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PubMed1983

Report on evaluation of hydron film as burn wound dressing.

Hydron Burn Dressing, an amalgam of Polyethylene Glycol-400, and Polyhydroxyethyl methacrylate formed directly on the burn wound has been used in 50 cases with comparable control areas on the same patients which were managed by Polybactrin spray and exposure. The 4-layer film was found to be easily applicable in indoor patients and was pain-free during application and reduced pain after application in superficial burns. It was found to be translucent, pliable, less liable to crack and did not peel off once dried. The rate of infection was found to be 12.5 per cent more than the controls but the healing time was shorter by 2.8 days. Patient's comfort and compliance was better than the scab of the control areas.

Adolescent↗
PubMed1983

Use of a semi-permeable membrane dressing in donor sites in Nigerians.

Most published studies on the use of a semi-permeable membrane dressing (opsite) on split-skin donor sites have been on Caucasians. To assess this new method on the black population of a developing country where donor sites are notoriously slow to heal, a study was conducted on fifty Nigerians of varying age groups in whom split-skin grafts of identical thickness were taken from both thighs by the same surgeon: 100 donor sites were studied. In all the patients one thigh was dressed with the conventional sofratulle and the other with opsite. The allocation was made randomly. Twenty-five donor sites (53.4%) treated with sofratulle healed by the 13th postoperative day. By contrast, thirty donor sites (62.5%) treated with opsite healed by the 7th postoperative day. All opsite treated wounds were completely healed by the 11th day but it took nearly four weeks for the sofratulle treated thighs to heal. Minimal discomfort was experienced by 10% of the patients treated with opsite but about 80% of those treated with sofratulle required mild analgesics on ambulation during the first 48 hours on account of pain. Opsite effectively reduces healing time in donor sites, is easy to apply, less bulky to use, painfree and well tolerated by patients.

Adolescent↗
PubMed1996

Sealing the catheter exit site with dressing film and its effectiveness in preventing exit-site infection: bacterial culture.

In this study, we performed exit-site care using one of three methods (A: cleanse the exit site with povidone-iodine daily and apply gauze dressing; B: cleanse the exit site with povidone-iodine once a week, cover the site with a small gauze, and seal it completely with dressing film; C: the same as in B, above, except once every two weeks). The results show that there was a higher rate of positive bacterial growth in method A (17/24, 71%), and we concluded that the sterility of the exit site was not maintained 24 hours after cleansing. In methods B and C, in which the exit site was kept sealed, we did not detect bacterial growth in almost any of the cases (B = 0/44, C = 1/7). Although the patients took a bath and did not perform any care of the exit site for one to two weeks, the results show that the exit site was protected from bacterial invasion. We believe that this method could reduce exit-site infection while requiring no daily care.

Aged↗
PubMed1984

Preliminary report on the use of a new hydrocolloid dressing in the treatment of burns.

Twenty-four patients who were referred to our outpatient clinic for treatment of burns were included in a study to evaluate the clinical effectiveness of a new hydrocolloid dressing (HCD). The depth of their burns ranged from superficial partial thickness to full thickness burns and the average size was 1.63 per cent of the total body surface. Seven patients had similar burns on other areas of their body which served as control areas. In six patients healing occurred slightly faster in the HCD treated wounds as compared to silver sulfadiazine (1 per cent), and at least as fast as compared with human allografts in these patients. Two patients were removed from the study; in the remaining non-control group (15 patients) healing progressed rapidly and the patients reported the treatment to be very comfortable. Follow-up visits after 1, 3 and 6 months showed excellent healing and there were no signs of hypertrophic scarring.

Adult↗
PubMed1989

Uses and abuses of a biosynthetic dressing for partial skin thickness burns.

The following report reviews 851 applications of Biobrane on partial skin thickness burn wounds awaiting epithelialization. After the patients had been evaluated and resuscitated as needed, the burn wounds were cleansed and debrided. Those evaluated as shallow were treated with Biobrane application. Joint surfaces were splinted for immobilization. The wound was inspected at 24 and 48 h and if any fluid had accumulated it was aspirated and the wound was redressed. When the Biobrane was adherent, the wound was covered with a light dressing and joint immobilization was discontinued. Treatment with Biobrane dressing provided certain advantages over other topical wound care. As the dressing changes were performed less frequently outpatient care was possible, with a resultant decrease in both the length of hospital stay and the ultimate cost of burn care. Wound desiccation is prevented and pain is decreased. Accurate diagnosis of wound depth is crucial if Biobrane is to be used. Very deep wounds will not allow Biobrane adherence, neither will it occur if the wound has a high bacterial count. If joint surfaces are not splinted, the Biobrane will shear and not adhere to the wound. Convex and concave surfaces can be treated with Biobrane, which may need to be meshed.

Adolescent↗
PubMed2005

A comparison of negative-pressure dressings versus Bolster and splinting of the radial forearm donor site.

OBJECTIVE: Negative-pressure dressings (NPDs) have been reported to improve split-thickness skin graft survival in some settings; we assessed whether NPDs could improve skin graft results in radial forearm donor sites. METHODS: Between October 2003 and November 2004, 45 radial forearm donor sites underwent split-thickness skin graft immobilization either with conventional bolster dressing and splint or with an NPD. Split-thickness skin graft take was recorded at 1 and 4 weeks postoperatively. RESULTS: Overall split-thickness skin graft healing was improved in the NPD group (92%) compared with the case of conventional splinting (81%) at 4 weeks (P = .10). The rate of major graft loss was less in NPDs (10%) compared with the case of conventional management (28%) after 4 weeks (P = .06). CONCLUSIONS: Split-thickness skin graft survival was significantly improved by the use of NPDs. Because the use of NPDs is expensive, we consider their use only in patients with potential wound-healing problems, when there is a need to monitor the hand, or when immediate postoperative hand immobilization might impede the patient's recovery.

Drainage↗
PubMed2004

[Basics foundation and results of the vacuum therapy in the reconstructive surgery].

Vacuum therapy (vacuum assisted wound closure (V.A.C.(R)) is a non invasive method to promote wound healing. It is based on defined, controlled negative pressure application via medical-grade reticulated polyurethane ether or polyvinyl foam dressing to wound surfaces. The technique is characterized by continuous removal of wound exudates and hence reduction of extravascular, interstitial fluid, subsequently leading to enhanced microcirculation. Experimental studies revealed a positive influence both on local microcirculation and on granulation tissue formation. Local mechanical physical factors, yet not completely understood, similar to tissue expansion, apply to the wound surface and seem to promote cell growth. In our own patients the vacuum technique has been used to pretreat chronic wounds in 139 patients, to fix split thickness skin grafts in 148 patients and to prefabricate or delay free or pedicled flaps in 11 patients so far. Thorough surgical debridement remains the mainstay of wound care. Vacuum therapy however, as an adjunctive procedure, offers significant advantages compared to conventional wound care methods, which call for further clinical and experimental studies to elucidate the basic mechanisms.

Debridement↗
PubMed2001

A technique for the treatment of sternal infections using the Vacuum Assisted Closure device.

BACKGROUND: Sternal infections after median sternotomy remain a serious cause of postoperative morbidity and mortality. The treatment of sternal infections has evolved over the past few decades, and now aggressive surgical debridement with rotational muscle flap closure has provided an acceptable means of managing this complication. However, there are several disadvantages with this approach, mainly related to the morbidity associated with serial debridements with dressing changes and open packing until the wound is closed. Other disadvantages include potential morbidity and mortality associated with the shearing forces between the beating heart and the debrided sternal edges, and the need to paralyze the patient during the period after debridement. METHODS: Our method of managing sternal infections is based on the triad of prompt surgical debridement, serial quantitative wound cultures, and the use of the Vacuum Assisted Closure (VAC) device (KCI International, San Antonio, TX). Following debridement and irrigation, a biopsy of the healthy appearing bone is sent for quantitative culture. If culture results are favorable, the wound is then fitted with the VAC device, which consists of a non-collapsible, open-cell, polyurethane sponge with embedded vacuum tubing, a vacuum pump, and transparent adhesive dressing. When systemic signs of infection and quantitative cultures indicate the resolution of the local infection, regional muscle flap or primary wound closure is performed. CONCLUSIONS: The VAC serves as a bridge to sternal wound closure and is a safe and effective therapeutic strategy for patients with impaired physiologic reserve and/or highly contaminated wounds. We feel that it is also reasonable to consider the VAC as a preventive strategy against right ventricular rupture. Furthermore, because the firmness of the vacuum sponge apparatus acts as an impressive sternal stabilizer, post-debridement extubation is possible, reducing the need for prolonged paralysis and mechanical ventilation. This stabilization also allows early postoperative ambulation with the VAC in place. In summary, we believe that the VAC device offers an effective means of managing patients with sternal infections.

Debridement↗
PubMed1998

[Vacuum sealing as carrier system for controlled local drug administration in wound infection].

Between 1.4.96 and 1.3.97 27 patients with acute infections of bone and soft tissues (n = 13), chronic osteomyelitis (n = 8), and chronic wounds (n = 6) were treated by using Instillation-Vacuum-Sealing. Polyvinylalcohol sponges with drainage tubes were used to cover the internal or external wound surfaces which resulted from surgical debridement. Having hermetically covered the wound with a transparent film dressing a vacuum source generated a partial vacuum in the sponge which was modified according to the type of wound between 20 and 80 kPa. Several times daily, the vacuum line was blocked and, in an alternating fashion, antiseptic or antibiotic solution instilled for 30 minutes. Then, the vacuum was reestablished and the fluids drained from the wound. Seven days later, intermittent drug instillation was stopped and there was either immediate or delayed wound closure by secondary suturing (n = 22), skin grafting (n = 3) or spontaneous epithelialization (n = 2). During a follow-up from the beginning of the instillation treatment of 4.2 (3-14) months there was one recurrency of infection in a patient with chronic osteomyelitis.

Adolescent↗
PubMed1995

Evaluation of the effects of a new Water-Jel system on specific bacterial and yeast strains in laboratory conditions.

In three previous studies the Water-Jel (WJ) system was found to protect burn wounds from microbial contamination, to have excellent analgesic and cooling effects when used as a first-aid dressing and to be bactericidal to 15 microorganisms including yeasts tested from the Ostrava Burn Unit. Now a new WJ system has been introduced without povidone iodine. An extensive bacteriological laboratory evaluation of the new WJ system showed quite clearly its excellent antimicrobial and antimycotic properties for 13 of the 15 strains of microorganisms tested, the only exceptions being Clostridium difficile and partially Streptococcus faecalis. In a preliminary study, the new WJ system was used for 24-48 h in 74 burned patients with superficial partial and deep partial skin thickness burns. In 89 per cent of them there were no signs of infection on their burn wound after 48 h. The new WJ system was well tolerated and no allergic reactions appeared.

Administration, Topical↗
PubMed1994

Local treatment of pressure sores in the elderly: amino acid copolymer membrane versus hydrocolloid dressing.

OBJECTIVE: To compare the clinical effectiveness and wound management properties of a copolymer membrane, Inerpan (Synthélabo), and a hydrocolloid dressing, Comfeel (Coloplast), in the treatment of decubitus ulcers in the elderly. DESIGN: Open, randomized, multicentric French study, with two parallel groups of patients. PATIENTS: 168 in-patients aged more 65 years (mean age: 82 years) suffering from grade II to grade IV (in the Shea classification) pressure sores. TRIAL PERIOD: Either 8 weeks or until the ulcer healed, whichever occurred first. MEASUREMENTS: In addition to a complete physical examination, patients were evaluated at baseline for nutritional status and risk factors. The wounds were described, their depth scored, and the areas traced at Weeks 0, 1, 2, 4, 6, and 8. The number of dressings used was recorded. RESULTS: Thirty-one Inerpan-treated patients and 23 Comfeel-treated patients achieved healing (P = 0.089), with respective median healing times of 32 and 38 days. Healing times were compared using survival curves (in the whole population) adjusted for ulcer depth effect and showed a significant difference in favor of Inerpan (P = 0.044 and 0.014). Progress of healing (percentage of ulcer healed) was calculated in the two groups. Clinically assessed the treatment performance scored at the completion of the study showed better results with Inerpan (P < 0.05). Both groups were similar in terms of granulation/exudation scores, surrounding skin, and ease of care. CONCLUSION: It is concluded that Inerpan is easy to use, safeguards the healing process, and is of particular value in the management of pressure sores.

Age Factors↗
PubMed2000

Biobrane improves wound healing in burned children without increased risk of infection.

A synthetic bilaminar membrane used as a skin substitute (Biobrane) has been shown to decrease pain and hospitalization in superficial second-degree burns. Despite these benefits, it has not been utilized universally, particularly in young children, due to a perceived increase in related infections. We propose that when this synthetic membrane is applied to superficial scald burns <25% of the total body surface area (TBSA), decreased healing times are expected without increased risk of infection. Between 1994-1999, 89 children treated within 48 h after receiving superficial partial thickness scald burns covering 5-25% TBSA with no indication of infection were seen at our hospital. Forty-one were assigned randomly to receive treatment with the skin substitute Biobrane and 48 to receive conservative treatment with topical antimicrobials and dressing changes. Comparisons of treatment were made between groups for length of hospitalization, wound healing times, and infectious complications. Children treated with Biobrane or topical antimicrobials were similar in age, race, sex, %TBSA burned, and location of burn. Those receiving Biobrane had shorter hospitalizations and healing times, which was significant for both infants and toddlers and older children. Treatment groups were not different in the use of systemic antibiotics or readmissions for infectious complications. Biobrane was removed in 5.9% of cases for non-adherence. The application of Biobrane within 48 h of superficial burns provides for shorter hospitalizations and faster healing times in children of all ages without increased risk of infection.

Anti-Infective Agents, Local↗
PubMed1998

[Lidocaine tape (Penles--a dressing tape based on 60% lidocaine--) reduces the pain of postherpetic neuralgia].

The treatment of postherpetic neuralgia (PHN) by topical administration of local anesthetics has a number of drawbacks. Lidocaine tape (Penles) is a 15 cm2 dressing tape based on 60% lidocaine used to anesthetize skin when an intravenous catheter is inserted. This study aims to evaluate the analgesic efficacy of lidocaine tape in patients with PHN by comparing the results with those of surgical drape (Tegaderm). In a single-blind, two session study, lidocaine tape or surgical drape was applied to the affected skin of 10 patients. In one session, lidocaine tape was applied to the painful skin area, and in another, surgical drape was applied to the same area. Pain score and side effects were measured over 12 hours. Pain score was reduced at measurements taken starting from 1 hour after lidocaine tape application (P < 0.05). Lidocaine tape induced minor side-effects, erythema in a patient and increase in pain in another patient. In conclusion, lidocaine tape is effective for relief of PHN.

Aged↗
PubMed1998

Use of Biobrane after laser resurfacing.

BACKGROUND: Laser skin resurfacing has become an ever more popular and effective technique for the treatment of photoaged skin. Often a prolonged postoperative healing period adversely affects patients and physician satisfaction. Erythema and a certain degree of patient discomfort are often believed to be inevitable as they are thought to reflect depth of wounding and consequently the efficacy of wrinkle removal. In addition, a high incidence of irritant contact dermatitis has been observed, complicating recovery. OBJECTIVE: To develop a simplified wound dressing protocol aimed at achieving mild, short-term erythema and minimal side effects following effective rhytidectomy performed by laser resurfacing. METHODS: In a retrospective study from September 1995 to May 1997, 85 patients undergoing laser resurfacing for rhytid removal were placed on a postoperative wound care protocol consisting of immediate postsurgical once-only application, for 6 days, of Biobrane, a biosynthetic semipermeable dressing followed by the topical use of only a 10% cartilage extract in ointment. RESULTS: Thirty-eight full-face/three-quarter face, 26 supralabial, 13 perioral, and eight lower eyelid/crow's feet cosmetic units were treated. The fine and course wrinkles were improved in most patients, comparing favorably with other reported series. In 94% of patients erythema was absent to light pink at 4 weeks. Mild pain necessitating a medication was used in only five patients. Twenty-six patients developed transient hyperpigmentation and three patients developed focal hypopigmentation. Delayed irritant contact dermatitis presented in three patients. No infections developed and no scarring was observed. CONCLUSION: With this wound healing protocol, carbon dioxide laser skin resurfacing can effectively improved facial rhytids with minimal to insignificant erythema or discomfort.

Adult↗
PubMed2000

The palliative management of fungating malignant wounds.

This study focused on the palliative management of fungating malignant wounds and individual experiences of living with such a wound. Dressings were evaluated for the ability to contain these wounds and reduce their impact on daily life. The project extended to collaboration with industry for the development and evaluation of dressings designed to meet patient needs. A longitudinal multiple case study design was adopted. The methodology evolved through three principal phases: quasi-experimental design; emergent collaborative design; and emergent theory-driven evaluation. The radical departure from the initial approach was in response to the methodological problems encountered in a study of individuals with uncontrolled disease. A non-probability sampling plan was adopted, mainly because of the lack of homogeneity in the patient population; 45 participants were included. The length of time patients remained in the study depended on how long they lived. This ranged from a few days to more than two years. A sampling plan was, however, adopted for the data collection. The study had a dual focus: methodology, and the generation of explanations for dressing performance and the management of fungating wounds. The methodological aspect included development of the Teler system as a method of measuring dressing performance against goals of optimal practice in fungating wound management. The second component was a system of reasoning developed as an analytical strategy for abstracting general issues from individual case study data in order to construct explanations. Theory was used to generalize beyond the individual cases. Two forms of explanation for fungating wound management were constructed. These included explanations of individual experiences of living with such a wound and knowledge of the elements of fungating wound management. The impact on the individual was explained in terms of the stigma attached to public disability and a revulsion in society for uncontrolled body fluids. A pivotal relationship emerged between exudate and other wound management problems, including psychosocial aspects. A final critical explanation was developed for the qualification of the theory of moist wound healing to explain the phenomenon of exudate management in fungating and, possibly, other exuding chronic wounds.

Alginates↗
PubMed1986

Reduction of skin damage from transcutaneous oxygen electrodes using a spray on dressing.

A spray on, copolymer acrylic dressing (Op-Site) was used to limit the skin damage caused by a transcutaneous oxygen electrode and its adhesive ring. Two identical electrodes were applied to the abdominal skin of 10 preterm infants, one on untreated skin, the other after application of Op-Site. It was found that Op-Site prevented the epidermal damage (as measured by transepidermal water loss) that occurs when the adhesive ring is removed from untreated skin. It did not interfere with transcutaneous oxygen measurements; absolute values and response times were unchanged. Op-Site is therefore useful in preventing the skin trauma that occurs when transcutaneous oxygen monitoring is being performed in preterm infants below 30 weeks' gestation in the first week of life. Care must be taken, however, to prevent a build up of Op-Site--it should be applied as a single layer, allowed to dry, and removed after use.

Electrodes↗
PubMed2005

Results of the clinical examination of an ointment with marigold (Calendula officinalis) extract in the treatment of venous leg ulcers.

The aim of this study was to determine the therapeutic efficacy of marigold (Calendula officinalis) extract on the epithelialization of lower leg venous ulcers. The experiment was carried out in 34 patients with venous leg ulcers. The patients were divided into two groups. In the first (experimental) group, patients were treated with an ointment containing marigold extract, which was prepared in an apparatus devised by Soxleth and was incorporated into a neutral base. Twenty-one patients with 33 venous ulcers were treated. Therapy was applied twice a day for 3 weeks. The second group was a control group that consisted of 13 patients with 22 venous ulcers. In the control group, saline solution dressings were applied to ulcers for 3 weeks. In the experimental group the total surface of all the ulcers at the beginning of the therapy was 67,544 mm2. After the third week the total surface of all the ulcers was 39,373 mm2 (a decrease of 41.71%). In seven patients, complete epithelialization was achieved. In the control group the total surface of all the ulcers at the beginning of the therapy was 69,722 mm2. After the third week the total surface of all the ulcers was 58,743 mm2 (a decrease of 14.52%). In four patients, complete epithelialization was achieved. There was a statistically significant acceleration of wound healing in the experimental group (p < 0.05). The results obtained are preliminary, but they suggest the positive effects of the ointment with marigold extract on venous ulcer epithelialization.

Administration, Topical↗
PubMed1989

Topical treatment of burns using aserbine.

A cream containing malic, benzoic and salicylic acid esters (Aserbine) was evaluated as a topical dressing for dermal burns. Children with thermal injuries covering less than 20 per cent of the body surface area (BSA) were treated with Aserbine (53 patients), Daromide (31 patients) or silver sulphadiazine (SSD) (16 patients). In these groups, hot liquids were the cause of injury in 92 per cent, 100 per cent and 80 per cent of patients respectively. There were no significant differences in the numbers of patients with clinical evidence of infection. Aserbine did not inhibit the growth of staphylococci or Ps. aeruginosa, partly inhibited beta-haemolytic streptococci and Proteus sp., and completely inhibited the growth of E. coli. The rate of wound healing did not differ significantly between the groups. No toxic effects of Aserbine were observed, apart from transient discomfort on application. Aserbine is a safe, inexpensive topical agent suitable for thermal burns which are not heavily contaminated.

Anti-Infective Agents, Local↗