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Vollmer AS, Hartmann M, Toberer F. [Multimodal therapy for peristomal pyoderma gangrenosum with topical cyclosporine]. Dermatologie (Heidelb) 2023; 74:782-786. [PMID: 37400600 DOI: 10.1007/s00105-023-05191-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/13/2023] [Indexed: 07/05/2023]
Abstract
Pyoderma gangrenosum (PG) is a rare neutrophilic disease. Clinically it shows a rapidly evolving painful ulceration with undermined violaceous wound edges. Peristomal PG is particularly resistant to treatment due to mechanical irritation. Two cases illustrate a multimodal therapeutic concept based on topical cyclosporine, hydrocolloid dressing and systemic glucocorticoids. In one patient re-epithelialization was attained after 7 weeks and the other patient experienced downsizing of the wound edges over 5 months.
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Affiliation(s)
- Anastasia S Vollmer
- Universitäts-Hautklinik Heidelberg, Ruprecht-Karls Universität Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Deutschland.
| | - Martin Hartmann
- Universitäts-Hautklinik Heidelberg, Ruprecht-Karls Universität Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Deutschland
| | - Ferdinand Toberer
- Universitäts-Hautklinik Heidelberg, Ruprecht-Karls Universität Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Deutschland
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Abello C, A Harding C, P Rios A, Guelfand M. Management of giant omphalocele with a simple and efficient nonsurgical silo. J Pediatr Surg 2021; 56:1068-1075. [PMID: 33341259 DOI: 10.1016/j.jpedsurg.2020.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/27/2020] [Accepted: 12/04/2020] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Giant omphaloceles can be a challenge for pediatric surgeons and neonatologists worldwide. It is a rare and low-frequency congenital anomaly with no standardized management schemes or treatment protocols. Over the past few decades, we have developed a simple and efficient staged management for giant omphaloceles that allows definitive closure in the neonatal period, the results of which we outline in this report. MATERIAL AND METHODS With IRB approval, a retrospective and multicentric cohort study was carried out between 1994 and 2019 with patients with giant omphalocele defined as an abdominal wall defect greater than 5 cm in diameter and/or that contains more than 50% of the liver within the sac. We included all patients managed with the nonsurgical silo technique. Data on demographics, gestational age, associated malformations, amnion reduction and inversion time, anatomic closure, requirement of a mesh, intra- and post-silo complications, mortality and follow-up were collected. The technique consists of the construction of a silo with an adhesive hydrocolloid dressing (DuodermⓇ) to achieve an omphalocele staged-reduction until complete abdominal reintegration of the liver and bowel preservation of the amnion sac. This also enables the simulation of abdominal closure before definitive surgical closure, being managed in the neonatal intensive care unit (NICU). RESULTS Forty patients, 21 of whom were female, were managed with this technique. The average weight was 2900 gs (890-3900), and the median gestational age was 38 weeks (28-40). In total, 37.5% of cases had an associated comorbidity. The average silo reduction time was 7.3 days (0-35), the average time of amnion inversion was 5 days (2-9), and the average time to closure was 14.6 days (6-38). Anatomical closure was achieved in 95% of cases. In 4 patients, an absorbable mesh was used to reinforce the anatomical closure, and in 2 patients (5%), a mesh (DualmeshⓇ) was required to achieve an abdominal closure. There was no mortality associated with this nonsurgical silo technique. The average follow-up time was 60 (6 - 288) months. CONCLUSION The staged silo management of giant omphalocele in this series is safe and effective and reduces the time to closure and potential morbidity and mortality compared with traditional surgical or medical management.
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Affiliation(s)
- Cristobal Abello
- Pediatric Surgery Department, Clinica Cmipediatrica International, Barranquilla, Colombia
| | - Constanza A Harding
- Pediatric Surgery Department, Hospital Dr Exequiel González Cortés, Santiago, Chile
| | - Alejandra P Rios
- Pediatric Surgery Department, Hospital Dr Exequiel González Cortés, Santiago, Chile
| | - Miguel Guelfand
- Pediatric Surgery Department, Hospital Dr Exequiel González Cortés, Santiago, Chile; Pediatric Surgery Department, Clínica Las Condes, Santiago, Chile.
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Valderrama OM, Goldstein AL, Del Carmen Monteza Gallardo S, de Moya M, Quiodettis M. Successful management of the open abdomen with hydrocolloid dressing in a resource-constrained setting. Hernia 2020. [PMID: 33009962 DOI: 10.1007/s10029-020-02311-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 09/17/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate and detail the management of a difficult, long-term, open abdomen in a resource constraint setting with the use of Hydrocolloid dressing. METHOD An observational retrospective study was conducted at a single level-1 trauma center. Over a 5-year period, all the open abdomen patients were evaluated and the cohorts who were treated with Hydrocolloid dressings were described in detail from their admission to their discharge. RESULTS During this period, there were 147 open abdomens. 7.5% (11) patients required long-term open abdomen management, in which Hydrocolloid dressing was utilized. Of this group, there were no entero/colonic-atmospheric fistulas, and there was either de-novo complete skin coverage, successful skin graft placement, or definitive abdominal wall repair in all the patients. De-novo complete skin coverage took an average of 7.4 months. All the patients were discharged home after an average of 107 days hospitalized. CONCLUSION Despite not being an optimal management of an open abdomen, there are always a small group of these patients who lose abdominal domain, are critically ill or injured, and have prolonged hospitalization with an open abdomen. In this cohort, and especially in resource constraint settings, Hydrocolloid dressing is a cost-efficient, simple, and effective method to treat the 'long-term' open abdomens.
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Xu S, Li S, Yan F, Han S, Lin S, Gu J, Yu Z, Shao T. "Sandwich" wound dressing to reduce surgical site infections during sacrococcygeal surgery: A retrospective analysis. J Tissue Viability 2020; 30:267-270. [PMID: 33637401 DOI: 10.1016/j.jtv.2020.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 07/13/2020] [Accepted: 07/29/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To explore whether the "sandwich" wound dressing method with a hydrocolloid dressing can effectively reduce surgical site infection rates in sacrococcygeal aseptic operations. METHODS A retrospective cohort of patients with sacrococcygeal aseptic operations (class I incision category) from January 2017 to March 2018 were divided into intervention (sandwich dressing) and control groups (conventional dressing). The surgical site infections (SSI) rate, wound healing course, hospitalization time, and medical costs in the two groups were determined. To exclude the influence of other factors, operation time, blood loss, age, sex ratio, the distance of the incision from the distal edge to the anus, and initial defecation times were compared between the groups. RESULTS The SSI rates and medical costs in the interventional group were significantly lower than the control group (0% vs 78.57%, P < 0.0001; 3.27 ± 0.98 vs 5.83 ± 1.66 ¥10,000, p < 0.0001). Hospitalization times were also lower in the intervention compared to the control group (17.05 ± 4.77 vs 34.50 ± 15.47 day, P = 0.001). CONCLUSIONS The sandwich wound dressing method with a hydrocolloid dressing can effectively prevent SSI during sacrococcygeal aseptic surgery.
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Affiliation(s)
- Sirui Xu
- Department of Spinal Surgery, First Affiliated Hospital of Harbin Medical University, No.23 Youzheng Street, 150001, Harbin, China.
| | - Song Li
- Department of Spinal Surgery, First Affiliated Hospital of Harbin Medical University, No.23 Youzheng Street, 150001, Harbin, China
| | - Fei Yan
- Department of Spinal Surgery, First Affiliated Hospital of Harbin Medical University, No.23 Youzheng Street, 150001, Harbin, China
| | - Shuang Han
- Department of Spinal Surgery, First Affiliated Hospital of Harbin Medical University, No.23 Youzheng Street, 150001, Harbin, China
| | - Shan Lin
- Hemodialysis Center, First Affiliated Hospital of Harbin Medical University, No.23 Youzheng Street, 150001, Harbin, China
| | - Jiaao Gu
- Department of Spinal Surgery, First Affiliated Hospital of Harbin Medical University, No.23 Youzheng Street, 150001, Harbin, China
| | - Zhange Yu
- Department of Spinal Surgery, First Affiliated Hospital of Harbin Medical University, No.23 Youzheng Street, 150001, Harbin, China.
| | - Tuo Shao
- Department of Spinal Surgery, First Affiliated Hospital of Harbin Medical University, No.23 Youzheng Street, 150001, Harbin, China.
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Chamorro AM, Vidal Thomas MC, Mieras AS, Leiva A, Martínez MP, Hernández Yeste MMS; Grupo UPP. Multicenter randomized controlled trial comparing the effectiveness and safety of hydrocellular and hydrocolloid dressings for treatment of category II pressure ulcers in patients at primary and long-term care institutions. Int J Nurs Stud 2019; 94:179-85. [PMID: 31048187 DOI: 10.1016/j.ijnurstu.2019.03.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 03/27/2019] [Accepted: 03/28/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Pressure ulcers are a major burden to patients because they affect health, well-being, and health-related quality of life. Thus, prevention and early treatment of pressure ulcers is a major challenge for health care professionals. OBJECTIVE To compare the efficacy of hydrocellular and hydrocolloid dressings after 8 weeks of treatment of category II pressure ulcers. DESIGN A prospective multicenter clinical trial with blinded outcome assessors. PARTICIPANTS AND SETTINGS Adult patients with category II pressure ulcers from primary and long-term care institutions on Majorca island. METHODS Category II ulcers were treated with ALLEVYN Adhesive® dressings or VARIHESIVE® GEL CONTROL dressings, with the primary outcome being healing of the ulcers in 8 weeks. Blinded confirmation of ulcer healing was performed by a treatment-group assessment committee. Estimates of cumulative survival probabilities were determined using the Kaplan-Meier method and analyses of effectiveness were performed using the chi-squared test. RESULTS A total of 169 patients with pressure ulcers were enrolled, 84 of whom received hydrocellular dressings and 85 of whom received hydrocolloid dressings. A total of 58% were women and 56% were from primary care institutions. The hydrocellular dressing group had a higher percentage of healed pressure ulcers at 8 weeks (90.7% vs. 77.1%, p = 0.039) and a shorter average healing time (3 weeks vs. 4 weeks, p = 0.015). Analysis of safety outcomes at 8 weeks indicated that the hydrocellular dressing group had a smaller proportion of ulcers that were unhealed (3.9% vs. 7.1%) and a smaller proportion of ulcers that progressed to a higher category or infection (5.3% vs. 15.7%), although these differences were not statistically significant. CONCLUSIONS This study of patients with category II pressure ulcers indicated that hydrocellular dressings were superior to hydrocolloid dressings in terms of healing at 8 weeks and time required for healing, although these two dressings had similar safety profiles.
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Halim AS, Nor FM, Mat Saad AZ, Mohd Nasir NA, Norsa'adah B, Ujang Z. Efficacy of chitosan derivative films versus hydrocolloid dressing on superficial wounds. J Taibah Univ Med Sci 2018; 13:512-20. [PMID: 31435371 DOI: 10.1016/j.jtumed.2018.10.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 10/17/2018] [Accepted: 10/18/2018] [Indexed: 02/06/2023] Open
Abstract
Objectives Chitosan, the N-deacetylated derivative of chitin, has useful biological properties that promote haemostasis, analgesia, wound healing, and scar reduction; chitosan is bacteriostatic, biocompatible, and biodegradable. This study determined the efficacy of chitosan derivative film as a superficial wound dressing. Methods This multicentre randomised controlled trial included 244 patients, of whom 86 were treated with chitosan derivative film and 84 with hydrocolloid. The percentage of epithelisation, as well as patient comfort, clinical signs, and patient convenience in application and removal of the dressings were assessed. Results The primary outcome of this study was the percentage of epithelisation. Except for race (p = 0.04), there were no significant differences between groups in sex, age, antibiotic usage, or initial wound size (p > 0.05). There was no significant difference in the mean epithelisation percentage between groups (p = 0.29). Patients using chitosan derivative film experienced more pain during removal of dressing than those in the hydrocolloid group (p = 0.007). The chitosan derivative film group showed less exudate (p = 0.036) and less odour (p = 0.024) than the control group. Furthermore, there were no significant differences between groups in terms of adherence, ease of removal, wound drainage, erythema, itchiness, pain, and tenderness. No oedema or localised warmth was observed during the study. Conclusion This study concluded that chitosan derivative film is equivalent to hydrocolloid dressing and can be an option in the management of superficial and abrasion wounds. Clinical trial No NMRR-11-948-10565.
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Xie LH. Hydrocolloid dressing in preventing nasal trauma secondary to nasal continuous positive airway pressure in preterm infants. World J Emerg Med 2014; 5:218-22. [PMID: 25225588 DOI: 10.5847/wjem.j.issn.1920-8642.2014.03.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 06/12/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Continuous positive airway pressure (CPAP) with nasal devices (nCPAP) is widely used in the respiratory management of newborns. The present study aimed to compare the incidence of nasal trauma secondary to nasal continuous positive airway pressure (nCPAP) protected with or without hydrocolloid dressing in preterm infants. METHODS This prospective controlled study was performed in the neonatal intensive care unit (NICU) of the Children's Hospital of Hunan Province from March 1, 2010 to June 31, 2010. A total of 65 infants, 46 males and 19 females, were recruited in this study. Their average gestational age was 32.6 weeks (range 28-37 weeks). The infants were randomly divided into clinical trial group (group A, n=33) and control group (group B, n=32). Paraffin oil was smeared around the nostrils before inserting prongs in group B; the infants in group A were covered on the infant's nostrils surface with hydrocolloid dressing (hydrocolloid dressing, 1.8 mm thick, 90029T, 3M Company, Minnesota, USA) with a size of 2-3 cm cutting two holes adapted to the nose and nostrils. The nostrils of those infants were inspected daily during nCPAP support until they were weaned off nCPAP. RESULTS Nine infants (2 in group A and 7 in group B) developed nasal injury during nCPAP support. The Chi-square test revealed that there was a statistically significant difference (P=0.01) in the incidence of nasal injury between groups A and B. CONCLUSION The study demonstrated that hydrocolloid dressing significantly decreased the incidence and the severity of nasal injury.
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Affiliation(s)
- Li-Hua Xie
- Hunan Children's Hospital, Changsha 410007, China
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Yamamoto N, Kiyosawa T. Histological effects of occlusive dressing on healing of incisional skin wounds. Int Wound J 2012; 11:616-21. [PMID: 23279979 DOI: 10.1111/iwj.12016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 11/02/2012] [Accepted: 11/20/2012] [Indexed: 11/29/2022] Open
Abstract
Occlusive dressing is widely accepted and used to manage skin ulcers. However, with respect to its application to incisional wounds, most studies have been conducted about the clinical effects on incisional healing of surgical sites. Studies of the histological effects of occlusive dressing for incisional wounds have been few. The aim of this study was to clarify the histological effects of occlusive dressings on healing of incisional skin wounds. Rat dorsal skin was incised down to the panniculus and sutured immediately. Dressing types included 2-octyl cyanoacrylate and hydrocolloid materials as occlusive dressings and no-dressing as the open therapy. Histological examination and dermoscopic observation were performed 1, 2, 4 and 7 days after surgery. The findings from each dressing type were compared. In the open therapy group, the upper portion of the edge of incision was necrosed minimally and finally healed with wide scar formation. However, in the occlusive dressing groups, micronecrosis of the incision edge seen in the no-dressing group was not observed, healing was more rapid and the remaining scar was finer. Occlusive dressing can prevent micronecrosis of the incision edge, resulting in rapid and excellent healing. This study shows that the efficacy of and supports the use of occlusive dressing in incisional wound management.
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Affiliation(s)
- Naoto Yamamoto
- Department of Plastic Surgery, National Defense Medical College, Tokorozawa, Saitama, 359-8513, Japan
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