Biologic, biosynthetic, and synthetic dressings as temporary wound covers: a biochemical comparison.
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Animals↗
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Select dressings that promote healing.
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Alginates↗
[Evaluation of the atraumatic properties f bandage material].
Experiments were made to examine atraumatic properties of 3 samples of dressing material. A dressing made of cotton wool and gauze served as control. It was shown that atraumatic properties of dressing material can be reliably evaluated by cytological examination of wound prints. Atraumatic properties of dressings are determined by structural features of materials used for the manufacture of dressing.
Animals↗
[Post-discharge surgical wound infection: what is to be done?].
Infection of the laparotomy wound cannot always be prevented--for a variety of reasons including patient-related, disease-related and surgery-related factors. Of importance is the early detection of a wound infection--with confirmation or exclusion of underlying pathology (e.g. anastomotic leakage)--before sepsis develops. As a rule, a laparotomy wound infection can be adequately controlled by re-opening, debridement and moist management. Innovative dressing techniques involving vacuum sealing and suction accelerate healing.
Bandages↗
Collagen film for burn wound dressings reconstituted from animal intestines.
Collagen was isolated and purified from sheep intestines and cast into a film. The collagen film was cross-linked with ultraviolet light and reinforced by imbedding a nylon mesh. The collagen membrane was evaluated as a wound dressing for second- and third-degree burns in rats. Histopathological studies of the burns with and without the collagen dressings were made. The study showed the burn wounds dressed with collagen membrane exhibited rapid epithelialization with little inflammatory change and dense fibrous tissue ingrowth in the subdermal layers.
Amino Acids↗
Comparative analysis of hemostatic agents in a swine model of lethal groin injury.
BACKGROUND: Techniques for better hemorrhage control after injury could change outcome. A large-animal model of lethal, uncontrolled hemorrhage was developed to test whether the use of various hemostatic agents would decrease bleeding and improve early survival. METHODS: A complex groin injury was created in 30 Yorkshire swine (42-55 kg) to produce uncontrolled hemorrhage. This injury included semitransection of the proximal thigh and complete division of the femoral artery and vein. After 5 minutes, the animals were randomized to (n = 6 animals per group) no dressing (ND), standard dressing (SD), SD and Rapid Deployment Hemostat (RDH) bandage, SD and QuikClot hemostatic agent (QC), or SD and TraumaDEX (TDEX). Limited volume 0.9% saline (1,000 mL over 30 minutes) resuscitation was started 30 minutes after injury. We measured blood loss, early mortality (180 minutes), and physiologic markers of hemorrhagic shock (e.g., cardiac output, blood pressure, hemoglobin, metabolic acidosis). RESULTS: Application of wound dressing decreased mortality in all groups compared with the ND group (83% mortality). However, this difference was significant (p < 0.05) only for the QuikClot hemostatic agent (0% mortality). Before the application of dressing (first 5 minutes), there were no differences in blood loss between the groups. After application of dressings, the QC group had the lowest blood loss (4.4 +/- 1.4 mL/kg). CONCLUSION: Of the hemostatic agents tested, QuikClot improved survival and decreased bleeding in a swine model of lethal vascular and soft tissue injury.
Animals↗
A systematic review of randomized controlled trials of wound dressings for chronic venous ulcer.
OBJECTIVE: To determine whether more "modern" complex wound dressings further improve the healing of venous ulcers over that with simple wound dressings, we conducted a systematic review of randomized controlled trials (RCTs) of wound dressing trials that were published from October 1, 1997, through September 1, 2005. METHODS: We searched MEDLINE, CINAHL, and the Cochrane Controlled Trials Registry Database to identify RCTs. Criteria for ultimate selection included treatment with compression and an objective outcome describing the proportion of wounds healed. Twenty RCTs were identified that satisfied these criteria and were classified into three wound dressing classes: semiocclusive/occlusive group (n = 8), growth factor group (n = 7), and human skin equivalent group (n = 5). RESULTS: Assessment of study design quality for the 20 RCTs showed a low percentage (<49%) of RCTs that incorporated at least 3 of 7 indicators of trial quality, but it seemed better in the 5 RCTs that showed significance for ulcer healing; 4 of the studies used at least 6 of the 7 characteristics of adequate study design. Five (25%) of the 20 RCTs had a statistically significantly improved proportion of ulcers healed in the experimental dressing group over control values: zinc oxide paste bandage (79% vs 56%) and Tegasorb (59% vs 15%) in the semiocclusive/occlusive group and perilesional injection of granulocyte-macrophage colony-stimulating factor (57% vs 19%) and porcine collagen derived from small-intestine submucosa (Oasis; 55% vs 34%) in the growth factor group. In the sole significant RCT from the human skin equivalent group, Apligraf (63%) was superior to Tegapore (48%). Four of these five studies also showed an improved time to complete healing by Kaplan-Meier estimate. CONCLUSIONS: Certain wound dressings can improve both the proportion of ulcers healed and the time to healing over that achieved with adequate compression and a simple wound dressing. The selection of a specific dressing, however, will depend on the dressing characteristics for ease of application, patient comfort, wound drainage absorption, and expense.
Bandages↗
Wound dressings of the nineties: indications and contraindications.
A revolution in wound management has occurred over the past 3 decades. A plethora of wound care dressings appear to enhance the wound repair process in acute and chronic wounds. However, extensive research is needed to discriminate between the beneficial effects of increased attention to all aspects of patient care, including wound management, and the salutary effects of dressing materials.
Algorithms↗
A salmon thrombin-fibrin bandage controls arterial bleeding in a swine aortotomy model.
BACKGROUND: Recently, a wide variety of bandages have been formulated to attempt to improve the effectiveness of emergency intervention in situations of uncontrolled bleeding. The best of these dressings contain a mixture of human thrombin and fibrinogen. The presence of human components in these bandages, although effective, increases the cost of the dressing and raises questions of availability of raw materials and transmission of pathogens. The purpose of this study was to investigate the efficacy of dressings composed of salmon thrombin and fibrinogen in a swine aortotomy model. METHODS: A 4.4-mm aortotomy was produced in the abdominal aorta of 19 anesthetized, splenectomized swine. The United States Army standard field gauze was applied to 8 animals, and the salmon thrombin-fibrin dressing (SFD) was applied to 11 animals. Survival, blood loss, and other parameters were measured over a 60-minute period. RESULTS: All 11 animals that received the SFD survived the aortotomy injury, and bleeding stopped within 7.5 +/- 1.5 min. Seven of 8 animals in the control group were killed when bleeding continued and blood pressures decreased to the cutoff values as outlined in the animal protocol. Bleeding was significantly less in the SFD group compared with the gauze group (241 +/- 65.3 vs. 932.7 +/- 142.4 mL). CONCLUSION: Fibrin dressing using salmon-derived thrombin and fibrinogen is effective in controlling severe, uncontrolled bleeding. This dressing may offer an alternative to dressings composed of human coagulation proteins.
Animals↗
[Abdominal dressing -- a new standard in therapy of the open abdomen following secondary peritonitis?].
INTRODUCTION: The management of patients with a laparostoma due to peritonitis is a challenge for every surgeon and intensivist. The goal of this study was to compare the different treatment strategies for the open abdomen: Abdominal Dressing (AD), the classic V.A.C. therapy (CV) and conventional open therapy (CT). METHODS: Between 2001 and 2005 we identified 62 patients in 4 surgical departments in Austria who had to be treated with a laparostoma due to peritonitis. 27 patients were conventionally treated, 16 with the Classic V.A.C. therapy and 19 patients with V.A.C. abdominal dressing. RESULTS: The mortality was 3/16 (14 %) in the AD group vs. 4/12 (21 %) patients in the CV group and 18/9 (59 %) in conventional therapy. There was no significant difference for survivors in the length of ICU stay: 26.6 +/- 23.0 days in the CT group, 34.6 +/- 30.2 days in the CV group and 38.9 +/- 27.2 days in the AD group. Apache II Score and Mannheimer Peritonitis Score showed no difference between the groups. CONCLUSION: We found a reduction of mortality in the V.A.C. Abdominal Dressing group by approximately 40 % (AD: 14 %, CT: 59 %). Although we could identify a difference in age in our retrospective study we believe that V.A.C. Abdominal Dressing is the important factor for the different clinical outcome. These first results indicate the need for further prospective evaluation of the V.A.C. Abdominal Dressing therapy, to prove if a new standard in the therapy of the open abdomen is created.
APACHE↗
[Occlusive dressing--s potential treatment for tympanic membrane rupture?].
In a rat study, an occlusive double-layer transparent hydrocolloid dressing, Duo-DERM, was compared with a rice paper dressing in the treatment of tympanic membrane perforation. The Duo-DERM dressing manifested better healing properties, and the healed membrane was histologically similar to spontaneously healed membrane, being generally thin with moderate connective tissue thickening. If this dressing is found to have good healing properties in clinical trials, it would mean a great saving in health care resources. The method is simple, inexpensive, and gives immediate improvement in hearing.
Animals↗
External compression as initial management of giant omphaloceles.
The authors describe a noninvasive technique for the management of giant omphaloceles. Two patients with giant omphaloceles were managed with external compression. Dry sterile dressings were used, buttressed by an Ace bandage in the first case and by a handcrafted Velcro abdominal binder in the second. The binder was tightened every 2 or 3 days. Renal, cardiovascular, respiratory, and gastrointestinal parameters were measured regularly to determine whether the binder was too tight. The first patient had only occasional emesis, and the defect was repaired after 40 days of compression. The second patient experienced intermittent hypertension, occasional emesis, and mild oxygen desaturation, which resolved when the binder was loosened slightly. The fascia muscle and skin were closed after 30 days of external compression. Both patients are currently living at home and doing well. This form of external compression is an effective, inexpensive, and low-risk method for the gradual reduction of giant omphaloceles, and should be considered for patients born with this problem.
Bandages↗
Iatrogenic compartment syndrome, A follow-up of four cases caused by elastic bandage.
We describe four patients suffering from lower limb compartment syndromes which were caused by constrictive bandages applied after stripping of varices. The dressing was erroneously only partially removed, when the patients started complaining of severe pain and tension in the operated legs. The damages varied from extended irreversible neuromuscular defects to lesser functional handicaps. Three patients had corrective surgery. The clinical follow up over several years showed little improvement, secondary complaints were frequent.
Adult↗
Camouflage of self-inflicted razor blade incision scars with carbon dioxide laser resurfacing and thin skin grafting.
BACKGROUND: Self-cutting using a razor blade is a type of self-mutilating behavior that leaves permanent and socially unacceptable scars with unique patterns, particularly on the upper extremities and anterior chest wall. These scars are easily recognized in the community and become a source of lifelong guilt, shame, and regret for the self-mutilators. In the presented clinical study, we aimed to investigate the effectiveness of carbon dioxide laser resurfacing and thin skin grafting in camouflaging self-inflicted razor blade incision scars. METHODS: A total of 26 anatomical sites (11 upper arm, 11 forearm, and four anterior chest) of 16 white male patients, whose ages ranged from 20 to 41 years (mean, 23.8 years), were treated between February of 2001 and August of 2003. Detailed psychiatric evaluation preoperatively; informing the patient that the procedure is a "camouflage" operation; trimming hypertrophic scars down to intact skin level; intralesional corticosteroid injection to hypertrophic scars; carbon dioxide laser resurfacing as a single unit; thin (0.2 to 0.3 mm) skin grafting; compressive dressing for 15 days; use of tubular bandage; and protection from sunlight for at least 6 months constituted the key points of the procedure. RESULTS: The scars were successfully camouflaged and converted to a socially acceptable appearance similar to a burn scar. Partial graft loss in one case and hyperpigmentation in another case were the complications. No new hypertrophic scar developed. CONCLUSIONS: The carbon dioxide laser resurfacing and thin skin grafting method is effective in camouflaging self-inflicted razor blade incision scars.
Adult↗
[Congenital digital syndactylia (author's transl)].
Congenital syndactylia of the fingers are discussed and the differential diagnosis is presented. While correction may be required for functional or easthetic purposes, the age of 4-6 years is recommended as the optimum time for correction. Early surgical treatment may be needed in cases of Apert's syndrome and in the case of congenital annular scars (amniotic bands). The operative technique is carefully described and general anaesthesia and exsanguination is recommended. Post-operative management is of equal importance and the fingers are dressed with vaseline gauze and a compression bandage. The author's experience is limited to 65 syndactylia operations and in only 3 of these was a repeat procedure necessary.
Child↗
Comparison of outpatient dressings for partial thickness burns.
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Ambulatory Care↗
Use of a transparent polyurethane dressing for peripheral intravenous catheter care.
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Bandages↗
[Evaluation of the usefulness of dressings made from chitosan and lyophilized human placenta on wound healing].
The goal of this study is evaluation in experimental and clinical circumstances of biological dressings obtained form lyophilized human placenta and chitosan. The therapeutic specificities of human placenta where confirmed in the course many years' observation in The Department of Surgery of the Digestive Tract. The reservation arose only because of inconvenience in using placenta fragile after lyophilization. The product was obtained in the course of studies which were performed in common with The Chemical Fibres Institute in Lódź. This product (which was a combination of placenta and chitosan) was free of defects considering defects of lyophilized placenta. The experimental part of study was performed on 50 female rats of Wistar strain. It was compared healing of wound 2 cm2 area provided with tested dressing and the other controlled wound. The result was evaluated on the ground of postoperative survival and the macroscopic and microscopic evaluation. In the clinical part of the study the experimental model was made by wounds provided by sutures passed by all layers on special "small drains" which under drains make bedsores placed symmetrically on both sides of incision line. The evaluation was performed randomly putting on one of these sides of tested dressing. There was evaluated the speed of demarcation, growth of granulation tissue and epithelialization. The evaluation was compared with standard dressing. Combination of therapeutic specificities of lyophilized human placenta with proper mechanical specificities of chitosan made possible to obtain comfortable and efficient dressing. In the clinical part of the study on the ground of macroscopic evaluation it was found that the process of the healing in tested group becomes shorter of about 48 hours.
Aged↗