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PubMed1992

Cutaneous heat loss shortly after burn injury in children.

1. Total heat loss and its components have been studied in cool (20 degrees C) and warm (30 degrees C) environments in 30 healthy children and 21 children who had been burned (10-17% body surface area) 0.5-29 h previously. 2. In healthy naked children at 20 degrees C, the partition of total heat loss was: radiation, 64%; convection, 32%; evaporation, 4%. On transfer to the warm, total heat loss was reduced by approximately 50%, with disproportionate reductions in the contributions from radiation and convection being offset, to some extent, by an increase in evaporative heat loss. 3. In patients during the first 5.5h after injury, the magnitude and pattern of heat loss at 20 degrees C and 30 degrees C were similar to those in control subjects and were unaffected by bandaging. 4. Ten to twenty-nine hours after injury, when the patients were bandaged and body temperature and heat content were significantly higher than in control subjects, radiant and convective heat losses were increased, but as evaporative heat loss tended to be reduced; total heat loss in the warm was unchanged. However, at this time at 20 degrees C, total heat loss was reduced compared with healthy children at the same ambient temperature. 5. The findings of unchanged or reduced total heat loss and reduced evaporative heat loss in injured patients are interpreted as inappropriate responses to an increased body temperature and heat content in children after burn injury.

Body Temperature Regulation↗
PubMed1999

Role of superficial venous surgery in the treatment of venous ulceration.

BACKGROUND: The aim of this study was to determine the ability of superficial venous surgery to heal venous ulcers in lower legs with isolated superficial venous incompetence. METHODS: This was a prospective study of patients recruited from a venous ulcer assessment clinic. Ulcers were considered venous if the ankle : brachial pressure index was greater than 0.8 and duplex imaging showed venous reflux. Patients with isolated superficial venous incompetence were offered saphenofemoral and/or saphenopopliteal surgery. Neither perforator surgery, skin grafting nor postoperative compression hosiery or bandaging was used. RESULTS: A total of 122 legs with normal deep veins underwent superficial venous surgery. Ninety procedures (74 per cent) were done under local and 32 (26 per cent) under general anaesthesia. Sixty operations (49 per cent) were done as a day case. The median time to healing was 18 (95 per cent confidence interval 14-21) weeks and the cumulative 6-, 12- and 18-month healing rates were 57, 74 and 82 per cent respectively. CONCLUSION: In patients with venous ulceration and isolated superficial venous incompetence, superficial venous surgery can produce ulcer healing in the majority of patients without the need for perforator surgery, postoperative compression bandaging or skin grafting.

Adult↗
PubMed2001

Allergic contact dermatitis due to benzalkonium chloride in plaster of Paris.

Plaster of Paris (POP) bandages are extensively used for splinting and casting injured or surgically repaired body parts. Allergic contact dermatitis caused by POP has been reported only rarely in the medical literature. An 81-year-old woman developed multiple large, tense, haemorrhagic bullae on the palm, and an acute vesicular eczematous eruption on the forearm, after the application of a POP splint. Subsequent patch testing revealed positive reactions to both the POP bandage used and to benzalkonium chloride, a component of the POP formulation. Patch tests to two other POP products without benzalkonium chloride were negative. These results confirm those of previous studies which have implicated the quaternary ammonium compound benzalkonium chloride as the allergen responsible for POP-induced allergic contact dermatitis.

Aged↗
PubMed2001

Elderly persons' experiences of living with venous leg ulcer: living in a dialectal relationship between freedom and imprisonment.

The aim was to illuminate elderly persons' experiences of living with venous leg ulcer. Fifteen persons 74-89 years of age with active leg ulcer were interviewed. Data were analysed utilizing a phenomenological-hermeneutic approach inspired by Ricoeur. The analysis includes dialectic movement between understanding and explanation of the text as a whole and its parts. In the structural analysis four themes were identified: emotional consequences of altered body image, living a restricted life, achievement of well-being in connection with a painful wound and bandage, and struggle between hope and despair with regard to a lengthy healing process. The comprehensive understanding indicated that the meaning of living with venous leg ulcer can be understood as a dialectal relationship between, on the one hand the feeling of being imprisoned in the body, the bandage and the home, and on the other hand, hope of freedom from a burdensome body. The results indicate that the concept, body of image, is vitally relevant to the caring of elderly people with venous leg ulcer. The study shows the importance of recognizing the persons' perceptions of their leg ulcers and the impact of these perceptions on well-being. Nurses can thereby anticipate problems and provide more sensitive care.

Adaptation, Psychological↗
PubMed2000

Tacky but refined: a "slick" technique for dressings that hold better.

For decades benzoin has been used to enhance the "stickiness" of the skin for improved adherence complementing the protective and functional aspects of well-constructed surgical bandages/dressings. The fully adherent and longer-lasting pressure dressing is both aesthetically pleasing to the patient (and surgeon) and, at the same time, functions to decrease seroma or hematoma formation, enhances antisepsis by blocking transient bacterial contamination, and inhibits traumatic sabotage of surgical wounds due to patient overactivity or inadvertent collision with a door jam, car door, table leg, or grandchild, etc. Also, when the bandage looks good, the patient realizes the operation was a success (at least aesthetically). Although simple, our additional steps of deoiling the skin with acetone, followed by multiple compress/release cycles of gauze to the Mastisol area reaps benefits to the patient and surgeon both in function (adherence) and in the production of a truly "dressy" beautiful and long-lasting dressing. In this way, the dressing "bed" is not only more receptive to one's aesthetically pleasing bandage, but is more tacky, yet refined. This same technique can be utilized prior to application of adhesive strips to healing wounds after sutures have been removed, allowing them to "stay on" longer with potentially better cosmesis and less spreading of the scar.

Adhesiveness↗
PubMed1997

[Effect of external stabilizing agents of the ankle joint on sports motor capacities in one legged jumping].

UNLABELLED: In order to document sport specific skills, 23 athletes with functionally unstable ankle joints as well as 18 healthy volunteers were evaluated by performing a single leg jumping test. For external stabilization of the ankle an Aircast-Brace, a Ligafix-Air-Brace, a Malleoloc-Brace as well as a tape bandage were applied. There was no negative influence on the jumping performance of the tested stabilizing devices in the uninjured ankle joints. There was also no significant difference between the devices. For functional unstable ankle joints most of the devices showed significant improvement of jumping performance. The best results were achieved by the Aircast-Brace, followed by the Malleoloc-Brace, the Ligafix-Brace and the tape bandage. Again, there was no significant difference between these devices. While the reaction time showed no difference in all test situations, the time for stabilizing the ankle joint was significantly worse in those ankle joints without a brace. CLINICAL RELEVANCE: For athletic activities, which are dominated by movement patterns comparable to the applied jumping test, the tested stabilizing devices seem to have no negative effect on sports specific capabilities.

Adult↗
PubMedDate not supplied

[Treatment of fibular capsular ligament rupture. A multicenter study].

The treatment of lateral ankle ligament tears has been by conservative and by operative means. 483 patients treated by a number of orthopaedic surgeons, general surgeons and trauma surgeons in Germany over a 2 1/2 year period were questioned one year after the injury. Treatment had been conservatively in 325 patients (tape bandage, elastic bandage, plaster cast, ankle brace, Aircast brace, others) and operatively in 158 patients (primary ligament repair, ligament reconstruction). A 100 point subjective ankle score was used for the 420 patients who responded. The mean score was 90.5 points. The average score of all patients undergoing surgery was 88.2 points, the mean score of all conservatively treated patients was 91.7 points. However, instability on stress radiographs after the injury was less in the conservative group. There was no clear correlation between the initial radiographic instability and the follow-up result. Young patients did better than older patients. The authors recommend conservative, early functional treatment for lateral ankle ligament tears.

Adolescent↗
PubMed2000

Prognostic indicators in venous ulcers.

BACKGROUND: Venous ulcers can be difficult to heal, and prognostic factors for healing have not been fully elucidated. OBJECTIVE: The objective of this study was to analyze the results of a large multicenter venous ulcer trial to retrospectively establish prognostic factors for venous ulcer healing. METHODS: This study examined data from a previously published prospective randomized placebo-controlled trial of an oral medication versus placebo treatment for venous ulcers. Local leg ulcer care involved the use of a moisture-retentive dressing and sustained graduated compression with a paste bandage and a self-adherent wrap. The oral medication or placebo was administered on a daily basis with the same dressings and bandage system in both groups for 12 weeks. A total of 165 patients completed the full 12-week treatment period; 83 received ifetroban, 82 received placebo. RESULTS: There was no statistically significant difference in outcome between the two groups. The study showed that consistent local ulcer treatment with a clearly defined system of care was associated with an unexpectedly high percentage (55%) of long-standing large venous ulcers (mean duration, 27 months; mean area, 15.9 cm(2)) being healed in both groups. Baseline ulcer area and duration of leg ulcer were found to be important in predicting outcome. Ulcers of short duration were found to be most likely to heal. Percent healing and ulcer area at week 3 were good predictors of 100% healing. Ulcers that had at least 40% healing by week 3 predicted more than 70% of the outcomes correctly. CONCLUSION: From this large study it was determined that baseline ulcer area and ulcer duration are significant predictors of 100% healing and time to heal. Percent healing and ulcer area at week 3 are good predictors of complete ulcer healing. Ulcers that are large, long-standing, and slow to heal after 3 weeks of optimal therapy are unlikely to heal rapidly, and might benefit from alternative therapies.

Double-Blind Method↗
PubMed1992

Operating in Vietnam.

'No bandages,' Florman said. 'Why no bandages? Because the mother will cry when she sees her child. Then she will see what you have done, and she will think you are God.'

Child↗
PubMed2000

Incidence and prevention of epithelial growth within the interface after laser in situ keratomileusis.

PURPOSE: To analyze the incidence of epithelial growth within the interface after laser in situ keratomileusis (LASIK) and describe a technique that may prevent its occurrence. METHODS: Results were reviewed for all LASIK procedures performed by two surgeons using identical surgical technique with either the Automated Corneal Shaper or Hansatome microkeratome. After laser ablation, the bed and posterior surface of the flap were irrigated with 0.2 microM filtered basic salt solution, and the surfaces were swept with lint-free sponges to clear the interface of epithelial and other debris. An aspirating lid speculum connected to suction was used to evacuate irrigation fluid and debris from the field. After the flap was smoothed into position, a bandage contact lens was used for the first day after surgery to prevent lifting of the flap edge during blinking. RESULTS: Seven hundred eighty-three eyes of 419 patients had primary LASIK, and 108 eyes had LASIK reoperation. Three eyes developed epithelial growth within the interface, with a minimum of 3 months of follow-up. The interface opacity appeared within 1 month of surgery in all three eyes. Two epithelial nests were small (1.0 and 1.5 mm in diameter, respectively) and did not increase in size on subsequent visits. Neither peripheral epithelial nest affected best-corrected visual acuity or caused any other sequelae. One ingrowth occurred early postoperatively in a case with a donut-shaped flap and was eliminated by transepithelial photorefractive keratectomy (PRK). CONCLUSION: Irrigating, wiping the stromal interface with sponges. aspirating irrigation fluid and debris with a suctioning lid speculum, and use of a bandage contact lens for the first day after surgery during LASIK and LASIK enhancement may markedly reduce the incidence of epithelial growth within the interface.

Acetates↗
PubMed2001

Primary graft failure caused by herpes simplex virus type 1.

PURPOSE: To present a cluster of four patients with primary graft failure (PGF) who consecutively underwent a penetrating keratoplasty (PKP) during a period of 17 days in one institution. PKP was performed for reasons unrelated to herpes simplex infection. Herpes simplex virus type 1 (HSV-1) is presented as the possible cause of these PGFs. METHODS: Viral culture of conjunctival swabs and of a bandage contact lens was performed on VERO, MRC-5, and Hep-2 cells. The four patients underwent subsequent regrafting. Polymerase chain reaction (PCR) for HSV-1 was carried out on aqueous humor and on a sample of iris and cornea with primers. Aqueous humor specimens were pretreated by boiling, and a qiagen extraction was performed according to the instructions of the manufacturer on biopsies of iris and cornea. Immunohistopathology was performed with polyclonal antibodies directed against HSV-1 and -2. RESULTS: Culture of a conjunctival swab in three patients and culture of a bandage contact lens in the fourth patient were positive for HSV-1. In three of the four patients, PCR was positive for HSV-1 on aqueous humor and corneal graft tissue. PCR on iris tissue was positive in all patients. In three patients, culture for HSV-1 of aqueous humor and of iris tissue could not be carried out because of insufficient sample. Viral culture of the iris tissue in one patient and of the corneal graft in the four patients were negative. Immunohistopathologic examination was positive for HSV-1 in three cases. CONCLUSION: These case reports strongly support the hypothesis that HSV-1 can be the cause of PGF.

Adult↗
PubMed2002

Epicorneal aspergilloma after penetrating keratoplasty.

PURPOSE: To report an epicorneal aspergilloma in a postkeratoplasty patient with a bandage soft contact lens. METHODS: Case report of a 77-year-old postkeratoplasty patient who presented with an epicorneal mass under a bandage soft contact lens placed for a nonhealing epithelial defect. On removal of the contact lens, a 4 x 4-mm placoid mass fell free from the corneal surface and was sent for culture and histopathology. RESULTS: Gram stain demonstrated septated branching hyphae, and cultures confirmed the diagnosis of Histopathologic sections of the epicorneal mass revealed a full-thickness aspergilloma. CONCLUSION: Contact lens removal and aggressive antimycotic treatment resulted in epithelial healing and resolution of the keratomycosis. The patient remained stable for 6 months followed by a successful repeat penetrating keratoplasty.

Aged↗
PubMedDate not supplied

Reduced wound contraction after grafting of full-thickness burns with a collagen and chondroitin-6-sulfate (GAG) dermal skin substitute and coverage with biobrane.

Full-thickness burns destroy both the epidermal and dermal tissues of the skin. This study evaluates a collagen and chondroitin-6-sulfate dermal skin substitute (graft) that was applied to excised full-thickness burns and covered with Biobrane. Experimental conditions included: (a) no burn, subcutaneous implantation of the graft; (b) burn, excision, graft, coverage with Biobrane and bandages; (c) burn, excision, no graft, coverage with Biobrane and bandages; (d) burn only. forty-one days post-surgery, subcutaneous implantation (N = 3) of the graft caused no detectable contraction or necrosis of the overlying skin, whereas all burn wounds contracted. Measurements of wounds (percentage of original wound size) showed statistically significant differences between the following treatments; (a) graft plus Biobrane (N = 10), 34%; (b) no graft plus Biobrane (N = 9), 25%; (c) untreated burns (N = 6), 16%. Semi-quantitative evaluation of time to healing indicated by spontaneous detachment of Biobrane from wounds showed that grafted, excised wounds healed in an average of 2.7 weeks, while ungrafted, excised wounds required an average of 4.3 weeks to heal. Histological appearance of healed wounds after grafting and coverage with Biobrane resembles undamaged skin without epidermal adnexal structures. Excision of full-thickness burn eschar, followed by grafting with a collagen and chondroitin-6-sulfate dermal skin substitute and coverage with Biobrane provides reduced wound contraction within a six-week period of observation compared to non-excised wounds. Both more rapid and more complete wound healing took place compared to excised wounds that were not grafted.

Animals↗
PubMed1984

Plasma palmitate turnover in subjects with thermal injury.

Using a continuous infusion of [1-13C] palmitic acid tracer, plasma palmitate turnover was measured 14 times in nine bandaged, thermally injured adults. Plasma glucose (102 +/- 4 mg/dl), insulin (21 +/- 4 microU/ml), and glucagon (296 +/- 34 pg/ml) levels were significantly elevated compared with values in uninjured controls. Circulating plasma epinephrine (67 +/- 11 pg/ml) and norepinephrine (219 +/- 57 pg/ml) levels were more than twofold their respective control values of 261 +/- 4 pg/ml and 211 +/- 7 pg/ml but less than the previously defined plasma threshold levels for lipolytic effects of these catecholamines as circulating hormones. Plasma palmitate and free fatty acid concentrations, 113 +/- 8 and 452 +/- 38 microM, respectively, were not different from control values but palmitate flux (2.66 +/- 0.28 mumol kg-1 min-1) and free fatty acid turnover calculated therefrom (10.53 +/- 1.13 mumol kg-1 min-1) were significantly elevated compared to the control rates. While palmitate turnover significantly correlated with plasma palmitate concentration and with per cent body surface area burned, there was no relationship between palmitate flux and circulating epinephrine or norepinephrine levels. These data raise new questions about the relative catabolic roles of catecholamines in bandaged, thermally-injured patients.

Adolescent↗
PubMed1999

The benefits of wearing a compression sleeve after ACL reconstruction.

PURPOSE: It was the purpose of the present study to examine the possibility of increased muscle coordination after anterior cruciate ligament (ACL) reconstruction through the wearing of a compression sleeve. METHODS: Thirty-six patients were studied who had undergone unilateral ACL reconstruction at least 12 months previously. All subjects were required to perform a 10-cm standing drop jump from an elevated platform onto a force plate, to land on one leg, and thereafter maintain a one-legged balance for 25 s. This task was repeated three times without and three times with an elastic compression sleeve worn on the reconstructed limb. For analysis, the task was partitioned into a landing phase (150 ms), an adjusting phase (10s), and a balancing phase (10s). The peak impact loadings were measured in each direction (Fx, Fy, and Fz) during landing, while force-time integrals (intFz, intFy, and intFz) and root mean square (RMS) error of these forces were calculated for the adjusting and balancing phases. The path length and RMS of the center of pressure coordinates (Ax and Ay) were obtained for the adjusting and balancing phases combined. RESULTS: Drop landings with the bandage produced significantly larger (P < 0.001) peak ground reaction forces in the vertical and anteroposterior direction, suggesting increased subject confidence in their knee. Wearing the knee bandage also enabled the patients to reduce all measured parameters in the anteroposterior direction (rmsFx, intFx, rmsAx) during both the adjusting and balancing phases (P < 0.001 ). A significant reduction in the center of pressure path length further indicated an enhanced steadiness during the one-legged stance. CONCLUSIONS: It was concluded that a compression sleeve improved the total integration of the balance control system and muscle coordination.

Adult↗
PubMed2004

Therapeutic use of a silicone hydrogel contact lens in selected clinical cases.

PURPOSE: To evaluate a silicone hydrogel contact lens as a continuous-wear bandage in selected clinical cases, a prospective, open, nonrandomized clinical study was conducted. METHODS: Seventy eyes from 70 patients with anterior segment conditions for which therapeutic lenses were indicated were enrolled in the study. In most patients (47 eyes, 67%), the presenting condition was bullous keratopathy. Patients were fitted with a lotrafilcon A silicone hydrogel lens (Focus Night & Day) that was worn continuously for 7 to 30 days, and the concomitant therapies were used. The corneal condition was assessed, and subjective comfort was recorded for 7 days to 18 months after fitting (mean follow-up, 69 days). RESULTS: Of 70 eyes, 64 (91%) showed improvement in the clinical condition of the eye, and 66 (94%) rated comfort when wearing the lens as very good or good. CONCLUSIONS: The study lens was found to be an effective and well-tolerated bandage lens in these selected patients.

Adult↗
PubMed2006

Comparison of conventional and silicone hydrogel contact lenses for bullous keratoplasty.

PURPOSE: To compare the efficacy and safety of conventional lenses and silicone hydrogel lenses in the treatment of bullous keratopathy. The silicone hydrogel bandage contact lenses used were Focus NIGHT & DAY and PureVision. The conventional lens used was Sauflon 85%. METHODS: This was a prospective, comparative study of 22 patients with painful bullous keratopathy in one eye. Patients visited a specialty contact lens department and were fitted with all three different lens types in their affected eye for 1 month each, for a total duration of 3 months. The main outcome measures were comfort and pain relief, which patients scored on a scale that ranged from 1 to 5, with 1 being very poor and 5 being excellent. Doctors assessed the fit of the lens, its movement, and any deposit buildup. The statistical tests applied were the Kruskal-Wallis test and the Mann-Whitney test. RESULTS: Sixteen of the 22 patients (24 eyes) successfully completed 1 month's wear of all three bandage contact lenses. The median comfort score was 3.9 for PureVision, 3.8 for Focus NIGHT & DAY, and 2.8 for Sauflon 85%; there was a statistical significance among the three groups (P=0.031). Silicone hydrogel lenses performed better than conventional lenses for comfort. The Mann-Whitney test showed that there was no statistically significant difference for comfort scores of Focus NIGHT & DAY versus PureVision (P<0.782) or of Focus NIGHT & DAY versus Sauflon 85% (P<0.073). However, there was a statistically significant difference for comfort scores of PureVision versus Sauflon 85% (P<0.0136). The median pain relief score was 3.8 for PureVision, 3.7 for Focus NIGHT & DAY, and 3.2 for Sauflon 85%. There was no significant difference among the three lenses for pain relief score. All three lens types were similarly good with regard to contact lens fit, movement, and deposit buildup. CONCLUSIONS: The use of silicone hydrogel lenses are a safe and effective alternative to conventional contact lenses for the treatment of bullous keratopathy.

Adult↗
PubMed2005

Perforated corneal hydrops treated with sulfur hexafluoride (SF6) gas and tissue adhesive.

PURPOSE: To report a case of a perforated acute hydrops in a mentally retarded patient that was successfully managed with intracameral sulfur hexafluoride gas and cyanoacrylate tissue adhesive. METHODS: Interventional case report. RESULTS: A 14-year-old mentally retarded male patient with keratoconus presented with a perforated acute hydrops. A bandage contact lens was applied. However, following a large emesis 2 days later, the aqueous leak worsened with shallowing of the anterior chamber. Under general anesthesia, sulfur hexafluoride was injected to reform the anterior chamber and cyanoacrylate tissue adhesive was applied to the perforated site and covered by a bandage contact lens and temporary tarsorrhaphy. A follow-up examination at 1 month showed a formed anterior chamber with tissue adhesive in situ and no aqueous leak. CONCLUSIONS: The successful use of intracameral sulfur hexafluoride and tissue adhesive in the management of perforated acute hydrops may avoid emergency tectonic penetrating keratoplasty and reduce potential complications in the poorly cooperative patient.

Adolescent↗