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PubMed1989

Uses and abuses of a biosynthetic dressing for partial skin thickness burns.

The following report reviews 851 applications of Biobrane on partial skin thickness burn wounds awaiting epithelialization. After the patients had been evaluated and resuscitated as needed, the burn wounds were cleansed and debrided. Those evaluated as shallow were treated with Biobrane application. Joint surfaces were splinted for immobilization. The wound was inspected at 24 and 48 h and if any fluid had accumulated it was aspirated and the wound was redressed. When the Biobrane was adherent, the wound was covered with a light dressing and joint immobilization was discontinued. Treatment with Biobrane dressing provided certain advantages over other topical wound care. As the dressing changes were performed less frequently outpatient care was possible, with a resultant decrease in both the length of hospital stay and the ultimate cost of burn care. Wound desiccation is prevented and pain is decreased. Accurate diagnosis of wound depth is crucial if Biobrane is to be used. Very deep wounds will not allow Biobrane adherence, neither will it occur if the wound has a high bacterial count. If joint surfaces are not splinted, the Biobrane will shear and not adhere to the wound. Convex and concave surfaces can be treated with Biobrane, which may need to be meshed.

Adolescent↗

PubMed1991

Immediate dressing of the burn wound--will it change its natural history?

Thirty deep dermal burns were inflicted on six domestic pigs. On the treated animals, the epidermis was removed and immediately replaced with Omiderm, Xeroform or Mettalin dressings. Burns in which the blister was left intact or not dressed after epidermis removal, served as controls. Macroscopic and microscopic assessment of the healing process was then carried out. Surprisingly, the no-epidermis controls healed somewhat faster than did the untreated controls (those with blister intact). On day 7, 83 per cent of the treated lesions showed initiation of epidermal regeneration, compared with 58 per cent in the no-treatment and no-epidermis controls. All dressing materials were found equal in this model, and differences between control and treatment groups were not significant after 12 days.

Animals↗

PubMed1992

DuoDERM hydroactive dressing versus silver sulphadiazine/Bactigras in the emergency treatment of partial skin thickness burns.

The study compared DuoDERM Burn Pack Hydroactive Dressings (DHD) with silver sulphadiazine/Bactigras dressings (SSD/Bactigras) in the outpatient management of small partial skin thickness burns. Forty-eight patients were entered into the study, and randomly allocated into either the DHD or SSD/Bactigras group. Burn wounds were followed until complete re-epithelialization occurred. There were no statistical differences between the groups, either with respect to their composition or characteristics of healing in days, and patients' subjective responses to treatment. However, application was easier in the DHD group (93 per cent), compared with 71 per cent in the SSD/Bactigras group (P = 0.0009), and the SSD/Bactigras were easier to remove (96 per cent) versus DHD (66 per cent, P = 0.0004). Furthermore, the DHD group had significantly less dressing changes; a mean of three changes per subject in the DHD group compared with eight in the SSD/Bactigras group (P = 0.117). Two burn wounds became infected in the DHD group, and one in the SSD/Bactigras group. In this study both modalities were found to be equally suitable and effective for small partial skin thickness burns.

Adolescent↗

PubMed1993

Management of partial thickness burns with Granuflex 'E' dressings.

In a prospective, open, randomized and parallel group trial, 98 patients with partial thickness burns suitable for outpatient management were treated with either Granuflex 'E' (n = 49) or Bactigras (n = 49). The objective was to compare the safety, efficacy and performance characteristics of Granuflex 'E' with Bactigras. The overall rating of the dressing by the investigators and the patients showed a significant preference for Granuflex 'E'. In addition, the quality of healing was rated as 'excellent' in 56 per cent of patients treated with Granuflex 'E', compared with only 11 per cent in the group treated with the conventional dressing. Granuflex 'E' is safe, effective and flexible and we recommend that it should be used as the first-choice dressing in the management of partial skin thickness burns.

Biological Dressings↗

PubMed1986

Polyurethane and silver sulfadiazene dressings in treatment of partial-thickness burns and abrasions.

Epi-Lock, a 1-mm-thick semipermeable sheet of modified polyurethane dressing material, was compared with silver sulfadiazene cream (Silvadene) in a prospective, randomized, cross-over-controlled study in which 50 patients alternated changing antibiotic cream daily with leaving the polyurethane sheet in place for a week. Overall, patient and physician preference for Epi-Lock was statistically significant (P less than 0.004), based on less pain, easier care, and faster healing. The collection of fluid under the polyurethane dressing and the necessity of leaving the wound covered for a week were less well accepted. Epi-Lock represents a major advance in wound dressing materials and should eventually gain wide application in outpatient treatment of partial thickness burns and abrasions.

Adolescent↗

PubMed2005

Evaluation of the effect of incorporation of dibutyryl cyclic adenosine monophosphate in an in situ-forming hydrogel wound dressing based on oxidized alginate and gelatin.

Cyclic adenosine monophosphate (cAMP) has long been regarded as a second messenger and a regulator of human keratinocyte proliferation. To explore more effective wound management, dibutyryl cyclic adenosine monophosphate (DBcAMP), a lipophilic analog of cAMP was incorporated into an in situ-forming hydrogel wound dressing based on periodate-oxidized alginate and gelatin. In vitro release of DBcAMP from the matrix into phosphate buffered saline was slow and increased with time. Only 50-60% of the compound was released into the medium over a period of 2 days suggestive of a sustained release into the wound bed over a period of few days. The wound-healing efficacy of the DBcAMP-incorporated dressing was evaluated on experimental full-thickness wounds in a rat model. It was found that dressing promoted wound healing leading to complete re-epithelialization of wounds within 10 days, whereas control wounds took 15 days for complete re-epithelialization. Data obtained in this study showed that the presence of DBcAMP accelerated healing and re-epithelialization of full-thickness wounds.

Alginates↗

PubMed2005

The cell based dressing with living allogenic keratinocytes in the treatment of foot ulcers: a case study.

In this study, we aimed to investigate the efficacy of cell based dressing with living allogenic keratinocytes in diabetic foot patients. To address this issue, the cultured keratinocytes were attached to the microcarriers produced from polyethylene and silica. The microcarriers were then applied to the wounds at 3-day intervals. Forty patients with grade II and III diabetic foot ulcers were included into the study. The patients were randomised into two groups (n=20). The treatment and control groups received cell based dressing and microcarriers kept in culture medium overnight, respectively. The wound size was recorded at 3 days intervals. The wounds were also categorised by a specific scoring system considering the wound contraction, granulation tissue formation, epithelisation and discharge from the wounds. The high score indicates better condition. The mean reduction of the wound area was 92% in the treatment group and 32% in the control group at the end of the 30 days treatment (p<0.001). When considered the complete healing, the mean number of dressings was 9.2+/-3.2 in the treatment group whereas it was 16.5+/-2.3 in the control group (p<0.001). The initial mean score of the treatment and control groups were 2.5 and 2.35, respectively. At the end of the 30th day, the mean score of the treatment group was 17.15+/-2.7 and of control group was 9.05+/-3. Allogenic keratinocyte treatment delivered with microcarriers can make significant contributions to wound healing in diabetic foot patients.

Biological Dressings↗

PubMed2006

The effect of local anaesthetic cream (EMLA) applied with an occlusive dressing on skin thickness. Does it matter?

EMLA cream is used in plastic surgery as a topical anaesthetic to harvest split skin grafts. It has been observed that the skin appears pale and oedematous after the application of EMLA. The aim our study was to determine the effect of EMLA with an occlusive dressing on skin thickness using a high frequency ultrasound. Twenty volunteers took part in this study after approval from the ethics committee. An area of skin was marked on both thighs and the skin thickness of each, measured using ultrasound. EMLA with an occlusive dressing was applied to one thigh. This was removed after at least 2 h of application time but at different time points and skin thickness of each thigh measured again. Data was analysed using t-test and Pearson's correlation. Mean age in years +/- SD (range) was 36.1 +/- 12.1 (23 - 61). Male:female ratio was 8:12. Mean skin thickness +/- SEM increased from 1.86 +/- 0.055 mm prior to EMLA application to 1.96 +/- 0.051 mm post-EMLA application p= 0.02. There was a significant correlation between the increase in skin thickness and duration of application of EMLA cream (p = <0.001, R2 = 0.59). The results conclude that EMLA applied under an occlusive dressing has an effect on skin tissue thickness and any surgeon who harvests split skin grafts under EMLA should be aware of this. Further research is needed to compare laser treatments performed under local anaesthetic creams against general anaesthesia as an increase in skin thickness may affect the depth of laser penetration.

Adult↗

PubMed2006

Development and in vitro evaluation of chitosan-polysaccharides composite wound dressings.

This study focuses on the design and evaluation of chitosan-based films intended for wound dressing application. Films of chitosan and their blends with cornstarch and dextran were developed to improve the films' physical strength. Polypropylene glycol at concentrations of 0.5, 1.0 and 1.5% (w/v) was added to improve the films' flexibility. Some properties required for successful wound dressing, such as liquid adsorption, vapor and oxygen penetration, bioadhesiveness, and film elasticity, were examined. Chitosan films showed the highest liquid adsorption and the adsorption tended to decrease with addition of cornstarch and dextran. Moisture vapor and oxygen were found to be able to penetrate through all film formulations, and those films with cornstarch and dextran showed increased penetration rates through the films. The bioadhesiveness test using a pig gut model did not show significantly different bioadhesive properties with the addition of cornstarch and dextran. The film elasticity of the formulation containing only chitosan exhibited the lowest elongation of the film at a force of 2N, but increased with the addition of cornstarch and dextran, respectively. In conclusion, the design and development of chitosan as a wound dressing can be improved by the addition of cornstarch or dextran, and propylene glycol to obtain the films with optimal properties for wound management.

Adhesiveness↗

PubMed1980

Hypospadias surgery: the X-shaped elastic dressing.

An effective, easily fashioned, adherent, long-term X elastic dressing is described. The dressing has been used predominantely in hypospadias operations. It affords excellent compression of the skin and glandular flaps, and reduces edema. The dressing provides for children comfort, freedom of motion without interference with normal bowel movements and effective compression of the genitalia, and it appears to have a broad-spectrum of application in pediatric and adult urologic surgery. Complications are rare.

Humans↗

PubMed1985

Occlusive wound dressings to prevent bacterial invasion and wound infection.

This study was designed to examine the possibility that some occlusive dressings are barriers to wound penetration by pathogenic bacteria. Two common skin pathogens, the nonmotile, Staphylococcus aureus, and the motile, Pseudomonas aeruginosa, were used to challenge dressings placed on partial-thickness wounds in swine. S. aureus was recovered from 100% of air-exposed wounds (log, 5.5 +/- 1.1) and from 50% of Op-Site-treated and Vigilon-treated wounds (log, 6.1 +/- 1.1). S. aureus was not isolated from DuoDERM-covered wounds. P. aeruginosa was recovered from 100% of air-exposed wounds (log, 5.1 +/- 0.5) and 100% of Op-Site-covered and Vigilon-covered wounds (log, 5.8 +/- 1.8). P. aeruginosa was not recovered from DuoDERM-covered wounds. These studies lend support to the idea that dressings may protect wounds from invasion by pathogenic bacteria and demonstrate the need to evaluate their bacterial barrier properties in situ.

Animals↗

PubMed1985

Wound dressings for dermatologic surgery.

Cutaneous surgery requires more than technical skill. A thorough understanding of instrumentation, suture material, sterile technic, and wound dressings is also imperative. This article will organize, primarily by pictorial essay, the often-neglected subject of surgical dressings. The principals and theory of dressings, the materials available to construct them, and the specific technics for tailoring them to difficult anatomic sites will be presented.

Bandages↗

PubMed1985

Dermal wound repair: role of collagen matrix implants and synthetic polymer dressings.

The effects of two different polymeric wound dressings and a new collagen matrix (CM) implant on the healing and scarring of full-thickness excision wounds were studied in swine. The synthetic polymers comprised an occlusive O2-impermeable hydrocolloid dressing (HCD) and an occlusive O2-permeable polyurethane film (PUF). The CM implant consisted of an acellular collagen sponge fabricated from purified bovine tendon type I collagen. Wounds were evaluated for granulation tissue--production capacity by measuring 14C proline incorporation into collagenase-sensitive protein. Epidermal resurfacing and wound contraction were measured by computerized morphometric image analysis of wounds made on a tattooed grid. In comparison with air-exposed wounds, the relative collagen synthetic capacity was greater in the granulation tissue of wounds treated with HCD, PUF, or CM with occlusion. Both HCD and PUF accelerated by 40% the epidermal resurfacing over the granulating wound bed. Wound contraction was significantly reduced by CM but was not altered by the occlusive dressings.

Animals↗

PubMed1983

Treatment of skin graft donor sites with a semipermeable polyurethane dressing.

The use of a semipermeable dressing for skin graft donor sites has been described. It permits patients with healing donor sites to ambulate, shower, and wear clothing with no pain during the healing phase. Healing is easily monitored, and signs of infection can be detected early and treated promptly, preventing involvement of the full thickness of the wound. Patients can be discharged from the hospital while the donor site is still healing. The dressing can be removed painlessly at home or in the office. The SPD appears superior to any of the more conventional dressings currently in use for treating skin graft donor sites.

Female↗

PubMed2001

A newly developed hydrofibre dressing, in the treatment of partial-thickness burns.

A newly developed, carboxymethylcellulose based hydrofibre dressing, Aquacel, was tested for the treatment of partial thickness burns. In this study 84 patients with mainly partial thickness burns were included, 76 patients received 1 or 2 days pre-treatment with a topical antimicrobial agent. Clinical behaviour showed a strong resemblance with cadaver skin treatment with respect to adherence to the wound. Adverse reactions, incidence of clinical wound infection, healing time and the need for wound excision and grafting were analysed, as was the final outcome using the 'Vancouver Scar Scale'. The mean size of the wounds treated with the hydrofibre dressing was 6.0% body surface area (min: 1%, max: 18%). Two patients clinically showed signs of a wound infection during treatment, but in general wound cultures were low or negative. In 42 patients (50%) the wounds healed completely within 10 days, in six patients (7%) small defects remained that healed by further treatment with a topical antimicrobial cream. In 36 patients (43%) excision and grafting of the remaining deeper parts of the wounds was performed as this is the standard therapy in the centre for all burned areas that have not healed within 2-3 weeks post-injury. The extent of the surgical procedures was limited since 66.1% of the wound area had healed already at the end of the hydrofibre treatment. In 54 patients the outcome of the treatment after 2-3 months was analysed by means of the Vancouver Scar Scale, which showed favourable results in general, and especially for patients who did not require surgery. Compared to earlier experience with allograft skin it was concluded that hydrofibre dressing is a safe, suitable and easy to use material for treatment of partial thickness burns.

Adolescent↗

PubMed1998

A study of the concentration of orally administered sparfloxacin found in exudates from suture wounds beneath occlusive dressings.

The concentration of orally administered sparfloxacin (SPFX), an antimicrobial agent, in exudates from the suture wounds beneath occlusive dressings has been measured. Twenty-one patients who received oral therapy with 100 mg of SPFX prior to surgery and 200 mg/day of SPFX after surgery were studied. During the operations, the suture wounds were covered by occlusive film. 48h post-operation, wound exudates under the dressings were drawn and measured using high performance liquid chromatography. SPFX values were 0.801+/-0.340 microg/ml (mean+/-SD). The results suggest that wound exudates beneath the occlusive dressing have concentrations of SPFX high enough to prevent infection in most cases when administered orally.

Administration, Oral↗

PubMed1999

Effectiveness of human amnion preserved long-term in glycerol as a temporary biological dressing.

Human amnion as a temporary biological wound dressing has remained a beneficial and cost-effective means of treating burns in developing countries. The aim of this study was to determine whether human amnion that has undergone long-term preservation in glycerol is an effective biological dressing compared to fresh amnion and glycerol-preserved human skin. Samples of human amnion and skin were preserved in sterile containers of 85% glycerol at 4 degrees C for over a year. Dorsal full-thickness or split-thickness skin wounds were produced in rats. The defects were divided into four areas, each of which was covered with preserved amnion, fresh amnion, preserved skin, or left uncovered as a control. The materials on the wounds were evaluated macroscopically and microscopically after 2, 4, 7, 10 and 14 days. The primary take or adherence of the grafts on full-thickness wounds was evaluated at 4 and 7 days, and material performance was scored based on several macroscopic and microscopic criteria. The bacteria levels reducing effect of the materials were examined by quantitative bacteriology in heavily infected full-thickness scald burn wounds of rats. Qualitative cultures confirmed that the storage conditions the materials were subjected to for over a year were aseptic and that the amnion and skin had maintained their characteristic properties. All materials were found effective on partial-thickness rat wounds as a cover under which re-epithelialization was completed by 7 days. The preserved skin performed better than either preserved or fresh amnion on full-thickness wounds but the performance of preserved amnion was comparable to that of fresh amnion. Glycerol-preserved amnion was found to be as effective as fresh amnion or skin in terms of decreasing bacterial levels in infected rat burn wounds. Amnion stored in glycerol is reliable and effective for a long period of time. Amnion banking could provide an unlimited quantity of biologic dressing for burn treatment at low cost, a factor that is particularly important in developing countries.

Amnion↗

PubMed2000

Analysis of cost of dressings in the care of burn patients.

This study aimed at analyzing the costs of material used in the occlusive dressings of burn patients. The subjects of the study were patients over the age of 18 years who were admitted to the Burns Unit of the Ribeirão Preto Medical School Clinical Hospital, University of São Paulo-Brazil, from 15 January to 11 September 1998. Data were collected concerning the costs and duration of bathing and dressing of these patients. We concluded that there was a positive relation between the real costs of the materials used and the percentage of the body surface burned. In addition, there was a positive correlation between the number of staff involved in care and the size of the burns. There was no significant difference between the cost of materials used in dressings for burns of different depths.

Adolescent↗