The effects of occlusive dressings on the recruitment of mononuclear cells by endothelial binding into acute wounds

Hair Transplantation by the Feathering Zone Technique: New Tools for the Nineties

In recent years, hair transplant surgeons have placed emphasis on refining the frontal hairline with minigrafts and micrografts in order to achieve a totally natural appearance. Minigrafts and micrografts can be used in areas other than the frontal hairline with excellent results. This article describes the newest techniques for harvesting and transplanting micrografts.

Randomized clinical trial of the effect of applying ointment to surgical wounds before occlusive dressing

BACKGROUND

A blinded randomized clinical trial was undertaken to evaluate the effect of applying ointment to a wound before occlusive dressing, in comparison with no ointment or sterile paraffin.

METHODS

Some 778 patients with 1801 surgical wounds following excision of skin lesions were enrolled in the trial. No ointment was placed on 510 sutured wounds of 247 patients, paraffin ointment was put on 729 wounds (269 patients) and mupirocin ointment on 562 wounds (262 patients). Wound infection, scar, haemorrhage, dehiscence and other complications were assessed at suture removal. At 6-9 months after surgery, patients were surveyed to assess the wounds, with a response rate of 74.0 per cent.

RESULTS

There were no significant differences in outcome for all endpoints evaluated. The infection rate was 1.4 per cent with no ointment, 1.6 per cent for paraffin and 2.3 per cent for mupirocin (P = 0.490). Total complication rates were 3.5, 4.7 and 4.8 per cent for no ointment, paraffin and mupirocin respectively (P = 0.590). Some 10.9, 10.3 and 8.2 per cent of patients respectively had a neutral or negative perception of their wounds at 6-9 months after surgery (P = 0.650). There was no difference in postoperative pain, degree of inconvenience or overall level of satisfaction with treatment.

CONCLUSION

Putting ointment on a surgical wound before occlusive dressing does not benefit the patient. In view of the risk of antibiotic resistance, mupirocin ointment is not indicated for clean surgical wounds.

Occlusive dressings

BACKGROUND

Although occlusive dressings speed epithelialization, reduce inflammation and tenderness, reduce the chance of infection, stimulate healing of chronic wounds, and produce less scarring, they are still underutilized by physicians and nurses. The principal reasons for their underutilization are fear of infection, the time needed for instructing patients in their use, a lack of knowledge about occlusive dressings, and the general unavailability and high cost of the dressings.

METHODS

This chapter describes the principles which help in selection of the proper dressing, discusses the mechanisms of action of occlusive dressings, lists some novel new occlusive dressings, and emphasizes some of the drawbacks of occlusive dressings for chronic wounds.

CONCLUSION

While occlusive dressings have become an important treatment protocol, their role in opening the minds of clinicians to the possibility of controlling the repair process may be their greatest contribution to medical science.