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Effect of adhesive retention on maxillofacial prostheses. Part I: skin dressings and solvent removers.

STATEMENT OF PROBLEM: The success of most maxillofacial prostheses depends on retention by medical adhesives. Products such as Smith-Nephew's Skin-Prep (SP) are available that can be used on the skin that could improve prosthesis adhesion protective dressing. The removal of adhesive from the skin is also problematic, so solvents, such as Uni-Solve adhesive remover (US), are often used. PURPOSE: This study measured the removal force of silicone elastomer strips with 2 adhesives from the skin of human subjects during the day, as affected by the use of SP and US, and determined the site of adhesive failure. MATERIAL AND METHODS: Silicone rubber strips were applied in a predetermined random order to the ventral arm surfaces of 20 human subjects. US was applied to half the sites 1 day before testing. SP was also applied to half the sites just before Epithane-3 (E3) or Secure(2) Medical Adhesive (SMA) were used to adhere the strips. They were peeled from the skin 6 hours later in an Instron at a rate of 10 cm/min. RESULTS: A 3-way within-group MANOVA revealed significant differences without interactions between adhesives (SMA=96.3 N.m, E3=24.1 N.m; P<.0005) and between use or nonuse of SP (SP=65.8 N.m, no SP=54.6 N.m; P<.0005). The use of US was not significant (no US=61.8 N.m, with US=58.6 N.m; P=.197). SMA adhered to the prostheses, whereas E3 adhered to the skin, leaving a residue (Fisher exact test; P<.0003). CONCLUSION: The combination of SMA and SP showed the highest adhesive bond strength. Overall, SMA was 3 to 5 times more retentive than E3. SP improved adhesion of both SMA (15%) and E3 (27%). SMA was still far more retentive. US had no effect on retention. SMA remained on the prostheses, whereas E3 left a difficult-to-remove residue on the skin.

Adhesiveness↗

Dressed polyions, counterion condensation, and adsorption excess in polyelectrolyte solutions.

The phenomenon of Manning-Oosawa counterion condensation is given an explicit statistical mechanical and qualitative basis via a dressed polyelectrolyte formalism in connection with the topology of the electrostatic free-energy surface and is derived explicitly in terms of the adsorption excess of ions about the polyion via the nonlinear Poisson-Boltzmann equation. The approach is closely analogous to the theory of ion binding in micelles. Our results not only elucidate a Poisson-Boltzmann analysis, which shows that a fraction of the counterions lie within a finite volume around the polyion even if the volume of the system tends towards infinity, but also provide a direct link between Manning's theta-the number of condensed counterions for each polyion site-and a statistical thermodynamic quantity, namely, the adsorption excess per monomer.

Adsorption↗

Antioxidant capacity of vegetables, spices and dressings relevant to nutrition.

Vegetables are the most important sources of phenolics in the Mediterranean diet. Phenolics, especially flavonoids, are suggested as being essential bioactive compounds providing health benefits. In this study, twenty-seven vegetables, fifteen aromatic herbs and some spices consumed in Central Italy (the Marches region) were studied to reveal total phenolic, flavonoid and flavanol content as well as their antioxidant capacity measured by the oxygen radical absorbance capacity (ORAC) method. A comparison in terms of antioxidant capacity was made between different salads, as well as between salads to which aromatic herbs had been added. Lemon balm and marjoram at a concentration of 1.5 % w/w increased by 150 % and 200 % respectively the antioxidant capacity of a salad portion. A 200 g portion of a salad enriched with marjoram corresponded to an intake of 200 (SD 10) mg phenolics and 4000 (SD 300) ORAC units (micromol Trolox equivalents). Olive oils and wine or apple vinegars were the salad dressings that provided the highest increase in antioxidant capacity. Among the spices tested, cumin and fresh ginger made the most significant contribution to the antioxidant capacity. The results are useful in surveying the antioxidant parameters of vegetables, herbs and spices produced and consumed in our geographical area as well as in quantifying the daily intake of phenolics and ORAC units. The results can be used in public health campaigns to stimulate the consumption of vegetables able to provide significant health protection in order to prevent chronic diseases.

Antioxidants↗

Effect of root canal dressings on the regeneration of inflamed periapical tissue.

The aim of this study was to evaluate the effects of chlorhexidine and calcium hydroxide on apical periodontitis in rats. Experimentally induced apical periodontitis was established on the mesial roots of maxillary molars of Wistar rats by leaving the root canals exposed to the oral cavity for 14 d. In the positive control group (n=10 teeth), the root canals were not further treated, but the coronal access openings were filled with composite. In the negative control group (n=10 teeth), partial pulpotomies were performed aseptically and the coronal access openings were sealed immediately. In a third control group (n=10 teeth) the canals were instrumented, left empty, and the coronal access openings were sealed. In the experimental groups, the root canals were instrumented and filled with either 2% chlorhexidine gel or calcium hydroxide paste (n=10 teeth per group). After 7 d all rats were killed and the histological sections were stained for microscopic analysis of periapical regeneration. The data of the subjective evaluation were analyzed with the Kruskal-Wallis test. Lesion sizes were measured and statistically analyzed using the ANOVA and post-hoc Scheffé test. The two treatment groups showed significantly lower average inflammatory scores and smaller lesion sizes than the positive and third control group (p<0.05). No statistically significant differences were obtained between the two treatment groups (p>0.05). Chlorhexidine used as an intra-canal medicament showed good periapical regeneration, suggesting that this may be an alternative to calcium hydroxide root canal dressing.

Analysis of Variance↗

Improvement of the radial forearm donor site by compression with hydrocolloid dressing and adhesive sponge.

CONCLUSIONS: With our method, general improvement is obtained as compared with traditional split-thickness skin grafting of the radial forearm flap donor site. As our method is simple and easy, the same results can be obtained wherever and by whomever it is performed. OBJECTIVE: The radial forearm flap is associated with complications of graft take and a poor aesthetic appearance despite its usefulness in reconstructing the oral cavity and oropharynx. We describe a simple technique for improvement of the radial forearm donor site. PATIENTS AND METHODS: We studied 12 patients who underwent reconstruction with radial forearm free flaps following resection of oral or oropharyngeal tumors. We covered the donor site defect using traditional split-thickness skin grafts and performed aftercare with a hydrocolloid dressing and an adhesive sponge to retain moisture and apply compression. After the treatment series, color matching, texture matching, depressive deformity, and hypertrophic scar were evaluated. RESULTS: The results of comprehensive evaluation of the two patients with premature discontinuation of compression were good. One patient was assigned only 1 point for hypertrophic scar, and another only 1 point for color match. The evaluation of the other 10 patients was excellent.

Adult↗

Spread of an enteric 'marker' organism during evisceration of New York dressed poultry in a simulated kitchen environment.

1. Five volunteers, with experience of eviscerating poultry or game birds in the home, each eviscerated three New York dressed chicken carcases that had been artificially inoculated in the colon with a readily identifiable "marker' strain of Escherichia coli. 2. In all cases, evisceration resulted in breakage of the intestines at one or more sites, often with leakage of gut contents, or extrusion of faeces from the cloaca because of pressure on the colon during the manipulations involved. 3. The marker organism was detected in the vent region and abdominal cavity of each carcase and sometimes on the breast and back, which appeared to reflect the degree of handling during evisceration, because the hands of each individual became heavily contaminated. 4. With some individuals, the marker also spread beyond the immediate preparation area and was detected on exposure plates. 5. Results support the view that evisceration of poultry in a domestic environment could lead to cross-contamination of other foods with any food-borne human pathogens present.

Animals↗

In vitro assessment of chlorhexidine gluconate-impregnated polyurethane foam antimicrobial dressing using zone of inhibition assays.

OBJECTIVE: To evaluate an antimicrobial dressing consisting of hydrophilic polyurethane foam with chlorhexidine gluconate for activity against several antibiotic-resistant clinical isolates as well as American Type Culture Collection reference strains using zone of inhibition assays. METHODS: Sterile foam samples with chlorhexidine gluconate and untreated controls were transferred onto inoculated agar plates. Plates were incubated at 35 degrees C to 37 degrees C for 24 hours and examined for zones of inhibition around the foam samples. RESULTS: Polyurethane foam with chlorhexidine gluconate showed antimicrobial activity in vitro against all of the challenge organisms including antibiotic-resistant clinical isolates. CONCLUSION: The data from this in vitro study support the hypothesis that polyurethane foam with chlorhexidine gluconate has an antimicrobial effect against antibiotic-resistant Staphylococcus and Enterococcus species, as well as Candida species.

Anti-Infective Agents, Local↗

Dressed neurons: modeling neural-glial interactions.

Based on recent experimental data, we design a model for neuronal membrane potentials that incorporates the influence of the surrounding glia (dressed neurons). A neurotransmitter released into the synaptic cleft triggers a Ca(2+) response in nearby glial cells that spreads as a Ca(2+) wave and interacts with other synapses via the release of glutamate from astrocytes. We consider the simple case of a neuron-glia circuit that consists of a single neuron that triggers a Ca(2+) response in the glial cell which in turn feeds back into synapses of the same neuron. It is shown that persistent spiking can occur if the glutamate receptors on the astrocytes are overexpressed--a condition that has been reported from patients suffering from mesial-lobe epilepsy.

Animals↗

Assessing comparability of dressing disability in different countries by response conversion.

BACKGROUND: Comparability of health data is a major challenge within the context of the Health Monitoring Programme of the European Commission. A common problem in surveys is that many variations of essentially the same question exist. METHODS: Response conversion is a new method for improving comparability by scaling the data onto a common scale. Comparisons between member states can then be made in terms of the common scale. A first step is the construction of a conversion key. This is a relatively complex activity, but needs to be done only once. The second step is the actual data transformation. This is simple, and can be repeatedly done on a routine basis as new information arrives. Construction of the key is only possible if enough overlapping information can be found. RESULTS: The method is illustrated for dressing disability from five European countries. Differences occur between countries, between sexes and between age groups. These were similar in magnitude. CONCLUSION: Response conversion is a new method for enhancing comparability among existing data. Conversion can only be done if a key is available. More work is needed to establish the technique. Future implications within the Health Monitoring Programme are discussed.

Activities of Daily Living↗

The effects of music therapy on pediatric patients' pain and anxiety during donor site dressing change.

The purpose of this study was to assess the effects of music therapy on pain and anxiety in pediatric burn patients during a donor site dressing change. Fourteen subjects were randomly selected to participate in this study. The experiment was conducted in the Reconstructive Unit of Shriners Burns Hospital-Boston. The experimental group's intervention consisted of live music and was compared to a control group whose intervention was verbal interaction. Psychological, behavioral, and physiological data were assessed through the Wong Baker FACES Pain Rating Scale, the Fear Thermometer, the Nursing Assessment of Pain Index, heart rate, and respiration rate. Data were analyzed using the ANCOVA, Mann-Whitney U, and regression analysis. The results were mixed and inconclusive. The members of the experimental group reported anecdotal information about the effects of music on pain and anxiety. An exploration of the limitations of the study and suggestions for further study are discussed.

Analysis of Variance↗

Transparent polyurethane (Omiderm) dressing for free flaps.

A transparent polyurethane dressing (Omiderm) for free flaps is presented. Considering the importance of reliable flap monitoring postoperatively, this synthetic membrane allows for constant ability to observe the flap, assess the capillary filling, and detect the blood flow with an ultrasound Doppler device.

Bandages↗

Otoplasty without a conformer dressing.

Since 1969, all our constructive, reconstructive, and aesthetic otoplasties have been managed without a conformer dressing. U-sutures, loosely tied over coated cotton rolls up until 1975, when thin and elastic silicone tubes began to be used, maintain the tissues in their new position. Experience and results of 193 ear operations are reported.

Ear Cartilage↗

A simple method for the classic tie-over dressing.

The classic tie-over dressing is commonly used in skin graft applications. A simple, quick, cheap, and effective method, using a stopper, is presented. The advantages of the stopper include ease of use, speed of application, and the ability to replace the device if early inspection of the graft is desired.

Bandages↗

The use of subatmospheric pressure dressing for the coverage of radial forearm free flap donor-site exposed tendon complications.

Since its description in China in 1978, the radial forearm free flap has become a workhorse for the reconstructive surgeon. However, the flap has known disadvantages in complications of the wrist donor site. Skin graft breakdown with exposure of the flexor tendons of the wrist is the most common. The authors describe in a patient series a new treatment for this complication. They used subatmospheric pressure dressing to stimulate granulation tissue coverage of the tendon and to facilitate epithelialization. As many as one third of all patients undergoing radial forearm free flaps develop exposed tendon complications and may benefit from Vacuum Assisted Closure (VAC) therapy.

Aged↗

Diffuse nodular eyelid lipogranuloma following sutureless transconjunctival blepharoplasty dressed with topical ointment.

PURPOSE: Transconjunctival blepharoplasty is becoming the approach of choice for many cosmetic surgeons. The authors describe a case of a diffuse, multinodular eyelid lipogranuloma following transconjunctival blepharoplasty, after which the unsutured wound was dressed with a topical ointment. METHODS: Report of clinical course and histopathologic findings. RESULTS: A patient developed multiple firm, nontender masses of the left lower eyelid that enlarged despite topical and systemic medical therapy. Prior to referral, the progressive lesions had recurred despite three successive attempts at surgical eradication. Histopathologic examination of excised tissue demonstrated a multifocal lipogranulomatous inflammation consistent with reaction to retained ointment. CONCLUSIONS: Sclerosing lipogranulomas are a known complication of intradermal lipid injection, as well as a late complication of sinus surgery after postoperative nasal packing with ointment-saturated gauze. The application of a topical ointment should be avoided until after transconjunctival lower blepharoplasty unless wound closure is secure or until conjunctival epithelialization is complete.

Administration, Topical↗

Influence of calcium hydroxide dressing on the obturation of simulated lateral canals.

The purpose of this in vitro study was to evaluate what influence an interappointment dressing with calcium hydroxide might have on the ability to subsequently obturate simulated lateral canals. Twenty extracted single-rooted human teeth were instrumented at the working length to a #35 file before creating three simulated lateral canals on the mesial and distal surfaces of the root, one in each third, using a #15 engine reamer. After enlarging the root canals to a #45 file, the teeth were randomly divided into two groups of 10. In both groups AH26 was used as the sealer. In group A, the obturation was performed immediately using Ultrafil. In group B, root canals were filled with calcium hydroxide and incubated for 7 days. The teeth were then reinstrumented, irrigated with 2.5% sodium hypochlorite solution, dried with paper points, and obturated as in group A. Teeth in group A showed a larger number of filled lateral canals compared with those in group B. Statistical significant differences were observed when comparing the same third in the two groups (apical third p < 0.05, middle third p < 0.01, and coronal third p < 0.01). No differences were found among the different thirds in the same group (p > 0.05).

Bismuth↗