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PubMed1998

[Effect of dressing materials on wound healing].

In the early 1970s, a major revolution in the management of wounds began. Simple woven absorbents that kept the wound as dry as possible were superseded by occlusive dressings that provided moist wound healing. The wound healing process is influenced by control of moisture content, thermal properties, gaseous permeability, pH effects, and impermeability to micro-organisms. Low adherence of the dressing provides protection of the newly formed tissue and relieves the patient's pain during removal.

Bandages↗
PubMed2004

Comparing a foam composite to a hydrocellular foam dressing in the management of venous leg ulcers: a controlled clinical study.

Venous leg ulcers are the most prevalent form of chronic wounds in the Western world. The principles of moist wound healing coupled with the use of graduated compression bandaging have become the cornerstone of treatment for venous leg ulcers but not all moist dressings are alike. To compare the attributes of a foam composite dressing with those of a hydrocellular foam dressing in the management of venous leg ulcers, a prospective, randomized, comparative 12-week study was conducted in 15 centers in the US, Canada, France, Germany, and the UK. Dressings were changed and compression bandages applied per manufacturer recommendations and dressing performance was assessed at every dressing change and at the final evaluation. Patients with venous ulcers were randomized to treatment for 12 weeks with either hydrocellular foam (n = 52) or foam composite (n = 55) dressing. Healing differences between the groups were not statistically significant, with 36% of patients using foam composite dressing healed in a mean of 66 days and 39% of patients using hydrocellular foam dressing healed in a mean of 73 days. However, the foam composite dressing performed significantly better than the hydrocellular foam dressing with regard to condition of the periwound skin - 55% of patients in the foam composite group having healed or markedly improved surrounding skin compared to 37% of patients using hydrocellular foam (P = 0.03). The foam composite dressing was rated significantly better than the hydrocellular foam dressing ("very good" to "excellent") in level of satisfaction with conformability (87% and 75%, respectively, P = 0.05); being non-sensitizing (73% and 52%, respectively, P = 0.02); and ease of application (93% and 81%, respectively, P = 0.01). The findings reported in this study suggest that the foam composite dressing offers significant improvements in the quality of life of patients with venous leg ulcers as well as for their caregivers.

Adult↗
PubMed2002

The effect of gel burns dressings on skin temperature.

OBJECTIVES: This study was designed to investigate the effect on skin temperature of different methods of use of a hydrogel dressing. METHODS: Twelve volunteers had temperature measured under a hydrogel dressing with different combinations of air movement and bandaging. RESULTS: A large drop in skin temperature was only achieved when the dressing was left exposed with air movement over the surface of the dressing. CONCLUSIONS: A temperature that gives effective analgesia is not reached if the dressing is used in accordance with the manufacturer's instructions (covered with an insulating layer). This explains the authors' observation that paramedics and patients often leave these dressings uncovered.

Burns↗
PubMedDate not supplied

Feasibility of day case varicose vein surgery in a district general hospital.

BACKGROUND: Day case surgery may reduce inpatient bed requirements, and varicose surgery may be an ideal operation to test the functioning of a day surgery service. AIMS: To evaluate retrospectively the feasibility of day case varicose vein surgery in all-comers, and to identify the risk factors for admission. METHODS: Over a three-year period from July 1995 to July 1998, all patients requiring varicose vein surgery had their procedure performed as a day case. A standard technique of sapheno-femoral ligation with below-knee stripping of the long saphenous vein and multiple stab avulsions of varicosities was performed. All limbs were dressed with wool in crepe bandage and were reviewed post-operatively at six weeks. RESULTS: Five hundred and forty two patients underwent varicose vein surgery, of whom 26% had bilateral varicose veins, 88% had primary varicose veins and 22% had recurrent disease. The procedure was performed under general anaesthesia in 86% of cases and under spinal anaesthesia in the rest. There was no peri-operative mortality. Ten patients (1.9%) developed post-operative complications. Seventy two per cent of patients were discharged on the day of surgery, a further 25% required admission for one night due to minor anaesthetic complications and patient preference. Four per cent required admission for more than 24 hours. The need for overnight admission was associated with the age of the patients (p < 0.0001), bilateral varicose vein surgery (p < 0.005) and the use of spinal anaesthesia (p < 0.01). CONCLUSION: Although varicose vein surgery is safe, acceptable and cost-effective as a day case procedure, if attempted in all-comers, overnight admission will be required in a significant proportion. Pre-operative selection is advised.

Ambulatory Surgical Procedures↗
PubMed1989

Poly(ether urethane) wound covering with high water vapour permeability compared with conventional tulle gras on split-skin donor sites.

The experimental poly(ether urethane) (PEU) wound covering with a high water vapour permeance was compared with tulle gras treatment on adjacent areas of the same 20 split-skin donor sites. All patients experienced little or no pain from the PEU-covered areas, while 70 per cent of the patients complained of more pain from the tulle gras-covered areas. The PEU covering did not absorb the wound exudate underneath, neither did it retain wound fluid, but turned the wound exudate into a jelly-like clot layer by allowing a high evaporative water loss from the wound. Tulle gras treatment also prevented wound desiccation, but the exudate was absorbed into the overlaying cotton pads, where it became dry at the outer surface. Microscopy revealed that re-epithelialization occurred at a similar rate under the PEU covering as under tulle gras. In conclusion, the high water vapour permeable PEU wound covering prevents fluid retention, induces clotting of the wound exudate and reduces pain in split-skin donor sites. Tulle gras dressed with gauzes and crêpe bandage prevents wound desiccation, but causes more pain.

Adolescent↗
PubMed1995

Serum-free cell culture medium induces acceleration of wound healing in guinea-pigs.

Among the current methods employed in the treatment of wounds, a moist dressing is considered to be the optimal environment for the process of healing thereby avoiding dessication of the wound bed. This study is based on the hypothesis that wound cell proliferation is dependent not only on moisture but also upon the composition of the moist microenvironment in the wound. That composition in turn is formed by diffusion of nutrients from the existing vascular bed in and around the wound as well as by the wound cells' cellular products. Since in wounds the impaired vascular supply causes tissue deprivation, a continuous supply of nutrients and hormones will create an optimal substrate for cellular mitogenic activity, synthesis of matrix, growth factors and cytokines leading to wound healing. Modified serum-free cell culture medium was supplemented with non-steroidal anabolic hormones: growth hormone, thyroxin and insulin, transferrin and sodium selenite. The medium was prepared in a 1 per cent alginate gel matrix. Under general anaesthesia with ketamine (Imalgene 1000, Rhone Merieux, France) four 2 x 2 cm full-thickness skin patches were surgically extirpated from the dorsum of Hartley-derived guinea-pigs. Each experimental group consisted of seven animals, i.e. 28 wounds that received the same treatment. Compositions of gelatin in saline, agarose in saline, agarose in medium and agarose in saline supplemented with the three hormones were compared to agarose in medium supplemented with the three hormones. After application of the gel (1 ml/cm2), the wounds were dressed with gauze, elastic adhesive bandage and netting.(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of Variance↗
PubMed1994

Treatment of pyoderma gangrenosum with cultured keratinocyte autografts.

BACKGROUND: Pyoderma gangrenosum is an uncommon chronic skin disease characterized by rapidly enlarging cutaneous ulcers. Immunosuppressive agents, such as corticosteroids, are the mainstay of therapy. OBJECTIVE: We describe a patient with pyoderma gangrenosum treated with cultured keratinocyte autografts for a full-thickness ulcer located on the dorsal and lateral aspects of the foot. METHODS: After stabilizing the ulcer with intralesional and systemic corticosteroids, the ulcer was debrided and cultured keratinocyte autografts were secured with nylon mesh. An outer dressing of gauze and elastic bandage was used. RESULTS: The patient had > 95% "take" of the grafts and the ulcer was fully healed in less than 1 month. The grafted area preserved the clinical phenotype of the palmar skin from which the original biopsy was taken. CONCLUSION: Cultured keratinocyte autografts can provide permanent wound coverage for patients on high doses of immunosuppressive medications.

Administration, Oral↗
PubMed1999

Treatment of lesions of osteomyelitis in the hind flippers of six grey seals (Halichoerus grypus).

Six rescued grey seal (Halichoerus grypus) pups had traumatic injuries to their hind flippers; three had osteomyelitis without fractures, one had a single fracture and associated osteomyelitis, and two had multiple compound fractures and large open wounds. The medical and surgical methods used to treat these lesions are described. A proprietary waterproof covering appeared to be a better method for dressing the wounds than conventional bandaging.

Animals↗
PubMed1995

The use of the Cryo/Cuff versus ice and elastic wrap in the postoperative care of knee arthroscopy patients.

Pain and swelling, which may lead to inhibition of the extensor mechanism and ultimately a delay in rehabilitation, are common complications of knee arthroscopy. Cryotherapy is the most often used means of decreasing both knee edema and discomfort. A number of methods have been used to provide cold pressure dressings, including ice and elastic bandages. Commercial devices, such as the Cryo/Cuff, also have been developed to provide similar beneficial effects. This article describes a multicenter randomized study undertaken to determine whether the Cryo/Cuff or the ice and elastic bandage offers the greatest convenience and relief of pain. One hundred two patients between the ages of 18 and 65 scheduled to undergo knee arthroscopy were enrolled. Postoperatively, the Cryo/Cuff patients required significantly less pain medication than those patients using the ice and elastic wrap. The Cryo/Cuff patients also expressed a high level of satisfaction with the effectiveness and convenience of the therapy. There were no differences between either group in the amount of pain reported, or preoperative and postoperative examinations in regard to knee range of motion and thigh circumference. These results indicate that the Cryo/Cuff is a useful adjunct in the rehabilitation of knee arthroscopy patients.

Adolescent↗
PubMedDate not supplied

The Unna 'sleeve': an effective postoperative dressing for pediatric arm burns.

The goal of this study was to develop a postoperative plan for sheet grafts that would protect the graft, yet would also eliminate the need for daily wound care. Eleven pediatric patients (13 arms burns) who underwent excision and grafting were included in our study. The total area on the arm ranged from 1% to 5% total body surface area. All grafts were sheet grafts held in place with steri-strips or sutures. The grafts were covered with a layer of greasy gauze, followed by an Unna done paste dressing, and then an elastic bandage. The Unna "sleeve" remained in place for an average of 6 days (range, 3 to 10 days). In eight cases, a second Unna sleeve was applied and removed 6 to 7 days later. In all 13 cases, additional wound care for grafts was unnecessary, and patients did not require extended inpatient hospitalization. Graft take was 100% in all cases, and no reconstruction was required.

Arm Injuries↗
PubMed2003

Modified rapid deployment hemostat bandage reduces blood loss and mortality in coagulopathic pigs with severe liver injury.

BACKGROUND: Hemostasis can be difficult to achieve after blunt abdominal trauma, especially if the patient is coagulopathic. The U.S. Food and Drug Administration has recently approved a hemostatic dressing for treating bleeding after extremity trauma (RDH bandage; Marine Polymer Technologies, Cambridge, MA). It has not been evaluated for internal bleeding after trauma. We redesigned this dressing for internal use, and then tested whether this modified bandage (Miami-modified Rapid Deployment Hemostat) could achieve hemostasis when used as an adjunct to standard laparotomy pad packing in a pig model of severe liver injury with coagulopathy. METHODS: Anesthetized swine (35-45 kg) received an isovolemic 45% blood volume replacement with refrigerated Hextend (6% hetastarch). Core body temperature was maintained at 33-34 degrees C with intra-abdominal ice packs. A coagulopathic condition was documented by thromboelastography. At this point a severe liver injury was induced by the avulsion of the left lateral hepatic lobe, then the pigs were randomized to treatment with either standard abdominal packing (control) or packing plus Miami-modified Rapid Deployment Hemostat. Two series of experiments were conducted. In series one (n = 14), the abdomen was closed and the animals were observed with no resuscitation. After one hour, the abdomen was opened, the packing was removed and the presence of bleeding was noted. In series two (n = 10), the abdomen was closed and the animal resuscitated with one unit of blood plus as much lactated Ringers intravenous fluid (IVF) as required to maintain a mean arterial pressure (MAP) > 70 mm Hg. After one hour, the packing was removed, the abdomen closed, and data were collected for an additional two hours. RESULTS: Series one: 6/7 animals in the control group had continued bleeding at one hour; 1/7 animals in the treatment group had active bleeding (p = 0.0291). Series two: With control vs. Miami-modified Rapid Deployment Hemostat, the three-hour survival was zero vs. 80% (p = 0.0476). The total blood loss was 1.2 +/- 0.1 vs. 0.3 +/- 0.1 mL/kg/min (p = 0.001) and the IVF requirement was 1.6 +/- 0.3 vs. 0.6 +/- 0.3 mL/kg/min (p = 0.026). CONCLUSIONS: The Miami-modified Rapid Deployment Hemostat bandage significantly reduced mortality, blood loss, and fluid requirements when used as an adjunct to standard abdominal packing following severe liver injury in coagulopathic pigs [corrected].

Animals↗
PubMed1996

Analysis of cryotherapy penetration: a comparison of the plaster cast, synthetic cast, Ace wrap dressing, and Robert-Jones dressing.

Four groups were studied to determine the cooling effect at skin level of ice application over common ankle bandages and casts. The plaster cast, synthetic cast, and Ace wrap dressing groups had 18 participants and the Robert-Jones dressing group had four participants. In a standardized fashion, ice bags were applied over each bandage or cast and skin temperatures were measured with a thermocouple over a 90-min period. The average final skin temperature was 16.5 degrees in the plaster cast, 18.8 degrees in the synthetic cast, 21.2 degrees in the Ace wrap dressing, and 28.7 degrees in the Robert-Jones dressing. The temperature curves showed that ice application effectively decreased skin temperatures through the plaster cast, synthetic cast, and Ace wrap dressing. The cooler temperature did not adequately penetrate the Robert-Jones dressing.

Adult↗
PubMedDate not supplied

Spyrosorb and Spyroflex.

With the numerous wound dressings now available, it is sometimes difficult to know which dressing is right for each different situation. This article examines the action of two products and highlights their appropriateness in varying circumstances.

Bandages↗