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PubMed2006

Silicon gel sheeting for preventing and treating hypertrophic and keloid scars.

BACKGROUND: Keloid and hypertrophic scars are common and are caused by a proliferation of dermal tissue following skin injury. They cause functional and psychological problems for patients, and their management can be difficult. The use of silicon gel sheeting to prevent and treat hypertrophic scarring is still relatively new, and started in 1981 with treatment of burn scars. OBJECTIVES: To determine the effectiveness of silicon gel sheeting for: (1) prevention of hypertrophic or keloid scarring in people with newly healed wounds (e.g. post surgery); (2) treatment of established scarring in people with existing keloid or hypertrophic scars. SEARCH STRATEGY: Trials were identified from searches of the Cochrane Wounds Group Specialised Register (searched September 2005), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2005); MEDLINE (1989 to June 2002); EMBASE (1988 to May 2002); CINAHL (1982 to May 2002) and reference lists of articles and relevant reviews. The major supplier of silicon gel sheeting (Smith and Nephew) was approached for details of unpublished, ongoing and recently published trials. SELECTION CRITERIA: Any randomised or quasi-randomised controlled trials, or controlled clinical trials comparing silicon gel sheeting for prevention or treatment of hypertrophic or keloid scars against no treatment, placebo, or any other treatment type except surgery. DATA COLLECTION AND ANALYSIS: All relevant trials were assessed for methodological quality. Data were extracted independently by both reviewers using a standardized form, and the results cross-checked. All trials, meeting the selection criteria were assessed for methodological quality. MAIN RESULTS: Thirteen trials, involving 559 people, ranging in age from 2 to 81 years, were included in the review. The trials compared adhesive silicon gel sheeting with control; non-silicon gel sheeting; silicon gel plates with added Vitamin E; laser therapy; triamcinolone acetonide injection, and non-adhesive silicon gel sheeting. In the prevention studies, when compared with a no treatment option; whilst silicon gel sheeting reduced the incidence of hypertrophic scarring in people prone to scarring, (RR 0.46, 95% CI 0.21 to 0.98) these studies were highly susceptible to bias. Silicon gel sheeting produced a statistically significant improvement in scar elasticity, (RR 8.60, 95% CI 2.55 to 29.02), but again these studies were highly susceptible to bias. AUTHORS' CONCLUSIONS: Trials evaluating silicon gel sheeting as a treatment for hypertrophic and keloid scarring are of poor quality and highly susceptible to bias. There is weak evidence of a benefit of silicon gel sheeting as a prevention for abnormal scarring in high risk individuals but the poor quality of research means a great deal of uncertainty prevails.

Cicatrix, Hypertrophic↗
PubMed2006

Patching for corneal abrasion.

BACKGROUND: Recent audits show that corneal abrasion is a common presenting eye complaint. Eye patches are often recommended for treating corneal abrasions despite the lack of evidence for their use. This systematic review was conducted to determine the effects of the eye patch when used to treat corneal abrasions. OBJECTIVES: The objective of this review was to test the hypothesis that patching an eye following a corneal abrasion improves healing or provides pain relief. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Group Trials Register) on The Cochrane Library (2005, Issue 2), MEDLINE (1966 to April 2005), EMBASE (1980 to April 2005), LILACS (13 April 2005), NRR (2005, Issue 2) and SIGLE (December 2004). There were no language or date restrictions in the searches. We also searched the reference lists of included studies, unpublished 'grey' literature and conference proceedings and contacted pharmaceutical companies for details of unpublished trials. SELECTION CRITERIA: We included randomised and quasi-randomised controlled trials that compared patching the eye with no patching to treat simple corneal abrasions. DATA COLLECTION AND ANALYSIS: Two authors independently assessed trial quality and extracted data. We contacted investigators for further information regarding quality of trials. The primary outcome was healing of the corneal epithelium and secondary outcomes were related to pain. MAIN RESULTS: Eleven trials, which randomised a total of 1014 participants, were included in the review. Meta-analysis of seven studies with dichotomous healing outcomes favoured no patching on the first day of healing (risk ratio (RR) 0.89, 95% Confidence Interval (CI) 0.79 to 0.99). For days two and three there was no significant difference between the two groups. Of the nine trials that measured pain scores two favoured no patching and none favoured patching. Complication rates were low and no differences were noted in these between the two groups. No-patch groups generally received more adjuvant treatment with antibiotics and/or cycloplegics than the patch group which is an important confounding factor. AUTHORS' CONCLUSIONS: Treating simple corneal abrasions with a patch does not improve healing rates on the first day post-injury and does not reduce pain. In addition, use of patches results in a loss of binocular vision. Therefore it is recommended that patches should not be used for simple corneal abrasions. Further research should focus on large (greater than 10 mm(2)) abrasions.

Corneal Injuries↗
PubMed2006

Interventions for stimulus deprivation amblyopia.

BACKGROUND: Stimulus deprivation amblyopia (SDA) develops due to an obstruction to the clear passage of light, preventing clear formation of an image on the retina for example, cataract, ptosis (droopy eyelid). It is particularly severe and can be resistant to treatment and the visual prognosis is often poor. Stimulus deprivation amblyopia is rare and precise estimates of prevalence difficult to come by; it probably constitutes less than 3% of all cases of amblyopia. In developed countries most patients present under the age of one; in less developed parts of the world presentation is likely to be significantly later than this.The mainstay of treatment is patching of the better-seeing eye but regimes vary, treatment is difficult to execute and results are often disappointing. OBJECTIVES: The objectives of this review were to evaluate the effectiveness of occlusion treatment for SDA, determine the optimum treatment regime and factors that may affect outcome. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials - CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) on The Cochrane Library (2006, Issue 1), MEDLINE (1996 to April 2006), EMBASE (1980 to April 2006) and LILACS (Latin American and Caribbean Literature on Health Sciences) (to November 2004). There were no date or language restrictions. SELECTION CRITERIA: We aimed to include randomised and quasi-randomised controlled trials of subjects with unilateral SDA defined as worse than 0.2 LogMAR or equivalent. There were no restrictions with respect to age, gender, ethnicity, co-morbidities, medication use, and the number of participants. DATA COLLECTION AND ANALYSIS: Two authors independently assessed study abstracts identified by the electronic searches. MAIN RESULTS: No trials were identified that met the inclusion criteria. AUTHORS' CONCLUSIONS: It is not possible to conclude how effective treatment for SDA is or which treatment regime produces the best results. There is a need for further study in this area.

Amblyopia↗
PubMed1990

Effects of selective neurotoxins on eye growth in the young chick.

We have determined the extent of retinal cell damage and eye growth after treatment with different neurotoxins. Day-old chicks received an intraocular injection containing 2, 10, 50, 100 or 200 nmol of kainic acid (KA), an excitotoxic analogue of glutamate. After 21 days, with 2 nmol KA damage was confined to a small proportion of bipolar cells, whereas with 10-200 nmol KA there was dose-dependent damage to amacrine cells, ganglion cells and photoreceptors. There was an increase in eye weight and size of the vitreal chamber with 10 nmol KA or more. In a similar protocol using 5, 50 or 200 nmol quisqualic acid (QUIS), there was massive loss of amacrine cells and slight loss of horizontal cells, and a large increase in the anterior chamber depth. A single dose of 200 nmol N-methyl-D-aspartate lesioned amacrine cells, but did not alter eye size. Thus, excitotoxins which have different retinotoxic effects also have different effects on eye size. In another study, we examined the effects of KA and QUIS on occlusion-induced eye enlargement. Treatment with 200 nmol QUIS alone resulted in increased depth of the anterior chamber. QUIS combined with occlusion for 3 weeks did not interfere with occlusion-induced growth of the vitreal chamber. Therefore, the loss of a large proportion of amacrine cells did not interfere with occlusion-induced growth. KA results in eye growth in its own right, but restricts occlusion-induced growth. These effects are associated with damage to photoreceptors, amacrine and bipolar cells and a small proportion of ganglion cells. Finally, we examined the effects of an intraocular injection of tunicamycin, a purported photoreceptor-specific neurotoxin in amphibia. Tunicamycin (0.1 or 1 mumg/eye) resulted in a flattened anterior chamber but did not affect growth of the vitreal chamber. Tunicamycin inhibited occlusion-induced growth, and treated retinae displayed massive disruption and loss of all cell types apart from a single row of pigmented retinal epithelium. We conclude that (a) normal and occlusion-induced eye growth may have separate mechanisms of action, (b) the vitreous and anterior chambers have different growth mechanisms, and (c) photoreceptors may play a critical role in occlusion-induced growth of the eye.

Animals↗
PubMed1990

Retinal influences on sclera underlie visual deprivation myopia.

Visual deprivation of chicks rapidly induces an increased growth of the vitreous chamber which results in axial myopia, even after a day or so. This experimental myopia provides an opportunity to trace the causal path from altered visual experience to altered eye growth. With respect to the visual factors involved, the gross activity of the retinal neurons seems an important variable. The eyes of animals raised wearing translucent occluders do not become myopic or elongated if stroboscopic illumination is present. Conversely, the eyes do become myopic and elongated if deprived of all form vision, if reared in a featureless environment or if deprived in only part of the visual field. The deprivation must, however, be continuous if myopia is to result; even as little as two hours of normal vision per day almost completely eliminates the effect of 12 hours of deprivation. The control of eye growth by vision seems to take place in local regions of the eye. Deprivation of various parts of the visual field produces myopia and elongation in only the deprived part, even in animals in which the optic nerve has been cut. It seems that at the level of the sclera ocular elongation (and thus myopia) results from local growth, because we find increases in synthesis of DNA and protein as well as more new cells. The protein synthesis increase is also local, in the sense that the posterior sclera grows much more than other parts, explaining why deprivation causes ocular elongation and myopia, rather than simply larger eyes. These results suggest that some factor in part of the retina can influence the growth of the subjacent sclera.

Animals↗
PubMed1976

Effect of plastic skin and wound drapes on the density of bacteria in operation wounds.

Operation wounds were sampled quantitatively by the velvet pad rinse technique to determine the effect of impervious plastic skin and wound drapes on the density of bacteria. A controlled trial (clean operations) revealed no significant difference between the bacterial density of herniotomy wounds for which the skin had been covered with adhesive plastic drapes, and the bacterial density of wounds in which skin drapes had not been used. The bacterial density in the wounds did not differ significantly from that on the adjacent skin; both densities were slightly higher at the end of operation than at the beginning. Within the operation wound, sites of low bacterial density were close to sites with a high density. Staphylococcus epidermidis predominated, while Staphylococcus aureus occurred only once; intestinal species were not isolated. In another controlled trial (potentially contaminated operations) plastic wound drapes gave an equally high reduction in bacterial density before closure of laparotomy wounds after either truncal vagotomy and pyloroplasty or gastric and colorectal operations. The reduction in the density of intestinal species was close to 100 per cent and did not differ significantly from that of alpha-haemolytic streptococci, the density of this species being significantly more reduced than that of staphylococci, diphteroids and bacilli. It is concluded that plastic skin drapes were without influence on the species and density of bacteria in operation wounds. Plastic wound drapes, on the other hand, considerably reduced not only exogenous but in particular endogenous bacteria, which otherwise would have remained in the operation wounds.

Adhesiveness↗
PubMed1980

A controlled trial to evaluate and compare a sutureless skin closure technique (Op-Site skin closure) with conventional skin suturing and clipping in abdominal surgery.

Sutureless wound closure employing a new product, Op-Site Skin Closure, was evaluated in comparison with two standard techniques of skin closure, using interrupted nylon sutures and Michel clips. The trial involved 110 patients undergoing elective and emergency abdominal surgery. The results showed that Op-Site Skin Closure was as good as the conventional techniques of skin closure with the advantages that it is easier and quicker to apply, produces a superior cosmetic result and, consequently, has gained excellent patient and nurse acceptance.

Abdomen↗
PubMed2002

Evaluation of a novel hemostatic device in an ovine parenchymal organ bleeding model of normal and impaired hemostasis.

Bleeding is a problem encountered by many surgeons, often complicated by the presence of coagulopathy or anticoagulant. The hemostatic effectiveness of CoStasis Surgical Hemostat (with bovine collagen, bovine thrombin, and autologous plasma) was evaluated and compared to a collagen sponge and to two investigational fibrin-sealant preparations under conditions of normal and impaired coagulation. A liver resection and controlled incisions in spleens and kidneys were made in sheep. Time to complete hemostasis and total blood loss were measured. Tissue response was evaluated at 7, 30, 60, and 75 days. CoStasis-treated sites demonstrated significantly shorter time to hemostasis (all surgical sites combined) compared with fibrin sealant (investigational fibrin sealant 1) (p= .005) or collagen sponge (p=0.013). In anticoagulated animals, CoStasis and fibrin sealant (investigational fibrin sealant 2) had comparable mean times to hemostasis, and CoStasis-treated sites exhibited lowered average blood loss compared to investigational fibrin-sealant-2 treated sites. CoStasis-treated sites demonstrated higher levels of tissue repair (lower inflammation, more extensive tissue repair, and less residual implant) compared to fibrin-sealant- or collagen-sponge-treated sites in Phases I and II. These findings demonstrate that CoStasis is a highly effective hemostatic agent for control of bleeding from parenchymal organs. Furthermore, under conditions of compromised coagulation, treatment with CoStasis demonstrates a reduction in average blood loss when compared to treatment with fibrin sealant.

Animals↗
PubMed1977

Evaluation of wound-covering materials.

Physical and in vivo (burned rat model) evaluations as wound coverings were performed for 1) a freeze-dried collagen/poly (epsilon-caprolactone) (PCL) film laminate, 2) a freeze-dried PCL "foam"/PCL film laminate, and 3) a heat-dried collagen/PCL film laminate. Porcine skin and cadaver skin were also evaluated in vivo for the purpose of comparison. Water-vapor transmission rates and Young's moduli were measured. The degree of adherence of the coverings to the wound were measured. Grafts which became significantly adherent (greater than 150 dyne/cm2) to the wound within 1 day were most successful in promoting the formation of a viable tissue bed which appeared ready to accept further grafting. The force required to remove the PCL foam laminate from a full-thickness excision wound was found to increase from 170 dyne/cm2 on the first day postgraft to 1500 dyne/cm2 by the tenth day. The force required to remove freeze-dried collagen laminate remained constant at 200 dyne/cm2 over the 10 day test period. For the heat-dried collagen laminate, a force of only 50 dyne/cm2 was required on day 1, increasing to 200 dyne/cm2 on day 6. Insensible water-loss rates of animals grafted with the laminates were found to be similar to those from animals with human cadaver skin grafts and less than that from animals with porcine skin grafts. When moistened, the laminates prepared using the freeze-dried materials were flexible and somewhat transparent permitting observation of the wound.

Animals↗
PubMed1981

Gelatin-based sprayable foam as a skin substitute.

Physical and antimicrobial properties of a newly developed gelatin based spray-on foam bandage for use on skin wounds have been evaluated. The aqueous foam is sprayed from aerosol containers and effectively covers and washes uneven wound surfaces. The foam dries to form an adherent and stable three-dimensional matrix which diminishes evaporative water losses. The foam possesses antimicrobial activity against gram-positive, gram-negative, and fungal contaminants.

Aerosols↗