普通敷料与湿性敷料在脓肿切开引流术后伤口护理中的临床效果比较

目的 探讨并观察普通辅料与湿性敷料在行脓肿切开引流术后患者护理中的临床效果,并对其效果做出评价。方法将本科行脓肿切开引流术的122例患者随机分为对照组和治疗组,术后分别使用普通敷料与湿性敷料,比较二者在伤口愈合时间、换药次数等方面的差异。结果与对照组比较,治疗组在行脓肿切开引流术后患者护理中伤口愈合时间、换药次数、疼痛评分方面有明显优势,差异有统计学意义（P〈0．05）。结论使用湿性敷料用于脓肿切开引流术后的护理可减少伤口愈合时间,减轻患者痛苦,临床效果优于传统干性敷料。     

Delivery of Therapeutics from Layer-by-Layer Electrospun Nanofiber Matrix for Wound Healing: An Update

Increasing incidences of chronic wounds urge the development of effective therapeutic wound treatment. As the conventional wound dressings are found not to comply with all the requirements of an ideal wound dressing, the development of alternative and effective dressings is demanded. Over the past few years, electrospun nanofiber has been recognized as a better system for wound dressing and hence has been studied extensively. Most of the electrospun nanofiber dressings were fabricated as single-layer structure mats. However, this design is less favorable for the effective healing of wounds mainly due to its burst release effect. To address this problem and to simulate the organized skin layer's structure and function, a multilayer structure of wound dressing had been proposed. This design enables a sustained release of the therapeutic agent(s), and more resembles the natural skin extracellular matrix. Multilayer structure is also referred to layer-by-layer (LbL), which has been established as an innovative method of drug incorporation and delivery, combines a high surface area of electrospun nanofibers with the multilayer structure mat. This review focuses on LbL multilayer electrospun nanofiber as a superior strategy in designing an optimal wound dressing.     

Wound healing dressings and drug delivery systems: a review

The variety of wound types has resulted in a wide range of wound dressings with new products frequently introduced to target different aspects of the wound healing process. The ideal dressing should achieve rapid healing at reasonable cost with minimal inconvenience to the patient. This article offers a review of the common wound management dressings and emerging technologies for achieving improved wound healing. It also reviews many of the dressings and novel polymers used for the delivery of drugs to acute, chronic and other types of wound. These include hydrocolloids, alginates, hydrogels, polyurethane, collagen, chitosan, pectin and hyaluronic acid. There is also a brief section on the use of biological polymers as tissue engineered scaffolds and skin grafts. Pharmacological agents such as antibiotics, vitamins, minerals, growth factors and other wound healing accelerators that take active part in the healing process are discussed. Direct delivery of these agents to the wound site is desirable, particularly when systemic delivery could cause organ damage due to toxicological concerns associated with the preferred agents. This review concerns the requirement for formulations with improved properties for effective and accurate delivery of the required therapeutic agents. General formulation approaches towards achieving optimum physical properties and controlled delivery characteristics for an active wound healing dosage form are also considered briefly.     

Management of acute and chronic open wounds: the importance of moist environment in optimal wound healing

The history of wound care and management closely parallels that of military surgery which has laid down the principles and dictated the practices of wound cleansing, debridement and coverage. From a treatment standpoint, there are essentially two types of wounds: those characterized by loss of tissue and those in which no tissue has been lost. In the event of tissue loss it is critical to determine whether vital structures such as bone, tendons, nerves and vessels have been exposed. It is also important to determine the amount of soft tissue contusion and contamination. In any case primary wound healing by early closure either primarily or with the help of grafts or flaps is preferred to secondary healing and wound contraction with subsequent contractures which interfere with range of motion and function. Whether the wound is acute or chronic, essential principles of wound care must be observed in order to avoid wound sepsis and achieve rapid and optimal wound healing. - Tissues must be handled gently. - Caustic solutions capable of sterilizing the skin should never be applied to the wound. It is desirable never to put anything in the wound that cannot be tolerated comfortably in the conjunctival sac. - All devitalized tissues must be debrided either hydrodynamically, chemically, mechanically or surgically. - All dead space must be obliterated. - Exposed vital structures must be covered by well vascularized tissues. An essential part of any wound management protocol is wound dressing. It cannot be too strongly emphasized that a wound dressing may have a profound influence on healing particularly of secondary type healing, a critical feature being the extent to which such dressing restricts the evaporation of water from the wound surface. A review of available dressing materials is reported with emphasis on the newly developed concept of moist environment for optimal healing. a practical guide for dressing selection is also proposed.     

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。     

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。     

藻酸盐医用敷料在糖尿病足部溃疡中的应用及机理研究

糖尿病足部溃疡是在糖尿病足的基础上,因外周血管、周围神经病变而导致的下肢感染、溃疡,是糖尿病患者最严重的并发症之一.其病程长、治疗费用高,预后不良,大多患者面临截肢的风险.藻酸盐医用敷料作为1种新型的湿性敷料,能给伤口提供理想的湿润环境,促进伤口愈合,缓解伤口疼痛.本文就藻酸盐医用敷料在糖尿病足部溃疡中的应用及其机制进...     

Hydrofiber dressing and wound repair: review of the literature and new patents

Effective management of wound healing is a considerable challenge for clinicians. Patients underlying condition, accurate assessment of the wound and exudates, as well as selection of an appropriate dressing is all important factors for success. A variety of dressings are available to the clinician for the management of exudates. Hydrofiber dressings are a relatively new concept, and can be very cost effective because they can be worn for several days at a time. This report will review clinical evidences on the use of Hydrofiber dressing for the management of epithelial lesions, deal with current knowledge on the mechanism of action of this compound towards the epithelial wound healing process, immunological aspects and will also discuss relevant patents.     

An innovative bi-layered wound dressing made of silk and gelatin for accelerated wound healing

In this study, the novel silk fibroin-based bi-layered wound dressing was developed. Wax-coated silk fibroin woven fabric was introduced as a non-adhesive layer while the sponge made of sericin and glutaraldehyde-crosslinked silk fibroin/gelatin was fabricated as a bioactive layer. Wax-coated silk fibroin fabrics showed improved mechanical properties compared with the non-coated fabrics, but less adhesive than the commercial wound dressing mesh. This confirmed by results of peel test on both the partial- and full-thickness wounds. The sericin-silk fibroin/gelatin spongy bioactive layers showed homogeneous porous structure and controllable biodegradation depending on the degree of crosslinking. The bi-layered wound dressings supported the attachment and proliferation of L929 mouse fibroblasts, particularly for the silk fibroin/gelatin ratio of 20/80 and 0.02% GA crosslinked. Furthermore, we proved that the bi-layered wound dressings promoted wound healing in full-thickness wounds, comparing with the clinically used wound dressing. The wounds treated with the bi-layered wound dressings showed the greater extent of wound size reduction, epithelialization, and collagen formation. The superior properties of the silk fibroin-based bi-layered wound dressings compared with those of the clinically used wound dressings were less adhesive and had improved biological functions to promote cell activities and wound healing. This novel bi-layered wound dressing should be a good candidate for the healing of full-thickness wounds.     

Wound dressings containing bFGF-impregnated microspheres

The primary objective was to synthesize a novel wound dressing containing basic fibroblast growth factor (bFGF)-loaded microspheres for promoting healing and tissue regeneration. Gelatin sponge was chosen as the underlying layer and elastomeric polyurethane membranes were used as the external layer. To achieve prolonged release, bFGF addition was loaded in microspheres. The microspheres were characterized for particle size, in vitro protein release and bioactivity. The bilayer dressings were tested in in vivo experiments on full-thickness skin defects created on pigs. Average size of the microspheres was 14.36 +/- 3.56 microm and the network sponges were characterized with an average pore size of 80-160 microm. Both the in vitro release efficiency and the protein bioactivity revealed that bFGF was released in a controlled manner and it was biologically active as assessed by its ability to induce the proliferation of fibroblasts. It was observed that sustained release of bFGF provided a higher degree of reduction in the wound areas. Histological investigations showed that the dressings were biocompatible and did not cause any mononuclear cell infiltration or foreign body reaction. The structure of the newly formed dermis was almost the same as that of the normal skin. The application of these novel bilayer wound dressings provided an optimum healing milieu for the proliferating cells and regenerating tissues in pig's skin defect models.     

鱼皮胶原蛋白-壳聚糖复合海藻酸盐水凝胶敷料对烧烫伤创面的促愈合作用

本文以海藻酸钠为原料,复配壳聚糖、鱼皮胶原蛋白,通过Ca2+离子交联制备成海藻酸盐水凝胶敷料。测试了该敷料的物理机械性能及其对大白兔浅Ⅱ度烧烫伤创面的促愈合作用。结果表明：鱼皮胶原蛋白-壳聚糖复合海藻酸盐水凝胶的含水量≥80%,具有良好的吸湿保湿和机械性能,是一种理想的伤口创面敷料;对浅Ⅱ度烧烫伤的愈合周期远远少于医用纱布、市售聚氨酯水凝胶敷料,且能消除伤口炎症,抑制瘢痕的生成,在伤口护理方面有着良好的前景和应用方向。     

鱼油伤口护理软膏的制备及其对皮肤切线伤的促愈合作用

鱼油中的多不饱和脂肪酸具有促进皮肤损伤修复的功能。以富含多不饱和脂肪酸的鱼油为原料，复配黄凡士林、液体石蜡，制备油性伤口护理软膏敷料。测试了该软膏敷料的细胞相容性、阻水性、阻菌性及其对Sprague Dawley（SD）大鼠切线伤的促愈合作用。结果表明，软膏浸提液培养的L929细胞相对存活率为（99.5 ± 2.2）%，具有优异的细胞相容性；软膏具有优异的阻水性和阻菌性；在切线伤护理中，所制备膏状敷料能够促进创面胶原的沉积与重排，减轻瘢痕的生成。鱼油伤口护理软膏在浅表性皮肤创面护理方面有着良好的应用前景。     

Reduced cellular toxicity of a new silver-containing antimicrobial dressing and clinical performance in non-healing wounds

Bacterial colonisation of wounds may delay wound healing. Modern silver-containing dressings are antimicrobial, yet cellular toxicity is a serious side-effect. We provide data for a newly formulated silver-containing ointment dressing, Atrauman Ag, for antimicrobial activity and cytotoxicity. Atrauman Ag effectively killed a panel of commensal skin as well as pathogenic bacterial strains while cytotoxicity for HaCaT keratinocytes was only around 10%. With these favourable in vitro tests, Atrauman Ag was analysed in 86 patients with traumatic and non-healing wounds of different aetiologies. The wound state was evaluated for 3 subsequent dressing changes. The slough score was reduced from 59.2 to 35.8%, granulation tissue increased from 27 to 40% and epithelialisation went up from 12.1 to 24%. We conclude that Atrauman Ag has a superior profile of antimicrobial activity over cellular toxicity and the low silver ion release rate may prevent interference with wound-healing mechanisms.     

藻酸盐联合泡沫敷料用于腹部术后脂肪液化伤口的效果分析

目的观察藻酸盐联合泡沫敷料用于腹部术后脂肪液化伤口的效果。方法对腹部术后发生脂肪液化伤口的150例随机纳入新型敷料组（藻酸盐联合泡沫敷料）和传统敷料组,收集患者一般资料,比较2组患者在减轻创面疼痛、平均愈合时间、换药间隔时间及患者舒适情况。结果根据纳入和排除标准,新型敷料组81例,传统敷料组69例,2组患者基线资料差异无统计学意义（P〉0.05）;新型敷料组创面疼痛程度较传统敷料组明显减轻（P〈0.05）,新型敷料组平均愈合时间明显短于传统敷料组（P〈0.05）;新型敷料组平均换药时间较传统敷料组长（P〈0.05）;新型敷料组患者不适例数少于传统敷料组（P〈0.05）。结论新型敷料组能有效减少皮肤不良反应的发生,减少了换药次数及医护人员的工作量,增加了患者的舒适度。新型敷料用于腹部术后脂肪液化伤口的换药方法优于传统的换药方法。     

Antibacterial biomaterials for skin wound dressing

Bacterial infection and the ever-increasing bacterial resistance have imposed severe threat to human health. And bacterial contamination could significantly menace the wound healing process. Considering the sophisticated wound healing process, novel strategies for skin tissue engineering are focused on the integration of bioactive ingredients,antibacterial agents included, into biomaterials with different morphologies to improve cell behaviors and promote wound healing. However, a comprehensive ...     

Toxicity and antimicrobial activity of a hydrocolloid dressing containing silver particles in an ex vivo model of cutaneous infection

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.     

湿性愈合疗法治疗下肢静脉性溃疡32例

目的探讨湿性愈合疗法与干性愈合疗法在下肢静脉性溃疡处理中的疗效。方法采用随机分组法，将60例患者分为试验组（32例）和对照组（28例），观察两种疗法的治疗效果。结果采用湿性愈合疗法对下肢静脉性溃疡处理，疗效满意，患者康复时间缩短1／3，费用较千性愈合疗法明显减少。结论湿性愈合疗法优于传统的干性愈合疗法，值得推广。     

Clinical Potential of a Silk Sericin-Releasing Bioactive Wound Dressing for the Treatment of Split-Thickness Skin Graft Donor Sites

Purpose

An ethyl alcohol-precipitated silk sericin/PVA scaffold that controlled the release of silk sericin was previously developed and applied for the treatment of full-thickness wounds in rats and demonstrated efficient healing. In this study, we aimed to further evaluate the clinical potential of this scaffold, hereafter called “silk sericin-releasing wound dressing”, for the treatment of split-thickness skin graft donor sites by comparison with the clinically available wound dressing known as “Bactigras®”.

Methods

In vitro characterization and in vivo evaluation for safety of the wound dressings were performed. A clinical trial of the wound dressings was conducted according to standard protocols.

Results

The sericin released from the wound dressing was not toxic to HaCat human keratinocytes. A peel test indicated that the silk sericin-releasing wound dressing was less adhesive than Bactigras®, potentially reducing trauma and the risk of repeated injury upon removal. There was no evidence of skin irritation upon treatment with either wound dressing. When tested in patients with split-thickness skin graft donor sites, the wounds treated with the silk sericin-releasing wound dressing exhibited complete healing at 12?±?5.0 days, whereas those treated with Bactigras® were completely healed at 14?±?5.2 days (p?=?1.99?×?10^?4). In addition, treatment with the silk sericin-releasing wound dressing significantly reduced pain compared with Bactigras® particularly during the first 4 postoperative days (p?=?2.70?×?10^?5 on day 1).

Conclusion

We introduce this novel silk sericin-releasing wound dressing as an alternative treatment for split-thickness skin graft donor sites.     

Clinical evaluation of hydrogel-type dressing materials after their 8-year use]

The subject to assessment were hydrogel dressings (in 42 patients) compared with the classical gauze dressing with an addition of various pharmaceuticals (in 65 patients). We found out that the gauze dressings get dry 24 hours after they have been applied, their replacement being very painful. The hydrogel dressings, on the other hand, do not cause any pain when replaced after the 24 hours. The hygroscopic properties of hydrogel dressings allow a quick cleaning of the wound from microorganisms. Permitting an easy absorption of antibiotics and other drugs, they contribute to an acceleration of the healing process and epidermis development.     

Wound Dressings Based on Chitosans and Hyaluronic Acid for the Release of Chlorhexidine Diacetate in Skin Ulcer Therapy

In the present work wound dressings, based on chitosan hydrochloride (HCS), 5-methyl-pyrrolidinone chitosan (MPC), and their mixtures with an anionic polymer, hyaluronic acid (HA), were prepared by freeze-drying. Chlorhexidine diacetate (CX) was used as an antimicrobic drug. The mechanical properties of the wound dressings were investigated. In particular, the wound dressings were subjected to dynamic hydration measurements to evaluate their capability to absorb wound exudate and to rheological analysis to investigate their resistance to mechanical stresses on hydration. The wound dressings were also characterized for drug release properties. The antioxidant and antimicrobial activities of medicated and non-medicated wound dressings were also investigated. All the wound dressings are characterized by mechanical resistance suitable for skin application. The addition of hyaluronic acid to chitosans leads to a reduction in wound dressing hydration properties and a modulation of drug release. The wound dressing based on MPC is characterized by the highest elastic properties and by the best scavenger activity. Antimicrobial activity against bacteria and C. albicans is shown by the dressing based on chitosan also in absence of chlorhexidine.