负压引流治疗创伤性大面积皮肤缺损的疗效观察

目的 观察持续封闭负压引流(VSD)技术治疗创伤性大面积皮肤缺损的临床效果.方法 对2007年1月至2010年1月临床收治的40例创伤性大面积皮肤缺损行手术清创,应用持续封闭负压引流敷料覆盖创面,吸引器持续吸引治疗一周后,拆除敷料行二期植皮术.结果 接受VSD治疗的患者中37例在一次使用后直接植皮均成活,3例患者行2次VSD治疗后植皮亦成活,创面均痊愈,无一例出现伤口感染或创伤性骨髓炎.结论 VSD能彻底清除创面的分泌物和坏死组织,刺激肉芽生长,明显缩短创伤性皮肤软组织缺损的治疗时间,减轻换药痛苦,效果显著.     

负压引流治疗创伤性大面积皮肤缺损的疗效观察

目的 观察持续封闭负压引流(VSD)技术治疗创伤性大面积皮肤缺损的临床效果.方法 对2007年1月至2010年1月临床收治的40例创伤性大面积皮肤缺损行手术清创,应用持续封闭负压引流敷料覆盖创面,吸引器持续吸引治疗一周后,拆除敷料行二期植皮术.结果 接受VSD治疗的患者中37例在一次使用后直接植皮均成活,3例患者行2次VSD治疗后植皮亦成活,创面均痊愈,无一例出现伤口感染或创伤性骨髓炎.结论 VSD能彻底清除创面的分泌物和坏死组织,刺激肉芽生长,明显缩短创伤性皮肤软组织缺损的治疗时间,减轻换药痛苦,效果显著.

Abstract：

Objective To observe the clinical therapeutic effect of the vacuum sealing drainage (VSD) technology on complicated traumatic skin and soft tissues defect. Methods Totally 40 complicated traumatic skin and soft tissues defect patients from January 2007 to January 2010 were enrolled in this study. VSD dressing was used in all patients to cover wounds after surgical debridement. Then the dressing was removed and secondary dermepenthesis was performed. Results Totally 37 of 40 patients survived after the secondary dermepenthesis, and other 3 patients accepted two VSD treatments. Conclusions VSD treatment can significantly accelerate healing of traumatic skin and soft tissues defects by draining the wound surface completely and stimulate the proliferation of granulation tissue. It can shorten the course of disease and reduce the pain for dressing change.     

负压引流治疗创伤性大面积皮肤缺损的疗效观察

目的 观察持续封闭负压引流(VSD)技术治疗创伤性大面积皮肤缺损的临床效果.方法 对2007年1月至2010年1月临床收治的40例创伤性大面积皮肤缺损行手术清创,应用持续封闭负压引流敷料覆盖创面,吸引器持续吸引治疗一周后,拆除敷料行二期植皮术.结果 接受VSD治疗的患者中37例在一次使用后直接植皮均成活,3例患者行2次VSD治疗后植皮亦成活,创面均痊愈,无一例出现伤口感染或创伤性骨髓炎.结论 VSD能彻底清除创面的分泌物和坏死组织,刺激肉芽生长,明显缩短创伤性皮肤软组织缺损的治疗时间,减轻换药痛苦,效果显著.     

Modelling the cost implications of using carboxymethylcellulose dressing compared with gauze in the management of surgical wounds healing by secondary intention in the US and UK

OBJECTIVE: To estimate the costs of using carboxymethyl cellulose dressing (CMCD; Aquacel* Hydrofiber) compared to gauze in managing surgical wounds healing by secondary intention in the US and UK. STUDY DESIGN: This was a modelling study performed from the perspective of payers (i.e. the hospital and community sector in the US and the National Health Service (NHS) in the UK). METHODS: Clinical outcomes attributable to managing surgical wounds healing by secondary intention with gauze were obtained from the published literature in the English language. There were no published studies on wounds healing by secondary intention with CMCD. Hence, the analysis conservatively assumed that wound healing rates associated with gauze would be the same for CMCD. These data were combined with resource utilisation estimates derived from a panel of clinicians enabling us to perform decision modelling. The models were used to determine the expected direct healthcare costs eight weeks after the surgical wounds were dressed by CMCD or gauze and left to heal by secondary intention in the US and UK. RESULTS: All wounds are expected to heal within eight weeks, irrespective of dressing. Managing abscesses and other surgical wounds with CMCD instead of gauze in the US is expected to reduce costs by 4% in both wound types (i.e. $247 and $507 respectively) per patient over eight weeks. In the UK, managing abscesses and other surgical wounds with CMCD instead of gauze is expected to reduce costs by 30% (574 pounds) and 12% (581 pounds) respectively per patient over eight weeks. The lower cost of managing CMCD-treated patients is due to decreased nursing costs associated with a lower frequency of CMCD changes compared to gauze dressing changes. CONCLUSION: Dressing surgical wounds healing by secondary intention with CMCD instead of gauze is expected to lead to a reduction in healthcare costs in both the US and UK. Hence, the purchase price of a dressing is not indicative of the cost effectiveness of a given method of surgical wound care.     

Accelerated wound healing and anti-inflammatory effects of physically cross linked polyvinyl alcohol–chitosan hydrogel containing honey bee venom in diabetic rats

Diabetes is one of the leading causes of impaired wound healing. The objective of this study was to develop a bee venom-loaded wound dressing with an enhanced healing and anti-inflammatory effects to be examined in diabetic rats. Different preparations of polyvinyl alcohol (PVA), chitosan (Chit) hydrogel matrix-based wound dressing containing bee venom (BV) were developed using freeze–thawing method. The mechanical properties such as gel fraction, swelling ratio, tensile strength, percentage of elongation and surface pH were determined. The pharmacological activities including wound healing and anti-inflammatory effects in addition to primary skin irritation and microbial penetration tests were evaluated. Moreover, hydroxyproline, glutathione and IL-6 levels were measured in the wound tissues of diabetic rats. The bee venom-loaded wound dressing composed of 10 % PVA, 0.6 % Chit and 4 % BV was more swellable, flexible and elastic than other formulations. Pharmacologically, the bee venom-loaded wound dressing that has the same pervious composition showed accelerated healing of wounds made in diabetic rats compared to the control. Moreover, this bee venom-loaded wound dressing exhibited anti-inflammatory effect that is comparable to that of diclofenac gel, the standard anti-inflammatory drug. Simultaneously, wound tissues covered with this preparation displayed higher hydroxyproline and glutathione levels and lower IL-6 levels compared to control. Thus, the bee venom-loaded hydrogel composed of 10 % PVA, 0.6 % Chit and 4 % BV is a promising wound dressing with excellent forming and enhanced wound healing as well as anti-inflammatory activities.     

The search for an "ideal" surgical dressing

Trials of a new occlusive dressing, Op-site (Smith Nephew), were conducted on a group of patients. Op-site is a fine, transparent, elastic, self-adhesive polyurethan film. Although non-porous and therefore water- and bacteria-proof, it is permeable to gases. The existing dressings fulfil only a few of the criteria of an "ideal" dressing and in some cases actually interfere with the healthy process. The main disadvantages are: the disturbance of newly formed epithelium, when many dressings are removed, their fibres become embedded in the new tissues and cause inflammation and delayed healing. Few dressings are true bacterial barriers and the hazard of infection of the wound is always present. Recent studies of the mechanism of wound healing have indicated that a moist, not dry surrounding provides the optimum conditions for wound repair. Healing under Op-site is said to be quicker because the serous exudate permits unhindered migration of new cells across the wound bed and prevents cellular dehydration. In contrast, under dry conditions healing is delayed because the new skin cells must first cleave a path through dehydrated dermis before migrating across the wound. The Op-site wound dressing can be readily applied over the joints and allows complete freedom of movement. The skin remains dry and the wound moist, providing the ideal environment for rapid healing. The film does not adhere to the moist wound and can therefore be removed without damage to the newly formed epidermis. The adhesive is low allergic. Finally, the wound can be assessed without removing the transparent Op-site.(ABSTRACT TRUNCATED AT 250 WORDS)     

Controlled Release of Chitosan and Sericin from the Microspheres-Embedded Wound Dressing for the Prolonged Anti-microbial and Wound Healing Efficacy

One approach in wound dressing development is to incorporate active molecules or drugs in the dressing. In order to reduce the frequency of dressing changes as well as to prolong wound healing efficacy, wound dressings that can sustain the release of the active molecules should be developed. In our previous work, we developed chitosan/sericin (CH/SS) microspheres that released sericin in a controlled rate. However, the difficulty of applying the microspheres that easily diffuse and quickly degrade onto the wound was its limitations. In this study, we aimed to develop wound dressing materials which are easier to apply and to provide extended release of sericin. Different amounts of CH/SS microspheres were embedded into various compositions of polyvinyl alcohol/gelatin (PVA/G) scaffolds and fabricated using freeze-drying and glutaraldehyde crosslinking techniques. The obtained CH/SS microspheres-embedded scaffolds with appropriate design and formulation were introduced as a wound dressing material. Sericin was released from the microspheres and the scaffolds in a sustained manner. Furthermore, an optimized formation of the microspheres-embedded scaffolds (2PVA2G+2CHSS) was shown to possess an effective antimicrobial activity against both gram-positive and gram-negative bacteria. These microspheres-embedded scaffolds were not toxic to L929 mouse fibroblast cells, and they did not irritate the tissue when applied to the wound. Finally, probably by the sustained release of sericin, these microspheres-embedded scaffolds could promote wound healing as well as or slightly better than a clinically used wound dressing (Allevyn®) in a mouse model. The antimicrobial CH/SS microspheres-embedded PVA/G scaffolds with sustained release of sericin would appear to be a promising candidate for wound dressing application.     

足负重区深度冻伤组织坏死显微清创与组织修复临床观察

目的探讨足负重区深度冻伤组织坏死的显微清创与组织修复方法。方法1999年1月-2012年1月收治以足负重区为中心深度冻伤组织坏死8例16足,利用显微镜的引导对冻伤区域准确的识别与清创,去除坏死组织,保护具有活性的组织结构,应用血运充足的小腿外侧腓动脉逆行岛状皮瓣和小腿内侧胫后动脉逆行岛状皮瓣进行修复。结果术后皮瓣全部成活,皮瓣与足创面一期愈合9足,二期愈合2足;前足残端直接短缩缝合5足,一期愈合4足,二期愈合1足。随访4—12个月,患者行走自如,足跟和前足皮瓣覆盖区组织营养状况良好,均恢复行走和正常生活。结论通过显微镜下精确的组织清创,使感染和坏死组织清除更确切、彻底,最大程度保留和保护正常组织,且以血运丰富、组织容量好、动脉供血的轴型组织瓣进行修复,可加速组织愈合,提高组织愈合质量。     

人工真皮修复慢性创面疗效观察

目的 探索慢性创面治疗方法.方法 回顾性分析我院2008年至2011年62例慢性创面患者的治疗方法.将其随机分成两组:对照组32例,予抗感染,改善微循环,聚维酮纱外敷,经换药治疗创面未愈者行植皮或皮瓣修复术;观察组30例,予抗感染,改善微循环,早期清创,感染控制后外敷人工真皮(皮耐克),诱导真皮重建,促进肉芽组织生长和创面愈合,创面较大者待其肉芽生长满意后行植皮术.结果 对照组平均住院天数( 58.2±1.3)d,其中植皮或皮瓣修复术修复18例,创面换药愈合者14例,创面愈合后疤痕增生明显.观察组平均住院天数( 31.4±1.1)d,其中7例患者创面较大,经外敷人工真皮,肉芽生长满意后予植皮手术,其余患者经外敷人工真皮、换药,创面治愈后外观满意,疤痕增生轻或不明显.结论 应用人工真皮可促进慢性创面愈合,减少疤痕增生,有效缩短住院天数,降低手术率和手术风险,值得借鉴、推广.     

An in vitro method for the quantitative determination of the antimicrobial efficacy of silver-containing wound dressings

Treatment with silver-containing wound dressings is becoming an increasingly popular strategy to eliminate growth of opportunistic wound pathogens during the healing process. However, there are concerns over the possible side-effects of silver to the patient; coupled to the cost of silver as an ingredient there is a desire to ensure that wound dressings contain the least quantity of active ingredient to ensure the minimum bactericidal concentration (MBC) of silver is maintained in the wound environment. This requires the ability to determine the efficacy of silver directly within the wound environment; an extremely complicated task that is difficult using classical (plate counting) microbiological assays because these cannot be conducted in situ. Here, we report a quantitative method for determining the efficacy of silver in wound dressings using an isothermal calorimetric method. The growth curves of P. aeruginosa (NCIMB 8628) were recorded in growth medium and in growth medium containing AQUACEL Ag Hydrofiber dressing. It was found that 10 mg of dressing was sufficient to ensure no detectable growth of organism in 2.5 mL of medium inoculated to 10(6) cfu/mL. This corresponded to a silver load of 1.1x10(-6) moles (equivalent to 4.4x10(-4) M, in the volume of medium used in the experiment). Experiments conducted with silver nitrate rather than dressing indicated the MBC of silver against P. aeruginosa was 1x10(-4) M. The results suggested that not all of the silver in the dressing was bioavailable, at least over the lifetime of the experiment. One advantage of this effect would be the lack of excess availability of the silver, which allays fears of potential toxicity to the patient and may provide an extended period of time over which the dressing is bactericidal.     

新型敷料配合湿润烧伤膏在慢性伤口护理中的应用研究

目的探讨湿润烧伤膏与新型敷料联合应用促进慢性伤口康复的方法及效果。方法按随机分组抽签法将60例慢性伤口患者随机分对照组和实验组各30例,对照组换药用生理盐水清洗,让伤口自然愈合、变干,每天换药1次等常规治疗及护理,实验组在常规治疗护理的基础上采用湿润烧伤膏与新型敷料联合应用,措施包括：正确评估伤口,根据伤口愈合不同阶段选择新型敷料及应用湿润烧伤膏,加强基础护理,增加营养,提高免疫力,落实严密的慢性伤口护理监控措施。结果实验组有效率为93.3％,对照组为70％,实验组明显高于对照组,两组比较差异统计学意义（P〈0．05）;经治疗2、3、5W后伤口愈合例数实验组明显多于对照组,两组比较差异统计学意义（P〈0．05）。结论湿润烧伤膏与新型敷料联合应用于慢性伤口的治疗及护理,可有效地缩短伤口的愈合时间,提高治疗效果。     

Evaluation of semi-interpenetrating polymer networks composed of chitosan and poloxamer for wound dressing application

We have elsewhere reported the work on the preparation of semi-interpenetrating polymer networks (SIPNs) composed of chitosan (CS) and poloxamer to improve the mechanical strength of CS sponge. This study focuses on evaluation of the CS/poloxamer SIPNs to intend for wound dressing application and the efficacy of dehydroepiandrosterone (DHEA)-loaded CS/poloxamer SIPNs in the wound model studies. The properties required for ideal wound dressing, such as equilibrium water content (EWC), water absorption (A(w)), water vapor transmission rate (WVTR), and evaporative water loss, were examined. The CS/poloxamer SIPNs were found to have a water content of 90% of their weight which could prevent the wound bed from accumulation of exudates and also have excellent water adsorption. The WVTR of CS/poloxamer SIPNs was found to be 2,508.2+/-65.7gm(-2)day(-1), indicating that the SIPNs can maintain a moist environment over wound bed in moderate to heavily exuding wound which enhances epithelial cell migration during the healing process. Also, the CS/poloxamer SIPNs in vitro assessment showed proper biodegradation and low cytotoxicity for wound dressing application. The wound healing efficacy of CS/poloxamer SIPNs as a wound dressing was evaluated on experimental full thickness wounds in a mouse model. It was found that the wounds covered with CS/poloxamer SIPNs or DHEA-loaded CS/poloxamer SIPNs were completely filled with new epithelium without any significant adverse reactions after 3 weeks. The results thus indicate that CS/poloxamer SIPNs could be employed in the future as potential wound dressing materials.     

Growth factor release from tissue engineering scaffolds.

Synthetic scaffold materials are used in tissue engineering for a variety of applications, including physical supports for the creation of functional tissues, protective gels to aid in wound healing and to encapsulate cells for localized hormone-delivery therapies. In order to encourage successful tissue growth, these scaffold materials must incorporate vital growth factors that are released to control their development. A major challenge lies in the requirement for these growth factor delivery mechanisms to mimic the in-vivo release profiles of factors produced during natural tissue morphogenesis or repair. This review highlights some of the major strategies for creating scaffold constructs reported thus far, along with the approaches taken to incorporate growth factors within the materials and the benefits of combining tissue engineering and drug delivery expertise.     

康复新液在肌腱及骨外露治疗中的应用1例

目的了解康复新液在肌腱及骨外露治疗中的应用。方法常规彻底清创后修复损伤的肌腱,换药过程中使用康复新液,3～4d换药一次。结果 6周后新鲜肉芽组织及新生表皮组织完全覆盖创面,无需植皮。结论康复新液能明显促进肉芽组织生长,促进创面愈合。     

Wound healing evaluation of benzalkonium chloride-loaded hydrocolloid in the wound infection model

An adequate environment for wound healing improves cell proliferation and cell activity, rearranges fibroblasts, and suppresses the multiplication of bacteria. The aim of this study was to evaluate the wound-healing effects of a semi-occlusive hydrocolloid wound dressing (HWD) containing a topical antiseptic drug, benzalkonium chloride (BKC) in an infectious wound model. In vivo wound-healing profiles in rats exhibited that BKC-loaded HWD successfully promoted epithelialization rate, compared with gauze control or HWD without BKC. Furthermore, the significant decrease in desquamated epithelial regions, numbers of microvessels and inflammatory cells infiltrated in granulation tissues and granulation tissue areas were observed in the histopathological and histomorphometrical profiles of BKC-loaded HWD. In conclusion, these results suggest that BKC-loaded HWD facilitates wound healing and re-epithelization, and has promising effects for the treatment of infected wounds, as compared to HWD without BKC.     

湿性敷料在腹部手术切口感染护理中的效果观察

目的观察在腹部手术切口感染中运用湿性敷料换药的效果。方法将83例腹部切口感染的患者按随机的原则分成两组。实验组：根据湿性愈合的理论,使用湿性敷料换药处理;对照组：使用传统的外科换药方法处理。结果实验组伤口平均治愈时间为（13．10±2．15）d,对照组伤几治愈时间为（18．25±2．65）d。两者比较,差异有统计学意义（P〈0．01）。结论在腹部手术切口感染中运用湿性敷料换药的方法效果明显优于使用传统外科换药的方法。     

银离子抗菌敷料用于Ⅱ度烧伤创面的疗效和安全性

目的 评价银离子抗菌敷料在Ⅱ度烧伤创面愈合中的作用及安全性.方法 采用自身对照的方式,在60例Ⅱ度烧伤患者身上分别选取2处面积相当的创面.对照组使用磺胺嘧啶银软膏;试验组使用银离子抗菌敷料.比较2组患者创面愈合时间、愈合率、平均换药次数,并对创面分泌物进行细菌培养,同时检测治疗前后患者血尿常规以及肝肾功能,记录治疗期间不良反应.结果 与对照组相比,试验组创面愈合时间缩短,用药后第7、14天创面愈合率增高,换药次数降低,两组比较差异有统计学意义（P〈0.05）;两组创面细菌培养阳性率比较差异无统计学意义（P〉0.05）.结论 与磺胺嘧啶银相比,银离子抗菌敷料在促进Ⅱ度烧伤创面愈合方面,能够缩短创面愈合时间,提高创面愈合率,减少换药次数,抑菌效果与磺胺嘧啶银相当,两组在治疗期间均无不良反应发生,是一种安全、有效的治疗Ⅱ度烧伤的外用药物.     

Recombinant human basic-fibroblastic growth factor: different medical dressings for clinical application in wound healing.

Recombinant human basic-Fibroblastic Growth Factor (rhb-FGF) is a basic single-chain protein showing high activity as mitogenetic and angiogenetic agent. The application of rhb-FGF in wound healing as stimulator of the tissue repair process is strictly connected with the covering of the wound by means of a proper dressing. A wide number of synthetic occlusive or non-occlusive wound dressings has been developed. Owing to the delicate proteic structure of rhb-FGF, and generally of all the Growth Factors, compatibility with the dressings has to be every time tested, to avoid its inactivation and consequent loss of tissue repair properties.     

Use of A Reconstituted Human Skin Model for Predicting the Inflammation Potential of Wound Care Products

Abstract

United States Pharmacopoeia protocols for cytotoxicity are conducted using a monolayer of cultured rodent fibroblasts. Major disadvantages of these tests are that they are conducted with nonhuman cells and that noncytotoxic inflammatory events go undetected. In our studies a commercially available hydrogel wound dressing and povidone-iodine were dosed onto a reconstituted human skin model. Cytotoxicity was determined by punch biopsying dosed tissues and extracting a vital dye. Inflammation potential was assessed by measuring prostaglandin E₂ from the spent media of treated tissues. Results showed that povidone-iodine has a substantially greater potential to produce cytotoxicity and biochemical inflammation in human tissue than hydrogel wound dressing. This information may assist physicians in selecting the best treatment modality for wounds.     

美宝湿润烧伤膏在尿道下裂术后创面应用特点

目的探讨美宝湿润烧伤膏在尿道下裂术后创面应用特点及效果。方法在尿道下裂术后创面换药中,采用美宝湿润烧伤膏（MEBO）涂抹于创面,再用4—6层无菌纱布包扎,构成内层敷料（以下简称MEBO敷料）,并与采用普通凡士林纱作内层敷料包扎作比较。结果使用MEBO敷料作内层敷料在尿道下裂术后创面的换药中具有明显的防粘附、促进创面愈合作用;同时换药时间短,减少患儿痛苦,降低医疗费用等优点。结论应用MEBO敷料作为一种尿道下裂术后创面的包扎是较理想的改进物质。