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PubMed2005

[Compression therapy in the treatment of acute deep vein thrombosis].

Especially in Europe patients with acute deep vein thrombosis (DVT) of the leg are treated with compression therapy. A look at the literature, however, reveals that the exact mechanism of compression therapy in the treatment of acute deep vein thrombosis is not completely understood. Effects on fibrinolysis, resolution of pain and swelling as well as a fixation of the thrombus towards the vessel wall have been discussed. The literature indicates that compression stockings were mostly used in the treatment of DVT although there is some evidence that inelastic compression bandages have a greater impact on resolution of swelling and pain. Large randomised multicenter trials are still not available. Furthermore, evidence-based data providing an advantage of thigh-length compression therapy in the treatment of acute DVT are lacking. Studies have, however, shown that compression therapy is a safe therapy and can reduce the development of postthrombotic syndrome after acute DVT.

Acute Disease↗
PubMed1990

The use of automatic blood pressure monitors in the burned patient.

Oscillometric automatic blood pressure monitors are now commonly used in theatres and intensive care units. An experimental model has been used to assess the accuracy of these machines when measurements are made from a proximal limb cuff applied over bulky bandages, as is commonly found in burned patients. This study suggests that monitoring arterial blood pressure under these circumstances is sufficiently accurate to make automatic monitoring useful as an adjunct to burns management. This would allow blood pressure measurement where it would otherwise be impossible without invasive techniques.

Bandages↗
PubMed1981

Flap wounds of the shin.

This survey is based on 113 patients with flap wounds of the shin treated by cleaning and securing the wound flaps with Steristrips and covering them with dry gauze, compression bandaging and elevating the leg at rest. Eighteen of the 113 patients had sutures inserted, 2 of them in other hospitals. These cases were consecutive and unselected and a further 450 patients have since been treated in the same way.

Adolescent↗
PubMed1981

Plastering: a combination of old and new.

This study compares the standard plaster-of-Paris cast (Gypsona) with a combination case consisting of plaster-of-Paris covered with a double layer of a polymer casting bandage (Baycast). Thirteen subjects were studied. Each wore concurrently a standard plaster on one leg and a combination plaster on the other. Weight bearing was commenced immediately after application and continued for 8 hours, when they were removed for examination. All the standard plasters cracked, but only one of the combination plasters, and this was due to a technical error.

Bandages↗
PubMed1988

Recovery following fractures of the clavicle treated conservatively.

A consecutive series of 140 patients with fractures of the clavicle were reviewed a minimum of 3 months after their injury. All had been treated conservatively using either a figure-of-eight bandage or broad arm sling. No statistical difference was found in the speed of recovery P greater than 0.05 when these two methods of treatment were compared in patients matched for sex and age. The patient's age at the time of the injury, however, did affect recovery with 33 per cent of those over the age of 20 years still having symptoms 3 months after they had sustained their fracture. Although lateral third fractures occurred more commonly in this age group than in the younger patients, the site of fracture did not adversely affect the speed of recovery P greater than 0.05.

Adolescent↗
PubMed1991

Isolated fractures of the ulnar shaft.

In a prospective study from January 1985 to December 1987, 60 consecutive patients with isolated fractures of the shaft of the ulna were divided into two groups. In group I, 28 patients were treated with plaster-of-Paris cast splintage, while in group II, 32 patients were given an elastic crêpe bandage support and were mobilized early. Average time to union in group I was 10.8 weeks while in group II it was 7.8 weeks. Two fractures in group I did not unite, whereas there was no case of non-union in group II. Isolated fractures of the ulna can be treated successfully with minimal support and early mobilization.

Adolescent↗
PubMedDate not supplied

The epidemiology of snake bite in Central Province and National Capital District, Papua New Guinea.

Snake bite is an important medical problem in some areas of Papua New Guinea and appears to be most common in the Central Province and National Capital District. The overall incidence for Central Province is 215.5 per 100,000 population, but Kairuku subprovince has an incidence of 526 per 100,000, which is amongst the highest in the world. The clinical pattern of envenoming also varies within the Province, suggesting that different species of snake may be responsible for bites in different areas. Most envenomed patients are bitten during daylight on the lower limb and are rarely able to describe the snake. The mortality rate in Central Province is 7.9 per 100,000; most patients die from ventilatory failure due to severe neurotoxicity. Mortality might be reduced by increased use of compression bandaging as a first aid measure, earlier treatment with antivenom and earlier referral to hospital.

Adolescent↗
PubMed1985

Priapism: review of 34 cases.

One hundred ninety-seven cases of priapism have been recorded in the medical files of Charity Hospital Louisiana in New Orleans from 1938-1982. One hundred seventy-two adults and 25 children were registered in this series. Ninety-three per cent of the patients with priapism were black, and 86 patients of this group underwent 93 surgical procedures. The cases of 34 patients treated between July 1, 1981, and December 31, 1982, were thoroughly reviewed. Sixteen patients had a previous history of priapism. Average delay between onset of symptoms and presentation to the hospital for treatment was thirty hours. Sickle cell screens were obtained in 28 patients and were positive in 17. Twenty-nine patients were initially treated conservatively, with 17 priapisms eventually resolving, but the remaining 12 patients required surgical intervention. Overall, 50 per cent of the 34 patients had surgery. All of the surgical cases resolved satisfactorily with the Winter procedure. Complications with this procedure were uncommon, but postoperative bandaging was the chief cause of morbidity. Follow-up for at least six months revealed comparable sexual potency (80-83%) in either conservatively or surgically managed patients.

Adult↗
PubMed1995

In vitro assessment of water vapour transmission of synthetic wound dressings.

The water vapour transmission rate (WVTR) of 14 commercially available wound dressings (11 hydrocolloids, 2 hydrogels and 1 polyurethane film) was evaluated over 24 and 48 h periods using a modified ASTM standard method (ASTM E96-90). For the 48 h studies a novel microcomputer-controlled apparatus was employed. The dressings exhibited a wide range of WVTRs (76-9360 g m-2 d-1 at 24 h under forced air convection of 0.4 m s-1). The influence of air velocity of 0.4 m s-1 was not significant if the WVTR of the dressing was less than 880 g m-2 d-1 when measured under static air conditions. The influence of outer barrier layers and additional bandages on WVTR was also examined.

Bandages↗
PubMed1996

Determinants of success and failure of EMLA.

Although EMLA is known to be an effective topical anesthetic, its rate of success is unknown. Indeed, researchers have suggested that EMLA may fail with young and apprehensive children. Therefore, the objectives of this study were to assess EMLA's rate of success as well as factors which predict success. A double-blind, placebo-controlled design was utilized. The sample included 258 children and adolescents aged 5-18 years who were having venipuncture or intravenous (i.v.) cannulation. After having their anxiety assessed, subjects were randomly assigned to have EMLA or placebo applied over the procedure site for 90 min. The visual analogue scale was used to assess pain caused by removal of the semi-permeable dressing and by the procedure. Other information that was collected included: duration of drug application, interval between drug removal and procedure, skin changes at bandage and drug sites and rated difficulty of the procedure. EMLA was successful 84% of the time for venipuncture and 51% of the time for i.v. cannulation. Factors which predicted success of EMLA included type of procedure, duration of drug application and anxiety. EMLA was less successful for i.v. cannulation compared to venipuncture even with duration of drug application controlled. Those who had a poor outcome were more anxious than those with a good outcome. Age of child was not a factor. Strategies for improving efficient use of EMLA were recommended.

Administration, Topical↗
PubMed1986

The physical effects of an adhesive dressing top layer on burn wound dressings.

Three hydrogels were assessed in respect of water-vapour transmission and conformability. These materials were tested alone and as part of a bilaminate dressing which incorporates an adhesive top layer. The adhesive layer used in this study was a compliant adhesive bandage, marketed under the name Mefix. It was observed that this layer reduced the normally high water-vapour transmission rates of the hydrogels to much lower, clinically more acceptable, levels. Mechanically, the Mefix layer protects the underlying hydrogel, prevents tearing and puncturing but decreases conformability by elastic restraint.

Acrylamides↗
PubMed1989

Poly(ether urethane) wound covering with high water vapour permeability compared with conventional tulle gras on split-skin donor sites.

The experimental poly(ether urethane) (PEU) wound covering with a high water vapour permeance was compared with tulle gras treatment on adjacent areas of the same 20 split-skin donor sites. All patients experienced little or no pain from the PEU-covered areas, while 70 per cent of the patients complained of more pain from the tulle gras-covered areas. The PEU covering did not absorb the wound exudate underneath, neither did it retain wound fluid, but turned the wound exudate into a jelly-like clot layer by allowing a high evaporative water loss from the wound. Tulle gras treatment also prevented wound desiccation, but the exudate was absorbed into the overlaying cotton pads, where it became dry at the outer surface. Microscopy revealed that re-epithelialization occurred at a similar rate under the PEU covering as under tulle gras. In conclusion, the high water vapour permeable PEU wound covering prevents fluid retention, induces clotting of the wound exudate and reduces pain in split-skin donor sites. Tulle gras dressed with gauzes and crêpe bandage prevents wound desiccation, but causes more pain.

Adolescent↗
PubMed2004

The effect of essential oils on methicillin-resistant Staphylococcus aureus using a dressing model.

Patchouli, tea tree, geranium, lavender essential oils and Citricidal (grapefruit seed extract) were used singly and in combination to assess their anti-bacterial activity against three strains of Staphylococcus aureus: Oxford S. aureus NCTC 6571 (Oxford strain), Epidemic methicillin-resistant S. aureus (EMRSA 15) and MRSA (untypable). The individual essential oils, extracts and combinations were impregnated into filter paper discs and placed on the surface of agar plates, pre-seeded with the appropriate strain of Staphylococcus. The effects of the vapours of the oils and oil combinations were also assessed using impregnated filter paper discs that were placed on the underside of the Petri dish lid at a distance of 8mm from the bacteria. The most inhibitory combinations of oils for each strain were used in a dressing model constructed using a four layers of dressings: the primary layer consisted of either Jelonet or TelfaClear with or without Flamazine; the second was a layer of gauze, the third a layer of Gamgee and the final layer was Crepe bandage. The oil combinations were placed in either the gauze or the Gamgee layer. This four-layered dressing was placed over the seeded agar plate, incubated for 24h at 37 degrees C and the zones of inhibition measured. All experiments were repeated on three separate occasions. No anti-bacterial effects were observed when Flamazine was smeared on the gauze in the dressing model. When Telfaclear was used as the primary layer in the dressing model compared to Jelonet, greater zones of inhibition were observed. A combination of Citricidal and geranium oil showed the greatest-anti-bacterial effects against MRSA, whilst a combination of geranium and tea tree oil was most active against the methicillin-sensitive S. aureus (Oxford strain). This study demonstrates the potential of essential oils and essential oil vapours as antibacterial agents and for use in the treatment of MRSA infection.

Anti-Bacterial Agents↗
PubMed2005

The influence of superficial venous surgery and compression on incompetent calf perforators in chronic venous leg ulceration.

OBJECTIVES: Previous studies have suggested that perforating vein incompetence is reduced by surgery to superficial veins. This study analysed the effect in a randomised clinical trial. DESIGN: Retrospective analysis of duplex data. METHODS: Patients in this study were part of the ESCHAR randomised controlled trial. All patients had chronic venous leg ulceration with superficial venous reflux. Patients were treated with compression bandaging alone or compression plus superficial venous surgery. Legs were assessed using colour venous duplex prior to treatment and at 3 and 12 months. RESULTS: Of 500 patients recruited to the ESCHAR trial, 261 were included in this study. One hundred and forty six of 261 legs were treated with compression alone and 115/261 underwent compression and superficial venous surgery. In the compression group, more legs had incompetent perforators at 12 months (77/131) compared to baseline (61/146, p =0.010, Wilcoxon Signed Ranks test for paired data in 131 legs). Following surgery, significantly fewer legs had incompetent calf perforators (59/115 vs 44/104 at 12 months, p =0.001, Wilcoxon Signed Ranks test for paired data in 104 legs). In addition, significantly fewer legs in the compression and surgery group developed new perforator incompetence in comparison to the group treated with compression alone (12/104 vs 36/131, p =0.003, Chi-Squared test). CONCLUSION: Surgical correction of superficial reflux may abolish incompetence in some calf perforators and offer protection against developing new perforator incompetence.

Bandages↗
PubMed2005

Implementation of outpatient treatment of deep-vein thrombosis in private practices in Germany.

OBJECTIVE: Implementation of outpatient treatment (OT) of deep-vein thrombosis (DVT) is slow despite clear evidence that it is effective, safe and cost-efficient. DESIGN AND METHOD: An initiative was launched with the help of the Professional Association of Phlebologists of Germany and the industry to familiarize physicians in private practice who had no prior experience with OT of DVT. Data on quality of treatment with the low-molecular-weight heparin tinzaparin and phenprocoumon, compliance, clinical outcome, venous ultrasound, patients' satisfaction and quality of life were collected in a registry, which was open from July 1999 to December 2000. The results were published and their impact on further management of patients was assessed in second survey reported here. Patients of both series were followed-up clinically and with ultrasound over the 1st month of treatment. RESULTS: Of 67 physicians entering 827 patients into the registry 26 answered a questionnaire on how they treated further patients. Their case load had increased by 450% and data were provided on 540 consecutive patients managed between January and June 2002. OT increased overall from 76 to 92%, that of popliteo-femoral DVT from 71 to 92%, and that of pelvic DVT from 38 to 65%. Medical reasons to decide against OT decreased from 89 to 56% (p<.01). Immediate leg compression was changed from bandaging to medical compression stockings in 20 of the 26 centres (p<.05). In total, data were gathered from OT of 1124 patients. No secondary hospitalisations were required and only one patient had a documented progression of the DVT. CONCLUSIONS: OT was successfully implemented in private practices through the initiative of individual physicians with support of the professional association and sponsoring by the industry-to the benefit of the providers but as much of the patients and their cost bearers.

Ambulatory Care↗
PubMed2004

Photoallergic contact dermatitis from ketoprofen induced by drug-contaminated personal objects.

BACKGROUND: Photoallergic contact dermatitis from ketoprofen has been recognized since the mid-1980s. Skin reactions have been reported to continue weeks after discontinuation of ketoprofen. One reason for this could be residual ketoprofen in the skin, which has been shown in a skin biopsy specimen. OBJECTIVE: We sought to report on 3 cases of photoallergic contact dermatitis from ketoprofen in topical anti-inflammatory gels and on relapses of dermatitis appearing after use of ketoprofen-contaminated objects. METHODS: We patch and photopatch tested, with standard series, the anti-inflammatory gel, ketoprofen, and its ingredients in serial dilutions and extracts of personal objects. We performed chemical investigations of personal objects with thin-layer chromatography, high-pressure liquid chromatography, and gas chromatography-mass spectrometry. RESULTS: Photoallergy was demonstrated to ketoprofen, which was detected in personal objects. CONCLUSION: Relapses of photoallergic contact dermatitis in patients photoallergic to ketoprofen can be induced by ketoprofen-contaminated objects such as bandages and slippers.

Administration, Topical↗
PubMed2006

Initial nonoperative management and delayed closure for treatment of giant omphaloceles.

PURPOSE: Traditional treatment of giant omphaloceles with silo closure has been associated with respiratory insufficiency, hemodynamic compromise, dehiscence, and inability to close the abdomen with subsequent death. To minimize such complications, initial nonoperative management with delayed closure of the defect has been used. METHODS: Between January 1981 and December 2002, 111 patients with omphaloceles were treated. Twenty-two patients with giant omphaloceles (19 containing liver) underwent initial nonoperative management consisting of silver sulfadiazine dressing changes. After pulmonary and other comorbidities stabilized, the contents were gradually reduced with a loose elastic bandage, and delayed closure was planned at 6 to 12 months. The medical records of these 22 patients were retrospectively reviewed to determine the efficacy and safety of this technique in the setting of severe associated anomalies. Those 15 patients (n = 15) from the latter 10 years were further reviewed to determine additional end points (length of hospital stay, length of intensive care unit stay, duration of mechanical ventilation, time to feed, time to closure, and type of closure). RESULTS: Of the 15 patients treated during the latter 10 years, mean gestational age and birth weight were 38 +/- 1.4 weeks and 3.1 +/- 0.57 kg, respectively. Median length of stay after birth was 20 days (range, 5-239 days). Median time to full diet was 8 days (range, 4-80 days). Four patients were discharged on oral feedings only, 7 with combination oral/gavage, and 4 with tube feedings. Pulmonary hypoplasia or pulmonary hypertension was present in 11 (50%) of 22 patients. There were 11 patients with major cardiac anomalies, 14 with a patent ductus arteriosus, and 8 with a patent foramen ovale. Three early complications (2 ruptured sacs and 1 bleeding sac) and 1 late complication (gastric necrosis) occurred in the initial nonoperative period. In addition, 4 patients were treated for line sepsis, 1 patient for acute renal insufficiency, and 1 for aspiration pneumonia. Three patients required tracheostomy and were discharged with home ventilators. There were no complications associated with the use of silver sulfadiazine. Of the 22 patients, 16 have undergone delayed repair, 2 did not require repair, 1 is awaiting repair, 2 died before closure, and 1 was lost to follow-up. Delayed closure was achieved at a median age of 14 months (range, 2-28 months) and mean weight of 8.8 +/- 3.3 kg. Four patients required implantation of mesh for definitive closure. Median postoperative length of stay was 4 days (range, 2-21 days). Postoperative complications included prolonged ileus, recurrent ventral hernia, and prolonged intubation. Overall mortality rate was 9.1%. One death occurred after diaphragmatic hernia repair, and 1 death was from overwhelming sepsis in the patient with a late gastric perforation. CONCLUSION: The use of silver sulfadiazine dressing changes for initial nonoperative management of giant omphaloceles is a safe and effective bridge to delayed closure. We recommend this method as initial nonoperative management given the high incidence of associated cardiopulmonary malformations because it may facilitate enteral feeding, minimize respiratory compromise, and reduce morbidity and mortality.

Abdominal Wall↗
PubMed2006

A systematic review of randomized controlled trials of wound dressings for chronic venous ulcer.

OBJECTIVE: To determine whether more "modern" complex wound dressings further improve the healing of venous ulcers over that with simple wound dressings, we conducted a systematic review of randomized controlled trials (RCTs) of wound dressing trials that were published from October 1, 1997, through September 1, 2005. METHODS: We searched MEDLINE, CINAHL, and the Cochrane Controlled Trials Registry Database to identify RCTs. Criteria for ultimate selection included treatment with compression and an objective outcome describing the proportion of wounds healed. Twenty RCTs were identified that satisfied these criteria and were classified into three wound dressing classes: semiocclusive/occlusive group (n = 8), growth factor group (n = 7), and human skin equivalent group (n = 5). RESULTS: Assessment of study design quality for the 20 RCTs showed a low percentage (<49%) of RCTs that incorporated at least 3 of 7 indicators of trial quality, but it seemed better in the 5 RCTs that showed significance for ulcer healing; 4 of the studies used at least 6 of the 7 characteristics of adequate study design. Five (25%) of the 20 RCTs had a statistically significantly improved proportion of ulcers healed in the experimental dressing group over control values: zinc oxide paste bandage (79% vs 56%) and Tegasorb (59% vs 15%) in the semiocclusive/occlusive group and perilesional injection of granulocyte-macrophage colony-stimulating factor (57% vs 19%) and porcine collagen derived from small-intestine submucosa (Oasis; 55% vs 34%) in the growth factor group. In the sole significant RCT from the human skin equivalent group, Apligraf (63%) was superior to Tegapore (48%). Four of these five studies also showed an improved time to complete healing by Kaplan-Meier estimate. CONCLUSIONS: Certain wound dressings can improve both the proportion of ulcers healed and the time to healing over that achieved with adequate compression and a simple wound dressing. The selection of a specific dressing, however, will depend on the dressing characteristics for ease of application, patient comfort, wound drainage absorption, and expense.

Bandages↗