Surgical wound management: the role of dressings

The history of surgical wound management illustrates how dressings have evolved over the years and sets the scene for modern wound-healing products. The aim of this article is to discuss the management of surgical wounds and the value of wound-healing products for carers and patients in the current healthcare climate of cost-efficacy and clinical governance.     

High-water-absorbing calcium alginate fibrous scaffold fabricated by microfluidic spinning for use in chronic wound dressings

More and more water-absorbing wound dressings have been studied since moist wound-healing treatment can effectively promote the healing of wounds. In this work, we introduce a novel method to produce improved wound dressings with high-water-absorbance. A high-water-absorbing calcium alginate (Ca-Alg) fibrous scaffold was fabricated simply by microfluidic spinning and centrifugal reprocessing. The structure and physical properties of the scaffold were characterized, and its water-absorbing, cytotoxicity properties and other applicability to wound dressings were comprehensively evaluated. Our results indicate that this material possesses high water-absorbing properties, is biocompatible, and has a 3D structure that mimics the extracellular matrix, while Ca-Alg fibers loaded with silver nanoparticles (AgNPs) exhibit broad-spectrum antibacterial activities; these properties meet the requirements for promoting the healing of chronic wounds and are widely applicable to wound dressings.

More and more water-absorbing wound dressings have been studied since moist wound-healing treatment can effectively promote the healing of wounds.     

The management of lower-extremity ulcers with zinc-saline wet dressings versus normal saline wet dressings

Zinc-saline wet dressings were compared to normal-saline wet dressings for the management of lower extremity ulcers in a pilot study of 28 elderly patients. Although both study groups were comparable at baseline, the data suggest that the use of zinc-saline wet dressings creates a wound environment that is associated with trends toward faster healing and enhanced rates of epithelialization, as well as significantly more efficient wound management than the normal-saline controls. These data are presented in light of the requirement for maintaining a moist, acidic environment within a wound in order to permit the best possible healing and remodeling.     

Dressing and securement for central venous access devices (CVADs): A Cochrane systematic review

ObjectivesTo compare the available dressing and securement devices for central venous access devices (CVADs).DesignSystematic review of randomised controlled trials.Data sourcesCochrane Wounds Group Specialised Register, the Cochrane Central Register of Controlled Trials, the Database of Abstracts of Reviews and of Effects, NHS Economic Evaluation Database, Ovid MEDLINE, CINAHL, EMBASE, clinical trial registries and reference lists of identified trials.Review methodsStudies evaluated the effects of dressing and securement devices for CVADs. All types of CVADs were included.Outcome measures were CVAD-related bloodstream infection, CVAD tip colonisation, entry and exit site infection, skin colonisation, skin irritation, failed CVAD securement, dressing condition and mortality. We used standard methodological approaches as expected by The Cochrane Collaboration.ResultsWe included 22 studies involving 7436 participants comparing nine different types of securement device or dressing. All included studies were at unclear or high risk of performance bias due to the different appearances of the dressings and securement devices.It is unclear whether there is a difference in the rate of CVAD-related bloodstream infection between securement with gauze and tape and standard polyurethane (RR 0.64, 95% CI 0.26 to 1.63, low quality evidence), or between chlorhexidine gluconate-impregnated dressings and standard polyurethane (RR 0.65, 95% CI 0.40 to 1.05, moderate quality evidence). There is high quality evidence that medication-impregnated dressings reduce the incidence of CVAD-related bloodstream infection relative to all other dressing types (RR 0.60, 95% CI 0.39 to 0.93).There is moderate quality evidence that chlorhexidine gluconate-impregnated dressings reduce the frequency of CVAD-related bloodstream infection per 1000 patient days compared with standard polyurethane dressings (RR 0.51, 95% CI 0.33 to 0.78). There is moderate quality evidence that catheter tip colonisation is reduced with chlorhexidine gluconate-impregnated dressings compared with standard polyurethane dressings (RR 0.58, 95% CI 0.47 to 0.73), but the relative effects of gauze and tape and standard polyurethane are unclear (RR 0.95, 95% CI 0.51 to 1.77, very low quality evidence).ConclusionsMedication-impregnated dressing products reduce the incidence of CVAD-related bloodstream infection relative to all other dressing types. There is some evidence that chlorhexidine gluconate-impregnated dressings, relative to standard polyurethane dressings, reduce CVAD-related bloodstream infection for the outcomes of frequency of infection per 1000 patient days, risk of catheter tip colonisation and possibly risk of CVAD-related bloodstream infection. Most studies were conducted in intensive care unit settings. More, high quality research is needed regarding the relative effects of dressing and securement products for CVADs.     

Using film dressings

Film dressings were one of the first modern wound-dressing products. They are extremely flexible, transparent and adhesive. They have no capacity to absorb fluid but are able to 'breathe off' small amounts of fluid by a process known as moisture vapour transpiration (MVT). The rate of MVT varies between brands but is, at best, minimal. This means that such dressings are not suitable for wounds that produce anything more than a minimal amount of exudate. Film dressings should not be used interchangeably with film products designed for intravenous cannula retention. Intravenous cannula dressings are designed to keep the cannula site dry and have a much higher MVT rate, whereas film dressings are designed to keep the wound moist.     

The cost and efficacy of two wound treatments

Using the physiology of moist wound healing as the framework, this nonexperimental, retrospective chart review compared the rate of wound healing and cost of wound care associated with wet-to-dry normal saline gauze dressings to the rate of wound healing and cost of wound care associated with amorphous hydrogel dressings for patients with infrainguinal arterial disease and diabetes. These patients were discharged from the hospital to home care for management of perioperative arterial surgical wound dehiscence and nonhealing ulcerations. The sample included 25 patients who used wet-to-dry normal saline gauze dressings and 25 patients who used amorphous hydrogel dressings. Repeated measures of analysis of covariance revealed a similar rate of wound healing in the two groups. The overall cost of wound care was significantly higher (P = .006) for patients in the normal saline group, with a higher number and cost of home nursing visits. The cost of supplies was not significantly different between groups, although amorphous hydrogel dressings cost an average of $50 more than wet-to-dry normal saline gauze dressings. The two treatments are equally efficacious in promoting wound healing, but amorphous hydrogel dressings are significantly more cost effective and, thus, a better value for the home care dollar. AORN J 77 (May 2003) 984-1004.     

A guide to the properties and uses of silver dressings in wound care

Silver-release dressings are extensively used for wound management, particularly in the treatment of burns, chronic leg ulcers and wounds requiring an antibacterial. A variety of products is now available. The properties and uses of these dressings are discussed, followed by a review of advances over recent years     

Effectiveness of silver in wound care treatment

Abstract

Background: Topical treatments impregnated with silver are being increasingly used in the treatment of acute and chronic wounds; however, the evidence on the effectiveness of silver wound care treatment is in question.

Objectives: To systematically review the literature examining the effectiveness of silver in wound care treatment.

Methods: Research databases were consulted including the Cumulative Index to Nursing and Allied Health Literature (CINAHL), ProQuest, MEDLINE and the Cochrane Database of Systematic Reviews for relevant clinical trials from 2000 to 2009. Studies deemed to have met inclusion criteria were scored using the Physiotherapy Evidence Database (PEDro) scale and those scoring 4/10 or higher were included in this review.

Results: Five clinical trials were identified including three randomized control trials including a total of 410 subjects. Methodological quality ranged from 4 to 10 out of 10. All five research studies showed positive effects of the use of silver dressings or topical agents.

Conclusion: This literature review analyzed the effectiveness of sliver hydroalginate, Contreet foam, hydrofiber Ag dressings along with hyaluronic acid plus silver sulfadiazine and silver sulfadiazine topical agents in wound care. Second degree burns, venous leg ulcers, diabetic foot ulcers, pressure ulcers and open surgical and traumatic wounds were analyzed in the included studies. The results of this literature review demonstrate that silver dressings and topical agents are promising as safe and effective treatment methods for wound care patients throughout the treatment period in the selected studies. However, further research should be conducted to provide additional evidence on the effectiveness of silver dressings and topical agents.     

某院262名ICU护士湿性愈合理论认知现状分析

目的了解ICU护士对伤口湿性愈合理论的认知程度及目前临床湿性愈合理论的运用现状,为开展伤口湿性愈合理论教学及提高临床伤口护理水平提供参考依据。方法自行设计调查问卷,采用横断面调查选取四川省某大型三级甲等医院262名ICU护士作为研究对象,从其对伤口湿性愈合概念、湿润环境、湿性愈合的优点、适应证及常用的湿性愈合敷料这5个方面的认知进行问卷调查,数据用SPSS 17.0进行统计学处理,采用中位数、四分位数间距、构成比等进行统计描述,用Wilcoxon法和Kruskal-Wallis H法等进行统计推断。结果 ICU护士湿性愈合知识得分中位数为26.00分,四分位数间距为10.25分,1.9%的护士完全不了解湿性愈合理论相关知识,8.4%护士对相关知识了解较多,一半以上护士的湿性愈合护理实践认知较差。48.5%的护士最近一次获取相关知识是在1个月时间内,获取知识来源最主要来源于同事之间的交流。结论 ICU护士对伤口湿性愈合理论的认知情况并不理想,临床伤口护理实践中需要不断增强伤口愈合知识的培训教育,更新观念,以提高临床伤口治疗水平。     

The effectiveness of silver‐releasing dressings in the management of non‐healing chronic wounds: a meta‐analysis

Aim. The purpose of this study was to examine the efficacy of silver‐releasing dressings in the management of non‐healing chronic wounds. Background. Non‐healing chronic wounds often have a negative physical impact on patients and place a financial burden on healthcare systems. Silver dressings are wound products designed to control infection and provide a wound environment conducive to healing. However, validation of the clinical efficacy of these dressings is lacking. Design. Systematic review and meta‐analysis. Methods. A systematic search of the major electronic databases PubMed, CINAHL, Cochrane, MEDLINE, British Nursing Index, EBSCO, OCLC and Proquest between 1950–June 2007 was conducted. Hand searches of selected periodicals, textbooks and checking reference lists and contacting experts was also performed. Results. Eight studies were selected from a potentially relevant 1957 references screened. Analysis incorporated data from 1399 participants in the eight randomised control trials. We found that silver dressings significantly improved wound healing (CI₉₅: 0·16–0·39, p < 0·001), reduced odour (CI₉₅: 0·24–0·52, p < 0·001) and pain‐related symptoms (CI₉₅: 0·18–0·47, p < 0·001), decreased wound exudates (CI₉₅: 0·17–0·44, p < 0·001) and had a prolonged dressing wear time (CI₉₅: 0·19–0·48, p = 0·028) when compared with alternative wound management approaches. An analysis of sensitivity in these studies by subgroup analysis generally supported these associations. Furthermore, studies indicated an improvement in quality of life (CI₉₅: 0·04–0·33, p = 0·013) using silver dressings in wound management with no associated severe adverse events. Conclusion. This meta‐analysis confirms the effectiveness of silver dressings in wound healing and improving patients’ quality of life. However, it also highlights the need for additional well‐designed randomised controlled trials to evaluate the effectiveness of silver‐related dressings further. Relevance to clinical practice. The results of this study provide objective data on the effectiveness of silver‐related dressing when applied to non‐healing chronic wounds.     

新型医用敷料的分类及特点

背景：临床应用的多种新型创面敷料可加速创面修复,减少伤口感染,提高治愈率,缩短病程,减轻患者痛苦.目的：回顾传统医用敷料及新型医用敷料的优缺点,展望新型医用敷料的临床应用及发展.方法：应用计算机检索2003年1月至2006年8月 PubMed 数据库及2000年1月至2006年8月 CNKI数据库有关医用敷料种类、特点及临床应用的研究,检索词为“Medical dressing,医用敷料”.结果与结论：医用新型敷料分为薄膜类、水凝胶类、藻酸盐类、泡沫类、水胶体类、药用类敷料.薄膜类敷料透明,便于观察伤口,能密切黏附于创面表面,有效保持创面渗出液,提供有利于创面愈合的湿润环境,促使坏死组织脱落,减轻创面疼痛会,缺点为吸水性能欠佳.水凝胶类敷料能与不平整的创面紧密粘合,减少细菌滋生,加速新生血管生成,促进上皮细胞生长.水胶体类敷料比薄膜类敷料厚许多,胶层的厚度决定其吸收能力的大小,水胶体敷料可吸收少量到中量渗液,不适用于渗出液多的创面.泡沫类敷料具有多孔性,表面张力低,富有弹性,可塑性强、轻便,对渗出液的吸收力强,对氧气及二氧化碳几乎完全通透,可作为药物载体.新型藻酸盐类敷料比较柔软,容易折叠,敷贴方便,在创面上形成柔软类似凝胶的半固体物质,为创面提供一个湿润环境,提高表皮细胞的再生能力,加快表皮细胞移动.药用类敷料有保护创面、止痛、止血、消炎、促进新生肉芽组织及上皮细胞生长,加速创面愈合等功能.     

湿性敷料治疗Ⅱ期压疮患者的效果

目的比较湿性敷料与普通敷料用于Ⅱ期压疮患者治疗效果的差异。方法将63例Ⅱ期压疮患者按随机数字表法分成观察组（31例）和对照组（32例）,两组分别给予湿性敷料与普通敷料治疗2周,观察创面愈合情况。结果湿性敷料治疗组患者疮面愈合时间短于普通敷料组、疗效优于普通敷料组,差异有统计学意义（P〈0.05）。结论湿性敷料更加有利于Ⅱ期压疮患者的创面愈合,缩短愈合时间,促进患者康复,且操作简便,可在临床推广使用。     

Hydrocoll: a 'new breed' of hydrocolloid wound dressing

Hydrocolloid dressings were first used in wound management in the 1960s. They provide the optimal environment for wound healing, i.e. a moist environment, constant wound temperature and infrequent dressing changes, and can be used on wounds in various stages of healing. As a result they are a popular treatment option for health professionals in both the community and hospital settings. This article describes the properties of Hydrocoll--a new and exciting range of hydrocolloid dressings from Paul Hartmann Ltd--which was launched in the UK in January 1998 and became available on the Drug Tariff in June 1998.     

Management of skin trauma

The majority of skin trauma incidents cause minor injury that can be treated effectively in the outpatient setting. A new approach to the closure of skin lacerations using tissue adhesive is presented and the current management of abrasions, blisters, burns, skin tears, and subungual hematomas are reviewed. An overview of wound dressings is provided to assist in obtaining the optimal wound-healing environment.     

Avoidance and management of peri-wound maceration of the skin

Excessive wound exudate or other bodily fluids, such as urine or sweat, can cause skin maceration to occur around a wound, which may delay healing and lead to other complications. This paper examines means of preventing maceration while ensuring a moist wound-healing environment and looks at management techniques if the condition develops.     

Biomedical materials for wound dressing: recent advances and applications

Wound healing is vital to maintain the physiological functions of the skin. The most common treatment is the use of a dressing to cover the wound and reduce infection risk and the rate of secondary injuries. Modern wound dressings have been the top priority choice for healing various types of wounds owing to their outstanding biocompatibility and biodegradability. In addition, they also maintain temperature and a moist environment, aid in pain relief, and improve hypoxic environments to stimulate wound healing. Due to the different types of wounds, as well as the variety of advanced wound dressing products, this review will provide information on the clinical characteristics of the wound, the properties of common modern dressings, and the in vitro, in vivo as well as the clinical trials on their effectiveness. The most popular types commonly used in producing modern dressings are hydrogels, hydrocolloids, alginates, foams, and films. In addition, the review also presents the polymer materials for dressing applications as well as the trend of developing these current modern dressings to maximize their function and create ideal dressings. The last is the discussion about dressing selection in wound treatment and an estimate of the current development tendency of new materials for wound healing dressings.

Wound healing is vital to maintain the physiological functions of the skin.     

Management of obesity

Advanced dressings have developed considerably over the last 40 to 50 years since research by George Winter realized the benefit of moist wound management. Coupled with the prevention of wound infection and removal of wound debris, the choices available under the heading of ‘Advanced’ wound management are over 2000 in number!     

Devices and dressings to secure peripheral venous catheters: A Cochrane systematic review and meta-analysis

BackgroundPeripheral venous catheterisation is the most frequent invasive procedure performed in hospitalised patients; yet over 30% of peripheral venous catheters fail before treatment ends.ObjectivesTo assess the effects of peripheral venous catheter dressings and securement devices on the incidence of peripheral venous catheter failure.Data sourcesWe searched the Cochrane Wounds Group Register, The Cochrane Central Register of Controlled Trials, MEDLINE; EMBASE and CINAHL for any randomised controlled trials comparing different dressings or securement devices used to stabilise peripheral venous catheters. The reference lists of included studies were also searched for any previously unidentified studies.ResultsWe included six randomised controlled trials (1539 participants) that compared various dressings and securement devices (transparent dressings versus gauze; bordered transparent dressings versus a securement device; bordered transparent dressings versus tape; and transparent dressing versus sticking plaster). Trial sizes ranged from 50 to 703 participants. The quality of evidence ranged from low to very low. Catheter dislodgements or accidental removals were lower with transparent dressings compared with gauze (two studies, 278 participants, risk ratio (RR) 0.40; 95% confidence interval (CI) 0.17–0.92, P = 0.03%). However, the relative effects of transparent dressings and gauze on phlebitis (RR 0.89; 95% CI 0.47–1.68) and infiltration (RR 0.80; 95% CI 0.48–1.33) are unclear. A single study identified less frequent dislodgement or accidental catheter removal with bordered transparent dressings compared to a securement device (RR 0.14, 95% CI 0.03–0.63) but more phlebitis with bordered dressings (RR 8.11, 95% CI 1.03–64.02). A comparison of a bordered transparent dressing and tape found more peripheral venous catheter failure with the bordered dressing (RR 1.84, 95% CI 1.08–3.11) but the relative effect on dislodgement was unclear.ConclusionsThere is no strong evidence to suggest that any one dressing or securement product for preventing peripheral venous catheter failure is more effective than any other product. All of the included trials were small, had high or unclear risk of bias for one or more of the quality elements we assessed, and wide confidence intervals, indicating that further randomised controlled trials are necessary. There is a need for suitably powered, high quality trials to evaluate the newer, high use products and novel – but expensive – securement methods, such as surgical grade glue.     

3M Tegasorb Thin: a hydrocolloid dressing for chronic wounds

Hydrocolloid dressings remain as popular today as when they were first developed in the early 1960s (Williams, 1994). The reason for this is that they provide a convenient and cost-effective treatment option for those who deal with the management of chronic wounds such as pressure sores and leg ulcers. This article examines Tegasorb Thin from 3M and shows how it can create the optimal moist wound healing environment.     

Central venous catheter dressings: a systematic review

BACKGROUND: Gauze and tape or transparent polyurethane film dressings such as Tegaderm, Opsite or Opsite IV3000 are the most common types of dressing used to secure central venous catheters (CVCs). Currently, there are no clear guidelines as to which type of dressing is the most appropriate. AIMS: To identify whether there are any differences between gauze and tape and/or transparent polyurethane film dressings in the incidence of CVC-related infection, catheter-related sepsis, catheter security, tolerance to dressing material, dressing condition and ease of application in hospitalized patients. METHODS: The Cochrane Controlled Trials Register and Medline, Embase and CancerLit databases were searched to identify any controlled trials comparing the effects of gauze and tape and/or transparent polyurethane dressings on CVCs. Additional references were sought from published and non-published literature. Twenty-three studies were reviewed. Data were extracted independently from each paper by two members of the review team and results compared. Differences were resolved either by consensus or referral to a third person. Authors were contacted for missing information. RESULTS: Of the 23 studies reviewed, 15 were excluded. Of the remaining eight, data were available for meta-analysis from six studies. Of the six included studies, two compared gauze and tape with Opsite IV3000, two compared Opsite with Opsite IV3000, one compared Tegaderm with Opsite IV3000, and one compared Tegaderm with Opsite. CONCLUSIONS: There was no evidence of any difference in the incidence of infectious complications between any of the dressing types compared in this review. Each of these comparisons was based on no more than two studies and all of these studies reported data from a small patient sample. Therefore it is unlikely that any of these comparisons would have had sufficient power to detect any differences between groups.