Alginate dressings in surgery and wound management: Part 2

Efficacy of Type-1 Fish Collagen Membrane v/s Human Amniotic Membrane as a Surgical Dressing Material in Maxillofacial Wounds: A Comparative Study

Management of maxillofacial wounds holds a major challenge for surgeons due to aesthetic concerns. Type I Fish Collagen Membrane and Human Amniotic Membrane (HAM), biologic materials have attained importance in various clinical fields, especially in wound healing. Though both materials have their own unique properties, there is a need to compare and evaluate the efficacy of Type I Fish Collagen Membrane and HAM as a surgical dressing material for soft tissue defects in Head and Neck region. A study encompassed total of 60 patients with maxillofacial wounds resulted either from trauma or by wide excision or ablation therapy of various benign pathologies in head and neck region. They were randomly divided into two groups, with 30 patients in each group. The groups were evaluated using following parameters like ease of operability, pain relief, wound healing, and safety of the membrane. The results indicated that pain relief and healing were much better in HAM cases and like operability and safety of the membranes were equally good. No complications such as infection, burning sensation, or graft rejection were noted. HAM dressing may be considered as safe, cheap and effective alternative method for treating head and neck wounds.

How Biodegradable Polymers Can be Effective Drug Delivery Systems for Cannabinoids? Prospectives and Challenges

Cannabinoids are compounds found in and derived from the Cannabis plants that have become increasingly recognised as significant modulating factors of physiological mechanisms and inflammatory reactions of the organism, thus inevitably affecting maintenance of homeostasis. Medical Cannabis popularity has surged since its legal regulation growing around the world. Numerous promising discoveries bring more data on cannabinoids' pharmacological characteristics and therapeutic applications. Given the current surge in interest in the medical use of cannabinoids, there is an urgent need for an effective method of their administration. Surpassing low bioavailability, low water solubility, and instability became an important milestone in the advancement of cannabinoids in pharmaceutical applications. The numerous uses of cannabinoids in clinical practice remain restricted by limited administration alternatives, but there is hope when biodegradable polymers are taken into account. The primary objective of this review is to highlight the wide range of indications for which cannabinoids may be used, as well as the polymeric carriers that enhance their effectiveness. The current review described a wide range of therapeutic applications of cannabinoids, including pain management, neurological and sleep disorders, anxiety, and cancer treatment. The use of these compounds was further examined in the area of dermatology and cosmetology. Finally, with the use of biodegradable polymer-based drug delivery systems (DDSs), it was demonstrated that cannabinoids can be delivered specifically to the intended site while also improving the drug's physicochemical properties, emphasizing their utility. Nevertheless, additional clinical trials on novel cannabinoids' formulations are required, as their full spectrum therapeutical potential is yet to be unravelled.

Multifunctionalized alginate/polydopamine cryogel for hemostasis, antibacteria and promotion of wound healing

Hemostasis and anti-infection are crucial for emergency treatment of severe trauma. Developing functional biomaterial with efficient hemostasis, antibacterial activity and wound healing is of great social significance and clinical value to fast stop bleeding and save lives, but it is still challenged. Here we designed a series of multifunctionalized SA/PDA cryogels by using two-step cross-linking of dopamine and sodium alginate. The resulting interpenetrating network structure had good swelling ratio, excellent mechanical and shape memory properties. Compared with cotton gauze and gelatin sponge, the cryogels exhibited excellent activation of coagulation cascade, more blood cells and platelet adhesion. Due to the action of polydopamine, the cryogel also showed good antioxidant activity and photothermal antibacterial ability assisted by near-infrared radiation, as well as better wound healing performance than gelatin sponge and Tegaderm™ film. Moreover, in the tests of mouse tail docking model, rat femoral artery hemostasis model and non-compressible rabbit liver defect model, the treatment by SA/PDA cryogels presented less blood loss and shorter hemostasis time than cotton gauze and gelatin sponge. Therefore, SA/PDA cryogels with simple preparation process, low cost, and good biocompatibility would be applied in the variety of great clinical applications in bleeding control, anti-infection and wound healing, etc.

A new hemostatic agent composed of Zn2+-enriched Ca2+ alginate activates vascular endothelial cells in vitro and promotes tissue repair in vivo

To control capillary bleeding, surgeons may use absorbable hemostatic agents, such as Surgicel® and TachoSil®. Due to their slow resorption, their persistence in situ can have a negative impact on tissue repair in the resected organ. To avoid complications and obtain a hemostatic agent that promotes tissue repair, a zinc-supplemented calcium alginate compress was developed: HEMO-IONIC®. This compress is non-absorbable and is therefore removed once hemostasis has been achieved. After demonstrating the hemostatic efficacy and stability of the blood clot obtained with HEMO-IONIC, the impact of Surgicel, TachoSil, and HEMO-IONIC on cell activation and tissue repair were compared (i) in vitro on endothelial cells, which are essential to tissue repair, and (ii) in vivo in a mouse skin excision model. In vitro, only HEMO-IONIC maintained the phenotypic and functional properties of endothelial cells and induced their migration. In comparison, Surgicel was found to be highly cytotoxic, and TachoSil inhibited endothelial cell migration. In vivo, only HEMO-IONIC increased angiogenesis, the recruitment of cells essential to tissue repair (macrophages, fibroblasts, and epithelial cells), and accelerated maturation of the extracellular matrix. These results demonstrate that a zinc-supplemented calcium alginate, HEMO-IONIC, applied for 10 min at the end of surgery and then removed has a long-term positive effect on all phases of tissue repair.

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A new Zn2+ enriched Ca2+ alginate hemostatic agent, HEMO-IONIC, has been developed.

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Non-absorbable, it achieves hemostasis with no foreign bodies left in the wound.

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HEMO-IONIC stimulates endothelial cell migration in vitro and angiogenesis in vivo.

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HEMO-IONIC, removed 10 min after application, promotes all stages of tissue repair.

Design of an Interpenetrating Polymeric Network Hydrogel Made of Calcium-Alginate from a Thermos-Sensitive Pluronic Template as a Thermal-Ionic Reversible Wound Dressing

Polymer-based hydrogels demonstrate superior performance when used as wound dressing. An ideal dressing should possess an active healing function, absorb wound exudates, and provide a moist interface on the wound for rapid injury repair and the prevention of pain and injury during replacement of the dressing. Thus, the aim of this study was to develop a novel, reversible, smart, interpenetrating polymeric network (IPN) by utilizing the thermosensitive network of pluronic F127 (PF127) as a template to regulate the conformation of calcium-ion-crosslinked alginate. We found that the IPN hydrogels formed soft and elastic thermosensitive networks, retaining their form even after absorbing a large amount of wound exudate. The exterior of the hydrogels was made up of a rigid calcium alginate network that supported the entire hydrogel, promoting the stability of the vascular endothelial growth factor (VEGF) payload and controlling its release when the hydrogel was applied topically to wounds. Raman spectroscopy confirmed the layered structure of the hydrogel, which was found to easily disintegrate even after moderate rinsing of the wound with cold phosphate-buffered saline. Taken together, these results show that the IPN hydrogel developed in this study could be a promising delivery platform for growth factors to accelerate wound healing.

Sulfated Polysaccharides from Marine Algae as a Basis of Modern Biotechnologies for Creating Wound Dressings: Current Achievements and Future Prospects

Wound healing involves a complex cascade of cellular, molecular, and biochemical responses and signaling processes. It consists of successive interrelated phases, the duration of which depends on a multitude of factors. Wound treatment is a major healthcare issue that can be resolved by the development of effective and affordable wound dressings based on natural materials and biologically active substances. The proper use of modern wound dressings can significantly accelerate wound healing with minimum scar mark. Sulfated polysaccharides from seaweeds, with their unique structures and biological properties, as well as with a high potential to be used in various wound treatment methods, now undoubtedly play a major role in innovative biotechnologies of modern natural interactive dressings. These natural biopolymers are a novel and promising biologically active source for designing wound dressings based on alginates, fucoidans, carrageenans, and ulvans, which serve as active and effective therapeutic tools. The goal of this review is to summarize available information about the modern wound dressing technologies based on seaweed-derived polysaccharides, including those successfully implemented in commercial products, with a focus on promising and innovative designs. Future perspectives for the use of marine-derived biopolymers necessitate summarizing and analyzing results of numerous experiments and clinical trial data, developing a scientifically substantiated approach to wound treatment, and suggesting relevant practical recommendations.

Hemostatic nanotechnologies for external and internal hemorrhage management

An uncontrolled hemorrhage can easily lead to death during surgery and military operations. Despite the significant advances in hemostatic research, there is still an urgent and increasing need for safer and more effective hemostatic materials. Recently, nanotechnologies have been receiving increasing interest owing to their unique advantages and have been propelling the developement of hemostatic materials. This review summarizes the fundamentals of hemostasis and emphasizes the recent developments regarding hemorrhage-related hemostatic nanotechnologies. In terms of external accessible hemorrhage management, natural and synthetic polymers and inorganic components that have been used in traditional hemostats provide novel nanoscale solutions. Regarding internal noncompressible hemorrhage management, current research endeavors are dedicated to the development of substitutes for blood components, and nanoformulated hemostatic drugs. This review also briefly discusses the main and persistent problems of hemostatic nanomaterials, including safety concerns and clinical translation challenges. This review is hoped to provide critical insight into hemostatic nanomaterial development.

Ameliorative and protective effects of fucoidan and sodium alginate against lead-induced oxidative stress in Sprague Dawley rats

The current study was performed to evaluate the possible protective effects of fucoidan (F) and sodium alginate (SA) against lead-induced oxidative damage in vivo, and to identify relevant underlying mechanisms. Health Sprague Dawley (SD) rats were divided into nine groups of ten rats each and treated orally with lead acetate (5 mg/kg, Pb2+) for 4 weeks, then gavaged with DMSA (Meso-2, 3-dimercaptosuccinic acid, 25 mg/kg), F (50, 100, 200 mg/kg) and SA (50, 100, 200 mg/kg) individually after successful modelling. We found that the administration of both F or SA resulted in a beneficial effect by significantly decreasing lead levels (p < 0.05) in the kidneys from 2.85 mg/kg to 0.79 mg/kg and improving antioxidant status (SOD, GSH, and CAT) thereby alleviating lead-induced damage and injury of the liver and kidneys (AST, BUN, and Cr). Both natural extracts exerted dose-dependent effects. Protective effects were further demonstrated by histopathology. Our results demonstrate that the F and SA are effective natural extracts for lead-eliminating, and that they can ameliorate oxidative damage induced by lead toxicity.

Genome sequencing and analysis of the first spontaneous Nanosilver resistant bacterium Proteus mirabilis strain SCDR1

Background

P. mirabilis is a common uropathogenic bacterium that can cause major complications in patients with long-standing indwelling catheters or patients with urinary tract anomalies. In addition, P. mirabilis is a common cause of chronic osteomyelitis in Diabetic foot ulcer (DFU) patients. We isolated P. mirabilis SCDR1 from a Diabetic ulcer patient. We examined P. mirabilis SCDR1 levels of resistance against Nanosilver colloids, the commercial Nanosilver and silver containing bandages and commonly used antibiotics. We utilized next generation sequencing techniques (NGS), bioinformatics, phylogenetic analysis and pathogenomics in the characterization of the infectious pathogen.

Results

P. mirabilis SCDR1 was the first Nanosilver resistant isolate collected from a diabetic patient polyclonal infection. P. mirabilis SCDR1 showed high levels of resistance against Nanosilver colloids, Nanosilver chitosan composite and the commercially available Nanosilver and silver bandages. The P. mirabilis -SCDR1 genome size is 3,815,621 bp. with G + C content of 38.44%. P. mirabilis-SCDR1 genome contains a total of 3533 genes, 3414 coding DNA sequence genes, 11, 10, 18 rRNAs (5S, 16S, and 23S), and 76 tRNAs. Our isolate contains all the required pathogenicity and virulence factors to establish a successful infection. P. mirabilis SCDR1 isolate is a potential virulent pathogen that despite its original isolation site, the wound, can establish kidney infection and its associated complications. P. mirabilis SCDR1 contains several mechanisms for antibiotics and metals resistance, including, biofilm formation, swarming mobility, efflux systems, and enzymatic detoxification.

Conclusion

P. mirabilis SCDR1 is the first reported spontaneous Nanosilver resistant bacterial strain. P. mirabilis SCDR1 possesses several mechanisms that may lead to the observed Nanosilver resistance.

Electronic supplementary material

The online version of this article (10.1186/s13756-017-0277-x) contains supplementary material, which is available to authorized users.

Microbial alginate dressings show improved binding capacity for pathophysiological factors in chronic wounds compared to commercial alginate dressings of marine origin

Marine alginates are well established in wound management. Compared with different modern wound dressings, marine alginates cannot prove superior effects on wound healing. Alginates from bacteria have never been studied for medical applications so far, although the microbial polymer raises expectations for improved binding of wound factors because of its unique O-acetylation. Due to its possible positive effects on wound healing, alginates from bacteria might be a superior future medical product for clinical use. To prove the binding capacity of microbial alginates to pathophysiological factors in chronic wounds, we processed microbial alginate fibres, produced from fermentation of the soil bacterium Azotobacter vinelandii ATCC 9046, into needle web dressings and compared them with commercial dressings made of marine alginate. Four dressings were assessed: Marine alginate dressings containing either ionic silver or zinc/manganese/calcium, and microbial alginate dressings with and without nanosilver. All dressings were tested in an in vitro approach for influence on chronic wound parameters such as elastase, matrix metalloproteases-2, tumour necrosis factor-α, interleukin-8, and free radical formation. Despite the alginate origin or addition of antimicrobials, all dressings were able to reduce the concentration of the proinflammatory cytokines TNF-α and IL-8. However, microbial alginate was found to bind considerable larger amounts of elastase and matrix metalloproteases-2 in contrast to the marine alginate dressings. The incorporation of zinc, silver or nanosilver into alginate fibres did not improve their binding capacity for proteases or cytokines. The addition of nanosilver slightly enhanced the antioxidant capacity of microbial alginate dressings, whereas the marine alginate dressing containing zinc/manganese/calcium was unable to inhibit the formation of free radicals. The enhanced binding affinity by microbial alginate of Azotobacter vinelandii to pathophysiological factors may be interesting to support optimal conditions for wound healing.

Preparation and characterization of nanoparticle reinforced alginate fibers with high porosity for potential wound dressing application

A novel fiber dressing was fabricated by blending nano-silica/hydroxyapatite with alginateviamicrofluidic spinning, demonstrating delayed degradation, greater mechanical property and superior bioactivity due to the reinforcing alginate fibers.

Choosing a Wound Dressing Based on Common Wound Characteristics

Significance: Chronic wounds are a major healthcare burden.The practitioner should have an appropriate understanding of both the etiology of the wound as well as the optimal type of dressings to use. Fundamental wound characteristics may be used to guide the practitioner's choice of dressings. The identification of optimal dressings to use for a particular wound type is an important element in facilitating wound healing. Recent Advances: Researchers have sought to design wound dressings that aim to optimize each stage in the healing process. In addition, dressings have been designed to target and kill infection-causing bacteria, with the incorporation of antimicrobial agents. Critical Issues: Chronic wounds are frequently dynamic in presentation, and the numerous wound dressings available make dressing selection challenging for the practitioner. Choosing the correct dressing decreases time to healing, provides cost-effective care, and improves patient quality of life. Future Directions: Research into the mechanisms of wound healing has enhanced our ability to heal chronic wounds at a faster rate through the use of moisture-retentive dressings. Newer dressings are incorporating the use of nanotechnology by incorporating miniature electrical sensors into the dressing. These dressings are engineered to detect changes in a wound environment and alert the patient or practitioner by altering the color of the dressing or sending a message to a smartphone. Additional investigations are underway that incorporate biologic material such as stem cells into dressings.

A clinical in-market evaluation of an alginate fibre dressing

Practice nurses working in GP surgeries are responsible for caring for patients with both acute and chronic wounds. The management of wounds is challenging and it is important to achieve and maintain an optimum healing environment. As practice nurses play an integral part in managing both acute and chronic wounds within a community setting, it is essential that they can make informed decisions as to which products to use. A clinical in-market evaluation of 23 patients was carried out to assess the performance of ActivHeal Aquafiber® in clinical practice. Overall, the dressing performed well in respect of fluid handling and durability. The dressing addressed patient needs in terms of easy application and removal, prevention of leakage and wound progression.

Synthesis and characterization of β-cyclodextrin-conjugated alginate hydrogel for controlled release of hydrocortisone acetate in response to mechanical stimulation

Alginate hydrogels are a class of biomaterials that can be used as local release depots for therapeutic agents. A particular drug that can take advantage of alginate hydrogel for controlled release is hydrocortisone acetate. Hydrocortisone acetate is a widely used anti-inflammatory agent, but is limited in application due to poor solubility and lack of controlled delivery. To overcome this limitation, a mechanically responsive β-cyclodextrin-conjugated alginate (Alg-β-CD) hydrogel was synthesized and characterized for enhanced aqueous solubility and controlled release of hydrocortisone acetate. We demonstrated that mono-6-deoxy-6-ethylenediamine-β-cyclodextrin and hydrocortisone acetate formed a 1:1 inclusion complex, thus resulting in marked increase in hydrocortisone acetate solubility, while causing no significant inhibition to the growth of cultured mouse fibroblasts (L929). More importantly, the release of hydrocortisone acetate from the hydrogel system was increasingly sensitive to mechanical compression, and the mechanical responsiveness of hydrocortisone acetate release increased dramatically as the concentration of mono-6-deoxy-6-ethylenediamine-β-cyclodextrin increased from 0% to 46%, whereas the swelling rate and stiffness of the hydrogel decreased as the concentration of mono-6-deoxy-6-ethylenediamine-β-cyclodextrin increased. The mechanical responsiveness of hydrocortisone acetate release was attributable to conformational distortion of mono-6-deoxy-6-ethylenediamine-β-cyclodextrin moieties and deformation of the polymer network. Moreover, we demonstrated that the hydrogel continuously released and accumulated hydrocortisone acetate in the medium when compressed for up to 72 h, which led to increasing suppression of nitric oxide production in the lipopolysaccharide-stimulated mouse macrophages (RAW264.7), indicating desirable anti-inflammatory effect at the cell level. Hence, this hydrogel system may provide a useful platform for drug delivery, such as hydrocortisone acetate release to wound site, by intentionally generated mechanical force.

Biotechnologically produced microbial alginate dressings show enhanced gel forming capacity compared to commercial alginate dressings of marine origin

Marine alginate fibre dressings are well established in wound management. Alginate fibres can absorb plenty of wound exudate due to their gel forming abilities and ion exchange. Alginates from bacteria have never been studied for medical applications so far, although the microbial polymer raises expectations for improved gelling capacity due to its unique O-acetylation. To prove the gelling capacity of bacterial alginate, we extracted the co-polymer from fermentation of the soil bacterium Azotobacter vinelandii ATCC 9046, cultivated on crude glycerol as an alternative carbon source. Bacterial alginate was isolated in high purity and extruded by a wet spinning method. Fibre structure and properties were characterised by infrared spectroscopy, NMR, GPC, scanning electron microscopy and tensile testing. The fibres could be processed into biocompatible needle web dressings, which showed more than twice the gel formation in saline compared to commercial dressings made of marine alginates. Gelled dressings of bacterial alginate formed stable hydrogels of sufficient shape and strength for wound healing applications. This work suggests that the increased gel formation of bacterial alginate from A. vinelandii may be optimal for the preparation of novel wound dressings.

First transplantation of isolated murine follicles in alginate

Aim: Our aim is to develop an artificial ovary allowing survival and growth of isolated follicles and ovarian cells, to restore fertility in women diagnosed with pathologies at high risk of ovarian involvement. Materials & methods: For this, alginate beads containing isolated preantral follicles and ovarian cells were autografted to immunocompetent mice. One week after grafting, the beads were invaded by proliferating murine cells (12.1%) and capillaries. Results: The recovery rate of follicles per graft ranged from 0% to 35.5%. Of the analyzed follicles, 77% were Ki67-positive and 81%, TUNEL-negative. Three antral follicles were also identified, evidencing their ability to grow in the matrix. Conclusion: Our results suggest that an artificial ovary is now conceivable, opening new perspectives to restore fertility in women.

Chitin-calcium alginate composite fibers for wound care dressings spun from ionic liquid solution

Chitin-calcium alginate composite fibers were prepared from a solution of high molecular weight chitin extracted from shrimp shells and alginic acid in the ionic liquid 1-ethyl-3-methylimidazolium acetate by dry-jet wet spinning into an aqueous bath saturated with CaCO₃. The fibers exhibited a significant proportion of the individual properties of both calcium alginate and chitin. Ultimate stress values were close to values obtained for calcium alginate fibers, and the absorption capacities measured were consistent with those reported for current wound care dressings. Wound healing studies (rat model, histological evaluation) indicated that chitin-calcium alginate covered wound sites underwent normal wound healing with re-epithelialization and that coverage of the dermal fibrosis with hyperplastic epidermis was consistently complete after only 7 days of treatment. Using a single patch per wound per animal during the entire study, all rat wounds achieved 95-99% closure by day 10 with complete wound closure by day 14.

Antifungal activity and cytotoxicity of zinc, calcium, or copper alginate fibers

The antifungal properties and cytotoxicity of alginate fibers were investigated to widen their application in tissue engineering. Calcium, zinc, and copper alginate fibers were separately prepared by replacing Na(+) with Ca(2+), Zn(2+), or Cu(2+). The antifungal properties of the three alginate fibers were studied after coming into contact with Candida albicans. Then, the fungal inhibitory rates were measured using the plate-count method following shake-flask test. Moreover, an inhibition-zone test and observation by scanning electron microscopy were carried out. The inhibitory rate of the calcium, copper, and zinc alginate fibers were, respectively, 49.1, 68.6, and 92.2 %. The results from inhibition-zone test and shake-flask test show that zinc alginate fibers have the most significant antifungal action and that copper alginate fibers have obvious inhibitory action, but the calcium alginate fibers have weak inhibitory effects. The scanning electron micrographs similarly illustrate that the fungal surfaces show most scraggly after the interaction between C. albicans and zinc alginate fibers. Moreover, the relative growth rates of zinc or calcium alginate fibers in human embryonic kidney cells and human fibroblast cells were more than 100 %. No significant results were obtained (P>0.05). The calcium alginate fibers in human fibroblast cells were not much different from the negative control group (P>0.05). However, zinc alginate fibers had a significant change (P<0.05). Therefore, the excellent antifungal property of zinc alginate fibers demonstrates potential application in skin tissue engineering comparing with calcium or copper alginate fibers.

Hemostasis for severe hemorrhage with photocrosslinkable chitosan hydrogel and calcium alginate

In patients with severe hemorrhage, complications such as shock or death may occur if the patient is not treated appropriately and expeditiously. To create a hemostat kit for severe hemorrhage, ultraviolet light irradiation was applied to photocrosslinkable chitosan hydrogel and calcium alginate. As a hemorrhage model, the femoral arteries and veins of anesthetized rats were cut. Hemodynamics and hematological parameters including red blood cell (RBC) count, hemoglobin concentration, hematocrit, white blood cell (WBC) count, and platelet count, and serum parameters including aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were measured as a marker of hemostasis. In rats for which no procedure was used, death occurred within 30 min. By using the hydrogel hemostat, the survival rate rose to 75% or more. RBC count, hemoglobin, hematocrit, and platelet levels were not significantly changed for 3 days. WBC count increased 1 day after hemostasis. AST and ALT increased 1 day after hemostasis, but it decreased 3 days later. The photocrosslinkable chitosan hydrogel and calcium alginate were biodegraded at 3 and 28 days, respectively, by neutrophils and keratinocyte chemoattractant.

Use of a new hemicellulose dressing (Veloderm) for the treatment of split-thickness skin graft donor sites A within-patient controlled study

A multi-centre, open, within-patient controlled study was performed on 23 adult burnt patients to investigate the effectiveness, safety and tolerability of Veloderm in comparison with Algisite M and Jaloskin in split-thickness skin graft donor site care. The areas dressed with Veloderm completely healed within 10-13 days in a significant higher proportion than the other two dressings (47.6% for Veloderm versus 26.3% for Algisite M and 10% for Jaloskin, P<0.03), showing during the whole study less incidence of exudates and of peri-lesional erythema. The aesthetic outcome of the treated lesions after healing was significantly better for Veloderm (P=0.0016). Veloderm) and Jaloskin required very few renewals of the medication during the first week of treatment, while Algisite M needed several multiple re-dressings. Veloderm was judged better than the other two treatments as far as the acceptability (P<0.001), ease of use (P<0.001) and efficacy (P<0.00001). Both pain during application or at removal of dressings and local infections were negligible with all treatments. No scars were formed in any skin donor site. In conclusion Veloderm is a safe and effective dressing for the re-epithelialization of the skin graft donor sites: it showed higher activity than the other two compared dressings.

Calcium alginate gel as a biocompatible material for endovascular arteriovenous malformation embolization: six-month results in an animal model

OBJECTIVE

We sought to expand our assessment of calcium alginate as an embolic agent in an animal model of a cerebral arteriovenous malformation (AVM). The objective of this study was to assess the long-term biocompatibility and stability of calcium alginate in AVM swine models that survived from 1 to 6 months.

METHODS

The swine model included a carotid-jugular anastomosis to redirect flow to the rete mirabile (RM), thereby simulating flow to an AVM. Alginate and the reactive component, calcium chloride, were injected from double-lumen or concentric-tube microcatheters to form an occlusion of the RM feeding vessel and the inferior portion of the RM.

RESULTS

Angiography and histology verified complete occlusion of the RM feeding vessel for up to 6 months in eight of nine swine. Blood flow remained open to the superior portion of the RM and the circle of Willis. No evidence of downstream calcium alginate gel was seen in the follow-up angiograms or the histological preparations of the circle of Willis. A minor bioactive response to the alginate gel was noted at 1 month, yet no degenerative or inflammatory response was seen. At 6 months, there was moderate fibrous tissue around the alginate, which further sealed off flow to the embolized areas of the RM.

CONCLUSION

Over a period of 6 months, calcium alginate was an effective endovascular occlusion material that blocked blood flow to the inferior portion of the RM. The chronic AVM model verified the long-term stability and biocompatibility of calcium alginate.

Management of bleeding in patients with advanced cancer

Bleeding occurs in up to 10% of patients with advanced cancer. It can present in many different ways. This article provides a qualitative review of treatment options available to manage visible bleeding. Local modalities, such as hemostatic agents and dressings, radiotherapy, endoscopic ligation and coagulation, and transcutaneous arterial embolization, are reviewed in the context of advanced cancer, as are systemic treatments such as vitamin K, vasopressin/desmopressin, octreotide/somatostatin, antifibrinolytic agents (tranexamic acid and aminocaproic acid), and blood products. Considerations at the end of life are described.

Calcium Alginate Provides a High Degree of Embolization in Aneurysm Models: A Specific Comparison to Coil Packing

OBJECTIVE

Although flexible, current coils do not fill intracranial aneurysms to a high degree, and questions remain regarding their thrombogenic capacity. We evaluated the usefulness of calcium alginate as an embolic material for endovascular embolization in aneurysm models.

METHODS

We assessed three endovascular methods of instilling calcium alginate into 10-mm sidewall and 7-mm bifurcation glass aneurysm models using a balloon catheter to seal the aneurysm orifice: 1) instillation of alginate and subsequent instillation of the reactive component calcium chloride (CaCl(2)) via a single-lumen catheter, 2) simultaneous instillation of alginate and CaCl(2) via a side-by-side double-lumen catheter, and 3) instillation of alginate mixed with CaCl(2) delivered from a concentric-tube microcatheter. A 13-mm sidewall silicon aneurysm model was used to measure and compare the volume of calcium alginate occupying the aneurysm models.

RESULTS

Instillation Method 1 did not achieve optimal filling of the aneurysm with calcium alginate. The percentage volumes of calcium alginate occupying the aneurysm were 69.2 +/- 7.7% and 84.6 +/- 5.4% for instillation Methods 2 and 3, respectively. In Method 3, calcium alginate began gelation upon leaving the catheter, entered the aneurysms in a strand form, and gelled to a mass that filled the aneurysm while conforming to its inner contour.

CONCLUSION

Calcium alginate fills aneurysm models to a significantly higher degree than published results of the space filled by coils. Instillation of calcium alginate, especially in strand form, may produce an embolization that better fills and conforms to the contour of aneurysms compared with coils.

Dressings in the management of open surgical wounds

This article looks at wound dressings, comparing traditional ribbon gauze dressing with occlusive dressings, focusing on the use of calcium alginates. The author looks at the nursing responsibilities concerning the choice of wound products from a professional and ethical perspective. She makes important recommendations about how this knowledge can be integrated into nursing practice in the operating theatre.

Standards and guidelines for biopolymers in tissue-engineered medical products: ASTM alginate and chitosan standard guides. American Society for Testing and Materials

The American Society for Testing and Materials (ASTM) is making a concerted effort to establish standards and guidelines for the entire field of tissue-engineered medical products (TEMPS). Safety, consistency, and functionality of biomaterials used as matrices, scaffolds, and immobilizing agents in TEMPS are a concern. Therefore, the ASTM has established a number of task groups to produce standards and guidelines for such biomaterials. Alginate is a naturally occurring biomaterial used for immobilizing living cells to form an artificial organ, such as encapsulated pancreatic islets. In order to aid in successful clinical applications and to help expedite regulatory approval, the alginate used must be fully documented. The ASTM alginate guide gives information on selection of testing methodologies and safety criteria. Critical parameters such as monomer content, molecular weight, and viscosity, in addition to more general parameters, such as dry matter content, heavy metal content, bioburden, and endotoxin content are described in the ASTM document. In a like manner, the characterization parameters for chitosan, a bioadhesive polycationic polysaccharide, are described in a separate guide. For chitosan, the degree of deacetylation is of critical importance. Control of protein content and, hence, potential for hypersensitivity, endotoxin content, and total bioburden are important in chitosan preparations for TEMPS. Together these two guides represent part of the effort on behalf of the ASTM and other interested parties to ensure quality and standardization in TEMPS.

Alginate dressings in surgery and wound management: Part 3

This final article in the series looks at the functioning of seaweed-derived dressings at a cellular level, as well as the importance of choosing appropriate secondary dressings