A review of the role of amniotic membranes in surgical practice.
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The authors discuss indications for using different temporary skin substitutes in local burn therapy. The clinical philosophy is based on an experience of 15 years. The advantages of those biological materials containing epidermis are stressed. Experimental results obtained in laboratory pigs show the importance of local therapy applied during the first 24 hours following injury, especially in cases of dermal skin loss. The healing of experimental dermal burns, mechanical defects, defects after necrectomy of dermal and full thickness burns were studied. In a further series of experiments in vitro, various biological and synthetic materials were tested as to their efficacy in evaporative waterloss prevention. Best clinical and experimental results were obtained with allografts (fresh and deep frozen) and with xenografts.
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This publication represents a contribution for the experimental investigation of a suitable skin substitute for temporary covering of vast burns. The synthetic skin substitute SYSpur-derm is a bilaminar polyurethane foam substance. It was tested in the experimental animal pig on skin lesions after third-degree burn and necrectomy. A clean regularly arranged and good vascular granulation tissue was macroscopically and histologically visible on the sixth to the eight day. So favourable conditions were given for the healing up of auto-transplants and it epithelialised partially spontaneously. SYSpur-derm answers the demands on a temporary skin substitute. The synthetic skin substitute offers advantages with regard to the permanent availability, the storage and application, the immunologic inactivity, the sterilisation, and the relatively low cost in face of other materials.
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OBJECTIVE: The objective was to examine the efficacy of several treatment regimens in improving wound healing of cutaneous sulfur mustard (HD) injuries. METHODS: Wound healing studies were conducted in weanling pigs. Superficial dermal HD injuries were debrided at 48 hours postexposure using an erbium-doped yttrium aluminum garnet (Er:YAG) laser, followed by application of a treatment adjunct. A variety of noninvasive bioengineering methods were conducted during the postsurgical observation period to examine the various cosmetic and functional aspects of the skin. Histopathology was performed at the end of each study (14 or 21 days postsurgery). RESULTS: As noted clinically, reepithelialization was nearly complete by 7 days postsurgery for many of the sites treated with petrolatum and scarlet red dressings. By 21 days, the skin elasticity of the petrolatum-dressed sites was not significantly different from that of sham-exposed skin. Upon dressing removal on postsurgery day 4, the neoepidermis of allograft- and thin film-dressed sites was partially removed, with resultant petechial hemorrhaging. Mean pathology scores for hydrocolloid-dressed sites were significantly lower than those of untreated HD-exposed sites on postsurgery day 14. CONCLUSIONS: Care must be taken during bandage changes, and a nonadherent dressing that could be left in place for a longer period of time (eg, 7 days) would be beneficial. The use of cultured epithelial allograft material may have a potential role if grown on a completely nonadherent backing and left undisturbed for at least a week. Xeroform Petrolatum and Scarlet Red Ointment dressings are effective and inexpensive treatment adjuncts for HD injuries.
Sixty patients undergoing total knee replacement were randomized to receive either a cold compression dressing (Cryo/Cuff, Aircast, UK) or a modified Robert Jones bandage immediately after surgery. The cold compression dressing was used for a minimum of 6 h per day throughout the hospital stay, and the modified Robert Jones bandage remained in place for 48 h from the time of operation. The 2 groups of patients were compared during their hospital stay for blood loss, range of movement, pain scores and need for analgesia. No difference was found between the 2 groups except for less blood loss in the surgical drains in the cold compression group (P < 0.05). Postoperative complications were seen in both groups, but no complication was associated with either the cold compression dressing or the modified Robert Jones bandage.
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The use of potato peels as a dressing for burn wounds has been reported previously. A technique of preparing bandage rolls with boiled potato peels is now presented, which makes dressing of a burn wound more convenient.