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Results for “OCCLUSIVE DRESSINGS”

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PubMed2004

The effect of semipermeable dressings on smallpox vaccine site evolution.

BACKGROUND: Many hospital systems in the United States are contemplating the implementation of a smallpox vaccination program. The Centers for Disease Control and Prevention and other organizations recommend use of occlusive dressings over the vaccination site of health care workers in contact with patients. Minimal data are available on the impact of an occlusive dressing on the evolution of the vaccinia inoculation site. METHODS: We conducted a prospective observational study in which subjects were instructed to cover their vaccination site with either a semipermeable dressing over gauze or gauze alone. We recorded the duration of semipermeable dressing use and parameters pertaining to vaccination site evolution, to include time until scab separation. RESULTS: The increased use of a semipermeable dressing is associated with increased time until scab separation (n = 41, r =.48, P =.001 by regression analysis). This analysis predicts a 9-day difference in time until scab separation between patients that wore semipermeable dressings 100% of the time versus not at all. No significant correlation was observed between semipermeable dressing use and size of maximum erythema, time until maximum erythema, size of erythema on day 6 or 8, nor time until pustule formation. CONCLUSION: Semipermeable dressing use appears to prolong the time until scab separation and possibly the duration of infectivity and risk of secondary transmission. Health care organizations may wish to consider this information when instituting a smallpox vaccination program.

Adult↗

PubMed1999

Histological comparison of postoperative wound care regimens for laser resurfacing in a porcine model.

BACKGROUND: The use of short-pulsed CO2 lasers for skin resurfacing is routinely performed, but few studies have examined postsurgical care. OBJECTIVE: To determine which postoperative treatments are most beneficial in promoting optimal healing after laser resurfacing. METHODS: Four pigs received laser resurfacing. The laser sites were randomly left untreated or treated with petroleum-based ointment or dressed with 1 of the following occlusive dressings: hydrocolloid, hydrogel or foam. Biopsies were taken from each treatment group on Days 2, 3, 4, 5, 8, 12, and 19. All samples were stained with hematoxylin and eosin. Each histological slide was evaluated by a blinded investigator. RESULTS: Differences were observed between treatment groups in the amount of cellular infiltrate, presence of necrotic tissue, progression of the epidermal sheet, maturation of the epidermis, presence of rete ridges, and appearance of new collagen. CONCLUSION: Postoperative treatments after laser resurfacing vary in their ability to influence the quality of healing.

Animals↗

PubMed2001

[Management of venous leg ulcer by French physicians, diversity and related costs: a prospective medicoeconomic observational study].

OBJECTIVES: The purpose of this study was to better ascertain how French physicians manage venous ulcers of the lower limbs. We explored the various therapeutic approaches used and their respective costs. Particular attention was focused on dressing prescriptions. MATERIAL AND METHODS: A prospective medicoeconomic study was conducted. Eight hundred general practitioners and specialists throughout France were included and followed two patients each, one with a "new ulcer" (less than two weeks) and another with a "longstanding ulcer" (more than six weeks). Patients were followed to healing or for up to six months. An observation chart was completed at each visit. Data collected were characteristics of the ulcer at inclusion, assessment of the clinical course, and the nature and the volume of medical care prescribed. Corresponding costs (total cost for the society) were calculated on the basis of 1996 public prices for drugs and the French national health insurance quotations for ambulatory care. For hospital care, cost was calculated from the cost of stay for homogeneous patient groups. RESULTS: Files established for 1,098 patients by 652 physicians could be assessed. Elderly female patients predominated in this population (mean age 72 years, 74% women). The length of the ulcer at inclusion was significantly correlated with its duration: 2.82 cm for new ulcers (52.6% of the cases) versus 5.03 cm for longstanding ulcers (47.3%). The mean number of consultations for all patients was 4.8 over a 29-day period. Mean cost resulting from these consultations was 5,827 FF per patient: 48% for care, 33 for drugs, 16% for hospitalizations, and 3% for work lay-off ). Cure was achieved in 77% of the cases within a mean delay of 3 months. Older ulcer was significantly associated with longer treatment (117 days for longstanding ulcers versus 80 days for new ulcers), lower cure rate (67% versus 86%) and higher cost (7 078 FF versus 4 669 FF). Dividing care methods between those using cleaning with compression or not showed that compression was prescribed in 76% of the cases at the inclusion consultation. This predominance of compression therapy did not preclude use of a variety of other therapeutic methods depending on the clinical and demographic situation of the patient. Cost varied accordingly with a mean ranging from 3 160 FF to 6 697 FF depending on the therapeutic attitude. The study also focused on the type and amount of dressings used. Dressings were prescribed for 56 patients in this series. It can be hypothesized that these patients already had dressings. Different indicators show that the absence of prescriptions for dressings concerned less severe and less costly ulcers (4 130 FF versus 5 918 FF for those with dressing prescriptions). Among the 1 042 patients for whom dressings were prescribed, 35% were for occlusive dressings, 29% for ointment dressings and also 24% for both occlusive and ointment dressings. The type was not specified in 55% of the cases. Mean cost for these different categories ranged from 4 921 to 7 019 FF.

Absenteeism↗

PubMed1992

[Randomized comparison between collagen administration and pressure dressings for occlusion of the arterial puncture after coronary angiography and coronary dilatation].

One hundred patients undergoing routine diagnostic or interventional catheterization were randomly assigned to receive either percutaneously applied collagen (group A; n = 50) or conventional pressure dressing (group B; n = 50) for sealing of the femoral artery. Clinical variables were comparable in both groups. The heparin dose was 100 IU/kg in 30 patients and 200 IU/kg in 20 patients of both groups. The average compression time was 4.3 min in group A and 42.3 min in group B (p < 0.001). In group A, 1/50 patients required pressure dressing compared to 50/50 patients in group B. Bleeding was not observed in group A, but was observed in 6/50 patients in group B. The time to ambulation was 6.4 (range, 4-12) h in group A and 21.6 (range, 10-48) h in group B (p < 0.001). Hematomas with a diameter of > 6 cm developed in 4/50 patients in group A and in 11/50 patients in group B (p < 0.05). Blood-transfusions or surgical interventions were not required and there was no loss of ankle pulses in either group. In conclusion, percutaneously applied collagen reduced compression time and duration of bedrest after diagnostic catheterization and PTCA. Despite earlier ambulation, the incidence of bleeding was lower with collagen than with conventional pressure dressing.

Angioplasty, Balloon, Coronary↗

PubMed1992

Alginates. A "new" dressing alternative.

BACKGROUND: Currently, a wide variety of bio-occlusive dressing materials are available. In general, these dressing materials provide a moist wound healing environment that has been shown to promote healing in both human and animal studies. To effectively use these dressings the clinician must have a full understanding of the properties of the materials as well as the pathophysiology of the particular wound. Most recently, a "new" biosynthetic dressing material, the alginates, has become available. OBJECTIVE: To highlight proper use of alginate dressings for the management of acute and chronic wounds. METHODS: Case study and literature review. RESULTS: Alginates were shown to be effective in a wide variety of acute and chronic wounds. CONCLUSION: Alginates possess several unique properties that should prove useful to the dermatologic surgeon as well as the dermatologist. Proper patient selection and use of this "new" dressing material, as well as a review of the literature is presented.

Alginates↗

PubMed1994

A novel model of cutaneous candidiasis produced in prednisolone-treated guinea-pigs.

In an attempt to develop an animal model of cutaneous candidiasis useful for the pre-clinical evaluation of antifungal drugs, experimental cutaneous Candida albicans infections were produced in mature and immature guinea-pigs treated with prednisolone. The morbidity of this model in terms of the extent and the duration of the superficial infection was compared with that of two other reported models: those produced by alloxan treatment, or the use of occlusive dressings. Infected animals were also included which received neither of these treatments. The Candida infection continued steadily for 14 days or more in both mature and immature animal groups treated subcutaneously with prednisolone and appeared to be more suitable than that produced with alloxan treatment or under occlusive dressings. In prednisolone-induced infection, most of the micro-organisms were confined to the epidermis and there was no evidence of their dermal penetration during the 14 day experimental period. In view of these facts, we attempted a more quantitative method by counting viable Candida in order to evaluate antimycotics in a shorter therapy period during which animals would receive less exposure to the vehicle. These findings appear to indicate that the experimental model of cutaneous C. albicans infection produced in prednisolone-treated mature and immature guinea-pigs would be useful for studies on the therapeutic efficacy of antifungal agents against cutaneous candidiasis.

Administration, Topical↗

PubMed2002

[Evaluating scar development with objective computer-assisted viscoelastic measurement].

In a prospective study we compared the subjective scar assessment by the Vancouver Scar Scale with an objective viscoelastic measurement. Donor sites from the thigh primarily dressed with vaseline gauze (F), biobrane or occlusive dressing(O) were evaluated 0.5 years postoperatively by VSS and with the Cutometer (Courage and Khazaka). VSS of donor sites was 2.74 +/- 0.91 (F), 4.25 +/- 0.77 (B) and 2.57 +/- 0.72(O) (mean +/- sem). All ratings were significant compared to normal mirror-sided skin. Viscoelastic measurements by the Cutometer were near normal compared to uninjured skin. No correlation was found between subscale VSS pliabilty rating and Cutometer readings.

Bandages↗

PubMed2000

Isolated arteriovenous dialysis access graft segment infection: the results of segmental bypass and partial graft excision.

Arteriovenous (AV) access graft infection results in disruption of dialysis and usually necessitates graft removal when the entire graft is involved. The management of an isolated infected segment of an otherwise noninfected AV access graft, however, remains controversial. To evaluate the utility of segmental bypass and partial graft excision for the treatment of an isolated infected AV access graft segment, 17 consecutive cases in 12 patients (7 females/5 males; 14 arm grafts/3 leg grafts; median age = 69 years) were analyzed on a vascular teaching service that performed 1244 total access procedures from January 1995 through February 1999. Infections presented as a draining sinus or a sinus with hemorrhage emanating from an area over the graft. At operation, the infected sinus was covered by a transparent occlusive dressing and the graft was explored through clean incisions proximal and distal to the infected segment. If the graft was incorporated and free of infection, a piece of expanded polytetrafluoroethylene (ePTFE) was anastomosed proximally end-to-end and tunneled through noninfected tissues around the infected sinus. After the distal anastomosis was performed, the skin incisions were closed and covered with occlusive dressings. The infected graft segment was then removed through the infected sinus wound. The technique of segmental bypass and partial graft excision results in predictable eradication of infection, graft salvage, and maintenance of uninterrupted dialysis in patients presenting with an isolated AV dialysis access infection.

Aged↗

PubMed2005

[Peripheral venous placement: evaluation of guidelines respect in prehospital setting].

INTRODUCTION: Respect of guidelines for peripheral venous placement has never been studied in prehospital setting. OBJECTIVE: Describe prehospital practice in peripheral venous placement and perform comparison with guidelines. MATERIAL AND METHODS: Prospective study, in mobile intensive care unit from a university hospital, October 2002 to January 2003. Study of prehospital practice for peripheral venous placement in prehospital setting and comparison with guidelines. Guideline from Anaes: wearing a cap and a mask, washing hands, washing insertion site with water and soap, wearing sterile gloves, using sterile gauze, applying iodine solution to the insertion site, using catheter with a protective system and applying occlusive dressing. RESULTS: Six hundred seventy-three reports were studied. A cap and a mask wearing and washing insertion site with water and soap were never respected. Washing hand with antiseptic was reported in 56% of the cases, washing insertion site with iodine solution in 4%, wearing sterile gloves in 21%, using catheter with a protective system in 89%, using sterile gauze in 1% and applying occlusive dressing in 99%. For each criterion, respect of guidelines was significantly more frequent in nurse practice than in physician practice. CONCLUSION: Guidelines for peripheral venous placement were not respected in prehospital setting. Education and formation are necessary to optimize infectious risk prevention in prehospital care.

Adolescent↗

PubMed1993

Wound healing microbiology.

The relationship between wound healing and cutaneous microbiology is a complex one mediated by the type of wound, its treatment, and the defense mounted by the injured individual. Acute wounds harbor microflora similar to that of noninjured skin. "Dirty" traumatic wounds or chronic wounds with devitalized tissue offer more opportunity for microflora colonization, with the potential for bacterial adherence to the host cells and ultimate invasion into viable tissue or infection. The alterations of these wound environments can be brought on by topical treatments. Occlusive dressings with various moisture vapor transmission rates can provide a wound environment suitable for microflora proliferation. In spite of this increase in numbers of organisms, most wounds do not become infected, as shown by a survey of published trials. Infection requires the proper pathogenic microorganism, its attachment, and subsequent multiplication. To cause an infection, an organism must invade viable tissue and evade the host defense response. The many occlusive dressing types available offer an opportunity to select a wound therapy tailored for the microenvironment most suitable for healing. Wounds can be protected from exogenous microfloral contamination with dressings. Some dressing types, such as hydrocolloid dressings with no moisture vapor transmission, should not be used on chronic wounds suspected of harboring anaerobic organisms. Other typical treatments, such as antiseptics, can injure tissue and make infection more probable, providing devitalized tissue for bacterial adhesion. Povidone-iodine solution has been shown not be efficacious, whereas povidone-iodine cream effectively limits bacteria and infection.(ABSTRACT TRUNCATED AT 250 WORDS)

Anti-Infective Agents, Local↗

PubMed2002

Hyperpigmentation induced by topical 5-aminolaevulinic acid plus visible light.

UNLABELLED: Photodynamic therapy (PDT) with 5-aminolaevulinic acid (ALA) is an alternative tool for the treatment of superficial non-melanoma skin cancers. Recently ALA-PDT has been employed with encouraging results also for warts, condylomata and psoriasis. In this study the effects of topical ALA plus irradiation with visible light on intact human skin have been evaluated. Five skin areas (A, B, C, D, and E) on the inner upper part of the arms of five healthy volunteers (skin types III and IV) were treated with (A) ALA 20% in base cream without irradiation, (B) only the vehicle (base cream) without ALA, (C, D and E) ALA cream at the concentrations of 5, 10 and 20%, respectively; all treatments were applied with an occlusive dressing. Four hours after ALA or vehicle application areas B, C, D and E were irradiated with a fixed dose of 40 J/cm(2). ALA penetration through the intact skin was evaluated by in vivo fluorescence determination. The effects on healthy skin were evaluated by clinical and chromometric examinations, light microscopy, immunohistochemistry and electron microscopy. RESULTS: (1) in vivo fluorescence demonstrated that ALA is able to penetrate through the intact skin, when applied with occlusive dressing and induces a classical fluorescence peak due to Protoporphyrin IX (PpIX) formation, which is the active photosensitiser. (2) Skin areas receiving ALA plus irradiation showed erythema and swelling just after the irradiative session and hyperpigmentation 48-72 h later. (3) Colourimetric data confirmed significant skin colour changes: values a* (representing the erythematous changes) increased only on the skin areas where ALA+irradiation were applied and during the 48 h after irradiation, thereafter a* began to decrease; values L* (pigmentation) increased during the 2 weeks following treatment. (4) Histopathological, immunohistochemical (S100, HMB-45) and electron microscopic findings showed an absolute increment of the number of melanocytes, which appeared clearly activated. In conclusion the application of ALA cream followed by irradiation is able to induce a pigmentation response in healthy human skin, at least in skin types III and IV. This melanocytic activation could have a potential for the treatment of skin disorders characterised by hypopigmentation.

Administration, Topical↗

PubMed2003

Factors influencing sunless tanning with dihydroxyacetone.

BACKGROUND: Sunless tanning preparations have been used for more than 50 years and are still very popular because they provide temporary pigmentation resembling an ultraviolet-induced tan. The pigment is the product of reactions between dihydroxyacetone (DHA) and amino acids in the stratum corneum. OBJECTIVES: To understand the factors that influence the reactions of DHA with amino acids in the stratum corneum with the ultimate goal of producing pigmentation with greater photoprotection. METHODS: The influence of hydration and/or oxygen on the development of DHA-induced pigment was assessed in vivo using an occlusive dressing and ex vitro on human epidermal preparations. Two spectroscopic techniques, diffuse reflectance and fluorescence emission, were used to monitor the extent of pigment development. The optimal relative humidity for DHA-induced pigmentation was assessed on the epidermal preparations. The formation of products from reactions between DHA and nine amino acids was studied in solutions buffered at pH 5 and 7. RESULTS: Development of DHA-induced pigmentation was inhibited by a 24-h occlusive dressing but appeared after its removal, indicating that DHA was still present. High hydration but not the absence of oxygen inhibited coloration of occluded skin. The extent of pigmentation did not vary in a simple manner with hydration, as pigment formation was positively correlated with humidity from 0 to 75% but negatively correlated from 75 to 100%. Lysine, glycine and histidine reacted most rapidly with DHA, with reaction rates greater at pH 7 than at pH 5. The products absorbed with maxima at wavelengths up to 340 nm. CONCLUSIONS: These results indicate that extent of hydration, pH and availability of certain amino acids influence the development of DHA-induced pigmentation in the stratum corneum and suggest that manipulation of these factors might produce pigmentation with greater photoprotection.

Amino Acids↗

PubMed1989

Steroid-induced dermal atrophy. Investigations on discontinuous application.

In this study several schedules of discontinuous application (DA) were tested, using various weak and strong topical corticosteroids (CS). The purpose of this study was to measure the influence of corticosteroids on skin thickness by means of a mechanical method. In a first experiment, betamethasone 17,21-dipropionate (Bet) and fluprednidene 21-acetate (Flu) were applied to the skin of the volar side of the forearm at a rhythm of 1:1 (1 day CS, 1-day interval) and 1:2 under occlusive dressing. The investigation period was 8 weeks. For comparison, Bet and Flu were applied continuously (CA) for 3 weeks. Flu thinned the skin to a lesser extent than Bet. With DA the skin was thinned to the same extent as with CA. In a second experiment, hydrocortisone 17-butyrate, betamethasone 17-valerate, desoxymethasone and hydrocortisone were tested. Here the treatment regimen was 5:9. The CS preparations were tested for 3 months on the volar side of the forearms under occlusive dressing. Skin thinning occurred during the 5 days of CS action and, in the beginning, receded again in the CS-free interval. However, this regressive process became weaker each time. At the end of the experiment the skin thinning persisted. With the exception of hydrocortisone, all CS tested produced statistically significant skin thinning after DA. The results of the investigation presented here show that thinning of the skin must also be expected with discontinuous application of topical CS.

Administration, Cutaneous↗

PubMed2000

Healing of untidy traumatic skin defect of the face by secondary intention.

BACKGROUND: Untidy facial skin defects manifest extensive soft tissue injury and contamination. Since modern surgical principles emphasize immediate wound closure, most surgeons should learn to convert an untidy wound to a tidy one and to reconstruct defects immediately if possible with the use of grafts and flaps. However, in some situations, healing by secondary intention remains advantageous. The purpose of this study is to reevaluate this traditional approach. METHODS: Twenty patients with untidy facial skin defects were treated conservatively over a 4-year period. The defects ranged from 2 x 2 cm2 to 6 x 4 cm2 in size. The depths of wounds were classified into partial-thickness in 9 patients, full-thickness in 7 patients, and deep defects in 4 patients. Each patient was instructed on wound care, which included daily cleaning with normal saline, followed by application of hydrocolloid occlusive dressing. Prophylactic antibiotics were not used. RESULTS: The mean follow-up period was 17 months. All wounds healed within 3 to 5 weeks. There was no wound infection. One patient developed a hypertrophic scar over the cheek, and received excision of the scar and resurfacing with full-thickness skin graft. Two patients had residual traumatic tattooing which was resolved by laser therapy. Two patients had hypopigmentation/hyperpigmentation problems. Most patients (18/20) were satisfied with both functional and cosmetic results. CONCLUSION: Conservative wound care with hydrocolloid occlusive dressing allows good healing by secondary intention for traumatic facial defects in selected patients.

Adolescent↗

PubMed1986

Microbial examination of kidney lithotripter tub water and epidural anesthesia catheters.

Kidney lithotripsy patients frequently receive epidural anesthesia via indwelling epidural catheters. In our hospital, patients are immersed in a tub of warm, continuously-flowing tap water. The epidural catheter-entry site is covered by a transparent occlusive dressing. To determine the risk of microbial colonization of the epidural catheter during lithotripsy, we performed quantitative cultures of tub water and semiquantitative cultures of catheters in 63 lithotripsy procedures. Most of the tub water organisms were typical tap water and skin flora isolates. Total colony counts were generally low with no significant progression during the course of serial procedures. Forty-two epidural catheters were cultured; 34 (81%) were sterile, 8 (19%) were colonized with small numbers of flavobacteria or coagulase-negative staphylococci. Only four catheters had organisms present on catheter segments covered by the transparent occlusive dressing (in each case there was a single colony forming unit per semiquantitative plate) and these organisms were probable contaminants. We conclude that with our current lithotripsy procedures, the risk for the development of epidural catheter-associated infection seems to be low.

Anesthesia, Epidural↗

PubMed1992

Topical fish oil in psoriasis--a controlled and blind study.

Omega-3 polyunsaturated fatty acids compete with arachidonic acid as substrates for lipoperoxidases, which transform them into leukotrienes with low biological activity. As this process, in skin, may benefit psoriatic patients, a randomized controlled single blind-study was carried out on a sample of 25 patients. In the study fish oil (FO) was compared with liquid paraffin (LP); both were topically applied and administered daily for 6 h under an occlusive dressing over a 4-week period. Evaluations were performed weekly assessing erythema, scaling, plaque thickness (induration) and itching. The results showed statistically significant improvement in erythema and scaling for both treatments compared to basal values; significant differences between treatments were achieved in scaling but not in erythema. Compared to baseline, FO significantly improved plaque thickness while LP did not. After 4 weeks, FO proved to be significantly better than LP. All patients accepted the treatment despite its unpleasant smell. Irritation and a burning sensation were reported in the FO treated plaque of one patient. This adverse effect reverted after completing the treatment. These findings demonstrate that topical FO shows a better performance than LP under an occlusive dressing.

Administration, Topical↗

PubMed2005

[Sensory nerve anesthesia with 4% liposomal lidocaine cream in healthy subjects by use of the neuroselective current perception threshold].

BACKGROUND: ELA-Max, an external liposomal preparation of lidocaine (4%) available without prescription in United States, has a recommended application time of 15 to 45 min without occlusive dressing, and the side effect has been reported to be rare. To investigate external anesthetic preparations to reduce neuropathic pain, we evaluated sensory nerve anesthesia by ELA-Max in comparison with placebo and other lidocaine topical preparations by double blind method. METHODS: We measured the neuroselective current perception threshold (N-CPT) 30 min after the application of ELA-Max on 30 healthy Japanese volunteers. Evaluation of anesthetic effect was performed by change in N-CPT rate before and after the application of 0.025 g x cm(-2) to the skin where stimulation was performed. RESULTS: ELA-Max increased N-CPT ratio in 4 out of 9 subjects stimulated at 5 Hz. However these CPT values were within normal ranges, and the change in N-CPT ratio was not statistically significant throughout all stimulation frequencies. CONCLUSIONS: The application of 0.025 g x cm(-2) ELA-Max for 30 min was not effective to induce therapeutic level of anesthesia. Extended application times as well as occlusive dressing may be needed for this preparation to be used clinically.

Adult↗

PubMed1995

Comparison of the repair of permanent tympanic membrane perforations by hydrocolloidal dressing and paper patch.

Thirty consecutive patients with permanent perforations of their tympanic membranes (TM) present from 2.5 to 50 years (mean 18.7 years) were admitted to a prospective study using two alternative methods of dressings for closure of the perforations. An adhesive-coated hydrocolloid material was compared with a conventional dressing of vaseline impregnated rice paper patch after de-epithelialization of the perforation border. Nine of the permanent TM perforations (30 per cent), five with the hydrocolloidal dressing and four with the rice paper patch had healed when followed-up after one year. The size of eight of the central perforations that had healed was equal to or less than 25 per cent of the TM. Also one perforation with a size of 65 per cent had healed. Seven perforations were located in the posterior part of the TM: four in the posterior-superior quadrant, one in the inferior quadrant, one had engulfed the posterior half of the TM and one included the anterior-inferior quadrant. Only two perforations out of 14, with a size of 25 per cent or less, located in the anterior-inferior quadrant, healed. No significant difference was demonstrated between the two types of dressings. Both groups noted an immediate improvement in hearing of 10.8 and 9.3 dB, respectively, after application of the dressing. The study demonstrates that application of an occlusive dressing or paper patch in 30 per cent of patients can promote the healing of long-standing perforations. The chances for healing are better if the perforation is located in the posterior part of the TM. This simple technique immediately improved hearing and should be tried before a patient is referred for myringoplasty surgery.

Adolescent↗