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At least 1,351 records · Page 75Linked to original sources
PubMed2006

[Vacuum-assisted closure (V.A.C.) of disastrous wound conditions in Madelung disease].

INTRODUCTION: A 54 year old patient presented with a Madelung disease. Symmetrically fatty deposits were present on both upper arms, at the abdomen and both thighs. Dermatitis was seen in the axillary fold at the skin bearing surfaces. Shoulder movement was impaired. Liposuction of both upper arms has already been performed, but no significant improvement was obtained. METHODS AND RESULTS: We performed a dermolipectomy of both upper arms. Postoperatively the patient suffered from a severe wound dehiscence with fulminant wound infection and septic clinical condition. Because of the large wound surface ((1/3) of the upper arm circumference) anemia occurred and had to be treated with blood transfusions. Wound exsudation caused a general hypoproteinemia. Multiple surgical debridements were necessary in order to clean the wound from necrotic tissue and afterwards moist dressings were applied. Furthermore the patient received intravenous antibiotic treatment. After stabilisation of the general condition of the patient and the wound situation a polyvinyl sponge and a vacuum-sealing were applied and continuous suction was performed (125 mm Hg). This resulted in a significant improvement of the wound situation in regards to wound cleaning, induction of granulation tissue, diminished wound size, reduction of oedema and pain reduction. After four weeks of vacuum therapy defect coverage was possible and split thickness skin grafting was performed. The skin graft was attached to the wound using a vacuum-dressing. After removal of the vacuum dressing on the fifth day the skin graft has completely healed. DISCUSSION: Vacuum therapy is suitable for disastrous wound conditions in order to achieve a defect size reduction, pain reduction and create a clean wound with granulation tissue for further surgical defect coverage using skin grafts or flaps.

Arm↗
PubMed1981

A therapeutic approach to postphlebitic ulceration.

In recent years I have used a conservative regimen as an office procedure for healing postphlebitic ulceration. The regimen--oral antibiotics, oral zinc sulphate, topical gentian violet solution, sterile Telfa dressings, a synthetic sponge pressure pad, support of the lower leg by a Rowden Foote elastic bandage--led to complete resolution of the lesions except where infection with Pseudomonas was present. Even then healing was achieved, although it entailed repeated and prolonged intravenous administration of sodium carbenicillin and admission to hospital. Of 28 patients treated all were healed, 2 after Pseudomonas had been eradicated.

Diagnosis, Differential↗
PubMedDate not supplied

The pig as a model for human wound healing.

The medical literature describes numerous in vitro and in vivo wound-healing models. The selection of an animal model depends on a number of factors including availability, cost, ease of handling, investigator familiarity, and anatomical/functional similarity to humans. Small mammals are frequently used for wound healing studies, however, these mammals differ from humans in a number of anatomical and physiological ways. Anatomically and physiologically, pig skin is more similar to human skin. The many similarities between man and pig would lead one to believe that the pig should make an excellent animal model for human wound healing. The purpose of this paper is to review the existing literature for evidence of this supposition and determine how well the various models correlate to human wound healing. Studies of wound dressings, topical antimicrobials, and growth factors are examined. Over 180 articles were utilized for this comparative review. Our conclusion is that the porcine model is an excellent tool for the evaluation of therapeutic agents destined for use in human wounds.

Animals↗
PubMed1990

Collodion as a safe, cost-effective dressing for central venous catheters.

Catheter-related sepsis continues to be a major problem with the use of central venous catheters. Controversy exists with respect to dressing material and frequency of dressing changes. Collodion is a solution of pyroxylin in a solution of 75% ether and 25% alcohol. Camphor and castor oil are added to create a flexible noncontracting dressing when applied to the skin. We retrospectively reviewed the charts of 34 patients requiring central venous catheters between 1986 and 1988. All catheters were placed via the subclavian approach. Collodion was used as a dressing on all patients. Dressings were not routinely changed. The catheters remained in position an average of 16.5 days. No insertion site became infected; one episode of catheter-related sepsis occurred, and two catheters were inadvertently dislodged. The overall incidence of catheter-related sepsis was 2.9%.

Bacterial Infections↗
PubMed2007

The potential utility of fibrin sealant dressing in repair of vascular injury in swine.

BACKGROUND: A previous study in which fibrin sealant dressing (FSD) secured hemostasis in major arterial hemorrhage for 96 hours suggested the applicability of this dressing in damage control operations after severe trauma. The objective of this study was to determine the effective duration of FSD hemostatic function in vivo and to examine its potential utility for definitive repair of a major arterial injury in swine. METHODS: High pressure bleeding in an infrarenal aortotomy was controlled by placing FSD on the wound with 4-minute compression (n = 15). If hemostasis was achieved, the abdominal cavity was closed. Surviving animals were killed at 2, 4, 6, and 8 weeks and aortotomy sites collected for histology. RESULTS: FSD stopped arterial hemorrhage after 4-minute compression in 14 of 15 (93%) pigs. Dressings failed in two pigs at 36 and 53 minutes after treatment. Twelve (80%) animals recovered and resumed normal activities. Of the remaining 12, two developed rebleeding at the aortotomy site on days 8 and 11 and were killed; another was killed because of idiopathic low hematocrit on day 10. Nine pigs survived until scheduled to be killed, maintaining hemostasis with stable hematological values. In the surviving animals, serial computed tomography scans showed formation of a pseudoaneurysm at the aortotomy site, which resolved after 2 to 3 weeks. The initial vascular defect and pseudoaneurysm were filled with fibroblast-myoblast collagen rich tissues covered by endothelium. CONCLUSION: FSD can seal an arterial injury, stop high pressure bleeding, and prevent rebleeding for at least 7 days. The dressing may be most beneficial in damage control operations. If combined with an elective interventional radiologic procedure (e.g. embolization or stenting), it may also offer an alternative to suture repair of vascular injuries in cases where profuse bleeding obstructs visualization.

Analysis of Variance↗
PubMedDate not supplied

The management of lower-extremity ulcers with zinc-saline wet dressings versus normal saline wet dressings.

Zinc-saline wet dressings were compared to normal-saline wet dressings for the management of lower extremity ulcers in a pilot study of 28 elderly patients. Although both study groups were comparable at baseline, the data suggest that the use of zinc-saline wet dressings creates a wound environment that is associated with trends toward faster healing and enhanced rates of epithelialization, as well as significantly more efficient wound management than the normal-saline controls. These data are presented in light of the requirement for maintaining a moist, acidic environment within a wound in order to permit the best possible healing and remodeling.

Aged↗
PubMed2002

[Treatment of traumatic soft tissue defect by vacuum sealing].

OBJECTIVE: To investigate the clinical effect of vacuum sealing in treatment of traumatic soft tissue defect. METHODS: From 1998. 8 to 2001. 2, 49 patients with 55 traumatic soft tissue defects were treated by vacuum sealing after debridement. Among them, there were 39 males and 10 females with mean age 38. 4 years. The wound area varied from 10 cm x 10 cm to 30 cm x 30 cm. In the experimental group, the wound surfaces or cavities were filled with polyvinyl alcohol foams with embedded drainage tubes connected with vacuum bottle (negative pressure of 50-60 kPa). Wound closure was performed with secondary suturing, or skin transplantation, or local flap grafting after 5-7 days. Besides, 126 patients were managed by traditional dressing as the control group. RESULTS: Out of 51 traumatic soft tissue defects (45 patients), the wound closure was performed with a free flap in 4, with local flap in 8, with skin grafting in 27, with secondary suturing in 6, and with vacuum sealing directly in the other 6 defects. Forty-five patients recovered and no complications (systemic and located) occurred. There were significant differences in time of secondary suturing, times of dressing, wound shrink and total therapeutic cost between two groups (P < 0.01). CONCLUSION: Vacuum sealing can protect the wound against contamination, evacuate the wound exudates completely, stimulate the growth of granulation tissue, and facilitate the wound healing; so vacuum sealing is a simple and effective method in treatment of traumatic soft tissue defect.

Adult↗
PubMed1992

Development of medicated aerosol dressings of chlorhexidine acetate with hemostatics.

Aerosol formulations to act as medicated aerosol dressings have been prepared with an aim of forming a protective film over the wound after spraying combining the properties of antiseptics and hemostatics. Chlorhexidine acetate along with three hemostatics namely zinc acetate, methyl cellulose and Calendula tincture were used for the formulations. The formulations were found to be satisfactory in their performance and purpose.

Aerosols↗
PubMed1984

A comparison of the in-vitro antibacterial and complement activating effect of 'OpSite' and 'Tegaderm' dressings.

Two readily available semipermeable polyurethane dressings, 'OpSite' and 'Tegaderm', were tested for their in vitro ability to kill potential bacterial pathogens and activate complement C3. In bacterial killing tests, 'OpSite' was superior to 'Tegaderm' and in addition only 'OpSite' activated C3. It is concluded that in the practical situation, 'OpSite' could well confer a greater margin of safety.

Bacteria↗
PubMedDate not supplied

Rapid evaluation of oxygen and water permeation through microplate sealing tapes.

Eight commercially available microplate sealing tapes and 10 other suitable materials (transparent wound dressings) are compared qualitatively in terms of their ability to minimize water evaporation from a multiwell plate while maintaining the oxygen supply as high as possible, which is necessary for applications like aerobic growth. The transparency and sterility of the products are considered as well. All evaluated commercially available sealing tapes fall into one of the following two classes: (1) O(2) transfer is comparable to that of an unsealed plate, but water vapor retention is relatively low, or (2) O(2) transfer via the sealing is slower, but the water retention capability is comparably high. All but one of the evaluated wound dressings fall under the second class. That dressing, however, constitutes a compromise by showing both moderate O(2) permeability and medium water retention. But the estimated mass transport in a microtiter plate sealed with this dressing is about 5 times slower than that of an unsealed 96 well plate. The aim of this publication is to enable the reader to choose a microtiter plate sealing from the materials evaluated within this work and to use the rapid methods described herein to easily perform tests of additional sealing materials.

Adhesives↗
PubMed2001

Topical negative pressure for treating chronic wounds: a systematic review.

Some wounds take a long time to heal, fail to heal or recur, causing significant pain and discomfort to the patient and cost to the National Health Service. This review assesses the effectiveness of topical negative pressure (TNP) in treating chronic wounds. The Cochrane Wounds Group Specialised Trials Register was searched for randomised controlled trials (RCTs) that evaluated the effectiveness of TNP on chronic-wound healing. Eligibility for inclusion, data extraction and details of trial quality were conducted by two reviewers independently. A narrative synthesis of results was undertaken as only two small trials, with different outcome measures, fulfilled the selection criteria. Trial 1 considered any type of chronic wound, trial 2 considered diabetic foot ulcers. Both trials compared TNP with saline-gauze dressings. Trial 1 reported a statistically significant difference in the percentage change in wound volume after 6 weeks, in favour of TNP. Trial 2 reported a difference in the number of days to healing and a difference in the percentage change in wound surface area after 2 weeks, in favour of TNP. These two small trials provide weak evidence to suggest that TNP may be superior to saline-gauze dressings in terms of wound healing. However, due to the small sample sizes and the methodological limitations of the studies, these findings must be interpreted with extreme caution. The effects of TNP on cost, quality of life, pain and comfort were not reported. It was not possible to determine the optimum TNP regimen. Further high-quality RCTs that address these issues are required.

Chronic Disease↗
PubMed2006

[Vacuum assisted closure (V.A.C.) therapy is an essential tool for treatment of complex defect injuries of the upper extremity].

INTRODUCTION: Complex injuries of the upper extremity remain a therapeutic challenge. The prognosis of the damaged extremity is often limited by soft tissue defects. Vacuum Assisted Closure (V.A.C.) therapy facilitates temporary coverage of soft tissue defects prior to surgical reconstruction. METHODS: In a retrospective study all patients with complex defect injuries of the upper extremity that were treated by V.A.C. prior to reconstruction between August 2003 and September 2005 were analyzed. RESULTS: 7 patients (6 male, 1 female, 14-70 years) were included in the study. The patients suffered from subtotal upper arm (n = 1) and forearm (n = 1) amputation, complex multilevel amputation injury of the forearm (n = 1), slash wound of the forearm with skin defect and discontinuity of all volar structures (n = 1), complex open forearm fractures with skin and soft tissue defects (n = 2), and almost complete necrosis of the flexor compartment following distal radius and proximal ulnar fracture and compartment syndrome (n = 1). Stabile defect coverage was achieved in all patients following V.A.C. therapy by myocutaneous free flaps (n = 2), split thickness skin grafts (STSG) (n = 2), sequential secondary suture (n = 1), and STSG + secondary suture (n = 2). Wound conditions improved significantly under V.A.C. therapy. 5 patients reported pain relief following induction of V.A.C. therapy. Due to reduction of tissue oedema secondary suture was facilitated in 3 patients. DISCUSSION: V.A.C. therapy represents an essential tool for treatment of complex injuries of the upper extremity with extended soft tissue defects. Decreased frequency of dressing changes as well as reduced tissue oedema considerably improved patient's comfort. Posttraumatic compartment syndrome or skin necrosis, which are often associated with macro amputations of the upper extremity, are efficiently treated with V.A.C., and secondary sutures may be performed despite initial skin defects.

Adolescent↗
PubMed1990

[Effect of an anthralin-containing hydrocolloid dressing in psoriasis vulgaris].

We investigated the effect of hydrocolloid dressings on the clearing of chronic plaque psoriasis. In comparison to a short-contact therapy with anthralin alone, following application of a hydrocolloid dressing accelerated the clearing of the plaques. This effect was significant after 3 weeks of therapy. A considerable improvement was achieved by the application of a hydrocolloid dressing containing anthralin. For this purpose anthralin in concentrations of 0.02 to 0.20 mg/cm2 was applied to the dressing immediately after it had been solved in acetone. The acetone was evaporated, and the anthralin was left on the dressing in a homogenous layer. In our study, the difference to short-contact anthralin was significant after 1, 2, 3, and 4 weeks of therapy. We conclude that this new way of anthralin application is suitable for the treatment of psoriasis and has therapeutical as well as technical advantages over a treatment with anthralin ointments.

Adult↗
PubMed1994

Collagenase during burn wound healing: influence of a hydrogel dressing and pulsed electrical stimulation.

Epithelialization of second-degree burn wounds is known to be accelerated by topical treatment with hydrogel dressings and further enhanced by pulsed electrical stimulation compared with no treatment (air exposure). Tissue collagenase has been proposed to be involved during the process of epithelialization. In the present study collagenase levels were examined in partial-thickness burn wounds in the skin of four domestic pigs. Collagenase levels, assayed on postburn days 1 to 10, were substantially reduced in deblistered and air-exposed burn wounds compared with excisional partial-thickness wounds. Early application of hydrogel dressing to the burn wounds was accompanied by elevated collagenase activities and an increased inflammatory reaction in dermis. Addition of pulsed electrical stimulation increased (p < 0.001) collagenase levels twofold above those with hydrogel alone during initiation of epithelialization (postburn days 3 and 4). These results suggest that collagenase is closely linked to wound epithelialization.

Animals↗
PubMed1984

A multivariate analysis of factors affecting wound-healing time.

For post-Mohs surgical defects of the head and neck, the width of the defect is the best predictor of the length of that time it will take the wound to heal. This conclusion is based on a multivariate analysis, testing the effect of the following factors on wound-healing time: (1) age, (2) sex, (3) sound location, (4) wound width, (5) wound length, and (6) wound length X wound width. After accounting for wound width, none of the other factors significantly influenced the rate of wound healing. The 64 wounds evaluated were dressed daily with one of five bandages. When compared with the controls, and after correcting for wound width, each of the test bandages shortened wound-healing time. Among the treatment groups, no significant differences were found in the cultures or in the appearance of the wounds.

Aged↗
PubMed2003

Hydropolymer dressings in the management of wound exudate.

In the UK the so-called 'foam' dressings are currently the most widely used absorbent dressings. They can, in certain cases, be particularly useful for the management of exuding wounds. One type of foam dressing--the Tielle hydropolymer adhesive dressing family (by Johnson & Johnson Wound Management)--is a range of five types of hydropolymer dressings: Tielle Original dressing, Tielle Lite dressing. Tielle Plus dressing, Tielle Borderless dressing and Tielle Packing dressing. The Tielle range shares a common basic composition that gives each dressing bacterial barrier properties and the capability of managing exudate by the combined process of absorption and moisture vapour transmission. Each type except Packing can be used as either a primary or as a secondary dressing. The choice should be based on the characteristics of the primary dressing, if any, on the degree of exudate that the wound is producing and on the condition of the surrounding skin. This article aims to give an overview of the Tielle range and a review of research-based clinical and scientific evidence to support the management of differing levels of exuding wounds in everyday clinical practice.

Absorption↗
PubMed1992

A silver-sulfadiazine-impregnated synthetic wound dressing composed of poly-L-leucine spongy matrix: an evaluation of clinical cases.

The management of severe burns requires the suppression of bacterial growth, particularly when eschar and damaged tissue are present. For such cases, silver sulfadiazine (AgSD) cream has been traditionally applied. This antibacterial cream, however, cannot be used in conjunction with a temporary wound dressing that is needed to promote healing. The authors developed a synthetic wound dressing with drug delivery capability for clinical use by impregnating a poly-L-leucine spongy matrix with AgSD, which is released in a controlled, sustained fashion. In general, the dressing adhered firmly to the wound in the case of superficial second-degree burns, and during the healing process it separated spontaneously from the re-epithelialized surface. In the management of deep second-degree burns where eschar and damaged tissue were present, the dressing had to be changed at intervals of 3 to 5 days until it adhered firmly to the wound. Once the dressing had firmly attached to the wound, it was left in place until it separated spontaneously from the re-epithelialized surface. Dressing changes were fewer than with other treatments and the pain was effectively reduced. Cleansed wounds were effectively protected from bacterial contamination. Of 52 cases treated with this wound dressing, 93% (14/15) of superficial second-degree burns, 75% (3/4) of deep second-degree burns, 85% (6/7) of superficial and deep second-degree burns, and 75% (12/16) of split-thickness skin donor sites were evaluated as achieving good or excellent results.

Adult↗
PubMed2003

Can a decision tree help nurses to grade and treat pressure ulcers?

OBJECTIVE: This study investigated whether a decision tree can aid pressure ulcer management. It hypothesised that nurses who use a decision tree in pressure ulcer care assess wound grade more accurately and select more appropriate dressings. METHOD: Sixty-six nurses were randomly assigned to two groups. Each nurse reviewed written information and pictures of three cases of pressure ulceration, and then graded and selected a dressing for the lesions. The absence or presence of a decision tree was used as an independent variable. Measurements included: mean and standard deviation; confidence intervals; percentages; Chi-square test, Pearson's correlation and Kruskal-Wallis test. RESULTS: Baseline characteristics were comparable for both groups. There was no statically significant difference between the grades selected by the two groups. But significantly more of the decision tree users selected an appropriate dressing (p < 0.02). Joint scores (ranging from 0 to 6) were assigned for each accurate decision. The mean score for the experimental group was 4.47 +/- 1.14 (95% CI: 0.95 [4.06-4.88]) and for the control group, 3.35 +/- 1.30 (95% CI: 0.95 [2.90-3.81]). CONCLUSION: Decision trees could help nurses to make complex clinical decisions. Further studies undertaken in a clinical setting are needed.

Adult↗