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PubMed1999

Care of venous leg ulcers.

For many decades, few advances occurred in the treatment of venous ulcers. Clinicians mainly relied on compression using gauze impregnated with zinc oxide--the Unna boot. During the past few years, however, much has changed in favor of clinicians. A variety of compression bandages are now available along with effective wound dressings that take advantage of moist wound healing, better topical agents, new systemic therapies, and living bioengineered skin. In fact, the problem facing clinicians today may be in deciding what treatments to use in addition to compression therapy, which remains the accepted standard of care for venous ulcers. This paper discusses advances that have occurred during the past several years in the understanding and treatment of venous leg ulcers, and their implications for clinical practice, education, and future research.

Bandages↗
PubMed1984

Clinical experience with Biobrane biosynthetic dressing in the treatment of partial thickness burns.

Biobrane, a synthetic, bicomposite wound dressing, has been used to treat 17 patients with partial thickness burn wounds covering 0.5-12.5 per cent of the total body surface area (mean 4.4 per cent). In 16 patients we found complete healing of the wound after removal of the dressing, 6-15 days after the injury. In one patient, the wounds were determined on the third day post-injury to be deeper than initially suspected, and she was taken to the operating room for surgical debridement and grafting. Biobrane is an effective wound covering for clean, superficial partial thickness burns of limited extent; the simultaneous use of topical antimicrobial agents for such wounds is not necessary.

Adult↗
PubMed2005

Comparison of two peri-wound skin protectants in venous leg ulcers: a randomised controlled trial.

OBJECTIVE: A randomised controlled trial was designed to determine whether or not early intervention with a suitable skin barrier preparation could prevent skin breakdown. This study was conducted to compare the efficacy and cost-effectivenss of two skin protectants, Cavilon No Sting Barrier Film (NSBF) (3M Health Care) and zinc paste compound, in the management of maceration and irritation of the peri-wound area of venous leg ulcers. METHOD: Thirty-five patients with venous leg ulcers and surrounding skin problems were randomised to receive either NSBF or zinc paste compound. The preparation was then applied at each dressing change for 12 weeks. All patients had been receiving compression bandaging before entering the study and continued wearing it throughout the 12-week study period. RESULTS: The decrease in wound area was 5.11+/-8.39cm2 in the NSBF group and 4.59+/-5.83cm2 in the zinc paste group. The healing rate was 0.046cm per week with NSBF and 0.039cm per week with zinc paste. There was a significant difference in the time required to remove and re-apply the skin protectants: an average of 0.19 (+/-0.17) minutes in the NSBF group and 5.53 (+/-2.10) minutes in the zinc paste group (p<0.0001). CONCLUSION: Both products were effective barrier preparations. However, NSBF was easy to apply and transparent. The zinc paste was messy to apply and difficult to remove, and thus took up considerably more nursing time than NSBF. DECLARATION OF INTEREST: This study was supported by 3M Health Care.

Aged↗
PubMed2002

[Efficacy and tolerance of Algosteril (calcium alginate) versus Jelonet (paraffin gauze) in the treatment of scalp graft donor sites in children. Results of a randomized study].

Split skin graft is frequently needed in the treatment of burned patients. Scalp is often free of burns. Due to its good skin quality and important surface, scalp is a very interesting skin donor site, specially in case of children. A controlled, randomised clinical trial was carried out in 10 French Plastic Surgery or Burns Units. It assessed the efficacy and the acceptability of calcium alginate dressing (Algosteril) versus paraffin gauze dressing (Jelonet) in the treatment of scalp donor sites in children. 67 children (mean age 54 months) entered the study, 34 in the alginate group and 33 in the control group. Follow-up visits were on day 2/d3, d5/d6, Day complete healing, d30 and d60 after surgery. The two groups were comparable on inclusion (demographic characteristics, burn nature and surface, donor site surface and thickness of split skin graft). The mean healing time was 10 and 11 days for Algosteril and Jelonet group respectively (ns). The quality of the newly formed tissue was estimated to permit a sooner skin reharvesting in the Algosteril group than in the control group (p = 0.003). Bleeding through dressing was significantly less important in the Algosteril group (p = 0.02). Changes were considered by investigators less painful with Algosteril on day complete healing (p = 0.0096). Hair growth is homogenous in both groups on day 30 and day 60 (ns). These results showed that scalp is a very interesting skin donor site and that Algosteril is of a real interest in donor site treatment.

Alginates↗
PubMed1984

On twisting bandages: an experimental study.

Following hand surgery, some surgeons prefer to bandage fingers individually, a technique that involves twisting the material as the dressing is continued onto the palm. A laboratory study was performed to observe changes in tension which occurred when twisting a bandage already under load. Six commonly used types of bandage were studied, each of three standard widths. The rise in bandage tension due to rotation of certain materials may increase tissue pressure to a level at which skin perfusion is significantly impaired.

Bandages↗
PubMed1986

Collagen-based wound dressings: control of the pore structure and morphology.

Collagen-based sponges have been used as both temporary and permanent coverings for dermal defects in animals and humans. Cellular ingrowth within such a sponge has been shown to depend on the porosity and the presence of fibrous structure. Collagen sponges were made by freezing and freeze-drying dispersions under acidic conditions. These studies involved the effects of dispersion pH and viscosity as well as freezing temperature on the surface and bulk morphology of collagen-based sponges. Using scanning electron and light microscopy, the results of these studies indicated that large surface pores that form connections (channels) with the interior of the sponge were formed using low-viscosity collagen dispersions. At high dispersion pH (3.2) and at a moderate freezing temperature (-30 degrees C), fibrous structure and a large number of channels were present. When a lower dispersion pH (2.0) and freezing temperature (-80 degrees C) were used, pores sizes were smaller with channels and fibrous structure, whereas a higher freezing temperature (-20 degrees C) resulted in a sheet-like structure and increased pore sizes. Differences in pore size and surface morphology were explained on the basis of ice crystal growth. In the case of abundant free water (high pH) and high freezing temperature, the pore size was greatest because of enhanced ice crystal growth.

Bandages↗
PubMed1993

Fibrin cuff lysis in chronic venous ulcers treated with a hydrocolloid dressing.

BACKGROUND: Pericapillary fibrin cuffs (PFC) are a recognized part of the pathology of venous stasis ulcers. A hydrocolloid dressing capable of lysing wound surface fibrin was tested in venous ulcers for its capacity to lyse pericapillary fibrin below the wound surface. METHODS: Tissue biopsies from the rims of 19 venous ulcers were evaluated for thickness of shallow and deep dermal PFCs before and after treatment with DuoDERM covered by Unna's boot and a compression bandage (DD+UB; n = 9) versus the same treatment without the hydrocolloid dressing (UB; n = 10). Frozen sections of all biopsies were stained with an immunofluorescent antibody to fibrin for rating of PFC thickness. Separate sections were stained with hematoxylin and eosin to assess capillary frequency, histopathology, and inflammation. All ratings and pathology assessments were performed blinded to treatment conditions. RESULTS: Both deep and shallow PFCs were reduced in 89% of ulcers treated with DD+UB versus 40% of ulcers treated with UB (alpha < 0.04). No other significant differences in inflammation, histopathology, or capillary frequency were observed. CONCLUSIONS: Treatment with DD+UB reduced PCFs in twice the number of ulcers than UB alone in 1 week. This is the first scientific documentation that a topical wound dressing could reduce the pathophysiology associated with venous ulcers, beyond the known beneficial effect of graduated compression. Not all hydrocolloid dressing are fibrinolytic, so this effect may not generalize to other dressings.

Bandages↗
PubMed2004

Randomized trial comparing vaccinia on the external surfaces of 3 conventional bandages applied to smallpox vaccination sites in primary vaccinees.

BACKGROUND: Concern about accidental contact transmission after smallpox vaccination has prompted various recommendations regarding vaccination site coverage. METHODS: On days 6-8 after their first-ever smallpox vaccination, 63 adult subjects were randomized to apply a self-adhesive bandage (n=20), gauze with adhesive tape (n=21), or gauze with a semipermeable dressing (n=22) over the vaccination site for a mean of 8+/-2 h. Swabs from the external bandage surfaces and the vaccination sites were then assessed by real time vaccinia-specific polymerase chain reaction (PCR) in blinded fashion. RESULTS: Among 58 subjects completing the study, PCR results were positive for the vaccination site in 55 (94.8%) and on 10 swabs (17.2%) from external bandage surfaces. There were no differences among the 3 bandages (P=.57). CONCLUSIONS: At 7 days after smallpox vaccination, a peak time for vaccinia shedding, a self-adhesive bandage was as effective as 2 bulkier, less convenient bandages in limiting PCR-detectable virus on the external surface.

Adult↗
PubMedDate not supplied

Randomized trial of cohesive short-stretch versus four-layer bandaging in the management of venous ulceration.

A multicenter prospective randomized clinical trial was undertaken to compare a generic four-layer bandage system with a cohesive short-stretch system (Actico, Activa Healthcare) in the management of venous leg ulceration. Both systems are designed to produce sufficient pressure to counteract venous hypertension. Patients in leg ulcer services with leg ulceration were screened for inclusion in this trial. Patients with arterial disease (ankle brachial pressure index < 0.8) and causes of ulceration other than venous disease were excluded. For patients with bilateral ulceration, the limb with the larger area of ulceration was studied. Patients were randomized to receive either type of compression bandage and simultaneously randomized to one of two foam dressings that were changed weekly unless more frequent changes were clinically required. In all, 156 patients met entry criteria and were randomized from the 12 clinical centers with median (range) ulcer size of 4.33 (0.33-123.10) cm(2). Analysis revealed that after 24 weeks a total of 111 (71%) of patients had complete ulcer closure, 32 (21%) had withdrawn from the trial, 12 (8%) remained with open ulceration, and one patient had died. Of the 74 patients randomized to the four-layer bandage, 51(69%) had ulcer closure on treatment compared with 60/82 (73%) on the cohesive short-stretch system. Intention-to-treat analysis produced a hazard ratio for healing of 1.08 (95 percent CI 0.63-1.85, p= 0.79). Withdrawal rates were similar between groups (15, 20% four-layer bandage; 17, 21% cohesive short-stretch system). Ulcer closure rates for patients treated with the cohesive short-stretch system were similar to those for patients managed by the four-layer bandage system in this trial.

Aged↗