A meshed aluminum foil wound dressing system.
A minimally adherent dressing of meshed aluminum foil has been designed and tested. The theoretical and practical advantages of this dressing are described.
Aluminum↗
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Mafenide acetate concentrations and bacteriostasis in experimental burn wounds treated with a three-layered laminated mafenide-saline dressing.
A laminated wound dressing was developed to deliver mafenide acetate to granulating wounds. This study, using mafenide acetate cream (11.2%) and isotope dilution of 14C-labeled mafenide, has established the peak concentration and decay time for mafenide in the saline layer over the wound. Pseudomonas inhibition under identical concentrations was studied. Peak concentrations of 1,200 mg per deciliter of saline were observed after 2 hours. These levels decayed to 400 mg after 10 hours. Remoistening the dressing was required to achieve the peak and duration just mentioned. Pseudomonas inhibition of 88% of discs was present at 1,200, 800, and 700 mg concentrations. This dropped to 44% at 550 mg and 0 at 400 mg. The effective anti-Pseudomonas period was, therefore, 6 hours.
Animals↗
The disc dressing for local irrigation of experimental burn wounds.
The newly designed disc dressing permits the surface of experimental burn wounds to be irrigated with liquid therapeutic agents without the need for frequent dressing changes. This approach is simple to handle, reduces the risk of trauma or contamination of the wound, and is not time consuming.
Animals↗
Bolster dressing to support a full-thickness skin graft.
The patient with a through-and-through defect of the nose suffers from a loss of skin, subcutaneous tissue, cartilage, and nasal lining. Repair of this defect is generally directed toward restoring the components of skin and lining. The forehead flap is a useful substitute for nasal skin. A full-thickness skin graft may be used to substitute for absent nasal mucosa and serve as a lining for the forehead flap, covering its deep surface and retarding wound contracture. In the case presented, firm contact was maintained between the forehead flap and its full-thickness graft lining using a bolster dressing of simple design. We believe this dressing discourages seroma and hematoma formation while maintaining contact between the graft and the vascularized flap bed.
Bandages↗
A controlled subatmospheric pressure dressing increases the rate of skin graft donor site reepithelialization.
The ability to increase the rate of skin graft donor site reepithelialization significantly in a cost-effective manner has important implications for the patient undergoing major reconstructive procedures. In this study the effect of externally applied reduced pressure (the V.A.C.) on the rate of healing of donor site wounds was initially investigated using a porcine model (N = 4), then repeated on humans (N = 10). Split-thickness skin grafts were harvested from the backs of pigs using standard technique. Half of the donor sites were treated with subatmospheric pressure (125 mmHg) and half were treated with an OpSite dressing. Biopsies taken every 48 hours demonstrated that sites exposed to reduced pressure healed at a much faster rate than sites treated with a standard occlusive dressing. Similarly, donor sites in humans reepithelialized faster in 7 of 10 patients, the rate was the same in 2 of 10 patients, and OpSite was faster in 1 of 10 patients. We believe this technology has the potential to be a relatively simple and cost-efficient method for increasing the rate of donor site healing.
Adult↗
Importance of dressing removal before radiolabeled WBC imaging for musculoskeletal infection.
Leukocyte imaging performed with in-111 or Tc-99m is gaining widespread acceptance as a method for detection of osteomyelitis associated with soft tissue injury or infection. The authors present three cases in which initial imaging was suggestive of a focal infectious process in bone and soft tissue. However, repeat imaging after the removal of wound dressings, which revealed sero-sanguineous discharge in all cases, resulted in a scan appearance that was much less remarkable for focal radiotracer accumulation in the bone. The authors conclude that accumulation of labeled WBCs in wound discharge can result in scans that are false-positive for osteomyelitis. Therefore, the authors recommend that wounds should be cleaned and dressings changed before imaging in order to avoid scans that are false-positive for osteomyelitis.
Adult↗
Wound dressings: a myriad of challenging decisions.
Choosing the appropriate wound dressing is critical to positive patient outcomes. This article helps the nurse choose dressings based on wound care principles and the comprehensive assessment. Tools are provided to choose the different products that can be used as the wound progresses through the stages of healing.
Algorithms↗
Outpatient skin grafting of extremity burn wounds with the use of Unna Boot compression dressings.
Thirty-one patients underwent split-thickness skin grafting for burn injuries of an extremity, after which Unna Boot compression dressings were applied for fixation of the graft. Three patients required hospitalization of 2 to 4 days, and 28 patients were treated strictly on an outpatient basis. The lower extremity was involved in 25 patients, and the upper extremity was involved in six. Average wound size was 284 cm2. Eighteen patients were treated with sheet grafts, and 13 received meshed grafts. Nine wounds extended across a joint. Patients were allowed immediate ambulation after surgery. All grafts resulted in 95% to 100% wound coverage, and no regrafting was required. Application of Unna boot compression dressings to extremity skin grafts provides excellent protection of both meshed and nonmeshed grafts and allows immediate ambulation and range of motion. Many patients with burn injuries may be treated on an outpatient basis with the use of this technique.
Adult↗
Effect of irrigating solution and calcium hydroxide root canal dressing on the repair of apical and periapical tissues of teeth with periapical lesion.
The objective of this study was to evaluate the apical and periapical repair after endodontic treatment of teeth with pulp necrosis and a chronic periapical lesion in dogs. Seventy-two root canals from four mongrel dogs were submitted to biomechanical preparation, using 5.25% sodium hypochlorite or 2% chlorhexidine digluconate as the irrigating solution. The root canals were subsequently either filled immediately with Sealapex, using active lateral gutta-percha condensation, or a calcium hydroxide root canal dressing was applied for 15 days before filling with Sealapex. After 210 days, the animals were killed by anesthetic overdose, and the obtained histological sections were stained with hematoxylin and eosin for optical microscopic analysis of apical and periapical repair. There was better histological repair in the groups with the root canal dressing (p < 0.05) than the groups with immediate obturation. Comparing the immediate obturation groups, irrigation with chlorhexidine solution resulted in better repair than sodium hypochlorite.
Animals↗
Dressing comparison in the healing of donor sites.
To determine the clinical effectiveness of commonly used impregnated gauze on the healing of donor sites, impregnated dressings (Vaseline, Scarlet Red, xeroform, and hydrophilic petrolatum) were compared to unimpregnated fine mesh gauze of identical weave and porosity. Rate and quality of healing were found to be virtually the same regardless of the dressing used. Plain fine mesh gauze continues to be the most effective, convenient, and inexpensive means of managing donor sites.
Bandages↗
The effect of Hydron burn wound dressing on burned rat and rabbit ear wound healing.
The effect of Hydron burn wound dressing was evaluated using a standard Walker burned rat model (N = 156) and a rabbit ear wound model (N = 34). In both studies Hydron was administered only once in one group and changed twice weekly in another. Animals were predesignated as controls and for pathologic examination. Gross observations, including photographic documentation, and the pathologic analyses revealed no gross purulence or sepsis. No deaths occurred in the rabbit study. Of the 156 animals in the rat study only two died; a culture of the wounds revealed no sepsis. Statistical analyses revealed that in the rat study the once only application was significantly better at 7 days postburn than the twice weekly treatment and control groups. No significant differences among the treatment and control groups used in the rabbit study were revealed. The application of Hydron burn wound dressing did not adversely affect the wound healing.
Animals↗
Reduction of blood loss using tourniquets and 'compression' dressings in excising limb burns.
Excessive blood loss can limit the area of burn excised per sitting, lead to selection of en bloc rather than tangential excision, and increase the number of surgical procedures required per patient. Twenty-four burned extremities were studied to measure blood loss, complications, and effectiveness of a technique for tangentially excising burns of extremities using tourniquet hemostasis followed by application of steel-wool-pad 'compression' dressings before tourniquet release. An average of 7.3 days postburn (PB), a mean of 7% body surface area (BSA) burn was excised per extremity with a mean blood loss of 29 ml/% BSA burn excised (less than one fifth of recently published values). Graft take averaged 91%. There was no evidence of neurocirculatory injury or other complications. When applied as described and carefully monitored, hemostatic tourniquets followed by 'compression' dressings can safely reduce blood loss associated with the exclision of limb burns and allow larger areas to be excised at each operation.
Bandages↗
Dry fibrin sealant dressings reduce blood loss, resuscitation volume, and improve survival in hypothermic coagulopathic swine with grade V liver injuries.
OBJECTIVE: The majority of early trauma deaths are caused by uncontrolled hemorrhage, and are frequently complicated by hypothermic and dilutional coagulopathies. Any hemorrhage-control technique that achieves rapid hemostasis despite a coagulopathy should improve the outcome of these patients. We conducted this study to determine whether dry fibrin sealant dressings (DFSD) would stop bleeding from grade V liver injuries in swine that were hypothermic and coagulopathic. METHODS: Nineteen swine weighing 39.7 kg (mean and 95% confidence interval, 36.3-43.1), underwent a 60% isovolemic, hypothermic exchange transfusion with 33 degrees C 6% hetastarch to produce a dilutional and hypothermic coagulopathy. The animals then received a grade V liver injury and one of three treatments: DFSD, conventional liver packing with gauze sponges, or immunoglobulin G (IgG) placebo sealant dressing (blinded control). All animals were resuscitated with lactated Ringer's solution to their preinjury mean arterial pressure. Blood loss after treatment, mean arterial pressure, resuscitation volume, hematologic variables, and core temperature were monitored for 1 hour. RESULTS: At the time of injury, core temperature = 33.3 degrees C (95% confidence interval, 33.2-33.4), hemoglobin concentration = 4.4 g/dL (4.2-4.6), platelet count = 132 x 10(5)/microL, (93-171), prothrombin time = 21.6 seconds (19.6-23.5), activated partial thromboplastin time = 25.2 seconds (range, 22.9-27.5 seconds), and fibrinogen = 83 mg/dL (range, 76-89 mg/dL) across treatments. The posttreatment blood loss in the DFSD group was 669 mL, (range, 353-1,268 mL), which was lower (p < 0.01) than the means of 3,321 mL (range, 1,891-5,831 mL) and 4,399 mL (range, 2,321-8,332 mL) observed in the packing and IgG groups, respectively. The resuscitation volume in DFSD was 2,145 mL (range 1,310-3,514 mL), which was lower (p < 0.05) than the means of 5,222 mL (range 3,381-8,067 mL) and 5,542 mL (range 3,384-9,077 mL) in the packing and IgG groups, respectively. One-hour survival in the DFSD group was 83%, whereas survival in the packing and IgG groups were 0% (p < 0.05). CONCLUSION: In swine with a grade V liver injury complicated by a dilutional and hypothermic coagulopathy, DFSD provided simple, rapid hemorrhage control, decreased fluid requirements, and improved survival.
Animals↗
A simple, rapid, reproducible tie-over dressing.
A simple and quickly performed technique for the construction of tie-over dressings is described. After adjustment of the graft to the skin defect, skin staples are used to tack simultaneously the graft and looped silk threads circumferentially. Securing the threads is achieved by using a shortened disposable syringe cylinder through which the threads are passed and held in place by the adjusted piston. A stable fixation is easily achieved in all cases using one or more of these devices depending on the size of the defect. This technique enables the subsequent application of the dressing if needed.
Bandages↗
Honey-medicated dressing: transformation of an ancient remedy into modern therapy.
Honey has been applied for medicinal purposes since ancient times. Its antibacterial effects have been established during the past few decades. Still, modern medical practitioners hesitate to apply honey for local treatment of wounds. This may be explained by the expected messiness of such local application. Moreover, secondary infectious disease may be caused by contamination of honey with microorganisms. Hence, if honey is to be applied for medicinal purposes, it has to meet certain criteria. The authors evaluated the use and safety of a honey-medicated dressing that was developed to meet these criteria in a feasibility (phase II) study featuring 60 patients with chronic (n = 21), complicated surgical (n = 23), or acute traumatic (n = 16) wounds. In all but 1 patient, it was found easy to apply, helpful in cleaning the wounds, and without side effects. Based on these results, the authors advise to subject this dressing to a randomized, double blind, phase III study.
Adolescent↗
The Speedo tie-over dressing.
A system is presented for the application of tie-over dressings. Following skin grafting, the graft is secured with a tie-over dressing covered with a sheath of 3-way stretch fabric. The fabric is secured with the aid of staples. This system is easy to apply and is useful for securing grafts in otherwise difficult anatomic locations.
Bandages↗
A large animal fatal extremity hemorrhage model and evaluation of a polymeric dressing (fatal extremity hemorrhage).
BACKGROUND: Extremity hemorrhage is a contributor to preventable battlefield mortality. The Army has liberalized tourniquet use guidelines in an attempt to prevent these deaths. To evaluate wound hemostatic agents that might allow for early tourniquet removal while maintaining hemorrhage control, a model of lethal extremity hemorrhage in the goat (Capra hircus) was developed and a polymeric dressing agent (BioFoam) tested. METHODS: After administration of a spinal block, animals were placed in lateral recumbancy with a head-up tilt of 6 degrees, 500 mL crystalloid was injected and 600 u/Kg of heparin was administered. After tourniquet application to the thigh, a soft tissue and vascular injury was created by transecting muscles and the femoral artery. The polymeric wound dressing was applied and the tourniquet was released. RESULTS: In testing, the primary endpoint was mortality within the first hour after tourniquet release. None of the control animals survived the full hour. Two out of five (40%) of the treated animals survived. With survivors' survival time calculated as 60 minutes, survival time was found not to differ between treated (34 +/- 19 minutes) and untreated (29 +/- 18 minutes) animals (p = 0.77). CONCLUSION: The physical characteristics of tissue injury, need for anticoagulation, and manipulation of blood pressure are vital factors contributing to the lethality of a large animal fatal extremity hemorrhage model. BioFoam was successful in preventing fatal arterial extremity hemorrhage after the release of an effective tourniquet in some cases. An agent that can reliably allow for safe tourniquet removal and restoration of collateral circulation is a potential solution to tourniquet-associated morbidity in traumatic extremity injury. The model developed will serve as a rigorous test for such agents.
Animals↗
Calcium alginate dressing-related hypercalcemia.
To date, no adverse effects or contraindications have been observed in association with the use of calcium alginate dressing on an exuding wound. This is the first case in the literature in which it is suggested that using a large quantity of calcium alginate dressing could be harmful. The scenario leading to the complication and suggestions to prevent similar conditions in the future are described.
Aged, 80 and over↗