SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
A variety of wound dressing groups is currently available on prescription. In a series of six articles, Jacqui Fletcher looks at the different groups of dressings, their composition, and indications for use. This first article looks at alginates. The second article in the series discusses foam dressings, and will appear in the Wound Care Supplement of 7 June.
Cultured skin substitutes (CSS) have become a useful adjunctive treatment for closure of burn wounds, but CSS are avascular and remain susceptible to microbial destruction longer than split-thickness skin grafts. Irrigation of CSS grafted to burn wounds with a topical antimicrobial solution (TAS) has been shown to promote engraftment of CSS, but TAS usage has potential limitations. Acticoat Burn Dressing (Acticoat; Westaim Biomedical, Exeter, NH) is a silver-coated barrier dressing reported to exhibit antimicrobial activity and to reduce infection in partial-thickness and full-thickness wounds. This study evaluated the cytotoxicity of Acticoat with CSS and the efficacy of Acticoat for the management of microbial contamination in CSS grafted to full-thickness wounds in athymic mice. The cytotoxicity of Acticoat was assessed in preliminary studies after 1 week of exposure to CSS during in vitro maturation or healing on wounds in athymic mice. Histologies were analyzed and cellular viability in the CSS was determined by MTT conversion on days 0, 1, and 7 of Acticoat exposure. At 1, 2, 3, and 4 weeks after grafting, wounds were traced, and areas of healing CSS were calculated by image analysis. At 4 weeks, wound biopsies were evaluated and scored for engraftment of human cells. In a subsequent study, wounds were inoculated with strain SBI-N of Pseudomonas aeruginosa at 1 x 10(5) cfu/wound before the application of CSS or inoculated onto the surface of Acticoat. At 4 weeks, swab cultures were collected from the surface of CSS and scored for the presence of SBI-N. Statistical significance was accepted at the 95% confidence level (P <.05). The data show that exposure in vitro of CSS to Acticoat was cytotoxic within 1 day, but 1 week of exposure in vivo did not injure CSS or inhibit wound healing. Contaminated wounds treated with Acticoat healed similarly to control treatments, with comparable rates of engraftment, and detection of SBI-N on the surface of only one graft. No SBI-N was detected on CSS after inoculation onto the surface of Acticoat. These results suggest that Acticoat may be suitable as a protective dressing to reduce environmental contamination of CSS, if used in conjunction with additional antimicrobials to control organisms present in the wound.
Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is an adverse drug reaction most commonly associated with aromatic antiepileptic agents. It is characterized by the triad of skin eruption, fever, and systemic involvement, with the latter usually manifesting as hepatitis and lymphadenopathy. Mortality is primarily due to hepatic failure and can be as high as 10%. Formerly referred to by names such as Dilantin hypersensitivity syndrome and anticonvulsant hypersensitivity syndrome, DRESS syndrome is a more precise term since this reaction pattern can be seen with other agents. DRESS syndrome has also been reported in association with sulfonamides, allopurinol, terbinafine, minocycline, azathioprine, and dapsone as well as with several antiretroviral agents such as abacavir and nevirapine. We describe a patient with HIV who developed nevirapine hypersensitivity syndrome who was successfully treated with intravenous immune globulin (IVIG).
In a 56-year-old woman, 'drug rash with eosinophilia and systemic symptoms' (DRESS) was diagnosed. She had been admitted to hospital twice in two months because of fever and skin rash. Further studies revealed that in addition to the skin rash, the woman also suffered from eosinophilia, lymphadenopathy and a temporary liver-function disorder. After infectious and malignant causes had been excluded, the DRESS syndrome was diagnosed. The syndrome was attributed to the oral skin-care supplement Imedeen. She had stopped using this preparation previously, after which the symptoms decreased markedly. Now she was treated with corticosteroids and methotrexate and recovered completely after almost four months. The DRESS syndrome is characterised by skin rash, fever, lymphadenopathy and haematological abnormalities, especially eosinophilia and/or atypical lymphocytosis. Single or multiple organ involvement, especially of the liver, kidney, lungs and/or heart, is also common. The syndrome is associated with a number of different drugs.
There are many reasons wounds are managed as open wounds rather than by primary closure. Indications include gross contamination, infection, and skin loss leading to insufficient adjacent tissue for wound closure. The most common method of managing an open wound is with wet-to-dry dressings. Wet-to-dry dressings provide mechanical debridement and promote the movement of viscous exudates away from the wound. Wet-to-dry bandages ideally are changed every 12 to 24 h. For nonhuman primates, it is desirable to develop wound management techniques that limit animal handling for bandage changes and thus the frequency of sedation. Anecdotal reports on the use of honey to treat wounds date back to 2000 B.C. Recently, scientific inquiries have found merit to these reports. Honey accelerates healing because of its direct effects on tissue and antibacterial properties. In addition, dressings with honey can be changed relatively infrequently. Honey decreases inflammatory edema, hastens sloughing of devitalized tissue, attracts macrophages which cleanse the wound, provides a local cellular energy source, and protectively covers the wound. A high osmolarity, acidity, and hydrogen peroxide content confer honey with antibacterial properties. Here we describe the use of honey to manage a bite wound in a stumptail macaque (Macaca arctoides). The wound healed rapidly: after 2 weeks of treatment, there was markedly less exudate and no necrotic tissue. This report describes how honey may be helpful in the management of open wounds in nonhuman primates by minimizing the need for sedation for bandage changes.
Drug rash with eosinophilia and systemic symptoms (DRESS) is a hypersensitivity syndrome. It presents with severe cutaneous eruption, fever, lymphadenopathy, hepatitis, haematological abnormalities with eosinophilia, atypical lymphocytes and may also involve other organs. The multi-organ involvement differentiates this entity from other common drug eruptions. DRESS has been associated with higher morbidity and mortality compared to other adverse drug reactions. Sulphasalazine hypersensitivity is rarely reported and we wish to highlight a case of sulfasalazine-induced DRESS presenting as leukocytoclastic vasculitis, hepatitis and haematological abnormalities in a 49-year-old Indian woman.
The transport properties of polymeric membraneous dresing silver ion containing Textus Bioactive were studied. This dressing is made of three types of theromoplastic polymeric fibers, formed into two-layers membrane. In first layer occure the polymeric fiber, which the core is hydrophobic and hydrophilic surfaces contain a silver zeolite. These fibers neighborours with hydrophilic super absorbing polymers. Third type of polymeric fibers occur in the second layer of membrane and is arranged parallel to surface's skin, creating a net preventing stick of membraneous dressing to treated wound. Using of the Kedem-Katchalsky equations the transport model of this membrane and the temporal and concentration characteristics of transport parameters (hydraulic permeability, refection and solute permeability) were determined. Experimental results show that the polymeric membranous dressing contain the silver ions posses non-linear transport properties, which are consequence of structure and physicochemical properties of polymeric membranes.
Acute pain and swelling following endodontic treatment are a challenge for both the patient and the dentist. According to previous studies, the incidence of flare-ups increases after endodontic treatment of teeth with necrotic pulps. Calcium hydroxide is currently used as a multi-purpose drug in root canal therapy. The aim of this study was to evaluate the incidence and severity of flare-ups after treatment of pulpless teeth using calcium hydroxide as an intracanal dressing. Sixty patients with single-root necrotic teeth participated in this study. These patients were randomly divided into three groups of 20. The patients were treated in Group A in a single-visit approach, in group B with a two-visit approach without any intracanal dressing and group C with a two-visit approach using calcium hydroxide as an intracanal dressing for one week. All of the patients were followed for 72 hours after each treatment session. The information about the incidence and severity of pain and swelling was recorded in tables, using a modified Visual Analogue Scale for pain severity measurement and a scale with four degrees for measuring the severity of swelling. The data were analyzed by chi-square test and GENMODE procedure.
Several thousand dressings are performed each year to treat the patients admitted to the St Luc Hospital Burn Care Unit. The use of paraffin gauze dressing (Jelonet) allowed standardization and rationalization of the four different types of dressings used in burns. Positive features of this product include ease of use, good tolerance, and low cost.
There have been significant developments in the dressings available to treat infected wounds; this increased choice can, however, be confusing. Jacqui Fletcher outlines the key considerations for using an antimicrobial dressing and describes the key dressing groups that can be used to treat wound infection.
OBJECTIVE: To explore the value of using Rapid Nasal Dressing with Gel Knit in the patients with the postoperative nasal cavity and sinuses or severe epistaxis. METHOD: A comparative study was carried out for the clinical effects of traditional Vaseline gauze with that of Rhino Rapid Nasal Dressing with Gel Knit as nasal packing materials, through a valuation on the patient discomfort with headache and control of postoperative bleeding and ease of removal. RESULT: There was a significant difference in headache during the period of packing and removal between two groups (P < 0.01, P < 0.05). There was no significant difference in the volume of bleeding during the 24 hours packing (P > 0.05), but there was one time during removal (P < 0.01), and it was also more ease of removal than that of the group with Vaseline gauze (P < 0.01 ). CONCLUSION: Rhino Rapid Nasal Dressing with Gel Knit is a kind of ideal material for nasal packing, because of its effect of drug hemostasis and compressive hemostasis.
In a controlled randomized study on 40 patients with venous leg ulcers, monotherapy with a dry wound dressing (silver-impregnated--activated charcoal xerodressing; SIAX) was tested. The xerodressing was applied throughout the entire study and was compared with the conventional phase-adapted therapy using diverse topical modalities, e.g. as granulating ointments, zinc paste. etc. The parameters of wound healing were documented in the two randomized groups over 6 weeks and were statistically evaluated. In the statistical comparison of SIAX therapy (n = 19) and conventional therapy (n = 19) significant differences were found in favour of the SIAX group (increase of epithelialization, reduction of ulcer size; P less than 0.05). In addition, the ulcers of 6/19 patients (= 31.6%) treated with SIAX healed completely within the study period, in contrast to only 2/19 patients (= 10.5%) receiving conventional therapy. Exudate, granulation and colonization of the ulcers as well as odour, necroses, erythema and oedema of the surrounding areas were not significantly different. The study shows that a consistent therapy performed with dry wound dressings such as SIAX is superior to the conventional topical therapy of venous leg ulcers in some cases. Wound dressings provide new therapeutic modalities, being easy to apply and fully efficient, without side-effects.
Twenty-four above-knee amputees (AKA) treated with rigid plaster dressings were randomized to receive ambulation on pylon within 24 hours of surgery or at time of suture removal. Casts were applied by physical therapists in half of each group, and by a prosthesist in the other half. There were no statistically significant differences among the groups with respect to age, sex, stump length, gait characteristics and wound healing. Time to prescription of final prosthetis was similar in all groups. Specifically, there was no delay in the group ambulated immediately. The immediate ambulators did have significantly greater stump pain requiring more analgesia than the group ambulated after suture removal. Patients with case applied by physical therapists used their prostheses more than patients with cases applied by prosthetists. There was no detectable difference among treatment groups with regard to participation in therapy, acceptance of prosthesis, and psychological status. Recommendation for management of AKA's include: use of rigid dressing; ambulation on pylon after suture removal; utilization of physical therapist for application of rigid dressings and alignment of pylon.
The rigid removable dressing technique for below-knee amputees has many advantages over other conventional systems. There is some reluctance to use this system in the presence of an open lesion. We present a patient with severe wound dehiscence who had success with this system. The advantages of the rigid removable dressing are protection of the stump and better shrinkage, combined with the ability to remove the dressing and look at the wound. This makes the technique ideal for a stump with poor wound healing.
The procedure of apex closure in wide-apexed nonvital teeth usually involves repeated Ca(OH)2 root canal dressings. In this trial of single dressing, only two teeth of twenty-six teeth studied required repeat Ca(OH)2 dressings.
Free split skin grafting is now widely practised on a routine basis in accident surgery. All conventional wound dressing methods have considerable drawbacks, and this is one of the reasons why successful skin grafting is still an unsafe procedure even under the very best of conditions and quite often resembles an experiment more than a scientific procedure, with an unpredictable outcome. Today, however, we can command over a wound dressing, using the polyacrylamide agar hydrogel developed by the Max Planck Institute of Immunobiology at Freiburg and which is being marketed under the trade name of Geliperm. This dressing can maintain the physiological wound environment during the first few critical days following grafting; it enables conditioning of the wound; it protects the wound against bacterial invasion and prevents drying-out of the graft and the base of the wound; and it is capable of absorbing wound secretion to a certain degree. Healing chances of the graft can be considerably improved by the use of Geliperm. Thanks to its high measure of elasticity it can adapt itself to the wound surface without sticking to it. The transparent nature of the material enables to observe and assess the healing processes at any time and to recognize possible complications during healing. Failures are almost always due to prolonged deposition of the gel plates, but this can be safely avoided by regularly changing the deposit. Deposits inadvertently left for too long, so that they have started drying at the wound surface, can be detached without any trouble and painlessly without any risk of damaging the graft.(ABSTRACT TRUNCATED AT 250 WORDS)
Synthetic Adhesive Moisture vapor permeable (S.A.M.) dressings, Op-Site and Tegaderm, are compared to Fine Mesh Gauze (F.M.G.), as a dressing for split-thickness skin graft donor sites. Scalp as a donor site is compared to nonscalp donor sites. The combination of S.A.M. dressings and scalp as a donor site allows for rapid reuse of a donor site. Pain is substantially decreased and rate of healing is increased when this combination is used. The scalp, because of its availability, accessibility, excellent color match for facial grafting, and rapid healing, is recommended as a donor site.
The multilayer unwoven fabric dressings have been examined both in laboratory and clinic. The properties of metalized and ordinary dressings have been compared. In clinical examinations the usefulness of metalized materials was proved to burns and granulating wounds. Also the advantages of unwoven fabric materials over the classic dressings have been ascertained.