纳米晶体银敷料治疗烧伤后残余创面的多中心临床研究

目的观察纳米晶体银敷料在治疗烧伤后残余创面、控制感染方面的疗效和安全性, 从而评价其临床应用价值。方法入选患者98例166个残余创面,采用随机、盲法、多中心、阳性平行对照的试验设计。在常规治疗的基础上,试验组(83处创面)参照伤口形状剪切大小合适的纳米晶体银敷料覆盖创面,对照组(83处创面)常规外用磺胺嘧啶银。观察至创面完全愈合或用药20d 时终止试验。比较两组患者创面愈合时间、愈合率及药物抗感染效果。结果试验组创面愈合时间为(12±5)d,较对照组(16±6)d明显缩短(P=0．005<0．01)。治疗总显效率试验组为97．05％, 较对照组的94．17％有升高趋势(P>0．05)。试验组用药后6、12 d累计细菌清除率分别为21．7％、 43．5%,较对照组明显增高(P<0．05)。用药后两组患者均未见明显不良反应。结论纳米晶体银敷料用于治疗烧伤后残余创面疗效确切,并可为进一步促进伤口愈合提供良好的基底。     

Hydrofiber dressing with silver for the management of split-thickness donor sites: A randomized evaluation of two protocols of care

Background

This randomized, open-label study evaluated Aquacel Ag^® Hydrofiber^® dressing with silver (HDS; ConvaTec, Skillman, NJ, USA) with an adherent or gelled protocol in the management of split-thickness donor sites.

Methods

HDS was the primary dressing in the adherent group (gauze as secondary covering) and gelled group (transparent film as secondary covering). Dressings were changed on study day 1 or 2 and study days 5 (optional), 10 (optional), and 14. The primary outcome was healing (≥90% re-epithelialization) at study day 14.

Results

Seventy subjects were treated (36 adherent, 34 gelled). By study day 14, 77% of donor sites had healed (67% adherent, 88% gelled). Pain scores decreased over time in both treatment groups. Investigators were “very satisfied” or “satisfied” with (adherent, gelled) time required to manage dressing change (89%, 79% of subjects), minimization of donor-site pain (64%, 82%), ease of application (97%, 94%), management of drainage (92%, 82%), ease of removal (77%, 85%), and ability of dressing to remain in place (69%, 76%). Thirty-nine (56%) subjects had adverse events, most commonly non-donor-site infection (11%) and gastrointestinal events (11%).

Conclusion

In this randomized, open-label study, HDS was well-tolerated, versatile, and effective in the management of split-thickness donor sites.     

Prospective randomised controlled trial of nanocrystalline silver dressing versus plain gauze as the initial post-debridement management of military wounds on wound microbiology and healing

Introduction

Recent conflicts have been characterised by the use of improvised explosive devices causing devastating injuries, including heavily contaminated wounds requiring meticulous surgical debridement. After being rendered surgical clean, these wounds are dressed and the patient transferred back to the UK for on-going treatment. A dressing that would prevent wounds from becoming colonised during transit would be desirable. The aim of this study was to establish whether using nanocrystalline silver dressings, as an adjunct to the initial debridement, would positively affect wound microbiology and wound healing compared to standard plain gauze dressings.

Methods

Patients were prospectively randomised to receive either silver dressings, in a nanocrystalline preparation (Acticoat™), or standard of care dressings (plain gauze) following their initial debridement in the field hospital. On repatriation to the UK microbiological swabs were taken from the dressing and the wound, and an odour score recorded. Wounds were followed prospectively and time to wound healing was recorded. Additionally, patient demographic data were recorded, as well as the mechanism of injury and Injury Severity Score.

Results

76 patients were recruited to the trial between February 2010 and February 2012. 39 received current dressings and 37 received the trial dressings. Eleven patients were not swabbed. There was no difference (p = 0.1384, Fishers) in the primary outcome measure of wound colonisation between the treatment arm (14/33) and the control arm (20/32). Similarly time to wound healing was not statistically different (p = 0.5009, Mann–Whitney). Wounds in the control group were scored as being significantly more malodorous (p = 0.002, Mann–Whitney) than those in the treatment arm.

Conclusions

This is the first randomised controlled trial to report results from an active theatre of war. Performing research under these conditions poses additional challenges to military clinicians. Meticulous debridement of wounds remains the critical determinant in wound healing and infection and this study did not demonstrate a benefit of nanocrystaline silver dressing in respect to preventing wound colonisation or promoting healing, these dressings do however seem to significantly reduce the unpleasant odour commonly associated with battlefield wounds.     

A prospective,randomized trial of silver containing hydrofiber dressing versus 1% silver sulfadiazine for the treatment of partial thickness burns

Silver sulfadiazine has been used as a topical burn wound treatment for many years. Pain associated with dressing changes is a common problem in burn wounds. Aquacel Ag, a hydrofiber dressing coated with ionic silver has been reported to reduce burn wound infection and promote antimicrobial activity. The purpose of this study was to show the benefits of Aquacel Ag for the treatment of partial thickness burns. This prospective randomized study was conducted in 70 patients who had partial thickness burns less than 15% of total body surface area and were treated at Siriraj outpatient burn clinic during December 2006–February 2008. Patients were divided into two groups: Aquacel Ag‐treated group with dressing changes every 3 days (35 patients) and 1% silver sulfadiazine‐treated group, with daily dressing changes (35 patients). There was no difference in demographic data including age, gender, burn percentage between groups. Time‐to‐wound healing pain score during dressing change and cost of treatment were compared between both groups. Time‐to‐wound closure was significantly shorter in the Aquacel Ag‐treated group (10 ± 3 versus 13.7 ± 4 days, P < 0·02) as well as pain scores at days 1, 3 and 7 (4·1 ± 2·1, 2·1 ± 1·8, 0·9 ± 1·4 versus 6·1 ± 2·3, 5·2 ± 2·1, 3·3 ± 1·9, respectively, P < 0·02). Total cost of treatment was 52 ± 29 US dollars for the Aquacel Ag‐treated group versus 93 ± 36 US dollars for the silver sulfadiazine‐treated group. This study showed that Aquacel Ag increased time to healing, decreased pain symptoms and increased patient convenience because of limiting the frequency of replacement of the dressing at lower total cost. This study confirms the efficacy of Aquacel Ag for the treatment of partial thickness burns at an outpatient clinic.     

Comparison of silver nylon wound dressing and silver sulfadiazine in partial burn wound therapy

The study aims to perform a comparative assessment of two types of burn wound treatment. To do the assessment, patients with partial thickness burn wounds with total body surface area <40% were simple randomised to treat with nanocrystalline silver nylon wound dressing or silver sulfadiazine cream. Efficacy of treatment, use of analgesics, number of wound dressing change, wound infection and final hospitalisation cost were evaluated. The study showed silver nylon wound dressing significantly reduced length of hospital stay, analgesic use, wound infection and inflammation compared with silver sulfadiazine.     

Open‐label clinical trial comparing the clinical and economic effectiveness of using a polyurethane film surgical dressing with gauze surgical dressings in the care of post‐operative surgical wounds

Surgical site infection (SSI) is a common postoperative complication and can cause avoidable morbidity and excessive costs for the health service. Novel dressings, designed specifically for postoperative wounds, can help to reduce the risk of SSI and other complications such as blistering. This study compared the use of a new polyurethane film surgical dressing (Opsite Post‐Op Visible, Smith & Nephew, Hull, UK) with gauze and tape in the management of postoperative wounds. The results show that the polyurethane film dressing results in a significant reduction in SSI (1·4% versus 6·6%, P = 0·006) as well as a reduction in other postoperative wound complications (e.g. blistering and erythema). Economic analysis conducted alongside the study suggests that these improved outcomes can be achieved at a lower treatment cost than gauze and tape dressings. The modest incremental cost of the polyurethane film surgical dressing is easily offset by the reduction in the costs related to treating SSI and other wound complications associated with gauze and tape dressings.     

传统纱布开放换药与负压封闭引流技术临时治疗不同软组织缺损的疗效比较

目的 比较传统纱布开放换药与负压封闭引流( VSD)装置临时覆盖创面的疗效.方法 回顾性分析2000年3月至2011年9月收治的2153例四肢软组织缺损患者资料,男1548例,女605例;年龄3～68岁,平均35.3岁,平均创面大小为195.9 cm2.创面类型:无菌创面53例,污染创面1388例,感染创面712例;根据临时覆盖创面的方法,分为纱布开放换药组(开放组,793例)和VSD创面封闭组(VSD组,1360例),后期行直接缝合、游离植皮或显微外科手术永久覆盖闭合创面.比较两组患者临时覆盖创面的时间及后期不同永久覆盖方法的选择. 结果 开放组与VSD组各类创面平均临时覆盖时间分别为:无菌创面(9.7±3.1)d和(7.0±1.9)d,污染创面(25.8±6.3)d和(17.8±3.7)d,感染创面(32.0±9.3)d和(21.7±4.0)d.开放组后期直接缝合9例,游离植皮137例,显微外科组织瓣移位(移植)647例;VSD组后期直接缝合47例,游离植皮580例,显微外科组织瓣移位(移植)733例.两组患者3种不同类型创面的临时覆盖时间及永久覆盖方法的选择比较差异均有统计学意义(P＜0.05).2132例患者术后获1～6个月(平均3个月)随访.永久覆盖术后创面愈合良好,大部分感觉恢复,对患肢功能无不良影响. 结论 与传统纱布开放换药临时覆盖创面比较,VSD技术能明显减少临时覆盖时间,对无菌创面可增加二期直接缝合创面的比例,对污染及感染创面可降低二期组织瓣移植闭合创面的比例.     

Efficacy of a new multifunctional surfactant‐based biomaterial dressing with 1% silver sulphadiazine in chronic wounds

Chronic wounds represent a large and growing segment of health care and add considerably to human suffering and economic burden as populations age. More effective materials, especially those promoting ease of use and economy, are needed to treat this increasing number of patients. A case series conducted at a European outpatient tertiary wound centre used a novel surfactant‐based biomaterial dressing containing 1% silver sulphadiazine on 226 chronic wound patients with various aetiologies. Eighty‐eight patients had been undergoing standard of care treatment at the facility, while the remainder (n = 138) began treatment with the surfactant‐based biomaterial dressing on enrollment. A total of 73% of the first group healed or showed improvement, with 60% healing by a median of 17 weeks after beginning treatment, and 86% of the group of new enrollees healed or showed improvement, with 73% healing within a median of 12 weeks of beginning treatment with the new product. Patient and clinician reports showed improved compliance, reduced pain and a favourable side‐effect profile. Limited economic analysis showed markedly reduced treatment costs compared with standard of care. Further research is recommended.     

银离子藻酸盐敷料在儿童四肢深II度烧伤创面中的应用效果观察

目的:探讨藻酸盐银离子敷料治疗儿童深II度烧伤创面中临床效果.方法:选取2015年7月—2016年5月我院烧伤整形科收治的四肢深II度烧伤患儿共60例,随机分为观察组和对照组.在创面清创后,观察组外用藻酸盐银离子敷料覆盖,无菌纱布包扎;对照组采用银锌霜皮肤黏膜抗菌剂涂抹,无菌纱布包扎.两组均根据创面渗出情况换药.比较两组患儿的换药次数、入院第7天的发热率、创面愈合率及愈合时间.结果:与对照组相比,观察组换药次数(8.63±2.37)次,明显少于对照组(14.70±2.30)次,差异有统计学意义(P<0.05).观察组治疗第7天患儿发热率为6.67%(2例),明显低于对照组23.33%(7例),差异有统计学意义(P<0.05);观察组治疗第7、11、15和19天创面愈合率明显高于对照组,差异有统计学意义(P<0.05);观察组创面愈合时间为(20.70±2.30)d,住院时间为(21.33±3.67)d,均较对照组[(27.63±3.63)d和(28.30±3.30)d]缩短,差异具有统计学意义(P<0.05).结论:应用银离子藻酸盐敷料治疗儿童四肢深II度烧伤创面能减少换药次数,加速创面愈合,减少患者痛苦,值得推广和应用.     

A retrospective review of the use of a nanocrystalline silver dressing in the management of open chronic wounds in the community

As part of an infection management protocol, antimicrobial dressings offer an appropriate, cost‐effective choice for the management of localised bioburden in chronic wounds. The choice of antimicrobial can impact significantly not only on the treatment outcomes and cost but also on the safety and well‐being of the patient. This retrospective study investigates these outcomes comparing health care records of 2572 patients with open chronic wounds, who were treated either with an Integrated Care Wound Bundle (ICB) including nanocrystalline silver (NCS) dressings (n = 330) or without NCS dressings and not on a ICB (n = 2242) in the community from March 2016 to March 2018. Wounds treated in the NCS dressing treatment bundle had a mean healing time of 10.46 weeks, vs 25.49 weeks for the non‐ICB treated wounds. In addition, the average interval time between dressing changes was in favour of the NCS dressing treatment bundle (3.98 vs 1.87 days), contributing to a substantial reduction in mean treatment labour costs ($1251 vs $6488). The use of a NCS dressing demonstrated improved efficacy and cost effectiveness of labour required for chronic wound management; highlighting the importance of choosing an effective antimicrobial dressing as part of an infection management protocol.     

百多邦用于痔术后开放性创面治疗效果观察

目的观察和评价百多邦用于痔术后开放性创面的临床疗效,并从理论和临床两个方面探索一种减少痔术后抗生素使用的方案。方法将确诊的160例痔患者,随机分为观察组和对照组,每组80例,其中观察组采用百多邦+紫草油纱条换药;对照组采用静脉输入抗生素+紫草油纱条换药。观察比较两组病例术后第1、3、5d创面疼痛情况,术后第5d炎性水肿、肉芽组织生长情况,并统计两组病例创面愈合时间。结果治疗后两组患者均完全愈合,观察组在减少术后疼痛、炎性水肿及促进肉芽组织的生长等方面的疗效均优于对照组,两者比较差异有统计学意义(P<0.05)。观察组创面愈合时间短于对照组,差异有统计学意义(P<0.05)。结论百多邦+紫草油纱条换药用于痔术后开放性创面治疗临床疗效明确,与静脉输入抗生素+紫草油纱条换药相比,前者能显著减少创面的疼痛、炎性水肿、促进肉芽组织生长及缩短创面愈合时间,是痔术后减少抗生素使用一种优化方案,值得在临床中进一步推广应用。     

Negative pressure wound therapy versus gauze dressings in managing open fracture wound of lower limbs: A meta-analysis of randomized controlled trials

BackgroundThe superiority of negative pressure wound therapy (NPWT) to standard gauze dressings for managing open fractures of the lower limbs remains controversial. This study aimed to comprehensively compare their clinical efficacy through a meta-analysis using randomized controlled trials (RCTs) alone. We hypothesized that NPWT would be more superior against infections.MethodsA literature search was implemented in various databases, including PubMed, Web of Science, Medline, Clinicaltrial.gov, and Cochrane Library, etc, to screen eligible RCTs. All included RCTs were evaluated for risk of bias using the Cochrane Collaboration tool. In accordance with the heterogeneity assessment, a fixed-effect or random-effect model was chosen for the data analysis.ResultsTen RCTs, including 2780 patients, were eligible for the meta-analysis. We found that patients in the NPWT group showed a lower overall infection rate (MD=0.70, 95% CI: 0.54–0.90, P = 0.005), acute wound infection rate (MD = 0.35, 95% CI: 0.16–0.77, P = 0.009), and shorter hospital stay (MD = 24.00, 95% CI: 6.82–84.46, P < 0.00001) compared with the control group. The NPWT group showed a higher proportion of patients with wound coverage than the control group. No significant difference was found between the two groups in terms of function score and other complications, including deep infection rate, amputation, and bone nonunion.ConclusionsFrom the pooled results, we suggest that NPWT may be superior than traditional gauze dressings for managing open fractures of the lower limbs.     

Outcomes of topical phenytoin in the management of traumatic wounds

IntroductionRegular dressing of traumatic wounds is of paramount importance for healing. Phenytoin, an anticonvulsant, is thought to promote wound healing through multiple mechanisms, including fibroblast proliferation, granulation tissue formation, antibacterial activity, and pain alleviation.AimTo assess the effect of topical phenytoin on traumatic wound healing in terms of granulation tissue formation, pain alleviation, and time taken for wound healing.MethodologyFifty patients with traumatic wounds were divided into equal and comparable groups. After cleaning the wound, phenytoin dressing was done in the study group and saline dressing in the control group. Thereafter, regular dressings of the wounds were done, and healing was assessed on day 14 and day 21.ResultsOn day 14, the wound surface area, percentage of granulation tissue, VAS score amongst cases was 39.4 ± 29.75 cm², 82.12 ± 9.71%, 4.52 ± 1.08, and that of controls was and 51.28 ± 25.33 cm², 62.72 ± 9.01%, 6.52 ± 1.22, respectively. On day 21, the wound surface area, percentage of granulation tissue, VAS score amongst cases were 29.4 ± 29.88 cm², 92 ± 4.46%, 2.8 ± 0.94, and that of controls were 38.92 ± 23.24 cm², 78.56 ± 8.19%, and 4.88 ± 1.17, respectively. The time taken for wound healing was 21.76 ± 5.28 days amongst cases and 31.64 ± 8.31 days amongst controls. Staphylococcus aureus was the commonest organism isolated in both the groups. On day 14,18(72%), wounds in the study group showed negative culture, whereas, in the control group, it was negative in 12 (48%) patients. The rate of granulation tissue formation was higher in cases when compared to controls amongst smokers and diabetics. The difference in all these parameters between the groups was statistically significant (P-value <0.05).Discussion and conclusionWe observed a considerable increase in granulation tissue formation, pain alleviation, and reduction in time taken for wound healing. Topical phenytoin is a safe, effective, readily available, and frugal agent that can accelerate wound healing through its multimodal action, thus reducing patient morbidity and economic burden.MeSH termsPhenytoin, Wound healing, Topical, Ulcer, Anticonvulsant, Granulation Tissue, Saline dressing.     

Clinical efficacy of wet dressing combined with chitosan wound dressing in the treatment of deep second-degree burn wounds: A prospective,randomised, single-blind,positive control clinical trial

To evaluate the efficacy and safety of wet dressing combined with chitosan wound dressing for deep II degree burn wounds, and provide the basis for clinical application. From October 2019 to October 2021, 80 patients with second-degree deep burn treated in the Department of burn and plastic surgery of our hospital were selected as the research objects. Patients were randomly divided into two groups. The control group (40n) was treated with wet compress, and the study group (40n) was treated with wet compress combined with chitosan wound dressing. The wound healing time, wound healing percentage and pain score were used as the effectiveness indexes, and the incidence of adverse events and serious adverse events and the detection rate of bacterial culture of wound exudates were used as the safety indexes. The efficacy and safety of the two groups were compared. The wound healing time of the study group (19.53 ± 2.74 days) was shorter than that of the control group (24.78 ± 4.86 days), the difference was significant (t = 3.571, P = 0.015). The percentage of wound healing at the 14th after treatment in the study group was higher than that in the control group (65.00% versus 37.50%) (X² = 6.054, P = 0.014). There was no significant difference in pain scores between the two groups at each time point. The scar growth was observed 3 months after wound healing. The scar score of the study group (6.00 ± 0.98) was lower than that of the control group (8.77 ± 1.19) (t = 2.571, P = 0.031). The positive rate of wound secretion culture on the 7th and 14th day was statistically significant (X² = 4.528, P = 0.033; X² = 6.646, P = 0.010), and the study group was lower than the control group (29.03% versus 81.82%; 8.11% versus 42.86%). There was no significant difference in treatment cost between the study group and the control group (1258.7 ± 223.6 versus 1248.9 ± 182.3) (t = 1.571, P = 0.071). No adverse events or serious adverse events occurred in both groups. Chitosan wound dressing can significantly shorten the time of wound healing and reduce wound pain and wound infection in patients with deep second-degree burns. And it can effectively improve the situation of scar hyperplasia, which is worthy of clinical application.     

Evaluation of Tielle hydropolymer dressings in the management of chronic exuding wounds in primary care

The concept of moist wound healing is not fully implemented in daily practice in Germany. Thus, the objective of this investigation was to evaluate the use of Tielle hydropolymer dressings in chronic exuding wounds in primary care. A total of 6,993 patients with pressure sores (26.6%), venous leg ulcers (59.8%), diabetic foot disease (9.5%) and other wounds (5.1%) were enrolled into three multicentre, open-label, single-arm, prospective phase-IV studies for an observational period of either 4 or 12 weeks. Within the 4 (12)-week study using Tielle, 43.3% (59.1%) of the wounds healed and 51.6% (36.9%) improved. Wound area was reduced by 78.2% (85.1%). Medium or strong levels of exudates were reduced from 57.4% to 6.7% (4.0%). Cosmetic results were excellent or good in 96.3%. Compared with patients' previous treatment, efficacy and tolerability were assessed as better or much better in 92.5% and 70.4%, respectively. 97.1% of the patients remained free of adverse events. The frequency of dressing changes was reduced from 5 to 3 per week (-43%). Tielle provides an effective and safe dressing in the management of chronic exuding wounds in primary care improving patient's comfort. Due to longer wearing times, Tielle may also be cost saving.     

A systematic review of silver-containing dressings and topical silver agents (used with dressings) for burn wounds

Silver preparations are commonly used for burns, but evidence of their effectiveness remains poorly defined. The aim of the study was to evaluate the effectiveness of silver-containing dressings and topical silver for preventing infection and promoting healing in burns wounds through a meta-analysis of the available evidence. The Cochrane Central Register of Controlled Trials and relevant databases were searched. Drug companies and experts in this field were also contacted. Randomised controlled trials (RCTs) of silver dressings or topical silver (used with dressings) compared with non-silver dressings were eligible for inclusion. We identified 14 RCTs involving 877 participants. One small trial of a silver-containing dressing showed significantly better healing time compared to the control [MD -3.6; 95% CI -4.94 to -2.26 for partial thickness burns and MD -3.9; 95% CI -4.54 to -3.26 for superficial burns]. Topical silver showed significantly worse healing time compared to the non-silver group [WMD 3.96; 95% CI 2.41-5.51] and showed no evidence of effectiveness in preventing wounds infection [WMD 2.48; 95% CI 0.39-15.73]. Our review suggests that silver-containing dressings and topical silver were either no better or worse than control dressings in preventing wound infection and promoting healing of burn wounds.     

Aquacel Ag with Vaseline gauze in the management of toxic epidermal necrolysis (TEN)

Toxic epidermal necrolysis (TEN) is a rare condition with potentially high mortality and involves severe exfoliative disease of the skin and mucous membranes induced by drugs. The reported fatality of TEN varies widely from 20% to 60%. The technique for TEN wound coverage described in this article involves the use of various dressings.     

The increased killing of biofilms in vitro by combining topical silver dressings with topical negative pressure in chronic wounds

Chronic wounds remain a significant medical and financial burden in hospitals of today. A major factor in the transition from an acute to a chronic wound is its bacterial bioburden. Developments in molecular techniques have shown that chronic wounds remain colonised by many species of bacteria and that the bacteria within these chronic wounds exist in two forms. Treatments of chronic wounds have maintained a challenging field and significant ongoing research is being conducted. With the development of an in vitro wound model, we applied topical negative pressure (TNP) dressings to a spectrum of common bacterial biofilms found in chronic wounds and studied the synergistic efficacy between the application of TNP and silver‐impregnated foam against these biofilms. This synergistic response was seen within the laboratory strains of staphylococcal biofilms over a 3‐day treatment period but lost following the 5 days of treatment. However, combining topical pressure dressings and silver foam lead to a synergistic inactivation in Pseudomonas species over both 3‐day and 5‐day treatments.     

Quality of measurements of acute surgical and traumatic wounds using a digital wound‐analysing tool

The aim of this study was to assess the reliability of measurements using a wound‐analysing tool and their interpretability. Wound surface areas and tissue types, such as granulation, slough and necrosis, in twenty digital photographs were measured using a specific software program. The ratio of these tissue types in a wound was calculated using a wound profile. We calculated the intraclass coefficient or κ for reliability, standard error of measurement (SEM) and smallest detectable change (SDC). The inter‐rater reliability intraclass correlation coefficient (ICC) was 0·99 for surface area, 0·76 for granulation, 0·67 for slough and 0·22 for necrosis. The profiles gave an overall κ of 0·16. For test–retest reliability, the ICC was 0·99 for surface area, 0·81 for granulation, 0·80 for slough and 0·97 for necrosis. The agreement of the applied profiles in the test–retest was 66% (40–100). SEM and SDC for surface area were 0·10/0·27; for granulation, 6·88/19·08; for slough, 7·17/19·87; and for necrosis, 0·35/0·98, respectively. Measuring wound surface area and tissue types by means of digital photo analysis is a reliable and applicable method for monitoring wound healing in acute wounds in daily practice as well as in research.