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The sensitizing potential of three periodontal dressing materials was evaluated by the guinea pig maximization test. The results indicated a difference in the sensitization rate of the three materials.
Collagen-based materials can be formed into a three-dimensional sponge for use as a wound dressing and as a support for cell cultured skin components. Factors such as biocompatibility, morphological structure and addition of non-collagenous molecules to collagen are analyzed and discussed. Large pores or channels, interchannel communications and combinations of macromolecules of the connective tissue enhance wound tissue infiltration in vivo as well as cell growth in vitro into collagen sponges. The presence of such factors can be useful in patients with excised burn wounds and pressure skin ulcers.
OBJECTIVE: Recent neurosurgical literature reflects rapidly evolving, technically enhanced methods that promise to improve neurosurgical outcomes. We review our experience with computer image guidance, linear or sigmoid incisions after minimal shaving, and liquid wound dressing with 2-octyl cyanoacrylate (Dermabond; Ethicon, Inc., Somerville, NJ) for tumor craniotomy or craniectomy in our attempt to optimize craniotomy or craniectomy for tumor. METHODS: After institutional review board approval, we retrospectively reviewed patients who underwent craniotomy or craniectomy for tumor with or without the combination of techniques specified above. A prior cohort of patients who underwent craniotomy or craniectomy with traditional techniques served as a retrospective basis of comparison. Analysis included in- and outpatient chart reviews, which included the operative notes, pathology reports, discharge summaries, outpatient office records, and intraoperative nursing records. Data were entered into a statistical spreadsheet for analysis and comparison. RESULTS: A total of 225 consecutive patients underwent a combination of less invasive techniques from July 2000 through October 2001. These patients were matched with 225 patients in a standard neurosurgical cohort that included patients who underwent operations from July 1994 through July 2000. Age, tumor type, radiation, reoperation rate, tumor location, and extent of resection were comparable for both groups. The overall wound complication rate was significantly lower in the minimally invasive group when compared with the control cohort of patients (0.9% versus 6.2%; P = 0.0298), even for early follow-up (0.9% versus 3.5%; P = 0.0427). Pedicle flap design was a variable that was significantly associated with wound complication. CONCLUSION: Modern neurosurgical techniques are beneficial for patients undergoing craniotomy or craniectomy for tumor and seem to be superior to standard techniques. Although the study is multifactorial and retrospective, this conclusion is further supported by the enhanced self-image patients have during the postoperative period.
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.
It has been known for many years that silver has antimicrobial properties. Arglaes is a film dressing that provides a continuous and controlled release of silver ions and is produced by Maersk Medical. The name is derived from argentum, which is Latin for silver, and Ag, the chemical symbol for silver. Since the emergence of resistant organisms, topical antibiotics are best avoided. Arglaes has been developed in the light of this and appears to control the bacteria in wounds and prevent bacterial contamination. Arglaes also provides a moist environment for the healing process and is suitable for many wound types.
Chronic wounds in patients with multiple systemic factors present a significant clinical challenge for clinicians. Oasis Wound Dressing is derived from porcine small intestine which, when placed in a non-infected wound, stimulates new tissue and an absorbable, natural template for the growth of new tissue. Emerging evidence suggests that it is beneficial for patients with chronic, non-healing wounds complicated by multiple systemic factors.
Expenditure on wound care continues to rise in the UK as new products and innovations are introduced. Nurse specialists in tissue viability are at the forefront of many of these advances and therefore it is vital that they consider both the clinical and economic benefits of each new treatment. In this article, the authors use a case study methodology to evaluate primary and secondary wound dressings. The aim was to focus on the opportunity for reducing overall costs in wound management without compromising clinical outcomes. Given the initial results observed there appears to be ample scope for a debate within the tissue viability specialty with regard to achieving best value for money in wound care. The authors suggest that the time has come to consider this area in greater detail and depth.
The effect of six different hydrogels on the development of sterile larvae (Lucilia sericata) was examined in a laboratory study. Five of the products had a marked adverse effect on maggot survival but one appeared to facilitate growth of the larvae when compared to control values. These results are consistent with clinical observations that larvae may not survive well in wounds containing residues of some hydrogel dressings.
In vitro laboratory tests and preliminary clinical trials have found that two silver-containing dressings, Contreet Foam and Contreet Hydrocolloid, promote healing in infected and chronic venous leg ulcers and diabetic foot ulcers.
OBJECTIVES: This four-centre feasibility study was undertaken to determine whether Medihoney, a proprietary blend of honeys, is an acceptable treatment for patients with leg ulcers in terms of pain relief, odour control and overall patient satisfaction. METHOD: Forty patients whose leg ulcers had not responded to 12 weeks of compression therapy were recruited. Medihoney dressings were applied on their ulcers for the 12-week study period. All other aspects of their care, including the use of compression bandaging, remained unchanged. Their leg ulcers were assessed every two weeks. This included the use of a patient questionnaire. RESULTS: Overall, ulcer pain and size decreased significantly and odorous wounds were deodorised promptly. This had a positive impact on patient satisfaction with the Medihoney treatment. CONCLUSION: The results support the previously reported positive effects of honey and revealed a high patient acceptance for this treatment. Following these results, comparative clinical trials, which should also consider pain, are now recommended.
A non-pressurised boot dressing keeps wounds moist, warm and humid, stimulating healing and providing a barrier against wound odour. Its use in the management of problematic neuroischaemic diabetic foot ulcers is reported.
The effect which a visible light-curing periodontal dressing material based upon a urethane dimethacrylate resin has upon HeLa cells and fibroblasts in its uncured and fully cured states has been studied in vitro. Fully-cured material has no effect on either cell type. Uncured material produces a surrounding zone of growth inhibition and cell death on direct contact. Inhibition is caused by the release into the medium of substances toxic to cells. However, this growth inhibition is overcome in time (5 days). It is suggested that partly-cured material containing residual free monomer in contact with a healing gingival site could impede rapid repair. Nuclear magnetic resonance microimaging has shown that in places where there is a greater depth of material (e.g., interproximal regions) this underlying material may be partly cured. Increasing the exposure to the curing light will prevent (or minimize) the presence of partly-cured material; the fully-cured material being compatible with the cells.
We subcutaneously injected collagen wound dressing (CAS) extracts equivalent to the area covering human body surface by 35 and 70%, respectively, into mouse dams from days 6 to 15 of pregnancy. No toxicity was observed in dams and no external, skeletal and visceral anomalies related to CAS treatment were observed in fetuses. It is, therefore, concluded that CAS extracts produces no teratogenesis after subcutaneous injection during organogenesis in mice.
OBJECTIVE: To determine the effects of a hydrolyzed bovine collagen dressing (HBCD) on healing of open wounds in healthy dogs. ANIMALS: 9 female Beagles. PROCEDURES: 2 full-thickness skin wounds were made bilaterally on the trunk of each dog. Wounds on 1 side were treated with powdered HBCD covered with a semiocclusive nonadherent bandage. Wounds on the other side (control wounds) were covered with a semiocclusive nonadherent bandage only. Wound healing was subjectively assessed, and percentage increase in tissue perfusion was assessed by use of laser Doppler perfusion imaging (LDPI). Planimetry was performed to determine the percentages of contraction, epithelialization, and total wound healing. Biopsy specimens were examined microscopically to evaluate histologic changes. RESULTS: The HBCD did not induce a strong inflammatory reaction, as reflected by results of LDPI and histologic examination. Moreover, HBCD appeared hydrophilic and provided an environment to keep wounds clean and enhance early epithelialization. After treatment for 7 days, treated wounds had a significantly greater percentage of epithelialization than control wounds (12.13 vs. 7.03%). CONCLUSION AND CLINICAL RELEVANCE: The hydrophilic property of HBCD may cleanse contaminated wounds with the body's homeostatic fluids and enhance early wound epithelialization.
The role of zinc in an occlusive, adhesive dressing (Zn-tape) was investigated in two experiments in the rat. In the first one Zn-tape was compared with a similar tape without zinc components and also with an inert plastic coated fabric with regard to the wound inflammatory reaction in excisional wounds. In the second experiment we attempted to assess possible systemic effects of zinc absorbed from Zn-tape-treated excisional wounds by studying the granulation tissue formation in subcutaneously implanted Ivalon sponges. The excisional wounds were treated with either the Zn-tape or a titanium tape in which the zinc oxide was replaced by an equivalent amount of titanium dioxide (Ti-tape). The granulation tissue produced was evaluated histologically, histochemically and biochemically. The plain adhesive mass and the Ti-tape elicited an intense inflammatory reaction as indicated both by high activities of alkaline phosphatases and histological examination. The Zn-tape reduced inflammatory processes in the granulation tissue of the excisional wounds. Zinc levels in serum and liver were raised in Zn-tape-treated animals. We conclude that zinc oxide in the Zn-tape affects inflammatory reactions in the granulation tissue of the wounds, possibly through a continuous release of zinc ions and by modifying the adhesive components of the Zn-tape. There was no evidence of a systemic effect of zinc absorbed from the excisional wounds on the granulation tissue formation in the implanted Ivalon sponges.
The purpose of this study was to examine whether epithelialisation is promoted when an allogeneic cultured dermal substitute is used as a biological wound dressing. The dermal substitute was prepared by plating fibroblasts on to a spongy collagen matrix, and then culturing them for 7 to 10 days. A new animal wound model was designed to measure re-epithelialisation quantitatively. A full thickness skin defect was made on the dorsum of each of 33 rats; the skin was excised, leaving a layer of pannicular carnosus with an island of intact skin in the central portion of the skin defect. In the first group of rats (n = 13), a piece of cultured dermal substitute was applied to the wound, and a medicated covering material was placed over it. Re-epithelialisation from the island of intact skin was monitored over a period of 7 days. In the second group of rats (n = 10), the wound was covered with an acellular collagen matrix in conjunction with the medicated covering material, and in the third group of rats (n = 10), the wound was covered with the medicated covering material alone. Both the macroscopic and histological findings indicated that the epithelial migration of the first group of rats was far more rapid than that in the other two groups. It comes to the conclusion that the application of this new fibroblastic cultured dermal substitute provided a good environment for the promotion of wound healing.
A pain wrap dressing in patients undergoing routine knee arthroscopy was evaluated to determine its ability to decrease postoperative pain and swelling. Bilateral knee examinations were performed pre- and postoperatively. Patients recorded narcotic usage and pain levels for 10 postoperative days. Twenty-four patients completed the study. The pain wrap group had lower pain ratings (2.2 versus 4.6 [P=.03]) and demonstrated lower skin temperatures (1.1 degrees F versus 3.9 degrees F [P=.02]). Less postoperative swelling was noted in the treatment patients, whereas postoperative arc of motion and narcotic usage was similar in both groups.
A compression dressing system is an easily learned and effective alternative to the Unna boot for treatment of venous stasis ulcer. The treatment is well accepted by patients and appears to have efficacy comparable to that achieved with the boot, but without the problems associated with the boot, such as maceration, poor fit, and inability to observe and bathe the skin.