Meshed Biobrane: a dressing for difficult topography

Biobrane temporary biosynthetic skin substitute has been well demonstrated in the treatment of superficial and deep wounds. We have used this product nearly 1000 times. It has previously been shown to be ineffective for use in areas with convex or concave topographies or in areas along joint surfaces. The following study covers an attempt to adapt this dressing for use in these difficult areas. Ninety-eight applications of meshed Biobrane temporary wound dressing were placed in anatomic locations, which ranged from the head to the foot, with an 86% success rate.     

Biobrane wound dressing used in the treatment of toxic epidermal necrolysis: a case report

Toxic epidermal necrolysis results in skin sloughing that resembles a partial-thickness thermal injury. If the exposed dermis can be protected from infection and desiccation, regeneration can occur from the skin appendages. Biobrane, a synthetic wound dressing, has been used with good results on donor sites and outpatient partial-thickness burns in our institution. We report a case of a 12-year-old boy with toxic epidermal necrolysis, whose skin lesions were dressed with Biobrane temporary wound dressing. The Biobrane dressings prevented infection, decreased wound pain, and allowed uncomplicated healing in this patient.     

Reduced wound contraction after grafting of full-thickness burns with a collagen and chondroitin-6-sulfate (GAG) dermal skin substitute and coverage with biobrane

Full-thickness burns destroy both the epidermal and dermal tissues of the skin. This study evaluates a collagen and chondroitin-6-sulfate dermal skin substitute (graft) that was applied to excised full-thickness burns and covered with Biobrane. Experimental conditions included: (a) no burn, subcutaneous implantation of the graft; (b) burn, excision, graft, coverage with Biobrane and bandages; (c) burn, excision, no graft, coverage with Biobrane and bandages; (d) burn only. forty-one days post-surgery, subcutaneous implantation (N = 3) of the graft caused no detectable contraction or necrosis of the overlying skin, whereas all burn wounds contracted. Measurements of wounds (percentage of original wound size) showed statistically significant differences between the following treatments; (a) graft plus Biobrane (N = 10), 34%; (b) no graft plus Biobrane (N = 9), 25%; (c) untreated burns (N = 6), 16%. Semi-quantitative evaluation of time to healing indicated by spontaneous detachment of Biobrane from wounds showed that grafted, excised wounds healed in an average of 2.7 weeks, while ungrafted, excised wounds required an average of 4.3 weeks to heal. Histological appearance of healed wounds after grafting and coverage with Biobrane resembles undamaged skin without epidermal adnexal structures. Excision of full-thickness burn eschar, followed by grafting with a collagen and chondroitin-6-sulfate dermal skin substitute and coverage with Biobrane provides reduced wound contraction within a six-week period of observation compared to non-excised wounds. Both more rapid and more complete wound healing took place compared to excised wounds that were not grafted.     

A prospective controlled trial of Biobrane versus scarlet red on skin graft donor areas

A prospective trial of Biobrane versus scarlet red as a skin graft donor site dressing was done in 21 burn patients with mean total body surface area burns of 31.9%. Corresponding body areas were randomly selected on each patient to receive one of the dressings. Daily evaluations were made of subjective expression of pain, exudate formation and infection, and time of separation of the dressing from the wound. Biobrane was found to be superior in reducing donor site pain. However, with Biobrane there was a higher incidence of infection (57% v 9.5%) and a significant delay in separation from the wound. Scarlet red was found to be more cost-effective. Occlusive dressings have previously been shown to have a high incidence of complications (30%). In extensive burns, isolating the donor site from the wound is difficult and may lead to increased complications. Scarlet red appears to be superior to Biobrane for skin graft donor sites in this patient population.     

生物材料创面敷料封闭负压引流在大面积创面植皮中的应用

背景:大面积创面植皮中封闭创面、减少渗出、避免难愈性伤口的出现是治疗中的关键,采用自主研发的新型生物材料创面敷料可以提高植皮成功率。目的:观察基于生物材料创面敷料封闭负压引流在大面积创面植皮应用中的疗效。方法:对于60例大面积创面植皮的患者采取志愿选择的方式,分为生物材料创面敷料组、合成敷料组及常规加压包扎组。敷料组患者清创邮票植皮后采用生物材料创面敷料、合成敷料覆盖,其外用生物半透膜封闭形成负压装置,或直接常规敷料加压包扎。常规敷料包扎组植皮后采用消毒油纱覆盖植皮创面、敷料加压包扎。植皮后1周创面的单位面积植皮覆盖率。结果与结论:采用负压引流能明显提高单位面积植皮覆盖率,单位面积植皮覆盖率生物材料创面敷料组高于合成敷料组(P<0.05),显著高于常规组。结果表明,新型生物材料创面敷料能有效引流,提高封闭负压引流的疗效。     

生物材料创面敷料封闭负压引流在大面积创面植皮中的应用

背景：大面积创面植皮中封闭创面、减少渗出、避免难愈性伤口的出现是治疗中的关键,采用自主研发的新型生物材料创面敷料可以提高植皮成功率。目的：观察基于生物材料创面敷料封闭负压引流在大面积创面植皮应用中的疗效。方法：对于60例大面积创面植皮的患者采取志愿选择的方式,分为生物材料创面敷料组、合成敷料组及常规加压包扎组。敷料组患者清创邮票植皮后采用生物材料创面敷料、合成敷料覆盖,其外用生物半透膜封闭形成负压装置,或直接常规敷料加压包扎。常规敷料包扎组植皮后采用消毒油纱覆盖植皮创面、敷料加压包扎。植皮后1周创面的单位面积植皮覆盖率。结果与结论：采用负压引流能明显提高单位面积植皮覆盖率,单位面积植皮覆盖率生物材料创面敷料组高于合成敷料组（P〈0.05）,显著高于常规组。结果表明,新型生物材料创面敷料能有效引流,提高封闭负压引流的疗效。     

聚维酮碘喷雾联合湿性敷料换药在大疱性表皮坏死松解型药疹创面管理中的应用

目的观察聚维酮碘喷雾联合湿性敷料换药在大疱性表皮坏死松解型药疹创面管理中的应用效果.方法在充分评估大疱性表皮坏死松解型药疹创面溃烂情况的基础上,选择合适方法对31例患儿彻底清除创面分泌物及死痂,配置0.1%聚维酮碘稀释液雾化喷洒创面,4h/次,采用软聚硅酮湿性敷料覆盖创面,每天换药一次,同时做好皮肤皱褶处护理、口腔护理、肛周护理等.结果在药物治疗的同时,所有创面均采取聚维酮碘稀释液雾化喷洒联合湿性敷料换药护理,创面均愈合良好,长出新鲜皮肤,平均新皮长出时间为(16.3±7.5)d,平均住院时间(19.1±4.3)d,其中4例患儿创面留有瘢痕,发生率为12.91%.结论采用聚维酮碘喷雾联合湿性敷料换药,可有效抑制大疱性表皮坏死松解型药疹创面感染进展,促进新鲜皮肤长出,缩短创面愈合时间,改善预后.     

细菌纤维素膜作为创伤性敷料的可行性(英文)

背景:细菌纤维素为纳米级纤维材料,具有良好的生物相容性、湿态时高的机械强度、良好的液体和气体透过性,有利于皮肤组织生长和限制感染,有可能成为一种临时皮肤代用品和有应用潜力的生物敷料.目的:通过动物实验观察细菌纤维素膜作为创伤敷料的可能性.方法:用自制创伤仪于大鼠背部脊柱两侧各制造2.0 cm×2.0 cm大小的皮肤伤口,深及真皮层,两个创面之间间隔1 cm.随机选择一侧为治疗组,表面敷以细菌纤维素膜,另一侧为对照组,敷以油纱布,用1号手术缝线缝扎固定于周围皮肤上.于术后4,7,14,21,28 d观察创面愈合情况,并进行光镜组织学观察.结果与结论:①所有实验动物无死亡.觅食饮水等活动正常,两组均未出现创面感染.②治疗组术后7,14,21,28 d伤口创面愈合率较对照组显著提高.③治疗组肉芽组织层形成较厚,成纤维细胞和血管内皮细胞增生活跃,胶原纤维束增多,真皮层内小血管增生明显.对照组肉芽组织层较薄,成纤维细胞和血管内皮细胞增生不活跃,胶原纤维含量较治疗组少,小血管数量少.结果提示细菌纤维素膜对皮肤创伤性损伤具有促进愈合和抗感染的作用.     

Maximizing wound healing with silver-impregnated porcine xenograft

1. Grossly contaminated or chronically infected wounds require adequate debridement of dead tissue and wound coverage or closure. 2. Porcine xenograft is a temporary wound covering that prevents evaporation and thereby creates an environment for new cells to propagate instead of being sacrificed by desiccation. 3. The addition of silver ions to the porcine xenograft provides a potent antimicrobial agent that is only active at the surface where it is needed, has no systemic effects, and allows epithelialization to proceed in half the time of uncovered or unsilvered methods. 4.Silver-impregnated porcine xenograft provides a temporary wound covering that is antimicrobial, physiologic, and allows even the most massive and chronically contaminated wounds of years duration to be healed by careful, consistent dressing changes without skin grafts or flaps.     

The effects of hydrocolloid dressing and gentian violet on radiation-induced moist desquamation wound healing

The aim of the study was to compare the effect of a gentian violet topical application with that of a moist dressing (hydrocolloid) on the rate and efficacy of radiotherapy-induced moist desquamation wound healing and the patients' satisfaction level with each method. This prospective randomized clinical trial used a stratified sampling design. A sample of 39 patients with 60 wounds had their wounds assessed on alternate days in terms of several wound-healing parameters including wound size, wound pain, incidence of infection, and time required for healing. Patient satisfaction with each treatment was evaluated at the completion of the study. Gentian violet significantly decreased wound size and reduced wound pain. However, this treatment received significantly lower ratings for dressing comfort and dressing aesthetic acceptance. Nevertheless, the time required for healing was not statistically different in the two groups. These findings suggest that the lower score of dressing satisfaction level in the gentian violet group may result from the skin discoloration and drying effects of the treatment, which renders patients unable to move or stretch their skin. Although the aim is to have complete wound healing, this may not be realistic for many lesions such as radiotherapy-induced moist desquamation wounds. The best evidence on which to make decisions about individual care can now be based on patients' own perception of quality.     

A silver-sulfadiazine-impregnated synthetic wound dressing composed of poly-L-leucine spongy matrix: an evaluation of clinical cases.

The management of severe burns requires the suppression of bacterial growth, particularly when eschar and damaged tissue are present. For such cases, silver sulfadiazine (AgSD) cream has been traditionally applied. This antibacterial cream, however, cannot be used in conjunction with a temporary wound dressing that is needed to promote healing. The authors developed a synthetic wound dressing with drug delivery capability for clinical use by impregnating a poly-L-leucine spongy matrix with AgSD, which is released in a controlled, sustained fashion. In general, the dressing adhered firmly to the wound in the case of superficial second-degree burns, and during the healing process it separated spontaneously from the re-epithelialized surface. In the management of deep second-degree burns where eschar and damaged tissue were present, the dressing had to be changed at intervals of 3 to 5 days until it adhered firmly to the wound. Once the dressing had firmly attached to the wound, it was left in place until it separated spontaneously from the re-epithelialized surface. Dressing changes were fewer than with other treatments and the pain was effectively reduced. Cleansed wounds were effectively protected from bacterial contamination. Of 52 cases treated with this wound dressing, 93% (14/15) of superficial second-degree burns, 75% (3/4) of deep second-degree burns, 85% (6/7) of superficial and deep second-degree burns, and 75% (12/16) of split-thickness skin donor sites were evaluated as achieving good or excellent results.     

Skin coverage with Biobrane biomaterial for the treatment of patients with toxic epidermal necrolysis.

Toxic epidermal necrolysis (TEN) is an exfoliative skin disorder that may involve a large body surface area and mucosal surfaces. The microscopic changes that occur with this condition are similar to those that occur with superficial dermal burns, such as dermal detachment from the underlying dermis. Complications of TEN are related to the loss of the epithelial skin barrier and include pain, fluid and electrolyte loss, and an increased risk of sepsis. The treatment of a patient with TEN is best accomplished in a burn unit, where expert treatment of these complications can be provided. Medical treatment includes the administration of immunosuppressive therapy and the discontinuation of any previous corticosteroid treatment. Surgical management includes the debridement of necrotic areas. In this article, the surgical management of 8 consecutive patients with TEN who were admitted to the intensive care burn unit at the Hospital Universitario de Getafe in Madrid, Spain, from 1996 to 1998 is described. These patients were treated with extensive early debridement of necrotic skin areas followed by wound coverage with Biobrane (Dow B. Hickam, Inc, Sugarland, Tex), a temporary semisynthetic skin substitute. Skin coverage with this material decreases pain and fluid loss, and it possibly facilitates epithelization and decreases the risk of sepsis, without adverse side effects. This semisynthetic material meets some standards of an ideal skin substitute: it is easy to use, provides several beneficial physiologic effects, and improves patients' comfort. In the 8 cases of patients with TEN that were studied, the use of Biobrane skin substitute for the coverage of massive areas of detached skin was found to be an important aspect of treatment.     

驻极体薄膜在烧伤创面的临床应用

目的 :观察FEP驻极体薄膜是否具有促进烧 (烫 )伤创面愈合作用。方法 :3 8例烧 (烫 )伤患者 ,浅Ⅱ°烧 (烫 )伤创面 2 6处 ,薄层皮片供皮区 12处 ,治疗面积 1%～ 3 %。实验组用 -70 0V驻极体薄膜覆盖创面 ,对照组分别用 0 0 5 %洗必泰液纱布及用凡士林纱布覆盖 ,外用多层纱布敷料包扎。结果 :与对照组相比创面疼痛明显减轻 ,点状出血增多 ,愈合提前 ;渗液印片检查治疗组创面中性粒细胞、巨噬细胞、淋巴细胞均较对照组提早出现且数量多 ;计算机灰度积分法计算结果 ,治疗组创面面积缩小率大于对照组。结论 :驻极体薄膜具有促进创面愈合作用。     

湿性敷料在切口裂开护理中的效果观察

目的观察使用湿性敷料换药对手术后裂开的愈合时间的影响。方法将38例切口裂开患者按照伤口基本条件相当的原则分为观察组和对照组,观察组中伤口渗出较少者选择清得佳凝胶填充伤口,外敷优赛,安舒妥薄膜封闭固定;伤口渗出多者选择优赛敷料填充伤口,外层敷料使用安普贴。对照组使用普通敷料换药,直至伤口愈合。对2组伤口愈合时间及换药次数进行比较。结果观察组伤口愈合时间和换药次数少于对照组,2组之间比较有显著性差异(P<0.05)。结论使用湿性敷料换药可缩短手术后裂开切口的愈合时间,效果优于普通敷料。     

Biobrane improves wound healing in burned children without increased risk of infection

A synthetic bilaminar membrane used as a skin substitute (Biobrane) has been shown to decrease pain and hospitalization in superficial second-degree burns. Despite these benefits, it has not been utilized universally, particularly in young children, due to a perceived increase in related infections. We propose that when this synthetic membrane is applied to superficial scald burns <25% of the total body surface area (TBSA), decreased healing times are expected without increased risk of infection. Between 1994-1999, 89 children treated within 48 h after receiving superficial partial thickness scald burns covering 5-25% TBSA with no indication of infection were seen at our hospital. Forty-one were assigned randomly to receive treatment with the skin substitute Biobrane and 48 to receive conservative treatment with topical antimicrobials and dressing changes. Comparisons of treatment were made between groups for length of hospitalization, wound healing times, and infectious complications. Children treated with Biobrane or topical antimicrobials were similar in age, race, sex, %TBSA burned, and location of burn. Those receiving Biobrane had shorter hospitalizations and healing times, which was significant for both infants and toddlers and older children. Treatment groups were not different in the use of systemic antibiotics or readmissions for infectious complications. Biobrane was removed in 5.9% of cases for non-adherence. The application of Biobrane within 48 h of superficial burns provides for shorter hospitalizations and faster healing times in children of all ages without increased risk of infection.     

Use of Exu-Dry in the management of a variety of exuding wounds

Exu-Dry is a relatively new product that is designed to manage a variety of exuding wounds. It is a one-piece, multilayer, highly absorbent, non-adherent wound dressing. It is unique in construction, and incorporates a non-adherent wound contact layer which, it is suggested, makes dressing changes less painful and traumatic. This article explores the use of Exu-Dry in wounds, including heavily exuding wounds, burns, pressure ulcers, skin grafts, donor sites and fungating wounds.     

去腐生肌活性敷料治疗小儿皮肤软组织擦挫伤的临床研究

目的探讨去腐生肌活性敷料治疗小儿急性皮肤软组织擦挫伤的临床效果。方法将152例患儿随机分为实验组和对照组。实验组78例常规清创后,使用本院自制的去腐生肌活性敷料均匀涂于创面,每天或隔天换药一次,直至痊愈;对照组74例用0.5%络合碘常规换药。观察两组患儿的痛苦程度、创面感染发生率、换药次数及愈合时间等。结果实验组不仅在创面感染发生率、换药次数及愈合时间等方面都明显少于对照组(P<0.01);而且止痛效果显著、快速,小儿换药痛苦少。结论在治疗急性皮肤软组织擦挫伤中,去腐生肌活性敷料的疗效明显优于传统方法换药,可作为一种治疗急性皮肤软组织擦挫伤的纯中药制剂在家庭及临床上推广应用,特别适用于小儿、老人、疼痛耐受性较差的患者。     

应用负压封闭引流技术治疗四肢大面积皮肤撕脱伤的探析

目的探讨应用负压封闭引流技术（Vacaumsealingdrainage,VSD）治疗四肢大面积皮肤撕脱伤的临床效果。方法2009．01—2011-06苏州大学附属第一医院应用负压封闭引流技术治疗四肢大面积皮肤撕脱伤患者16例,采用保留有血运的撕脱皮瓣,切除无血运部分及挫伤较严重的撕脱皮肤,将其用鼓式取皮机切取成中厚皮片,在皮片上打孔后覆盖于创面,然后用VSD材料（商品名维斯第）覆盖在皮片上,持续负压吸引（维持负压在-300--450mmHg之间）,5～7d后,拆除VSD材料,观察皮片成活情况,加压包扎7d后拆线。结果16例患者中10例皮片全部存活,创面全部愈合,6例皮片大部分成活,伴有局限性皮片坏死,较散在,经换药后创面全部愈合。术后随访3～6个月,皮片成活,周边有轻度瘢痕增生,功能恢复满意。结论应用负压封闭引流技术治疗四肢大面积皮肤撕脱伤是一种简便、有效的修复四肢大面积皮肤撕脱伤的治疗方法,值得临床推广应用。     

An investigation of the benefits of Aquacel Hydrofibre wound dressing

Aquacel wound dressing, produced by ConvaTec, uses the main ingredient of the hydrocolloid dressing in a new way to produce a hydrofibre dressing. Aquacel is designed for use in moderate to heavily exuding wounds as it absorbs exudate directly into its fibres. It has been shown to be effective in pressure sores, leg ulcers and surgical wounds, producing warm, moist, local wound conditions for optimum wound healing. Aquacel can lock exudate away thus protecting the surrounding skin.     

组织工程皮肤修复皮肤缺损成功率与手术方法的相关性

背景:皮肤缺损的常规修复方法多采用自体皮肤移植,需要健康供皮区且会遗留不同程度的瘢痕畸形。组织工程皮肤的成功构建并应用于临床,标志着皮肤缺损治疗的重大突破。目的:通过组织工程皮肤修复皮肤缺损,分析手术方法与愈合率的关系,为组织工程皮肤的临床应用提供实验依据。设计:随机对照观察。单位:解放军第四军医大学口腔医学院口腔颌面外科,组织病理学教研室,组织工程实验中心。材料:实验于2003-10/2004-03在解放军第四军医大学口腔医学院口腔组织工程实验中心完成。选用2.5～3月龄健康清洁级约克猪6只,随机分为3组:组织工程全层组、组织工程真皮 自体表皮组、自体移植组,2只/。每只猪制作8个直径50mm的圆形皮肤缺损创面,16个创组面/组,共48个创面。方法:①制备组织工程全层皮肤和组织工程真皮。②组织工程全层组:沿画线自脂肪层切除全厚皮肤,彻底止血,以湿生理盐水纱布覆盖创面备用,此时取出组织工程全层皮肤并于组织工程皮肤上均匀打引流孔以利引流,用生理盐水冲去组织工程皮肤表面的培养液,使表皮层向上平铺于创面上,注意与创面间不能产生气泡。其上分别覆盖单层油纱布,生理盐水纱布、无菌干纱布、弹性海绵垫,每层厚度约为3～5mm,常规打包包扎,最后再以弹性绷带加压包扎。③组织工程真皮 自体表皮组:以同样方法切除全厚皮肤,将取下的皮肤用取皮鼓反取厚约0.1～0.2mm的刃厚表皮泡于生理盐水中备用。以同样方法取出处理组织工程真皮后覆盖于创面上,即刻覆盖自体刃厚表皮。其余处理同组织工程全层组。④自体移植组:切除全厚皮肤并去除脂肪组织后,回植于自体创面,覆盖各层敷料,加压包扎。⑤每次换药打开创面时,移植皮肤无感染、坏死、脱落且直径不小于3mm即为成活,否则即为失败。于术后4周统计各组创面成活率。主要观察指标:术后4周各组移植皮肤成活情况。结果:术后4周时,组织工程全层组移植皮肤成活率75%,组织工程真皮 自体表皮组移植皮肤成活率87%,自体移植组移植皮肤成活率94%,3组比较基本相似(χ2=2.34,P>0.05)。结论:组织工程皮肤移植修复皮肤缺损的效果与自体表皮移植接近,证明组织工程皮肤修复皮肤缺损是可行的。