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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.
In recent years, the concept of cost-effectiveness, including medical delivery and health service fee systems, has become widespread in Japanese health care. In the field of pressure ulcer management, the recent introduction of penalty subtraction in the care fee system emphasizes the need for prevention and cost-effective care of pressure ulcer. Previous cost-effectiveness research on pressure ulcer management tended to focus only on "hardware" costs such as those for pharmaceuticals and medical supplies, while neglecting other cost aspects, particularly those involving the cost of labor. Thus, cost-effectiveness in pressure ulcer care has not yet been fully established. To provide true cost effectiveness data, a comparative prospective study was initiated in patients with stage II and III pressure ulcers. Considering the potential impact of the pressure reduction mattress on clinical outcome, in particular, the same type of pressure reduction mattresses are utilized in all the cases in the study. The cost analysis method used was Activity-Based Costing, which measures material and labor cost aspects on a daily basis. A reduction in the Pressure Sore Status Tool (PSST) score was used to measure clinical effectiveness. Patients were divided into three groups based on the treatment method and on the use of a consistent algorithm of wound care: 1. MC/A group, modern dressings with a treatment algorithm (control cohort). 2. TC/A group, traditional care (ointment and gauze) with a treatment algorithm. 3. TC/NA group, traditional care (ointment and gauze) without a treatment algorithm. The results revealed that MC/A is more cost-effective than both TC/A and TC/NA. This suggests that appropriate utilization of modern dressing materials and a pressure ulcer care algorithm would contribute to reducing health care costs, improved clinical results, and, ultimately, greater cost-effectiveness.
Topical treatment with an antifungal agent was performed in 70 cases of onychomycosis (69 cases of tinea unguium and 1 case of Candida onychomycosis). The patients were treated every night by occlusive dressing using bifonazole cream containing 40% urea, and then by simple application of 1% bifonazole solution in the morning. During the treatment period, the softened affected nails were removed as completely as possible with nail clippers and files. The nails were observed every two weeks, and the efficacy was evaluated after 12 weeks. Two cases were excluded and 28 cases dropped out leaving 40 cases for efficacy evaluation. Among the 40 patients, 20 appeared to be mycologically negative (mycological cure rate: 50.0%). Clinical response was judged by the changes in opacity and thickness of the nails. Nine patients were evaluated as showing "marked improvement" and 16 as showing "improvement" (improvement rate: 62.5%). Erosion was noted as an adverse reaction in 2 patients. In one patient, treatment was stopped and the lesion was improved by antibiotic ointment, and in another, treatment was resumed when erosion was cured by discontinuation of the treatment. These results suggest that the topical treatment of onychomycosis by occlusive dressing is a useful method for those patients who have difficulties in or do not wish to be treated with oral antifungal agents.
Three sprayed dressings (Novitas' wound spray, Nobecutan, and Sraycutan) were evaluated as wound covers by using guinea-pigs as experimental animals. There were no statistically significant differences between the closure rates of the wounds covered with the three sprays. All the dressings protected the wounds equally against suppuration, which caused irregular and ugly scars in the non-sprayed control wounds of the same animals. Histologically, the non-treated wounds showed a greater number of leucocytes and oedema than the sprayed ones. This was demonstrable from the 8th to the 16th postoperative hours onwards. There were no histological differences between the variously covered wounds. Histochemically, the most intense enzymatic response to injury was demonstrable in the wounds treated with Novitas' wound spray, followed, in order of decreasing response, by Nobecutan, Spraycutan, and the non-treated wounds. These differences were most marked 4-6 hours after wounding. An intense enzymatic response to injury is considered to be beneficial to the healing process.
Alginates are versatile dressings able to support moist wound healing. They can absorb large amounts of wound exudate. Although similar to alginates, hydrofibre dressings are hydrocolloids.
In the present paper the anti-bacterial effect of bacitracin released from the collagen-based dressing and penetrating to the Staphylococcus aureus-colonised polyurethane sponge was assessed. The bacteria-colonised sponge, regarded as the "in vitro model of an infected wound", was used as a modification of the previously utilised by us analogous experimental systems. In addition, kinetics of the penetration of bacitracin from the collagen dressing to the sponge was estimated. The results indicate that in spite of the fact that the amount of bacitracin in the polyurethane sponge exceeded the minimal bactericidal concentration (MBC), not all bacteria from the S. aureus species colonising the sponge could be killed. Moreover, it appeared that in order to efficiently eradicate the sponge-adherent staphylococci the concentration of bacitracin 50-fold higher than the MBC value must be used.
Donor site complications of the radial forearm are a significant cause of post-operative morbidity. 15 patients had radial forearm free tissue donor sites treated with split skin grafts and a negative pressure dressing. All grafts showed 100% take at 5 days. The advantages of this technique include rapid healing at an unfavourable graft recipient site, increased graft take and decreased donor site complications. This method is ideally suited for the management of large defects. The dressing can be quickly and easily applied and there have been no significant complications.
After some remarks upon the value and the importance of periodontal surgical dressing in general and in case of incomplete dentition in particular, the author reports of a case in which a temporary plastic bridge had been combined with a dressing plate. This combination may also be recommended as a model to busy stomatological practices.
Only one previous study has been performed to assess the efficacy of pressure dressings after removal of a femoral artery sheath. The results of a 739-patient randomised study show there is no benefit in the routine application of pressure dressings after arterial sheath removal. This practice can be abolished with no negative impact on patient safety.
The choice of wound dressing after abdominal surgery is not always easy. We describe a simple technique using acyanoacrylate wound adhesive to provide a water resistant, flexible, sealed dressing which is simple to use, requires no nursing time to 'maintain' and is particularly useful in the presence of stomas or open drains.
In order to evaluate some of the physical properties of the Haifa Occlusive Dressing, which is in use in our Department, temperature, moisture and the transfer of gases were measured. The Haifa Occlusive Dressing does not significantly raise the temperature of the covered burn, nor does it hinder the diffusion of gases, even when wet. Measurements taken from a patient suffering from a deep second degree burn showed that the amount of secretion over a 9-h period was 270 cm3 and the rate of secretion/unit area was 0.0125 cm/h.
Further characterization has been undertaken of a visible light cured periodontal dressing material (Barricaid), which has been shown to exhibit superior physical properties to those of the standard (chemically curing) dressing materials. In particular, water sorption and solubility were studied, with a greater solubility found at 37 degrees than at 23 degrees with little further increase at 50 degrees C. Water sorption increased from 23 degrees C to 37 degrees C but decreased at 50 degrees C. Cure depth, determined by a penetrometer method, showed a constant resistance of 5.8 kg to probe penetration to a material thickness of 11 mm but resistance to penetrometer penetration, i.e. the level of cure, decreased sharply at greater thickness. The tensile strength of the material was unchanged when immersed up to 7 days in water at 37 degrees C, indicating a highly coherent material unaffected by water over a period corresponding to average clinical use. Previous studies showed that interlocking into the embrasures was required for adequate adhesion of Barricaid. To overcome this problem, teeth were etched and a bonding agent applied to the etched enamel surface. This chemo-mechanical lock gave an immediate adhesion value of 43.94 MPa, which decreased to 37.17 MPa at 7 days. The immediate adhesion value without etching and bonding was 34.23 MPa which decreased to 19.32 MPa at 7 days. Soaking decreased adhesion to enamel, but the effect was markedly less when the enamel was pretreated by etching and priming.
Multicentric trial to test the efficacy of the combined use of two hydrocolloid dressings (AQUACEL + Varihesive Extra Fino) or a hydrocolloid dressing and gauze in the treatment of different aetiology lesions. Includes 1,805 patients with lesions that can be treated with the cure system under study, without wound dimensions or severity restrictions. At the end of the trial period, 78.3% of the lesions reached healing or a significant improvement of their condition, resulting in an increase of patients' quality of life. 90% of patients confirmed their willingness to continue the treatment with AQUACEL.
Among the many categories of advanced wound dressing products available today, hydrogels are popular because they are effective, comfortable, easy to use, and cost effective. With proper use, these agents provide control of wound surface hydration, sometimes absorbing excess exudate and often providing moisture. This review describes the chemistry of hydrogels, the physiology of their interaction with the wound surface, and their role in patient care. Hydrogels have been proven effective in facilitating repair of pressure, diabetic, vascular, burn, and other wounds, and they have supplanted saline-moistened gauze for many applications. Clinical evidence suggests that no particular hydrogel is significantly more efficacious than any other, implying that other factors such as cost and ease of use may guide clinician choice of product within this class of wound dressings.
A new technique is described for dressing of surgical wounds in total knee arthroplasty that is a combination of a semi-permeable dressing and suction drainage. This technique has been used in 100 consecutive cases and drainage was collected in 92. The average volume was 198 ml (range 30 to 850 ml). There was no superficial or deep sepsis. Haematoma formation causing moderate soft tissue tension and some patient discomfort was noted in 9 knees. This form of postoperative wound management retains the nursing and hygiene advantages of deep suction drainage, whilst avoiding the patient discomfort and potential complication possibilities associated with deep internal drainage.
Periodontal dressing consisting of collagen and Lactobacillus casei 37 cell suspension (cell concentration 108 cells/ml) was created and used in combined treatment of patients with chronic generalized parodontitis. Efficacy of the developed isolation was explained by a considerable decrease of the number and frequency of isolation of aggressive microbial representatives (pigment synthesizing Bacteroids, Actinomyces and Str. intermedius) in periodontal pockets and also Fungus (Candida albicans). This periodontal dressing provided remission up to 10-12 months.
Results of development of new biologically active dressings and up-to-date methodology of local treatment of wounds (based on their differential application according to phase and features of wound process) are demonstrated. Data about main properties and specific activity of new biologically active dressings based on natural and synthetic polymers with immobilized drugs are presented. Future trends and efficacy of their appliance in complex treatment of purulent and necrotic wounds are demonstrated.
Occlusive dressings are the foundation of wound care and have been shown to speed epithelialization and healing of surgical sites. Many different dressings have been introduced over the years including antibacterial ointments with gauze and adhesive, hydrocolloid bandages, and liquid adhesives. All of these have their limitations and advantages. We introduce our experience with a new organic polymer in solvent which when applied to a wound forms a flexible occlusive bandage. The material has been shown to have antimicrobial properties and be well-tolerated by patients.