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Elver AA, Wirtz K, Hu J, Daon E. Treatment of Cardiac Surgical Wounds with Silver Dressings. Kans J Med 2021; 14:269-272. [PMID: 34868467 PMCID: PMC8641440 DOI: 10.17161/kjm.vol14.15506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 07/08/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Mediastinitis is a deadly surgical site infection (SSI) after cardiac surgery. Although rare, mortality is as high as 47%. Best practices for infection prevention to eliminate this deadly complication must be identified. Surgical dressings impregnated with silver have been shown to reduce SSIs in other surgical specialties. The aim of this study was to determine if the routine use of silver surgical dressings is beneficial to prevent mediastinitis after cardiac surgery. Methods A single-center retrospective study was performed on patients who underwent sternotomy from 2016 to 2018 at the University of Kansas Medical Center. Prior to June 2017, all cardiac surgical patients were treated with gauze surgical dressings and designated as Group A. The routine use of silver-impregnated surgical dressings was implemented in June 2017; patients after this change in practice were designated as Group B. Patient characteristics and rates of deep and superficial sternal wound infections (SWI) were compared. Results There were 464 patients in Group A and 505 in Group B. There were seven SWIs in Group A (7/464, 1.5%) and five in Group B (5/505, 1%; p = 0.57). Of these, there was one deep SWI per group (p = 0.61) and six superficial SWIs in Group A compared to four in Group B (p = 0.74). Severe COPD was higher in Group A (p = 0.04) and peak glucose was higher in Group B (p = 0.02). Conclusions The analysis conferred no benefit with silver-impregnated surgical dressings to prevent mediastinitis. Choice of gauze surgical dressings may be preferable to reduce cost.
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Affiliation(s)
- Ashlie A Elver
- University of Kansas School of Medicine, Kansas City, KS
| | - Katy Wirtz
- University of Kansas Health System, Kansas City, KS
| | - Jinxiang Hu
- University of Kansas School of Medicine, Kansas City, KS.,Department of Biostatistics and Data Science, University of Kansas School of Medicine, Kansas City, KS
| | - Emmanuel Daon
- University of Kansas School of Medicine, Kansas City, KS.,Department of Cardiovascular and Thoracic Surgery, University of Kansas School of Medicine, Kansas City, KS
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Lee KS, Young A, King H, Jenkins ATA, Davies A. Variation in definitions of burn wound infection limits the validity of systematic review findings in burn care: A systematic review of systematic reviews. Burns 2021; 48:1-12. [PMID: 34127336 DOI: 10.1016/j.burns.2021.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/12/2021] [Accepted: 05/07/2021] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Systematic reviews (SR) of high-quality randomised controlled trials can identify effective treatments for burn wound infections (BWIs). Clinical heterogeneity in outcome definitions can prevent valid evidence synthesis, which may limit the reliability of the findings of SRs affected by this heterogeneity. This SR aimed to investigate whether there is variation BWI definitions across studies in SRs of burn care interventions and its impact on identification of effective treatments for patients with burn injuries. METHODS A systematic search of five databases was conducted. Included SRs were: in English, published from January 2010 to October 2018, assessed intervention effects for patients with a burn injury, and reported data about BWI. RESULTS Twenty-nine SRs, which included 248 studies reporting BWI outcomes, were included in our final dataset. Three SRs used a definition of BWI to select studies for inclusion. Fourteen reported BWI definitions from included studies in the review results. There was heterogeneity of BWI definition in their included studies; across 29 SRs, 32 different BWI indicators were used, with the median across SRs ranging from 1 to 7 (range 1-14). Fourteen SRs accounted for BWI definition heterogeneity in their conclusions, indicating that the issue impacted whether a conclusion could be drawn, and limited the validity of the SR findings. CONCLUSIONS There is variation in BWI definition across SRs and within the studies included in SRs of interventions assessing BWI outcomes. This heterogeneity has prevented conclusions about intervention effects being drawn, and only half of the SR authors have accounted for it in their findings. Reviews that have collated this data without reference to the heterogeneity should be viewed with caution, since it may limit the validity of evidence for the identification of effective treatments for BWI. The use of a newly developed core indicator set to support consistent reporting of indicators and standardisation of BWI outcome reporting will enable effective evidence synthesis.
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Affiliation(s)
- Keng Siang Lee
- Centre for Academic Child Health, University of Bristol, 1-5 Whiteladies Road, Bristol BS8 1NU, United Kingdom
| | - Amber Young
- Children's Burns Research Centre, Bristol Royal Hospital for Children, Bristol BS2 8BJ, United Kingdom; Bristol Centre for Surgical Research, Canynge Hall, University of Bristol, Bristol BS8 2PS, United Kingdom
| | - Hayley King
- Centre for Academic Child Health, University of Bristol, 1-5 Whiteladies Road, Bristol BS8 1NU, United Kingdom
| | - A Toby A Jenkins
- Department of Chemistry, University of Bath, BA2 7AY, United Kingdom
| | - Anna Davies
- Centre for Academic Child Health, University of Bristol, 1-5 Whiteladies Road, Bristol BS8 1NU, United Kingdom.
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Vaage SJ, Brudvik C, Vindenes H, Bergh TH, Steen K, Bernardshaw S. Does a polyurethane film improve the burn healing properties of an ionic silver hydro-fiber dressing in the treatment of minor partial-thickness burns? A retrospective review of medical records comparing healing time, patient satisfaction and medical costs in two different treatment modalities. BURNS OPEN 2021. [DOI: 10.1016/j.burnso.2021.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Roman M, Rigo C, Castillo-Michel H, Urgast DS, Feldmann J, Munivrana I, Vindigni V, Mičetić I, Benetti F, Barbante C, Cairns WRL. Spatiotemporal distribution and speciation of silver nanoparticles in the healing wound. Analyst 2020; 145:6456-6469. [DOI: 10.1039/d0an00607f] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
First observation of AgNPs dynamics in the wounds of real patients through elemental imaging and speciation.
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Affiliation(s)
- Marco Roman
- Ca’ Foscari University of Venice
- Department of Environmental Sciences
- Informatics and Statistics (DAIS)
- 30172 Venice Mestre
- Italy
| | - Chiara Rigo
- Ca’ Foscari University of Venice
- Department of Environmental Sciences
- Informatics and Statistics (DAIS)
- 30172 Venice Mestre
- Italy
| | | | - Dagmar S. Urgast
- University of Aberdeen
- Trace Element Speciation Laboratory
- Aberdeen AB24 3UE
- UK
| | - Jörg Feldmann
- University of Aberdeen
- Trace Element Speciation Laboratory
- Aberdeen AB24 3UE
- UK
- University of Graz
| | - Ivan Munivrana
- University Hospital of Padua
- Burns Centre
- Division of Plastic Surgery
- 35128 Padua
- Italy
| | - Vincenzo Vindigni
- University Hospital of Padua
- Burns Centre
- Division of Plastic Surgery
- 35128 Padua
- Italy
| | - Ivan Mičetić
- University of Padua
- Department of Biomedical Sciences
- 35131 Padua
- Italy
| | - Federico Benetti
- EcamRicert Srl
- European Centre for the Sustainable Impact of Nanotechnology (ECSIN)
- Corso Stati Uniti 4
- 35127 Padua
- Italy
| | - Carlo Barbante
- Ca’ Foscari University of Venice
- Department of Environmental Sciences
- Informatics and Statistics (DAIS)
- 30172 Venice Mestre
- Italy
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Lang TC, Zhao R, Kim A, Wijewardena A, Vandervord J, Xue M, Jackson CJ. A Critical Update of the Assessment and Acute Management of Patients with Severe Burns. Adv Wound Care (New Rochelle) 2019; 8:607-633. [PMID: 31827977 PMCID: PMC6904939 DOI: 10.1089/wound.2019.0963] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 04/18/2019] [Indexed: 12/14/2022] Open
Abstract
Significance: Burns are debilitating, life threatening, and difficult to assess and manage. Recent advances in assessment and management have occurred since a comprehensive review of the care of patients with severe burns was last published, which may influence research and clinical practice. Recent Advances: Recent advances have occurred in the understanding of burn pathophysiology, which has led to the identification of potential biomarkers of burn severity, such as protein C. There is new evidence about the potential superiority of natural colloids over crystalloids during fluid resuscitation, and new evidence about components of initial and perioperative management, including an improved understanding of pain following burns. Critical Issues: The limitations of the clinical examination highlight the need for imaging and biomarkers to assist in estimations of burn severity. Fluid resuscitation reduces mortality, although there is conjecture over the ideal method. The subsequent perioperative period is associated with significant morbidity and the evidence for preventing and treating pain, infection, and fluid overload while maximizing wound healing potential is described. Future Directions: Promising developments are ongoing in imaging technology, histopathology, biomarkers, and wound healing adjuncts such as hyperbaric oxygen therapy, topical negative pressure therapy, stem cell treatments, and skin substitutes. The greatest benefit from further research on management of patients with burns would most likely be derived from the elucidation of optimal fluid resuscitation protocols, pain management protocols, and surgical techniques from randomized controlled trials.
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Affiliation(s)
- Thomas Charles Lang
- Department of Anesthesia, Prince of Wales and Sydney Children's Hospitals, Randwick, Australia
| | - Ruilong Zhao
- Sutton Laboratories, The Kolling Institute, St. Leonards, Australia
| | - Albert Kim
- Department of Critical Care Medicine, Royal North Shore Hospital, St. Leonards, Australia
| | - Aruna Wijewardena
- Department of Burns, Reconstructive and Plastic Surgery, Royal North Shore Hospital, St. Leonards, Australia
| | - John Vandervord
- Department of Burns, Reconstructive and Plastic Surgery, Royal North Shore Hospital, St. Leonards, Australia
| | - Meilang Xue
- Sutton Laboratories, The Kolling Institute, St. Leonards, Australia
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Silver in Wound Care-Friend or Foe?: A Comprehensive Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2390. [PMID: 31592393 PMCID: PMC6756674 DOI: 10.1097/gox.0000000000002390] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 06/19/2019] [Indexed: 12/12/2022]
Abstract
Due to its strong antimicrobial activity, silver is a commonly used adjunct in wound care. However, it also has the potential to impair healing by exerting toxic effects on keratinocytes and fibroblasts. The published literature on the use of silver in wound care is very heterogeneous, making it difficult to generate useful treatment guidelines.
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Neres Santos AM, Duarte Moreira AP, Piler Carvalho CW, Luchese R, Ribeiro E, McGuinness GB, Fernandes Mendes M, Nunes Oliveira R. Physically Cross-Linked Gels of PVA with Natural Polymers as Matrices for Manuka Honey Release in Wound-Care Applications. MATERIALS (BASEL, SWITZERLAND) 2019; 12:E559. [PMID: 30781788 PMCID: PMC6416547 DOI: 10.3390/ma12040559] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 02/08/2019] [Accepted: 02/10/2019] [Indexed: 12/29/2022]
Abstract
Manuka honey is a well-known natural material from New Zealand, considered to have properties beneficial for burn treatment. Gels created from polyvinyl alcohol (PVA) blended with natural polymers are potential burn-care dressings, combining biocompatibility with high fluid uptake. Controlled release of manuka honey from such materials is a possible strategy for improving burn healing. This work aimed to produce polyvinyl alcohol (PVA), PVA⁻sodium carboxymethylcellulose (PVA-CMC), PVA⁻gelatin (PVA-G), and PVA⁻starch (PVA-S) cryogels infused with honey and to characterize these materials physicochemically, morphologically, and thermally, followed by in vitro analysis of swelling capacity, degradation/weight loss, honey delivery kinetics, and possible activity against Staphylococcus aureus. The addition of honey to PVA led to many PVA crystals with defects, while PVA⁻starch⁻honey and PVA⁻sodium carboxymethylcellulose⁻honey (PVA-CMC-H) formed amorphous gels. PVA-CMC presented the highest swelling degree of all. PVA-CMC-H and PVA⁻gelatin⁻honey presented the highest swelling capacities of the honey-laden samples. Weight loss/degradation was significantly higher for samples containing honey. Layers submitted to more freeze⁻thawing cycles were less porous in SEM images. With the honey concentration used, samples did not inhibit S. aureus, but pure manuka honey was bactericidal and dilutions superior to 25% honey were bacteriostatic, indicating the need for higher concentrations to be more effective.
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Affiliation(s)
| | | | - Carlos W Piler Carvalho
- Brazilian Agricultural Research Corporation/Embrapa Food Technology, Brasília 70770-901, Brazil.
| | - Rosa Luchese
- Department of food engineering, UFRRJ, Seropédica-RJ 23890-000, Brazil.
| | - Edlene Ribeiro
- Department of food engineering, UFRRJ, Seropédica-RJ 23890-000, Brazil.
| | - Garrett B McGuinness
- Centre for Medical Engineering Research, School of Mechanical and Manufacturing Engineering, Dublin City University, Dublin 9, Ireland.
| | | | - Renata Nunes Oliveira
- Postgraduate Program of Chemical Engineering/DEQ, UFRRJ, Seropédica-RJ 23890-000, Brazil.
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Nherera L, Trueman P, Horner A, Watson T, Johnstone AJ. Comparison of a twin interlocking derotation and compression screw cephalomedullary nail (InterTAN) with a single screw derotation cephalomedullary nail (proximal femoral nail antirotation): a systematic review and meta-analysis for intertrochanteric fractures. J Orthop Surg Res 2018; 13:46. [PMID: 29499715 PMCID: PMC5834859 DOI: 10.1186/s13018-018-0749-6] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 02/22/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Intertrochanteric hip fractures are common and devastating injuries especially for the elderly. Surgical treatment is the optimal strategy for managing intertrochanteric fractures as it allows early rehabilitation and functional recovery. The relative effects of internal fixation strategies for intertrochanteric fracture after operation remain limited to relatively small studies which create uncertainty in attempts to establish evidence-based best practice. METHODS We conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) and observational studies to assess the clinical effectiveness of two commonly used intramedullary devices: a twin screw integrated cephalomedullary nail (InterTAN) versus a single screw cephalomedullary nail (proximal femoral nail antirotation) in patients with intertrochanteric fractures. The following outcomes were considered: revisions, implant-related failures, non-unions, pain, Harris Hip Score and intraoperative outcomes. Odds ratios or mean differences with 95% confidence intervals in brackets are reported. RESULTS Six studies met the inclusion criteria, two randomised controlled trials and four observational studies enrolling 970 patients with mean age of 77 years, and 64% of patients were female. There was a statistically significant difference (p value < 0.05) for revisions OR 0.27 (0.13 to 0.56), implant-related failures OR 0.16 (0.09 to 0.27) and proportion of patients complaining of pain OR 0.50 (0.34 to 0.74). There was no difference in non-unions and Harris Hip Score (p value > 0.05). There was a significant difference in blood loss and fluoroscopy usage in favour of PFNA, whilst no difference in operating times were observed between the two devices. CONCLUSIONS Our meta-analysis suggests that a twin screw integrated cephalomedullary nail InterTAN is clinically more effective when compared to a single screw cephalomedullary nail proximal femoral nail antirotation resulting in fewer complications, fewer revisions and fewer patients complaining of pain. No difference has been established regarding non-unions and Harris Hip Score. Intraoperative outcomes favour PFNA with less blood loss and fluoroscopy usage. Further studies are warranted to explore the cost-effectiveness of these and other implants in managing patients with intertrochanteric fractures.
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Affiliation(s)
- Leo Nherera
- Smith & Nephew Advanced Wound Management, Hull, UK
| | - Paul Trueman
- Smith & Nephew Advanced Wound Management, Hull, UK
| | - Alan Horner
- Smith & Nephew Advanced Wound Management, Hull, UK
| | - Tracy Watson
- Department of Orthopaedic Surgery, Saint Louis University School of Medicine, St. Louis, Missouri USA
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