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Epidermolysis bullosa (EB) is a severe blistering skin disorder. Care for an individual diagnosed with EB can be challenging. Wound care for the more severe types of EB can consume an individual's life; therefore, one of the most important nursing considerations is to educate individuals and family members about proper wound care, products, and different dressing techniques.
Two different wound dressings were tested on human drainage wounds. Improved healing was observed under an occlusive, oxygen-impermeable hydrocolloid dressing compared with petroleum gauze. Infection tendency was not increased under the occlusive dressing.
The advantages of moist wound treatment by means of ointment gauze dressing are based on the following attributes of the marked tulle gras preparations: --easy to handle; storage without problem --the gauze dressings can be modeled easily even on difficult body contoures (for example in the face) --the gauze dressing can be changed easily --Synthetic tulle gras dressings do not fray so that no residues remain in the wound. Therefore the danger of adhesion with the wound can be minimized. --There is no congestion of secretions undermath the gauze dressing. --undisturbed healing: a presupposing factor for optimal cosmetic and therapeutic result. --Minimal danger of contact dermatitis by using paraffin gauze dressing without antiseptic additives.
Indication for synthografts is given in open wound treatment as well as in the treatment of infected wounds prior to grafting. Clinical examination of two different synthografts (Epigard and another synthograft) with regard to development of a granulation tissue and cleansing of contaminated wounds in 33 cases. Clinical examinations demonstrated less adhesive power and easier detaching of the other synthograft compared to Epigard; prolonged application of these two materials showed earlier wound debridement and better conditioning effect of Epigard connected with less secretion and better epithelisation. Short application in fresh wounds showed no great difference in granulation tissue except the more secretion under the other synthograft. In our opinion Epigard must be seen as a real synthograft, the other material as a sterile wound dressing.
The fluid handling properties of four hydrogel dressings were examined in a laboratory-based study to determine their ability to absorb liquid from or donate liquid to a range of standard test substrates simulating wound tissue in various states of hydration. The tests suggest that three of the dressings are likely to be effective fluid-donating agents, and one of the dressings has a dual ability to donate or absorb liquid depending upon moisture content and nature of the substrate to which it is applied. These observations are discussed in the context of the clinical use of hydrogel dressings.
Despite the plethora of modern dressings available for leg ulcers, and the huge financial and social cost of inappropriately treated ulcers, many are still left virtually untreated. This comparison of two modern dressings illustrates the benefits of using appropriate dressings.
Eight full-thickness (to the depth of adipose tissue) skin wounds were surgically inscribed on the backs of four Yucatan micropigs (32 wound sites in total). Wound sites were created to allow for controlled comparative evaluation between wound sites, wound dressings, and specified postoperative healing time. The wounds were dressed with either ClearSite hydrogel dressing (New Dimensions in Medicine, Dayton, Ohio) or Duoderm hydrocolloid wound dressing (ConvaTec Inc., Princeton, New Jersey). Tracings and photographs of each wound site were made and computerized planimetry was done to compare the rate of epithelialization for like wounds and like wound dressings. Histomorphometric measurements were also made to compare the effects of the dressing on the wounds at the cellular level. The results of this study indicate that the wounds covered with the hydrogel dressing exhibited a more rapid rate of closure and reepithelialization as compared with the hydrocolloid wound dressing.
Infection is one of the most frequent complications of wound healing despite the use of antibiotics and modern sterile technique; it accounts for considerable patient morbidity, discomfort, and prolonged hospitalization, and it must be avoided to permit proper healing. For this purpose, topical antiseptics have been employed for several years. Among these povidone-iodine formulations (polyvinylpyrrolidone iodine; PVP-I; e.g., Betadine preparations), which consist of a water-soluble complex of elemental iodine and a synthetic polymer, have a broad antimicrobial spectrum, and have not been reported to develop bacterial resistance. Because some reports have suggested that PVP-I may interfere with wound healing, a critical review of studies concerning PVP-I and wound healing was undertaken, with emphasis placed on in vivo models that replicate, as closely as possible, human wound healing. Four forms of PVP-I were evaluated: PVP-I solution, PVP-I skin cleanser/surgical scrub, PVP-I ointment, and PVP-I cream. PVP-I solutions had virtually no deleterious effect on wound healing: application of 10% PVP-I solution to rat, guinea pig, rabbit, or pig wounds did not reduce wound tensile strength or delay re-epithelialization. In three human studies, no significant difference in healing was observed for 1%, 5% or 10% PVP-I solution except for a slight delay during the first 24 hours after the application of 5% PVP-I solution in one study; healing was normal by 72 hours. PVP-I skin cleansers/surgical scrubs contain ammonium nonoxynol-4-sulphate and lauramide DEA which, like all detergents, can cause tissue damage and delay healing. This was substantiated by a guinea pig study in which the detergent component but no the antiseptic produced these effects. In human trials, no damage occurred if cleansing of the wound with PVP-I skin cleansers/surgical scrubs was followed by saline irrigation. These results are consistent with recommendations for promptly rinsing the wound with water to remove the detergent if detergent-containing PVP-I preparations are used for wound care. PVP-I ointment (10%) delayed wound closure inn rats during the fourth through tenth days post-treatment; however, during the next two weeks, healing was accelerated, and by day 24, healing was equal to the controls. No delays occurred when pigs or rabbits were tested. In human wounds, no delays occurred in healing, even when gel-type occlusive dressings were added to the wounds; in fact, bandage-wearing time was shortened in those patients treated with PVP-I ointment. PVP-I cream (5%) was also studied in humans; the cream formulation appeared to decrease healing time. Based on these studies, it can be concluded that povidone-iodine preparations do not have a deleterious effect on wound healing.
BACKGROUND: The aim of this study was to evaluate early insertion of ocular prostheses for aesthetic rehabilitation after enucleation and review current methods of enucleation surgery. METHODS: Twelve patients with large intraocular malignancies were treated by enucleation with implant. At the end of surgery, a medium-size conformer was inserted onto the closed conjunctival wound (just before applying a pressure dressing). The pressure dressing was removed 3 to 5 days after surgery. Immediately after bandage removal, the patients saw themselves in a mirror and were offered placement of a relatively small ocular prosthesis. Patients were asked if they preferred their aesthetic appearance with or without the prosthesis. RESULTS: Eight patients (67%) tolerated introduction of the prosthesis at the time of removal of their pressure dressing (3 to 5 days after enucleation surgery). Because of discomfort, 4 were able to receive their prostheses at their second postoperative visit (day 12 or 13). The manipulation at prosthesis insertion and subsequent wearing was found to have no effect on wound closure, final prosthetic fittings, or movement of the permanent prosthesis. All patients were pleased with the cosmetic benefit afforded by early introduction of the prosthesis and preferred their appearance to that of their eye with the conformer. CONCLUSIONS: Early replacement of the conformer by an ocular prosthesis allows for cosmetic rehabilitation and improved quality of life.
This paper discusses treatment methods for amputation residual limb (stump) ulcers and infected or failed-amputation wounds. Local wound care and abstinence from prosthetic limb use and weight bearing have been found effective in the treatment of decubitus ulcers, as has the use of occlusive hydroactive dressings such as DuoDERM (ConvaTec, Princeton, NJ). DuoDERM application and prosthetic socket modification have been found useful for the treatment of decubitus ulcers in ambulatory patients. The techniques of, and benefits obtained from, DuoDERM therapy are explored; we conclude that the relief of local wound pressure and shear forces obtained with this therapy generally enhances ambulation capacity.
BACKGROUND: Hydrocolloid wound dressings have been in use for nearly two decades, and have rarely caused allergic contact dermatitis. DuoDERM E (DuoDERM CGF) is a newer version of DuoDERM (ConvaTec Ltd, a division of Bristol-Myers Squibb Co, Princeton, NJ) that contains a sensitizing derivative of colophony. OBJECTIVE: We describe three patients who developed eczematous lesions under this type of wound covering. METHODS: The patients were patch tested to the European standard series, to a glues and adhesives series, and to pieces of various adhesive dressings. RESULTS: The patients displayed positive patch tests to colophony and to DuoDERM E or DuoDERM CGF hydrocolloid dressings. CONCLUSION: These dressings contain the pentaerythritol ester of hydrogenated rosin as a tackifying agent, and this substance retains the sensitizing potential of colophony. The addition of this compound is an important change that may negatively alter the good safety record of ConvaTec dressings.
By appreciating the concept of capillarity and by determining whether or not the dressing to be used next to the wound should be hydrophilic or hydrophobic, a dressing can be designed that acts to remove secretions from a draining wound. It also may protect a wound from exogenous secretions.
BACKGROUND: Moisture chambers can protect the eye in corneal lubrication or eyelid closure disorders. However, in cases with protrusio bulbi or pronounced chemosis conjunctivae direct damaging contact of the cornea or conjunctiva on the one hand and the inside of the moisture-chamber-bandage on the other hand are possible. Since commercial moisture-chamber-bandages are not available with different internal radii, new methods are necessary to increase the distance between the bandage and the eye. MATERIAL AND METHODS: A special pressure relieving foam dressing used in the therapy and prophylaxis of decubitus was prepared in such a way that a periocular attachment was enabled and an opening for the eye was left blank. This central opening was covered with a commercial moisture-chamber-bandage. Five test persons and two ventilated patients with protrusio bulbi and manifest lagophthalmus were treated with the modified moisture chamber. The relative humidity within the bandage was measured. RESULTS: The modified moisture chamber allows an individual adaptation to the periocular shape of the face and rises the level of the monoculus for about 7 mm. The internal relative humidity was for eight hours at 98% in both test persons and patients. All test persons felt more comfortable with the modified moisture chamber on their skin. CONCLUSIONS: The presented modified moisture chamber is a derivative of the commercial monoculus bandage for patients with sensitive protrusio bulbi.
Forty-five children with isolated fingertip injuries were randomized for treatment with either Mepitel silicone net dressings or paraffin gauze dressings. Over a 4 week period, the objective adherence of the dressing, and the perceived level of stress caused to the child by the dressing change were scored by linear analogue scales. The wounds were also assessed for the progress of healing and presence of infection. Twenty children received Mepitel dressings and 25 had paraffin gauze dressings. There was no difference in duration of healing or complication rates between the two groups. Statistically lower scores were seen for the Mepitel group for the first 3 weeks in both adherence and stress scores. These results suggest that silicone net dressings may be a less adherent and less painful method of dressing fingertip injuries in children.
This study compared a polyurethane foam dressing with a hydrocolloid dressing for ease of application and removal, adhesion, conformability, absorbency and wear time. A randomised study was carried out, including 61 patients with stage two or three pressure sores in five centres in the UK. Dressings were applied for up to 30 days and assessments were carried out at each dressing change. The results indicated that both dressings are easy and convenient to apply; absorbency and ease of removal were significantly better with the polyurethane foam dressing than the hydrocolloid dressing; wear times were similar.
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The authors analyze the effectiveness of a collagen cicatrizant powder for use in treating radiodermatitis compared with extra fine hydrocolloidal dressings by evaluating skin lesions according to the Radiation Therapy Oncology Group (RTOG) intensity scale. As the same time, the authors evaluate the patient's opinion regarding the treatment he/she receives. This study was carried out in the Valladolid University Clinical Hospital's Department of Radiotherapy. This study showed that the Catrix brand dressing is more effective than hydrocolloidal dressings as a treatment of lesions caused by radiodermatitis. Both the nursing personnel and patients involved in this study rated this Catrix product higher than those hydrocolloidal dressings products tested.