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PubMed2006

Tissue-engineered temporary wound coverings. Important options for the clinician.

Finding an ideal temporary wound dressing is challenging. Although TransCyte, built on Biobrane, offers many of the characteristics of the ideal wound dressing, and may have added benefits from the delivery of extra-cellular matrix (ECM) and growth factors to the wound, the downside of high cost and less convenient storage and usage are considerable barriers to its broader adoption. The low cost and established clinical utility of Biobrane sets the bar high for new products.

Burns↗
PubMedDate not supplied

Nursing care of donor site wounds.

The list of ideal donor site characteristics includes many items related to nursing care such as the ability of the dressing to minimize pain, permit patient mobility, and simplify postoperative care. Biobrane must adhere to the donor site wound bed and be allowed to dry without fluid accumulation. Coarse-mesh gauze wraps applied over the Biobrane in the operating room help maintain contact between Biobrane and the wound bed, protect the donor site from traumatic dislodgment in the early postoperative period, and serve to wick wound drainage in the first 24 hours. Twenty-four hours after surgery the nurse removes the outer dressing. The Biobrane is usually adherent to the wound, and the site is left open to dry. The primary goal of nursing care is to maintain sufficient airflow around the site. Nursing care of Biobrane-covered donor sites is uncomplicated but requires adherence to certain procedures to promote optimal donor site healing.

Biocompatible Materials↗
PubMed2003

Hypertrophic scars and keloids: etiology and management.

Keloid and hypertrophic scars have affected patients and frustrated physicians for centuries. Keloid and hypertrophic scars result from excessive collagen deposition, the cause of which remains elusive. Clinically, these scars can be disfiguring functionally, aesthetically, or both. A thorough understanding of the pathophysiology and clinical nature of the scar can help define the most appropriate treatment strategy. Although many articles have been published on the management of hypertrophic and keloid scars, there is no universally accepted treatment protocol. Prevention of keloid and hypertrophic scars remains the best strategy; therefore, those patients with a predisposition to develop excessive scar formation should avoid nonessential surgery. Once a scar is present, there are many treatments from which to choose. Hypertrophic scars and keloids have been shown to respond to radiation, pressure therapy, cryotherapy, intralesional injections of corticosteroid, interferon and fluorouracil, topical silicone or other dressings, and pulsed-dye laser treatment. Simple surgical excision is usually followed by recurrence unless adjunct therapies are employed. Biologic agents that are directed towards the aberrant collagen proliferation that characterizes keloid and hypertrophic scars might be an important addition to the current armamentarium of modalities in the near future.

Antineoplastic Agents↗
PubMed1987

Improved pressure sore healing with hydrocolloid dressings.

We prospectively followed inpatients receiving treatment for pressure sores to identify the better of two local treatment regimens. Twenty-seven patients with 76 pressure sores received treatment with hydrocolloid dressings (HCDs) and 25 patients with 52 pressure sores received treatment with Dakin's solution (chloramine-T)-soaked wet-to-dry dressings. Thirty-eight (73%) patients initially had severe nutritional depletion. The mean serum albumin value of the pressure sore treatment groups was lower than that of an age-matched group without pressure sores. In the HCD group, 66 (86.8%) pressure sores improved compared with 36 (69.2%) pressure sores in the wet-to-dry dressings group. The HCD regimen was more efficacious even in a subgroup of patients who received inadequate nutritional support during treatment. Adequate nutritional intake during the study was associated with better healing in both local treatment groups.

Age Factors↗
PubMed1997

A comparison of two dressings in the management of chronic wounds.

A hydropolymer dressing (Tielle) and a hydrocolloid dressing (Granuflex) were compared in a randomised controlled clinical study involving 100 patients with leg ulcers and 99 patients with pressure sores in the community. Statistically significant differences in favour of the hydropolymer dressing were detected for dressing leakage and odour production, but no statistically significant differences were recorded in the number of patients with either leg ulcers or pressure sores who healed in each treatment group.

Aged↗
PubMed1990

Stasis ulcer treatment with compression dressing.

A compression dressing system is an easily learned and effective alternative to the Unna boot for treatment of venous stasis ulcer. The treatment is well accepted by patients and appears to have efficacy comparable to that achieved with the boot, but without the problems associated with the boot, such as maceration, poor fit, and inability to observe and bathe the skin.

Humans↗
PubMed1982

Treatment of burns by exposure in an attempt to reduce cross infection.

The advantages of treatment with betadine and glycerol are: cost containment of agent and dressings, ease of observing wounds, reduction of direct nursing care and, most importantly, reduction of ward epidemics, especially Pseudomonas. Major disadvantages are increased time to grafting, potential psychological effects on patients and visitors upon viewing the wounds and the relatively minor pain during application.

Adult↗
PubMed1991

[Development of a resorbable temporary skin replacement for large surface burn wounds].

Most of the temporary dressing used in the treatment of extensive burn wounds pose immunological permeability, or transparency problems. All available dressings must be removed, and removal is often painful and traumatic. The development of biodegradable wound dressings made of copolymers of lactic and caproic acid was part of a research program (BMFT/FRG). Four parameters determine the properties of the copolymers: Purity, mole ratio of monomers, molecular weight, and sequence. Films of these copolymers can be made transparent, permeable, and flexible. They are degraded by hydrolysis and the normal ways of metabolism.

Animals↗
PubMed1996

Use of a hydrocolloid dressing in combination with a topical steroid in plaque psoriasis.

The treatment of chronic stable plaque psoriasis continues to present a challenge to the practitioner. The use of topical steroids to treat lesions is often associated with resistance and rebound upon discontinuation of prolonged use. Use of hydrocolloid dressings enhances the efficacy of topical steroids and reduces the amount of medication required to control plaques. We report results obtained with a hydrocolloid dressing used for a seven-day period with triamcinolone acetonide 0.1 percent. In a group of six patients, an average of 44 percent improvement was achieved, while untreated sites remained stationary. Patient satisfaction with results and rating of convenience of the treatments was high.

Administration, Topical↗
PubMed1999

Techniques for applying subatmospheric pressure dressing to wounds in difficult regions of anatomy.

Subatmospheric pressure dressing (SPD) has been commercially available in the United States since 1995 as the vacuum-assisted closure (VAC) device. SPD increases local blood flow, decreases edema and bacterial count, and promotes the formation of granulation tissue. Despite recent clinical successes with the use of SPD in a variety of wound types, problems may occur with application of VAC system in certain areas of the body. The main limitation occurs when attempting to maintain an airtight seal over irregular surfaces surrounding a wound. For example, application of the adhesive drape and creation of a seal are particularly difficulty in the hip and perineum. In addition, wounds of the lower extremity can occur in multiple sites, posing the problem of providing a vacuum dressing to more than one wound from one suction pump machine. To address these challenging clinical wounds, we have developed techniques to allow the successful application of SPD to sacral pressure ulcers near the anus, and to multiple large lower extremity ulcers.

Adhesives↗
PubMed2000

Tacky but refined: a "slick" technique for dressings that hold better.

For decades benzoin has been used to enhance the "stickiness" of the skin for improved adherence complementing the protective and functional aspects of well-constructed surgical bandages/dressings. The fully adherent and longer-lasting pressure dressing is both aesthetically pleasing to the patient (and surgeon) and, at the same time, functions to decrease seroma or hematoma formation, enhances antisepsis by blocking transient bacterial contamination, and inhibits traumatic sabotage of surgical wounds due to patient overactivity or inadvertent collision with a door jam, car door, table leg, or grandchild, etc. Also, when the bandage looks good, the patient realizes the operation was a success (at least aesthetically). Although simple, our additional steps of deoiling the skin with acetone, followed by multiple compress/release cycles of gauze to the Mastisol area reaps benefits to the patient and surgeon both in function (adherence) and in the production of a truly "dressy" beautiful and long-lasting dressing. In this way, the dressing "bed" is not only more receptive to one's aesthetically pleasing bandage, but is more tacky, yet refined. This same technique can be utilized prior to application of adhesive strips to healing wounds after sutures have been removed, allowing them to "stay on" longer with potentially better cosmesis and less spreading of the scar.

Adhesiveness↗
PubMed1993

[Finger tip injuries. A comparative study of silver sulfadiazine and fucidin gauze].

Eighty-eight superficial finger-tip lesions were randomized after thorough cleaning to either silver sulphadiazine treatment of Fucidin fusidic acid gauze. In the silver sulphadiazine group the wounds were covered with a non-sterile PVC gloce and redressed at least every third day; in the other group Fucidin gauze was applied and a tubigauze dressing was left in situ for ten days, after which a new dressing was applied. All patients were treated until healed and followed for at least six months after injury. Patients in the silver sulphadiazine group required shorter time for healing and shorter sick leave. The treatment is recommended because of the easy procedure and the good results.

Adult↗
PubMed1993

Effect of fibrin glue and opsite on open wounds in DB/DB mice.

Fibrin glue is a hemostatic and adhesive agent that has been used for many years in Europe. It is made by the simultaneous mixing of concentrated fibrinogen complex and bovine thrombin reconstituted in a solution of calcium chloride. Upon mixing, the final stages of the coagulation cascade are mimicked, resulting in formation of a fibrin clot. Fibrin is vital in wound healing because the network formed in the wound acts not only as a hemostatic barrier but also as a scaffold for migrating cells. In this study, fibrin glue (60 mg/ml) was applied on 6-mm-diameter circular full-thickness wounds in homozygous, genetically diabetic mice. Results showed delayed wound closure as compared to paired control wounds. Dilution of the protein concentration of fibrin glue to 1 mg/ml resulted in higher histological scores compared to those for wounds treated with 60 mg/ml fibrin glue. Finally, the application of an adherent semipermeable dressing (Opsite) over the wound per se resulted in delayed wound closure. Delayed closure may be due either to mechanical obstruction to the migration or proliferation of cells that actively participate in the wound healing process, mechanical inhibition of wound contraction, or both.

Animals↗
PubMed1987

'Tegaderm' dressings prevent recolonization of chlorhexidine-treated skin.

'Tegaderm', a semi-permeable, self-adhesive dressing made of polyurethane film, applied to intact upper arm skin in Intensive Care Unit (ICU) patients reduced the aerobic skin flora compared to adjacent exposed skin sites. We also applied 'Tegaderm' to skin disinfected with chlorhexidine; the aerobic skin flora remained unchanged at a low level for 5 days.

Adult↗
PubMed1989

Iatrogenic compartment syndrome, A follow-up of four cases caused by elastic bandage.

We describe four patients suffering from lower limb compartment syndromes which were caused by constrictive bandages applied after stripping of varices. The dressing was erroneously only partially removed, when the patients started complaining of severe pain and tension in the operated legs. The damages varied from extended irreversible neuromuscular defects to lesser functional handicaps. Three patients had corrective surgery. The clinical follow up over several years showed little improvement, secondary complaints were frequent.

Adult↗
PubMed2003

Central venous catheter dressings: a systematic review.

BACKGROUND: Gauze and tape or transparent polyurethane film dressings such as Tegaderm, Opsite or Opsite IV3000 are the most common types of dressing used to secure central venous catheters (CVCs). Currently, there are no clear guidelines as to which type of dressing is the most appropriate. AIMS: To identify whether there are any differences between gauze and tape and/or transparent polyurethane film dressings in the incidence of CVC-related infection, catheter-related sepsis, catheter security, tolerance to dressing material, dressing condition and ease of application in hospitalized patients. METHODS: The Cochrane Controlled Trials Register and Medline, Embase and CancerLit databases were searched to identify any controlled trials comparing the effects of gauze and tape and/or transparent polyurethane dressings on CVCs. Additional references were sought from published and non-published literature. Twenty-three studies were reviewed. Data were extracted independently from each paper by two members of the review team and results compared. Differences were resolved either by consensus or referral to a third person. Authors were contacted for missing information. RESULTS: Of the 23 studies reviewed, 15 were excluded. Of the remaining eight, data were available for meta-analysis from six studies. Of the six included studies, two compared gauze and tape with Opsite IV3000, two compared Opsite with Opsite IV3000, one compared Tegaderm with Opsite IV3000, and one compared Tegaderm with Opsite. CONCLUSIONS: There was no evidence of any difference in the incidence of infectious complications between any of the dressing types compared in this review. Each of these comparisons was based on no more than two studies and all of these studies reported data from a small patient sample. Therefore it is unlikely that any of these comparisons would have had sufficient power to detect any differences between groups.

Bandages↗
PubMed2006

[V.A.C.-therapy: a treatment option for wound healing complications after achilles tendon reconstruction].

INTRODUCTION: The postoperative course after Achilles tendon reconstruction is associated with a high incidence rate of infections and wound healing complications, which can lead to protracted healing process and, hence, limit the clinical outcome. PATIENT-METHODS: A 66-year-old male was referred to our clinic with an Achilles tendon rupture. MRI confirmed the diagnosis, an augmented tenoplasty was performed for tendon reconstruction. 11 weeks after surgery the patient presented himself again with an open wound and local infection signs. RESULTS: The surgical treatment included debridement and jet lavage. The V.A.C.-device with the white polyvinyl sponge at an initial pressure of 200 mm Hg was used. A pathogen organism could not be identified. For infection eradication a broad spectrum systemic antibiosis (cefuroxime and gentamicin) was applied. On 3., 6. and 14. day the dressings were changed and the wound was revised under progredient closure. At beginning formation of granulation tissue the pressure was reduced to 150-100 mm Hg. At decreasing blood inflammation parameters and amelioration of the local wound condition the patient could check out after 3 weeks hospitalization. After further successful ambulant management by means of the V.A.C.-therapy a meshgraft transplantation was performed (enlargement factor 1.5; layer thickness 0.3 mm). The V.A.C.-device was applied again at a pressure of 150 mm Hg with a single dressing change after 5 days. At a follow-up of 31 months no further complications occurred. DISCUSSION: The V.A.C.-therapy seems to be a valuable tool in the treatment of wounds with a critical local vascularity. After successful wound preconditioning the healing process of skin grafts transplants can be also optimised by means of the V.A.C.-device.

Achilles Tendon↗
PubMed1996

Water vapour transmission rates in burns and chronic leg ulcers: influence of wound dressings and comparison with in vitro evaluation.

One of the main functions of wound dressings is to control water vapour transmission rate (WVTR) from wounded skin. In this paper, the influence of hydrocolloid, knitted viscose and gauze dressings was evaluated through in vivo measurement of WVTR in burns and chronic leg ulcers utilizing an evaporimeter. The results suggest that the evaporative water vapour loss from exposed skin wounds depends mainly on the wound depth, and that chronic leg ulcers have the same level of the WVTR as full thickness burns. Compared with the knitted viscose and gauze dressings, hydrocolloid dressing has a greater effect on reducing evaporative water loss, with WVTR being 20-30% of that of exposed wounds under the conditions used in this study. This result is in agreement with that obtained in an in vitro evaluation.

Adult↗