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Acute surgical wounds left to heal by secondary intention are often routinely managed with gauze fabric dressings. This paper reviews research that suggests newer, modern dressings are more cost-effective and cause less pain on removal.
In this article the authors discuss the problem faced by physicians when trying to use moisture-retentive dressing in pressure sores (decubitus ulcers). First, they report the results of an in vitro study using a new model of experimental wound (radio-isotopic investigation) that assesses the release of Ringer's solution from interactive dressings continually during fourteen hours. Second, they perform an animal experiment that assesses the incidence of wound infection in defects treated conventionally or using interactive dressings. The defects treated with interactive pads had lower incidence of wound infection, and the process of wound healing was rapid. Finally, the authors discuss their experience in four paraplegic patients with decubitus ulcers where they used moisture-retentive dressing on ulcers and on the surrounding intact skin before surgical procedure to detect the possibility of maceration of healthy skin. Histological evaluation was performed in order to find microscopically changes after moisture healing. The changes of healthy skin were not significant after treatment of moisture-retentive dressings.
Porcine full-thickness excisional wounds were treated with 4 different hydrocolloid (HCD) dressings--DuoDERM (ConvaTec/E. R. Squibb), Intrasite HCD (Smith and Nephew Medical), Tegasorb (3M) and Replicare (Smith and Nephew Medical). Animals were killed at 4, 10, 21 and 90 d post-wound, excision sites were fixed in formalin and processed for histological analysis. Granulomatous lesions were observed following treatment with each of the 4 HCD dressings. Such lesions developed between 4 and 10 d post-wound, exhibiting little evidence of resolution at 90 d post-wound. Of the 4 dressings examined, DuoDERM and Intrasite HCD precipitated the most severe reaction, each treatment resulting in granulomata with a distinct and different morphology. Treatment with DuoDERM resulted in granulomata characterised by a random distribution of dendritic cells, epithelioid cells, multinucleated giant cells, lymphocytes and plasma cells. In contrast, treatment with Intrasite HCD resulted in highly organised granulomata, consisting of a central focus of epithelioid cells surrounded by a peripheral cuff of macrophages, lymphocytes and plasma cells. This experimental study highlights chronic inflammatory lesions that may, if reflected in the clinical environment, question the efficacy and indication of HCD dressings in the treatment of wounds having a number of different aetiologies.
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Explore the source record for details and available documents.
The incidence of catheter-related sepsis associated-with the use of Tegaderm or Opsite IV3000 dressings on 100 critically ill patients with liver disease was studied. All the patients had central venous catheters in situ and they were randomly assigned to one of the two dressings. In this study the sites of insertion were assessed at each dressing change, together with any fluid under the dressing. No statistically significant difference between the two dressings was found in accumulation of fluid, skin microbial colonization, local infection or systemic infection of patients in our sample. There was no apparent advantage to using the more permeable Opsite IV3000 dressing.
Alginates are characterized by their gel-forming and absorbent nature, a feature that makes them ideally suited for use in wound-care applications. This article examines the structure, properties, and performance of alginates and highlights the differences between the various types. The characteristics that should be built into the next generation of dressings are discussed, together with applications that are ripe for development.
The pathology of bedsores located in the sacro-coccygeal region continues to be present in hospital and health care institutions in spite of all the modern scientific advances. Bedsores constitute a serious problem, given their very high cost when they occur and their prevalent nature. Since the relative mortality rate of persons suffering bedsores is significantly higher than that of those who do not suffer them, a careful appraisal and preventive measures are fundamentally desired. Using local therapeutic alternatives based on cicatrisation in a humid medium with modern dressings, those authors proposed an open, prospective, multi-centric study which evaluates the efficiency as well as the behavior of a new hydropolymeric dressing in 3-D specifically designed for ulcerations located in the sacro-coccygeal area. The results indicate that the selected dressing proves to be very useful as a local treatment of sacrum bedsores and in use as a first degree level preventive measure in these areas. This study took under consideration the acceptance of this dressing on behalf of nursing professionals and subjective opinions from patients.
Cultured autologous keratinocytes (CAK) have been used in eight patients as part of their definitive treatment for burn wound closure. The CAK grafts were placed on surgically excised wounds rather than mature granulation tissue. This technique guaranteed that permanent skin coverage derived from cultured cells, and not residual epidermal cells from surviving dermis. Graft take was variable, ranging from zero in the case of one of the children to 85%. Long-term assessment noted adequate permanent coverage, confirmed by biopsy. Electron micrographs demonstrated no well formed anchoring fibrils, which may account for the graft fragility which has been reported as much as 1 year postgraft. Advantages of using CAK are that an acceptable permanent wound closure can be achieved without depending on donor site availability. An almost unlimited quantity of skin is available because the original biopsy can be expanded manyfold in the laboratory.
The safety of Chuangyuling (CYL) dressing-a multifunctional medicine carrying biomaterial was evaluated in order to provide foundation for the application of CYL as material used in the wound healing. The traditional Chinese medicine (TCM) extract solution was compounded with scaffolds (gelatin and Bletilla hyacinthine gum), and then frozen and dried to form spongy and porous material CYL. According to the standard of biological evaluation of medical devices that was instituted by the ministry of health of China, the biological evaluation of CYL dressing was conducted. The results showed that all the contents of biological evaluation test consisting of acute toxicity, skin irritation, sensitization and cytotoxicity met the requirement of standards. It was concluded that the biomaterial carrying TCM (CYL dressing) is safe for application of wound healing.
Firm contact to the underlying recipient bed and immobilization are necessary for survival of an areolar skin graft, yet compression of the nipple must be avoided when performing nipple-areola reconstruction. A simple dressing technique is described that simultaneously accomplishes both goals and can be carried out with commonly available materials.
Negative pressure wound therapy, available in the United States through Kinetic Concepts, Incorporated, San Antonio, Texas, as Vacuum Assisted Closure (VAC) therapy, is a must in plastic surgery. VAC therapy and the VAC dressing change procedure are described. Benefits of VAC therapy as well as cost concerns are discussed.
This study compared a polyurethane foam dressing with a hydrocolloid dressing for ease of application and removal, adhesion, conformability, absorbency and wear time. A randomised study was carried out, including 61 patients with stage two or three pressure sores in five centres in the UK. Dressings were applied for up to 30 days and assessments were carried out at each dressing change. The results indicated that both dressings are easy and convenient to apply; absorbency and ease of removal were significantly better with the polyurethane foam dressing than the hydrocolloid dressing; wear times were similar.
This paper reviews different types of treatment of the amputation stump. Following an examination of the historical development there are sections on bandaging, semi-rigid dressings, rigid cast dressing and controlled environment treatment. The merits and demerits of each type of treatment are discussed.
Three patients with cutis aplasia of the scalp presented to Arkansas Children's Hospital over a period of eighteen months. Two of the patients required operative intervention for closure of the defects and the third patient healed with dressing changes. Surgery required the combined efforts of both neurosurgery and plastic surgery.
Before sloughy or necrotic wounds can begin to heal, they must be debrided. Some of the modern wound dressings are not only extremely effective in this, but they do not damage surrounding tissue.
Seventy-eight pediatric burn patients treated by enzymatic debridement with collagenase clostridiopeptidase A (CCA), were compared to 41 patients those burn wounds were excised surgically. Patients whose burn wounds were initially assessed as partial-thickness at admission were enrolled in the study. Total removal of eschar was achieved in 49 of 78 (62.8%) patients by CCA only (group D). In 29 patients (37.2%), therapy with CCA was ceased because of the development of burn wound infection or a manifest need for grafting of the wound, therefore, these patients underwent tangential wound excision (group DS). The records of 41 patients, treated by early tangential excision, having similar burn wounds by extent and depth with groups D and DS were used as controls (group S). There was no significant difference between the time to achieve a clean wound bed in groups D, DS and S (mean 7.8, 8, and 7 days, respectively, P>0.05). In group D, none of the patients required blood transfusion, except one. Patients in group DS were found to have fewer excisions (mean 1.1) when compared to those in group S (mean 1.5, P<0.05). The shortest hospital stay was found in group D (12.5 days, P<0.01). In conclusion, the use of CCA, provided a short hospital stay, reduced the overall need for surgery and blood transfusions in patients with partial-thickness burns. Thus, CCA should be considered as an initial treatment of choice for removal of eschar in children, having a partial-thickness burn wound without infection.