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At least 37 records · Page 2Linked to original sources

PubMed1999

Economic evaluation of the treatment of chronic wounds: hydroactive wound dressings in combination with enzymatic ointment versus gauze dressings in patients with pressure ulcer and venous leg ulcer in Germany.

OBJECTIVE: The treatment costs for pressure ulcers and venous leg ulcers were estimated based on the hospital administrator's perspective in Germany. DESIGN: A spreadsheet model using input data from various hospitals in Germany was developed. INTERVENTIONS: Five currently used treatment strategies were analysed: gauze, impregnated gauze, calcium alginate and hydroactive wound dressing with enzymatic ointment. PARTICIPANTS: All cases used for and in the analysis were treated in the inpatient setting (4 hospitals and 120 patients were included). MAIN OUTCOME MEASURES AND RESULTS: The outcome distributions were calculated using the Monte Carlo method. For the whole treatment process, the attributable costs for the hospital were calculated for different cases (severity) and all treatment strategies (1997 values). The costs for treatment with gauze were the highest, whereas the costs for treatment with hydroactive wound dressings and enzymatic ointment were the lowest. The relation between personnel and material costs for gauze is approximately 95 to 5% and for hydroactive wound dressings 67 to 33%, respectively. The cost savings per case were between 1196 deutschmark (DM) and DM9826 using hydroactive wound dressings instead of gauze dressings (depending on the severity of the pressure ulcer), and between DM135 and DM677 for venous leg ulcers. The results were robust and did not change in any performed sensitivity analysis (parameter: 'personnel costs per minute', 'time required for changing a wound dressing', 'total number of wound dressing changes'). CONCLUSIONS: Despite the higher material costs of the hydroactive wound dressings in combination with enzymatic wound cleaning compared with other wound dressings, they should be recommended for the treatment of pressure ulcers and venous leg ulcers. This therapy alternative brings about significant reductions in total costs for hospitals because of significant reductions in personnel costs and the duration of treatment.

Alginates↗

PubMed1999

A comparison of an opaque foam dressing versus a transparent film dressing in the management of skin tears in institutionalized subjects.

Epidemiological studies suggest that at least 1.5 million skin tears occur each year in institutionalized adults. Despite this incidence, very little is known about the management of skin tears in elderly persons. Studies related to wound dressings and healing rates for these skin tears have rarely been reported in the medical literature. A randomized, prospective trial of 37 subjects compared the treatment of skin tears using either an opaque foam dressing or a transparent film dressing. Subjects had either a modified Payne-Martin Category II (25%-75% epidermal loss) or Category III (100% epidermal loss) skin tear. Category I skin tears (linear with no tissue loss) and skin tears greater than 48 hours old were excluded. Mean subject age was 85.1 +/- 9.7 years. Subjects were followed weekly until healed or for up to 21 days. Subjects in the comparison groups did not differ at baseline in age, sex, wound severity score, presence of diabetes, nutrition score, ambulation and mobility score, or mental status score. Complete healing occurred in 94% (16/17) of subjects treated with the foam dressing as opposed to 65% (11/17) of subjects treated with the film dressing (P < 0.05). Complete healing correlated only with dressing type (P < 0.05) and age (P < 0.01). No other factor was associated with the healing outcome. The number of dressing changes was similar in each group, 3.1 +/- 1.2 versus 3.4 +/- 1.1. Based on the results of this study, we conclude that this opaque foam dressing is a superior wound dressing for skin tears.

Activities of Daily Living↗

PubMed2001

Adhesive retention dressings are more comfortable than alginate dressings on split skin graft donor sites--a randomised controlled trial.

A prospective randomised trial examining the effectiveness, comparative comfort and ease of care of two different split skin graft donor site dressings was performed. One of the dressings was an alginate (Kaltostat), and the other an adhesive retention tape (Mefix). Alginates are the standard plastic surgical dressing, whereas the use of adhesive retention tapes as a donor site dressing presents a novel use of a readily available product. A total of 30 consecutive patients requiring split skin grafts were randomised to receive either alginate or retention donor site dressings. Dressings were assessed by interview and questionnaire at 24 h and 48 h and at 2 weeks, and by wound review at 2 weeks. Retention dressings were found to be more comfortable. They also required less nursing care and attention. The retention dressings allowed the patients easier mobility and a greater range of daily activities, especially washing. There was no significant difference in wound healing nor in complications. Adhesive retention tape applied directly to the split skin graft donor site wound is an effective, cheap and comfortable dressing requiring little postoperative care.

Adhesiveness↗

PubMed1994

Evaluation of Mesalt dressings and continuous wet saline dressings in ulcerating metastatic skin lesions.

The care of chronic ulcerating metastatic skin lesions is not well established or supported by research. Because these cancerous lesions may be present for many years, patients and their caregivers are confronted with ongoing dressing care to control and prevent odor, bleeding, drainage, and infection. Eleven patients in this study compared Mesalt dressings (Sancella Incorporated, Oakville, Ontario, Canada) with continuous wet saline dressings using a crossover design. Results indicated that Mesalt dressings received significantly higher ratings when compared with continuous wet saline dressings for ease of application and odor control and were significantly preferred by patients. No significant differences were found for ease of removal and comfort of the dressing. Neither were there any significant differences in the occurrence of clinical infection, number of dressing changes, and time spent for the care of the lesion. Mesalt dressings were more expensive than continuous wet saline dressings, but benefits may outweight the costs.

Aged↗

PubMed1994

Anosodiaphoria for dressing apraxia: contributory factor to dressing apraxia.

We report 2 patients with bilateral dressing apraxia. One patient had prominent bilateral dressing apraxia without severe constructional apraxia together with anosodiaphoria for dressing apraxia. The other patient had mild dressing apraxia with severe constructional apraxia and was aware of her disabilities. This dissociation implies that anosodiaphoria for dressing apraxia is an important factor in the severity of bilateral dressing apraxia. This also explains why automatic acts in dressing are more severely affected than when patients are asked to put clothing on in dressing examination.

Adult↗

PubMed1996

A comparative study of silicone net dressing and paraffin gauze dressing in skin-grafted sites.

This prospective randomized study has compared paraffin gauze dressing (n = 19) with silicone net dressing (Mepitel, n = 19) applied as the first layer to newly grafted burn wounds. At the first postoperative dressing visual analogue pain scores were greater in the paraffin gauze group (mean 4.4) than in the silicone net group (mean 1.4, P < 0.01). All patients in the paraffin gauze group experienced some degree of pain on dressing removal, whereas 53 per cent of patients in the silicone net group experienced no pain. Overall graft take was similar in both groups, (silicone net mean 95.7 per cent; paraffin gauze mean 94.3 per cent). Dressings were harder to remove in the paraffin gauze group as assessed by a simple scoring system (P < 0.001). In conclusion silicone net dressing confers advantages over conventional paraffin gauze, especially in reducing patient discomfort during dressing changes.

Adolescent↗

PubMed1998

Comparison of the effect of a collagen dressing and a polyurethane dressing on the healing of split thickness skin graft (STSG) donor sites.

Recent advances in the resurfacing of burn wounds with dermal equivalents and collagen preparations have shown the efficacy of collagen. To investigate the benefits (if any), standardised split skin donor areas were chosen to compare the influence of collagen on re-epithelialisation. A bovine collagen preparation consisting of type-I collagen was prospectively compared with polyurethane film dressing in a study of 20 split thickness skin graft donor sites. The rates of epithelialisation, the discomfort experienced by the patients and the convenience of the dressings were assessed. The median time from operation to the observation of complete healing was 7.5 (+/- 2.5) days for the donor sites dressed with the collagen membrane and 12.5 (+/- 3.4) days for the the donor areas dressed with a polyurethane film (p < 0.001). The discomfort experienced by the two groups of patients was significantly less after wound coverage with collagen (p < 0.005). Haematomas or seromas that required repeated aspiration was seen under the polyurethane film dressing. The collagen dressing was more expensive than the polyurethane film, but improved wound healing compared with the polyurethane dressings.

Collagen↗

PubMedDate not supplied

Daily dressing change effects on skin flora beneath subclavian catheter dressings during total parenteral nutrition.

Septicemia is a persistent problem during total parenteral nutrition (TPN). The skin around the catheter insertion site is one possible source of this infection. In previous studies we showed mechanical cleansing of the skin was more important than the ointment applied; however, alternate day dressing changes did not completely eradicate all skin organisms. The present study was designated to examine the effects of daily dressing changes on the skin flora beneath the subclavian dressing. Fifteen patients receiving TPN were studied for a minimum of 11 days each. The dressing was changed daily and the catheter site cultured immediately. The area was then scrubbed with polyvinylpovidine-iodine, an antibiotic ointment was placed on the catheter insertion site, and a new dressing applied. There were no positive skin or blood cultures in this group during a total study period of 242 patient-days. The control group consisted of 23 patients receiving identical subclavian catheter care but on an alternative rather than daily basis. In the control group there was a 3.5% incidence of positive skin cultures in 530 patient-days. Daily dressing changes eliminated all skin organisms beneath the subclavian dressing during TPN and would be useful in patients who are at high risk for septic complications.

Adolescent↗

PubMed1999

Adsorption of serum-derived proteins by primary dressings: implications for dressing adhesion to wounds.

Using an in vitro immunolocalization technique, an exploratory study was carried out into the serum-derived protein adsorption capacity and the cell adherence of a traditional gauze dressing versus a new gelling fibre gauze dressing. We found that the traditional gauze dressing adsorbed protein more readily than the new dressing. The findings indicate that reduced binding of serum proteins to the surface of the gelling fibre dressing may help reduce the adherence characteristics for this type of dressing, minimising trauma and possibly reducing the acute pain experienced during dressing changes.

Adsorption↗

PubMedDate not supplied

[Slowly progressive dressing and constructional apraxia: symptomatological study, especially for dressing apraxia].

In 1982, Mesulam drew attention to a clinical picture characterized by slowly progressive aphasia without dementia, and since then, there have been many such reports. Recently, there have been 30 reports of slowly progressive apraxia. However, the nature of this apraxia is not uniform. We now report a patient with slowly progressive dressing and constructional apraxia. The patient is a 60-year-old right-handed woman with a 2-year history of a slowly progressive praxic disturbance. On admission, she was alert and aware of this difficulty. A neurological examination disclosed mild rigidity and myoclonus in her left hand. A neuropsychological assessment disclosed severe dressing apraxia, which was unlikely to be caused by dementia and moderate constructional apraxia. Her dressing apraxia was manifested in upper limbs, neck, trunk and lower limbs. However, she could express verbally the action of dressing. She also showed mild limb-kinetic apraxia, but neither ideational apraxia nor ideomotor apraxia was present. Aphasia and agnosia were also absent. On an MRI, the bilateral cerebral hemispheres were atrophic (right > left). A 99m-Tc ECD SPECT revealed decreased uptake in the right cerebral hemisphere and left frontal lobe, and an EEG showed slow waves over the right cerebral hemisphere. There have been 30 reports of slowly progressive apraxia. Most of these cases presented with slowly progressive clumsiness in one or both hands as an initial symptom, followed by constructional, ideomotor or dressing apraxia. Our patient differed from these cases in that dressing and constructional apraxia progressed slowly without any other apraxia except only mild limb-kinetic apraxia. There was a similarity between dressing apraxia of our patient and that of Marie's and Brain's original cases.

Activities of Daily Living↗

PubMed1998

Acemannan hydrogel dressing versus saline dressing for pressure ulcers. A randomized, controlled trial.

Aloe vera has been used for centuries as a topical treatment for various conditions and as a cathartic. An amorphous hydrogel dressing derived from the aloe plant (Carrasyn Gel Wound Dressing, Carrington Laboratories, Inc., Irving, TX) is approved by the Food and Drug Administration for the management of Stages I through IV pressure ulcers. To evaluate effectiveness of this treatment, 30 patients were randomized to receive either daily topical application of the hydrogel study dressing (acemannan hydrogel wound dressing) or a moist saline gauze dressing. Complete healing of the study ulcer occurred in 19 of 30 subjects (63%) during the 10-week observation period. No difference was observed in complete healing between the experimental and the control groups (odds ratio 0.93, 95% CI 0.16, 5.2). This study indicates that the acemannan hydrogel dressing is as effective as, but is not superior to, a moist saline gauze wound dressing for the management of pressure ulcers.

Adjuvants, Immunologic↗

PubMed1992

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.

Animals↗

PubMed1998

The effects of cadexomer iodine paste in the treatment of venous leg ulcers compared with hydrocolloid dressing and paraffin gauze dressing. Cadexomer Iodine Study Group.

BACKGROUND: The aim was to examine cadexomer iodine paste in a comparative clinical trial. METHODS: A 12-week, randomized, open, controlled, multicenter, multinational trial in patients with exudating, venous leg ulcers of cadexomer iodine paste (Iodosorb/Iodoflex), hydrocolloid dressing (Duoderm E, Granuflex E), or paraffin gauze dressing (Jelonet) was carried out. All patients used short-stretch compression bandages (Comprilan) throughout the study. The primary efficacy variable was a reduction in ulcer size (%), and the secondary end-point was the time taken to stop exudation, when the patient had completed the study according to the protocol. A total of 153 patients entered the study and were treated for 12 weeks or until cessation of exudation. RESULTS: The mean reduction in ulcer size in all patients was 62% with cadexomer iodine vs. 41% and 24% for hydrocolloid and paraffin gauze (ns). Of those treated for 12 weeks (n = 51), ulcer area reduction was 66% for cadexomer iodine and 18% for hydrocolloid (p = 0.0127). For the whole material, the rate of healing (ulcer area reduction per week) was significantly higher for cadexomer iodine than for paraffin gauze (0.64 cm2/week vs. 0.19 cm2/week, p = 0.0353). The treatment costs were similar in all groups; however, when the costs were correlated with healing over a 12-week period, cadexomer iodine paste was found to be more cost effective than hydrocolloid dressing or paraffin gauze dressing. CONCLUSIONS: This study shows that cadexomer iodine paste is an efficient, cost-effective and safe alternative to hydrocolloid dressing and paraffin gauze dressing for the treatment of venous leg ulcers.

Adult↗

PubMed1993

Bacterial clearance capability of living skin equivalent, living dermal equivalent, saline dressing, and xenograft dressing in the rabbit.

Two new skin substitutes, Living Skin Equivalent (LSE) and Living Dermal Equivalent (DE), have recently been developed. In this experiment, the ability of the LSE and DE preparations to function as biological dressings in an acute wound model was tested. Forty full-thickness wounds were made in New Zealand White rabbits. Each wound was inoculated with 5 x 10(5) Staphylococcus aureus organisms. Twenty-four hours later, one of the following four dressings was applied: saline gauze, porcine-derived xenograft, LSE, or DE. Daily dressing changes and wound biopsies for bacterial counts were performed. At 96 hours after inoculation, split-thickness autograft was applied to all wounds. Skin graft take was assessed 5 days later. In all treatment groups, bacterial counts decreased over time (p = 0.02). At 72 and 96 hours after inoculation, wounds dressed with LSE or DE had significantly lower mean bacterial counts than wounds treated with xenograft dressing (p < 0.01). No significant differences were found among the LSE-, DE-, or saline-treated groups. Skin grafts took well in LSE- and DE-treated wounds. In conclusion, the LSE and DE were more effective than xenograft in reducing bacterial wound contamination in this model, thereby demonstrating their potential application as biological dressing materials.

Animals↗

PubMed2001

[New approach to hand dressings in young children: the puppet dressing].

Applying a postoperative dressing on a child's hand is a very important matter, for it must be done rigorously and according to well established principles in order to be effective and inoffensive. The strictness of execution, that holds the surgeon's attention, makes us sometimes forget that the dressing is for a child who is usually anxious. First, we recall the general principles of a postoperative dressing adapted to young children. Then, we explain a method of applying a dressing in the shape of a puppet, which at first can appear to be funny, but seriously which is completely adapted to a young child. This pediatrician adaptation, that parents appreciate very much, makes the situation less stressful because the child finds himself in a game situation. The puppet dressing seems to be an advantageous modification of the traditional dressing of a child's hand.

Age Factors↗

PubMed1985

A randomized study comparing a transparent polyurethane dressing to a dry gauze dressing for peripheral intravenous catheter sites.

We studied rates of peripheral intravenous (IV) catheter tip and insertion site colonization after randomly assigning patients to transparent polyurethane (TP) dressings (N = 316) or dry gauze (DG) dressings (N = 421). The study was conducted during both summer and fall seasons, in a facility which lacked air conditioning. All patients had a teflon plastic catheter inserted, maintained and cultured by a member of the IV therapy team; no antibiotic or antiseptic ointments were used. Colonization rates were higher in the summer than in the fall for both catheter tips (9.0% vs 3.5%, p = 0.005) and sites (21.6% vs 7.0%, p = 0.001). During the summer season, the rate of catheter tip colonization with TP dressings was nearly twice that of DG dressings (12.4% vs 6.8%, p = 0.04). Logistic regression analysis indicated that catheter tip colonization was associated with the summer season (odds ratio = 3.0, 95% CI 1.4-6.2) and TP dressings (odds ratio = 1.8, 95% CI 1.1-3.2), and that site colonization was associated with both summer (odds ratio = 4.0, 95% CI 2.2-7.1) and receipt of antibiotics (odds ratio = 1.9, 95% CI 1.1-3.2). Coagulase-negative staphylococci were isolated from 55.5% of the colonized catheter tips and insertion sites. The data suggest that bacterial colonization of peripheral IV catheters is increased in summer, and that use of TP dressings may increase both tip colonization and cost nearly twofold.

Bacterial Infections↗

PubMed1989

Comparison of soft dressing and rigid dressing in the healing of amputated limbs of rabbits.

Thirty white male New Zealand rabbits underwent forelimb amputation below the elbow under sterile operating conditions. Fifteen of the amputation stumps were dressed in a soft, bulky dressing while the remaining 15 rabbits had their stumps immobilized in a rigid plaster dressing. On each of the postoperative days 3, 6, 9, 12 and 15, three rabbits from each group were killed and the amputated limb disarticulated and fixed in formalin. Then, histological examination of the suture line and subcutaneous tissue was carried out by a pathologist to determine the effects, if any, that the type of immobilization has on wound healing. Based on microscopic evaluation of wound approximation, interstitial edema and presence of granulation tissue, there was no significant difference between the stumps immobilized in a plaster dressing and those dressed with a soft, bulky dressing.

Amputation Stumps↗

PubMed1996

Analysis of cryotherapy penetration: a comparison of the plaster cast, synthetic cast, Ace wrap dressing, and Robert-Jones dressing.

Four groups were studied to determine the cooling effect at skin level of ice application over common ankle bandages and casts. The plaster cast, synthetic cast, and Ace wrap dressing groups had 18 participants and the Robert-Jones dressing group had four participants. In a standardized fashion, ice bags were applied over each bandage or cast and skin temperatures were measured with a thermocouple over a 90-min period. The average final skin temperature was 16.5 degrees in the plaster cast, 18.8 degrees in the synthetic cast, 21.2 degrees in the Ace wrap dressing, and 28.7 degrees in the Robert-Jones dressing. The temperature curves showed that ice application effectively decreased skin temperatures through the plaster cast, synthetic cast, and Ace wrap dressing. The cooler temperature did not adequately penetrate the Robert-Jones dressing.

Adult↗