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PubMed1998

Interleukin-1alpha and collagenase activity are elevated in chronic wounds.

Interleukin-1-alpha (IL-1alpha) is a member of a family of proinflammatory polypeptide mediators that has been shown in vitro to stimulate collagenase production. Collagenase is a proteolytic enzyme classified as one of the matrix metalloproteinases (MMP-1) that specifically recognizes and cleaves collagen. Therefore, the objective of this study was to compare the levels of these two proteins in chronic wounds as possible factors in the pathogenesis of chronic wounds. Fluids from 10 chronic wounds were collected before and after a 1-week treatment with a hydroactive dressing (Cutinova cavity). In addition, fluids were collected from 20 acute wounds for comparison. IL-1alpha and MMP-1 levels were quantified using sandwich ELISA. Collagenase activity was measured using a radiolabeled collagen as substrate. Clinically, the chronic wounds showed decreased area (-21.0 cm2) and reduced volume (-134.5 cm3) by 4 weeks after treatment with the hydroactive dressing. There were no significant differences in the protein concentrations between acute wound fluids (21.0 +/- 3.0 mg/ml) and chronic wound fluids before and after treatment with the hydroactive dressing (18.3 +/- 5.5 and 25.2 +/- 7.6 mg/ml, respectively). Levels of IL-1alpha in the acute wound fluids were low (0.019 pg/mg), whereas in the chronic wound fluid before treatment they had been significantly elevated (44.9 + 21.8 pg/mg). Following treatment with the hydroactive dressing, the IL-1alpha levels dropped to 10.3 + 3.3 pg/mg (p < 0.05). Collagenase activity was not detectable in acute wound fluid, elevated in pretreatment chronic wounds (12.9 + 3.4 units), and decreased in chronic wounds after treatment (11.4 + 3.3 units). This study correlated clinical healing of chronic wounds with biochemical changes in the ulcer microenvironment. As the chronic wounds began to heal, there was a significant decrease in the IL-1alpha levels and collagenase activity, thus suggesting that these two proteins may contribute to the lack of healing characteristic of chronic wounds.

Chronic Disease↗
PubMed2004

Topical negative pressure therapy: mechanisms and indications.

Topical negative pressure (TNP) therapy has emerged as a high-technology, microprocessor-controlled physical wound-healing modality. Complex effects at the wound-dressing interface following application of a controlled vacuum force have been documented. These include changes on a microscopic, molecular level and on a macroscopic, tissue level: interstitial fluid flow and exudate management, oedema reduction, effects on wound perfusion, protease profiles, growth factor and cytokine expression and cellular activity, all leading to enhanced granulation tissue formation and improved wound-healing parameters. Primary indications for clinical use have been documented and include traumatic wounds, open abdominal wounds, infected sternotomy wounds, wound bed preparation, complex diabetic wounds and skin-graft fixation. Whilst this therapy now forms an essential part of the wound healing armamentarium, extensive clinical trials are recommended to confirm efficacy and delineate its optimum use.

Bandages, Hydrocolloid↗
PubMed1983

[Initial observations on the biocompatibility of a polymer used as a skin dressing].

In the development of a dressing for burn wound covers, a material is required which combines good oxygen permeability, high water content and good biocompatibility with reasonable mechanical properties. One of the most important functions of the cover is to protect the burned surfaces from drying out and to constitute the first defence against microbial invasion. In this study composite sheets crosslinked either in presence of glicerol or diacetin, obtained by reinforcing PHEMA with a tricot PET net have been implanted subacute in rabbits, to test their biocompatibility. The same composites crosslinked in presence of diacetin and grafted on a polybutadene film, have been used as a skin graft on rabbits.

Animals↗
PubMedDate not supplied

[Our experience with a new material for skin graft areas].

The authors describe a new method of medicating disepidermised areas from which a dermo-epidermic graft has been removed to cover burn areas or following post-traumatic loss of substance. This method consists of the use of a thin microfibrillar film of a polysaccharidic type, which serves as a temporary substitute for the skin, offering selective permeability, the possibility of transpiration and gaseous exchange, but at the same time being impermeable to liquids and microorganisms. A study was performed to evaluate the efficacy and tolerability of this new dressing, involving 30 patients of both sexes aged between 9 and 87 years old. The site, dimensions, and type of graft were assessed in each patient together with the duration of pain and the time taken for the lesion to heal. This study has highlighted the positive function performed by medication with microfibrillar film in facilitating the cicatricial process, achieving complete re-epithelisation within an average of 8-9 days, with a considerable reduction in pain and satisfactory esthetic and functional result. No collateral effects or complications relating to the use of this material are reported in any of the cases studied.

Adolescent↗
PubMed1990

Inhibitory effect of zinc oxide on contact allergy due to colophony.

Contact allergy to a wound dressing with an adhesive mass consisting of colophony, zinc oxide and rubber (Mezinc) was studied in 179 patients with a history of eczema. 12 patients were found to be allergic to colophony, whereas only 4 of these patients also showed a positive patch test reaction to the wound dressing. 14 patients with verified moderate contact allergy to colophony were patch tested with adhesive mass (10%), Portuguese colophony (10%), zinc oxide (10%), purified resin acids (10%), and Portuguese colophony (10%), in combination with zinc oxide. Only 3 patients reacted to the adhesive mass, whereas all patients showed a positive patch test reaction to Portuguese colophony. A combination of zinc oxide (10%) with Portuguese colophony (10%) provoked a positive patch test reaction in only 5 of these 14 patients. An allergic reaction to abietic acid (90-95% purity) was found in 7 patients and to neoabietic acid (99 + %) in 3 patients, whereas no reactions to dehydroabietic (99 + %), isopimaric (99 + %) or levopimaric acids (98 + %) were found.

Adult↗
PubMed2000

Wound care following CO2 laser resurfacing using Kaltostat, Duoderm, and Telfa for dressings.

BACKGROUND: There are a variety of dressings available for wound care following CO2 laser resurfacing. OBJECTIVE: To share the experience of using Kaltostat and Duoderm for wound care following laser resurfacing. METHODS: A total of 27 patients underwent laser resurfacing, including 12 for wrinkles and 15 for acne scars. Kaltostat pads and Duoderm sheets were cut into appropriate shapes to cover the laser-treated areas. The patients' families changed the dressings when the exudate accumulating under Duoderm began to leak. Kaltostat pads were used only for the first 2-3 days when the amount of discharge was profuse. Telfa pads were used rather than Kaltostat in two cases. Duoderm alone was used thereafter to the day of complete reepithelialization. Patients returned to the hospital on days 4, 7, and 10. RESULTS: Complete reepithelialization occurred by day 7 in patients with wrinkles and day 10 in patients with acne scars. The degree of postoperative erythema was mild to moderate. CONCLUSIONS: Duoderm worked well for postresurfacing wound healing. Kaltostat fibers were difficult to remove totally. Telfa pads can be used instead of Kaltostat.

Alginates↗
PubMed2001

Effects of adhesive dressings on the stratum corneum of the skin.

Two human models were developed to quantify the stratum corneum removed by different adhesive dressings and to measure the peel force of dressing removal and relate this to stratum corneum removal. The first was an open study designed to compare the effects of applying Mepiform Safetac, Tielle and Duoderm Extra Thin to the skin of 12 normal volunteers aged 19-53 years. Treatments were applied once (one 24-hour application) or three times (three x 24-hour applications) to forearm skin which had been prestained with methylene blue. After dressing removal the dye left on the skin was sampled using the skin surface biopsy method and measured spectrophotometrically. The results show that, after one and three applications, the Mepiform Safetac sites had a higher level of dye than those on which the other dressings had been applied (p < 0.05, after three applications). Based on the assumption that the more dye is left on the skin, the less damage is caused, this suggests that Mepiform Safetac is less damaging to the skin surface than the other products tested. In the second study the peel force needed to remove adhesive dressings from prestained skin was measured and related to the amount of stratum corneum removed. Mepilex Border Safetac, Duoderm Extra Thin, Allevyn Adhesive, Biatain Adhesive and Tielle Hydropolymer Dressing were compared in 20 normal volunteers aged 23-64 years. Three consecutive 24-hour applications of each product were made, with measurements of peel force at 24, 48 and 72 hours. The amount of dye remaining on the skin at 72 hours was assessed by the surface biopsy method. Statistically significant differences between products were observed in terms of both peak force and steady state force of removal. Differences in the level of damage to the superficial stratum corneum were also detected. However, low levels of peel force were not always associated with low damage and, therefore, other factors must contribute to stratum corneum removal in this model.

Adhesives↗
PubMed2003

Use of Allevyn heel in the management of heel ulcers.

OBJECTIVE: This small uncontrolled study examined the effectiveness of Allevyn Heel. METHOD: Twenty-two patients were recruited: 13 with heel pressure ulcers, four with diabetic heel ulcers, four with arterial heel ulcers and one 'other'. Ulcers were assessed before treatment and after the start of the dressing regimen at weeks two and four and at the end of the study. RESULTS: Patients were treated with Allevyn Heel for a mean of 47.2 days, and dressings were left in place for an average of 2.2 days before being changed. By the end of treatment, 32% of the ulcers had completely or almost healed, and a further 27% were showing evidence of granulation. Application was considered easy in 98% of instances, and 91% of the patients reported that Allevyn Heel was comfortable to wear. CONCLUSION: Allevyn Heel was found to be effective and easy to use. This extends the range of wounds that are suitable for management with Allevyn, although a larger-scale study is needed to confirm the utility of Allevyn Heel for these type of heel wounds. DECLARATION OF INTEREST: This study was supported by Smith and Nephew, Germany.

Aged↗
PubMed2001

Vacuum-assisted closure in the treatment of a 9-year-old child with severe and multiple dog bite injuries of the thorax.

The vacuum-assisted closure (VAC; KCI International, San Antonio, TX) device is a negative pressure dressing, which we have used in the treatment of wounds with devitalized or infected tissues. Although introduced in plastic and reconstructive surgery, its use has extended to orthopedic and cardiothoracic surgical practice in the treatment of infected joint replacement and sternal wound infections, respectively. Although the VAC is becoming more widely used in surgical practice, only a small number of case reports exist in addition to the original case series by Argenta and Morykwas in 1997. Previously, the device was described in treating single wounds in adult patients. We report a case where it was successfully used to treat multiple dog bite injuries in a 9-year-old child.

Animals↗
PubMed2006

[Optimizing vacuum therapy in extensively undermined wounds].

INTRODUCTION: Extensively undermined wound cavities represent a common surgical problem. By a modified vacuum therapy the healing of such wounds can be accelerated. MATERIALS AND METHODS: Based on our experience in selected cases with wound healing disorders or extremely undermined wounds following degloving injuries or abscess formations the application of topical negative pressure therapy to fix wound margins to the wound ground while at the same time allowing exudates emission with additional drainages is described. RESULTS: In 5 patients we were able to demonstrate the efficacy of vacuum dressing system described here with successful and lasting adaptation of the wound margins to the defect. All wounds were brought to permanent healing. CONCLUSION: Extensive tissue degloving and wound healing disorders after excessive tissue mobilization during plastic surgical defect coverage can be treated successfully with topical negative pressure therapy (TNP). Whereas longterm complete conventional polyurethane foam lining of wound cavities is an effective method and may be necessary in special situations, the application of TNP can lead to a firm adhesion of wound margins in extensive subcutaneous or epi-fascial wounds to the undersurface. To avoid exudate formation in the adjoining tissue TNP can be effectively optimized by the placement of drainage tubes into the surrounding tissue.

Abdominal Wall↗
PubMed2002

Abdominal compartment syndrome in the open abdomen.

BACKGROUND: Multiple methods exist to manage in the intensive care unit the patient with an open abdomen. An increasingly common method is the vacuum packed technique. This method accommodates considerable expansion of intra-abdominal contents and should obviate the potential development of the abdominal compartment syndrome (ACS). Despite this, some patients with these temporary abdominal dressings will go on to develop ACS. For the purpose of this study we have defined this clinical entity as the open abdomen ACS. HYPOTHESIS: Patients with an open abdomen who develop ACS have a poor prognosis. Fluid requirements and resuscitative indices may predict which of these patients will develop open abdomen ACS. METHODS: A retrospective review was performed of patients with trauma who had an open abdomen treated with vacuum packed dressings at our urban level I trauma center. Over 1 year (July 1, 1999-June 30, 2000), 5 patients managed with an open abdomen developed ACS. These patients were compared with 15 consecutive patients with an open abdomen who did not develop clinical ACS during that same period. Fluid resuscitation, base deficit, pH, lactate level, systolic blood pressure, prothrombin time, temperature, peak inspiratory pressure, and PCO(2) were abstracted. The Fisher exact test was used for statistical analysis. RESULTS: In patients managed with an open abdomen, ACS developed between 1.5 and 12 hours (mean [SD], 7.5 [3.9] hours) after placement of the vacuum packed dressing. The base deficit, pH, peak inspiratory pressure, PCO(2,) and lactate level were more abnormal and the crystalloid requirements were significantly higher in the ACS group. The systolic blood pressure, temperature, and prothrombin time did not differ between groups. Three patients with ACS developed a second episode of ACS. Mortality in the ACS group was 3 (60%) of 5 patients vs 1 (7%) of 15 patients in the control group. CONCLUSIONS: Management of the open abdomen with the temporary abdominal closure does not prevent the development of ACS. Mortality is high when ACS occurs in this scenario. Severe physiologic derangement and high crystalloid requirements may predict which patients will develop ACS.

Abdomen↗
PubMed1990

Experiences using silicone gel tie-over dressings following skin grafting.

Twenty-six patients with 27 skin grafts treated with tie-over dressings using silicone gel sheets containing 0.02 per cent Ofloxacin are described. This method ensured direct in-progress inspection of healing of the grafted skin. Although the silicone gel tie-over procedure without any additional pressure resulted in haematoma and congestion in four out of 12 grafts (33.3 per cent), in the group with additional pressure (approximately 20-30 mmHg) limited to the early period after surgery there was no haematoma and congestion of the grafts in 15 grafts (P less than 0.05, Chi-square test). It is surmised that adequate pressure applied to the graft for a few days after surgery would be beneficial in preventing haematoma formation.

Adolescent↗
PubMed1997

Healing rate and bacterial necrotizing vasculitis in venous leg ulcers.

Morbidity associated with venous leg ulcers is important in the elderly. The biological processes involved during attempts at healing are much more complex than in most models of experimental wounds. In addition, there is still controversy on deleterious effects elicited by both microorganisms and antiseptics on cells involved in the healing process. Using histology, immunohistochemistry and iterative computerized planimetry, we evaluated the bacterial load, the inflammatory aspects and the healing rate of leg ulcers present in 15 eligible women aged from 57 to 73 years. Each patient had at least 2 chronic ulcers treated with hydrocolloid dressing alone or in combination with daily applications of povidone-iodine solution (PVP-I). The weekly reduction in wound area was superior for hydrocolloid+PVP-I treatment than in hydrocolloid-treated ulcers. After a 4-week treatment, hydrocolloid-treated ulcers contained clumps of microorganisms and showed massive infiltration by phagocytes including Mac 387+ and factor XIIIa+ cells. Leukocytoclastic vasculitis was present as well. These features were less pronounced in ulcers treated with hydrocolloid+PVP-I. In sum, a broad-spectrum antimicrobial such as PVP-I may be beneficial in reducing deleterious bacteria-related inflammation. As a result, the healing rate leg ulcers is enhanced.

Aged↗
PubMed1994

Topical haemotherapy for leg ulcers.

Several growth factors, present in the plasma or delivered by blood cells, are involved in wound healing. We have treated 15 chronic atonic leg ulcers by topical application of autologous heparinized blood under a hydrocolloidal dressing. This 'topical haemotherapy' (THT) was applied every other day. After the first THT, 30% of the fibrinonecrotic material had already been removed. After a mean of 9 THT applications (range: 5-18), granulation tissue covered up to 75% of the surface of the ulcer (range: 30-100%) allowing autologous skin grafting. No local or systemic side-effects occurred during the treatment. THT is feasible and well tolerated; it is an easy and inexpensive treatment of chronic leg ulcers that rapidly induces granulation tissue. Growth factors and proteases produced by the blood cells could play a relevant role in this process.

Administration, Topical↗
PubMed2000

Experiences with hydrofibres in the moist treatment of chronic wounds, in particular of diabetic foot.

BACKGROUND: Chronic wounds are an everyday problem in general medicine. Likewise, their persistence, painfulness and frequency of relapse are everyday problems which strain the stamina of patients and doctors to the point of desperation. Over recent years, the moist therapy concept has proven to be a major advance in wound treatment. The introduction of innovative wound dressings in the 1990's made it possible to substantially accelerate wound healing and couple it with a simultaneous alleviation of pain. PATIENTS: In the scope of our team's experience one such product is the hydrofibre. This paper offers information on the possibilities for using this material on the basis of 135 wound situations, 44% of which are within the context of diabetes mellitus. RESULTS: There was a positive influence on wound healing in 92% of the cases. This treatment result is analysed in terms of causal, topographic and iconographic aspects. CONCLUSION: Given the main focal points of our group of patients, it may be stated that hydrofibres are suitable for diabetic wounds.

Adult↗
PubMed2000

Investigation of amine and polyol functionality in extracts of polyurethane wound management dressings using MALDI-MS.

Polyurethane (PU) foams used in wound management are produced by a reaction between aromatic diisocyanates and polyether polyols. There is concern that residues of these starting materials, which may contain aromatic amine functionality, may leach from the finished polymer during in vivo applications. Furthermore, oligomers and additives may be leached from the PU system after the polymerization process is complete. Finished polymers have, therefore, been extracted with a range of solvents, such as water, diethyl ether and dilute HCl. The extracts were subjected to MALDI-MS (matrix-assisted laser desorption ionization mass spectrometry) analysis in an attempt to determine the amine and polyol functionality. Direct MALDI-MS analysis of the wound dressing extracts indicated the presence of components based on the polyols [corrected] used in the formulation of the foam. The spacing between the peaks identified the base monomer used in the polyol. MALDI-MS analysis of the fluorescamine derivatives of model amine compounds has demonstrated the anticipated increase in mass (278 for monoamines and 278 and 556 for diamines). Similar results were obtained from the derivatization of model polyols with phenyl isocyanate, where the mass shift (n x 119) was a direct measure of the number of active hydroxyl groups. Fluorescamine labelling of PU foams shows the colour change which could be [corrected] indicative of the presence of an amine, but the subsequent MALDI-MS analysis was unable to demonstrate the anticipated increase in mass.

Amines↗
PubMed2002

Integra as a dermal replacement in a meshed composite skin graft in a rat model: a one-step operative procedure.

BACKGROUND: Current use of Integra, the collagen-based dermal analogue, requires a two-step grafting procedure to achieve wound closure with an "ultrathin" autograft. METHODS: A one-step operative procedure of meshed composite skin graft (MCSG) using Integra as a dermal template for a meshed split thickness autograft was developed in rats. The silicon layer of Integra was removed, the resulting dermal analogue was meshed (1:1.5), expanded, and placed on excised full thickness wound and covered with a meshed (1:1.5 or 1:6) split thickness autograft. Grafted wounds were dressed with BioBrane, Vaseline gauze, silver-impregnated nylon, or silver-nylon and direct current (SNDC). At scheduled intervals up to 3 months postgrafting, wounds were examined for epithelialization, collagen deposition and fibrosis, hair growth, and contraction. The results of wound closure and healing following the one-step procedure were compared with the outcome of the two-step grafting procedure where application of meshed Integra (step one) was followed in 14 days by removal of the silicon layer and application of the meshed autograft (step two). RESULTS: The one-step procedure applied to meshed autograft/Integra (1:1.5/1:1.5) composite graft accelerated wound closure by 6-19 days when compared with the two-step procedure. At 3 months postgrafting, the contraction of the healed wound dressed with SNDC, BioBrane, or Vaseline gauze was reduced by 13-16% following the one-step procedure compared with the two-step procedure (p < 0.05). The one-step procedure allowed the expansion of the autograft layer to 1:6 while achieving wound healing results similar to grafting with 1:1.5 meshed autograft layer using the two-step grafting procedure. CONCLUSION: Single-step application of meshed, thin, split thickness autograft over meshed Integra-derived dermal substitute allows more rapid wound closure with less contraction and more efficient use of graft donor skin than can be obtained with the commonly used two-step grafting procedure.

Analysis of Variance↗
PubMed1976

A comparative study of three sprayed dressings in healing skin wounds.

Three sprayed dressings (Novitas' wound spray, Nobecutan, and Sraycutan) were evaluated as wound covers by using guinea-pigs as experimental animals. There were no statistically significant differences between the closure rates of the wounds covered with the three sprays. All the dressings protected the wounds equally against suppuration, which caused irregular and ugly scars in the non-sprayed control wounds of the same animals. Histologically, the non-treated wounds showed a greater number of leucocytes and oedema than the sprayed ones. This was demonstrable from the 8th to the 16th postoperative hours onwards. There were no histological differences between the variously covered wounds. Histochemically, the most intense enzymatic response to injury was demonstrable in the wounds treated with Novitas' wound spray, followed, in order of decreasing response, by Nobecutan, Spraycutan, and the non-treated wounds. These differences were most marked 4-6 hours after wounding. An intense enzymatic response to injury is considered to be beneficial to the healing process.

Adenosine Triphosphate↗