An improved tie-over dressing technique for skin grafts using a hydrocellular dressing.
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Superficial wounds in a Yorkshire pig were treated with a semiocclusive polyurethane film dressing (PUD) or left open. The number and types of microflora present in the wounds each day was determined by a scrub technique, selective media, and the spiral plating system. In wounds covered with the PUD, the number of organisms increased, and there were more gram-negative pathogens. We concluded that microorganisms in wound beds multiply and survive better beneath a semiocclusive dressing than with air exposure.
A randomised prospective trial was carried out to compare the use of semipermeable and petroleum gauze dressings in fingertip injuries. The results demonstrate advantages in the use of semipermeable dressings.
At present the following guidelines for treatment of venous leg ulcers from our department are: Check the patients' general health--special attention to heart incompensation with oedema of the legs and the peripheral circulation. The most relevant laboratory tests are haemoglobin and urine-glucose. Routine bacterial cultivation is not necessary in non-diabetic patients as the result will generally not influence diagnosis, treatment or prognosis. Furthermore, treatment with topical antibiotics should be avoided. It is not only unnecessary, wasteful and sensitizing, but it also involves a risk of causing antibiotic resistance. Systematic antibiotic therapy is indicated only when obvious inflammatory signs in the tissues surrounding the ulcer are present, e.g. erysipelas or cellulitis. Non-sensitizing topical remedies should be applied. Avoid wool, alcohols, parabens, topical antibiotics and oxiquinolines. When eczema occurs use a hydrocortisone preparation in an inert base. Epicutaneous testing might be indicated. Bandages to be recommended are double-layer bandages consisting of an inner zinc oxide impregnated stocking and an outer elastic bandage and hydrocolloid dressing plus compression bandage.
BACKGROUND: Laser skin resurfacing has become an accepted technique for the treatment of facial rhytides and associated solar skin damage. Achieving a successful result is directly related to proper postoperative wound care during the reepithelialization process. There are open and closed approaches to the treatment of the post-laser resurfacing patient with distinct advantages and disadvantages. OBJECTIVE: To review the most commonly used closed dressings after facial laser skin resurfacing and compare their advantages and disadvantages. To compare clinical findings with a group of patients treated exclusively with an open technique. METHODS: Review of composite foams, polymer film, polymer mesh, and hydrogel products and prospective observations of clinical outcomes of patients treated with each dressing category after facial laser skin resurfacing. We perform a retrospective chart review of a group of patients treated exclusively with an open technique comparing crust formation, comfort, and pruritus with the prospective group of patients treated with closed dressings. RESULTS: The closed dressings available today each have unique structural configurations and adhesive properties intended to maintain an occlusive wound environment. Patient acceptance of these dressings was favorable, with improved comfort compared to the open dressing group. Complications of bacterial infections and contact dermatitis were not observed when closed dressings were used with a protocol for dressing changes performed at 48 hours. Rates of reepithelialization did not vary according to dressing category. Crust formation and postoperative pruritus occurred less frequently when closed occlusive dressings were worn by patients. CONCLUSIONS: When used properly, these dressings improve patient comfort, simplify their postoperative wound care, and do not increase the risk of infection or contact dermatitis. Overall satisfaction was highest with perforated mesh and polymer dressings for full-face wounds.
Hypertrophic scars represent an abnormal, exaggerated healing response after skin injury. In addition to cosmetic concern, scars may cause pain, pruritus, contractures, and other functional impairments. Therapeutic modalities include topical medications, intralesional corticosteroids, laser therapy, and cryosurgery. Topical therapies, in particular, have become increasingly popular because of their ease of use, comfort, noninvasiveness, and relatively low cost. This review will discuss the properties and effectiveness of these agents, including pressure therapy, silicone gel sheeting and ointment, polyurethane dressing, onion extract, imiquimod 5% cream, and vitamins A and E in the prevention and treatment of hypertrophic scars.
Hydrogel dressings are gaining increased clinical acceptance as a wound management modality. The purpose of this study was to compare the effect of three amorphous hydrogels with occlusive, control treatment (Tegaderm) on healing of experimental wounds. Eight partial-thickness cutaneous wounds (2.5 cm x 2.5 cm x 0.04 cm) were made, using an electrokeratome, and the four treatments were allocated by randomisation within a cephalad and a caudal region on each of six 60-kg domestic pigs. In total, twelve wounds were each treated with 2.0 ml of each type of hydrogel--an experimental amorphous hydrogel ("Exgel"), IntraSite Gel and a poloxamer gel containing 3% hydrogen peroxide--and covered with Tegaderm, or treated with Tegaderm alone. At 66 h post-operatively, formalin-fixed, paraffin-embedded sections of wounds were hematoxylin-eosin-stained and assessed morphometrically for epithelium coverage in a blinded fashion. The Exgel remained macroscopically intact on the wounds in contrast to the other hydrogels, which had dissolved completely after treatment. Exgel significantly (p < 0.05) increased epithelial coverage of the wounds, compared with the other treatments (by 20% more than Tegaderm-treated wounds). In vitro experiments indicated that the polymeric matrix of Exgel sequesters bioactive molecules present in wound fluid and that it may in vivo act as a protective reservoir that delivers bioactive molecules at a rate that promotes epithelial migration. Exgel may represent a new treatment principle to promote wound healing.
We treated 34 patients during 1987-1990 with a collagen wound dressing. Eleven patients had traumatic soft tissue defects, 10 patients had 3 degrees-grade open fractures, 7 patients had infected soft tissue wounds and 6 patients had deep 2 degrees and 3 degrees-degree burns. Our clinical experience confirmed the excellent clinical experimental results of collagen wound dressings. In all cases after 4 until 6 days of treatment good granulation and vascularisation of the wound bed was obtained, so that a skin transplant could be performed, which in all cases healed primarily. Moreover, the wound dressing had a good antibacterial effect and integrated actively in the wound healing process.
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