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Before sloughy or necrotic wounds can begin to heal, they must be debrided. Some of the modern wound dressings are not only extremely effective in this, but they do not damage surrounding tissue.
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HydroColloid Dressing (Duoderm, HCD) is a new kind of dressing, based on the fact that occlusion can provide an optimum wound environment for quick re-epithelialization. Seventy patients with superficial and deep partial thickness burns of up to 7% TBSA were treated with HCD. In 16 patients a second burned area, similar in size and depth of the burn treated with HCD, was treated with human allografts or silversulfadiazine (SSD). Five patients with very small full thickness burns were also treated with HCD. In three patients (4.5%) the treatment with HCD had to be discontinued before total re-epithelialization had occurred, for various reasons. Statistically, HCD provided faster re-epithelialization than allografts or SSD. The cosmetic and functional results were excellent. After six months only one patient was found to have a small area of hypertrophy. In this study HCD was found to be a very good dressing for the treatment of smaller partial thickness burns.
Wound healing is promoted by dressings that maintain a moist environment. Specifically, hydrocolloid dressings allow excess fluid to escape without permitting wound desiccation. However, the fluid handling capacity of hydrocolloid dressings depends on many factors such as the physicochemical properties of the gel formulation, and the design of the dressing. We measured the moisture uptake kinetics of different hydrocolloid dressings by placing the gel side of a sample in contact with water. The time evolution of the thickness was measured by means of a video camera linked to a computer. The theory of Tanaka and Fillmore (1979) was used to predict the kinetics of uniaxial swelling of a cylindrical gel sample. The model allows to associate to an experimental curve a total thickness increase hf-h0 (where hf and h0 are respectively the final and initial thickness) and a characteristic time tau. The model also relates hf-h0 and tau to the physiochemical composition of the dressing, and to the initial thickness h0. The influence of h0 is discussed by means of experiments performed on dressings with different initial thickness.
The authors stress out the importance of an application of elastic bandage for a prevention of the early postoperative hemathomas in traumatized patients, whose effect can be controlled by ultrasound. 58 patients were elaborated, of whom in 30 cases an elastic bandage was placed at the end of surgery, and 28 patients (control group) without dressing. In 8 patients of the control group, an existence of postoperative hemathomas was proved by ultrasound, while only in two cases with postoperative bandage a presence of such hemathoma could be discovered. Lesser number of postoperative hemathomas in patients with elastic bandage is statistically important (p less than 0.001). Obtained results indisputably point out the value of elastic bandage application in the course of first three postoperative days in traumatized patients.
OBJECTIVE: To determine the effect of a silicone dressing on the rate and quality of repair of limb wounds and compare microvascular occlusion and apoptosis in wounds treated with the silicone dressing and those treated with a conventional dressing in horses. ANIMALS: 5 horses. PROCEDURE: Horses received two 6.25-cm2 wounds on each metacarpus. Ten wounds were treated with a silicone dressing; the other 10 were treated with a control dressing. Quality of repair and wound size were evaluated at each bandage change. Time to healing and the number of excisions of exuberant granulation tissue were recorded. Biopsy specimens taken from healed wounds were evaluated semiquantitatively via histologic examination, p53 immunohistochemical analysis, terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling (TUNEL) to quantify apoptosis, and electron microscopic examination to measure microvessel luminal diameters. RESULTS: The silicone dressing surpassed the conventional dressing in preventing formation of exuberant granulation tissue and improving tissue quality. Microvessels were occluded significantly more often in wounds dressed with the silicone gel, which also diminished the expression of mutant p53, an indirect inhibitor of apoptosis, although greater apoptosis was not confirmed quantitatively by use of TUNEL. CONCLUSIONS AND CLINICAL RELEVANCE: Because the silicone dressing inhibited the formation of exuberant granulation tissue, it may be integrated in a management strategy designed to improve the repair of limb wounds in horses.
Microbial cellulose (MC) synthesized in abundance by Acetobacter xylinum shows vast potential as a novel wound healing system. The high mechanical strength and remarkable physical properties result from the unique nanostructure of the never-dried membrane. This article attempts to briefly summarize the recent developments and applications of MC in the emerging field of novel wound dressings and skin substitutes. It considers the properties of the synthesized material, its clinical performance, as well as progress in the commercialization of MC for wound care products. Efficient and inexpensive fermentation techniques, not presently available, will be necessary to produce large quantities of the polymer.
STUDY OBJECTIVE: Comparison of four layer bandage system with traditional adhesive plaster bandaging in terms of (a) compression achieved and (b) healing of venous ulcers. DESIGN: Part of larger randomised trial of five different dressings. SETTING: Outpatient venous ulcer clinic in university hospital. PATIENTS: (a) Pressure exerted by both bandage systems was measured in the same 20 patients. (b) Healing with the four layer bandage was assessed in 148 legs in 126 consecutive patients (mean age 71 (SE 2); range 30-96) with chronic venous ulcers that had resisted treatment with traditional bandaging for a mean of 27.2 (SE 8) months. INTERVENTIONS: (a) Four layer bandage system or traditional adhesive plaster bandaging for pressure studies; (b) four layer bandaging applied weekly for studies of healing. END POINTS: (a) Comparison of pressures achieved at the ankle for up to one week; (b) complete healing within 12 weeks. MEASUREMENTS AND MAIN RESULTS: (a) Four layer bandage produced higher initial pressures at the ankle of 42.5 (SE 1) mm Hg compared with 29.8 (1.8) for the adhesive plaster (p less than 0.001; 95% confidence interval 18.5 to 6.9). Pressure was maintained for one week with the four layer bandage but fell to 10.4 (3.5) mm Hg at 24 hours with adhesive plaster bandaging. (b) After weekly bandaging with the four layer bandage 110 of 48 venous ulcers had healed completely within 12 (mean 6.3 (0.4)) weeks. CONCLUSION: Sustained compression of over 40 mm Hg achieved with a multilayer bandage results in rapid healing of chronic venous ulcers that have failed to heal in many months of compression at lower pressures with more conventional bandages.
BACKGROUND: The aim was to examine cadexomer iodine paste in a comparative clinical trial. METHODS: A 12-week, randomized, open, controlled, multicenter, multinational trial in patients with exudating, venous leg ulcers of cadexomer iodine paste (Iodosorb/Iodoflex), hydrocolloid dressing (Duoderm E, Granuflex E), or paraffin gauze dressing (Jelonet) was carried out. All patients used short-stretch compression bandages (Comprilan) throughout the study. The primary efficacy variable was a reduction in ulcer size (%), and the secondary end-point was the time taken to stop exudation, when the patient had completed the study according to the protocol. A total of 153 patients entered the study and were treated for 12 weeks or until cessation of exudation. RESULTS: The mean reduction in ulcer size in all patients was 62% with cadexomer iodine vs. 41% and 24% for hydrocolloid and paraffin gauze (ns). Of those treated for 12 weeks (n = 51), ulcer area reduction was 66% for cadexomer iodine and 18% for hydrocolloid (p = 0.0127). For the whole material, the rate of healing (ulcer area reduction per week) was significantly higher for cadexomer iodine than for paraffin gauze (0.64 cm2/week vs. 0.19 cm2/week, p = 0.0353). The treatment costs were similar in all groups; however, when the costs were correlated with healing over a 12-week period, cadexomer iodine paste was found to be more cost effective than hydrocolloid dressing or paraffin gauze dressing. CONCLUSIONS: This study shows that cadexomer iodine paste is an efficient, cost-effective and safe alternative to hydrocolloid dressing and paraffin gauze dressing for the treatment of venous leg ulcers.
The authors described their own suggestions of advantages of the hydrogel bandages in ENT practice. The hydrogel is produced by Radiation Technique Institute of Polytechnique High School in Lódź.
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One of the more important properties of a burn dressing is its ability to control fluid balance. This can be achieved by absorption and/or water vapour transmission. Unfortunately, the rate of fluid loss from a burn wound has not been thoroughly investigated, therefore 'ideal' quantitative values for dressing absorption and water vapour transmission have not been defined. However, when the data that is available regarding fluid loss from burn wounds is analysed, valuable information about dressings can be obtained which should benefit dressing design.
BACKGROUND/PURPOSE: To report a case of toxic epidermal necrolysis (TEN) involving 90% body surface area, successfully treated with a nanocrystalline silver dressing (Acticoat, Smith & Nephew, Largo, FL). METHODS: A review of the hospital and acute wound center patient records and the recent English medical literature regarding TEN and nanocrystalline silver dressing. RESULTS: We found only 1 report of TEN treated with a nanocrystalline silver dressing. The nanocrystalline silver dressing was both effective in preventing wound infection and convenient for treating our patient with TEN. CONCLUSION: The use of nanocrystalline silver dressing should be considered for the treatment of TEN.
BACKGROUND: Venous leg ulcers are a growing socioeconomic burden. Pale sulfonated shale oils (PSSO) are used for therapy of inflammatory skin diseases and have been shown to enhance wound healing in vitro and in vivo. The aim of this study was to investigate whether PSSO is capable of enhancing venous ulcer healing beyond compression therapy alone. METHODS: One hundred nineteen patients were enrolled in this randomized, multicenter, observer-blind study. In the treatment group, PSSO 10% was applied daily for 20 weeks, and the control group received the vehicle only. Wounds were covered by a nonadherent gauze dressing, and compression therapy with short-stretch elastic bandages was performed in an outpatient setting. The primary study end point was defined as cumulative reduction in wound area; the secondary study end point was treatment success as assessed by both physicians and patients. Additionally, adverse events, including changes with respect to physical examination and vital signs, were documented. RESULTS: At the end of the study period, ulcer size was significantly more reduced in the PSSO group compared with the vehicle group (15 +/- 15.9 to 6.2 +/- 12.9 cm(2) vs 11.4 +/- 14.5 to 10.8 +/- 15.7 cm(2); P = .0005). The cumulative relative reduction in ulcer area was significantly higher in the PSSO group (-4391 +/- 4748.7 vs -231.9 +/- 6283.6 % x days; P < .0001). Relative reduction in wound area was significantly greater in the PSSO group as early as 6 weeks after the beginning of treatment (-47.4 +/- 28.4 vs -23.8 +/- 42.2%; P < .001). PSSO was judged successful both by physicians and patients. There were no significant differences in adverse events (PSSO, 9 [12.2%]; vehicle, 7 [11.1%]. Similarly, tolerability of PSSO was equal to the tolerability of the vehicle. CONCLUSION: Pale sulfonated shale oils were capable of favoring venous ulcer healing in addition to compression therapy. PSSO should be considered for future wound care protocols for treatment of venous leg ulcers.
Appropriate wound management is an important component in determining the outcome of surgical procedures. Increased edema can complicate postoperative results by causing wound dehiscence and increasing inflammation, and, thereby, patient discomfort. In addition, inappropriate wound management can lead to hematoma formation that increases the risk of infection and patient discomfort. These issues are likely more pertinent in high-energy trauma; however, they are also relevant in elective surgery. Results are dependent on postoperative treatment (ie, rest, ice, elevation, antiinflammatories); however, the authors believe edema control can be further facilitated by the application of a foam compression dressing.
Pressure applied over a skin graft prevents formation of hematoma and shearing of the graft. Most of the methods used to obtain adequate pressure are often cumbersome to apply and time-consuming. This report describes a quick and simple method for fixing and applying pressure over skin graft with foam dressing and staples.