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PubMedDate not supplied

Growth peptide release from biologic dressings: a comparison.

Biologic dressings are believed to stimulate wound healing in a variety of wound types. Cryopreserved allograft skin (CAS) is used as a biologic dressing for excised wounds, partial-thickness wounds, and meshed split-thickness skin grafts, and the use of allogenic or autologous cultured epithelial sheets (CES) has been reported to enhance healing of skin ulcers and deep partial-thickness wounds. However, limitations of allograft skin include bacteriologic and viral safety, limited availability, cost, and ease of handling. Previously we have reported the successful use of human keratinocytes cultured to single-layer confluence on Hydroderm polyurethane membranes (HD/HK) for grafting of full-thickness wounds. In this study we evaluated the release of five different growth peptides (transforming growth factors alpha and beta (TGF-alpha, TGF-beta), interleukin-6, interleukin-8, and melanoma growth stimulatory activity from CAS, CES, and HD/HK grafts. Highest levels of TGF-alpha were found for HD/HK (728 +/- 115 pg/10 cm2 of membrane) followed by CES (491 +/- 137 pg/10 cm2; NS). No TGF-alpha was detectable for CAS, and 3.7-fold, and 25-fold higher levels of interleukin-6 were found for CES (257 +/- 12.7 U/10 cm2) compared with HD/HK and CAS, respectively. Interleukin-8 had similar levels for CES (0.65 +/- 0.7 ng/10 cm2) and HD/HK (0.88 +/- 0.12 ng/10 cm2), whereas melanoma growth stimulatory activity was elevated in CES (2314 +/- 97 pg/10 cm2) compared with HD/HK (1071 +/- 55 pg/10 cm2). TGF-beta was barely detectable for CES and HD/HK. Cryopreserved allograft showed high levels of TGF-beta (5.2 +/- 1.6 ng/10 cm2). Overall mitogenic activity of the supernatants on keratinocyte cultures was assessed. Highest proliferation was seen for CES supernatants followed by HD/HK (NS). Supernatants from CAS had an antiproliferative effect on keratinocytes. We conclude that a single layer of keratinocytes cultured on a polyurethane membrane facilitates keratinocyte proliferation similar to CES, whereas cryopreserved allograft has no mitogenic effect on keratinocytes.

Analysis of Variance↗
PubMed1980

Evaluation of biological dressings.

The use of biological dressings in the treatment of burns is reviewed. Many theoretical advantages were initially proposed, but time and controlled studies have disproved some of them. Biological dressings are nevertheless helpful in relieving pain, protecting exposed vital structures, reducing exudative protein and erythrocyte loss and evaporative water loss, protecting granulation tissue, antibacterial activity, and testing a recipient bed's readiness for grafting. They probably offer no benefit in final wound debridement and primary dressings for partial thickness burns or split skin donor sites. There is no conclusive evidence that biological dressings alter epithelialization or the rate of formation of granulation tissue. A review of our last 100 cases at the Bothin Burn Center generally supports these conclusions with evidence of the superiority of homografts over heterografts.

Bandages↗
PubMed1984

Characteristics and uses of biologic dressings and skin substitutes.

Biologic dressings used for temporary coverage of open wounds exert both mechanical and physiologic effects by protecting the wound, maintaining microbial control, and hastening wound maturation. Synthetic wound dressings modeled after the biologic dressings have been evaluated by several investigators. Those studies have shown unilaminate synthetic membranes to be ineffective when applied to full-thickness wounds and have identified a bilaminate construction as being necessary for membranes to serve as effective skin substitutes. The desirable properties of skin substitutes have been identified and incorporated in the design of recently developed membranes. Recent studies in this and other laboratories have resulted in the development of collagen-synthetic bilaminates, a totally synthetic biologically inert bilaminate, and tissue culture-derived membranes. The characteristics and limitations of each skin substitute determine the optimum usage of these composite membranes and define the modifications needed to improve the effectiveness of such dressings.

Animals↗
PubMed2006

Update on tissue-engineered biological dressings.

Tissue-engineered biological dressings offer promise in the treatment of burns, chronic ulcers, donor site and other surgical wounds, and a variety of blistering and desquamating dermatologic conditions. For example, the prevalence of diabetic foot ulcers ranges from 4.4% to 10.5% of diabetics, resulting in 82,000 lower extremity amputations annually; venous leg ulcers affect 0.18% to 1.35% of the population; and pressure ulcers are found in 5.0% to 8.8% of institutionalized patients and 14.8% of patients in acute care facilities. Despite the large number of potential beneficiaries, cellular tissue-engineered products have suffered setbacks in recent years and have garnered considerably lower market share than commercial promoters anticipated. The mechanism of action of these products is not universally agreed upon, but delivery of growth factors and extracellular matrix components to the wound is thought to be important; graft "take" is not usually considered to occur. These "engineered" products do not specifically match a treatment modality to an underlying pathology. Clinical effect is often modest, and sometimes not justi- fiable from a cost-benefit perspective. Nevertheless, clinical reports in the literature of uses of tissueengineered biological dressings continue to mount, indicating that these products are finding niche applications where clinical utility is high and the cost can be defended. Despite commercial setbacks, the first-approved products, Dermagraft, Apligraf, and Cultured Epidermal Autograft (Epicel) are still being marketed, and new ones, such as OrCel, continue to be developed. The major indications for these products are summarized and a brief review of the available clinical literature is offered.

Biological Dressings↗
PubMed1982

Enzymatic chemical modification of human amniotic membrane and skin as a means for the preparation of biological dressing.

A non-antigenic biological dressing of amniotic membrane and skin was prepared by treatment with the enzyme ficin and dialdehyde starch. The dressing was tested in experimental animals for the coverage of full-thickness skin defects. The healing process was studied, as well as the durability of the biological dressing. Testing for flexibility, adherence and antigenicity, there was no change in the ficin-treated dressing when used even after being stored for a period of up to 2 years. The enzyme treatment did not result in a superior biological dressing.

Amnion↗
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↗
PubMed1975

Treatment of gastroschisis and omphalocele with biological dressings.

Porcine skin grafts and human amniotic membranes have been used as biological dressings for the treatment of gastroschisis or omphalocele in 16 newborn infants. Eleven infants with gastroschisis were managed initially by the Silastic pouch technique but delayed healing resulted in separation of the Silastic sheeting from the wound margins and required use of biologic dressings to achieve complete closure. Biological dressings were used in five patients with intact omphaloceles for all or part of their course. Average time to achieve complete closure was 55 days. Three patients died of associated anomalies. One patient developed an enteric fistula. Biologic dressings appear to be useful adjuncts in the management of some patients with gastroschisis or omphalocele.

Abdominal Muscles↗
PubMed1999

Effectiveness of human amnion preserved long-term in glycerol as a temporary biological dressing.

Human amnion as a temporary biological wound dressing has remained a beneficial and cost-effective means of treating burns in developing countries. The aim of this study was to determine whether human amnion that has undergone long-term preservation in glycerol is an effective biological dressing compared to fresh amnion and glycerol-preserved human skin. Samples of human amnion and skin were preserved in sterile containers of 85% glycerol at 4 degrees C for over a year. Dorsal full-thickness or split-thickness skin wounds were produced in rats. The defects were divided into four areas, each of which was covered with preserved amnion, fresh amnion, preserved skin, or left uncovered as a control. The materials on the wounds were evaluated macroscopically and microscopically after 2, 4, 7, 10 and 14 days. The primary take or adherence of the grafts on full-thickness wounds was evaluated at 4 and 7 days, and material performance was scored based on several macroscopic and microscopic criteria. The bacteria levels reducing effect of the materials were examined by quantitative bacteriology in heavily infected full-thickness scald burn wounds of rats. Qualitative cultures confirmed that the storage conditions the materials were subjected to for over a year were aseptic and that the amnion and skin had maintained their characteristic properties. All materials were found effective on partial-thickness rat wounds as a cover under which re-epithelialization was completed by 7 days. The preserved skin performed better than either preserved or fresh amnion on full-thickness wounds but the performance of preserved amnion was comparable to that of fresh amnion. Glycerol-preserved amnion was found to be as effective as fresh amnion or skin in terms of decreasing bacterial levels in infected rat burn wounds. Amnion stored in glycerol is reliable and effective for a long period of time. Amnion banking could provide an unlimited quantity of biologic dressing for burn treatment at low cost, a factor that is particularly important in developing countries.

Amnion↗
PubMed2006

[Clinical evaluation of eschar grinding and biological dressing A for treatment of deep partial-thickness burn wound on the extremities].

OBJECTIVE: To evaluate the clinical effect of eschar grinding and wound coverage by biological dressing A in the management of deep partial-thickness burn wound on the extremities. METHODS: Seventy-three patients with deep partial-thickness burns on the extremities were divided into two groups to receive different managements. The patients in group 1 were treated with eschar grinding and wound coverage with biological dressing A, and group 2 received conventional treatment. The white blood cell count, body temperature, incidence of wound infection and wound healing time were observed. RESULTS: Compared with conventional treatment, wound management with eschar grinding and coverage by biological dressing A could increase the effective rate (29/32 vs 31/41, P<0.05), inhibit systemic inflammation and scar hypertrophy, and shorten the wound healing time (13.79-/+5.72 vs 17.08-/+8.39, P<0.01). CONCLUSION: Eschar grinding and wound coverage by biological dressing A can be effective for management of deep partial-thickness burns on the extremities, and earlier treatment with the dressing A achieves better effect.

Biological Dressings↗
PubMed1976

Comparison of coarse mesh gauze with biologic dressings on granulating wounds.

Twenty patients with large area granulating wounds were selected for the study. On each patient, a small area of uniform appearance was divided into four subareas, and each subarea was randomly assigned treatment with a single 24 hour application of cadaver allograft, fresh porcine xenograft, formalinized xenograft, or "wet-to-dry" applications of coarse mesh gauze changed three times daily. At 24 hours, all four areas were uncovered. The subareas were ranked in terms of appearance on a best, second best, third best, and worst scale by experienced paramedical personnel who were not told which area received which treatment. Contact sponge quantitative microbiology was performed on each subarea before and after treatment on seventeen of the twenty patients. The results of these rankings suggest that coarse mesh gauze, changed three times daily, was significantly better at improving wound appearance than any of the biologic dressings. Among the biologic dressings, formalinized xenograft was significantly the worst. There was no significant difference between cadaver allograft and porcine xenograft. Analysis of quantitative cultures was limited by the problems of applying statistical methods to series of paired cultures in which initial values are quite different. Within the framework of such limitations and our 24 hour study, there was not significant change in surface colonization when either coarse mesh gauze or biologic dressings were used.

Adolescent↗
PubMed1980

The use of biological dressings in radical vulvectomy.

The use of biological dressing techniques accelerates recovery from radical vulvectomy combined with lymphadenectomy. Our earliest interest in the field arose as a result of the morbidity rate which ensued subsequent to surgical therapy of cancer of the vulva. The technique involved in 8 such procedures is described, and its applicability illustrated with photographic plates and review of the literature.

Aged↗
PubMed1993

[The treatment of extensive burns using a primary biological dressing in the Clinitron fluidized bed].

The treatment of extensive burns using a method recently adopted in this country, namely application of primary biological dressing in patients undergoing treatment under conditions of "Clinitron" fluid bed, is discussed. The ten-year follow-up study covers 1100 patients with extensive burns, distributed in three groups according to the method of local treatment employed: 1) Patients treated by closed method in conventional conditions. 2) Patients treated by closed method under fluid bed conditions. 3) Patients treated on a fluid bed plus primary dressing with the newly obtained biopreparations for local application--Cypocol and skin collagen transplant. The approach outlined is consistent with the traditional treatment procedures. By combining the curative properties of biopreparations, used as primary biological dressing, with those of the fluid bed, a clinical effect considerably superior over the one thus far recorded is attained. Emphasis is laid on the advantages of the therapeutic approach proposed-suppressing endo-and exogenous infections, and substantial reduction of the hospitalization term.

Adult↗
PubMed2004

Evaluation of lyophilised, gamma-irradiated amnion as a biological dressing.

Burns, non-healing wounds and pressure sores cause extensive damage to the skin leading to infection and loss of precious body fluids. Despite advances in burn management the mortality rate continues to be high and the search for an economical and easily available dressing to control burn wound infection continues. Autologous skin has limited availability and is associated with additional scarring. Conventional dressings require frequent changes which can be painful and may even require anaesthesia. Amnion is an excellent biological dressing and its use in the treatment of burns has special appeal in India as there are religious barriers to the acceptance of bovine and porcine skin.Lyophilised, irradiated amnion provided for the first time in the country by the Tata Memorial Hospital Tissue Bank was evaluated as a temporary biological dressing. It was used to treat 35 patients with burns, 21 patients with bedsores and non-healing ulcers and the skin graft donor sites of 11 patients. The amnion was easy to handle and stuck well to the raw wound bed. An open dressing was used in most of the second degree burns which healed with hyperemia and early pigmentation. In patients with third degree burns, ulcers or skin graft donor sites, closed dressings were used. The exudate and induration were reduced and patients were more comfortable and experienced less pain. There was healthy granulation with good re-epithelialisation. Amnion was not used in patients with infected third degree burns.

Adult↗
PubMedDate not supplied

[Use of amniotic membranes as biological dressings. Preliminary report].

The authors compared the results obtained with the use of amniotic membranes as biological dressings in the treatment of 15 patients with skin loose of different etiology and that obtained with the conventional therapy. The associated benefits obtained with this treatment were lessen of the pain, low incidence of infections, early cicatrization of the wounds and shortening of the hospital time. The primary observations permit a wide investigation about the therapeutic usefulness of this kind of biological dressings.

Adult↗
PubMed2003

So-called biological dressing effects of cultured epidermal sheets are mediated by the production of EGF family, TGF-beta and VEGF.

BACKGROUND: Cultured epidermal sheet (CES) grafts accelerate wound healing as a result of so-called biological dressing effect, which is thought to be mediated by various growth factors. However, the profile of growth factor expression in CESs is unclear. OBJECTIVE: To investigate whether CESs produce growth factors along with stratification we investigated the production of growth factors and their regulation in CESs. METHODS: CESs conditioned medium was harvested and the concentration of TGF-alpha, TGF-beta1, TGF-beta2, and VEGF was measured using ELISA. The mRNA of EGF family, TGF-beta family and VEGF was detected by Northern blot or RNase protection assay. RESULTS: The concentration of TGF-alpha was 100 pg/ml in the monolayer culture, but dramatically increased to 600 pg/ml 2 days after stratification. It decreased to baseline, and then gradually increased to 300 pg/ml in the presence of EGF and remained at that level until day 20. TGF-beta1 increased from 50 to 400 pg/ml after stratification, and remained at that level day 20. TGF-beta2 was undetectable in the monolayer culture, but dramatically increased to 200 pg/ml 2 days after stratification. Unlike TGF-beta1, TGF-beta2 gradually increased over time after stratification. VEGF increased with stratification from 500 to 1500 pg/ml. The addition of EGF upregulated EGF family, TGF-beta, and VEGF production in CESs, as confirmed by ELISA, Northern blot, and RNase protection assay. CONCLUSION: These results indicate that so-called biological dressing effect of CESs is mediated by production of the EGF family, TGF-beta, and VEGF. Our results also demonstrate the ability of EGF to enhance growth factor production in CESs.

Biological Dressings↗
PubMed1980

Biological dressings in burns--a review.

A history of the development of the various biological dressings is presented. Substances currently in use--homografts, heterografts (including amniotic membranes), collagen-based dressings, and synthetic films--are reviewed in terms of their indications for use, method of application, future, and advantages and disadvantages.

Amnion↗
PubMed1988

Antimicrobial properties of antiseptic-impregnated biological dressings.

Three antiseptics--chlorhexidine acetate, silver nitrate and povidone-iodine--were incorporated into biological dressings (human skin and amnio-chorion) and evaluated in vitro against disparate micro-organisms. Results indicated that antimicrobial levels of chlorhexidine and silver were released from the dressings over a clinically relevant time period, whereas povidone-iodine was ineffective. Chlorhexidine dressings demonstrated broad-spectrum activity, whereas silver dressings were most effective against Pseudomonas aeruginosa.

Anti-Infective Agents, Local↗