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This paper discusses the suitability of potato peel as a burn wound dressing in developing countries. Clinical trials have demonstrated that epithelial growth occurs under the potato peel dressing in superficial partial thickness skin loss burns. In deep partial, full skin thickness burns and in the late granulating burn wound the results are not so favourable. More experience is required.
The use of silastic foam as a surgical dressing in 15 children with full thickness burns to the hand is described. Silastic foam is a safe, easy and effective means of dressing the hand following surgery. It is rigid enough to act as a splint, and at the same time is deformable and accommodates postoperative swelling.
The use of quantitative bacteriology in the burns unit has been thought to be efficient in predicting sepsis or graft loss. To examine the relationship between clinical outcome and bacterial densities on and in the burn wound, 69 biopsy/surface swab pairs were collected from 47 patients on 64 occasions, either immediately prior to excision and grafting, or at routine change of dressings. The mean per cent TBSA burn was 16 (range 1-65). There was a significant correlation between log total bacterial count by biopsy with total white cell count and age (P = 0.028), and a significant negative correlation between total bacterial count by swab with per cent TBSA (P = 0.006). There was no significant difference in bacterial counts between patients judged to be a clinical success or clinical failure (72 h follow-up), either after undergoing excision and grafting, or change of dressings, and no difference in counts between patients with perioperative bacteraemia and those without. With burns > 15 per cent TBSA, a relationship between bacterial counts and subsequent sepsis or graft loss still was not demonstrated. It is suggested that quantitative bacteriology by burn wound biopsy or surface swab does not aid the prediction of sepsis or graft loss.
The FID, DRESS, CRISIS/CODEX, and STEAM techniques for localized 31P NMR spectroscopy were compared using a Siemens Magnetom SP63 1.5 T whole-body imager and a surface-coil, 80 mm in diameter, acting as transmitter and receiver coil. The comparison was performed with phantom experiments and human in vivo investigations on the calf muscle. The phantom experiments which used the same volume size showed a comparable signal-to-noise ratio for FID and DRESS, while the two fully localized techniques showed a reduction in signal-to-noise ratio to 76% for CRISIS/CODEX and 31% for STEAM. The in vivo measurements confirm the phantom results and reveal that CRISIS/CODEX gains a 2.5 fold higher signal-to-noise ratio than STEAM under the same conditions.
1. A long term low level exposure experiment was conducted on rats in order to determine the metabolic patterns of realistic environmental dietary levels of cadmium from different sources. 2. Male and female rats were fed a diet for 6 months with a high crab content containing 4 mg Cd/kg as organic bound cadmium from dressed crab, a diet with low crab content containing 0.2 mg Cd/kg as organic bound cadmium, a casein based diet containing 4 mg Cd/kg as cadmium chloride and a low cadmium level control diet. 3. Analysis of the cadmium levels in the kidney, liver and spleen showed that uptake from the dressed crab was only half of that from the diet fortified with cadmium chloride.
This paper describes the difference between wounds which heal by first and secondary intention. A brief overview of the stages of healing is then given: inflammation, granulation, epithelialisation and contraction plus the difficulties sometimes associated with the scarring of wounds. The properties of the ideal dressing for optimum wound healing rate are outlined, plus references to associated research. The litigation aspects of acute wound care in Accident and Emergency are covered, and then each dressing family is explored with indications given for appropriate application. Pain, infection, stab and gunshot wounds, plus the influence of factors delaying wound healing and the importance of patient education, are covered under separate headings. The importance of the nurse in planning and evaluating wound care is stressed.
Chitin grafted with poly(acrylic acid) (chitin-PAA) was prepared with the aim of obtaining a hydrogel characteristic for wound dressing application. The chitin-PAA films were synthesized at various acrylic acid feed contents to investigate its effect on water sorption ability. Acrylic acid (AA) was first linked to chitin, acting as the active grafting sites on the chain that was further polymerized to form a network structure. The evidences of grafting were found from FTIR and solid state 13C NMR spectra. The TGA results exhibited the high degradation temperature of the grafted product suggesting the formation of a network structure. The degree of swelling (DS) of chitin-PAA films was found in the range of 30-60 times of their original weights depending upon the monomer feed content. The chitin-PAA film with 1:4 weight ratio of chitin:AA, possessed optimal physical properties. The cytocompatibility of the film was investigated with a cell line of L929 mouse fibroblasts. The morphology and behavior of the cells on the chitin-PAA film were determined after different time periods of culture up to 14 days. The L929 cells proliferated and attached well onto the film. These results suggested that the 1:4 chitin-PAA has a potential to be used as a wound dressing.
The battle against methicillin-resistant Staphylococcus aureus (MRSA) wound infection is becoming more difficult as drug resistance is widespread and the incidence of MRSA in the community increases. Manuka honey dressing has long been available as a non-antibiotic treatment in the management of chronic wound infections. We have been using honey-impregnated dressings successfully in our wound care clinic and on the maxillofacial ward for over a year.
UNLABELLED: Burn sepsis is a leading cause of mortality and morbidity in patients with major burns. The use of topical anti-microbial agents has helped improve the survival in these patients. There are a number of anti-microbials available, one of which, Silvazine (1% silver sulphadiazine (SSD) and 0.2% chlorhexidine digluconate), is used only in Australasia. No study, in vitro or clinical, had compared Silvazine with the new dressing Acticoat. This study compared the anti-microbial activity of Silvazine, Acticoat and 1% silver sulphadiazine (Flamazine) against eight common burn wound pathogens. METHODS: Each organism was prepared as a suspension. A 10 microl inoculum of the chosen bacterial isolate (representing approximately between 10(4) and 10(5) total bacteria) was added to each of four vials, followed by samples of each dressing and a control. The broths were then incubated and 10 microl loops removed at specified intervals and transferred onto Horse Blood Agar. These plates were then incubated for 18 hours and a colony count was performed. RESULTS: The data demonstrates that the combination of 1% SSD and 0.2% chlorhexidine digluconate (Silvazine) results in the most effective killing of all bacteria. SSD and Acticoat had similar efficacies against a number of isolates, but Acticoat seemed only bacteriostatic against E. faecalis and methicillin-resistant Staphylococcus aureus. Viable quantities of Enterobacter cloacae and Proteus mirabilis remained at 24h. CONCLUSION: The combination of 1% SSD and 0.2% chlorhexidine digluconate (Silvazine) is a more effective anti-microbial against a number of burn wound pathogens in this in vitro study. A clinical study of its in vivo anti-microbial efficacy is required.
One of the problems with the dermal substitute Integra has been securing the material to the wound bed to prevent shearing and loss. Techniques to achieve stability include staples and elastic netting with an over layer of absorbent dressings that can be changed regularly. We report an effective technique using suction dressings to immobilise Integra. This technique led to firm application underlying tissue, and appeared to decrease fluid collection under the Integra. Earlier mobilisation and discharge from hospital were facilitated.
The use and aims of various wound dressings are discussed. Application and indications in the horse vary according to the type and location of the wound as well as the nature and availability of the dressing material. Coaptation and immobilization are essential to promote healing in certain locations. Techniques used for bandage application in horses are described, with special emphasis on problem areas.
New materials have allowed the role of the bandage to expand from passive protector to active participant in the wound healing process. By building a bandage that maintains a moist wound environment,the veterinarian uses the patient's own wound healing mechanisms to provide selective autolytic debridement, speed granulation and epithelialization, decrease infection, and increase patient comfort. A large variety of primary dressings are available to custom-make a bandage appropriate to each stage of wound healing. This article discusses the principles of moist wound healing, selection and application of primary dressings, special considerations for applying and changing bandages and splints, and prevention of bandage complications.
Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a serious condition associated with drugs. We report the case of a patient with a febrile skin eruption associated with eosinophilia and hepatitis following drug intake. Serological testing for human herpes virus 6 (HHV-6) was positive. Skin biopsy was compatible with DRESS syndrome. Despite discontinuation of all medications and initiating of corticosteroids, the patient developed acute renal and cardiac failure leading to death. Diagnosis, pathophysiology, and treatment are discussed.
Conventional circumcision techniques may result in bleeding, limited control of the mucosal collar, and the need for dressings. We describe a modified bipolar technique enabling near-bloodless dissection with precise mucosal trimming. Following bipolar division of the preputial skin, the inner mucosa is separated using two forceps and retracted proximally, creating a protective plane for safe skin adjustment. The mucosal collar is trimmed with scissors. The wound is closed with sutures and 2-octyl cyanoacrylate, avoiding dressings. This technique has been performed in 55 consecutive cases (median age: 2 years and 2 months; range: 0 days-17 years and 5 months) with no reported complications over a median follow-up of 2 years and 7 months (range: 3 months-4 years and 1 month).
INTRODUCTION: Skin grafting of penile defects is difficult because of the flexibility of the underlying recipient bed. This leads to disruption of the vascular ingrowth into the skin graft and compromises the results of the reconstruction. TECHNICAL CONSIDERATIONS: We successfully used a vacuum-assisted closure dressing with an incorporated wooden framework to secure penile skin grafts in place during the early postoperative period. CONCLUSIONS: A vacuum-assisted closure dressing can be used successfully to secure large and circumferential skin grafts, as well as skin grafts on concealed penises.
Newer endoscopic techniques have been successful at reducing saphenous vein donor-site wound complications, but not entirely eliminating them. Tissue necrosis with superimposed infection is typically treated with antibiotics and surgical debridement. Typically, primary reclosure is not possible and the open leg wound is allowed to slowly granulate with dressing changes until a skin graft can be performed. This report describes an alternative treatment using subatmospheric pressure dressing to promote granulation tissue and wound closure in saphenous vein donor-site wounds.
BACKGROUND: Clinical deterioration after burn wound manipulation may be related to the release of cytokines including tumour necrosis factor-alpha (TNF) and interleukin-6 (IL-6). METHODS: The two cytokines were assayed by immunoenzymetric assay in blood samples taken before and during manipulation of the burn wound. An antibiotic, teicoplanin, was administered to half the patients at the start of the procedure in a randomized fashion as part of a separate trial. FINDINGS: Sixty patients with a median burn size of 8% (range 1-56%) were studied during dressing change (n = 40) or burn excision (n = 20). There was little change in TNF levels between preoperative and recovery samples but IL-6 concentrations increased three-fold, particularly in those with large recent burns or bacteraemia, and were correlated with poor clinical outcome. The presence of teicoplanin did not significantly affect the levels of either cytokine. INTERPRETATION: The systemic cytokine response to burn wound dressing or debridement is predominantly that of IL-6 and it is not significantly reduced by preventing Gram-positive bacteraemia during the procedure.
The concentrations of nonylphenols and phthalates in depth profiles of eight differently dressed, fertilised and cultured fields were investigated. The fields were typical for Danish agriculture and comprised an uncultured location, two manured fields, an artificially fertilised field and three fields amended with different amounts of sewage sludge. In addition, a location receiving run-off from a sewage sludge storage facility were investigated. At each location, two 50 cm vertical soil cores were taken, divided into sections of 10 cm each and analysed for nonylphenols and phthalates by high-resolution mass spectrometry. Di-(2-ethylhexyl)-phthalate (DEHP) was the most abundant phthalate in all samples whereas Di-(n-butyl)-phthalate (DBP) played a minor role. Nonylphenols occurred in significant concentrations only in soil samples exposed to high amounts of sludge and at the run-off location. A close relationship was found between the concentrations of contaminants in the soil samples and the method of dressing. The concentrations were low at comparable levels in the soil samples from the artificially fertilised field and in the fields amended with low amounts of sludge, as well as in the manured fields. Remarkably, these concentrations did not differ significantly from the level in an uncultured recreational preserved area, which was used as a reference. In contrast, much higher levels of contaminants were found in the soil samples from fields exposed to high amounts of sludge. We must conclude that sludge amendment below a certain limit does not lead to elevated levels of nonylphenols and phthalates in the soils, whereas heavy sludge amendment leads to the accumulation of these contaminants. For the vertical distribution of substances in the soils, an influence of soil characteristics on the concentration profile was noted. Thus, in soils with visible clay in the upper layers, a DEHP maximum occurred at a depth of 10-20 cm, whereas in most sandy soils no such maximum was observed. A 2-year time trend study of the highly sludge amended soil showed no measurable reduction in the substances during this period. The time study further suggested a downward movement of the DEHP maximum of approximately 10 cm per year.