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The use of a dressing with silver nitrate stabilized in dimexide in the treatment of 33 patients with phlegmons of different location permitted to reduce the duration of wound preparation for placing sutures, autodermoplasty 2-2.5 fold when compared to the control group of 30 patients, who were treated by conventional methods.
Posterior skin graft donor sites furnish large areas of skin for wound coverage, but the sites frequently are management problems. The wounds tend to become moist and to develop excessive drainage and fluid accumulation that may interfere with adherence of dressings, including our preferred donor site dressing, Biobrane II (red label, large pore). We studied the use of specialty airflow beds for improving the outcome of posterior donor sites. We evaluated 50 patients aged 1 to 69 years (mean 29.45 years) with posterior skin graft donor sites of the back, thigh, or buttocks that were covered with Biobrane II. Sites ranged in size from 3% to 13% body surface area (mean 8.34%). Forty patients were placed on a FluidAir Plus bed, and 10 were placed on air-filled pillow therapy beds (five on KinAir III, five on Therapulse) (Kinetic Concepts, Inc.) All patients were kept in the supine position. We evaluated six criteria: drainage, fluid accumulation under Biobrane, infection, days until Biobrane separated, days until epithelialization, and days of specialty bed usage. We related these criteria to nursing-care actions that interfere with airflow and prevent the drying action of the bed, such as use of a "linen saver" under the patient in the area of the donor site, a foam wedge under the back, and dressings applied over the Biobrane. Most donor sites had no complications. Donor site infections developed in six patients. Five of these patients had fluid accumulation under the Biobrane, necessitating early removal. Fluid accumulated under the Biobrane in 21 patients; nine of these incidences were related to a nursing-care action that impeded airflow.(ABSTRACT TRUNCATED AT 250 WORDS)
Fifty-eight patients participated in a controlled evaluation that compared a transparent film dressing (TFD [Bioclusive]) with a combination of conventional dry gauze dressing (Curity) and antibiotic ointment (Polysporin) in the treatment of fresh skin wounds following Mohs micrographic surgery. The TFD group showed a faster rate of wound contraction and reepithelialization and a shorter total healing time. The TFD was rated better with regard to comfort, ease of use, and ease of dressing removal. At six-month follow-up, the TFD group had scars that were softer, smoother, and showed less thickening and anatomic deformities. Better cosmetic appearance and greater patient acceptance were also noted with the TFD.
A new technique in surgical dressing is described which is a combination of a semi-permeable dressing and suction drainage. This dressing has been used successfully in 20 orthopaedic patients without any wound complication and with satisfactory comfort to the patient. This form of post-operative wound management appears to retain the nursing and hygiene advantages of suction drainage, whilst avoiding the patient discomfort and the possibilities of wound infection, associated with deep internal drainage.
Selecting the correct dressing for a wound can be complicated as there are so many products from which to choose. The selection process is made easier once the healthcare professional has performed a holistic assessment. This article discusses some of the principles of wound management and the efficacy of Askina Transorbent and Askina Biofilm, two new products from B/Braun. Both of these maintain the moist environment required for optimum wound healing to take place.
Two methods of autograft donor site management were tested in 31 patients with burn injuries. Two donor sites of equivalent size were respectively covered with Biobrane and Scarlet Red, two commercial dressing materials available for donor wound coverage. Pain, the amount and type of exudate developing underneath the dressing, adherence, and cellulitis were evaluated on a daily basis, and healing time was determined. Biobrane proved superior to Scarlet Red with respect to control of pain, accumulation of exudate, and healing time; the materials were equal with regard to adherence to the wound, the character of exudate, and the appearance of cellulitis.
The maintenance of healthy skin depends on factors such as moisture, the nutritional status of the patient, and mechanical forces. A barrier film can be a valuable adjunct in the prevention and treatment of injury to skin. One hospital evaluated barrier film, a new alcohol-free film-forming liquid skin protectant, in its geriatric and spinal cord rehabilitation units. A total of 33 patients were enrolled in the study. The purpose of the evaluation was to determine if barrier film reduced redness, assisted in the adhesion of dressing and condom catheters, prevented or reduced maceration, prevented or reduced skin stripping, and/or had any adverse effects on patients. Redness was reduced in 96% of patients who were at risk. Maceration was prevented in 94% of subjects, and skin stripping was prevented in 100% of patients. Dressing adhesion improved significantly in 90% of subjects. For all subjects, regardless of method of application, barrier film was easy to apply. No patient experienced any adverse effects during the study. On the basis of this clinical trial, we found barrier film to be an effective liquid skin sealant and protectant.
Skin grafting is one of the most common procedures in plastic and reconstructive surgery. Various methods of fixation and dressing, to achieve good approximation and immobilization of skin grafts and, thus, to bring about better graft survival, are described. A simple method utilizing readily available latex and staples provides good fixation and compression. This technique has been applied in 50 patients requiring skin grafts. The morbidity and complications were minimal, and the grafts have taken satisfactorily. Pressure study with an animal model has revealed adequate compression.
OBJECTIVE: To describe the clinical features and outcome of patients with toxic epidermal necrolysis. DESIGN: Case series. SETTING: Ross Tilley Burn Centre, Wellesley Hospital, Toronto. PATIENTS: Ten patients (seven women) with toxic epidermal necrolysis referred to the centre from 1984 to 1990. INTERVENTION: Biobrane (Winthrop Pharmaceuticals, New York) was applied to all raw surfaces after the epidermis had been completely separated. It was not removed until the epidermis had regenerated. MAIN RESULTS: The age of the patients varied from 27 to 90 (mean 45) years. The proportion of body surface area involved was 20% to 95% (mean 58.5%). Nine of the patients had received steroids and antibiotics prophylactically before being referred to the burn centre; the steroids were immediately tapered and the antibiotics withdrawn unless there was a specific infection. Urinary tract infection developed in seven patients, respiratory failure in six and systemic sepsis in six. All of the patients ultimately required antibiotics for treatment of systemic infections. Two patients died; both had severe illness before the onset of the toxic epidermal necrolysis. Biobrane provided a marked reduction in pain, eliminated the need for further dressings and allowed early, aggressive physiotherapy. The wounds healed completely within 14 to 21 days, with no significant scarring or need for skin grafting. CONCLUSIONS: The use of a temporary skin substitute is recommended for the treatment of toxic epidermal necrolysis. There is no indication for prophylactic steroid or antibiotic therapy; indeed, such therapy is probably contraindicated.
Poor wound healing remains a critical problem in our daily practice of surgery, exerting a heavy toll on our patients as well as on the health care system. In susceptible individuals, scars can become raised, reddish, and rigid, may cause itching and pain, and might even lead to serious cosmetic and functional problems. Hypertrophic scars do not occur spontaneously in animals, which explains the lack of experimental models for the study of pathologic scar modulation. We present the results of three clinical comparative prospective studies that we have conducted. In the first study, secondary healing and cosmetic appearance following healing of partial thickness skin graft donor sites under dry (semi-open Sofra-Tulle dressing) and moist (moist exposed burn ointment, MEBO) was assessed. In the second study, healing of the donor sites was evaluated following treatment with Tegaderm or MEBO, two different types of moisture-retentive dressings. In the third study, 3 comparable groups of primarily healed wounds were evaluated. One group was treated by topical antibiotic ointment, the second group was treated by Moist Exposed Burn Ointment (MEBO), and the third group did not receive any topical treatment. In the second study, secondary healing of partial thickness skin graft donor sites was evaluated following treatment with Tegaderm or MEBO, two different types of moisture-retentive dressings. In the second and third studies, healed wounds were evaluated with the quantitative scale for scar assessment described by Beausang et al. Statistical analysis revealed that for both types of wound healing, scar quality was significantly superior in those wounds treated with MEBO.
We have devised an algorithm employing the exclusive use of biosynthetic dressing (Biobrane) to treat the less extensive burn wounds of patients under DRG 460. This protocol has allowed us to decrease the hospital stay of these patients by 46 percent and turn this patient group from a deficit for the hospital to a substantial profit.
The study compared DuoDERM Burn Pack Hydroactive Dressings (DHD) with silver sulphadiazine/Bactigras dressings (SSD/Bactigras) in the outpatient management of small partial skin thickness burns. Forty-eight patients were entered into the study, and randomly allocated into either the DHD or SSD/Bactigras group. Burn wounds were followed until complete re-epithelialization occurred. There were no statistical differences between the groups, either with respect to their composition or characteristics of healing in days, and patients' subjective responses to treatment. However, application was easier in the DHD group (93 per cent), compared with 71 per cent in the SSD/Bactigras group (P = 0.0009), and the SSD/Bactigras were easier to remove (96 per cent) versus DHD (66 per cent, P = 0.0004). Furthermore, the DHD group had significantly less dressing changes; a mean of three changes per subject in the DHD group compared with eight in the SSD/Bactigras group (P = 0.117). Two burn wounds became infected in the DHD group, and one in the SSD/Bactigras group. In this study both modalities were found to be equally suitable and effective for small partial skin thickness burns.
Outpatient wound care centers are often challenged with patients whose wounds have multiple etiologies. These patients require a plan of care that debrides devitalized tissue, promotes wound healing, and addresses underlying factors. Because of the chronic nature of these wounds and the time required for healing, clinicians practicing in ambulatory settings also must coordinate care and appreciate the unique challenges when wound management extends into the home healthcare setting.
The effect on the normal cutaneous flora after iodine and alcohol disinfection of the skin of three commercially available moisture-permeable polyurethane dressings was compared with that of a gauze-and-tape dressing. Dressings also were evaluated clinically for membrane adhesion and skin erythema, pruritus, hyperpigmentation, vesiculitis, and tenderness. Each of 50 healthy volunteers and 49 long-term inpatients, 25 of whom were receiving antibiotic therapy, received simultaneously on their volar forearm patches of Op-Site, Tegaderm, Uniflex, and gauze dressings. Controls consisted of one exposed skin site and one covered with moisture-retaining vinylidene film (Saran Wrap). Although after 3 days of adhesion, commercial dressings prevented indigenous flora from returning to normal population densities, no significant quantitative differences were found between them and the gauze-and-tape dressing. Generally, all clinical dressings maintained normal flora at one tenth the population of the uncovered site; the Saran Wrap control supported 100-fold more bacteria than the exposed site. No differences were discovered in the levels of gram-negative bacteria, or among patient groups and between patients and healthy subjects, except for the lower incidence of erythema and itching among patients compared with healthy subjects.
With vascular injuries, both the first measures at the site of the accident and also rapid transport (helicopter) to a central specialized hospital with possibilities for vascular surgical care are of decisive importance for the maintenance of life and limb of the patient. From our experience in 169 patients with vascular injuries which were treated between 1967 and 1975, observation of the diagnostic and therapeutic measures described is of the greatest importance for the prognosis of vascular trauma.
A three-tiered, multicenter study evaluated the safety and efficacy of a new synthetic dressing for burn injuries. The first tier compared use of the test dressing with use of a conventional topical chemotherapeutic agent; the test dressing afforded greater patient comfort, equivalent control of bacterial growth, less frequent dressing change, and possibly faster reepithelialization. Drawbacks included difficulty of application, poor adherence during the first 24 hours after injury, frequent necessity to repair cracks and fissures, and inability to easily monitor burn wounds for bacterial growth. Subsequent tiers were noncomparative but included patients with more severe injuries. The test dressing may be useful in treating superficial and moderate second-degree burns of less than 20% of the total body surface area and possibly in treating iatrogenic "burn" wounds such as donor sites. Its use on third-degree burns is not recommended.
Progress in treatment of pressure ulcers over the past decade has contributed to our ability to more effectively treat problem ulcers. Through choice of the proper dressing, wound environment and cellular activity may be positively influenced and wound repair accelerated. Electrical stimulation, biologic implants, and growth factors are advanced forms of treatment that will become more accessible during the 1990s. Despite all the progress made, one must remember that these modalities are not substitutions for the care necessary to prevent the occurrence of pressure ulcers. Appropriate care and knowledge of available products are necessary to ensure the most effective treatment.
Strips of gauze and furacin gauze were implanted into the subcutaneous space and employed as dressing of dorsal incisions of albino rats. The animals were sacrificed after 24 hours, 2, 5, and 7 post-operative days. The pieces were processed for histological examination. It is possible to conclude that the furacin gauze provokes more severe inflammatory reactions and does not favour the connective neoformation and the epithelization. The furacin gauze should be utilized only as germicide aim.