Controlled trial of occlusive dressings in healing chronic venous ulcers

Fifty-six patients with chronic venous ulcers present for a mean of 2.4 years were randomized to either a new occlusive hydrocolloid dressing (Granuflex, Squibb Surgicare) or a porous non-adherent dressing (N A, Johnson and Johnson). In all patients, dressings were applied beneath a standard graduated compression bandage. There was no difference between the two groups, with complete healing in 21 out of 28 (75 per cent) of occlusive dressing patients and 22 out of 28 (78 per cent) with N A dressings by 12 weeks. Careful graduated compression bandaging achieves healing even in the majority of so-called resistant chronic venous ulcers; there was no additional benefit from applying occlusive dressings which tend to be expensive.     

A retrospective analysis of ambulatory burn patients: focus on wound dressings and healing times

INTRODUCTION

In this study, we retrospectively analysed healing times of ambulatory burn patients after silver-based dressings were introduced in late December 2005, and compared the results with those obtained before.

PATIENTS AND METHODS

Data were collected in November–December 2005 and in January–February 2006. We excluded from the study: (i) admitted patients; (ii) patients with mixed superficial partial thickness and deep partial thickness burns; (iii) patients with full-thickness burns; and (iv) operated patients that came for follow-up. We recorded the age, sex, cause (flame vs scald), burn depth, dressings used and healing times.

RESULTS

We selected 347 patients corresponding to 455 burned areas (64.4% superficial and 35.6% deep; 47.7% treated in 2005 and 52.3% in 2006). During the years 2005 and 2006, there was an increase in the use of silver-based dressings (2005, 9.7%; 2006, 38.7%; chi-squared test, P < 0.001) and a decrease in the use of paraffin gauzes (2005, 66.4%; 2006, 40.3%; chi-squared test, P < 0.001). The healing time of overall burns and of superficial burns showed no significant differences between 2005 and 2006. However, in deep partial thickness burns, a significant reduction was present (2006, 19; 2005, 29 days; Student''s t-test, P < 0.01). Among all dressings, paraffin gauzes had the shortest healing times in superficial burns (5 days); with silver-based dressings in deep burns, the healing times were nanocrystalline silver (16 days) and silver carboxymethylcellulose (21 days).

CONCLUSIONS

Results of our retrospective study would suggest that paraffin gauzes are a valuable option in superficial burns, while silver-based dressings are preferable in deep burns.     

A retrospective review of burn dressings on a porcine burn model

This is a study to compare wound healing among three types of dressings on a porcine model with deep-dermal-partial-thickness burns. The burns in this study were from eight animal trials conducted in the past for other purposes and only burns with a uniform pale appearance that had served as controls in original experiments were selected. In total, there were 57 burns in 33 pigs, using one of following three dressings: Acticoat (Silver) (3 trials), Jelonet (Gauze) (3 trials), and Solosite Gel/Jelonet (Gel/Gauze) (2 trials). The wound healing assessments included wound re-epithelialisation during a 6-week period, clinical and histological scar assessments at week 6 after burn. Of all wound healing/scar assessments, only re-epithelialisation showed statistical difference between dressings. Earlier re-epithelialisation was observed in Gel/Gauze dressings compared to Silver and/or Gauze dressings. However, this study revealed huge variation in wound healing outcome between 3 trials within both Silver and/or Gauze dressings, supported by significant differences on re-epithelialisation, clinical and histological scar measurements. In addition, it was found that larger animals healed better than smaller ones, based on weights from 21 pigs. Of all dressings, Silver delivers the best protection for wound colonization/infection. Wound colonization/infection was found to confine wound healing and lead to thinner RND in scars. From this study, we cannot find enough evidence to suggest the beneficial effect of one dressing(s) over others on burn wound healing outcome on a porcine model with small deep-dermal-partial-thickness burns with a relative small sample size.     

The effect of occlusive dressings on collagen synthesis and re-epithelialization in superficial wounds

The effects on superficial wounds in domestic pigs of (1) two different occlusive dressings, (2) non-occlusive wet to dry gauze dressings, and (3) air exposure were compared. Collagen synthesis and re-epithelialization were increased in the wounds treated with occlusive dressings. Re-epithelialization was increased beneath both the oxygen-impermeable and the oxygen-permeable dressing. When they were removed the wet to dry gauze dressing and one of the occlusive dressings often damaged the new epidermis.     

不同敷料对深度烧伤创面植皮后愈合情况的影响对比

目的:对比分析不同敷料对深度烧伤创面植皮后愈合情况的影响。方法:选取我院于2011年5月～2012年5月收治的69例深度烧伤并接受创面植皮的患者,选择患者身上2处大小为1%的邻近创面,将创面内层覆盖物为聚酰胺薄纱的所有创面作为实验组,内层覆盖物为凡士林油纱的创面作为对照组。对比分析两组术后的创面蒸发量、不同时间点的创面愈合率、创面愈合时间及换药时的疼痛情况。结果:术后5天,实验组内层敷料表面的蒸发量要明显少于对照组[(25.3±6.1)ml.h-.1m-2vs(35.8±4.9)ml.h-.1m-2t=11.147 P<0.05],所有患者内层敷料表面的蒸发量要显著少于裸露创面(P<0.05),但高于正常皮肤表面(P<0.05);实验组术后10天,15天及20天的创面愈合率均高于对照组[(81.2±19.5,95.3±9.4,99.8±0.4)%vs(72.4±7.6,84.6±10.4,97.2±2.3)%t=3.493,6.340,9.251 P<0.05],且创面完全愈合时间要显著短于对照组[(14.1±2.0)天vs(17.2±2.5)天t=8.043 P<0.05];实验组术后5天换药及揭除内层敷料时的VAS评分要明显低于对照组[(3.3±0.7,5.0±0.6)vs(4.9±0.4,7.9±0.5),t=16.485,30.843 P<0.05]。结论:相比与传统的凡士林油纱,聚酰胺薄纱更有利于深度烧伤创面植皮后的愈合,且减轻了患者换药时的疼痛,值得推广。     

The effect of occlusive dressings on the energy metabolism of severely burned children.

Metabolic studies were performed on 23 burned children. They were studied sequentially until their burn wounds were healed. A metabolic study lasted 20 minutes, during which continuous measurements were made of O2 consumption and CO2 production rates, rectal temperature, average surface temperatures (dressings, skin and wound), body heat content, and rate of body weight loss using a bed scale. These measurements allowed solution of the heat balance equation for each study period. After 24 hours in a constant temperature room kept at 28 C and 40% relative humidity, metabolic studies were initiated when blood was drawn for catecholamine assay, followed by a metabolic analysis, after which dressings were removed and fresh silvadene applied to the wounds. No dressings were applied. Metabolic analyses were repeated after two and four hours of exposure, after which blood for catecholamine analysis was drawn and the study terminated. Without dressings in a thermally neutral environment, burn patients demonstrated an increased rate of heat loss of 27 watts/square meter body surface area (W/M2), compared with the predicted normal. The major portion of this increment is by evaporation, which increased 300%. The rate of heat production equals heat loss, and is increased 50% above the predicted normal. Occlusive dressings result in a 15 W/M2 decrease in the rate of heat loss, about evenly divided between evaporative and dry routes, with a corresponding 15 W/M2 decrease in the rate of heat production. Plasma catecholamine levels of bandaged burn patients are not significantly different from values for healed burn patients, and do not correlate with the rate of heat production. The increased heat production of burn patients is a response to an increased rate of heat loss, not vice versa. The use of occlusive dressings substantially reduces the energy requirements to manageable levels, even in patients with very large burns.     

A comparative study of three new occlusive dressings for healing of graft donor sites versus conventional therapy

Summary A comparative study of four skin graft donor site dressings was undertaken. This was a prospective and cross-over study of 25 consecutive patients with burns up to 40% TBSA treated with split skin grafts. Each donor site was divided into four sections and covered with different dressings in order to evaluate their effectiveness in healing, the time required for complete epithelialization, patient acceptance and any intolerance or local infection. The results showed that the occlusive hydrocolloid dressing significantly decreases (p<0.01) the mean time required for complete healing (7.45 days) compared with a semiocclusive hydrocolloid (10.29 days), a polyurethane sheet (9.4 days) and the conventional dressing (10.04 days).Presented at the IV European Burns Congress in Barcelona, Spain, September 25, 1991 (Abstract No. 117)     

Hemocompatibility of different burn wound dressings

A variety of wound dressing are available for burns. Furthermore, although their impacts on wound healing have been studied sufficiently, their effects on blood remain unclear. Meanwhile, this aspect is extremely important, since blood interacts with the wound dressing, especially in extensive burn injuries. Therefore, the aim of this study is to evaluate the hemocompatibility and immunogenicity of different burn wound dressings. Accordingly, human whole blood (n = 5) was anticoagulated with heparin, treated with different wound dressings and incubated at 37°C for 30 minutes. Different parameters for coagulation and hemocompatibility were evaluated before and after incubation. Consequently, Jelonet, Xenoderm, and Matriderm showed higher TAT‐III concentrations, Jelonet, Xenoderm, EZ Derm, and Matriderm were higher β‐thromboglobulin; EZ Derm and Burntec showed higher SC5b‐9 concentrations after incubation with whole blood. Our ex vivo study provided initial insights into the hemocompatibility and immunogenicity of different burn wound dressings. Moreover, Xenografts (Xenoderm and EZ Derm), Jelonet and Matriderm showed a hemostyptic effect, while EZ Derm and Burntec activated the complement system. Therefore, further studies must be conducted to analyze the possible effects in vivo.     

Topical oxygen and burn wound healing: a review

Oxygen is essential for the epithelialization and contraction of the burn wound as well as for the collagen maturation and synthesis. Inspiration of pure oxygen or employing hyperbaric oxygen might delay wound healing due to an intensive vasoconstriction. The accumulated data suggest a beneficial effect of topical oxygen on the wound healing process of burns.     

Preclinical assessment of burn wound dressings

Preclinical assessment procedures for wound dressings have been established taking into account the important parameters of tensile mechanical properties, conformability to body surfaces, water-vapour transmission and gas permeability. A new test has been specifically developed to assess dressing conformability, while the other parameters were assessed using established techniques. The procedures aid clinicians by providing a screen reducing the number proceeding to full expensive clinical trials. They are also of assistance to manufacturers in their bid to optimize the characteristics of dressings and evaluate candidate materials.     

The effect of jaw relaxation on pain anxiety during burn dressings: Randomised clinical trial

Aim

The purpose of this randomised clinical trial (RCT) was to determine the effect of jaw relaxation on pain anxiety related to dressing changes in burn injuries.

Introduction

Patients hospitalised with burns experience high levels of anticipatory anxiety during dressing changes, which cannot be completely managed by anxiolytic drugs. Nurses as members of the burn care team contribute to pain management by using relaxation techniques as one of the most frequently used approaches to pain anxiety management. However, there is not enough information about the effects of these techniques on pain anxiety of patients with burns. The aim of this study was to determine the effect of jaw relaxation on pain anxiety related to dressing changes in burn injuries.

Methods

It was a randomised clinical trial with a control group. A total of 100 patients hospitalised in Shahid Motahari Burn Centre affiliated with Tehran University of Medical Sciences were recruited by convenience sampling and were randomly assigned to either experimental or control groups using minimisation. With institutional approval and written consent, the experimental group practiced jaw relaxation for 20 min before entering the dressing room. Data were collected by the Burn Specific Pain Anxiety Scale (BSPAS) during July–December 2009 and analysed using Statistical Package for the Social Sciences (SPSS)-PC (17).

Results

An independent t-test showed no significant difference between mean pain anxiety scores in the experimental and control group before intervention (p = 0.787). A dependent t-test showed significantly less pain anxiety after intervention (before dressing) in the experimental group (p < 0.05). Moreover, the independent t-test showed that the post-dressing pain anxiety of the experimental group was less than the control group (p < 0.05). However, the dependent t-test showed no significant difference between before and after dressing pain anxiety (after intervention) in the experimental group (p = 0.303).

Conclusion

Nurses can independently decrease the pain anxiety of patients with burns and its subsequent physical and psychological burden by teaching the simple and inexpensive technique of jaw relaxation. Further research is needed to study the effect of this technique on pain anxiety of patients suffering from other painful procedures.     

Comparison of the efficacy of silver-based antimicrobial burn dressings in a porcine model of burn wounds

PurposeA variety of silver-based antimicrobial dressings are available on the market and are commonly used to prevent infection. Such prophylaxis is particularly important in treating burns, yet there is a paucity of evidence confirming the efficacy of commercially available dressingsin vivo. We describe here an in vivo porcine model of burns, which we use to test the antimicrobial efficacy of three common wound dressings and a control.ProceduresDomestic Yorkshire-cross pigs were medicated for pain management before inflicting burns with a heated brass rod. The wounds were artificially challenged with a mixture of two pathogens commonly associated with burn wound infection:Staphylococcus aureus and Pseudomonas aeruginosa. The following dressing materials were sutured in place: gauze, nanocrystalline silver, silver-plated nylon, and polyethylene/polyester coated with high-oxidation silver salts. After 1 and 3 days, the wounds were assessed for erythema, swelling, and re-epithelialization, tissue was biopsied to determine the recovery of the challenge microorganisms, and histology was performed. We also examined the number of microorganisms present on the dressings themselves.ResultsHistology indicated that 30 s was sufficient to produce burns extending into the deep dermal layer. After 3 days, nanocrystalline silver and silver-plated nylon led to slightly reduced swelling relative to simple gauze, although none of the dressings significantly affected erythema or wound re-epithelialization. All the dressings led to decreased recovery of the challenge organisms from the burn tissue, relative to simple gauze. However, the magnitude of the reduction was greatest for nanocrystalline silver (log₁₀ reduction = 4–5); additionally, only nanocrystalline silver gave a statistically significant decrease (P = 0.02). Notably, the antimicrobial effect for all dressings was reduced by Day 3 relative to Day 1. Similar trends were observed for microbial retention on the dressings themselves.ConclusionNanocrystalline silver-based wound dressings generally outperformed silver-plated nylon and high-oxidation silver salts in thisin vivo model of burn wounds. Relative to prophylactic use, it may be advisable to change the dressings more frequently when treating an infected wound.     

The effect of occlusive dressings on re-epithelializations of wounds in children with epidermolysis bullosa

Hydrocolloid dressing (HCD), a new oxygen impermeable occlusive dressing, was studied in a controlled clinical trial of three pediatric patients with dystrophic epidermolysis bullosa (RDEB). Advantages of this material over such dressings as paraffin gauze (PG) or the perforated plastic film (TELFA), include considerably faster re-epithelialization, pain free movement of the injured part and fewer dressing changes. The most significant advantage of HCD for RDEB patients has been in the reduction of scar tissue formation, because in this disease, wounds heal with scarring that causes mutilating deformities.     

A review of the etiology and treatment of skin ulcers with wound dressings: comparison of the effects of occlusive and nonocclusive dressings

This article reviews the etiology and treatment of skin ulceration caused by external pressure, vascular insufficiency, and diabetes. In the case of pressure sores, compression of skin against bone may cause ischemic injury to underlying fat and muscle that precedes necrosis of dermis and epidermis. Venous and arterial insufficiency lead to leg ulcers as a result of incompetency of the valves in the veins connecting the superficial to the deep venous systems and atherosclerosis, respectively. Diabetics are susceptible to foot ulcers because of atherosclerosis and the resulting occlusive arterial disease and peripheral neuropathy. Once the underlying medical condition is solved, occlusive and nonocclusive wound dressings can be used in an attempt to promote healing. A review of the literature of animal and clinical studies suggests that both occlusive and nonocclusive wound dressings promote healing compared with air-exposed wounds. Dressings that absorb wound fluid offer some advantages over those that do not absorb large quantities of fluid in heavily exudative wounds and may require less frequent dressing changes. However, the chemistry of the material that comprises the wound dressing seems unimportant unless the material is biologically active. It is likely that the next generation of wound dressings will be composed of a moisture-retaining material coupled with material that has biological activity.     

Treatment of second-degree burns of the hand: A comparison of occlusive dressings and gloves

In a prospective outpatient study of 140 hands with second-degree burns the conventional occlusive dressing was compared with a polythene glove in which nitrofurazone was used.There was no difference in overall wound healing rates between the two groups. Owing to the fact that the use of polythene gloves is quick and easy and gives the patients a much higher degree of independence, we recommend this treatment.     

Nonoperative management of fingertip pulp amputation by occlusive dressings

Nonoperative management of fingertip pulp amputations has been employed in eighteen adults. After wound cleansing and debridement, the wound was covered by an occlusive dressing. Healing of the amputated fingertip occurred within four weeks. The healed fingertip had an excellent sensory perception, normal range of motion and an acceptable cosmetic appearance. This satisfactory outcome was realized with less than ten days lost from work.