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1.

Introduction

Recent conflicts have been characterised by the use of improvised explosive devices causing devastating injuries, including heavily contaminated wounds requiring meticulous surgical debridement. After being rendered surgical clean, these wounds are dressed and the patient transferred back to the UK for on-going treatment. A dressing that would prevent wounds from becoming colonised during transit would be desirable. The aim of this study was to establish whether using nanocrystalline silver dressings, as an adjunct to the initial debridement, would positively affect wound microbiology and wound healing compared to standard plain gauze dressings.

Methods

Patients were prospectively randomised to receive either silver dressings, in a nanocrystalline preparation (Acticoat™), or standard of care dressings (plain gauze) following their initial debridement in the field hospital. On repatriation to the UK microbiological swabs were taken from the dressing and the wound, and an odour score recorded. Wounds were followed prospectively and time to wound healing was recorded. Additionally, patient demographic data were recorded, as well as the mechanism of injury and Injury Severity Score.

Results

76 patients were recruited to the trial between February 2010 and February 2012. 39 received current dressings and 37 received the trial dressings. Eleven patients were not swabbed. There was no difference (p = 0.1384, Fishers) in the primary outcome measure of wound colonisation between the treatment arm (14/33) and the control arm (20/32). Similarly time to wound healing was not statistically different (p = 0.5009, Mann–Whitney). Wounds in the control group were scored as being significantly more malodorous (p = 0.002, Mann–Whitney) than those in the treatment arm.

Conclusions

This is the first randomised controlled trial to report results from an active theatre of war. Performing research under these conditions poses additional challenges to military clinicians. Meticulous debridement of wounds remains the critical determinant in wound healing and infection and this study did not demonstrate a benefit of nanocrystaline silver dressing in respect to preventing wound colonisation or promoting healing, these dressings do however seem to significantly reduce the unpleasant odour commonly associated with battlefield wounds.  相似文献   

2.
Occlusive dressing is widely accepted and used to manage skin ulcers. However, with respect to its application to incisional wounds, most studies have been conducted about the clinical effects on incisional healing of surgical sites. Studies of the histological effects of occlusive dressing for incisional wounds have been few. The aim of this study was to clarify the histological effects of occlusive dressings on healing of incisional skin wounds. Rat dorsal skin was incised down to the panniculus and sutured immediately. Dressing types included 2‐octyl cyanoacrylate and hydrocolloid materials as occlusive dressings and no‐dressing as the open therapy. Histological examination and dermoscopic observation were performed 1, 2, 4 and 7 days after surgery. The findings from each dressing type were compared. In the open therapy group, the upper portion of the edge of incision was necrosed minimally and finally healed with wide scar formation. However, in the occlusive dressing groups, micronecrosis of the incision edge seen in the no‐dressing group was not observed, healing was more rapid and the remaining scar was finer. Occlusive dressing can prevent micronecrosis of the incision edge, resulting in rapid and excellent healing. This study shows that the efficacy of and supports the use of occlusive dressing in incisional wound management.  相似文献   

3.
Negative pressure wound therapy (NPWT) has emerged as a cutting‐edge technology and provides an alternative solution to the problem of wounds. This study was undertaken to assess the efficacy of this technique in the treatment of chronic wounds. A prospective clinical study was used to evaluate our experience in use of NPWT in the healing of pressure ulcers and chronic wounds over 2 years. The primary end point of the study group was the time taken for appearance of healthy granulation tissue and full reepithelialisation without drainage. All patients with sepsis were excluded from the study. The statistical analysis of the data was carried out. Of the 60 patients studied, 41 had associated comorbidities including diabetes mellitus. The commonest site of occurrence was the lower limb. Coverage in the form of a flap was required at presentation in 63·33% of patients. However, after initiation of NPWT, none of them required the procedure and they healed spontaneously either by secondary intention or by skin grafting. The time taken for appearance of healthy granulation tissue was 14·36 ± 4·24 days. Complete healing of wounds occurred by 33·1 ± 10·22 days. There was a statistically significant difference in the volume of the wounds before and after the intervention (P = 0·000). Complications resulting from NPWT were minimal. This technique is an excellent adjunct to surgical debridement.  相似文献   

4.
IntroductionRegular dressing of traumatic wounds is of paramount importance for healing. Phenytoin, an anticonvulsant, is thought to promote wound healing through multiple mechanisms, including fibroblast proliferation, granulation tissue formation, antibacterial activity, and pain alleviation.AimTo assess the effect of topical phenytoin on traumatic wound healing in terms of granulation tissue formation, pain alleviation, and time taken for wound healing.MethodologyFifty patients with traumatic wounds were divided into equal and comparable groups. After cleaning the wound, phenytoin dressing was done in the study group and saline dressing in the control group. Thereafter, regular dressings of the wounds were done, and healing was assessed on day 14 and day 21.ResultsOn day 14, the wound surface area, percentage of granulation tissue, VAS score amongst cases was 39.4 ± 29.75 cm2, 82.12 ± 9.71%, 4.52 ± 1.08, and that of controls was and 51.28 ± 25.33 cm2, 62.72 ± 9.01%, 6.52 ± 1.22, respectively. On day 21, the wound surface area, percentage of granulation tissue, VAS score amongst cases were 29.4 ± 29.88 cm2, 92 ± 4.46%, 2.8 ± 0.94, and that of controls were 38.92 ± 23.24 cm2, 78.56 ± 8.19%, and 4.88 ± 1.17, respectively. The time taken for wound healing was 21.76 ± 5.28 days amongst cases and 31.64 ± 8.31 days amongst controls. Staphylococcus aureus was the commonest organism isolated in both the groups. On day 14,18(72%), wounds in the study group showed negative culture, whereas, in the control group, it was negative in 12 (48%) patients. The rate of granulation tissue formation was higher in cases when compared to controls amongst smokers and diabetics. The difference in all these parameters between the groups was statistically significant (P-value <0.05).Discussion and conclusionWe observed a considerable increase in granulation tissue formation, pain alleviation, and reduction in time taken for wound healing. Topical phenytoin is a safe, effective, readily available, and frugal agent that can accelerate wound healing through its multimodal action, thus reducing patient morbidity and economic burden.MeSH termsPhenytoin, Wound healing, Topical, Ulcer, Anticonvulsant, Granulation Tissue, Saline dressing.  相似文献   

5.
目的:观察短波紫外线(UVC)疗法对老年人慢性难愈合创面的疗效,并初步分析影响其剂量和疗效的相关因素。方法:选择老年慢性难愈合创面患者58例共106个创面,患者年龄73~91岁。紫外线治疗剂量为36~1800mJ/cm^2,每日或隔日1次,直至创面完全上皮化。观察不同部位和不同分期创面的愈合情况和愈合时间,分析UVC治疗剂量和创面部位与创面愈合状态的关系。结果:经UVC治疗后,创面愈合77例,显效25例,无效4例,总有效率96.2%。不同部位创面UVC治疗剂量差异显著,手足区〉肛周会阴区〉头颈区〉四肢区〉躯干区(P〈0.01);不同部位创面愈合总有效率差异不显著(P=0.4724),但不同部位治疗次数和创面愈合时间差异显著,肛周会阴区〉躯干区〉手足区〉四肢区〉头颈区(P〈0.01)。在93个压力性溃疡创面中,52个Ⅱ期创面治疗次数[(2.71±0.68)次]及愈合时间[(7.78±2.12)d]均少于41个Ⅲ期创面[分别为(4.09±0.84)次和(13.96±2.38)d],创面愈合率(92.3%)和总有效率(100.0%)也均高于Ⅲ期创面(愈合率为61.0%,总有效率为90.2%,P〈0.01)。结论:UVC治疗老年人慢性难愈合创面疗效显著,病灶部位是影响UVC治疗剂量的重要因素,而病变分期是影响创面愈合效果和时间的主要因素。  相似文献   

6.

Objective

To assess the effects of recombinant human granulocyte/macrophage colony-stimulating factor (rhGM-CSF) hydrogel on the healing of deep partial thickness burn wounds.

Methods

Ninety three wounds of 65 burn patients who suffered from a deep partial thickness burn of <5% TBSA and could not heal over 3 weeks were included in this study. The patients were randomly assigned to use rhGM-CSF hydrogel (GC group, n = 32) or hydrogel without rhGM-CSF (control group, n = 33). rhGM-CSF hydrogel or hydrogel without rhGM-CSF was topically applied to the wounds, the dressing was changed once a day. Wound healing time and percentage, wound discharge, periwound inflammation, the positive wound swabs culture count, and adverse drug reactions were observed and compared between two groups.

Results

Healing time was 12.2 ± 5.0 days after the application of rhGM-CSF hydrogel. This was significantly shorter than that of control wounds (15.5 ± 4.7 days). Healing percentage at 14 days in the rhGM-CSF-treated wounds was 97.5 ± 7.7%, which was markedly higher than the control (85.9 ± 6.8%). At 3, 6, 12, 14 day, the GC group was significantly superior to the control group with respect to the score of periwound inflammation, wound purulence and discharge. The positive wound swabs culture count of the GC group on the 7th and 14th day post-treatment was 14 and 4, respectively, which was significantly lower than the control.

Conclusion

rhGM-CSF hydrogel promotes the healing process of deep partial thickness burns effectively. No adverse reaction of the drug was observed during the study.  相似文献   

7.
Normal wound healing is a well-orchestrated process of inflammatory response,cell proliferation,and tissue remodeling.However,this orderly and precise process is impaired in chronic wounds.A series of ...  相似文献   

8.

Introduction

Chronic, non-healing wounds are often characterised by an excessive, and detrimental, inflammatory response. We review our experience of using a combined topical steroid, antibiotic and antifungal preparation in the treatment of chronic wounds displaying abnormal and excessive inflammation.

Methods

A retrospective review was undertaken of all patients being treated with a topical preparation containing a steroid (clobetasone butyrate 0.05%), antibiotic and antifungal at a tertiary wound healing centre over a ten-year period. Patients were selected as the primary treating physician felt the wounds were displaying excessive inflammation. Healing rates were calculated for before and during this treatment period for each patient. Changes in symptom burden (pain, odour and exudate levels) following topical application were also calculated.

Results

Overall, 34 ulcers were identified from 25 individual patients (mean age: 65 years, range: 37–97 years) and 331 clinic visits were analysed, spanning a total time of 14,670 days (7,721 days ‘before treatment’ time, 6,949 days ‘during treatment’ time). Following treatment, 24 ulcers demonstrated faster rates of healing, 3 ulcers showed no significant change in healing rates and 7 were healing more slowly (p=0.0006). Treatment generally reduced the burden of pain and exudate, without affecting odour.

Conclusions

In normal wound healing, inflammation represents a transient but essential phase of tissue repair. In selected cases, direct application of a steroid containing agent has been shown to improve healing rates, presumably by curtailing this phase. Further evaluation is required to establish the role of preparations containing topical steroids without antimicrobials in the management of chronic wounds.  相似文献   

9.
The foundation of health care management of patients with non‐healing, chronic wounds needs accurate evaluation followed by the selection of an appropriate therapeutic strategy. Assessment of non‐healing, chronic wounds in clinical practice in the Czech Republic is not standardised. The aim of this study was to analyse the methods being used to assess non‐healing, chronic wounds in inpatient facilities in the Czech Republic. The research was carried out at 77 inpatient medical facilities (8 university/faculty hospitals, 63 hospitals and 6 long‐ term hospitals) across all regions of the Czech Republic. A mixed model was used for the research (participatory observation including creation of field notes and content analysis of documents for documentation and analysis of qualitative and quantitative data). The results of this research have corroborated the suspicion of inconsistencies in procedures used by general nurses for assessment of non‐healing, chronic wounds. However, the situation was found to be more positive with regard to evaluation of basic/fundamental parameters of a wound (e.g. size, depth and location of a wound) compared with the evaluation of more specific parameters (e.g. exudate or signs of infection). This included not only the number of observed variables, but also the action taken. Both were significantly improved when a consultant for wound healing was present (P = 0·047). The same applied to facilities possessing a certificate of quality issued by the Czech Wound Management Association (P = 0·010). In conclusion, an effective strategy for wound management depends on the method and scope of the assessment of non‐healing, chronic wounds in place in clinical practice in observed facilities; improvement may be expected following the general introduction of a ‘non‐healing, chronic wound assessment’ algorithm.  相似文献   

10.
Eosinophils can influence fibroblasts and the extracellular matrix in vitro and can participate in tissue remodelling in vivo. Therefore; we analysed the expression of eosinophils and mastocytes in healing laser excisions and control excisions made by scalpel. Carbon dioxide (CO2) laser (continuous wave, 5 W) or scalpel excision wounds were created in the dorsal tongue mucosa of 96 rats. Sixteen additional rats were kept as untreated controls. Specimens from the tongues were cut at 16 different healing time points and fixed in 10% formalin. Histological staining with slow Giemsa was done to determine microscopically the eosinophils and mastocytes. Mastocytes were always present, especially in large numbers around blood vessels, in scalpel and in laser wounds. The maximum number of eosinophils was almost two times higher in scalpel excisions than in laser excisions. The peak value was reached after 6 days in laser wounds and after 3 days in scalpel wounds. The increase reverted to normal levels after 10 days in laser wounds and after 6 days in scalpel wounds. The appearance and disappearance of eosinophils was slower in laser wounds. Mastocytes were always present in both groups. This identification as a potential source of transforming growth factor (TGF) α and TGF β clearly permits a role for the eosinophils and influences epithelial cell proliferation, angiogenesis and organization of the wound.  相似文献   

11.
A burn is one of the most difficult injuries people can face.The primary pathology is coagulation necrosis resulting from tissue damage.Many wound care products have been developed to be used in situations such as the poor general condition of the patient and lack of solid area to be grafted. However, the high costs of these products make their use complicated.In this study, the effect of PEMF on cutaneous wound healing in an animal burn model was evaluated and the dose and duration of the magnetic field should be discussed for this effect to occur. Animals were divided into five groups including eight each (n = 40) (Groups 1, 2, 3, 4, 5).Group 1 was the control group; received no treatment after second-degree burn wound. Group 2 received daily wound care with saline. Group 3 received daily wound care with pomade containing mupirocin. Group 4 received Pulsed Electromagnetic Field signal for 60 min (1.5 m T and 40 Hz for seven days and Group 5 also received PEMF signal for 60 min the same frequency and intensity for14 days. Microscopically, second-degree burn wounds were successfully detected in all rats. Histopathological examination results in no significant difference between groups in neutrophil infiltration. The difference between the groups in vascularization was statistically significant between Group II and Group V (p < 0.001) and between Group I and Group V (p = 0.005) Epithelialization was present in 75% of the rats in Group V, while no epithelialization was observed in any of the other groups. In conclusion, we observed a significant improvement in the stasis zone of the group receiving Pulsed Electromagnetic Field for two weeks.  相似文献   

12.
The prevalence of the chronic metabolic disorder, diabetes mellitus, is expected to increase in the coming years and worldwide pandemic levels are predicted. Inevitably, this will be accompanied by an increase in the prevalence of diabetic complications, including diabetic foot ulcers. At present, treatment options for diabetic foot ulcers are in many cases insufficient, and progression of the condition results in the requirement for limb amputation in a proportion of patients. To improve therapy, an increase in our understanding of the pathobiology of diabetic complications such as impaired wound healing is necessary. In this review, recent advances in molecular aspects of normal and impaired diabetic wound healing are discussed. Furthermore, investigations of the role of epigenetic processes in the pathogenesis of impaired diabetic wound healing are now emerging. Indeed, epigenetic changes have already been identified as key factors in diabetes and related complications and these are overviewed in this review.  相似文献   

13.
目的 观察纳米银纱布对海水及自来水浸泡的兔后肢枪伤伤道的治疗作用。方法 兔双后肢致枪伤后伤道分为 2组。组 1:伤道海水浸泡 5h ;组 2 :伤道自来水浸泡 5h。两组实验侧用纳米银纱布 ,对照侧用凡士林纱布换药治疗。各组均于浸泡后 30min和 1、2、3、4、5h取伤道组织活检 ,观察其病理改变。结果 组 1:实验侧较对照侧创周炎出现晚 ,程度轻 ,伤道内干燥 ,分泌物少。平均愈合时间 :实验侧入口 (2 9 4± 6 6 )d ,对照侧入口 (36 3± 6 0 )d (P <0 0 1) ;实验侧出口 (2 0 1± 6 0 )d ,对照侧出口 (2 7 3± 5 7)d (P <0 0 1)。组 2 :实验侧仅 1只兔创周轻度红肿 ,对照侧创周均有红肿 ,分泌物多。平均愈合时间 :实验侧入口 (13 0± 1 5 2 )d ,对照侧入口 (16 0± 3 10 )d(P <0 0 1) ;实验侧出口 (11 0± 2 75 )d ,对照侧出口 (15 6± 2 85 )d(P <0 0 1)。结论 纳米银纱布有抗感染和加速创面愈合的作用  相似文献   

14.
Epidermal growth factor (EGF) is a potent stimulant of epithelialisation. However, topical application of EGF to achieve facilitated re-epithelialisation in partial thickness wounds has been controversial. A total of 10 pigs, each with eight 4 x 4 cm partial thickness wounds, were treated twice a day for 10 days to observe the effect of human recombinant EGF in concentrations of 0.1, 1, 5, 10, 25 ug/g, vehicle only and two controls. The control and the vehicle-only wounds each demonstrated 100% healing time (HT100) of 9.31 +/- 1.34 and 8.5 +/- 1.12 while the wounds treated with EGF ointment with concentrations of 0.1 (HT100 = 6.4 +/- 0.71), 1 (HT100 = 5.2 +/- 0.63), 5 (HT100 = 5.8 +/- 0.85), 10 (HT100 = 7.1 +/- 1.45) and 25 ug/g (HT100 = 7.4 + 0.57) demonstrated significant reduction in time to achieve re-epithelialisation. Among the EGF-treated wounds, the wounds treated with EGF concentrations of 1 and 5 ug/g achieved the fastest re-epithelialisation with evidence of substantial increase in basal keratinocyte activity observed through Ki-67 activity. In conclusion, this article demonstrates the efficacy of human recombinant EGF in facilitating re-epithelialisation of partial thickness wounds with the most efficient healing found in EGF concentrations of 1 and 5 ug/g.  相似文献   

15.
Within the last ten years, 79 patients were treated for 114 chronically contaminated, intractable irradiation wounds using various methods of the modern plastic surgery. Radical excision of the devitalised contaminated tissue has been impracticable in 25 cases due to the risk of life-threatening complications or significant functional loss. Different types of flaps such as cutaneous, fasciocutaneous, musculocutaneous, split muscle, isolated vascularised fascia and greater omentum have been used. Despite the incomplete excision, 84% of wounds healed primarily. The essential factor for good wound healing seems to be the biologic activity (BA) of the flap's deep tissue layer that directly contacts the wound bed. BA includes density of the vascular net, ability of neovascularisation, plasticity and specific immunological capacities. It seems to be possible to classify the flaps according to the BA level. Tissue defects in which the chances for radical debridement are poor need the highest BA level in the flap reconstruction.Presented to the European Congress on Wound Healing and Skin Physiology, Bochum, Germany, 1992  相似文献   

16.
Adult bone marrow-derived stem cells may aid the healing of chronic lower extremity wounds by transplanting a population of progenitor cells locally into the wound. We present results from three cases in which bone marrow aspirate containing marrow-derived cells was applied/injected locally into complex lower extremity chronic wounds of differing aetiologies. Our case series suggest that bone marrow aspirate, applied topically and injected into the wound periphery, may be a useful and potentially safe adjunct to wound simplification and ultimate closure.  相似文献   

17.
封闭负压引流技术对兔耳急性创面愈合的影响   总被引:3,自引:2,他引:3  
目的 研究封闭负压引流技术 (VAC)对急性创面愈合的影响 ,探讨其可能的治疗机制。方法 以免耳背急性全层皮肤缺损创面为模型 ,选取左侧耳背的创面为治疗组 ,给予封闭负压引流治疗 ;右侧创面为对照组 ,给予常规油纱敷料包扎治疗。分别在创面形成即刻和第 3、6、9天给创面摄影 ,应用图像分析软件计算创面愈合率。另外切取各时间点创面标本进行组织形态学观察。结果 在创面形成第 6天和第 9天 ,VAC组愈合率均高于对照组 ,两者差异有非常显著性 (P <0 .0 1)。组织形态学观察可见VAC组创面炎症反应较轻 ,肉芽组织生长和再上皮化速度均较对照组快。结论 封闭负压引流技术能减轻创面炎症反应 ,加快肉芽组织生长和再上皮化速度 ,显著促进兔耳背急性创面愈合。  相似文献   

18.
Advances in preoperative care, surgical techniques and technologies have enabled surgeons to achieve primary closure in a high percentage of surgical procedures. However, often, underlying patient comorbidities in addition to surgical‐related factors make the management of surgical wounds primary closure challenging because of the higher risk of developing complications. To date, extensive evidence exists, which demonstrate the benefits of negative pressure dressing in the treatment of open wounds; recently, Incisional Negative Pressure Wound Therapy (INPWT) technology as delivered by Prevena? (KCI USA, Inc., San Antonio, TX) and Pico (Smith & Nephew Inc, Andover, MA) systems has been the focus of a new investigation on possible prophylactic measures to prevent complications via application immediately after surgery in high‐risk, clean, closed surgical incisions. A systematic review was performed to evaluate INPWT's effect on surgical sites healing by primary intention. The primary outcomes of interest are an understanding of INPWT functioning and mechanisms of action, extrapolated from animal and biomedical engineering studies and incidence of complications (infection, dehiscence, seroma, hematoma, skin and fat necrosis, skin and fascial dehiscence or blistering) and other variables influenced by applying INPWT (re‐operation and re‐hospitalization rates, time to dry wound, cost saving) extrapolated from human studies. A search was conducted for published articles in various databases including PubMed, Google Scholar and Scopus Database from 2006 to March 2014. Supplemental searches were performed using reference lists and conference proceedings. Studies selection was based on predetermined inclusion and exclusion criteria and data extraction regarding study quality, model investigated, epidemiological and clinical characteristics and type of surgery, and the outcomes were applied to all the articles included. 1 biomedical engineering study, 2 animal studies, 15 human studies for a total of 6 randomized controlled trials, 5 prospective cohort studies, 7 retrospective analyses, were included. Human studies investigated the outcomes of 1042 incisions on 1003 patients. The literature shows a decrease in the incidence of infection, sero‐haematoma formation and on the re‐operation rates when using INPWT. Lower level of evidence was found on dehiscence, decreased in some studies, and was inconsistent to make a conclusion. Because of limited studies, it is difficult to make any assertions on the other variables, suggesting a requirement for further studies for proper recommendations on INPWT.  相似文献   

19.
Wound healing complications in the early postoperative period can be severely detrimental to clinical outcomes after total knee arthroplasty. Thorough knowledge of preoperative risk factors, meticulous surgical technique and wound closure, along with careful postoperative wound monitoring can prevent wound complications or lead to their resolution without subsequent morbidity. If complications arise in the postoperative period, the wound must be evaluated and treated promptly to avoid periprosthetic infection.  相似文献   

20.
Cutaneous wounds are prompt to be contaminated by bacteria, but the clinical benefits of applying antibiotics and antiseptics in wound management have not been proven. Statins are 3‐hydroxy‐3‐methylglutaryl‐coenzyme A (HMG‐CoA) reductase inhibitors commonly used to lower cholesterol levels. Studies indicated that statins, especially simvastatin, promote wound healing in experimental models. As Staphylococcus aureus is one of the most important microorganism responsible for wound infections, the aims of this study were to characterise the anti‐staphylococcal activity of simvastatin and to evaluate the application of simvastatin as a topical therapy for S. aureus‐contaminated wounds. In the present study, simvastatin was bacteriostatic against S. aureus at sub‐inhibitory concentrations up to 8 hours after exposure. Further increased concentrations of simvastatin above the minimal inhibitory concentration (MIC) did not enhance the growth inhibitory effect. By contrast, the ability of simvastatin to inhibit S. aureus biofilm formation was concentration dependent. Topical application of simvastatin at its MIC against S. aureus accelerated the healing and bacterial clearance of S. aureus‐contaminated wounds in an excisional mice wound model. This effective concentration is well below the safe concentration for topical use. Collectively, topical application of simvastatin has the potential as a novel modality for managing wound infections and promoting wound healing.  相似文献   

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