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Three semi-permeable polyurethane dressings, 'Ensure', 'OpSite' and 'Tegaderm', were tested for their ability to prevent the increase in bacterial population under naturally hydrated, occluded volar forearm skin. Only 'OpSite' inhibited the bacterial multiplication in these tests. It is concluded that in the practical situation, 'OpSite' could well confer a greater margin of safety.
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Dibutyryl chitin (DBC) is a modified chitin carrying butyryl groups at 3 and 6 positions; its peculiarity is that it dissolves promptly in common solvents, while being insoluble in aqueous systems. The high biocompatibility of dibutyryl chitin in the form of films and non-wovens has been demonstrated for human, chick and mouse fibroblasts by the Viability/Cytotoxicity assay, In situ Cell Proliferation assay, Neutral Red Retention assay, Lactate Dehydrogenase Release assay, MTS cytotoxicity assay, and scanning electron microscopy. DBC was hardly degradable by lysozyme, amylase, collagenase, pectinase and cellulase over the observation period of 48 days at room temperature, during which no more than 1.33% by weight of the DBC filaments (0.3 mm diameter) was released to the aqueous medium. DBC non-wovens were incorporated into 5-methylpyrrolidinone chitosan solution and submitted to freeze-drying to produce a reinforced wound dressing material. The latter was tested in vivo in full thickness wounds in rats. The insertion of 4x4 mm pieces did not promote any adverse effect on the healing process, as shown histologically. DBC is therefore suitable for contacting intact and wounded human tissues.
Porcine full-thickness excisional wounds were treated with 4 different hydrocolloid (HCD) dressings--DuoDERM (ConvaTec/E. R. Squibb), Intrasite HCD (Smith and Nephew Medical), Tegasorb (3M) and Replicare (Smith and Nephew Medical). Animals were killed at 4, 10, 21 and 90 d post-wound, excision sites were fixed in formalin and processed for histological analysis. Granulomatous lesions were observed following treatment with each of the 4 HCD dressings. Such lesions developed between 4 and 10 d post-wound, exhibiting little evidence of resolution at 90 d post-wound. Of the 4 dressings examined, DuoDERM and Intrasite HCD precipitated the most severe reaction, each treatment resulting in granulomata with a distinct and different morphology. Treatment with DuoDERM resulted in granulomata characterised by a random distribution of dendritic cells, epithelioid cells, multinucleated giant cells, lymphocytes and plasma cells. In contrast, treatment with Intrasite HCD resulted in highly organised granulomata, consisting of a central focus of epithelioid cells surrounded by a peripheral cuff of macrophages, lymphocytes and plasma cells. This experimental study highlights chronic inflammatory lesions that may, if reflected in the clinical environment, question the efficacy and indication of HCD dressings in the treatment of wounds having a number of different aetiologies.
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Wound textiles suitable for placing immediately over a wound and materials for securing them in position are discussed. Wound texiles have a curative function (blotting-paper effect, antigravitation effect). Conditions for their use are three-dimensional capillary drainage, plane compression, and nonstick and cooling properties. Cellulose fibers absorb moisture in all three dimensions, while synthetic fibers transport moisture around their strands in a two-dimensional course. The nonstick properties are achieved by means of overtwisted threads in the warp (tunnel effect) in woven fabrics, and in nonwoven fabrics (when moisture is produced) by combination with overstretched cellulose, producing corrugations, or (for drying) by the uneven incorporation of overtwisted fibers into the fabric, which produces a ventilating effect. The nonstick properties always become obvious when the dressings are moistened.
Self adherent foam padding has unlimited opportunities for plastic and general surgical use. Skin blisters do occur but less often than with tape. It may also be used over the shoulder and scapula where other types of more invasive immobilization were usually necessary and has also been effectively utilized as postmammoplasty support, as facial and postrhytidectomy dressings, and over leg grafts. Furthermore, it can be used for postpilonidal and axillary pad dressings.
A case is reported of significant ischaemic damage to a fingertip from the use of Sellotape. The elasticity of Sellotape has been tested and compared with that of Elastoplast, illustrating the stiffness of Sellotape and thus emphasizing its unsuitability. The general public needs to be aware of the dangers of using non-proprietary dressings and the medical profession must remain vigilant about the elasticity of dressings.
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Secretion from wounds after cryosurgery of cutaneous malignancies may be excessive and may constitute a problem in management. It was found possible to collect and quantitate such discharges by use of highly hydrophilic dextranomer beads (Debrisan). They were applied in convenient, small "tea-bag" pads. The amount and duration of postoperative oozing was approximately proportional to the sizes of the lesions and more impressive in sites of sparse subcutaneous tissue. The absorbent pads also proved to be effective and safe for use as postoperative dressings.
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The prevalence of individuals with venous ulcers is estimated to be over 500,000 in the United States. Management should be based on an understanding of the pathophysiology of venous insufficiency and venous ulcers. This article presents a review of the anatomy venous system of the lower leg and the pathophysiology of venous insufficiency. In addition, a current theory of the etiology of venous ulcers, their complications, and management options are discussed. Emphasis is placed on patient education, compression therapy, and dressing choices.
Post-operative wounds healing by primary intention are often seen as the simplest areas of modern wound care. However, have we overlooked the problems that can exist and are we really looking at postoperative dressing selection with the same vigour we attach to other areas of wound care? This article outlines the development of modern post operative dressings, both fabric and film-based and raises the question 'if postoperative wound infection is a problem should we consider more effective barrier dressings?'
Wound dressings are classified according to their ingredients, but in many cases dressings within the same group have different recommended uses and even ingredients. Should future classifications be based on dressing functions?
Venous leg ulcers may affect up to 3.5% of the general patient population. The purchase price for dressing is not the true indication of cost effectiveness of any given method of care; rather cost is a combination of the price of the dressing plus labor required. Total cost equals nursing time, physician time, hospital stay, home-health costs, risks, and costs of complications (for example, infection), and the frequency of dressing changes.