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PubMed2005

Hemostatic efficacy of two advanced dressings in an aortic hemorrhage model in Swine.

BACKGROUND: An effective hemostatic agent capable of stopping severe arterial bleeding and sustaining hemostasis over a prolonged time is required. The U.S. Army recently distributed fibrin sealant (under an Investigational New Drug-approved protocol) and chitosan dressings among deployed medics for treating severe external hemorrhage on the battlefield. The purpose of this study was to evaluate the efficacy of these dressings, as compared with the standard gauze army field dressing, to provide initial and sustained hemostasis up to 96 hours in a lethal uncontrolled arterial hemorrhage model. METHODS: Anesthetized pigs were splenectomized and chronically instrumented for fluid/drug administration and continuous monitoring of vital signs. An infrarenal aortotomy was created using a 4.4-mm aortic hole punch and free bleeding was allowed for 5 seconds. While bleeding profusely, a dressing was applied and pressed into the wound for 4 minutes (occluding the distal flow) and then released. If hemostasis was not obtained, the dressing was replaced with a new one (maximum, two dressings per experiment) with another 4-minute compression. If hemostasis was achieved, the abdomen was closed; the animal was then recovered and monitored up to 96 hours. Initial hemostasis, duration of hemostasis, survival time, blood loss, and other variables were measured. RESULTS: Application of army field dressing (gauze) did not stop the arterial hemorrhage and led to exsanguination of all the pigs (n = 6) within 10 to 15 minutes of the injury. Chitosan dressing produced initial hemostasis in five of seven pigs. However, the dressings failed to maintain hemostasis for more than 1.6 hours (range, 28-102 minutes), resulting in secondary bleeding and death of the animals. Fibrin sealant dressing produced initial hemostasis in all the pigs (n = 6) and maintained hemostasis in five cases, with one failure at 2.2 hours. These pigs resumed normal activities and lived for the 96-hour experiment duration. Computed tomographic images and histologic sections of the aortas from surviving fibrin sealant dressing-treated animals showed formation of pseudoaneurysms and early granulation tissue at the aortotomy site. The posttreatment blood loss, duration of hemostasis, and survival time were significantly different in the fibrin sealant dressing group than the chitosan dressing and army field dressing groups. CONCLUSION: Both chitosan dressing and fibrin sealant dressing stopped initial arterial bleeding that could not be controlled by the standard army field dressing. However, although the fibrin sealant dressing secured hemostasis for up to 4 days, the chitosan dressing consistently failed within 2 hours after application. There may be a risk of rebleeding for high-pressure arterial wounds treated with chitosan dressings, particularly in situations where definitive care is delayed substantially.

Analysis of Variance↗
PubMed2006

Dressings for healing venous leg ulcers.

BACKGROUND: Venous leg ulcers, sometimes called varicose or stasis ulcers, are a consequence of damage to the valves in the veins of the legs, leading to raised venous pressure. Venous ulcers are characterised by a cyclical pattern of healing and recurrence. The main treatment is the application of compression, either in the form of compression bandages or hosiery. Dressings are usually applied beneath the compression to aid healing, comfort and to control exudate. Wounds heal quicker in a moist environment and dressings are used to absorb excess fluid or retain fluid in an otherwise dry wound in order to achieve a 'moist wound environment'. There are a large number of dressing products and types available. It is unclear whether particular dressings aid healing of leg ulcers. OBJECTIVES: To assess the effectiveness of wound dressings for the treatment of venous leg ulcers. SEARCH STRATEGY: We searched the Cochrane Wounds Group Specialised Register (April 2006) and CENTRAL (issue 1, 2006) and several other electronic databases (up to April 2005). Manufacturers of dressing products were contacted for unpublished studies. SELECTION CRITERIA: Randomised controlled trials that evaluated dressings for the treatment of venous leg ulcers. There was no restriction in terms of source, date of publication or language. Ulcer healing was the primary endpoint. DATA COLLECTION AND ANALYSIS: Data from eligible studies were extracted and summarised using a data extraction sheet by two authors independently. MAIN RESULTS: 42 randomised controlled studies were identified that met the inclusion criteria. The main dressing types that were evaluated were hydrocolloids (n = 23), foams (n = 6), alginates (n = 4), hydrogel dressings (n = 6) and a group of miscellaneous dressings (n = 3). In none of the comparisons was there evidence that any one dressing type was better than others in terms of number of ulcers healed. Current evidence does not suggest that hydrocolloids are more effective than simple low adherent dressings used beneath compression (9 trials; relative risk for healing with hydrocolloid 1.09 (95% CI 0.89 to 1.34)). For other comparisons there was insufficient evidence. AUTHORS' CONCLUSIONS: The type of dressing applied beneath compression has not been shown to affect ulcer healing. For the majority of dressing types there was insufficient data to allow us to draw strong conclusions except for hydrocolloid compared with a low adherent dressing. The result of the meta-analysis indicate no significant difference in healing rates between hydrocolloid dressings and simple, low-adherent dressings when used beneath compression. Decisions regarding which dressing to apply should be based on local costs of dressings and practitioner or patient preferences.

Bandages↗
PubMed1997

A comparative study of three occlusive dressings in the treatment of full-thickness wounds in pigs.

BACKGROUND: Little objective information is available on the influence of occlusive dressings on the healing of cutaneous full-thickness wounds. OBJECTIVE: Our purpose was to examine the effects of three occlusive dressings-two hydrocolloid dressings (Comfeel Ulcer Dressing, Coloplast A/S, Espergaerder, Denmark [hydrocolloid dressing A] and DuoDERM; ConvaTec, Princeton, N.J. [hydrocolloid dressing B]) and one polyurethane film dressing (OpSite, Smith & Nephew, Hull, U.K. [film dressing])-on tissue reactions, degree of inflammation, wound contraction, and epithelialization in full-thickness wounds in domestic pigs. METHODS: Standardized 20 mm full-thickness punch biopsy wounds were treated for 10 days. Healing was assessed by light microscopy and by planimetry. RESULTS: Material from both hydrocolloid dressings was phagocytosed as indicated by the presence of foam cells in the granulation tissue. Granulomatous tissue reactions around extracellular vacuoles were found in 10 of 12 hydrocolloid dressing B-treated wounds compared with one in hydrocolloid dressing A-treated wounds and in none of the 10 film dressing-treated wounds (p < 0.0001). Inflammation was significantly (p < 0.002) more pronounced in hydrocolloid dressing B-treated wounds. The extracellular vacuoles in the hydrocolloid dressing B group contained dressing material as demonstrated by Fourier transform infrared microscopy. There was a tendency (p < 0.07) towards a delayed entry into the contraction phase with hydrocolloid dressing B, but there was no significant difference in epithelialization between the three dressings. CONCLUSION: Wound tissue reactions to different hydrocolloid dressings vary depending on composition. The tissue reactions had no significant effect on wound contraction or epithelialization.

Animals↗
PubMed2003

Gauze and tape and transparent polyurethane dressings for central venous catheters.

BACKGROUND: Central venous catheters facilitate venous access, allowing the intravenous administration of complex drug treatments, blood products and nutritional support, without the trauma associated with repeated venepuncture. However, central venous catheters are associated with a risk of infection. Some studies have indicated that the type of dressing used for central venous catheters may affect the risk of infection. Gauze and tape or transparent polyurethane film dressings such as Tegaderm, Opsite or Opsite IV3000 are the most common types of dressing used to secure central venous catheters. Currently, it is not clear which type of dressing is the most appropriate. OBJECTIVES: To compare gauze and tape and transparent polyurethane central venous catheter dressings in terms of catheter related infection, catheter security, tolerance to dressing material and dressing condition in hospitalised adults and children. SEARCH STRATEGY: The Cochrane Wounds Group Specialised Trials Register (October 2002), the Cochrane Controlled Trials Register (4th Quarter 2002) and the databases; MEDLINE (1966-December 2002, CINAHL (1982-October 2002) and EMBASE (1980-December 2002) were searched to identify any randomised controlled trials comparing the effects of gauze and tape and/or transparent polyurethane dressings for central venous catheter sites. Additional references were identified from bibliographies of published literature and were also sought from other sources. SELECTION CRITERIA: All randomised controlled trials evaluating the effects of dressing type (i.e. gauze and tape and/or transparent polyurethane dressings) on central venous catheter related infection, catheter security, tolerance to dressing material and dressing condition in hospitalised patients. DATA COLLECTION AND ANALYSIS: Twenty-three studies were reviewed. Data was extracted from each paper by two members of the review team independently and results then compared. Differences were resolved either by consensus or by referral to a third member of the review team. Authors were contacted for missing information. MAIN RESULTS: Of the 23 studies reviewed, 14 were excluded. Nine studies were included. Data was only available for meta-analysis from six of the nine included studies. Of the six included studies with available data, two compared gauze and tape with Opsite IV3000, two compared Opsite with Opsite IV3000, one compared gauze and tape with Tegaderm, and one compared Tegaderm with Opsite. There was no evidence of any difference in the incidence of infectious complications between any of the dressing types compared in this review. Each of these comparisons was based on no more than two studies and all of these studies reported data from a small patient sample. Therefore it is probable that the finding of no difference between dressing types is due to the lack of adequate data. REVIEWER'S CONCLUSIONS: There is a high level of uncertainty regarding the risk of infection with the central venous catheter dressings identified in this review. Therefore, at this stage it appears that the choice of dressing for central venous catheters can be based on patient preference. To identify the most appropriate central venous catheter dressings, further research is necessary. It is paramount that any future studies investigating this issue must be rigorously performed randomised controlled trials.

Bacterial Infections↗
PubMed2004

Frequency of vaccinia virus isolation on semipermeable versus nonocclusive dressings covering smallpox vaccination sites in hospital personnel.

BACKGROUND: The Centers for Disease Control and Prevention recommends a semipermeable occlusive dressing for hospital workers who receive smallpox vaccination. OBJECTIVE: The study was designed to determine the frequency of vaccinia virus isolation from the outer surface of semipermeable dressings and to compare the prevalence of vaccinia virus on the outer surface of semipermeable dressings with its prevalence on the outer surface of nonocclusive dressings. METHODS: A prospective, observational study was conducted on hospital employees who received smallpox vaccination at a military academic medical center. Subjects were instructed to wear a semipermeable dressing if they had direct patient contact. Employees without direct patient care had the option of wearing a semipermeable dressing or a nonocclusive dressing. Prior to a programmed dressing change, the outer surface of the bandage site was swabbed and cultured for virus. Samples were considered positive when cytopathic effects were observed, with results confirmed as vaccinia by polymerase chain reaction. RESULTS: A total of 212 cultures were obtained from 93 subjects. All cultures directly obtained from active lesions were positive (13/13). Positive cultures were obtained from 7% (10/135) of the semipermeable dressings and 23% (15/64) of the nonocclusive dressings (P <.05). Ten percent (8/79) of the semipermeable dressings with purulent exudate observed underneath the bandage were culture positive, compared with 4% (2/56) of semipermeable dressings with no purulent exudate observed underneath the bandage (P=.19). CONCLUSIONS: Compared with nonocclusive dressings, the semipermeable dressing reduced, but did not eliminate, the frequency with which vaccinia virus was cultured from the surface of the dressing. Virus was present, but only rarely, on the dressing surface in the absence of purulent exudate under the semipermeable dressings.

Bandages↗
PubMed2006

Death of Salmonella, Escherichia coli O157:H7, and Listeria monocytogenes in shelf-stable, dairy-based, pourable salad dressings.

The objectives of this study were to determine the death rates of Salmonella, Escherichia coli O157:H7, and Listeria monocytogenes in three commercially manufactured full-fat ranch salad dressings, three reduced-fat ranch salad dressings, two full-fat blue cheese salad dressings, and two reduced-fat blue cheese salad dressings and to affirm the expectation that these dressings do not support the growth of these pathogens. The respective initial pH values of the four types of shelf-stable, dairy-based, pourable dressings were 2.87 to 3.72, 2.82 to 3.19, 3.08 to 3.87, and 2.83 to 3.49, respectively. Dressings were inoculated with low (2.4 to 2.5 log CFU/g) and high (5.3 to 5.9 log CFU/g) populations of separate five-strain mixtures of each pathogen and stored at 25 degrees C for up to 15 days. Regardless of the initial inoculum population, all test pathogens rapidly died in all salad dressings. Salmonella was undetectable by enrichment (<1 CFU/25-ml sample in three replicate trials) in all salad dressings within 1 day, and E. coli O157:H7 and L. monocytogenes were reduced to undetectable levels by enrichment between 1 and 8 days and 2 and 8 days, respectively. E. coli O157:H7 was not detected in 4 of the 10 salad dressings stored for 2 or more days and 9 of the 10 dressings stored for 6 or more days after inoculation. L. monocytogenes was detected in 9 of the 10 salad dressings stored for 3 days but in only one dressing, by enrichment, at 6 days, indicating that it had the highest tolerance among the three pathogens to the acidic environment imposed by the dressings. Overall, the type of dressing (i.e., ranch versus blue cheese) and level of fat in the dressings did not have a marked effect on the rate of inactivation of pathogens. Total counts and populations of lactic acid bacteria and yeasts and molds remained low or undetectable (<1.0 log CFU/ml) throughout the 15-day storage period. Based on these observations, shelf-stable, dairy-based, pourable ranch and blue cheese salad dressings manufactured by three companies and stored at 25 degrees C do not support the growth of Salmonella, E. coli O157:H7, and L. monocytogenes and should not be considered as potentially hazardous foods (time-temperature control for safety foods) as defined by the U.S. Food and Drug Administration Food Code.

Colony Count, Microbial↗
PubMedDate not supplied

Problems with dressing in the frail elderly.

OBJECTIVE: Dressing is an important activity of daily living, yet many older adults have difficulty due to impairments. The purpose of this study was to explore the use of assistive devices for dressing by older persons with impairments, and to look at differences among frail elders with no dressing difficulty, upper-extremity-only dressing difficulty, lower-extremity-only dressing difficulty, and both upper- and lower-extremity dressing difficulty. METHOD: We conducted in-home interviews and functional assessments with 1,101 elderly persons with activities of daily living and/or instrumental activities of daily living limitations in Western New York and Northern Florida. Participants were assigned to one of four groups based on Functional Independence Measure item scores for upper-extremity dressing and lower-extremity dressing. Descriptive statistics were used to report results. RESULTS: Compared to women, there were relatively more men with lower-extremity dressing difficulty than with upper-extremity dressing difficulty. The group with both upper- and lower-extremity dressing difficulty reported the highest level of pain and scored lowest on all measures of functional status and mental status. The most commonly used dressing devices were associated with lower-extremity dressing. CONCLUSION: There are differences in gender, health status, functional status, and mental status among elderly persons grouped by upper- or lower-extremity dressing difficulty. Results suggest that therapists should consider such differences as gender and type of difficulty (upper- or lower-extremity dressing) in both therapeutic approaches and recommendations for assistive devices. Pain is another important consideration, but it can often be reduced during dressing by using assistive devices.

Activities of Daily Living↗
PubMed1987

Effects of nonadherent dressing materials on the healing of open wounds in dogs.

Four types of nonadherent dressing materials (rayon/polyethylene dressing, cotton nonadherent film dressings, fine mesh gauze petrolatum dressings, and commercial petrolatum emulsion dressings) were applied on small full-thickness skin defects on the backs of 12 Beagles. At 7 days, the wounds treated with the petrolatum-containing dressings had more contraction than wounds dressed with cotton nonadherent film dressings and wounds dressed with rayon/polyethylene dressings. However, by days 14 and 21, there was little difference in the amount of contraction of any of the wounds. At 7, 14, and 21 days, the wounds dressed with petrolatum-containing dressings had less epithelialization than wounds dressed with cotton nonadherent film dressings and rayon/polyethylene dressings. The uniform open mesh of the commercial petrolatum emulsion dressings allowed the best absorption of exudate and bacteria into the secondary overlying bandage.

Animals↗
PubMed1998

Closed dressings after laser skin resurfacing.

OBJECTIVE: To evaluate the safety, efficacy, and patient acceptance of closed dressings after full facial resurfacing with the carbon dioxide laser. DESIGN: Prospective cohort of men and women undergoing full facial carbon dioxide laser resurfacing. SETTING: Ambulatory surgical center at a university hospital. PATIENTS: Forty consecutive patients randomized to 1 of 4 dressing groups. INTERVENTIONS: All patients underwent full facial resurfacing with a carbon dioxide laser system. One of 5 closed dressings (single- or 3-layer composite foam, plastic mesh, hydrogel, or polymer film) was placed immediately after the procedure. Closed dressings were changed on postoperative day 2 and removed on postoperative day 4. OUTCOME MEASURES: Objective postoperative criteria of erythema, scarring, reepithelialization, and surface irregularities were recorded and photodocumented. Comparisons were made among the closed dressing groups as well as with a group of historical control subjects treated with open dressings. The ease of application, office time for preparation and application, and cost of the individual dressings were collected. Patient characteristics of overall acceptance, comfort, and ease of maintenance were recorded with a visual analog scale. RESULTS: There were no complications of scarring, surface irregularities, or contact dermatitis from the application or maintenance of the closed dressings. There were no significant differences in the number of days of postoperative erythema or in the rate of facial reepithelialization among the groups. Most patients preferred not to continue with the closed dressings past 2 days. Positive features from the use of closed dressings included reduction in crust formation, decreased pruritus, decreased erythema, and decreased postoperative pain, compared with historical controls. Negative features included time in preparation and application of the dressings. Costs ranged from $9.79 to $50 per dressing change. CONCLUSIONS: Closed dressings are safe and offer benefits noted during the first 4 postoperative days. Patients can be expected to maintain a closed dressing for at least 24 hours but no longer than 4 days. The positive features of closed dressings and patient acceptance outweigh the cost and office time involved with their application and maintenance.

Adult↗
PubMedDate not supplied

The effect of occlusive and semi-occlusive dressings on the healing of acute full-thickness skin wounds on the forelimbs of dogs.

This project compared the effects of hydrocolloid (HC) and hydrogel (HG) occlusive dressings and a polyethylene (PE) semi-occlusive dressing on the healing of acute full-thickness skin wounds on the forelimbs of 10 dogs. All treatments resulted in a similar degree of healing at postoperative days 4 and 7. No significant differences existed in the number of wounds that were more than 90% healed at postoperative day 28 between the group treated with the HG dressing and the group treated with the PE dressing. There were significantly fewer wounds more than 90% healed at postoperative day 28 in the group treated with the HC dressing. Wounds under the HG dressing had the largest mean percentage of contraction at postoperative days 21 and 28. Wounds under the HG dressing also had the largest contraction/re-epithelialization ratio (postoperative days 21 and 28) compared with wounds under the PE and HC dressings. Wounds under the PE dressing had a significantly higher mean percentage of re-epithelialization than wounds under both occlusive dressings on postoperative days 14, 21, and 28. Wounds under the two occlusive dressings had exuberant granulation tissue present more often than wounds under the PE dressing. The two occlusive dressings had significantly higher bacterial counts on wounds compared with wounds under the PE dressing; analysis of variance (ANOVA), P = .0008. Wounds under the HC dressing showed the poorest healing in all parameters.

Animals↗
PubMed2003

Evaluation of banana leaf dressing for partial thickness burn wounds.

An important factor in the healing of superficial and moderate partial thickness burn is early and effective coverage with a dressing that protects the wound from trauma and dessication and is non-adherent. In our country cost is also a very important factor. Disturbed by the pain and anxiety experienced by the patients during and after dressing changes, search for a new dressing material was begun for partial thickness burn wounds and the banana leaf dressing (BLD) was subsequently developed and optimised by June 1996. An open controlled study was carried out to compare banana leaf dressing and boiled potato peel bandage (BPPB), the dressing being used in our Burn Unit since 1994. Thirty patients all less than 40 years of age, with burn size less than 50% TBSA, involving comparable body areas with partial thickness burn, were included in the study. BLD along with a topical agent was applied over the right sided extremity while BPPB was applied with the same topical agent on the left sided extremity. Dressing was changed every day. The pain during dressing change, feeling of comfort and ease of handling dressing was assessed by awarding scores by the patients and care givers for each type of dressing. Analysis of the scores revealed that both BLD and BPPB caused easily tolerable, minimal pain during dressing change in majority of the patients. The days taken for epithelialisation, eschar formation and the need for skin grafting over deep partial thickness burns, did not reveal any significant difference between the areas treated by BLD and those by BPPB. So both the dressings were observed to have equal efficacy in protecting the wounds and aiding healing. Thus, the efficacy of BLD and BPPB was parallel in all respects. But BLD is 11 times cheaper than BPPB. Banana plants can be easily grown, the leaves are easily available throughout the year. The leaves of banana are large thus offering larger surface area and the surface is non-adherent, waxy and cool. The dressing can be prepared very easily with little training. It is also the cheapest dressing available today. We strongly recommend the use of banana leaf dressing for all partial thickness burn wounds in our environment.

Adult↗
PubMed1994

A prospective, randomized trial of gauze and two polyurethane dressings for site care of pulmonary artery catheters: implications for catheter management.

OBJECTIVES: To compare the safety of a conventional polyurethane transparent dressing and a novel highly permeable polyurethane dressing, as compared with standard gauze and tape, as site dressings for pulmonary artery catheters; and to rigorously determine the sources of bloodstream infections deriving from these catheters. DESIGN: Prospective, randomized, clinical trial. SETTING: General adult intensive care units (ICUs) in a university hospital. PATIENTS: A total of 442 adult patients with pulmonary artery catheters were studied. Two thirds of the catheters had been inserted in the operating room and one third had been inserted in an ICU. INTERVENTIONS: Patients were randomized at the time of pulmonary artery catheter insertion to have one of three dressing regimens: a) sterile gauze and tape (control), replaced every 2 days; b) a conventional polyurethane dressing, replaced every 5 days; or c) a highly permeable polyurethane dressing, also replaced every 5 days. MEASUREMENTS AND MAIN RESULTS: The origin of each catheter-associated bloodstream infection was sought by quantitatively culturing the skin of the insertion site and all potential sources on the catheter, including the hub and infusate from each lumen of the introducer sheath and the pulmonary artery catheter, and intravascular segments of the introducer sheath and pulmonary artery catheter. Bloodstream infection was confirmed by demonstrating concordance between isolates from the device and blood cultures by pulsed-field electrophoresis of genomic DNA, digested with low-frequency-cleavage, restriction endonucleases. One hundred thirty catheters were randomized to be dressed with sterile gauze and tape (control), 127 with the conventional polyurethane dressing, and 185 with the highly permeable polyurethane dressing. Patients and catheters in the three dressing groups were very comparable. Ninety-six (21.7%) of the 442 catheters studied showed colonization of the introducer sheath or the pulmonary artery catheter, and five (1.1%) catheters caused bloodstream infection. Catheter-related bloodstream infections were associated with concordant cutaneous colonization of the insertion site (n = 2), a contaminated catheter hub or infusate (n = 3), contamination of the extravascular segment of a repositioned catheter beneath the external protective plastic sleeve (n = 1), or hematogenous colonization of the catheter (n = 1). All pulmonary artery catheter-related bloodstream infections occurred with catheters (introducers) in place for > or = 5 days (p < .001). Cutaneous colonization under the dressing at catheter removal was lowest with gauze (10(1.3) colony-forming units), intermediate with the new highly permeable polyurethane dressing (10(1.8) colony-forming units; p < .01), and highest with the conventional polyurethane dressing (10(2.0) colony-forming units; p < .001). There were no significant differences in catheter colonization (20.0 to 25.2 cases per 100 catheters) or catheter-related bloodstream infection (0.8 to 1.6 cases per 100 catheters) between the three groups. CONCLUSIONS: The incidence of pulmonary artery catheter-related bloodstream infection has decreased over the past 5 yrs. Pulmonary artery catheter-related bloodstream infections originate from multiple sources, indicating that measures to prevent bacteremic infections of these devices must focus both on reducing cutaneous colonization at the insertion site and averting contamination of infusate and catheter hubs. Efforts should be made to limit the duration of catheterization with pulmonary artery catheters (including the introducer) to no longer than 4 days. The polyurethane dressings studied appear to be safe for use with pulmonary artery catheters and may be left on for up to 5 days between dressing changes.

Aged↗
PubMed2004

Effects of 3 biologic dressings on healing of cutaneous wounds on the limbs of horses.

Three biologic dressings [split-thickness allogeneic skin (STS)], allogeneic peritoneum (P), and xenogenic porcine small intestinal submucosa (PSIS)] were studied to determine their effects on bacterial proliferation, inflammatory reaction, vascularization, and overall healing and to compare the effects of these dressings with the effects of a nonbiologic dressing, a nonadherent synthetic pad (NASP). A medial wound (3 cm in diameter) and 2 lateral wounds (2 cm in diameter) were created at the junction of the proximal and middle thirds of each metacarpus and metatarsus in 5 horses. Each medial wound and the proximolateral wound received an STS, P, PSIS, or NASP dressing on day 8 after wounding. The other lateral wound received an NASP dressing. Bacterial proliferation, inflammatory reaction (histologic changes), and drhessing vascularization were evaluated 6 d after application of the dressing. Percentages of contraction and epithelialization, as well as healing time, were determined when the wounds had completely epithelialized. The practical applicability of the different dressings to equine wound management was also assessed. No significant difference was detected in the parameters evaluated among the treated wounds or between the treated and control wounds. The biologic dressings had no effect on infection, inflammatory response, or healing time. Vascularization was not identified in any of the biologic dressings. The PSIS and P dressings required numerous applications over the study period. The STS dressings are more practical than PSIS and P dressings owing to ease of application and stability. Thus, these biologic dressings offer no apparent advantage over a nonbiologic dressing for treatment of small granulating wounds.

Animals↗
PubMed2004

Comparing a foam composite to a hydrocellular foam dressing in the management of venous leg ulcers: a controlled clinical study.

Venous leg ulcers are the most prevalent form of chronic wounds in the Western world. The principles of moist wound healing coupled with the use of graduated compression bandaging have become the cornerstone of treatment for venous leg ulcers but not all moist dressings are alike. To compare the attributes of a foam composite dressing with those of a hydrocellular foam dressing in the management of venous leg ulcers, a prospective, randomized, comparative 12-week study was conducted in 15 centers in the US, Canada, France, Germany, and the UK. Dressings were changed and compression bandages applied per manufacturer recommendations and dressing performance was assessed at every dressing change and at the final evaluation. Patients with venous ulcers were randomized to treatment for 12 weeks with either hydrocellular foam (n = 52) or foam composite (n = 55) dressing. Healing differences between the groups were not statistically significant, with 36% of patients using foam composite dressing healed in a mean of 66 days and 39% of patients using hydrocellular foam dressing healed in a mean of 73 days. However, the foam composite dressing performed significantly better than the hydrocellular foam dressing with regard to condition of the periwound skin - 55% of patients in the foam composite group having healed or markedly improved surrounding skin compared to 37% of patients using hydrocellular foam (P = 0.03). The foam composite dressing was rated significantly better than the hydrocellular foam dressing ("very good" to "excellent") in level of satisfaction with conformability (87% and 75%, respectively, P = 0.05); being non-sensitizing (73% and 52%, respectively, P = 0.02); and ease of application (93% and 81%, respectively, P = 0.01). The findings reported in this study suggest that the foam composite dressing offers significant improvements in the quality of life of patients with venous leg ulcers as well as for their caregivers.

Adult↗
PubMed1997

A comparison of transparent polyurethane and dry gauze dressings for peripheral i.v. catheter sites: rates of phlebitis, infiltration, and dislodgment by patients.

BACKGROUND: Before a meta-analysis by Hoffman et al was published, polyurethane dressings were used at insertion sites for peripheral i.v. catheters at our institution. On the basis of the results of the meta-analysis, we began to use gauze dressings. The change from polyurethane dressings to gauze dressings limited direct observation of the i.v. insertion site, and i.v. catheters were anecdotally reported not to be anchored as securely as before. OBJECTIVES: The purpose of this study was to compare the effects of the use of transparent polyurethane dressings and gauze dressings at insertion sites for peripheral i.v. catheters on the frequency of phlebitis, infiltration, and catheter dislodgment by patients. METHODS: Two hundred twenty-nine patients were randomized to receive either gauze (n = 121) or transparent polyurethane (n = 108) dressings, and observations were recorded. RESULTS: The frequency of catheter dislodgment by the patient was significantly higher (P < .05) in patients with the gauze dressing (15%) than in patients with the transparent polyurethane dressing (6%). A trend toward lower frequencies of phlebitis (1.8% vs 3.3%) and infiltration (17.6% vs 20.7%) was noted in the patients with the transparent polyurethane dressings. DISCUSSION: The clinical advantages of the transparent polyurethane dressings lie in the ease of direct visualization of the i.v. insertion site and the securement of the i.v. catheter. CONCLUSION: At our institution, given the decreased disruption of the i.v. therapy with the transparent polyurethane dressings and the lack of differences in the rates of phlebitis or infiltration with the two types of dressings, we prefer to use transparent polyurethane rather than gauze dressings at insertion sites for peripheral i.v. catheters.

Catheterization, Peripheral↗
PubMedDate not supplied

A pilot study on efficacy treatment of acne vulgaris using a new method: results of a randomized double-blind trial with Acne Dressing.

For many years the positive effect of hydrocolloid dressings on skin-related conditions attracted the attention of the medical scientific community. The use of Acne Dressing, a tape of hydrocolloid dressing, for the treatment of acne has not been reported previously. The aim of this study was to evaluate the clinical efficacy and beneficial effect of Acne Dressing on the marker for sebum output evaluations. We also determined the cosmetic outcome of this application during the treatment of acne and whether the material could prevent hand touching and UVB light from reaching the skin surface. The objective of this study was to assess improvement in acne vulgaris and tolerability during one week of short contact treatment with Acne Dressing compared to skin tapes. Efficacy data specific to treatment of acne vulgaris with Acne Dressing (3M Health Care) from a double-blind, randomized, skin types-controlled study is reported. A total of 20 patients with mild-to-moderate acne vulgaris applied the skin tapes or Acne Dressing every two days for up to one week. Twenty patients were enrolled in this study: ten patients received Acne Dressing and ten patients received skin tapes. Both groups showed decreases from baseline to the end of treatment in the mean of the overall severity scale (decrease of 1.37 from 1.8 to 0.43 with Acne Dressing and 0.28 from 1.08 to 0.8 with skin tapes). A statistically significant greater reduction was observed over a period of three to seven days in the overall severity of acne and inflammation in the Acne Dressing group compared with the mono-therapy (skin tapes) group. Similarly, Acne Dressing resulted in a significantly greater improvement in the redness, oiliness, dark pigmentation, and sebum casual level at days 3, 5, and 7. The ratio of transmission of UVB light with Acne Dressing was 7.4%, and 38% with skin tapes, which shows less UVB light reaching the skin surface with the Acne Dressing. No significant adverse events were identified in either group. The pilot study shows the benefit of treatment with Acne Dressing in improving mild-to-moderate inflammatory acne vulgaris. A future study will investigate a large set of patients in longer followup periods.

Acne Vulgaris↗
PubMed2000

Normal saline wound dressing--is it really normal?

Gauze swabs soaked in normal saline are frequently used as dressing on open wounds. Their exact mechanism of action is not known. This study was designed to assess the hypothesis that normal saline dressings act in part as an osmotic dressing. Ten patients had skin ulcers (n = 10) dressed with normal saline soaked sponges. Acting as controls (n = 10) identical sponges were placed upon intact skin. The sponge fluid osmolarity and electrolyte concentrations were serially assayed to test our hypothesis. In the control group, the osmolarity, sodium and chloride concentrations increased with time as a result of evaporation, altering it from an isotonic to a hypertonic dressing. However, in the ulcer group, the osmolarity, sodium and chloride concentrations in the sponge fluid remained relatively isotonic with time. This result is statistically significant (P< 0.05). We postulate that, as a result of evaporation, the sponge dressing increases its tonicity. This draws fluid from the wound into the dressing so that a dynamic equilibrium occurs and the sponge dressing regains isotonicity. The dressing remains functional provided that the wound fluid is absorbed freely from the wound. This process is terminated when either the dressing completely absorbs the wound fluid or the dressing dries out. The latter often occurs prematurely in a contaminated wound or in a wound where exudate forms a non-permeable barrier which prevents osmosis and allows the remaining water in the dressing to evaporate completely. This correlates with the observation in clinical practice that for maximum efficacy the dressing should be changed regularly.

Chlorides↗
PubMed2001

Evaluation of a combined calcium sodium alginate and bio-occlusive membrane dressing in the management of split-thickness skin graft donor sites.

The optimal treatment of the split-thickness skin graft (STSG) donor site remains an unresolved issue. This study was conducted to evaluate the combined use of calcium sodium alginate and a bio-occlusive membrane dressing in the management of STSG donor sites. This study was a prospective evaluation of all patients requiring an STSG over a 6-month period ending October 1998. There were 57 patients with a mean age of 61 years. All skin grafts were harvested with an electric dermatome from the anterior thigh and were 0.012 to 0.016 inches thick. Donor sites were dressed with calcium sodium alginate followed by a bio-occlusive dressing. Postoperatively, the skin graft donor site dressing was removed and replaced. The mean skin graft area was 114 cm2. The first dressing change occurred, on average, 3 days postoperatively. All dressings were taken down and the wounds reevaluated 7 days postoperatively. Fifty-two patients (91%) had achieved complete reepithelialization by this time. Five patients (9%) required an additional dressing. All wounds were healed completely by postoperative day 10. Donor site discomfort was minimal and limited to the time of dressing change. There were no wound-related complications. The average cost of dressing supplies was $48.00 per patient and $23.00 per dressing. This method of managing STSG donor sites allowed for unimpeded reepithelialization without wound complication. The bio-occlusive dressing eliminated the pain typically associated with fine mesh gauze dressings. The absorptive property of the calcium sodium alginate eliminated the problem of seroma formation and leakage seen routinely with the use of a bio-occlusive dressing alone. These results confirm that this technique is both efficacious and cost-effective.

Adult↗