Costs of dressings in the community

This study compares the costs of dressings used in the treatment of patients with a variety of wound aetiologies. The two dressings investigated were a hydrocolloid dressing and a hydrocellular dressing. Secondary objectives included a comparison of dressing durability, time to complete healing, ease of wound cleansing and dressing removal. The study was an open prospective single-centre randomised parallel group trial involving 100 patients, treated in the community, who were randomised to the two dressing groups. For all aetiologies except pressure sores, the costs of the hydrocolloid dressing were less than the costs of the hydrocellular dressings. Similar healing rates were observed in the leg ulcer and 'other wound' groups. There were, however, significant differences in the number of healed wounds observed in patients with pressure sores treated with the hydrocellular dressing.     

Mefilm: an adherent polyurethane dressing for superficial wounds

Research has demonstrated that wounds heal faster in a moist environment. Film dressings are used to promote a moist environment. Mefilm is part of the M?lnlycke Health Care chronic wound care system and is a gentle, adherent polyurethane dressing. This product focus discusses the development of the semi-permeable film dressing, Mefilm, examining its uses, application and removal.     

Treatment of granulating wounds with silastic foam dressings

We have examined the usefulness of a Silastic foam dressing in the management of open granulating wounds in 55 outpatients. It is an acceptable and comfortable dressing, which allows earlier discharge from hospital. The method of making the dressing, and the daily care of the wound are described. Improved wound care is achieved by providing two dressings, so that when one is in place the other is being thoroughly cleaned. This technique has been shown to reduce bacterial contamination of the wounds and to improve wound healing (p less than 0.02).     

A new silver sulfadiazine water soluble gel

Silver sulfadiazine is the most commonly used topical antibacterial agent for the treatment of burn wounds. It has many clinical advantages, including a broad spectrum of antimicrobial activity, low toxicity, and minimal pain on application. The current formulation of silver sulfadiazine contains a lipid soluble carrier, polypropylene glycol, that has certain disadvantages, including pseudo-eschar formation and the need for twice daily application. The purpose of this investigation was to describe a new formulation of silver sulfadiazine in a water soluble gel, poloxamer 188. The antibacterial activity of this new gel has been compared to that of the commercially available silver sulfadiazine cream by in vitro and in vivo testing. The results of the in vitro antibacterial testing of these two different agents demonstrated the superiority of the new gel formulation. In experimental wounds, the antibacterial activity of the gel and the commercially available silver sulfadiazine cream were not significantly different when applied once a day. The antibacterial activity of the gel when applied once a day was comparable to that encountered by twice daily applications of the silver sulfadiazine cream by experimental wounds. The major advantage of this gel was its ease of application and removal that is attributed to its water solubility.     

Comparison of closed-suction drainage and no drainage after primary total knee arthroplasty

One hundred thirty-six primary total knee arthroplasty patients were randomized for the use of closed-suction, nonreinfusable wound drains. Blood loss was identical in the drained and undrained groups. Forty percent of undrained wounds compared with 0% of drained wounds required dressing reinforcement. Sixty-nine percent of undrained wounds compared with 39% of drained wounds developed ecchymosis, measuring 92 cm2 in the undrained group and 28 cm2 in the drained group. This study concludes that a simple wound drain effectively minimizes the undesirable accumulation of blood in the surrounding soft tissues and the postoperative wound dressing after total knee arthroplasty.     

Melgisorb: a highly absorbent calcium/sodium alginate dressing

Alginates have been used in wound care for many years. In recent years alginate dressings have developed to provide an extremely cost-effective way of managing wounds with a moderate to high level of exudate. The dressing gel has traditionally been either soft or firm on removal, but with new technology softness and fast gelling may now be combined with high integrity in a single product. An example of such a product is Melgisorb from M?lnlycke Health Care (the makers of Mepore). Melgisorb is just one dressing in their range of chronic wound care products.     

Pulmonary vascular disease in a child with atrial septal defect of the secundum type and type I glycogen storage disease

Suppression of cell-mediated immunity (CM) and lowering of survival rate follow major thermal injury are associated with absorption of burn toxin. Wistar rats received 30% full-thickness burn, and were then treated with early burn excision or wet dressing of cerium nitrate for the wound. At day 14 postburn, both survival rates and peripheral blood Th/Ts rate were monitored. It was found that both excision and cerium nitrate could prevent marked lowering of survival rate and Th/Ts ratio were monitored. It was found that both excision and cerium nitrate could prevent markly lowering of survival rates and Th/Ts ratio induced by severe burn. This indicated that CE, in the early postburn days, may replace early burn excision to prevent the suppression of CMI following severe burn.     

Dressing wounds

This article describes the choice and method of application of wound dressing in a variety of situations. The types of wounds covered include those in awkward areas, cavity wounds and fungating wounds. The problems of patients with allergies to wound dressings are also discussed.     

Cryopreserved cadaveric allografts for treatment of unexcised partial thickness flame burns: clinical experience with 12 patients

Partial thickness burns (PTB) usually heal within 3 weeks. Prevention of infection and desiccation of the wounds are crucial for optimal healing. Early tangential excision of the burn eschar and allografting prevent deepening of the burns, and are therefore advocated for treatment with the best functional and aesthetic results. For superficial partial thickness burns (SPTB) conservative use of topical antimicrobial agents with frequent dressing changes are implemented. We compared the conservative treatment for PTBs and SPTBs to grafting cryopreserved cadaveric allografts with no prior excision. Twelve patients with flame PTB areas were allografted after mechanical debridement without excision of the burn wounds. The allografts were cadaveric skin cryopreserved by programmed freezing and stored at -180 degrees C for 30-48 months. Matching burns for depth and area were treated with silver sulfadiazine (SSD) one to two times daily until healing or debridement and grafting were required. It was found that 80 per cent of the cryopreserved allografts adhered well and 76 per cent of the treated areas healed within 21 days, whereas only 40 per cent of the SSD-treated burns healed within 21 days. Partial thickness burns can be treated successfully with viable human allografts (cryopreserved cadaveric skin) with no prior surgical excision. The burn wounds heal well within 3 weeks. For deep partial thickness burns (DPTB) treatment with allografts has no advantage if they have not been previously excised.     

Role of advanced glycation end products in aging collagen. A scanning force microscope study

The purpose of this trial was to prepare for a large randomized trial comparing Arglaes film dressing, a recent innovation containing silver ions, against Tegaderm, a transparent polyurethane dressing. Thirty-one patients admitted to the intensive care unit and requiring the insertion of an arterial line or central venous catheter were recruited into the study. Skin swabs were taken from the insertion sites prior to catheterization and on removal of the intravascular device to measure skin colonization rate between the two dressings. The catheter tips were also cultured on removal to establish if there was a difference between the two groups. No statistical differences were found in bacterial growth between the two dressings.     

Lyofoam

Foam dressings provide an excellent healing environment for granulating wounds. Lyofoam is a polyurethane foam dressing that comes in a variety of presentations for differing wound types. Lyofoam is suitable for light to moderately exuding, granulating wounds; Lyofoam Extra, a new addition, for heavily exuding wounds; Lyofoam A, an all-in-one dressing, for granulating wounds; Lyofoam T, a standard Lyofoam dressing with a special cross-cut, for tracheostomy wounds; and Lyofoam C, which has a carbon layer, for malodorous wounds. Lyofoam is a well-established, clinically proven wound dressing that promotes the ideal wound environment for healing. It has a low-adherent contact layer which leaves delicate granulation tissue undisturbed. It is also effective in the treatment of overgranulation.     

Wound care: fact and fiction about hydrocolloid dressings

1. Hydrocolloid dressings have two layers. The inner, hydrocolloid adhesive layer has particles that absorb exudate to form a hydrated gel over the wound, creating a moist environment that promotes healing and protects new tissue. The outer layer (film, foam, or both) forms a seal to protect the wound from bacterial contamination, foreign debris, urine, and feces; it also maintains a moist environment and helps prevent shearing. 2. Hydrocolloid dressings are designed to be worn for up to a week. Infrequent dressing changes are less disruptive to the wound bed, provided that healthy skin is not compromised. Many patients--and even some medical professionals--still incorrectly believe that wounds need to be exposed to the air to heal properly. 3. Hydrocolloids are not always the dressing of choice in wounds that have limited drainage or in wounds with copious amounts of drainage. The hydrocolloid dressing is designed to manage drainage; if drainage is minimal, another approach may be more economical and comfortable for the patient.     

Acute surgical wound care 1: An overview of treatment

The first article in this series of articles on acute surgical wound care traces the history of surgical wound care, from primitive dressings and techniques of closure used in the past to the present-day approach. The history of surgical wounds is discussed together with a classification of the different types of surgical wound closure. Nowadays, it is recognized that the management of surgical wounds has to be planned carefully to achieve adequate exposure to the area of surgery. At the same time the surgeon has to be conscious of how the wound will heal to ensure optimal postoperative function and cosmetic results. To do this an understanding of the principles underpinning surgical incisions, and of alternative techniques for their closure, drainage and wound dressing, is needed. The role of the nurse in preparing patients preoperatively and supporting and caring for them postoperatively is paramount.     

A silicone-coated nylon dressing reduces healing time in burned paediatric patients in comparison with standard sulfadiazine treatment: a prospective randomized trial

Mepitel is a new grid like silicone coated nylon dressing containing no additional biological compounds. We describe a prospective randomized pilot study comparing Mepitel to the standard silver sulfadiazine cream (Flamazine) dressing for the topical treatment of paediatric burns. Seventy-six children presenting within 24 h of injury with a non previously treated burn were randomly assigned to Mepitel treatment (group M) or Flamazine treatment (group F). Age, sex, surface area of burn and causal agent were noted at admission. The depth of the burn, cumulative number of dressings, presence or absence of a complete epithelial cover, infection, bleeding and allergy were noted at each dressing change. There were 41 children in group M and 35 children in group F. Five children were subsequently withdrawn from each group because they required skin grafting. Analysis of the above mentioned criteria showed no statistical difference between the two groups except for the healing time (group M: 7.58+/-3.12, group F: 11.26+/-6.02, p < 0.01) and the number of dressings (group M: 3.64+/-1.5, group F: 5.13+/-2.9, p < 0.05). Mepitel has proved to be an easy-to-remove dressing, adhering only to intact skin. The faster healing time found in the Mepitel group may be related to a direct effect of silicone on epithelial growth or to a decrease in surface-cell damage compared to the silver sulfadiazine group. This attractive product will be further assessed on a larger scale trial to confirm our observations.     

Susceptibility of Aspergillus strains from culture collections to amphotericin B and itraconazole

BACKGROUND: Over the last decade the benefits of occlusive dressings have been appreciated. These dressings allow the epithelium to resurface easier. The wound heals quicker. OBJECTIVE: To evaluate a new silicone sheeting for immediate post-op wound care. Our objective was to determine its benefit in the wound care management after laser skin resurfacing. METHOD: The silicone sheeting was applied immediately after laser resurfacing in 35 individuals. This temporary skin replacement was held in place with 4 x 4 gauzes and tube gauze netting. Although the tube netting and the 4 x 4 gauzes were changed daily the silicone sheeting remained in place for 4 or 5 days. Following this, applications of a petrolatum-based ointment were continued for another 5 days. At day 10 the skin care program was changed to a moisturizing sunscreen. Bleaching cream was added at day 15 in darker complexed individuals. RESULTS: The dressing accelerated wound healing. Pain and swelling were minimized under the sheeting. Histologic examinations demonstrated a more rapid reepithelialization at these treated sites. Other than technical problems, such as the riding up of the dressing over the jawline or retraction of the dressing off the lips or off the eyelids, there were no adverse sequelae. The wound healed rapidly and allowed the rapid progression to the application of a moisturizer-sunscreen or a skin-bleaching cream. Other than these technical problems there were no complications. No wound infections were noted. CONCLUSION: The use of silicone sheeting following skin resurfacing facilitated a rapid reepithelialization of treated areas. There was a remarkable reduction in erythema and edema accompanying the use of the dressing. The program made it possible for patients to return to work in 12-15 days.     

Infectious complications: prevention and strategies for their control

Despite major advances in burn wound management and other supportive care regimens, infection remains the leading cause of morbidity in the thermally injured patient. Changes in nursing practices and patient isolation have played a significant role in reducing the incidence of burn wounds and other infections, particularly those that result from cross-contamination in the hospitalized burn patient. This article focuses on the sources of the most common infections seen in burn centers today and on the infection control strategies developed for their prevention and treatment.     

Wound healing after laser surgery

Compared with scalpel wounds, CO2 laser wounds show delays in inflammation, collagen production, reepithelialization, and tensile strength in the early stages of healing. Some of these delays are similar to those seen with electrocautery and burn wounds. Later stages compensate for these early deficiencies, because scalpel and laser wounds become more similar in epithelialization and wound strength over time. Healed CO2 laser wounds tend to have less scar contraction than scalpel wounds. Débridement of initial laser wound char, tissue cooling techniques during lasering, and pulsed modes of laser delivery all seem to result in more rapid, favorable healing. Similar wound healing trends have been seen with the CO2 laser in bone, with other lasers, and with laser vascular and neural anastomosis. Biostimulation with low-level laser energy is a complex subject of ongoing investigations.     

Non-comparative evaluation of a new hydrofiber dressing in the treatment of vascular ulcers

OBJECTIVE: To evaluate the performance of the hydrofiber dressing in the treatment of leg ulcers. METHODS: Multicenter, open, non-comparative study of 23 patients with the mean age of 69.6 years. The mean duration of actual ulcer was 2.6 years. RESULTS: Twelve (55%) patients had marketed improvement in overall change in the condition on the wound and 5 (23%) patients had mild improvement. The majority of dressing changes were pain-free (63%). The dressing changes, application and removal, were easy 171 (99%) and 149 (87%). The mean dressing wear time was 2.4 days. The mean ulcer area at the start of the study was 2.730 mm2 and the final dressing change was 1.963 mm2. The median percentage reduction was 36%. CONCLUSION: The use of the non-occlusive hydrofiber dressing is suitable for the treatment of exudating leg ulcers.     

Our experience with the use of cerium sulphadiazine in the treatment of extensive burns

The development of the burn disease with infection as the most important complication represents still a major problem in burn patients. With the introduction of the method of early surgical excision of the Af1p4r with immediate grafting in major burns, improved survival has been achieved, particularly in children. However, especially in adults, early massive excisions did not prove to be of much benefit for survival. In these cases, more-or-less sequential staged excisional procedures have been introduced by many renown burn surgeons. In 1976 Monafo et al. presented the cerium nitrate-silver sulphadiazine cream (CSD) combination for topical therapy. The addition of 2.2% of the rare earth metal cerium salt to silversulphadiazine causes the formation of a relatively hard, yellow, leather-like eschar with excellent resistance to infection and good long-term adherence to the burn wound. This allows the surgeon to perform late tangential excision and immediate autografting thus decreasing the open wound size and the rate of severe infections originating in the burn wound itself. We report our experience with the treatment of 20 patients with deep burns exceeding 20% of the BSA with cerium nitrate-silver sulphadiazine cream compared with a similar group of burn patients treated by silver sulphadiazine cream alone. CSD proved to be safe and effective in the treatment of deep and extensive burns. Its advantages include easy and painless application and removal, turning the necrotic skin to yellow, and a leathery crust with good resistance to infection, thus enabling later, or staged, sequential excisions in cases where early massive excisions are not possible.     

Serum sodium imbalance in the bedridden elderly. Part One: Realities and problem of management

This study assessed the topical effects of bitumen on burn wounds and their surrounding skin in guinea-pigs. It consisted of three different experiments. The bitumen used in this experiment was a soft tar produced by Daye Steel Plant. The first experiment showed that the skin of the bitumen group marked pathological changes under both light and electron microscopes. The second experiment suggested that healing of the burn wounds of bitumen group was delayed, and less hair follicle counts and a lower intradermal thickness were found as compared with the other groups. The third experiment indicated that the wound edges had been seriously destroyed by bitumen, leading to enlargement of the size of the ulcers, and hypertrophy of scar occurred after healing. It is concluded that bitumen, especially the soft coal tar, has more errosive, irritating and destructive effects, therefore in bitumen burns the bitumen must be immediately and entirely removed from burn wounds.