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PubMedDate not supplied

[Use of vacuum-assisted closure in the treatment of surgical infection sites].

Surgical site infection is one of the most important health problems representing an increase in morbi-mortality and economical devastation for the patient. There have been a variety of procedures that surgeons have employed to control this situation, from very refined surgical procedures, advanced antimicrobial therapy to local therapy with alginates, hydrocolloid dressings and many others with active topical substances. One of the newest treatments is the VAC (Vacuum-Assisted Closure). This therapy has been proven to be useful in wound infection control and we used it to carry out this study in 38 patients with wound infections. We present the results with this therapy in our institution.

Debridement↗

PubMedDate not supplied

Epigard: a synthetic skin substitute with application to podiatric wound management.

The authors present a synthetic skin substitute, Epigard, which was developed in 1973 and has been used worldwide for temporary coverage of open wounds. Epigard is a two-layer, non-medicated wound dressing which approximates the function of human skin. The article discusses the proper indications and usage of Epigard, as well as post operative wound management and definitive wound closure decisions. A case presentation involving a serious diabetic wound infection is discussed. At Doctors Hospital, Epigard has become an important adjunctive therapy in wound management by improving wound healing time and decreasing patient hospital stay.

Debridement↗

PubMed1994

Prophylactic application of an intra-alveolar socket medicament to reduce postextraction complications in HIV-seropositive patients.

A prospective, controlled trial was performed to investigate the effect of a prophylactic socket medicament containing chlortetracycline, aspirin, and local anesthetics, in reducing the incidence of postextraction pain and infection in patients who are HIV-seropositive. Fifty patients were in the study; 25 received the experimental dressing and 25 had no dressing. Patients were asked to complete a questionnaire rating the pain at 24 hours and 48 hours after surgery. Seven days after extraction, socket healing was scored, and sockets with delayed healing sampled for culture. Four of 25 (16%) patients who received the experimental dressing and 8 of 25 (32%) controls experienced pain during the 48 hours after extraction (p = not significant). None of the group who received the experimental dressing and 7 of 25 (28%) in the control group had delayed healing, of these 4 had alveolar osteitis and three had infected sockets (p = 0.0096). We conclude that the experimental agent is useful as a prophylactic agent to reduce delayed healing in HIV-positive patients who undergo exodontia.

Acquired Immunodeficiency Syndrome↗

PubMed1987

Minor burns: a review.

Two million burns occur annually in the USA, of which 95% are treated in an out-patient setting. The treatment of burns is controversial. There are few data from controlled studies to provide rational guidelines for the frequency of both dressing changes and patient visits for the physician. Conclusions concerning infection drawn from studies on major burns are misleading when applied to the management of minor burns. Trauma to regenerating epithelium caused by frequent dressing change is of relatively less importance in treating major burns, because the control of infection is of overriding importance. In the treatment of minor burns, the traumatic consequences of too frequent changes of dressing may assume greater importance. There is a clear need to study the variables in the treatment of minor burns and to generate criteria for their clinical management that are distinct from those of major burn management. Collaborative studies of out-patient populations by providers of primary health care are suggested as a useful approach to such investigation. The effects of several additional therapies are reviewed, including initial cold therapy, debridement of blisters and antibiotics.

Ambulatory Care Facilities↗

PubMedDate not supplied

Cultured allogeneic keratinocyte sheets accelerate healing compared to Op-site treatment of donor sites in burns.

Donor site treatment is a crucial issue in the treatment of extensive burns. In this single-blind, randomized study treatment of donor sites with a polyurethane dressing, Op-Site (Smith & Nephew, York, U.K.) is compared to treatment with allogeneic cultured keratinocyte sheets. Results show a mean healing time of 6.7 days with use of cultured keratinocyte sheets compared to mean healing time of 13.6 days with Op-Site treatment. Also, improvement in the comfort of patients as the result of less exudate formation and pain attenuation was noted.

Adolescent↗

PubMed1986

Microsurgical hypospadias repair.

Successful primary hypospadias repair depends on careful execution of surgical principles, particularly during the urethroplasty portion of the procedure. These principles include careful tissue handling, development of well-vascularized flaps, and avoidance of placing sutures in the uroepithelial surface. Despite meticulous repair, the complication rate requiring secondary surgery is 15 to 30 percent. For the past year, the authors have utilized an operating room microscope, microsurgical instruments, a specially designed microsuture, and a Biooclusive dressing to decrease the postoperative morbidity and subsequent complications requiring secondary surgery (6.5 percent). A comparison of 50 hypospadias patients on whom no microsurgical repair had been used was made with 62 patients on whom microsurgical techniques were employed. The nonmicrosurgical group had 17 complications, 12 of which required reoperation (24 percent). The microsurgical group had 8 complications, 4 of which required reoperation (6.5 percent).

Child, Preschool↗

PubMedDate not supplied

Randomized clinical study of Hydrofiber dressing with silver or silver sulfadiazine in the management of partial-thickness burns.

This prospective, randomized study compared protocols of care using either AQUACEL Ag Hydrofiber (ConvaTec, a Bristol-Myers Squibb company, Skillman, NJ) dressing with silver (n = 42) or silver sulfadiazine (n = 42) for up to 21 days in the management of partial-thickness burns covering 5% to 40% body surface area (BSA). AQUACEL Ag dressing was associated with less pain and anxiety during dressing changes, less burning and stinging during wear, fewer dressing changes, less nursing time, and fewer procedural medications. Silver sulfadiazine was associated with greater flexibility and ease of movement. Adverse events, including infection, were comparable between treatment groups. The AQUACEL Ag dressing protocol tended to have lower total treatment costs (Dollars 1040 vs. Dollars 1180) and a greater rate of re-epithelialization (73.8% vs 60.0%), resulting in cost-effectiveness per burn healed of Dollars 1,409.06 for AQUACEL Ag dressing and Dollars 1,967.95 for silver sulfadiazine. A protocol of care with AQUACEL(R) Ag provided clinical and economic benefits compared with silver sulfadiazine in patients with partial-thickness burns.

Adult↗

PubMed1986

The physical effects of an adhesive dressing top layer on burn wound dressings.

Three hydrogels were assessed in respect of water-vapour transmission and conformability. These materials were tested alone and as part of a bilaminate dressing which incorporates an adhesive top layer. The adhesive layer used in this study was a compliant adhesive bandage, marketed under the name Mefix. It was observed that this layer reduced the normally high water-vapour transmission rates of the hydrogels to much lower, clinically more acceptable, levels. Mechanically, the Mefix layer protects the underlying hydrogel, prevents tearing and puncturing but decreases conformability by elastic restraint.

Acrylamides↗

PubMed2000

[Comparison of the effectiveness and cost of treatment with humid environment as compared to traditional cure. Clinical trial on primary care patients with venous leg ulcers and pressure ulcers].

INTRODUCTION: The discovery of moist environment dressings as alternatives to the traditional treatments based on exposing wounds to air, opened new expectations for the care and treatment of chronic wounds. Over the years, these expectations have led to the availability of new moist environment dressings which have made it possible to improve the care provided to patients suffering this kind of wounds, as well as providing important reasons to weigh in terms of cost-benefit-effectiveness at the time of selecting which type of treatment should be employed. The lack of comparative analysis among traditional treatments and moist environment treatments for chronic wounds among patients receiving primary health care led the authors to perform an analysis comparing these aforementioned options of treatment on patients suffering venous leg ulcers or pressure ulcers. PATIENTS, MATERIALS AND METHODS: The authors designed a Randomized Clinical Trial involving patients receiving ambulatory care in order to compare the effectiveness and cost-benefit of traditional versus moist environment dressing during the treatment of patients suffering stage II or III pressure ulcers or venous leg ulcers. In this trial, variables related to effectiveness of both treatments, as well as their costs were analyzed. MAIN RESULTS: 70 wounds were included in this Randomized Clinical Trial, 41 were venous leg ulcers of which 21 received a moist environment treatment while 20 received traditional cure, the other 29 wounds were pressure ulcers of which 15 received moist environment dressings treatment and 14 received traditional dressings. No statistically significant differences were found among the defining variables for these lesions in either group under treatment. In the venous leg ulcer study group, the authors conclusions were an average of 18.13 days, 16.33 treatment sessions and a cost of 10,616 pesetas to heal one square centimeter of the initial surface area of a wound on patients treated with traditional treatment compared to an average of 18.22 days, 4.54 treatment sessions and a cost of 2409 pesetas to heal one square centimeter of the initial surface area of a wound on patients treated with moist environment dressings. In the pressure ulcers study group, the authors conclusions were an average of 12.18 days, 12.1 treatment sessions and a cost of 15,490 pesetas to heal one square centimeter of the initial surface area of a wound on patients treated with traditional treatment compared to an average of 7.12 days, 1.86 treatment sessions and a cost of 2610 pesetas to heal one square centimeter of the initial surface area of a wound on patients treated with moist environment dressings. COMMENTS: The results of this randomized clinical trial demosntrated that the moist environment treatment group was more effective and had a better cost-benefit ratio than the traditional treatment group in the treatment of pressure ulcers and venous leg ulcers on patients cared for by nursing personnel in primary health care centers all of which agrees with publications consulted by authors.

Chronic Disease↗

PubMed1992

[Treatment of crural varicose with topical dressings of "synthetic skin"].

In Dermatological Department of the Lublin Medical Academy 22 patients with crural varicose ulcerations have been treated with topical Codogard dressings. Before this treatment the patients were given some antiinflammatory and vasodilatatory drugs. The treatment lasted from 4 to 12 weeks (mean 6). In 9 patients complete healing was reported (they had small ulcerations). In 10 cases the improvement was evident, in 2 cases the treatment was discontinued. The obtained results point to clinical usefulness of Codogard, as the drug is easy to be applied and it may play a significant role to outpatients.

Aged↗

PubMedDate not supplied

Controlling wound bioburden with a novel silver-containing Hydrofiber dressing.

Clinicians now recognize that both aerobic and anaerobic microorganisms have the ability to degrade or damage host tissue at a wound site through the production of a variety of enzymes and toxins. Silver-containing dressings offer one method for controlling this polymicrobial wound bioburden, and research efforts are currently ongoing to determine their efficacy against aerobic, anaerobic, and antibiotic-resistant microorganisms. The current study aimed to determine the antimicrobial activity of a new silver-containing Hydrofiber dressing (AQUACEL Ag) on both aerobic and anaerobic microorganisms, using the zone-of-inhibition method. This method provides a measure of the ability of the dressing to make available a sufficient concentration of silver to have an antimicrobial effect. To some extent this test mimics the clinical use of the dressing and predicts its microbicidal activity at the wound-dressing interface. The results show that the silver-containing dressing makes silver available at a dressing-agar interface at a concentration that is effective against a broad range of aerobic, anaerobic, and antibiotic-resistant microorganisms. In the context of wound healing, the results showing antimicrobial activity against antibiotic-resistant microorganisms are particularly important, as the control and eradication of these organisms is a major concern within the health care profession.

Administration, Topical↗

PubMed2005

An economic evaluation of the use of TNP on full-thickness wounds.

OBJECTIVE: Topical negative pressure (TNP) (vacuum therapy) is frequently used in the management of acute, traumatic, infected and chronic full-thickness wounds. This prospective clinical randomised trial compared the costs of TNP with conventional therapy (moist gauze) in the management of full-thickness wounds that required surgical closure. METHOD: The direct medical costs of the total number of resources needed to achieve a healthy, granulating wound bed that was 'ready for surgical therapy' were calculated. RESULTS: Fifty-four patients admitted to a department of plastic and reconstructive surgery were recruited into the trial. Cost analysis showed significantly higher mean material expenses for wounds treated with TNP (414euros+/-229euros [SD]) compared with conventional therapy (15euros+/-11euros; p<0.0001 ), but significantly lower mean nursing expenses (33euros+/-31 euros and 83euros+/-58euros forTNP and conventional therapy respectively; p<0.0001). Hospitalisation costs were lower in theTNP group (1788euros+/-1060euros) than in the conventional treatment group (2467euros+/-1336euros; p<0.043) due to an on average shorter duration until they were'ready for surgical therapy'. There was no significant difference in total costs per patient between the two therapies (2235euros+/-1301euros for TNP versus 2565euros+/-1384euros for conventional therapy). CONCLUSION: TNP had higher material costs. However, these were compensated by the lower number of time-consuming dressing changes and the shorter duration until they were 'ready for surgical therapy', resulting in the therapy being equally as expensive as conventional moist gauze. DECLARATION OF INTEREST: This work was partly supported by the Plastic and Reconstructive Surgery Esser Foundation, and KCI Medical, Houten,The Netherlands. The authors have no conflicts of interest.

Combined Modality Therapy↗

PubMed1993

Medical applications of copolyester elastomer films.

Medical dressings and devices are now required to fulfil a number of demands. These include preventing the entry of bacteria to the wound and improving the healing rate. Copolyester elastomers (COPEs) can play a significant role in providing these benefits because they can be blended to offer a range of characteristics. In this article, the author discusses the mechanical and physical properties of COPEs and discusses how these properties have been utilized, and their potential for future development.

Drug Delivery Systems↗

PubMed2005

The effectiveness of a hydrogel dressing compared with standard management of pressure ulcers.

OBJECTIVE: To compare a hydrogel dressing with a conservative topical wound-care regimen (gauze with povidone-iodine) for the treatment of pressure ulcers. METHOD: A prospective study comprising 27 (24 male and three female) spinal-cord injury patients with a total of 49 pressure ulcers. Wounds were randomised into a treatment group (n=25) or control group (n=24). The primary outcome measure was the rate of wound healing (cm2/days). RESULTS: Healing rates in the treatment group were higher than in the control group, although this was not statistically significant. Some 84% of the wounds in the treatment group and 54% in the control group epithelialised, which was statistically significant (p=0.04). The mean healing time in the treatment group was 48 days compared with 45 days for the controls. CONCLUSION: Our results suggest that hydrogel occlusive wound dressings facilitate healing by promoting more rapid epithelialisation of pressure ulcers, when compared with conservative wound care.

Administration, Cutaneous↗

PubMed1987

[Effect of biologically active dressings of wounds on the course of the wound process].

A comparative analysis of the effectiveness and expediency of the local application of collocyl (128 patients), trypsin immobilized on textile cellulose and kapron matrix (186 patients) and gauze bandage moistened with a solution of enzymes and 10% sodium chloride was made. It was shown that collocyl as well as trypsin modified gauze and kapron accelerated cleansing the wounds of nonviable tissues, decreased their infectivity, reduced intoxication of the organism and improved the course of the wound process.

Administration, Topical↗

PubMed2006

Negative pressure wound therapy with off-the-shelf components.

BACKGROUND: The KCI Wound VAC system (Kinetic Concepts, Inc, San Antonio, TX) for providing negative-pressure therapy for wounds is expensive and may not be available for patients without insurance. We have examined the feasibility of using off-the-shelf components to provide comparable negative pressure therapy at less cost. METHODS: Adhesive iodine-impregnated drape, a flat Jackson-Pratt drain (Cardinal Health, McGaw Park, IL), and foam prep sponges stapled together are used to assemble a dressing connected to wall suction (negative 75-100 mm Hg) to create negative pressure wound therapy that is relatively inexpensive (<60 US dollars component cost). RESULTS: We have used this system in more than 40 cases with results that seem comparable to the commercial system and have not seen bleeding or other complications. CONCLUSION: Off-the-shelf components can be safely employed to provide effective negative pressure therapy for wounds and skin grafts.

Equipment Design↗

PubMed2006

Modern papineau technique with vacuum-assisted closure.

We describe a contemporary modification of the Papineau technique by implementing a vacuum-assisted closure (V.A.C.(R)) device in lieu of wet-to-dry dressing changes. The method makes use of a protocol similar to that of Papineau and others for the treatment of chronic osteomyelitis. This protocol includes aggressive excisional debridement of infected or necrotic bone, open bone grafting with cancellous autograft, vacuum-assisted wound closure by secondary intent, and eradication of chronic infection with concomitant parenteral antibiotics. A representative case report is included to illustrate the technique.

Adult↗

PubMed2003

The use of honey for the treatment of two patients with pressure ulcers.

Chronic wounds such as pressure ulcers, leg ulcers and diabetic wounds are a common problem among older people and alternative methods to the current time-consuming and costly practices of wound management in the nursing home need to be identified. To this end, we trialled the use of a honey alginate on two elderly males in our nursing home who were suffering from pressure ulcers (one on the ankle and one on the sacral region), to evaluate its effectiveness as a viable alternative to the current wound management practices in nursing homes. The use of honey resulted in a rapid and complete healing of both wounds. In addition, the antibacterial activity of honey had a deodorizing effect on the wounds and its anti-inflammatory actions helped reduce the level of pain. Similar healing results are also being observed in other patients with pressure-induced ulcers and as a result honey alginates are now being used as the 'standard' treatment for chronic wounds in our nursing home.

Aged↗