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Cerny MK, Wiesmeier A, Hopfner U, Topka C, Zhang W, Machens HG, van Griensven M, Broer N, Duscher D. Wound fluid under occlusive dressings from diabetic patients show an increased angiogenic response and fibroblast migration. J Tissue Viability 2021; 30:446-453. [PMID: 33707159 DOI: 10.1016/j.jtv.2021.02.013] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/16/2021] [Accepted: 02/28/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Metabolic diseases like diabetes mellitus often show prolonged healing and chronic wounds. Occlusive wound dressings are known to support wound closure by creating a moist environment which supports collagen synthesis, epithelialization and angiogenesis. We aimed to assess the effect of occlusion on diabetic wound fluid on the cellular level regarding fibroblast activity and angiogenetic response. MATERIAL AND METHODS 22 split skin donor sites from 22 patients (11 patients with diabetes mellitus) were treated with occlusive dressings intraoperatively. On day 3, fluid and blood serum samples were harvested while changing the dressings. The influence of wound fluid on fibroblasts was assessed by measuring metabolic activity (Alamar Blue assay, Casey Counter), cell stress/death (LDH assay) and migration (in vitro wound healing assay) of fibroblasts. Angiogenesis of endothelial cells (HUVEC) was analyzed with the tube formation assay. Furthermore, a Magnetic Luminex Assay for multi-cytokines detection was performed focusing on inflammatory and pro-angiogenetic cytokines. RESULTS The influence of wound fluid under occlusive dressings from diabetic patients showed a significantly increased angiogenic response and fibroblast migration compared to the non-diabetic patient group. Additionally, cell stress was increased in the diabetic group. Cytokine analysis showed an increase in VEGF-A in the diabetic group. CONCLUSION Occlusive dressings may stimulate regenerative effects in diabetic wounds. Our in-vitro study shows the influence of wound fluid under occlusive dressings from diabetic patients on angiogenesis, migration and proliferation of fibroblasts, which are essential modulators of wound healing and scar modulation.
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Affiliation(s)
- Michael K Cerny
- Department for Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, Germany.
| | - Anna Wiesmeier
- Department for Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, Germany
| | - Ursula Hopfner
- Department for Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, Germany
| | - Charlotte Topka
- Department for Plastic-, Reconstructive, Hand- and Burn Surgery, Bogenhausen Hospital, Städtisches Klinikum München, Germany
| | - Wen Zhang
- Department of Cell Biology-Inspired Tissue Engineering, MERLN Institute, Maastricht University, the Netherlands
| | - Hans-Günther Machens
- Department for Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, Germany
| | - Martijn van Griensven
- Department of Cell Biology-Inspired Tissue Engineering, MERLN Institute, Maastricht University, the Netherlands
| | - Niclas Broer
- Department for Plastic-, Reconstructive, Hand- and Burn Surgery, Bogenhausen Hospital, Städtisches Klinikum München, Germany
| | - Dominik Duscher
- Department for Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, Germany
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Raventós XC, Flores Climente VA, García Navarro X, Perez Gil A, Salido Vallejo R, Vázquez Doval FJ. Efficacy of an Innovative Film-Forming Wound Dressing on Open Wounds. Skinmed 2019; 17:298-304. [PMID: 31782702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Standards in post-surgery wound care management require a rapid healing process in order to prevent and minimize abnormal scarring. For the healing process to start as early as possible, the ideal dressing should be applied directly on the open wound and perfectly adapt to it. The authors report a case study series regarding the efficacy of a flexible film-forming wound dressing in the form of a gel (Stratamed®, Stratpharma AG, Switzerland) that is approved for the use on open wounds and injured skin. Evidence from the current study shows that, while remaining safe to use, the dressing was efficacious in promoting epithelialization and accelerated wound healing of areas in which skin integrity had been compromised, and at the same time prevented the formation of abnormal scars. Results were observed across a broad range of dermatologic surgical procedures. All treated conditions showed a beneficial outcome, as well as an overall favorable patient treatment perception.
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Affiliation(s)
- Xavier Cubiró Raventós
- From the Servicio de Dermatología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain;
| | | | | | - Amalia Perez Gil
- Departamento de Dermatologia, Hospital Universitario Nuestra Señora de Valme, Sevilla, Spain
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Abstract
BACKGROUND Published audits have demonstrated that corneal abrasions are a common presenting eye complaint. Eye patches are often recommended for treating corneal abrasions despite the lack of evidence for their use. This systematic review was conducted to determine the effects of the eye patch when used to treat corneal abrasions. OBJECTIVES The objective of this review was to assess the effects of patching for corneal abrasion on healing and pain relief. SEARCH METHODS We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (2016, Issue 4), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to May 2016), EMBASE (January 1980 to May 2016), Latin American and Caribbean Health Sciences Literature Database (LILACS) (January 1982 to May 2016), System for Information on Grey Literature in Europe (OpenGrey) (January 1995 to May 2016), the ISRCTN registry (www.isrctn.com/editAdvancedSearch), ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 9 May 2016. We also searched the reference lists of included studies, unpublished 'grey' literature and conference proceedings and contacted pharmaceutical companies for details of unpublished trials. SELECTION CRITERIA We included randomised and quasi-randomised controlled trials that compared patching the eye with no patching to treat simple corneal abrasions. DATA COLLECTION AND ANALYSIS Two authors independently assessed the risk of bias and extracted data. Investigators were contacted for further information regarding the quality of trials. The primary outcome was healing at 24, 48 and 72 hours while secondary outcomes included measures of pain, quality of life and adverse effects. We graded the certainty of the evidence using GRADE. MAIN RESULTS We included 12 trials which randomised a total of 1080 participants in the review. Four trials were conducted in the United Kingdom, another four in the United States of America, two in Canada, one in Brazil and one in Switzerland. Seven trials were at high risk of bias in one or more domains and one trial was judged to be low risk of bias in all domains. The rest were a combination of low risk or unclear.People receiving a patch may be less likely to have a healed corneal abrasion after 24 hours compared to those not receiving a patch (risk ratio (RR) 0.89, 95% confidence interval (CI) 0.79 to 1.00, 7 trials, 531 participants, low certainty evidence). Similar numbers of people in the patch and no-patch groups were healed by 48 hours (RR 0.97, 95% CI 0.91 to 1.02, 6 trials, 497 participants, moderate certainty evidence) and 72 hours (RR 1.01, 95% CI 0.97 to 1.05, 4 trials, 430 participants, moderate certainty evidence). Participants receiving a patch took slightly longer to heal but the difference was small and probably unimportant (mean difference (MD) 0.14 days longer, 95% CI 0 to 0.27 days longer, 6 trials, 642 participants, moderate certainty evidence).Ten trials reported pain scores. Most studies reported pain on a visual analogue scale (VAS). It was not possible to pool the data because it was skewed. In general, similar pain ratings were seen between patch and no-patch groups. Data from two trials reporting presence or absence of pain at 24 hours was inconclusive. There was a higher risk of reported pain in the patch group but wide confidence intervals compatible with higher or lower risk of pain (RR 1.51, 95% CI 0.86 to 2.65, 2 trials, 193 participants, low certainty evidence). Five trials compared analgesic use between the patch and no-patch groups. Data from three of these trials could be combined and suggested similar analgesic use in the patch and no-patch groups but with some uncertainty (RR 0.95, 95% CI 0.69 to 1.32, 256 participants, low certainty evidence). Frequently reported symptoms included photophobia, lacrimation, foreign body sensation and blurred vision but there was little evidence to suggest any difference in these symptoms in people with or without a patch.Activities of daily living (ADL) were assessed in one study involving children. There was little difference in ADL with the exception of walking which was reported to be more difficult with a patch on: VAS 1.7 cm (SD 2.1) versus 0.3 cm (SD 0.7).Complication rates were low across studies and there is uncertainty about the relative effects of patching or not patching with respect to these (RR 3.24, 95% CI 0.87 to 12.05, 8 trials, 660 participants, low certainty evidence). Three trials reporting rates of compliance to treatment found that 22% of participants did not have their eye patches during follow-up. No-patch groups generally received more adjuvant treatment with antibiotics or cycloplegics, or both, than the patch group. There were limited data on the effect of patching on abrasions greater than 10mm(2) in size. AUTHORS' CONCLUSIONS Trials included in this review suggest that treating simple corneal abrasions with a patch may not improve healing or reduce pain. It must be noted that, in these trials, participants who did not receive a patch were more likely to receive additional treatment, for example with antibiotics. Overall we judged the certainty of evidence to be moderate to low. Further research should focus on designing and implementing better quality trials and examining the effectiveness of patching for large abrasions.
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Affiliation(s)
- Chris HL Lim
- The Royal Melbourne HospitalMelbourneVictoriaAustralia
| | - Angus Turner
- Royal Victorian Eye and Ear Hospital32 Gisborne StEast MelbourneVictoriaAustralia3002
| | - Blanche X Lim
- National University Health System/Jurong General Health ServicesDepartment of OphthalmologySingaporeSingapore
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Tang HL, Lau KK, Sam R, Ing TS. Chest wall abscesses due to continuous application of silicone gel sheets for keloid management. BMJ Case Rep 2015; 2015:bcr2014206777. [PMID: 25920733 PMCID: PMC4422926 DOI: 10.1136/bcr-2014-206777] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2015] [Indexed: 11/03/2022] Open
Abstract
A patient with three episodes of chest wall abscesses as a result of 6 years of round-the-clock, uninterrupted (except during bathing) application of silicone gel sheets to a chest wall keloid is described. Two of the episodes occurred during hot weather. It is suggested that, in the space beneath the silicone sheet, the higher humidity and temperature, both generated as a result of prolonged sheeting, especially during hot weather, might have caused the keloid and its neighbouring skin to become soggy. This sogginess might have facilitated bacterial invasion. It is suggested that some sheeting-free time during a 24 h period might be indicated so that a keloid and its adjacent skin have the time to recover from their sheeting-induced sogginess. A sheeting-free period might especially be needed in the face of sweat accumulation beneath the silicone sheet.
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Affiliation(s)
- Hon-Lok Tang
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong, Hong Kong
| | - Keith K Lau
- Department of Paediatrics, University of Hong Kong, Hong Kong, Hong Kong
| | - Ramin Sam
- Department of Medicine, San Francisco General Hospital and University of California, San Francisco, California, USA
| | - Todd S Ing
- Department of Medicine, Loyola University Chicago, Chicago, Illinois, USA
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Margolis AM, Tang N, Levy MJ, Callaway DW. Management of open chest wounds in tactical emergency casualty care: application of vented versus nonvented chest seals. J Spec Oper Med 2014; 14:136-138. [PMID: 25399384 DOI: 10.55460/sgb8-4x9c] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/01/2014] [Indexed: 06/04/2023]
Abstract
The 2014 midyear, full meeting of the Committee for Tactical Emergency Combat Care (C-TECC) was hosted by the Johns Hopkins University Center for Law Enforcement Medicine on June 9 and 10 in Baltimore, Maryland. As the C-TECC guidelines are increasingly recognized as the best-practice recommendations for civilian, high-threat, prehospital trauma response, a focused guidelines discussion occurred to develop best-practice recommendations for the management of open chest wounds, specifically regarding the application of vented and nonvented chest seals.
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Schmieder GJ, Huang EY, Jarratt M. A multicenter, randomized, vehicle-controlled phase 2 study of blue light photodynamic therapy with aminolevulinic acid HCl 20% topical solution for the treatment of actinic keratoses on the upper extremities: the effect of occlusion during the drug incubation period. J Drugs Dermatol 2012; 11:1483-1489. [PMID: 23377520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Photodynamic therapy (PDT) with aminolevulinic acid (ALA) has been shown to be safe and effective in the treatment of actinic keratoses (AKs) of the face and scalp. A recent small study has suggested that ALA-PDT can be effective for AKs of the dorsal hands/forearms. However, studies designed to provide sufficient statistical power to test this hypothesis are lacking in the literature. OBJECTIVES To determine and compare the safety and efficacy of blue light ALA-PDT vs blue light placebo vehicle (VEH) in the treatment of AKs of the upper extremities and to evaluate the effect of occlusion after application of ALA vs VEH. METHODS ALA or VEH was applied to both dorsal hands/forearms for the 3-hour incubation period before blue light treatment (10 J/ cm2). One extremity of each subject was covered with occlusive dressing during the incubation period. Treatment was repeated at week 8 if any AK lesions remained. RESULTS The median AK lesion clearance rate at week 12 was 88.7% for extremities treated with occluded ALA (ALA+OCC), 70.0% for extremities treated with nonoccluded ALA, 16.7% for extremities treated with occluded VEH (VEH+OCC), and 5.6% for extremities treated with nonoccluded VEH (P<.0001). ALA+OCC resulted in a significantly higher clearance rate compared with the nonoccluded extremity at weeks 8 (P=.0006) and 12 (P=.0029). Thirty-four percent (12/35) of extremities treated with ALA+OCC had complete clearance of lesions at week 12 compared with 0% (0/35) of extremities treated with VEH+OCC (P=.0002). The safety pro!le in this study is consistent with previously reported side effects of the therapy. CONCLUSION Blue light ALA-PDT following a 3-hour incubation appears efficacious for AK clearance of the upper extremities. Incubation using an occlusive dressing significantly increases the efficacy of the procedure and also increases the incidence and severity of some acute inflammatory side effects of PDT.
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Ng KW, Achuth HN, Moochhala S, Lim TC, Hutmacher DW. In vivo evaluation of an ultra-thin polycaprolactone film as a wound dressing. Journal of Biomaterials Science, Polymer Edition 2012; 18:925-38. [PMID: 17688748 DOI: 10.1163/156856207781367693] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The use of ultra-thin films as dressings for cutaneous wounds could prove advantageous in terms of better conformity to wound topography and improved vapour transmission. For this purpose, ultra-thin poly(epsilon-caprolactone) (PCL) films of 5-15 microm thickness were fabricated via a biaxial stretching technique. To evaluate their in vivo biocompatibility and feasibility as an external wound dressing, PCL films were applied over full and partial-thickness wounds in rat and pig models. Different groups of PCL films were used: untreated, NaOH-treated, untreated with fibrin, NaOH-treated with perforations, and NaOH-treated with fibrin and S-nitrosoglutathione. Wounds with no external dressings were used as controls. Wound contraction rate, histology and biomechanical analyses were carried out. Wounds re-epithelialized completely at a comparable rate. Formation of a neo-dermal layer and re-epithelialization were observed in all the wounds. A lower level of fibrosis was observed when PCL films were used, compared to the control wounds. Ultimate tensile strength of the regenerated tissue in rats reached 50-60% of that in native rat skin. Results indicated that biaxially-stretched PCL films did not induce inflammatory reactions when used in vivo as a wound dressing and supported the normal wound healing process in full and partial-thickness wounds.
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Affiliation(s)
- Kee Woei Ng
- Department of Surgery, National University of Singapore, Singapore 117576
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Zhang H, Xiong EQ, Liu LM, Yan SX, Zhou ZS, Lu GS. Penile necrosis after circumcision owing to inappropriate postoperative treatment. J Pediatr Surg 2011; 46:1469-70. [PMID: 21763857 DOI: 10.1016/j.jpedsurg.2011.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Revised: 03/09/2011] [Accepted: 03/09/2011] [Indexed: 11/29/2022]
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Kobaly K, Somani AK, McCormick T, Nedorost ST. Effects of occlusion on the skin of atopic dermatitis patients. Dermatitis 2010; 21:255-261. [PMID: 20920411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND Atopic dermatitis (AD) may be exacerbated by occlusion from items such as occlusive gloves or textiles, especially if the occlusion is removed suddenly, creating a steep humidity gradient. Most previous studies of occlusion have focused on normal skin. Occlusion has been shown to be beneficial in psoriatic skin, but many atopic patients complain of increased inflammation after occlusion. OBJECTIVE To evaluate the response of noninflamed AD skin to occlusion. METHODS Six patients with AD were patch-tested with occlusive polyethylene wrap and sodium lauryl sulfate (SLS) in standard Finn Chambers taped to noninflamed skin of the back. Cytokine and chemokine messenger ribonucleic acid (mRNA) for interleukin-8 (IL-8), interleukin-1 alpha (IL-1α), and interleukin-1 receptor antagonist (IL-1RA), as well as the 18S rRNA housekeeping gene, was obtained via tape-stripping the skin and measured using quantitative real-time polymerase chain reaction. We also measured transepidermal water loss after removal of occlusion. RESULTS Polyethylene occlusion alone with abrupt removal induced IL-8 and IL-1α levels similar to or exceeding that of SLS. IL-1RA was up-regulated by SLS and occlusion, with SLS showing a stronger response. CONCLUSION Removal of occlusion with polyethylene film up-regulates the inflammatory cytokines IL-8, IL-1α, and IL-1RA in patients with AD. This may explain the worsening of AD with the use of occlusive gloves, athletic equipment, and fabrics.
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Affiliation(s)
- Kristen Kobaly
- Department of Dermatology, University Hospitals Case Medical Center, Cleveland, OH, USA
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Volden G, Kragballe K, Van De Kerkhof PC, Aberg K, White RJ. Remission and relapse of chronic plaque psoriasis treated once a week with clobetasol propionate occluded with a hydrocolloid dressing versus twice daily treatment with clobetasol propionate alone. J DERMATOL TREAT 2009; 12:141-4. [PMID: 12243704 DOI: 10.1080/09546630152607862] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Many studies have shown the clinical efficiency of occlusion therapy for psoriasis, particularly corticosteroids used under hydrocolloid dressings. However, there are no data from comparative clinical studies evaluating the remission and relapse characteristics of such occlusion therapy compared with orthodox topical steroid monotherapy. METHODS In a randomised, open-label, parallel group study from three centres, the remission and relapse characteristics were investigated for the use of a hydrocolloid dressing (HCD) over clobetasol propionate 0.05% lotion once a week compared with the same steroid in ointment formulation used unoccluded twice a day in 61 patients with stable chronic plaque psoriasis. RESULTS There was a pronounced treatment difference in favour of the HCD + clobetasol propionate lotion group with respect to time to clearance, but there was little evidence for a difference with respect to time to relapse. CONCLUSION The combination of the HCD + clobetasol propionate lotion provides a fast and highly effective remission induction.
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O'Meara S, Tierney J, Cullum N, Bland JM, Franks PJ, Mole T, Scriven M. Four layer bandage compared with short stretch bandage for venous leg ulcers: systematic review and meta-analysis of randomised controlled trials with data from individual patients. BMJ 2009; 338:b1344. [PMID: 19376798 PMCID: PMC2670366 DOI: 10.1136/bmj.b1344] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To compare the effectiveness of two types of compression treatment (four layer bandage and short stretch bandage) in people with venous leg ulceration. DESIGN Systematic review and meta-analysis of patient level data. DATA SOURCES Electronic databases (the Cochrane Central Register of Controlled Trials, the Cochrane Wounds Group Specialised Register, Medline, Embase, CINAHL, and National Research Register) and reference lists of retrieved articles searched to identify relevant trials and primary investigators. Primary investigators of eligible trials were invited to contribute raw data for re-analysis. Review methods Randomised controlled trials of four layer bandage compared with short stretch bandage in people with venous leg ulceration were eligible for inclusion. The primary outcome for the meta-analysis was time to healing. Cox proportional hazards models were run to compare the methods in terms of time to healing with adjustment for independent predictors of healing. Secondary outcomes included incidence and number of adverse events per patient. RESULTS Seven eligible trials were identified (887 patients), and patient level data were retrieved for five (797 patients, 90% of known randomised patients). The four layer bandage was associated with significantly shorter time to healing: hazard ratio (95% confidence interval) from multifactorial model based on five trials was 1.31 (1.09 to 1.58), P=0.005. Larger ulcer area at baseline, more chronic ulceration, and previous ulceration were all independent predictors of delayed healing. Data from two trials showed no evidence of a difference in adverse event profiles between the two bandage types. CONCLUSIONS Venous leg ulcers in patients treated with four layer bandages heal faster, on average, than those of people treated with the short stretch bandage. Benefits were consistent across patients with differing prognostic profiles.
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Affiliation(s)
- Susan O'Meara
- Department of Health Sciences, University of York, York YO10 5DD.
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Vokurka S, Bystricka E, Visokaiova M, Scudlova J. Once- versus twice-weekly changing of central venous catheter occlusive dressing in intensive chemotherapy patients: results of a randomized multicenter study. Med Sci Monit 2009; 15:CR107-CR110. [PMID: 19247240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Changing a central venous catheter occlusive dressing on a twice-weekly basis is usually recommended in hemato-oncological patients. A longer interval is believed to give rise to infections. However, frequent dressing changes might cause local cutaneous damage. MATERIAL/METHODS Local cutaneous damage and infections were compared in patients with once-weekly versus twice-weekly changes of central venous catheters occlusive dressings. This was a prospective, randomized, multicenter trial. RESULTS Eighty-one patients with acute myeloid leukemia being treated with intensive chemotherapy were enrolled (twice-weekly group: n=42, once-weekly group: n=39). They had a non-tunneled polyurethane central venous catheter inserted into the vena subclavia and the insertion site was covered by a polyurethane semi-permeable occlusive dressing. No differences were observed between the groups with respect to local cutaneous damage, fevers, or positive catheter blood cultures. There were more insertion-site inflammations in the twice-weekly group (55% vs. 25%, p=0.008). In the once-weekly group it was necessary to change the occlusive dressing sooner in 42% of the cases, mostly due to a soiled dressing and local bleeding, and the real mean interval of changes was 5.4 days. CONCLUSIONS Prolonging the frequency of occlusive dressing change to a once-weekly interval was limited by an increasing number of unplanned dressing changes. The prolonged interval of dressing changes, with a real mean interval of 5.4 days, did not lead to an increased number of local cutaneous complications or central venous catheter blood culture positivity and even contributed to reduced insertion-site inflammation occurrence.
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Affiliation(s)
- Samuel Vokurka
- Department of Hemato-Oncology, University Hospital in Plzen (Pilsen), Plzen, Czech Republic.
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Bowler P. A question of rigour. J Wound Care 2008; 17:90; author reply 90-1. [PMID: 18389834 DOI: 10.12968/jowc.2008.17.2.28185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Widman TJ, Oostman H, Storrs FJ. Allergic contact dermatitis from medical adhesive bandages in patients who report having a reaction to medical bandages. Dermatitis 2008; 19:32-37. [PMID: 18346394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Medical adhesive bandages are extensively used in both inpatient and outpatient medicine. However, few reports describing proven allergic contact dermatitis (ACD) from medical adhesive bandages exist in the literature. These reports do not adequately correspond to the frequency that patients report having an "allergy" to medical adhesive bandages. OBJECTIVE To determine if there is a chemical present in medical adhesive bandages that causes ACD in people who identify themselves as having an "allergy" to medical adhesive bandages. METHODS Twenty-six patients were enrolled and underwent patch testing with our standard trays (104 chemicals) and a customized adhesive tray (54 chemicals and 10 tapes and bandages in their whole form). RESULTS We were able to identify an allergen in four patients that was related to their presumed adhesive allergy (Mastisol, neomycin/bacitracin [two different patients], and cortisone-10 cream, respectively). However, there were no positive allergic reactions to the tapes or bandages or any relevant allergic reactions to our customized adhesive tray. Eight (73%) of the 11 patients who had the bandage or tape left on for 7 days had an irritant reaction. CONCLUSION We feel that the perceived reactions are not secondary to ACD but instead are due to an irritant contact dermatitis.
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Young S, Bielby A, Milne J. Use of ultrasound to characterise the fluid-handling characteristics of four foam dressings. J Wound Care 2007; 16:425-431. [PMID: 18065018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To observe and measure the process of hydration and dehydration in four commonly used adhesive foam dressings using high frequency ultrasound. METHOD High frequency ultrasound (20MHz) with an axial resolution of 60 microm was used to image the inside of the wound dressings under investigation and thereby assess their level of hydration. This allowed the uptake of a bolus of fluid into the dressing via absorption and the subsequent loss of fluid via evaporation to be both observed and measured. Four dressings were assessed:ActivHeal Foam Island (10 x 10cm), Allevyn Adhesive (10 x 10 cm), Biatain Adhesive (12 x 12cm), and Mepilex Border (10 x 10 cm). RESULTS Part I showed that Allevyn hydrated most rapidly followed byActivHeal, Biatain and Mepilex. Part 2 indicated that Allevyn dehydrated most rapidly followed by Mepilex,ActivHeal and Biatain. CONCLUSION High frequency ultrasound proved to be an effective tool in assessing the fluid handling properties of wound dressings. Of the dressings tested Allevyn demonstrated the best fluid handling properties in terms of how rapidly it could hydrate and dehydrate.
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Affiliation(s)
- S Young
- Barnsley Hospitals NHS Foundation Trust, UK.
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Sanmartin M, Gomez M, Rumoroso JR, Sadaba M, Martinez M, Baz JA, Iniguez A. Interruption of blood flow during compression and radial artery occlusion after transradial catheterization. Catheter Cardiovasc Interv 2007; 70:185-9. [PMID: 17203470 DOI: 10.1002/ccd.21058] [Citation(s) in RCA: 142] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To analyze the possible relationship between compression after transradial catheterization and radial artery occlusion. BACKGROUND Radial artery occlusion is an important concern of transradial catheterization. Interruption of radial artery flow during compression might influence the rate of radial artery occlusion at follow-up. METHODS A prospective study including 275 consecutive patients undergoing transradial catheterization was conducted. Arterial sheaths were removed immediately after procedures and conventional compressive dressings were left in place for 2 hr. The pulse oximeter signal in the index finger during ipsilateral ulnar compression was used for the assessment of radial artery flow. RESULTS Radial artery flow was absent in 174 cases (62%) immediately after entry-site compression. After 2 hr of conventional hemostasis, radial artery flow was absent in 162 cases (58%) before bandage removal. At 7-day follow-up, 12 patients (4.4%) had absent pulsations and radial artery flow was absent in 29 cases (10.5%). Patients with an occluded radial artery at follow-up had significantly smaller arterial diameters at baseline (2.23+/-0.4 mm vs. 2.40+/-0.5 mm; P=0.032) and more frequently had absent flow during hemostasis (90% vs. 54%, P<0.001). Stepwise logistic regression analysis revealed that absent flow before compressive bandages removal was the only independent predictor of radial artery occlusion at follow-up (OR=6.7; IC 95%: 1.95-22.9; P=0.002). CONCLUSIONS Flow-limiting compression is a frequent finding during conventional hemostasis after transradial catheterization. Absence of radial artery flow during compression represents a strong predictor of radial artery occlusion.
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Affiliation(s)
- Marcelo Sanmartin
- Unidad de Cardiología Intervencionista, Medtec, Hospital Meixoeiro, Vigo, Spain.
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17
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Chun BY, Kwon SJ, Chae SH, Kwon JY. Reduction of deviation angle during occlusion therapy: in partially accommodative esotropia with moderate amblyopia. Korean J Ophthalmol 2007; 21:159-62. [PMID: 17804922 PMCID: PMC2629679 DOI: 10.3341/kjo.2007.21.3.159] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate changes in ocular alignment in partially accommodative esotropic children age ranged from 3 to 8 years during occlusion therapy for amblyopia. Methods Angle measurements of twenty-two partially accommodative esotropic patients with moderate amblyopia were evaluated before and at 2 years after occlusion therapy. Results Mean deviation angle with glasses at the start of occlusion treatment was 19.45±5.97 PD and decreased to 12.14±12.96 PD at 2 years after occlusion therapy (p<0.01). After occlusion therapy, 9 (41%) cases were indications of surgery for residual deviation but if we had planned surgery before occlusion treatment, 18 (82%) of patients would have had surgery. There was a statistical relationship between increase of visual acuity ratio and decrease of deviation angle (r=-0.479, p=0.024). Conclusions There was a significant reduction of deviation angle of partially accommodative esotropic patients at 2 years after occlusion therapy. Our results suggest that occlusion therapy has an influence on ocular alignment in partially accommodative esotropic patients with amblyopia.
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Affiliation(s)
- Bo Young Chun
- Department of Ophthalmology, Kyungpook National University, School of Medicine, Daegu, Korea
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18
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Whitaker IS, Worthington S, Jivan S, Phipps A. The use of Biobrane by burn units in the United Kingdom: a national study. Burns 2007; 33:1015-20. [PMID: 17764848 DOI: 10.1016/j.burns.2006.11.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2006] [Accepted: 11/28/2006] [Indexed: 10/22/2022]
Abstract
Biobrane is a biosynthetic wound dressing, first used by Woodruff in 1979, which has many of the ideal properties of a dressing as outlined by Pruitt and Levine [Pruitt Jr BA, Levine NS. Characteristics and uses of biologic dressings and skin substitutes. Arch Surg 1984;119(3):312-22]. It is becoming increasingly popular in the management of superficial and moderate depth partial thickness burns and a range of other conditions. When used appropriately, it has been shown to reduce pain levels, healing time, inpatient stay and nursing requirements when compared to traditional dressings. We present the results of a national study concerning the use of Biobrane in the United Kingdom, highlight variations in practice, discuss the pertinent issues, make suitable recommendations and highlight the versatility of Biobrane as a wound dressing.
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Affiliation(s)
- I S Whitaker
- The Yorkshire Regional Burns Unit, Pinderfield's Hospital, Wakefield, United Kingdom.
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19
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Affiliation(s)
- Sammy Al-Benna
- Royal Victoria Infirmary, Newcastle-upon-Tyne, United Kingdom
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20
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Segers P, de Jong AP, Kloek JJ, van der Horst CM, Spanjaard L, de Mol BA. Topical negative pressure therapy in wounds after cardiothoracic surgery: successful experience supported by literature. Thorac Cardiovasc Surg 2006; 54:289-94. [PMID: 16902874 DOI: 10.1055/s-2006-924003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Patients undergoing cardiothoracic surgery are at substantial risk of developing surgical site infections (SSI). SSI is not only associated with an increased morbidity but also with high mortality. Topical negative pressure therapy (TNP) is a promising method for treating surgical site defects (SSD). In recent years, we have gained a wide experience with TNP in a great variety of SSD. METHODS We completed a prospective follow-up report of all patients treated with TNP after cardiothoracic surgery at the Academic Medical Centre Amsterdam, a university hospital. A review of the current evidence for TNP in cardiothoracic surgery is presented. RESULTS Between August 2000 and March 2005, TNP was used in 105 patients in 113 SSD. As we gained more experience, we saw a decline in hospital stay ( P < 0.0001) and duration of TNP therapy. Surgical closure was performed in 62 % of patients using simple surgical (reconstructive) techniques. Therapy-related complications were rare (n = 1). CONCLUSION Based on clinical findings and supported by the research presented, the treatment modality of choice for SSD after cardiothoracic surgery is TNP.
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Affiliation(s)
- P Segers
- Department of Cardiothoracic Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
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Takahashi J, Yokota O, Fujisawa Y, Sasaki K, Ishizu H, Aoki T, Okawa M. An evaluation of polyvinylidene film dressing for treatment of pressure ulcers in older people. J Wound Care 2006; 15:449-50, 452-4. [PMID: 17124819 DOI: 10.12968/jowc.2006.15.10.26971] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To compare the effectiveness of polyvinylidene (PVL) food wrap as a dressing material versus conventional ointments and gauze dressings for pressure ulcers in patients aged 60 years or over. METHODS A prospective open controlled trial was conducted. The severity of pressure ulcers in both groups was evaluated using the DESIGN system. Scores were compared at baseline, four, eight and 12 weeks. RESULTS Twenty-five patients were treated with the PVL film (test) dressings and 24 with the conventional treatment (control). The test group showed greater improvement in DESIGN scores than the control group throughout the observation period, and the difference reached statistical significance at 12 weeks (p < 0.05). The incidences of local wound infection in the two groups were not statistically different (p > 0.999). CONCLUSION The PVL film dressing was more effective than conventional treatment in the management of severe pressure ulcers.
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Affiliation(s)
- J Takahashi
- Department of Psychiatry, Minakuchi Hospital, Koka City, Japan.
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Caruso DM, Foster KN, Blome-Eberwein SA, Twomey JA, Herndon DN, Luterman A, Silverstein P, Antimarino JR, Bauer GJ. Randomized clinical study of Hydrofiber dressing with silver or silver sulfadiazine in the management of partial-thickness burns. J Burn Care Res 2006; 27:298-309. [PMID: 16679897 DOI: 10.1097/01.bcr.0000216741.21433.66] [Citation(s) in RCA: 107] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This prospective, randomized study compared protocols of care using either AQUACEL Ag Hydrofiber (ConvaTec, a Bristol-Myers Squibb company, Skillman, NJ) dressing with silver (n = 42) or silver sulfadiazine (n = 42) for up to 21 days in the management of partial-thickness burns covering 5% to 40% body surface area (BSA). AQUACEL Ag dressing was associated with less pain and anxiety during dressing changes, less burning and stinging during wear, fewer dressing changes, less nursing time, and fewer procedural medications. Silver sulfadiazine was associated with greater flexibility and ease of movement. Adverse events, including infection, were comparable between treatment groups. The AQUACEL Ag dressing protocol tended to have lower total treatment costs (Dollars 1040 vs. Dollars 1180) and a greater rate of re-epithelialization (73.8% vs 60.0%), resulting in cost-effectiveness per burn healed of Dollars 1,409.06 for AQUACEL Ag dressing and Dollars 1,967.95 for silver sulfadiazine. A protocol of care with AQUACEL(R) Ag provided clinical and economic benefits compared with silver sulfadiazine in patients with partial-thickness burns.
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Affiliation(s)
- C Williams
- Department of Community Based Medicine, University of Bristol, Bristol, UK.
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24
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Abstract
INTRODUCTION Extensively undermined wound cavities represent a common surgical problem. By a modified vacuum therapy the healing of such wounds can be accelerated. MATERIALS AND METHODS Based on our experience in selected cases with wound healing disorders or extremely undermined wounds following degloving injuries or abscess formations the application of topical negative pressure therapy to fix wound margins to the wound ground while at the same time allowing exudates emission with additional drainages is described. RESULTS In 5 patients we were able to demonstrate the efficacy of vacuum dressing system described here with successful and lasting adaptation of the wound margins to the defect. All wounds were brought to permanent healing. CONCLUSION Extensive tissue degloving and wound healing disorders after excessive tissue mobilization during plastic surgical defect coverage can be treated successfully with topical negative pressure therapy (TNP). Whereas longterm complete conventional polyurethane foam lining of wound cavities is an effective method and may be necessary in special situations, the application of TNP can lead to a firm adhesion of wound margins in extensive subcutaneous or epi-fascial wounds to the undersurface. To avoid exudate formation in the adjoining tissue TNP can be effectively optimized by the placement of drainage tubes into the surrounding tissue.
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Affiliation(s)
- A Grimm
- Abteilung für Plastische und Handchirurgie, Universitätsklinikum Erlangen
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25
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Affiliation(s)
- Zahid Hassan
- The Burns Unit, Central Manchester and Manchester Children's NHS Trust, Department of Plastic Surgery, Booth Hall Children's Hospital, Charlestown Road, Blackley, Manchester M9 7AA, UK
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Sekundo W, Dick HB, Meyer CH. Benefits and Side Effects of Bandage Soft Contact Lens Application after LASIK. Ophthalmology 2005; 112:2180-3. [PMID: 16225925 DOI: 10.1016/j.ophtha.2005.06.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2005] [Accepted: 06/13/2005] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To evaluate benefits and side effects of bandage soft contact lens (BSCL) insertion after LASIK in relation to patients' characteristics. DESIGN Prospective, randomized, bicenter comparative investigational trial. PARTICIPANTS One hundred patients (200 eyes) with myopia and/or myopic astigmatism. METHODS Each patient underwent consecutive (Marburg, Germany) or simultaneous (Mainz, Germany) bilateral LASIK. At the end of the procedure, the first treated eye received a drop of ofloxacin and dexamethasone, patch, and transparent protective shield for 2 to 4 hours. The fellow eye received in addition a BSCL, soaked in the same eyedrops for 20 to 24 hours. MAIN OUTCOME MEASURES Schirmer II test results, first-day uncorrected visual acuity (UCVA), and tolerance of contact lens wear (poor, moderate, good) were recorded. Patients' subjective preference for the BSCL on the first postoperative day was graded as more comfortable than fellow eye, no difference, or less comfortable. Three months after surgery, the corneal flap was photographed in retroillumination for objective evaluation of microstriae. Statistical significance was determined using the Kruskal-Wallis 1-way analysis of variance on ranks test. RESULTS Fifty-four percent of patients felt discomfort in the eye that had the BSCL (contra-BSCL subgroup), whereas 27% enjoyed having a BSCL (pro-BSCL subgroup). The remaining 19% felt no difference. The average Schirmer II value was 16.6 mm (+/-7.7) in the pro-BSCL subgroup, 14.9 mm (+/-6.4) in the no difference subgroup, and 12.3 mm (+/-7.7) in the contra-BSCL subgroup. There was a female preponderance in the contra-BSCL (39:15) and no difference (15:6) subgroups. A preoperative history of poor contact lens tolerance was recorded in 50% of the contra-BSCL subgroup patients; 41%, no difference; and 33%, pro-BSCL. Postoperative parameters such as first-day UCVA, number of eyes with microstriae, folds requiring stretching, or cases of diffuse lamellar keratitis did not differ significantly. Eyes with flap microstriae had a significantly deeper mean ablation (114.5 microm [range, 52-146 microm]) than eyes without any flap abnormalities (75.4 microm [39-120 microm]). No significant differences were found between the consecutive and simultaneous groups. CONCLUSION The majority of patients did not experience better postoperative comfort from the application of a BSCL. Only 27% of patients reported more comfort from postoperative BSCL use. The latter have better tear film characteristics and a history of less difficulty with contact lenses preoperatively. A BSCL does not protect from the occurrence of microstriae.
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Affiliation(s)
- Walter Sekundo
- Department of Ophthalmology, Philipps University, Marburg, Germany.
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Abstract
STUDY DESIGN Case report. OBJECTIVE To report an unusual case of paraplegia. SETTING University Hospital Bursa, Turkey. CASE REPORT A 22-year-old woman presented with paraplegia following a left-sided thoracotomy. Magnetic resonance imaging showed a dorsal epidural mass at the level of T6. The patient underwent an emergency T6/7 laminectomy and removal of a tuft of oxidised regenerated cellulose, which had migrated through the intervertebral foramen causing spinal cord compression. CONCLUSION In cases of neurological deficits after surgery at the posterolateral edge of a thoracotomy, the clinician should be aware of the above possibility. Urgent radiological diagnosis and decompressive laminectomy is the treatment of choice.
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Affiliation(s)
- S Dogan
- Department of Neurosurgery, School of Medicine, Uludağ University, Bursa, Turkey
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28
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Abstract
Primary cutaneous mucormycosis is an unusual mycotic infection associated to immunosupression. We present a 34 year-old woman with HIV infection with a necrotic primary mucormycosis of the skin associated to a venous catheter. She was treated with amphotericin B and surgical debridement.
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Affiliation(s)
- Adriana Pérez-Uribe
- Departamento de Dermatología, Hospital General Dr. Manuel Gea González SS, Tlalpan, México DF, México
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29
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Horch RE, Gerngross H, Lang W, Mauckner P, Nord D, Peter RU, Vogt PM, Wetzel-Roth W, Willy C. [Indications and safety aspects of vacuum-assisted wound closure]. MMW Fortschr Med 2005; 147 Suppl 1:1-5. [PMID: 16739365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Problem wounds continue to challenge medical care. In recent times, good results have been achieved through the application of negative pressure wound therapy. This approach, known as vacuum-assisted wound closure (VAC) involves the use of a defined,controlled negative pressure over a polyurethane or polyvinyl sponge placed in the wound. The wound effluent is evacuated continuously. The result is an improvement of microcirculation, and wound healing is enhanced. Animal experiments have confirmed an increase in cell growth. The basis for surgical wound management continues to be appropriate debridement. In this connection, negative pressure therapy, as a supportive measure, has proved to have major advantages over traditional methods of wound management, advantages that need to be further investigated clinically and experimentally. Consideration of the safety aspects and risk factors associated with the procedure can contribute to the optimization of therapeutic safety.
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Affiliation(s)
- R E Horch
- Universitätsklinikum Erlangen, Krankenhausstrasse 12, D-91054 Erlangen.
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30
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Abstract
We report an erosion and hemorrhage of a left anterior tibial artery associated with a vacuum-assisted closure device. To our knowledge, this report represents the first arterial erosion associated with a vacuum-assisted closure device. We estimate our patient lost 6 units of blood. The hemorrhage was complicated by anticoagulation and a traumatic setting. Based on our complication, we believe great care should be taken when placing a vacuum-assisted closure device adjacent to an exposed artery.
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Affiliation(s)
- Richard A White
- Department of Orthopaedic Surgery, University Hospital at University of Missouri-Columbia, Columbia, MO, USA
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31
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Stephens C. Wound-contact layers: a re-evaluation. J Wound Care 2005; 14:30. [PMID: 15656463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
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32
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Affiliation(s)
- F Burton
- University Hospitals Coventry and Warwickshire NHS Trust, UK.
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34
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Affiliation(s)
- M Trop
- Department of Paediatrics, PICU and Children's Burns Unit, University of Graz, Auenbruggerplatz 30, 8036 Graz, Austria.
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35
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Meaume S. [Wound and dressings note. 6--Carbon and silver films]. Soins 2004:25-6. [PMID: 15042764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
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37
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Schaller M, Laude J, Bodewaldt H, Hamm G, Korting HC. Toxicity and Antimicrobial Activity of a Hydrocolloid Dressing Containing Silver Particles in an ex vivo Model of Cutaneous Infection. Skin Pharmacol Physiol 2004; 17:31-6. [PMID: 14755125 DOI: 10.1159/000074060] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2003] [Accepted: 06/06/2003] [Indexed: 11/19/2022]
Abstract
In the present study we examined the effects of two hydrocolloid wound dressings (conventional silver-free Comfeel, silver-incorporating Contreet-H) on uninfected and Candida albicans- or methicillin-resistant Staphylococcus aureus-infected reconstituted human epithelium (RHE). The morphological alterations of the keratinocytes caused by infection and by treatment were analysed with light and electron microscopy. As a measure of epithelial cell damage the release of lactate dehydrogenase from epithelial cells into the surrounding medium was monitored. Application of Contreet-H or Comfeel to uninfected RHE induced no major morphological effects on epithelial cells. Both wound dressings reduced the growth of micro-organisms. Specific alterations of the infected epithelium (vacuoles, spongiosis, oedema, detachment of keratinocytes) and invasion of the epithelium were significantly reduced only by treatment with Contreet-H. At the ultrastructural level release of silver by Contreet-H and superior antimicrobial efficacy could be verified. In summary, treatment with both wound dressings reduced the number of pathogens, with the silver-based wound dressing providing a more effective antimicrobial activity. This resulted in a strong decrease of pathogen-specific alterations of the infected epithelium. We present evidence that delivering silver to infected keratinocytes in a moist healing environment improves the benefit/risk ratio as compared to silver-free wound dressings.
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Affiliation(s)
- M Schaller
- Department of Dermatology and Allergology, University of Munich, Frauenlobstrasse 9-11, DE-80337 Munich, Germany.
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38
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Maume S, Van De Looverbosch D, Heyman H, Romanelli M, Ciangherotti A, Charpin S. A study to compare a new self-adherent soft silicone dressing with a self-adherent polymer dressing in stage II pressure ulcers. Ostomy Wound Manage 2003; 49:44-51. [PMID: 14581709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
Pressure ulcers are common among elderly nursing home residents. To be effective in managing these wounds, a dressing should maintain a moist environment, facilitate healing, absorb exudate, remain in place for a number of days, and prevent trauma to the surrounding skin. An 8-week, open, randomized, multicenter, controlled study was conducted to compare the effects of a new self-adherent soft silicone dressing and a self-adherent hydropolymer dressing on Stage II pressure ulcers. Thirty-eight (38) residents participated in the study. Eighteen residents (mean age 83.8 years, range 74.9 to 95.1 years) were randomized to wound management with a soft silicone dressing, and the ulcers of 20 residents (mean age 82.5 years, range 66.4 to 91.9 years) were managed with a hydropolymer dressing. Wound healing, wound and surrounding skin characteristics, and ease of dressing removal were measured and documented. During the study, eight (44%) ulcers in the soft silicone group and 10 (50%) in the hydropolymer dressing group healed. Both dressings were changed approximately once a week and no differences in signs of inflammation, amount of exudate and odor, or incidence of leakage were observed. Damage to the surrounding skin, maceration, and dressing removal difficulties were less common with the soft silicone dressing. Differences in tissue damage between the two dressings were significant during weeks 1, 2, and 3 (P < 0.05). Studies with a larger sample size are needed to confirm these findings.
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Affiliation(s)
- Sylive Maume
- Department of Gerontology, H pital Charles Foix, Paris, France.
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39
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Abstract
Acute surgical wounds left to heal by secondary intention are often routinely managed with gauze fabric dressings. This paper reviews research that suggests newer, modern dressings are more cost-effective and cause less pain on removal.
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Affiliation(s)
- E Bethell
- City Hospital NHS Trust, Birmingham, UK.
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40
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Abstract
The primary objective of this study was to assess the skin stripping of wounds (defined as periwound skin blistering; Fowler, 1990) when treated with an adhesive hydrocellular foam dressing (Allevyn trade mark Adhesive, Smith and Nephew) and a self-adherent soft silicone foam dressing (Mepilex trade mark Border, MöInlycke Health Care). The secondary objectives were to assess wound healing, wound appearance and pain. Data were collected over one year from 403 wounds in 206 patients treated in nursing homes. At follow-up assessment, there was some evidence of skin stripping with both products - 5% (5/106) with the adhesive hydrocellular, and 4% (4/100 with the self-adherent dressing. The results of the study reveal that the closure rates achieved with the two dressings were similar, and that both dressings were equally safe in terms of skin stripping. Independent nurse evaluations highlighted the failure of the self-adherent soft silicone foam dressing to either initially adhere to the wound area, or to remain in contact for more than a few days, and frequently needed the application of additional tape to ensure adhesion. The failure of the self-adhesive soft silicone foam dressing to adhere to the periwound area was a significant deterrent to staff to use this type of dressing routinely.
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Kuruenko AI, Bogdanets LI, Bogachev VI, Zhuravleva OV. [Results of an open comparative study on efficacy and safety of Voscopran bandages used for local treatment of venous ulcers in the II and III stages of wound healing]. Khirurgiia (Mosk) 2003:38-40. [PMID: 14533380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
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Abstract
Staphylococcal scalded skin syndrome (SSSS) may cause significant morbidity in children. It is common practice for adhesive occlusive dressings to be used to apply topical local anaesthetic prior to venepuncture. We report two cases in which removal of these dressings from children with SSSS caused injury and discomfort in areas previously free from blistering. We recommend that an alternative method of topical anaesthetic application is used to minimize skin trauma in these patients.
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Affiliation(s)
- S A Holme
- Department of Dermatology, Royal Gwent Hospital, Cardiff Road, Newport, UK
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43
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Abstract
Topical negative pressure (TNP) has achieved widespread use in the treatment of problematic wounds. We report the case of a patient treated with TNP for groin-wound dehiscence following inguinal block dissection. During treatment, clinical signs of sepsis developed, in association with a progressively worsening anaerobic wound infection. This infection settled with antibiotic therapy and cessation of TNP treatment. We postulate that the air-free environment created by TNP potentiated the growth of the anaerobic bacteria, resulting in significant sepsis, and therefore recommend close surveillance of bacterial flora while using this therapy, particularly in susceptible patients.
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Affiliation(s)
- D L Chester
- Department of Plastic Surgery, University Hospital Birmingham NHS Trust, Selly Oak Hospital, Birmingham, UK
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45
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Hamanová H, Broz L. Topigel in the treatment of hypertrophic scars after burn injuries. Acta Chir Plast 2002; 44:18-22. [PMID: 12053431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
The authors present the results of a medium-term study in which they investigated the therapeutic effect of the silicone elastomer TopiGel on developing hypertrophic scars in a group of patients after burn injuries classified as IIb or deeper. The hitherto published results are very encouraging. This medium-term study confirmed the hypothesis that TopiGel has a positive effect on the reduction, stabilization and normalization of hypertrophic scars. In 48 patients (96%) out of a total of 50, stabilization of the scar occurred as well as its functional and cosmetic normalization, although the subjective view of the patients or parents (in case of pediatric patients) differed in some instances. In two children (4%) only a significant reduction of the scar occurred and not normalization, due to incorrect application of the gel by the parents, lack of adherence to basic hygienic principles or the recommended procedure of gel application. In case of repeated complications, treatment was not pursued. In two patients (4%) treatment was discontinued for a short time due to an allergic skin reaction subsequently, treatment was resumed until complete stabilization of the scar was achieved. The study ruled out a positive therapeutic effect of the silicone sheet on the painfulness of a scar and old, mature hypertrophic scars.
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Affiliation(s)
- H Hamanová
- Department of Rehabilitation, Medical Faculty and Teaching Hospital, Charles University, Hradec Králové, Czech Republic
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46
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Grange-Prunier A, Couilliet D, Grange F, Guillaume JC. [Allergic contact dermatitis to the Comfeel hydrocolloid dressing]. Ann Dermatol Venereol 2002; 129:725-7. [PMID: 12124516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
INTRODUCTION Allergic contact dermatitis is frequent in patients with chronic leg ulcers. However, it rarely occurs with modern wound dressings and is exceptional with hydrocolloids. CASE REPORT A 66-year-old woman was treated for a leg ulcer with the Comfeel plus(R) transparent hydrocolloid dressing for two months. She developed a pruriginous, erythematous and vesiculous dermatitis under the hydrocolloid plaques. Patch tests for the Comfeel plus(R) transparent hydrocolloid, the Comfeel plus(R) hydrocolloid, balsam of Peru and epoxy resin were positive. Only the positive test for the Comfeel plus(R) transparent hydrocolloid was clinically pertinent. The histological examination of the positive test was suggestive of eczema. DISCUSSION To our knowledge, allergic contact dermatitis to Comfeel plus(R) hydrocolloid dressings has not been reported. Most previous studies which included systematic patch-testings in patients with leg ulcers showed high sensitization rates for various allergens, but no allergy to hydrocolloids. Only isolated cases of allergic contact dermatitis to another hydrocolloid (Duoderm E(R)) have been reported. Our case report shows that allergic contact dermatitis is a possible side-effect of Comfeel plus(R) hydrocolloid dressings. However, it seems exceptional. Since the patch-tests failed to identify the constituent responsible for this allergy in our observation, comprehensive allergologic investigations should be repeated in further cases.
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Affiliation(s)
- A Grange-Prunier
- Service de Dermatologie, Hôpital Pasteur, 39, avenue de la Liberté, 68024 Colmar Cedex
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Bhalla RK, Murphy J, Jones TM, Roland NJ. Foreign body reaction to calcium alginate fibre mimicking recurrent tumour of the submandibular salivary gland. Br J Oral Maxillofac Surg 2002; 40:172-4. [PMID: 12180215 DOI: 10.1054/bjom.2001.0758] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A 50-year-old woman was referred after the discovery of adenoid cystic carcinoma in an excised left submandibular gland. Treatment involved clearance of the left submandibular fossa, and bilateral levels II and III selective neck dissections. A left-sided submandibular haematoma developed during the immediate postoperative period. After removal of the clot, there was a persistent, low volume capillary ooze from the left submandibular fossa and a calcium alginate fibre pack (Kaltostat) was left in place to control the bleeding. After an extended period of time the pack excited a foreign body reaction which, on a computed tomogram, mimicked a recurrence of the tumour. We review the role of Kaltostat in this setting and its potential for foreign body reaction, which may mimic serious disease.
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Affiliation(s)
- R K Bhalla
- Department of Otolaryngology and Head & Neck Surgery, University Hospital Aintree, Liverpool, UK
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Abstract
In order to elucidate the blood gas and heart rate changes caused by bilateral nasal packing, 21 healthy subjects who had had septoplasty or septorhinoplasty were investigated with pre- and post-operative blood gas measurements and 24-h Holter monitoring. Nasal packing caused a significant decrease in O2 saturation (P < 0.05), a borderline decrease in PO2 (P = 0.09), insignificant changes in PCO2, pH and HCO3 (P > 0.05), a significant increase in minimum and mean heart rates (P < 0.05) and insignificant changes in maximum heart rates; however, further research is necessary to elucidate the direct cause-and-effect relationship. No serious arrhythmias were observed. Although these changes may be within normal levels for healthy subjects, they may have serious consequences for patients with cardiopulmonary diseases.
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Affiliation(s)
- Oguz Ogretmenoglu
- Hacettepe University, Faculty of Medicine, Department of Otolaryngology-Head and Neck Surgery, Bahçelievler Ankara, Turkey
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Abstract
Occlusion, widely used to enhance percutaneous absorption of drugs, also increases penetration of other chemicals and antigens, and hence may exacerbate irritant and allergic contact dermatitis. This overview summarizes the adverse effects of occlusion.
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Affiliation(s)
- H Zhai
- Department of Dermatology, University of California, School of Medicine, Box 0989, Surge 110, San Francisco, CA 94143-0989, USA
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50
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Abstract
The non-adherent siliconised dressing Mepitel is excellent for burns, especially in children. It provides a moist wound environment, promotes wound healing and is easy and relatively painless to use. However, surgeons should be aware that in black children its use has been associated with pigmentation abnormalities.
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Affiliation(s)
- G Williams
- St Andrews Centre for Burns and Plastic Surgery, Court Road, Broomfield, Essex CM1 7ET, Chelmsford, UK
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