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The usual topical therapy for shallow ulcers involves frequent dressing changes, which are especially difficult in the paraplegic. A special karaya-Stomahesive dressing is presented which may, in certain cases, be changed only once or twice a week with good results.
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.
The purpose of this research utilization project was to determine if a sufficient research base was present to support the use of gauze rather than transparent dressings for peripheral intravenous catheter sites. The research articles reviewed in this article do not support a relationship between dressing type and complications of peripheral intravenous catheters.
Epithelialization of second-degree burn wounds is known to be accelerated by topical treatment with hydrogel dressings and further enhanced by pulsed electrical stimulation compared with no treatment (air exposure). Tissue collagenase has been proposed to be involved during the process of epithelialization. In the present study collagenase levels were examined in partial-thickness burn wounds in the skin of four domestic pigs. Collagenase levels, assayed on postburn days 1 to 10, were substantially reduced in deblistered and air-exposed burn wounds compared with excisional partial-thickness wounds. Early application of hydrogel dressing to the burn wounds was accompanied by elevated collagenase activities and an increased inflammatory reaction in dermis. Addition of pulsed electrical stimulation increased (p < 0.001) collagenase levels twofold above those with hydrogel alone during initiation of epithelialization (postburn days 3 and 4). These results suggest that collagenase is closely linked to wound epithelialization.
The authors report the use of a new polyurethane dressing, studied in 20 patients undergoing breast surgery. Based on objective criteria, this study analyses the contribution of this dressing in the postoperative course.
A new transparent dressing, IV3000 is reported to be successful in preventing moisture accumulation around the catheter site. A trial was thus undertaken to compare its effectiveness in preventing catheter-related sepsis with a conventional film dressing.
Lacerations occur commonly during competitive contact sports. Such injuries often limit the ability of the athlete to continue competition because of concerns about further trauma to the site and risks of infection. We describe herein the use of a biosynthetic dressing, Duoderm Thin, to protect lacerations received during competitive wrestling. The dressing was able to support the skin, protect the laceration from further injury, shield the wound from exposure to infectious agents, and prevent transmission of blood or serum to other wrestlers. Such protection enabled two wrestlers to continue competition and/or practice without adverse effects.
The treatment of chronic stable plaque psoriasis continues to present a challenge to the practitioner. The use of topical steroids to treat lesions is often associated with resistance and rebound upon discontinuation of prolonged use. Use of hydrocolloid dressings enhances the efficacy of topical steroids and reduces the amount of medication required to control plaques. We report results obtained with a hydrocolloid dressing used for a seven-day period with triamcinolone acetonide 0.1 percent. In a group of six patients, an average of 44 percent improvement was achieved, while untreated sites remained stationary. Patient satisfaction with results and rating of convenience of the treatments was high.
In this study, we performed exit-site care using one of three methods (A: cleanse the exit site with povidone-iodine daily and apply gauze dressing; B: cleanse the exit site with povidone-iodine once a week, cover the site with a small gauze, and seal it completely with dressing film; C: the same as in B, above, except once every two weeks). The results show that there was a higher rate of positive bacterial growth in method A (17/24, 71%), and we concluded that the sterility of the exit site was not maintained 24 hours after cleansing. In methods B and C, in which the exit site was kept sealed, we did not detect bacterial growth in almost any of the cases (B = 0/44, C = 1/7). Although the patients took a bath and did not perform any care of the exit site for one to two weeks, the results show that the exit site was protected from bacterial invasion. We believe that this method could reduce exit-site infection while requiring no daily care.
By appreciating the concept of capillarity and by determining whether or not the dressing to be used next to the wound should be hydrophilic or hydrophobic, a dressing can be designed that acts to remove secretions from a draining wound. It also may protect a wound from exogenous secretions.
Currently our understanding of chronic wound pathophysiology is deficient in knowing what specifically is lacking during arrested wound healing. Autologous or allogenic keratinocytes have been used successfully to treat chronic wounds, as have composites containing diverse substances such as allogenic dermis, polyglycolic acid, or collagen mesh combined with keratinocytes or fibroblasts (Table 6). In spite of great technological advances and increased understanding, there is much work to be done. We look forward to the day when our knowledge of wound healing has progressed to the point when specific deficiencies can be supplemented by dressing contents, and when "smart" dressings can adapt to the changing wound as it progresses through the phases of healing.
In the early 1970s, a major revolution in the management of wounds began. Simple woven absorbents that kept the wound as dry as possible were superseded by occlusive dressings that provided moist wound healing. The wound healing process is influenced by control of moisture content, thermal properties, gaseous permeability, pH effects, and impermeability to micro-organisms. Low adherence of the dressing provides protection of the newly formed tissue and relieves the patient's pain during removal.
A random sample of parents of children admitted to the pediatric inpatient services of a university teaching hospital was studied using sets of paired photographs of house staff physicians wearing one of three typical outfits to assess the relationship between house staff physician dress and parents' perceptions of competence. The results indicated that parents were twice as likely to attribute competence to the physician wearing formal dress compared with the physician wearing an operating room outfit and four times more likely compared with the physician wearing an intern uniform. The likelihood of making assumptions of competence was significantly reduced in parents with a university education and in parents who had never previously had a child hospitalized. The gender of the physician had no effect on perceptions of competence.
A polyurethane foam (Lyofoam) has been reported to accelerate epithelization of a wound. The purpose of this study was to evaluate its efficacy as a donor-site dressing for thermally injured patients. Thus, partial-thickness injuries were made in ten pigs and covered with Lyofoam, Xeroform, Telfa, Scarlet Red, and fine-mesh gauze. Gross and histologic examinations failed to show accelerated healing under the Lyofoam dressing but did show that Scarlet Red covered donor sites healed the fastest. On clinical evaluation, nine patients only showed that Lyofoam separated earlier from the underlying wound but there was no evidence to suggest that the wound was more mature than that covered with fine-mesh gauze.
A prospective randomized controller trial of dextranomer beads (Debrisan) and silicone foam elastomer (Silastic) dressings in open infected surgical wounds has been performed. The results indicate that the healing time for wounds treated by Debrisan (n = 25) and elastomer (n = 25) is similar, being 40.92 +/- 3.98 and 36.90 +/- 3.18 days respectively. The time taken for wounds to become pain-free was similar in both treatment groups, as was the persistence of signs in the wounds of erythema, oedema and slough. Comparison of cost reveals the elastomer dressing to be considerably cheaper than Debrisan.
One hundred patients undergoing routine diagnostic or interventional catheterization were randomly assigned to receive either percutaneously applied collagen (group A; n = 50) or conventional pressure dressing (group B; n = 50) for sealing of the femoral artery. Clinical variables were comparable in both groups. The heparin dose was 100 IU/kg in 30 patients and 200 IU/kg in 20 patients of either group. The average compression time was 4.3 min in group A and 42.3 min in group B (p < .001). Bleeding was not observed in group A but was observed in 6/50 patients in group B. The time to ambulation was 6.4 hr (range, 4-12 hr) in group A and 21.6 hr (range, 10-48 hr) in group B (p < .001). Hematomas with a diameter of > 6 cm developed in 4/50 patients in group A and in 11/50 patients in group B (p < .05). Blood-transfusions or surgical interventions were not required and there was no loss of ankle pulses in either group. In conclusion, percutaneously applied collagen reduced compression time and duration of bedrest after diagnostic catheterization and PTCA. Despite earlier ambulation, the incidence of bleeding was lower with collagen than with conventional pressure dressing.
Different poly(vinyl alcohol) (PVA)/chitosan lactate (ChL)-blended hydrogels containing nitrofurazone as a local anti-infective drug were prepared by the phase-inversion technique. The swelling degree, surface free energy, mechanical properties, and nitrofurazone release of these membranes were determined. Blood compatibility of these systems was evaluated by the open-static platelet adhesion test with whole human blood. The results showed that water absorption into the PVA/ChL membranes slowed down, governed by the rate at which the dressing interacted with the physiological fluid. Swelling degree values up to 200% were observed. The rate of release of nitrofurazone seemed to depend on the ChL percentage on the blend as well as the pH of the solution. The surface free energy values were in the range of 20-30 dynes/cm, which was appropriate for a favorable interaction with blood. From the Young's module curve, it could be seen that elastic hydrogels were obtained with increment of ChL in the PVA/ChL blends. Values of platelet adhesion and whole blood clotting times for the PVA/ChL blends as well as the increase of ChL, which appears to reduce the fibrinogen adsorption on the PVA/ChL membranes, demonstrated that the blood compatibility of PVP/ChL blends is superior to that separated polymers. The results of in vivo experiments in rats were in very good agreement with these observations, suggesting that PVA/ChL may serve as a new type of potential wound-dressing material.
Occlusion and elasticity were combined in a novel cotton-based alginate dressing containing a nontoxic elastase inhibitor. Cotton gauzes were modified with a textile finishing process for incorporating alginate to yield a dressing material that retains elasticity while enhancing absorption. The algino-cellulose conjugates were formed through citric acid crosslinking of cellulose and alginate. The alginate-citrate finishes were applied to cotton gauzes in various formulations containing citric acid, sodium hypophosphite, and polyethylene glycol. The modified gauzes contain a citrate conjugate of alginate and cellulose that gels upon hydration. The alginate-citrate finishes were combined with the neutrophil elastase inhibitor, oleic acid, to demonstrate the ability of the algino-cellulose fibers to release the inhibitor and neutralize destructively high levels of neutrophil elastase found in nonhealing and burn wounds. Four types of gauzes were examined for the effect of the algino-cellulose finish on cotton gauze absorbency and elasticity. Fourier transform infrared (FTIR) spectroscopy of the film and alginate-citrate finished cotton showed formation of the alginate and citrate cellulose esters. Scanning electron microscopy analysis revealed large areas of the yarn surface covered by the alginate film with a smooth surface on the original fibers. Wetting of the gauze surface resulted in formation of a hydrated gel on the yarns with apparent swelling of the film and the fiber-coated alginate.