural↗