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Allergic contact dermatitis from hydrocolloid dressings.

BACKGROUND: Hydrocolloid wound dressings have been in use for nearly two decades, and have rarely caused allergic contact dermatitis. DuoDERM E (DuoDERM CGF) is a newer version of DuoDERM (ConvaTec Ltd, a division of Bristol-Myers Squibb Co, Princeton, NJ) that contains a sensitizing derivative of colophony. OBJECTIVE: We describe three patients who developed eczematous lesions under this type of wound covering. METHODS: The patients were patch tested to the European standard series, to a glues and adhesives series, and to pieces of various adhesive dressings. RESULTS: The patients displayed positive patch tests to colophony and to DuoDERM E or DuoDERM CGF hydrocolloid dressings. CONCLUSION: These dressings contain the pentaerythritol ester of hydrogenated rosin as a tackifying agent, and this substance retains the sensitizing potential of colophony. The addition of this compound is an important change that may negatively alter the good safety record of ConvaTec dressings.

Adult↗

The treatment of hypopigmentation after skin resurfacing.

BACKGROUND: Hypopigmentation has plagued all methods of skin resurfacing. Whether the physician uses chemical peels, dermabrasion or laser resurfacing hypopigmentation can develop. OBJECTIVE: To examine the pathogenesis and treatment of hypopigmentation after resurfacing. METHODS: Areas of hypopigmentation after skin resurfacing were blended in with laser-assisted chemabrasion (LACA). The process begins with preconditioning of the skin with vitamin A/glycolic skin conditioning lotions. Then the area is resurfaced with the LACA. This resurfacing usually requires three to four freeze-sand cycles to remove the areas of hypopigmentation associated with dermal fibrosis. The resurfaced skin is then occluded with a combination of polyethylene/silicone sheeting during the acute phase of wound healing. Ultraviolet photography and histologic examination were used to demonstrate the improvement in dermal fibrosis and hypopigmentation. RESULTS: The LACA improved areas of hypopigmentation in the 22 cases studied. Under occlusive wound dressings, the melanocytes migrated into the areas of hypopigmentation, and the wounds healed without extensive fibrosis. This produced a blending of skin color. CONCLUSION: It is possible with skin preconditioning, LACA, and occlusive wound healing to provide for a wound healing environment that blends in areas of hypopigmentation that have developed after previous skin resurfacing.

Adult↗

Chitosan membrane as a wound-healing dressing: characterization and clinical application.

Chitosan prepared from natural biopolymer chitin and cast into membranes has been tested as wound dressing at the skin-graft donor site in patients. Bactigras, a commonly used impregnated tulle gras bandage, served as a control. Chitosan membrane, prepared with a 75% degree of deacetylation and a thickness of 10 microm, was used in nonmesh or mesh form. The progress in wound healing was compared by clinical and histological examination. Itching and pain sensitivity of the wound dressed area was scored with the use of a visual analogue scale. Mesh chitosan membrane in contrast to the nonmesh membrane allowed blood to ooze into the surrounding gauze. After 10 days, the chitosan-dressed area had been healed more promptly as compared with the Bactigras dressed area. Moreover, the chitosan mesh membrane showed a positive effect on the re-epithelialization and the regeneration of the granular layer. The data confirm that chitosan mesh membrane is a potential substitute for human wound dressing.

Animals↗

Swelling of hydrocolloid dressings.

Wound healing is promoted by dressings that maintain a moist environment. Specifically, hydrocolloid dressings allow excess fluid to escape without permitting wound desiccation. However, the fluid handling capacity of hydrocolloid dressings depends on many factors such as the physicochemical properties of the gel formulation, and the design of the dressing. We measured the moisture uptake kinetics of different hydrocolloid dressings by placing the gel side of a sample in contact with water. The time evolution of the thickness was measured by means of a video camera linked to a computer. The theory of Tanaka and Fillmore (1979) was used to predict the kinetics of uniaxial swelling of a cylindrical gel sample. The model allows to associate to an experimental curve a total thickness increase hf-h0 (where hf and h0 are respectively the final and initial thickness) and a characteristic time tau. The model also relates hf-h0 and tau to the physiochemical composition of the dressing, and to the initial thickness h0. The influence of h0 is discussed by means of experiments performed on dressings with different initial thickness.

Absorption↗

The role of Mepitel silicone net dressings in the management of fingertip injuries in children.

Forty-five children with isolated fingertip injuries were randomized for treatment with either Mepitel silicone net dressings or paraffin gauze dressings. Over a 4 week period, the objective adherence of the dressing, and the perceived level of stress caused to the child by the dressing change were scored by linear analogue scales. The wounds were also assessed for the progress of healing and presence of infection. Twenty children received Mepitel dressings and 25 had paraffin gauze dressings. There was no difference in duration of healing or complication rates between the two groups. Statistically lower scores were seen for the Mepitel group for the first 3 weeks in both adherence and stress scores. These results suggest that silicone net dressings may be a less adherent and less painful method of dressing fingertip injuries in children.

Bandages↗

Negative-pressure dressings in the treatment of hidradenitis suppurativa.

Negative-pressure dressings have been used in the treatment of a variety of open wounds, and as a bolster for skin grafts. The benefits of these dressings include increased oxygen tension in the wound, decreased bacterial counts, increased granulation formation, and the prevention of shear force on wounds. Also, by virtue of the diminished need for daily dressing changes, there are the additional advantages of enhancing patient comfort, decreasing nursing work, and diminished cost of wound care. Hidradenitis suppurativa (HS) is a chronic infection of the apocrine sweat glands. Treatment options range from oral isotretinoin to radical excision. Wound closure may be achieved by secondary intention, skin grafting, or flap closure. Complications may still arise and include disease progression and squamous cell carcinoma. Radical excision yields the best results in terms of disease eradication. The authors describe using the negative-pressure dressing in two cases of bilateral axillary HS to secure skin grafts firmly to the wound bed after radical excision of all involved tissues. Patient comfort and acceptance was high, and skin graft take was excellent. The dressings themselves are simple to apply and are highly effective.

Adult↗

Comparison of donor-site healing under Xeroform and Jelonet dressings: unexpected findings.

Split-thickness skin grafts remain central to the strategy of burn wound treatment. The dressing used to cover the donor wound site has a significant effect on healing parameters. The purpose of this study was to compare split-thickness skin graft donor site reepithelialization under Xeroform and Jelonet dressings. A dermatome was used to cut two consecutive strips of skin from 25 paired donor sites on the thigh, calf, or back of 19 participants. Standardization of the harvest method was achieved by using the same surgeon to harvest the compared skin graft strips, with attention to consistency of dermatome skin-thickness setting, downward pressure, and angle of dermatome approach. A strip of Xeroform or Jelonet was applied to one of each pair of wounds. Epidermal and dermal thickness was measured from biopsy specimens cut at the midpoint of each split-thickness graft strip. The day of final dressing separation was declared the day of complete donor reepithelialization (healing). The mean healing time for Xeroform and Jelonet was 10.4 +/- 2.6 days (n = 25) and 10.6 +/- 2.8 days (n = 25) (p = 0.76) at sites cut to a mean depth of 0.23 +/- 0.08 mm and 0.23 +/- 0.09 mm (p = 0.89), respectively. There was no correlation between graft thickness and healing time for sites dressed with Xeroform (r = 0.17) or Jelonet (r = 0.02). Donors sites reharvested 10 to 21 days after a prior harvest healed an average of 3.1 days earlier than virgin sites (8.4 +/- 1.6 versus 11.5 +/- 2.6 days, p < 0.001), although reharvested grafts were on average 0.05 mm thicker (p = 0.10). The mean thickness of reepithelialized donor-site epidermis (0.13 +/- 0.04 mm, n = 30) was found to be twice the thickness of virgin epidermis from the same sites (0.06 +/- 0.02 mm, n = 38, p < 0.001). Thirty-six grafts harvested with dermatomes set to cut 8/1000 inch (0.20 mm) deep ranged from 0.12 to 0.42 mm thick, with only eight of these grafts measuring within +/-10 percent of the desired thickness setting. Before donor dressing separation, Xeroform and Jelonet dressings were judged to be more comfortable by nine patients and one patient, respectively, whereas no difference was detected by six patients. The authors now use Xeroform as the preferred donor dressing.

Adolescent↗

Fibrin cuff lysis in chronic venous ulcers treated with a hydrocolloid dressing.

BACKGROUND: Pericapillary fibrin cuffs (PFC) are a recognized part of the pathology of venous stasis ulcers. A hydrocolloid dressing capable of lysing wound surface fibrin was tested in venous ulcers for its capacity to lyse pericapillary fibrin below the wound surface. METHODS: Tissue biopsies from the rims of 19 venous ulcers were evaluated for thickness of shallow and deep dermal PFCs before and after treatment with DuoDERM covered by Unna's boot and a compression bandage (DD+UB; n = 9) versus the same treatment without the hydrocolloid dressing (UB; n = 10). Frozen sections of all biopsies were stained with an immunofluorescent antibody to fibrin for rating of PFC thickness. Separate sections were stained with hematoxylin and eosin to assess capillary frequency, histopathology, and inflammation. All ratings and pathology assessments were performed blinded to treatment conditions. RESULTS: Both deep and shallow PFCs were reduced in 89% of ulcers treated with DD+UB versus 40% of ulcers treated with UB (alpha < 0.04). No other significant differences in inflammation, histopathology, or capillary frequency were observed. CONCLUSIONS: Treatment with DD+UB reduced PCFs in twice the number of ulcers than UB alone in 1 week. This is the first scientific documentation that a topical wound dressing could reduce the pathophysiology associated with venous ulcers, beyond the known beneficial effect of graduated compression. Not all hydrocolloid dressing are fibrinolytic, so this effect may not generalize to other dressings.

Bandages↗

Moist wound healing: a concept that changed our practice.

Winter's seminal paper from 1962 showed that a moist wound environment accelerates healing. Since then, different types of dressings have been developed based on this concept. This paper describes their background and correct usage.

Bandages, Hydrocolloid↗

[Is cooling harmful to wounds?].

An adequate blood supply and stable temperature of the wound are very important for the healing process. During healing of a wound we can observe in the surrounding area two of rises temperature. The first rise is produced by the inflammation in the close vicinity of the wound and its peak is approximately on the 5th-10th day after treatment. The second peak can be found locally after 10 days. It is due to new formation of capillaries and thus a more ample blood supply of the wound and an increased tissue metabolism in the area surrounding the wound. Algidity affects healing in an adverse manner. The author mentions the results of some experiments which provide evidence of the favourable effect of stable temperature on wound healing. This can be achieved by adequate dressing technique and a correct procedure when changing dressings. Wounds must not remain undressed for prolonged periods to avoid drying up and cooling.

Animals↗

[Wound dressings].

The wide variety of dermatologic surgical procedures has resulted in a corresponding choice of wound dressings. Considering the chemical and physical properties as well as the function of the dressings, standardized dressing techniques can be performed with relatively few materials. This saves both time and money.

Bandages↗

Investigations on preparation and properties of modified polyacrylamide hydrogels for application as wound dressing materials.

Investigations on the influence of the polymerization conditions and feed ratio as well as various modification of the composite polyacrylamide-agar hydrogels on their properties has been presented. Results of the model studies have been utilized in the optimalization of the manufacturing parameters and procedures of the preparation of hydrogel dressing foils and granulated dressing gels.

Absorption↗

Clinical experience with the negative pressure wound dressing.

Between 1997 and 1999, more than 300 patients have been treated using negative pressure wound dressings. The technique has been used successfully to prepare various acute, chronic or infected wounds to accept a skin graft or flap, and to promote graft take at difficult donor sites. The advantages include rapid healing by secondary intention, reduced time to skin grafting, an increase in the rate of graft take and a reduction in donor site complications. The dressing can be applied quickly and easily and there have been no serious complications.

Humans↗