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PubMed2002

Clinical and scientific data of a hydropolymer range of dressings.

The Tielle trade mark family (Johnson and Johnson Medical) is a range of hydropolymer foam dressings that come in a variety of shapes and sizes, and are designed to fit the different types and locations of wounds that occur in practice. There are three types: Tielle, Tielle Lite and Tielle Plus. Each can be based on the characteristics of the primary dressing, if any, and on the degree of exudate that the wound is producing. This article aims to give an overview of the range and a summary of research-based clinical and scientific evidence to support clinical practice.

Evidence-Based Medicine↗
PubMed2003

A study to compare a new self-adherent soft silicone dressing with a self-adherent polymer dressing in stage II pressure ulcers.

Pressure ulcers are common among elderly nursing home residents. To be effective in managing these wounds, a dressing should maintain a moist environment, facilitate healing, absorb exudate, remain in place for a number of days, and prevent trauma to the surrounding skin. An 8-week, open, randomized, multicenter, controlled study was conducted to compare the effects of a new self-adherent soft silicone dressing and a self-adherent hydropolymer dressing on Stage II pressure ulcers. Thirty-eight (38) residents participated in the study. Eighteen residents (mean age 83.8 years, range 74.9 to 95.1 years) were randomized to wound management with a soft silicone dressing, and the ulcers of 20 residents (mean age 82.5 years, range 66.4 to 91.9 years) were managed with a hydropolymer dressing. Wound healing, wound and surrounding skin characteristics, and ease of dressing removal were measured and documented. During the study, eight (44%) ulcers in the soft silicone group and 10 (50%) in the hydropolymer dressing group healed. Both dressings were changed approximately once a week and no differences in signs of inflammation, amount of exudate and odor, or incidence of leakage were observed. Damage to the surrounding skin, maceration, and dressing removal difficulties were less common with the soft silicone dressing. Differences in tissue damage between the two dressings were significant during weeks 1, 2, and 3 (P < 0.05). Studies with a larger sample size are needed to confirm these findings.

Aged↗
PubMed1991

[Clinical evaluation of hydrogel-type dressing materials after their 8-year use].

The subject to assessment were hydrogel dressings (in 42 patients) compared with the classical gauze dressing with an addition of various pharmaceuticals (in 65 patients). We found out that the gauze dressings get dry 24 hours after they have been applied, their replacement being very painful. The hydrogel dressings, on the other hand, do not cause any pain when replaced after the 24 hours. The hygroscopic properties of hydrogel dressings allow a quick cleaning of the wound from microorganisms. Permitting an easy absorption of antibiotics and other drugs, they contribute to an acceleration of the healing process and epidermis development.

Acrylamides↗
PubMed1987

[Dressing technic with silastic foam following penis operations].

Silastic foam has very good properties as dressing material. After operations on the penile urethra or the corpora cavernosa the liquid foam is applied to the wound area. The foaming material avoids formation of pouches and hollow spaces. The compressive bandage prevents post surgical edemas and hematomas respectively. It can be removed without pain.

Humans↗
PubMed2005

The use of vacuum-assisted closure in the treatment of post-transplant wound infections: a case series.

We present 6 cases of the successful use of vacuum-assisted closure dressings as the primary treatment of wound infection after thoracic organ transplantation. In a series of 160 successive transplant operations, deep wound infections developed in 6 patients (3.7%). These all fully resolved over 3 to 29 days with the use of vacuum dressings. We believe vacuum-assisted closure therapy in the context of heart and lung transplantation is effective, well tolerated, and avoids the need for repeated surgical debridement and reconstruction.

Adult↗
PubMed2003

The effect of dilution on the rate of hydrogen peroxide production in honey and its implications for wound healing.

OBJECTIVE: Honey is an effective antiseptic wound dressing, mainly the result of the antibacterial activity of hydrogen peroxide that is produced in honey by the enzyme glucose oxidase. Because the rate of production of hydrogen peroxide is known to vary disproportionately when honey is diluted, and dilution of honey dressings will vary according to the amount of wound exudate, it is important to know more about the production of hydrogen peroxide at different concentrations of honey. DESIGN: The rates of hydrogen peroxide production by honey with respect to honey dilution were measured in eight different samples of honey from six different floral sources. SETTINGS: Honey Research Unit, Waikato University, Hamilton, New Zealand. MAIN RESULTS: The maximum levels of accumulated hydrogen peroxide occurred in honey solutions diluted to concentrations between 30% and 50% (v/v) with at least 50% of the maximum levels occurring at 15-67% (v/v). This is equivalent to a 10 cm x 10 cm dressing containing 20 mL of honey becoming diluted with 10 to 113 mL of wound exudate. Maximum levels of hydrogen peroxide reached in the diluted honeys were in the range of 1-2 mmol/L. CONCLUSION: Significant antibacterial activity can be maintained easily when using honey as a wound dressing, even on a heavily exuding wound. Concentrations of hydrogen peroxide generated are very low in comparison to those typically applied to a wound, thus, cytotoxic damage by hydrogen peroxide is very low.

Anti-Infective Agents, Local↗
PubMed2006

Silver based wound dressings and topical agents for treating diabetic foot ulcers.

BACKGROUND: Foot ulceration affects 15-20% of people with diabetes. It is a major precursor to amputation in this patient group, and early and appropriate treatment provides the greatest opportunity for healing. The use of silver for its antimicrobial properties has re-emerged, and modern wound dressings that release a sustained amount of free silver ions, are now widely used in wound management. OBJECTIVES: To evaluate the effects of silver-containing dressings and topical agents on infection rates and healing of diabetes related foot ulcers. SEARCH STRATEGY: Searches were made of the Cochrane Wounds Group Specialised Register (August 2005), the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library Issue 3 2005) MEDLINE (1966 to October week 2 2004), EMBASE (1980 to October week 2 2004) and CINAHL (1982 to October week 2 2004). The Journal of Wound Care (Volume 12/13 Issues 1-10) was hand-searched. Manufacturers, researchers and local and international wound groups were contacted in order to identify unpublished trials. Web sites for wound groups and World Wide Wounds (www.worldwidewounds.com) were searched. SELECTION CRITERIA: Randomised controlled trials and non-randomised controlled clinical trials were considered for inclusion. Studies were included if they involved participants with Type 1 or Type 2 diabetes and related foot ulcers, met the requirements for randomisation, allocation and concealment where appropriate, and compared the intervention with a placebo or a sham dressing, an alternative non silver based dressing or no dressing, and reported outcomes that represent healing rate or infection. DATA COLLECTION AND ANALYSIS: Two authors independently evaluated the papers identified by the search strategy against the inclusion criteria but identified no trials eligible for inclusion in the review. It was not possible to perform planned subgroup and sensitivity analysis in the absence of data. In future, if eligible trials become available, a random effects model will be applied for meta-analysis in the presence of statistical heterogeneity (estimated using the I(2) statistic). Dichotomous outcomes will be reported as risk ratios with 95% confidence intervals (CI), and continuous outcomes as weighted mean differences (WMD) with 95% CI. Statistical significance will be set at P value < 0.05 for all outcomes and the magnitude of the effect will be estimated by calculating the number needed to treat (NNT) with 95% CI. MAIN RESULTS: No studies were identified that met with the inclusion criteria AUTHORS' CONCLUSIONS: Despite the widespread use of dressings and topical agents containing silver for the treatment of diabetic foot ulcers, no randomised trials or controlled clinical trials exist that evaluate their clinical effectiveness. Trials are needed to determine clinical and cost-effectiveness and long term outcomes including adverse events.

Administration, Topical↗
PubMed1990

A silicone gel sheet dressing containing an antimicrobial agent for split thickness donor site wounds.

Treatment of a split thickness donor site wound in 20 patients by means of a silicone gel sheet containing Ofloxacin, an antimicrobial agent, has been tested. For a comparison, each wound was divided into two parts, one for the silicone gel treatment and the other with a collagen sheet (10 cases) or an ointment-impregnated gauze (10 cases). Although Staphylococcus aureus was detected in three wounds treated with the collagen sheet, no wound treated with the silicone gel developed an infection even though the infected wound was adjacent. Results have shown that prompt epithelialisation occurred in the silicone gel-covered wounds, with little exudate and pain compared to wounds treated with either of the dressings. Although some wounds treated with the silicone gel tended to exhibit a slightly prolonged redness compared to wounds treated with an ointment-impregnated gauze, no subsequent cosmetic problem resulted.

Adolescent↗
PubMed1997

Hemostatic efficacy of a fibrin sealant-based topical agent in a femoral artery injury model: a randomized, blinded, placebo-controlled study.

PURPOSE: The efficacy of currently available topical hemostatic agents requires the formation of fibrin generated from circulating blood. Fibrin sealant, which is prepared from high concentrations of thrombin and fibrinogen, has been used in liquid form to promote hemostasis during vascular surgery. In a blinded, randomized, placebo-controlled fashion, we evaluated a dry dressing of purified, viral-inactivated human fibrinogen and human thrombin in a large animal model of arterial injury. METHODS: Dressings were prepared by application of a layer of lyophilized human fibrin sealant or immunoglobulin G (IgG, control) to a silicone backing material. Six anesthetized female Yorkshire pigs (16 to 27 kg) received bilateral, 4 mm longitudinal femoral arteriotomies after surgical exposure of the arteries. The arteriotomies were not closed. In each animal a fibrin sealant dressing was applied to one artery and a control dressing to the other. Each dressing was secured on the arteriotomy by a mechanical device. After application of the dressings, blood flow was restored to each limb for 1 hour. The compressive device was released for 5 seconds at intervals of 15 minutes to assess hemostasis. Blood flow was measured distal to each arteriotomy with a dual-channel flowmeter to adjust equal bilateral compression. RESULTS: Blood loss (mean +/- SEM) was significantly less from the arteriotomy treated with the fibrin-based dressing compared with the control dressing (4.9 +/- 4.0 ml versus 82.3 +/- 11.1 ml; p = 0.0005). Complete hemostasis was achieved at the first 15-minute interval in five of six arteriotomies treated with fibrin sealant and in none of the six control arteriotomies during 1 hour of assessment (p = 0.03). Blood flow through each femoral artery at baseline was the same in both treatment and control arteries (fibrin sealant, 114.2 +/- 17.4 ml/min; control, 106.7 +/- 16.5 ml/min; p = 0.24) and was not significantly different throughout the experiment. CONCLUSIONS: Fibrin-based dressings provide effective hemostasis in a large animal model of arterial injury. Further development of these dressings will address optimal formulation and configuration for clinical use. Our results suggest that fibrin-based dressings will be effective in promotion of hemostasis in arterial bleeding, without compromising blood flow.

Animals↗
PubMed2004

[The treatment of heel pressure ulcer with V.A.C. therapy using the new V.A.C. GranuFoam "Heel-Dressing"].

The treatment of heel pressure ulcer represents one od the difficulties in treatment of pressure ulcer, because of its pressure load conditional on the calcaneus, the missing of muscle buffer and the huge number of tender insertions. With the V.A.C.-Therapy based upon interdisciplinary pretreatment (debridement, control of infection, circulation and metabolism and pressure relief) the growth of granulation tissure succeeds in a very fast time. The new V.A.C.-GranuFoam Heel Dressing contains the possibility to apply the V.A.C.-Therapy safe and very quick, in spite of the difficult ulcer location at the heel. Moreover it includes the necessary transfer of the T.R.A.C-Pad on the top of the foot to prevent new increase of pressure.

Aged↗
PubMed1991

A new dressing method for free skin grafting in hands.

Using adhesive drapes and a disposable suction drain, the grafted area is compressed by positive pressure that is equivalent to the negative pressure of a suction drain. With this dressing method, the graft can be observed throughout the postoperative course, and can be applied with uniform and constant pressure. Thin drapes accommodate well to various shapes, so this method is uniquely qualified in free skin grafting of hands.

Adult↗
PubMed2001

Nipple-areolar reconstruction: a different approach to skin graft fixation and dressing.

Nipple-areolar reconstruction (NAR) is now an integral component of any type of breast reconstruction. This study presents a simple and reliable skin graft fixation and dressing technique used on 278 NARs in 221 patients from 1996 to 2000. Nipples and areolas were reconstructed with a modified skate flap and a full-thickness skin graft, respectively. Skin grafts were sutured and stented using Steri-Strips. A Tielle hydropolymer dressing with a central fenestration was used to cover the whole nipple-areolar complex. The nipple is dressed further with gauze and Microfoam tape. All nipples demonstrated 100% survival. There was one partial skin graft loss and 5% of the grafts had mild epidermolysis with eventual full reepithelialization. This dressing regime is simple and reliable in ensuring optimal skin graft take and nipple viability. It provides compression of the graft to prevent shearing and fluid accumulation, excellent absorbing capacity, a moist environment to promote wound healing, and maximal patient comfort.

Breast↗
PubMed2004

Treatment of partial-thickness burns: a prospective, randomized trial using Transcyte.

BACKGROUND: The purpose of the present study was to compare the effectiveness of three burns dressings (TransCyte, a bio-engineered skin substitute; Biobrane; and Silvazine cream (silver sulphadiazine and 0.2% chlorhexidine)), in treating children with partial-thickness burns. The primary objective was to determine the days until > or =90% re-epithelialization. The secondary objectives were to evaluate the number of wounds requiring autografting and the number of dressing changes/local wound care required. METHODS: Study wounds were identified on each patient and the patients were randomized to receive TransCyte or Biobrane or Silvazine. Assessment of study wound closure began at 2 days after treatment and continued at least every other day thereafter until the wounds re-epithelialized or were autografted. A laser Doppler imaging system was used as an adjunct to assessing the depth of the burn. RESULTS: Thirty-three patients with 58 wound sites enrolled in the study (TransCyte, n = 20, Biobrane, n = 17; Silvazine, n = 21). Mean time to re-epithelialization was 7.5 days for TransCyte, 9.5 days for Biobrane, and 11.2 days for Silvazine. The number of wounds requiring autografting were 5/21 (24%) for Silvazine, 3/17 (17%) for Biobrane, and 1/20 (5%) for TransCyte. CONCLUSIONS: When used in partial-thickness burns in children, TransCyte promotes fastest re-epithelialization and required less overall dressings then Biobrane or Silvazine. Patients who received Silvazine or Biobrane require more autografting than those treated with TransCyte.

Anti-Infective Agents, Local↗
PubMed2003

Comparison of dressing removal following hypospadias repair.

Hypospadias occurs when the urethral folds fail to fuse on the ventral aspect of the penis (Thomas and Barker, 1997). Surgical repair is often warranted and standard postoperative practice in the UK often includes the application of a dressing around the penis. This article reports the outcome of a small randomized controlled feasibility study to compare two methods of dressing removal following hypospadias repair. The same dressing was used throughout the study--a control group used a standard method of dressing removal, while an experimental group had an additional barrier film applied before the dressing was attached to the wound. The primary outcome measure was the time taken to remove the dressing. The time interval between starting the process of dressing removal and having no dressing left in place was used for statistical analysis. Secondary measures included assessment of the child's pain at different intervals by the parents and by an independent nurse observer. General discussion took place with the parents regarding any experience of anxiety. This was to assess whether parental anxiety should be measured in a future randomized controlled trial (RCT). There appeared to be implications with regard to time savings with the new method of dressing removal. Issues about the most suitable environment to remove dressing and differences between pain assessments of nurse and parent are noted. This was only a small-scale study. To investigate these issues more fully, a RCT has since been developed, has gained ethical approval and is due to start in August 2003.

Adolescent↗
PubMed2005

Silver absorption and antibacterial efficacy of silver dressings.

OBJECTIVE: To evaluate the patterns of silver release from selected sustained silver-release dressings and the protective role of proteins in wound exudate and wound scale. The bactericidal action of silver in chronic wound therapy is also examined. METHOD: Sequential microbiological examination of wound swabs from seven patients with chronic wounds and sampling of wound exudate and wound scale. Silver content was measured using atomic absorption spectrometry. The ability of Contreet Foam to absorb exudate and release silver was studied in punch biopsy wounds in a rodent model. RESULTS: Silver accumulation in wound exudate correlated well with its viscosity and protein content. Silver bound to wound scale and debris was approximately proportional to the silver ion release from dressings. Bacterial burden was controlled, but not eliminated, following chronic silver therapy. CONCLUSION: Silver dressings (Acticoat-7, Actisorb Silver, Contreet Foam, Aquacel Ag and Flamazine) were found to be safe for use in chronic wound therapy. Excess silver ion is bound by wound exudate and wound scale as a protective mechanism. Silver-release dressings are not likely to result in germ-free wounds. Further studies are needed to examine potential silver resistance.

Aged↗
PubMed2006

Gauze packing of open surgical wounds: empirical or evidence-based practice?

INTRODUCTION: Most surgical wounds are closed primarily, but some are allowed to heal by secondary intention. This usually involves repeated packing and dressing of the raw wound surfaces. Although the long-term care of such wounds has devolved to the care of nurses in the community or out-patient setting, the initial wound dressing or cavity packing is done by the surgeon in the operating theatre. Many surgeons are unaware of the growth of the discipline of wound care, and still use traditional soaked gauze for dressing and packing open surgical wounds and cavities. RESULTS: This review summarises the some of the modern alternatives available and the evidence--or the lack of it--for their use in both the acute and chronic setting.

Bandages↗
PubMed2006

The clinical efficacy and cost effectiveness of the vacuum-assisted closure technique in the management of acute and chronic wounds: a randomized controlled trial.

BACKGROUND: Vacuum-assisted closure therapy is a relatively new concept described in the literature that increases wound-healing capacity. The authors aimed to investigate the effect of vacuum-assisted closure therapy on wound healing, granulation tissue formation, bacterial clearance, pain, time involvement of the staff, and total costs in all types of wounds in comparison with modern wound dressings. METHODS: Sixty-five patients with a chronic or acute wound were randomized to initial treatment with vacuum-assisted closure or modern dressings. The authors' primary endpoint was a granulated wound or a wound ready for skin grafting or healing by secondary intention. RESULTS: The time to the primary endpoint with vacuum-assisted closure therapy was not significantly shorter, except for patients with cardiovascular disease and/or diabetics. Vacuum-assisted closure therapy did not result in significantly faster granulation or wound surface reduction or better bacterial clearance, but patient comfort was an important advantage. Time involvement and costs of nursing staff were significantly lower for the vacuum-assisted closure therapy, but overall costs were similar for both groups. CONCLUSIONS: With vacuum-assisted closure therapy, wound healing is at least as fast as with modern wound dressings. Especially cardiovascular and diabetic patients benefit from this therapy. The total costs of vacuum-assisted closure are comparable to those of modern wound dressings, but the advantage is its comfort for patients and nursing staff.

Acute Disease↗