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Lan Z, Kar R, Chwatko M, Shoga E, Cosgriff-Hernandez E. High porosity PEG-based hydrogel foams with self-tuning moisture balance as chronic wound dressings. J Biomed Mater Res A 2023; 111:465-477. [PMID: 36606332 DOI: 10.1002/jbm.a.37498] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/21/2022] [Accepted: 12/30/2022] [Indexed: 01/07/2023]
Abstract
A major challenge in chronic wound treatment is maintaining an appropriate wound moisture balance throughout the healing process. Wound dehydration hinders wound healing due to impeded molecule transport and cell migration with associated tissue necrosis. In contrast, wounds that produce excess fluid contain high levels of reactive oxygen species and matrix metalloproteases that impede cell recruitment, extracellular matrix reconstruction, and angiogenesis. Dressings are currently selected based on the relative amount of wound exudate with no universal dressing available that can maintain appropriate wound moisture balance to enhance healing. This work aimed to develop a high porosity poly(ethylene glycol) diacrylate hydrogel foam that can both rapidly remove exudate and provide self-tuning moisture control to prevent wound dehydration. A custom foaming device was used to vary hydrogel foam porosity from 25% to 75% by adjusting the initial air-to-solution volume ratio. Hydrogel foams demonstrated substantial improvements in water uptake volume and rate as compared to bulk hydrogels while maintaining similar hydration benefits with slow dehydration rates. The hydrogel foam with the highest porosity (~75%) demonstrated the greatest water uptake and rate, which outperformed commercial dressing products, Curafoam® and Silvercel®, in water absorption, moisture retention, and exudate management. Investigation of the water vapor transmission rates of each dressing at varied hydration levels was characterized and demonstrated the dynamic moisture-controlling capability of the hydrogel foam dressing. Overall, the self-tuning moisture control of this hydrogel foam dressing holds great promise to improve healing outcomes for both dry and exudative chronic wounds.
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Affiliation(s)
- Ziyang Lan
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, Texas, USA
| | - Ronit Kar
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, Texas, USA
| | - Malgorzata Chwatko
- Department of Chemical and Materials Engineering, University of Kentucky, Lexington, Kentucky, USA
| | - Erik Shoga
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, Texas, USA
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Hubner P, Marcilio NR, Tessaro IC. Gelatin/poly(vinyl alcohol) based hydrogel film - A potential biomaterial for wound dressing: Experimental design and optimization followed by rotatable central composite design. J Biomater Appl 2021; 36:682-700. [PMID: 33557668 DOI: 10.1177/0885328221992260] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The development of hydrogel films for biomedical applications is interesting due to their characteristics. Hydrogel films based on gelatin and poly(vinyl alcohol) (PVA) are developed and characterized using a rotatable central composite design. The optimized hydrogel film is obtained by the function desirability of the Statistica® software and is also characterized by swelling kinetics, oxygen permeability, adhesiveness, TGA, DSC, and XRD. The results of the experimental design show that gelatin and PVA concentrations have a significant influence on the response variables, and the exposure doses to UV light show no significant effect. The optimized hydrogel film is elastic, presents good mechanical resistance and swelling capacity in water and exudate solution, is permeable to oxygen, and is capable of adjusting itself and maintains contact close to the skin. In this way, considering all the properties evaluated, the optimized film has characteristics suitable for biomedical applications as wound dressings.
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Affiliation(s)
- Patricia Hubner
- 28124Universidade Federal do Rio Grande do Sul (UFRGS), Chemical Engineering Department (DEQUI), Porto Alegre, Rio Grande do Sul, Brazil
| | - Nilson Romeu Marcilio
- 28124Universidade Federal do Rio Grande do Sul (UFRGS), Chemical Engineering Department (DEQUI), Porto Alegre, Rio Grande do Sul, Brazil
| | - Isabel Cristina Tessaro
- 28124Universidade Federal do Rio Grande do Sul (UFRGS), Chemical Engineering Department (DEQUI), Porto Alegre, Rio Grande do Sul, Brazil
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Umar M, Ullah A, Nawaz H, Areeb T, Hashmi M, Kharaghani D, Kim KO, Kim IS. Wet-spun bi-component alginate based hydrogel fibers: Development and in-vitro evaluation as a potential moist wound care dressing. Int J Biol Macromol 2020; 168:601-610. [PMID: 33338524 DOI: 10.1016/j.ijbiomac.2020.12.088] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 12/02/2020] [Accepted: 12/11/2020] [Indexed: 11/16/2022]
Abstract
In this study, bi-component alginate-hyaluronic acid (AHA) fibers were developed by using two different routes. In the first method, sodium alginate dope solution was extruded into a coagulation bath containing CaCl2 and subsequently dip-coated with hyaluronic acid (HA) whereas, in the second method, hyaluronic acid-containing sodium alginate dope solution was directly extruded into CaCl2 bath. The resulting AHA fibers were then dehydrated in 25-100% v/v acetone solutions and dried in air. The fibers were characterized by surface morphology, physicochemical analysis, mechanical performance, swelling percentage, and total liquid absorption (g/g), cell viability, and release behavior. The results showed that AHA fibers produced by the second method have better mechanical performance, high liquid absorption, and swelling percentage with a more controlled release of hyaluronic acid. The AHA fibers showed high biocompatibility toward nHDF cell line in in-vitro testing, and the MVTR values (650-800 g/m2/day) are in a suitable range for maintaining a moist wound surface proving to be appropriate for promoting wound healing.
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Affiliation(s)
- Muhammad Umar
- Nano Fusion Technology Research Group, Institute for Fiber Engineering (IFES), Interdisciplinary Cluster for Cutting Edge Research (ICCER), Shinshu University, Tokida 3-15-1, Ueda, Nagano, Japan; Department of Materials, University of Manchester, Manchester, United Kingdom
| | - Azeem Ullah
- Nano Fusion Technology Research Group, Institute for Fiber Engineering (IFES), Interdisciplinary Cluster for Cutting Edge Research (ICCER), Shinshu University, Tokida 3-15-1, Ueda, Nagano, Japan
| | - Hifza Nawaz
- Department of Materials, University of Manchester, Manchester, United Kingdom
| | - Tanzeel Areeb
- Department of Bioengineering, Oakland University, Rochester Hill, USA
| | - Motahira Hashmi
- Nano Fusion Technology Research Group, Institute for Fiber Engineering (IFES), Interdisciplinary Cluster for Cutting Edge Research (ICCER), Shinshu University, Tokida 3-15-1, Ueda, Nagano, Japan
| | - Davood Kharaghani
- Department of Calcified Tissue Biology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, Japan
| | - Kyu Oh Kim
- Department of Fiber-System Engineering, Dankook University 152, Jookjeon-ro, Suji-gu, Yongin-si, Gyeonggi-do, Republic of Korea
| | - Ick Soo Kim
- Nano Fusion Technology Research Group, Institute for Fiber Engineering (IFES), Interdisciplinary Cluster for Cutting Edge Research (ICCER), Shinshu University, Tokida 3-15-1, Ueda, Nagano, Japan.
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S. S, A. SK, Nair PD, Thomas LV. A nonadherent chitosan-polyvinyl alcohol absorbent wound dressing prepared via controlled freeze-dry technology. Int J Biol Macromol 2020; 150:129-140. [DOI: 10.1016/j.ijbiomac.2020.01.292] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 01/29/2020] [Accepted: 01/29/2020] [Indexed: 11/28/2022]
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Wlaschin KF, Ninkovic J, Griesgraber GW, Colak Atan S, Young AJ, Pereira JM, Solberg MJ, Smith G, Parks PJ, McNulty AK, Langer-Anderson DL. The impact of first-aid dressing design on healing of porcine partial thickness wounds. Wound Repair Regen 2019; 27:622-633. [PMID: 31276609 DOI: 10.1111/wrr.12747] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 06/18/2019] [Accepted: 06/30/2019] [Indexed: 11/30/2022]
Abstract
Literature describes that a well-maintained moist wound healing environment leads to faster healing by preventing scabbing and drying of the wound. A moist wound speeds healing by allowing for unimpeded movement of newly dividing epidermal cells in the wound. Contrary to what is described in literature and practiced by clinicians, first-aid dressings used at home by consumers advertise breathability and absorptivity as benefits. This manuscript examines the effects of dressing breathability and highly absorptive pads on healing and wound appearance in a porcine dermatome wound model, designed to mimic an abrasion injury. Partial thickness wounds were covered with an experimental silicone-polymer film dressing and various over-the-counter bandages for time frames ranging from 4 to 11 days. The progression of healing was quantified by histology and wound-size reduction measurements. The thickness and persistence of a scab or serocellular crust (SCC) over the injury was measured using both pixel density and optical coherence tomography to supplement visual observations, demonstrating new tools for quantification of SCC over wounds. The results of the experiments illustrate the impact of dressing features on the rate of wound reepithelialization and the formation of SCC. Both a low moisture vapor transmission rate (MVTR) and the absence of an absorptive layer were important in speeding wound healing. Surprisingly, use of a dressing with a low MVTR and a highly absorptive pad healed significantly more slowly than a comparative dressing with a low MVTR and no absorptive pad, even though both dressings had very little scab formation over the wound. This study shows that breathability and absorbency of dressings play independent roles in providing an optimal healing environment, and that these properties can vary widely among commercially available dressings.
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Affiliation(s)
| | - Jana Ninkovic
- 3M Corporate Materials Research Labs, Saint Paul, Minnesota
| | | | | | - Alexi J Young
- 3M Corporate Materials Research Labs, Saint Paul, Minnesota
| | | | | | - Graham Smith
- 3M Health Care Business Group, Saint Paul, Minnesota
| | | | - Amy K McNulty
- 3M Medical Solutions Division, Saint Paul, Minnesota
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Tsioli V, Gouletsou PG, Galatos AD, Psalla D, Lymperis A, Sideri AI, Papazoglou LG. The Effect of a Hydrocolloid Dressing on Second Intention Wound Healing in Cats. J Am Anim Hosp Assoc 2018; 54:125-131. [PMID: 29558215 DOI: 10.5326/jaaha-ms-6604] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The objective of the present study was to evaluate the effect of a hydrocolloid dressing on second intention wound healing in cats. Two full-thickness skin wounds, measuring 2 × 2 cm, were created on both sides of the dorsal midline of 10 cats; bilaterally, one randomly selected wound was bandaged with a hydrocolloid dressing and the second one (control) with a semiocclusive pad. Subjective clinical evaluation of granulation tissue formation, of the quantity and nature of wound exudate, and planimetry were performed on the right-side wounds, and histological examination on the left. No significant differences in subjective clinical evaluation or in planimetry were observed between the hydrocolloid-treated wounds and controls. Most wounds had serous or absence of exudate (41.25% and 25%, respectively), whereas purulent exudate was observed in 7.5% of wounds. Edema was significantly increased in the hydrocolloid-treated wounds compared with controls on day 7 but no significant differences in the other histological variables were observed.
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Affiliation(s)
- Vassiliki Tsioli
- From the Department of Surgery (V.T., A.D.G., A.L., A.I.S.) and Department of Obstetrics and Reproduction (P.G.G.), Faculty of Veterinary Medicine, University of Thessaly, Karditsa, Greece; and the Department of Clinical Studies, Companion Animal Clinic (L.G.P.), and Laboratory of Pathology (D.P.), School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Pagona G Gouletsou
- From the Department of Surgery (V.T., A.D.G., A.L., A.I.S.) and Department of Obstetrics and Reproduction (P.G.G.), Faculty of Veterinary Medicine, University of Thessaly, Karditsa, Greece; and the Department of Clinical Studies, Companion Animal Clinic (L.G.P.), and Laboratory of Pathology (D.P.), School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Apostolos D Galatos
- From the Department of Surgery (V.T., A.D.G., A.L., A.I.S.) and Department of Obstetrics and Reproduction (P.G.G.), Faculty of Veterinary Medicine, University of Thessaly, Karditsa, Greece; and the Department of Clinical Studies, Companion Animal Clinic (L.G.P.), and Laboratory of Pathology (D.P.), School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitra Psalla
- From the Department of Surgery (V.T., A.D.G., A.L., A.I.S.) and Department of Obstetrics and Reproduction (P.G.G.), Faculty of Veterinary Medicine, University of Thessaly, Karditsa, Greece; and the Department of Clinical Studies, Companion Animal Clinic (L.G.P.), and Laboratory of Pathology (D.P.), School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Antonios Lymperis
- From the Department of Surgery (V.T., A.D.G., A.L., A.I.S.) and Department of Obstetrics and Reproduction (P.G.G.), Faculty of Veterinary Medicine, University of Thessaly, Karditsa, Greece; and the Department of Clinical Studies, Companion Animal Clinic (L.G.P.), and Laboratory of Pathology (D.P.), School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aikaterini I Sideri
- From the Department of Surgery (V.T., A.D.G., A.L., A.I.S.) and Department of Obstetrics and Reproduction (P.G.G.), Faculty of Veterinary Medicine, University of Thessaly, Karditsa, Greece; and the Department of Clinical Studies, Companion Animal Clinic (L.G.P.), and Laboratory of Pathology (D.P.), School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Lyssimachos G Papazoglou
- From the Department of Surgery (V.T., A.D.G., A.L., A.I.S.) and Department of Obstetrics and Reproduction (P.G.G.), Faculty of Veterinary Medicine, University of Thessaly, Karditsa, Greece; and the Department of Clinical Studies, Companion Animal Clinic (L.G.P.), and Laboratory of Pathology (D.P.), School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Yang Y, Hu H. Application of Superabsorbent Spacer Fabrics as Exuding Wound Dressing. Polymers (Basel) 2018; 10:E210. [PMID: 30966246 PMCID: PMC6415116 DOI: 10.3390/polym10020210] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 02/14/2018] [Accepted: 02/20/2018] [Indexed: 01/22/2023] Open
Abstract
Exuding wound care requires a dressing to quickly absorb exudates and properly manage moisture during the healing process. In this study, the superabsorbent spacer fabrics were designed and fabricated for application in exuding wound dressings. The fabric structure consists of three layers, including two outer hydrophobic layers made of polyester/spandex yarns and one superabsorbent middle layer made of superabsorbent yarns. In order to confirm the performance of these superabsorbent spacer fabrics, their dressing properties were tested and compared with two commercial foam dressings. The results showed that all the superabsorbent spacer fabrics had much faster wetting speeds (less than 2 s) than the foam dressings (6.04 s for Foam A and 63.69 s for Foam B). The absorbency of the superabsorbent spacer fabrics was at least twice higher than that of the foam dressings. The air permeability of the superabsorbent spacer fabrics (higher than 15 mL/s/cm² at 100 Pa) was much higher than that of the foam dressings which had a too low permeability to be measured by the testing device. In addition, the water vapor permeability, thermal insulation, and conformability of superabsorbent spacer fabrics were comparable to foam dressings. The study indicates that the superabsorbent spacer fabrics are suitable for exuding wound dressing applications.
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Affiliation(s)
- Yadie Yang
- Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China.
| | - Hong Hu
- Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China.
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Debridement Techniques and Non–Negative Pressure Wound Therapy Wound Management. Vet Clin North Am Small Anim Pract 2017; 47:1181-1202. [DOI: 10.1016/j.cvsm.2017.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Mahajan K, Verma V, Singh GK, Kumar S, Avasthi S. A Randomized Controlled Study to Compare Conventional and Evidence Based Treatment Protocols in Fresh Compound Fractures. J Clin Diagn Res 2016; 10:RC01-RC05. [PMID: 27790530 PMCID: PMC5072030 DOI: 10.7860/jcdr/2016/19234.8405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 06/06/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION A recent concept review in Journal of Bone and Joint Surgery (JBJS) outlines evidence to control peri-operative infections in compound fractures. However, evidence for impact of adopting a protocol combining measures that have some evidence is lacking in literature. The present method of treatment at King George's Medical University (KGMU) is representative of the conventional practice of managing compound fractures in India and is an appropriate control for trial against the Experimental Evidence Based Protocol (EBP). AIM To study the additional impact of adopting Evidence Based Protocol on parameters defining infection rate and bone union. MATERIALS AND METHODS This randomized controlled study was conducted at the orthopaedics department of KGMU. Two hundred and twenty six patients of compound fractures of both bone leg, age > 12y were randomized to two groups. One group received standard treatment and the experimental group received treatment as per JBJS review. STATISTICAL ANALYSIS Random allocation was tested by comparing baseline characteristics of the two groups. The two groups were compared for all the outcome variables in terms of time to a negative wound culture, time to wound healing, time to union at fracture site and time to achieve complete range of motion at knee joint. RESULTS Random allocation was successful. EBP group reported significantly lesser time to a negative culture report from wound (mean in conventional=4.619, experimental=1.9146, p=0.0006), lesser time to bony union (mean in conventional=23.8427 weeks, experimental=22.8125 weeks, p=0.0027), lesser time to wound healing (mean in conventional=14.4425 weeks experimental=10.4513 weeks, p=0.0032), and a lesser duration of hospital stay (mean in conventional=6.5982 days, experimental=4.5000 days, p=0.0343). CONCLUSION EBP based on the guidelines suggested by Fletcher et al., significantly shorten the time taken for achieving a negative culture and hasten wound and fracture healing. Therefore EBP is recommended for use in settings like the KGMU trauma center.
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Affiliation(s)
- Kanika Mahajan
- PhD, Department of Orthopedic Surgery, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Vikas Verma
- Associate Professor, Department of Orthopedic Surgery, Era’s Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India
| | - Girish Kumar Singh
- Director, All India Institute of Medical Sciences-Patna, Patna, Bihar, India
| | - Santosh Kumar
- Professor, Department of Orthopedic Surgery, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Sachin Avasthi
- Associate Professor, Department of Emergency Medicine, Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Effects of two occlusive, hydrocolloid dressings on healing of full-thickness skin wounds in cats. Vet Comp Orthop Traumatol 2016; 29:298-305. [PMID: 27326422 DOI: 10.3415/vcot-15-04-0058] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 03/16/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To determine the effects of two occlusive, hydrocolloid dressings on second intention wound healing in cats. METHODS Three 2×2 cm full-thickness skin wounds were created on each side of the trunk of 10 cats. Two bilateral wounds were bandaged using different hydrocolloid dressings, namely Hydrocoll and DuoDerm while a semi-occlusive pad (Melolin) was applied to the third bilateral wound (control group). Wound planimetry, subjective evaluation of wound healing, and qualitative bacterial cultures were performed on the right-sided wounds, whereas left-sided wounds were subjected to histological examination. RESULTS Subjective evaluation revealed accelerated (p <0.01) granulation tissue formation in hydrocolloid-treated wounds. The amount of wound exudate was initially greater (p <0.01) in these wounds. Seventeen out of 120 evaluated wounds (14.2%) produced purulent exudate, 11 of which showed Staphylococcus aureus growth. Fewer control wounds (3/17) emitted purulent exudate, but all of them yielded moderate bacterial growth as compared to hydrocolloid-treated wounds (8/17) which had a low incidence of bacterial growth. The only significant difference in histological variables was increased cellular infiltration noted on day 7 in Hydrocoll-treated wounds compared to controls. No significant differences in planimetry variables were found between groups. CLINICAL SIGNIFICANCE Despite the initially increased amount of wound exudate and the low growth of Staphylococcus aureus, hydrocolloid dressings accelerate granulation tissue formation and can hence be suggested for second intention wound healing in cats.
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Han HH, Oh DY. Selection of dressing materials in chronic wound management. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2015. [DOI: 10.5124/jkma.2015.58.9.809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Hyun Ho Han
- Department of Plastic and Reconstructive Surgery, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Deuk Young Oh
- Department of Plastic and Reconstructive Surgery, The Catholic University of Korea College of Medicine, Seoul, Korea
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Abstract
Covering wounds, acute and chronic, is one of the most fundamental activities of any medical practitioner. Although wound dressings primarily serve to contain the "good" and keep out the "bad," research has characterized more specifically the sophisticated interaction between the human wound bed and its dressing counterpart. Wound dressings for today's chronic wounds come in many flavors, ranging from the classic types of moisture-retentive dressings to silver-coated varieties to biologic dressings serving as skin substitutes. Moisture-retentive dressing types include foams, films, hydrogels, hydrocolloids, and alginates. Appropriate use of these dressings can help to keep the wound bed moist, which allows for epithelial migration, angiogenesis, retention of growth factors, autolytic debridement, and maintenance of electrical gradients.
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Abstract
The concept of wound bed preparation (WBP) heralded a new era in terms of how we treat wounds. It emphasized the difference between acute and chronic wounds, and it cemented the idea that the processes involved in the healing of acute wounds do not apply completely to the healing of chronic wounds. The arbitrary division of the normal healing process into the phases of hemostasis, inflammation, proliferation, and maturation addresses the events in acute wound healing. We have realized that the impediments to healing in chronic wounds lead to a failure to progress through these phases and are independent factors that make the chronic wound a much more complex condition. A major advance in resolving or addressing the chronic wound has been the concept of WBP. WBP allows us to address the problems of wound healing individually the presence of necrotic tissue, hypoxia, high bacterial burden, corrupt matrix, and senescent cells within the wound bed. In WBP we can optimize our therapeutic agents to accelerate endogenous healing or to increase the effectiveness of advanced therapies.
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Abstract
CONTEXT Acute skin trauma during sport participation, resulting in partial-thickness abrasions, is common. The limited investigations focusing on the acute wound environment and dressing techniques and the subsequent lack of evidence-based standards complicate clinical wound care decisions. OBJECTIVE To examine the effects of occlusive dressings on healing of standardized, partial-thickness abrasions. DESIGN Controlled, counterbalanced, repeated-measures design. SETTING University laboratory. PATIENTS OR OTHER PARTICIPANTS Sixteen healthy women (n = 10) and men (n = 6). INTERVENTION(S) Four standardized, partial-thickness abrasions were inflicted. Film, hydrogel, and hydrocolloid occlusive dressings and no dressing (control) were applied. Participants returned on postwound days 1, 3, 5, 7, 10, and 14 for digital imaging. Wound healing time was measured by change in wound contraction (cm(2)) and change in wound color (chromatic red) and luminance in red, green, and blue color values. MAIN OUTCOME MEASURE(S) Wound contraction, color (chromatic red), and luminance. RESULTS A day-by-dressing interaction was found for wound contraction, color, and luminance. Post hoc testing indicated that the film and hydrocolloid dressings produced greater wound contraction than the hydrogel and no dressing on days 7 and 10. Film, hydrogel, and hydrocolloid dressings also resulted in greater wound contraction than the control on day 14. Hydrocolloid dressings produced smaller measures of color and greater measures of luminance than no dressing on day 7. Film, hydrogel, and hydrocolloid dressings also resulted in smaller measures of color and greater measures of luminance compared with no dressing on days 10 and 14. CONCLUSIONS When compared with the control (no dressing), the film, hydrogel, and hydrocolloid occlusive dressings were associated with a faster healing rate of partial-thickness abrasions across time measured by wound contraction, color, and luminance. Overall, these data indicate that occlusive dressings were more effective in healing than no dressing was.
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Affiliation(s)
- Joel W Beam
- University of North Florida, Brooks College of Health, Athletic Training & Physical Therapy Department, Jacksonville, FL 32224, USA.
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High-valve vapor-permeable film dressing versus fine mesh gauze dressing on skin graft donor areas in diabetic patients: a prospective randomized controlled trial. EUROPEAN JOURNAL OF PLASTIC SURGERY 2008. [DOI: 10.1007/s00238-008-0273-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
The concept of wound bed preparation (WBP) heralded a new era in terms of how we treat wounds. It emphasized the difference between acute and chronic wounds, and it cemented the idea that the processes involved in the healing of acute wounds do not apply completely to the healing of chronic wounds. The arbitrary division of the normal healing process into the phases of hemostasis, inflammation, proliferation, and maturation addresses the events in acute wound healing. We have realized that the impediments to healing in chronic wounds lead to a failure to progress through these phases and are independent factors that make the chronic wound a much more complex condition. A major advance in resolving or addressing the chronic wound has been the concept of WBP. WBP allows us to address the problems of wound healing individually-the presence of necrotic tissue, hypoxia, high bacterial burden, corrupt matrix, and senescent cells within the wound bed. In WBP we can optimize our therapeutic agents to accelerate endogenous healing or to increase the effectiveness of advanced therapies.
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Affiliation(s)
- Jaymie Panuncialman
- Department of Dermatology and Skin Surgery, Roger Williams Medical Center, Providence, RI 02908, USA
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Rajendran S, Rigby AJ, Anand SC. Venous leg ulcer treatment and practice — part 2: wound management. J Wound Care 2007; 16:68-70. [PMID: 17319620 DOI: 10.12968/jowc.2007.16.2.27005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- S Rajendran
- Centre for Materials Research and Innovation, University of Bolton, Bolton, UK.
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Abstract
PURPOSE To provide an overview of moisture balance and its importance in wound healing. TARGET AUDIENCE This continuing education activity is intended for physicians and nurses with an interest in wound care. OBJECTIVES After reading this article and taking the test, the reader should be able to: 1. Discuss the wound healing process and wound assessment. 2. Describe the types of dressings available and how they meet the needs of the individual patient.
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Affiliation(s)
- Denis Okan
- Memorial University of Newfoundland, St. John's, Newfoundland, Canada
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Abstract
Decubitus ulcers appear to be associated with insidious trauma. Differential diagnosis can be tricky, and etiology is controversial with sustained localized pressure which plays a significant role. Sustained pressure can stretch soft tissues and blood vessels, causing multiple microthrombi around the point of maximum compression. This leads to prolonged ischemia and produces a plaque of dead tissue surrounded by microthrombi. Prevention often includes regular movement or supports that move the patient. Good nutrition is important, but the adverse effects of fever should not be overlooked. Anti-thrombotic agents should be considered. Occlusive dressings can be used for existing ulcers, while traditional treatments are less appropriate. Pressure and other stresses theoretically should be relieved.
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Affiliation(s)
- Lawrence Charles Parish
- Department of Dermatology and Cutaneous Biology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA 19107, USA.
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25
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Abstract
Optimal management of full-thickness wounds requires a thorough knowledge of wound-healing principles and practices. In the absence of underlying disease, almost every full-thickness wound will heal with minimal intervention; however, the process can be enhanced by judicious wound management. The first clinical decision to be made is whether to repair the wound or to allow it to heal by second intention. This decision is guided by a host of objective and subjective factors. Reconstruction options include primary closure, flaps, and grafts. Materials to aid reconstruction, including the introduction of tissue adhesives, continue to evolve. Both primary and secondary intention wounds are aided by occlusive dressings and adjutants. A plethora of wound-healing adjuncts have been developed to aid wound healing in diseased states, and a working knowledge of their use is beneficial in managing all full-thickness wounds.
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Affiliation(s)
- Albert E Rivera
- Department of Dermatology, Mt Sinai School of Medicine, New York, NY, USA
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26
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Mosti G, Iabichella ML, Picerni P, Magliaro A, Mattaliano V. The debridement of hard to heal leg ulcers by means of a new device based on Fluidjet technology. Int Wound J 2006; 2:307-14. [PMID: 16618317 PMCID: PMC7951525 DOI: 10.1111/j.1742-4801.2005.00147.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Debridement plays an essential role in the wound-bed preparation of necrotic and sloughy ulcers, being a mandatory step to achieve a well-debrided bed, proceeding towards healing. This study reports our experience with Versajet [Versajet Hydrosurgery System (Smith & Nephew, Hull, UK)], a new device for the debridement of exudating ulcers, based on Fluidjet technology, which excises and aspirates the unwanted tissue by using the Venturi effect. In a 10-month time period, a total of 68 patients, out of a setting of 167 patients, hospitalised as affected by chronic, hard-to-heal leg ulcers, stuck in the inflammatory phase, were treated with Versajet. Based on ulcer characteristics and clinical conditions, the remaining 99 patients underwent traditional debridement with moist dressings (controls). In the majority of Versajet-treated cases (46), an adequately debrided wound bed was achieved with one operative procedure; two and three procedures were required in 17 and 5 patients, respectively. Almost all the procedures were performed in the ward at the patient's bedside. This procedure is quick (mean time per treatment is about 5 minutes); when compared with a traditional treatment with moist dressings, Versajet considerably shortens the in-hospital stay and promotes a quicker healing process. When used by an experienced surgeon, Versajet allows a selective debridement, as it makes it possible to remove only the tissue centred in the working end and spare the healthy tissue. Debriding with Versajet is highly effective in reducing the bacterial load of the ulcer bed. The pain caused by Versajet is well tolerated, especially when set for gentle debridement. If multiple treatments are required, the combined use with moist dressings is synergistic, as the dressings soften the necrotic tissue, thus facilitating the following Versajet debridement. The results indicate that Versajet offers more precision than standard mechanical debridement and, at high settings, offers an alternative to surgical debridement.
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Affiliation(s)
- Giovanni Mosti
- Reparto di Angiologia e Cardiologia, Clinica Barbantini, Lucca, Italia
| | | | - Pietro Picerni
- Reparto di Angiologia e Cardiologia, Clinica Barbantini, Lucca, Italia
| | - Antonio Magliaro
- Reparto di Angiologia e Cardiologia, Clinica Barbantini, Lucca, Italia
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27
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Abstract
Pressure ulcers are complex chronic wounds for which no gold standard for prevention or treatment has yet been established. Several attempts at developing guidelines has been undertaken by different organizations. Pressure ulcers are devastating comorbidities for patients and difficult to prevent or manage. Whether or not pressure ulcers are preventable remains controversial. The strategy for prevention includes recognizing the risk, decreasing the effects of pressure, assessing nutritional status, avoiding excessive bed rest and prolonged sitting, and preserving the integrity of the skin. The principles of treatment of pressure ulcers include assessing severity, reducing pressure, friction and shear forces, optimizing local wound care, removing necrotic debris, managing bacterial contamination, and correcting nutritional deficits.
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Affiliation(s)
- David R Thomas
- Division of Geriatric Medicine, St Louis University Health Sciences Center, St Louis, MO 63104, USA.
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28
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Abstract
Nasal packing is used to control bleeding in epistaxis and after endonasal surgery, for internal stabilization, and to prevent synechiae or restenosis, particularly after surgery. Generally accepted standards regarding the materials that should be used for packing, how long the packing should be left in place, or the indications for nasal packing are lacking. In view of the present lack of standardization and the many different packing materials used, we review the currently available materials and outline their respective properties, indications, and risks.
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Affiliation(s)
- R Weber
- Department of ENT-Head and Neck Surgery, Marienhospital, Stuttgart, Germany
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29
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Davis SC, Eaglstein WH, Cazzaniga AL, Mertz PM. An octyl-2-cyanoacrylate formulation speeds healing of partial-thickness wounds. Dermatol Surg 2001; 27:783-8. [PMID: 11553164 DOI: 10.1046/j.1524-4725.2001.00322.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Occlusive dressings have been known to accelerate the rate of healing. Every year new dressings are being introduced in the marketplace. OBJECTIVE The purpose of this study was to evaluate the effect of a new octyl-2-cyanoacrylate liquid dressing as compared to two over-the-counter bandages on partial-thickness wounds. Performance parameters were epithelialization, erythema, scab formation, material adherence, hemostasis, and infection. METHOD Eight pigs with a total of 645 partial-thickness wounds were assigned to one of the following treatments: liquid dressing, standard bandage, hydrocolloid bandage, or untreated air exposed. RESULT The liquid bandage enhanced the rate of epithelialization and was the only treatment to provide complete hemostasis, reduced scab formation, and did not induce an irritant response (erythema) or infection. CONCLUSION The liquid bandage is an easy to use material that stops bleeding (instantaneous hemostasis) while enhancing healing of partial-thickness wounds.
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Affiliation(s)
- S C Davis
- Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, Miami, Florida 33136, USA.
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30
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An Octyl-2-Cyanoacrylate Formulation Speeds Healing of Partial-Thickness Wounds. Dermatol Surg 2001. [DOI: 10.1097/00042728-200109000-00001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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31
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Thomas DR. Issues and dilemmas in the prevention and treatment of pressure ulcers: a review. J Gerontol A Biol Sci Med Sci 2001; 56:M328-40. [PMID: 11382790 DOI: 10.1093/gerona/56.6.m328] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Considerable dogma and rhetoric, rather than evidence-based results, have accompanied recommendations for the prevention and treatment of pressure ulcers. Therapy for pressure ulcers is generally empiric, based on anecdotal experience, or borrowed from the treatment of patients with acute wounds. The treatment of pressure ulcers is problematic because of multiple comorbidities of patients, the chronic duration of pressure ulcers, and often by the physician's relative unfamiliarity with treatment options. Issues and dilemmas in the prevention of pressure ulcers center around risk assessment, means of pressure relief, and nutritional support. Similar issues in the treatment of pressure ulcers include implementing pressure relief, nutritional support, local wound care, the best method of debridement, diagnosing infection, the use of topical growth factors, and surgical treatment. The accumulating data for the prevention and management of pressure ulcers permits an outline of clinical strategies.
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Affiliation(s)
- D R Thomas
- Division of Geriatric Medicine, Saint Louis University Health Sciences Center, Missouri, USA.
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32
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Abstract
Decreasing hospital length of stay has dictated that postacute and long-term care facilities bear the brunt of treating acute and chronic wounds. Two types of chronic wounds are discussed: (1) pressure ulcers and (2) diabetic ulcers. The differential diagnosis of these ulcers is imperative because the management of both types of wound differs substantially. Wound therapy includes relieving pain, correcting nutritional deficiencies, maintaining an optimal wound environment, shielding the wound from further damage, removing necrotic debris, promoting granulation tissue formation, protecting against bacterial contamination, choosing an appropriate dressing, and surgical treatment. The application of these principles is discussed, and the differences among wound types are highlighted.
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Affiliation(s)
- D R Thomas
- Division of Geriatric Medicine, Department of Internal Medicine, St. Louis University Health Sciences Center, St. Louis, Missouri 63104, USA
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33
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Davis SC, Badiavas E, Rendon-Pellerano MI, Pardo RJ. Histological comparison of postoperative wound care regimens for laser resurfacing in a porcine model. Dermatol Surg 1999; 25:387-91; discussion 392-3. [PMID: 10469078 DOI: 10.1046/j.1524-4725.1999.08116.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The use of short-pulsed CO2 lasers for skin resurfacing is routinely performed, but few studies have examined postsurgical care. OBJECTIVE To determine which postoperative treatments are most beneficial in promoting optimal healing after laser resurfacing. METHODS Four pigs received laser resurfacing. The laser sites were randomly left untreated or treated with petroleum-based ointment or dressed with 1 of the following occlusive dressings: hydrocolloid, hydrogel or foam. Biopsies were taken from each treatment group on Days 2, 3, 4, 5, 8, 12, and 19. All samples were stained with hematoxylin and eosin. Each histological slide was evaluated by a blinded investigator. RESULTS Differences were observed between treatment groups in the amount of cellular infiltrate, presence of necrotic tissue, progression of the epidermal sheet, maturation of the epidermis, presence of rete ridges, and appearance of new collagen. CONCLUSION Postoperative treatments after laser resurfacing vary in their ability to influence the quality of healing.
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Affiliation(s)
- S C Davis
- Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, Miami, Florida 33136, USA
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34
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Abstract
Laser resurfacing has become a commonly used technique for the treatment of a variety of skin conditions including facial actinic damage, rhytides, and acne scarring. Although the procedure has the ability to deliver consistently good results with an excellent safety profile, complications do occur even in the best of hands. Independent of the type of laser used or the surgical technique, the risk of complications and the final outcome can be greatly influenced by the care of the skin before and after the procedure. This article will focus on the preoperative assessment of the patient, the concept of preconditioning the skin, and postoperative wound management after laser resurfacing. Various occlusive dressing products will be discussed, as well as their role in wound healing. A pre- and posttreatment skin care regimen will be provided to use as a guide in the management of patients undergoing laser resurfacing.
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Affiliation(s)
- S L Hrabovsky
- Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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35
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Affiliation(s)
- J A Witkowski
- University of Pennsylvania School of Medicine, Pennsylvania College of Pediatric Medicine, Philadelphia, USA
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36
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Abstract
Wound care after cutaneous surgery can play an integral role in wound healing. Wound care regimens have changed dramatically over the last 35 years as the physiology of wound healing has become better understood. Foremost is the improvement in wound healing achieved by keeping the wound occluded and moist. This observation has led to an explosion of a whole new category of occlusive dressings at the surgeon's disposal in healing postoperative wounds. These dressings have numerous applications as discussed previously. Generally, for acute surgical wounds, occlusive dressings are most useful for split-thickness wounds, such as graft donor sites and after dermabrasion, chemical peel, or laser treatment, and full-thickness wounds allowed to heal by secondary intention. Occlusive dressings may have greater benefit for the treatment of chronic ulcers of varying etiologies. The different categories of dressings share the common disadvantage of being relatively expensive. For routine sutured wounds, the authors prefer the readily available and inexpensive Telfa-type dressing combined with a topical antibiotic ointment. Topical antiseptics are useful for reducing bacterial counts on intact skin in preparation for surgery. Povidone-iodine (Betadine) and chlorhexidine gluconate (Hibiclens) have emerged as the two agents of choice. However, antiseptics have been shown to be toxic to healing tissue, and should not be used on open wounds. In contrast, topical antibiotic ointments are safe to use on open wounds, effective in preventing wound infections, and promote wound healing by maintaining a moist wound environment. The authors prefer the combination antibiotic ointment Polysporin for routine postoperative wound care. Antibiotic prophylaxis in dermatologic surgery to prevent wound infection is appropriate in certain cases. Surgery performed on grossly contaminated or infected skin requires a full 7 to 10 day course of antibiotics. Procedures in anatomic areas considered contaminated as well as in clean areas with significant environmental or patient risk factors may benefit from antibiotic prophylaxis. The choice of antibiotics should be based on the organism most likely to cause wound infection at the particular surgical site. Evidence supports giving a single preoperative dose 1 hour before surgery with a second dose possible 6 hours later if the procedure is prolonged or delayed. The risk of bacterial endocarditis after dermatologic surgery is not known. Antibiotics are indicated for any procedure on obviously infected skin, but are not routinely required for very minor procedures, such as small biopsies, on intact skin. Antibiotic prophylaxis may be prudent for those patients classified as high risk by the (AHA). The antibiotic chosen should again cover the organism most likely to cause infection. One dose can be given 1 hour before surgery and repeated 6 hours postoperatively. Finally, wound healing can be greatly impacted by what the patient does or does not do after leaving the office. Therefore, wound care instructions should be clear, detailed, and provided in both oral and written form. Information should also be provided about what to expect as the wound heals.
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Affiliation(s)
- C Y Cho
- Department of Dermatology, Mohs Micrographic and Cutaneous Reconstructive Surgery Center, Southern California Permanente Medical Group, Fontana, USA
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37
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Abstract
The properties of an ideal wound dressing do not change with the introduction of new types of wound dressing, but the range of effects on wound healing increases. The number of dressings available is enormous, and the choice between them is often bewildering. Because there is still no ideal dressing for all wound types, it is necessary to get to know a few well, and to avoid switching to new therapies solely on the basis of anecdotal reports. The adoption of novel dressings should be based on scientific evidence. At present, dressings are still chosen on the basis of local traditions and personal empirical experience, together with evidence from the few double-blind, placebo-controlled trials that have been performed. In the management of ulcers, a particular wound management plan should not be changed if the ulcer being treated is decreasing in size and the patient is comfortable. The dressing should be chosen with care. The type of chronic ulcer and its appearance, the amount of exudate and the presence or absence of pain all assist in the selection of an appropriate wound dressing product. Quality-of-life aspects are important. In the elderly, good quality of life may not necessarily require complete ulcer healing, although this is naturally desirable. Dressing changes should be minimised and the ulcer should be kept moist and the surrounding skin dry. The high cost of interactive dressings is a potential disadvantage of their use. However, if the wound can be re-dressed at longer intervals and if healing occurs more quickly, their use may be cost effective and associated with less pain and a better quality of life.
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Affiliation(s)
- C Hansson
- Department of Dermatology, Sahlgrenska University Hospital, Gothenburg, Sweden.
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38
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Abstract
BACKGROUND Occlusive dressings have become increasingly popular in the management of wound care. Numerous types of occlusive dressings are presently available for the treatment of acute and chronic wounds. Occlusion enhances wound healing primarily by preventing wound dessication. As a result, epidermal necrosis and eschar formation do not occur, and wounds reepithelialize more quickly. OBJECTIVE Choosing a dressing to meet the specific needs of the patient can often become confusing for the physician. We review the various types of occlusive dressings and their advantages and disadvantages in the practical management of acute and chronic wounds. METHODS A literature review of the subject was performed. RESULTS Occlusive dressings enhance reepithelialization by preventing wound dessication. Lower infection rates are generally achieved despite bacterial proliferation under some occlusive dressings. CONCLUSION Occlusive dressings simplify wound care and are an excellent choice in the management of most acute and chronic wounds. This review should enable the clinician to choose the best dressing to meet the individual wound of the patient.
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Affiliation(s)
- G A Kannon
- Department of Dermatology, Medical College of Virginia, Richmond 23298, USA
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39
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Affiliation(s)
- L C Parish
- Department of Dermatology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
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40
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Affiliation(s)
- T Helfman
- Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, FL 33136
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41
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Abstract
Maintaining a moist wound environment facilities the wound-healing process. The beneficial effects of a moist versus a dry wound environment include: prevention of tissue dehydration and cell death, accelerated angiogenesis, increased breakdown of dead tissue and fibrin, i.e., pericapillary fibrin cuffs, and potentiating the interaction of growth factors with their target cells. In addition, pain is significantly reduced when wounds are covered with an occlusive dressing. Concerns that moisture in wounds would increase the risk of clinical infection over traditional therapies are unfounded. The use of hydrocolloid occlusive dressings in maintaining a moist wound environment has proved to be a useful adjunct in facilitating wound healing.
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Affiliation(s)
- F K Field
- Department of Surgery, Hahnemann University School of Medicine, Philadelphia, Pennsylvania 19102-1192
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