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PubMed2005

Pediatric hand dressing: technical report.

A compressive or conforming dressing is an important aspect of hand surgery, particularly the role of uniform pressure to the entire hand. Pediatric hand patients require special considerations with respect to appropriate postoperative dressing to maintain equal limb compression and to maintain the dressing during the postoperative period. This article describes a specific upper-limb hand dressing that can be used in the infant and young child.

Bandages↗
PubMed2005

Effect of rotary or manual instrumentation, with or without a calcium hydroxide/1% chlorhexidine intracanal dressing, on the healing of experimentally induced chronic periapical lesions.

OBJECTIVE: To evaluate the healing of experimentally induced chronic periapical lesions in dogs at 30, 75, and 120 days after root canal instrumentation with rotary NiTi files or manual K-files, with or without a calcium hydroxide/1% chlorhexidine paste intracanal dressing. STUDY DESIGN: The second, third, and fourth mandibular premolars and the second and third maxillary premolars of 5 dogs (12 to 18 months of age, weighing 8 to 15 kg) were selected for treatment (a total of 82 root canals). After pulp removal, the root canals were left exposed to the oral cavity for 7 days to allow microbial contamination, after which the root canals were sealed with ZOE cement until periapical lesions were confirmed with radiography. Group I and II teeth were instrumented with manual K-files using the crown-down technique. In group III and IV teeth, NiTi rotary files were used. The apical delta was perforated by using #20 to #30 K-files at the length of the tooth, thus creating a standardized apical opening. The apical stop was enlarged to size 70, with 2.5% sodium hypochlorite irrigation at each file change. Teeth in groups II and IV were dressed with calcium hydroxide (Ca(OH) 2 )/1% chlorhexidine (CHX) paste for 15 days before root filling. Group I and III teeth did not receive an intracanal dressing. The access openings of the teeth were permanently restored with silver amalgam condensed on a glass ionomer cement base. Pairs of standardized periapical radiographs were taken at the beginning of the treatment (0 days) and at 30, 75, and 120 days after filling. RESULTS: There was no significant difference in the rate of radiographic healing of the periapical lesions between manual and rotary instrumentation. Radiographs taken at 120 days showed that the treatment with Ca(OH) 2 /1% CHX paste resulted in a significant reduction in mean size of the periapical lesions in comparison to single-session treatment. These findings were also true for histologic observations. CONCLUSION: The findings support the hypothesis that, regardless of the instrumentation technique (manual or rotary), the use of an intracanal dressing is important in the endodontic treatment of dog's teeth with experimentally induced chronic periapical lesions.

Analysis of Variance↗
PubMed1975

Treatment of gastroschisis and omphalocele with biological dressings.

Porcine skin grafts and human amniotic membranes have been used as biological dressings for the treatment of gastroschisis or omphalocele in 16 newborn infants. Eleven infants with gastroschisis were managed initially by the Silastic pouch technique but delayed healing resulted in separation of the Silastic sheeting from the wound margins and required use of biologic dressings to achieve complete closure. Biological dressings were used in five patients with intact omphaloceles for all or part of their course. Average time to achieve complete closure was 55 days. Three patients died of associated anomalies. One patient developed an enteric fistula. Biologic dressings appear to be useful adjuncts in the management of some patients with gastroschisis or omphalocele.

Abdominal Muscles↗
PubMedDate not supplied

Choosing a wound dressing.

With more than 2000 wound care products on the market, choosing an appropriate dressing for the geriatric patient can prove to be a difficult task. Age-related changes in skin structure and decreased resistance to noxious stimuli in the environment place the elderly patient at higher risk for wound complications. Understanding the principles of moist wound healing and how dressing materials can be used to promote healing outcomes gives the clinician a foundation upon which to base treatment decisions. Assigning products to generic dressing categories further facilitates dressing selection, allowing the treatment protocol to be individualized to the patient, the wound, and the setting.

Aged↗
PubMed2001

[DRESS (Drug Rash with Eosinophilia and Systemic Symptoms) syndrome after sulfasalazine and carmazepine: report of two cases].

INTRODUCTION: To better individualize drug hypersensitivity reaction, Bocquet et al. have recently called this adverse drug reaction DRESS (Drug Rash with Eosinophilia and Systemic Symptoms). EXEGESIS: We report two cases of DRESS and highlight the main characteristics of this syndrome. Two patients presented severe febrile skin eruption following drug intake (carbamazepine or sulfazalazine), with hypereosinophilia and hepatitis. All symptoms resolved after drug withdrawal and corticosteroid therapy. DRESS syndrome is an idiosyncratic reaction characterised by febrile eruption, occurring 2 to 6 weeks after the beginning of the treatment, accompanied by systemic symptoms and biological abnormalities (hypereosinophilia, hepatitis). Some complications can occur. This syndrome can be fatal. Numerous drugs can be responsible for this reaction to medication. The physiopathology has not yet been elucidated, and the treatment is not codified, but the triggering agent must immediately be stopped. Corticotherapy is sometimes used. CONCLUSION: It is important to recognize this entity recently named DRESS syndrome because it can mimic other pathologies, is potentially serious, and because withdrawal of the incriminating drug is imperative.

Adolescent↗
PubMed2003

Antimicrobial properties of silver-containing wound dressings: a microcalorimetric study.

The studies reported here have been undertaken to assess the potential use of isothermal microcalorimetry in studying the antimicrobial efficacy of wound dressings that contain antimicrobial agents. The microcalorimetric technique allows non-invasive and non-destructive analysis to be performed directly on a test sample, regardless of whether it is homogeneous or heterogeneous in nature. Microcalorimetry is an established procedure that offers quantitative measurements and has the distinct advantage over traditional antimicrobial test methodologies in that calorimetric measurements are made continuously over real-time, thus the dynamic response of microorganisms to an antimicrobial agent is observed in situ. The results described in this paper are for interaction of two silver-containing wound care products AQUACEL Ag Hydrofiber (ConvaTec, Deeside, UK) and Acticoat 7 with SILCRYST (Smith and Nephew Healthcare, UK) with the wound pathogenic organisms Staphylococcus aureus and Pseudomonas aeruginosa. Both dressings are shown, microcalorimetrically, to have the capacity to kill these common wound pathogens within 1-2 h of contact. A dose-response study was conducted with the AQUACEL Ag dressing. Microcalorimetry is shown to be rapid, simple and effective in the study of the antimicrobial properties of gel forming wound dressings.

Anti-Infective Agents↗
PubMed1996

A simple in vitro model to test the efficacy of antimicrobial agents released from dressings.

A new model for in vitro evaluation of an activity of antibacterial agents released from delivery systems containing antibiotics or antiseptics was developed. The model was composed of two layers of agar gel of two different concentrations in PBS. In the upper gel, the wells were cut and filled with polyurethane sponges saturated with bacterial broth culture. The sponges were then covered with tested dressings containing antibacterial agent. The model was tested by using two bacterial strains, Pseudomonas aeruginosa or Staphylococcus aureus and experimental collagen dressing with doxycyclin, amikacin, or with silver sulfadiazine. The number of colony-forming units (CFU) in the polyurethane sponges was significantly lower under the dressings with antibacterial agents as compared to the control (the same dressing without antimicrobials) during 3 days of observation. The new in vitro model can be recommended for examination of different antibacterial delivery systems instead of experimentally infected wounds in laboratory animals or instead of the other in vitro models.

Agar↗
PubMed1999

Description of pressure ulcer pain at rest and at dressing change.

PURPOSE: To describe and compare the pain experienced by patients with stage II, III, and IV pressure ulcers both at rest and during dressing change. PATIENTS AND SETTING: Thirty-two subjects were recruited from acute, extended, and home care settings in the Midwest. The sample population ranged in age from 47 to 95 years (mean age 74.7 years, SD = 12.8), were white, and evenly divided between male and female patients. METHODS: Patients used the McGill Pain Questionnaire to rate their pressure ulcer pain at rest and again at dressing change. RESULTS: Twenty-eight subjects (87.5%) reported pain at dressing change and 27 (84.4%) experienced pain at rest, compared with 4 (12.5%) subjects who reported no pressure ulcer-related pain. Of the 28 reporting pain, 21 (75%) rated their pain as mild, discomforting, or distressing, and 5 (18%) described their pain as horrible or excruciating. Twelve (42%) reported their pain as continuous, occurring both at rest and during dressing changes. Despite these reports, only 2 (6%) subjects had received medication for their pressure ulcer pain. Although none of the hypotheses were statistically significant, we observed that patients with stage II, III, and IV pressure ulcers experienced pain. CONCLUSIONS: Within this study sample, the majority of patients had pressure ulcer-related pain, which for some was severe and constant. Therefore we conclude that the potential for pressure ulcer-related pain should be anticipated and assessed on a regular basis. In addition, further research is needed to increase our understanding of pressure ulcer pain and to find effective interventions for its relief.

Aged↗
PubMed1997

The influence of dressings on venous ulcer healing--a randomised trial.

OBJECTIVE: To assess the effect of different dressings on venous ulcer healing. DESIGN: A randomised clinical trial. MATERIALS: Patients were randomised to treatment with one of three dressings: a zinc oxide impregnated bandage, a zinc oxide impregnated stockingette, or an alginate dressing. All patients were treated as outpatients and had compression bandaging with two minimal stretch bandages (Elastocrepe) and a stockingette (Tubigrip) to keep the bandages in place. METHODS: One hundred and thirteen patients (133 ulcerated limbs) with chronic ulceration of the leg due to venous disease alone, and attending Fremantle Hospital Leg Ulcer Clinic, Western Australia were entered into the study. Healing was measured as complete healing of the ulcerated limb or failure of the limb to heal within 9 months. RESULTS: There was no significant difference between the three groups in ulcer size, duration, and other parameters compared. Healing was affected significantly by ulcer size and which leg was ulcerated. There was significantly faster healing with the paste bandage. CONCLUSION: The use of a paste bandage significantly improved the healing of chronic venous ulcers when used in combination with compression bandaging, and compared to an alginate dressing and a zinc oxide impregnated stockingette.

Adult↗
PubMed2000

An audit of patient perception compared with medical and nursing staff estimation of pain during burn dressing changes.

In order to prescribe appropriate analgesia for burns dressing changes the pain experienced by 30 burned patients during this procedure was recorded. Patients received analgesia prior to their dressing changes according to the current protocol in the burns unit. During the same period the medical and nursing staff in the unit who were involved in prescribing and administering the analgesia for the dressing change, were asked to assess the severity of pain that they thought patients experienced during dressing changes. Patients recorded their worst pain as none or mild in 64% of procedures. In contrast, no surgeon and only one nurse, rated pain as none or mild. The discrepancy between severity of pain recorded by patients and the pain predicted by staff prescribing and administering analgesia has clinical implications.

Acetaminophen↗
PubMed2003

Dressing size and pain: a prospective trial.

BACKGROUND: Pain is a personal, subjective experience. In the postoperative period, pain may be influenced by patient, pharmacological and environmental factors. In surgery the aim is to reduce pain in this period by educating patients and using adequate analgesia. The aim of the present study was to assess the effect of perceived wound size on pain, as indicated by wound dressing, in the immediate postoperative period. METHODS: Patients undergoing appendicectomy were randomized into a group having a dressing the same size (SSD) as the surgical wound or double the size (DSD) of the wound. Patients' pain perception and analgesic requirements were then recorded and analysed to compare the two groups. RESULTS: Both groups had similar results when comparing pain perception. The median total pain score for the SSD and DSD groups at 12 and 24 h postoperatively revealed no statistically significant difference (P > 0.05). CONCLUSION: The data do not support the hypothesis that postoperative pain may be altered by perceived wound dressing size. Dressing size does not appear to be a variable that could easily be altered to reduce postoperative pain in surgical patients.

Adolescent↗
PubMed2001

Sodium carboxyl-methyl-cellulose dressings in the management of deep ulcerations of diabetic foot.

AIMS: To test the safety and effectiveness of carboxyl-methyl-cellulose dressing (Aquacel; ConvaTec, UK) in the management of deep diabetic foot ulcers, a group of consecutive out-patients attending the foot clinic of the Department of Metabolic Diseases was studied. METHODS: Patients were selected according to the following inclusion criteria: a foot ulcer deeper than 1 cm for > 3 weeks, good peripheral blood supply (palpable peripheral pulses or ABPI > 0.9). Exclusion criteria were as follows: active infection, as evident from clinical signs (purulent discharge, redness, swelling, tenderness) and confirmed by culture exams, plasma creatinine > 2 mg/dl, recent episodes of ketoacidosis, malignancies, and any therapy or pathology which might interfere with the healing process. Twenty patients were enrolled in the study and having obtained their informed consent, their lesions were surgically debrided with the complete elimination of all necrotic tissue and debris up to the bleeding healthy tissue; then ulcers were staged and measured, and patients were randomly assigned to two different treatment groups. Patients in group A were dressed with saline-moistened gauze, while patients in group B were dressed with Aquacel according to the manufacturer's instructions. All patients in both groups received special post-operative shoes (Podiabetes; Zeno Buratto, Treviso, Italy) and crutches until complete re-epithelialization. Ulcers were all left to heal by secondary intent. After 8 weeks patients were blindly evaluated for: the rate of reduction of lesional volume (RLV), rate of granulation tissue (GT), number of infective complications (IC). Intralesional (ILTC) and perilesional (PLTC) temperatures were also recorded with a thermocouple surface digital thermometer, and the difference between the two values (Delta TC) was calculated. Healing time (HT, days), was then compared between the two groups. Data were compared by analysis of variance (ANOVA), linear regression, Kaplan-Meier survival analysis and Fisher's exact test. RESULTS: HT was significantly shorter in Group B than in Group A (P < 0.001). RLV was significantly (P < 0.01) higher in Group B patients compared with Group A, as well as GT (P < 0.05). IC were in 1/10 Group B and in 3/10 Group A (P = 0.582). In addition, both ILTC and Delta TC were higher in Group B compared with Group A ones (P < 0.01). CONCLUSIONS: Carboxyl-methyl-cellulose dressings were shown to be safe, effective and well tolerated in the management of non-ischaemic, non-infected deep diabetic foot ulcers.

Adult↗
PubMed1999

The evaluation of a cadexomer iodine wound dressing on methicillin resistant Staphylococcus aureus (MRSA) in acute wounds.

BACKGROUND: Many bacteria have become resistant to commonly-used antibiotics. OBJECTIVE: The purpose of this study was to examine the effect of a cadexomer iodine wound dressing on methicillin resistant Staphylococcus aureus (MRSA). METHOD: Partial thickness wounds were made on the backs of three pigs and inoculated with a known amount of MRSA. Wounds were treated with either cadexomer iodine dressing or vehicle dressing (without iodine), or they were left untreated. Three wounds from each treatment group per animal were cultured using quantitative scrub techniques after 24, 48, or 72 hours of treatment. CONCLUSIONS: The cadexomer iodine dressing significantly reduced MRSA and total bacteria in the wounds as compared to both the no treatment control and vehicle. No significant differences were observed in the number of bacteria recovered between the no treatment control and cadexomer (vehicle) treated wounds. Cadexomer iodine may be an effective agent for preventing proliferation of MRSA in wounds.

Animals↗
PubMed1999

Another method of tie-over dressing for surgical wounds of hair-bearing areas.

BACKGROUND: We describe a modified tie-over dressing for any kind of surgical wound in the hair-bearing areas. METHODS: The long ends of the sutures are tied over the gauze pad to secure it. CONCLUSIONS: This modified technique of tie-over dressing can be utilized for the majority of surgical wounds in hair-bearing areas, such as the scalp. The dressing can be removed 1 or 2 days postoperatively by the patients, and the wound can be washed thereafter. The dressing helps ensure hemostasis, is simple to perform, looks tidy, and is well accepted by the patients.

Bandages↗
PubMed2000

Unna and elastic postoperative dressings: comparison of their effects on function of adults with amputation and vascular disease.

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.

Aged↗
PubMed2004

Conscious sedation: Off-label use of rectal S(+)-ketamine and midazolam for wound dressing changes in paediatric heat injuries.

BACKGROUND: Wound dressing changes after heat injuries expose the patient to repeated painful and frightening procedures in short intervals. Safe, adequate, and easily administered analgesia and sedation are required. The goal of this study was to evaluate the off-label use of rectally administered S(+)-ketamine and Midazolam by paediatric surgeons during repeated outpatient dressing changes for paediatric burns and scalding. PATIENTS AND METHODS: A total of 47 dressing changes of 30 children with I - IIa degrees burns were evaluated. Vital signs, side-effects, complications, anxiolysis, and analgesia were recorded during the procedure and for the following two hours. Patients were assessed by a discharge scoring system and an age-appropriate pain scoring system at regular intervals. Before discharge, parents were interviewed on their level of satisfaction with the protocol. RESULTS: Adequate sedation and analgesia was achieved in 44 procedures (94 %). No complications and, in particular, no compromise of breathing, ventilatory, and cardiovascular functions were recorded. The discharge scoring system indicated a return to baseline function 30 minutes after the procedure in all patients. The parents were generally very satisfied with the protocol. All children old enough to be questioned were found to have an anterograde amnesia for the duration of the procedure. CONCLUSION: Conscious sedation with rectally applied S(+)-ketamine and Midazolam allows safe and painless dressing changes after heat injuries in children.

Adjuvants, Anesthesia↗
PubMed2002

Influence of root canal dressings and sealers on repair of apical periodontitis after endodontic treatment.

OBJECTIVE: The objective of this study was to evaluate the histopathologic response of periapical tissues after root canal treatment of necrotic dog teeth with chronic apical periodontitis by using 2 calcium hydroxide-based root canal dressings and 2 root canal sealers. STUDY DESIGN: Seventy-eight root canals were instrumented by using 5.25% sodium hypochlorite as the irrigating solution, after which a calcium hydroxide paste (Calen/PMCC or Calasept) was placed for 30 days as a dressing. The root canals were then filled by using cold lateral gutta-percha condensation and an endodontic sealer (Sealapex or AH Plus). After 360 days, the animals were killed by anesthetic overdose; then, the teeth were histologically prepared, sectioned, and stained with hematoxylin and eosin for optical microscopic analysis of apical and periapical tissue repair. RESULTS: Statistical analysis showed that the poorest histopathologic results were observed in the Calasept/AH Plus group and that the Sealapex sealer overall resulted in better apical repair than the AH Plus sealer. The histopathologic results of Calen/PMCC paste with both AH Plus and Sealapex and Calasept paste with only Sealapex were statistically similar but were different from the results of Calasept with AH Plus. CONCLUSIONS: The results of this study in the dog showed differences in apical and periapical tissue repair of teeth with chronic apical periodontitis by using 2 calcium hydroxide root canal dressings and 2 sealers. More research is necessary to determine the best combination of dressings and sealers.

Animals↗
PubMed2006

Wound dressings containing bFGF-impregnated microspheres.

The primary objective was to synthesize a novel wound dressing containing basic fibroblast growth factor (bFGF)-loaded microspheres for promoting healing and tissue regeneration. Gelatin sponge was chosen as the underlying layer and elastomeric polyurethane membranes were used as the external layer. To achieve prolonged release, bFGF addition was loaded in microspheres. The microspheres were characterized for particle size, in vitro protein release and bioactivity. The bilayer dressings were tested in in vivo experiments on full-thickness skin defects created on pigs. Average size of the microspheres was 14.36 +/- 3.56 microm and the network sponges were characterized with an average pore size of 80-160 microm. Both the in vitro release efficiency and the protein bioactivity revealed that bFGF was released in a controlled manner and it was biologically active as assessed by its ability to induce the proliferation of fibroblasts. It was observed that sustained release of bFGF provided a higher degree of reduction in the wound areas. Histological investigations showed that the dressings were biocompatible and did not cause any mononuclear cell infiltration or foreign body reaction. The structure of the newly formed dermis was almost the same as that of the normal skin. The application of these novel bilayer wound dressings provided an optimum healing milieu for the proliferating cells and regenerating tissues in pig's skin defect models.

Animals↗