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At least 379 records · Page 21Linked to original sources
PubMed2004

Rapid healing of intractable diabetic foot ulcers with exposed bones following a novel therapy of exposing bone marrow cells and then grafting epidermal sheets.

BACKGROUND: Diabetic foot ulcers with exposed bones commonly result in amputation. OBJECTIVES: To determine whether exposure of bone marrow cells and subsequent grafting of epidermal sheets accelerates healing and reduces the need for amputation. METHODS: Thirty-eight patients with chronic wounds caused by diabetes mellitus were enrolled in this study. Epidermal sheets obtained from suction blisters of each patient were grafted on to diabetic foot ulcers without exposed bones (n = 10) and were compared with the standard treatment of local wound care, debridement with a scalpel when indicated, bed rest and parenteral antibiotics (n = 8). In another group of patients, diabetic wounds with exposed bones were treated either with the standard procedure (n = 9) or with a newly developed experimental procedure (n = 11). In that new procedure, the affected bone was initially exposed by debridement with a scalpel, followed by partial excision with a bone scraper until fresh bleeding was observed from the exposed bone. The lesions were then immediately covered with an occlusive dressing, and finally the wound was covered with an epidermal graft of skin harvested from suction blisters. Patients in each group were matched with their counterparts by age, sex, wound size, wound infection and wound duration, to compare the time needed for total skin repair and rates of amputation. RESULTS: Epidermal grafting significantly accelerated the healing of diabetic foot ulcers (P = 0.042) without exposed bones, with site-specific differentiation. The newly developed combination therapy resulted in the healing of all diabetic ulcers with exposed bones without the occurrence of osteomyelitis or the necessity for amputation (P < 0.0001). CONCLUSIONS: Our study indicates that early aggressive debridement of diabetic foot ulcers with exposed bones down to a bleeding vascularized base and then grafting epidermal sheets significantly improves healing and reduces the rate of amputation.

Adult↗
PubMed1992

Control of the hypermetabolic response to burn injury using environmental factors.

This study was performed to establish the relative efficiency of occlusive dressings and variable ambient temperature (group I) versus no dressings and variable ambient temperature (group II) versus no dressings and electromagnetic heaters (group III) for controlling the postburn hypermetabolic response. Fifteen burn patients and five normal controls (group IV) were studied when subjectively comfortable using partitional calorimetry, after which each patient was cold stressed by sequentially decreasing external energy support, and repeating calorimetry studies and serial plasma catecholamine assays. The percentage increase in heat production above predicted normal values was significantly increased for all groups when cold (C) versus neutral (N) (group I: [N] 24 +/- 24 versus [C] 49 +/- 25%; group II: [N] 46 +/- 35 versus [C] 74 +/- 47%; group III: [N] 21 +/- 20 versus [C] 78 +/- 25%; group IV: [N] -9 +/- 12 versus [C] 16 +/- 10%, p less than 0.05 all comparisons). Plasma catecholamine values did not increase significantly when patients were subjectively cold. These studies do not support the role of catecholamines as the primary mediator in the cause of the postburn hypermetabolic response. Using the patients' subjective comfort status as a guide for external energy support, it is possible to greatly reduce but not to eliminate the hypermetabolic response to burn injury.

Adult↗
PubMed2001

Ulcerated hemangiomas: clinical characteristics and response to therapy.

BACKGROUND: Hemangiomas represent the most common benign tumor of infancy, with ulceration its most frequent complication. OBJECTIVE: Our purpose was to review our experience with this challenging problem by evaluating the clinical features, management, and therapeutic responses of ulcerated hemangiomas. METHODS: A retrospective analysis of ulcerated hemangiomas at the University of California, San Francisco outpatient pediatric dermatology clinics and Oakland Children's Hospital from 1987 to 1997 was performed. RESULTS: The medical records of 60 patients were examined. Forty-nine female and 11 male patients were seen with a female/male ratio of 4.5:1. The majority of ulcerated hemangiomas were of the plaque type (n = 50; 83%) and relatively large; 47 (78%) were larger than 6 cm(2). The perineum was the single most frequently involved site, affected in 20 cases (33%). Topical antibiotics, barrier creams, and bio-occlusive dressings were used in most cases. Systemic antibiotics were used in 26 cases (43%) for overt or presumed infection. Systemic corticosteroids were used in 21 children (37%), 5 of whom did not show a response. Intralesional triamcinolone was used in 7 cases (12%), with 4 showing definite improvement. The flashlamp pulsed-dye laser was the modality used in 22 children (37%), 11 (50%) of whom showed definite improvement, 4 (18%) who showed no significant response, and 1 (5%) who showed definite worsening. Interferon alfa-2a was required in 5 patients (8%), all of whom showed improvement without appreciable neurologic side effects. Immediate surgical excision was required in only 2 cases (3%). Pain control with oral acetaminophen, acetaminophen with codeine, and topical 2.5% lidocaine ointment was effective in managing the pain of lip and perineal hemangiomas, with no side effects noted. CONCLUSION: No one uniformly effective treatment modality was found, and frequently several were used concurrently. The decision to use specific therapies was dependent on the age of the patient, as well as the location, size, and stage of growth or involution of the hemangioma. Our approach to management included 4 major areas: local wound care, management of infection, specific therapeutic modalities (systemic and intralesional corticosteroids, flashlamp pulsed-dye laser, and interferon alfa-2a), and pain management.

Adrenal Cortex Hormones↗
PubMed2006

The treatment of sulphur mustard burns with laser debridement.

The chemical warfare agent, sulphur mustard (SM), is a potent blistering agent in man. Skin exposure can produce partial-thickness burns which take up to three months to heal. The aim of this study was to investigate the use of early laser ablation as a means of accelerating this exceptionally slow rate of healing. Four circular partial-thickness SM burns were induced on the dorsum of nine large white pigs (under general anaesthesia). At 72 h post-exposure, three burns per animal were ablated with a single pass of an UltraPulse 5000C CO(2) laser, at a fluence of 5-6 J cm(-2). All the burns were dressed with silver sulphadiazine and a semi-occlusive dressing. At one, two and three weeks post-surgery three animals were culled and all lesions excised for histological analysis. Burn depth was confirmed and measurements of the radii of regenerative epithelium were performed allowing the area of the zone of re-epithelialisation in each lesion to be calculated. Laser-treated lesions showed a significant increase (350%) in healing rates compared to controls (p<0.005). At two weeks, the laser-treated sites were 95% healed in comparison with control sites (28% healed). These data suggest that laser ablation may be effective in the treatment of partial-thickness SM-induced skin injury.

Animals↗
PubMed1983

Halometasone cream by day and halometasone ointment at night for the treatment of patients with chronic psoriasis vulgaris.

In an open non-comparative trial forty-three hospitalized patients with chronic psoriasis vulgaris were treated with 0.05% halometasone cream (without dressing) by day and 0.05% halometasone ointment (with occlusive dressing) at night. This combined regimen yielded good to very good results in 93.1% of the patients treated. The trial treatment was fairly well tolerated, did not have any systemic adverse effects and had to be discontinued in only one patient, due to severe pustular eruption at the site of application.

Administration, Topical↗
PubMed2001

Interpenetrating polymer network wound dressing versus petrolatum following facial CO2 laser resurfacing: a bilateral comparison.

BACKGROUND: Occlusive dressings increase the speed of epidermal wound healing by decreasing wound adherence, maintaining a moisture barrier, and allowing contact with healing factors. OBJECTIVE: To test whether a thin film of silicone and polytetrafluoroethylene blended into an interpenetrating polymer network (SPIPN) can provide improved healing over petrolatum following CO2 laser resurfacing injury. METHODS: A bilateral comparison of closed SPIPN versus open healing following two different CO2 laser delivery systems for resurfacing was performed. Twenty patients were followed and evaluated at days 1, 2, 3, 7, 14, 30, 60, and 90 for exudate, erythema, rate of epithelialization, pigment changes, postoperative pain, pruritus, cosmetic results, preference, and duration of postoperative complications. RESULTS: Results demonstrated improved healing for SPIPN compared to petrolatum alone. Markedly decreased exudate was seen in 90% of the SPIPN dressing sides. Erythema during the first 72 hours was 1.95 for SPIPN versus 2.6 for open (scale 1-4) (P <.05). Pruritus was 1.67 versus 2.44 (P <.05) for SPIPN versus open during the first 3 days postoperatively. Approximately 75% of the patients preferred SPIPN to control petrolatum. The rate of reepithelialization was also better for the SPIPN dressing, taking only 2 days versus 2.8 days for open control. Approximately 50% of the patients reported decreased pain on the SPIPN side at days 1 and 2. CONCLUSIONS: SPIPN dressing provides an easily applied, easily tolerated dressing for use after laser resurfacing. Many patients benefit from faster healing, reduced exudate, better appearance during the postoperative period, and decreased postoperative discomfort.

Bandages↗
PubMed1998

Accelerated laser resurfacing wound healing using a triad of topical antioxidants.

BACKGROUND: The speed of wound healing and the duration of erythema are the primary complaints after laser skin resurfacing. Antioxidants have been shown to enhance the healing of wounds by reducing free radical damage. Reepithelialization is also enhanced by the moist environment produced by occlusive dressings. OBJECTIVE: This study was conducted to compare two occlusive agents: white petrolatum and "melting" petrolatum. Another arm of the study evaluated the use of melting petrolatum with and without a triad of topical antioxidants (TTA). RESULTS: Plain white petrolatum proved superior to melting petrolatum in time required for reepithelialization as well as in discomfort. Crusting and pain were decreased with white petrolatum but duration of erythema was equivalent. Wound healing was enhanced when TTA was added. Time for reepithelialization, duration of crusting and scabbing, pain, redness, and swelling were decreased when TTA was added to topical therapy. CONCLUSION: TTA compound enhances and hastens wound healing. White petrolatum as a base occlusive vehicle shortens reepithelialization compared with "melting" petrolatum.

Administration, Cutaneous↗
PubMed2004

Wound dressings in diabetic foot disease.

Wound dressings represent a part of the management of diabetic foot ulceration. Ideally, dressings should alleviate symptoms, provide wound protection, and encourage healing. No single dressing fulfills all the requirements of a diabetic patient with an infected foot ulcer. Dressings research in this area is generally poor. However, each category of dressings has particular characteristics that aid selection. Nonadhesive dressings are simple, inexpensive, and well tolerated. Foam and alginate dressings are highly absorbent and effective for heavily exuding wounds. Hydrogels facilitate autolysis and may be beneficial in managing ulcers containing necrotic tissue. Dressings containing inidine and silver may aid in managing wound infection. Occlusive dressings should be avoided for infected wounds. All dressings require frequent change for wound inspection. Heavily exudating ulcers require frequent change to reduce maceration of surrounding skin. Dressing choice should be guided by the characteristics of the ulcer, the requirements of the patient, and costs.

Bandages↗
PubMedDate not supplied

Use of triple-lumen subclavian catheters for administration of total parenteral nutrition.

This study evaluated the safety of triple vs single-lumen catheters in intravenous nutrition. Patients who were judged likely to benefit from a triple-lumen catheter were randomized to receive either a single-lumen catheter, with additional peripheral or central venous access as needed, or a triple-lumen catheter. All patients were at increased risk of catheter-related infection because of one or more of the following conditions: > 60 years of age, breakdown of skin integrity, severe underlying illness, diagnosis of acute pancreatitis, recent head or neck surgery, or presence of a preexisting infection. Patients were excluded who had neutropenia, were immunosuppressed, had body burns > 40%, or had contaminated wounds in the subclavicular area. Of 204 patients entered between June 1989 and November 1991, 177 completed the required > or = 7 days of therapy. Seventy-eight of these patients were randomized to a single-lumen catheter and 99 to a triple-lumen catheter. Catheters were inserted and maintained by the Nutrition Support Team. Dressings were monitored daily and changed weekly using a bio-occlusive dressing. When parameters were met for a possible septic episode, simultaneous peripheral and central catheter blood cultures were obtained using the Isolator method. Catheter-related sepsis was considered present if the colony count from a central catheter lumen was > or = 5 times that of the peripheral blood. The incidence of catheter-related sepsis for single-lumen catheters was 2.6% (2 of 78) compared with 13.1% for triple-lumen catheters (13 of 99) (p < .01). No correlation was found with the number of insertion attempts, catheter days, or patient's age.(ABSTRACT TRUNCATED AT 250 WORDS)

Bacterial Infections↗
PubMedDate not supplied

Perspective on the management of catheter-related infections in cancer patients.

The risk of infectious complications ranges from 9 to 80% depending on patient population and definition of catheter-related infection. In the vast majority of these patients, those infections can be treated successfully without catheter removal. The major exceptions to this guideline are patients with significant exit site or tunnel infections or with fungal isolates. Because the majority of those infections are caused by Gram-positive organisms such as S. epidermidis or S. aureus that have variable sensitivities to the antistaphylococcal penicillins, intravenous vancomycin along with gentamicin should be administered empirically until culture results are available. It appears to be unnecessary to remove the Silastic catheter automatically just because the patient is febrile, particularly if there is no microbiological evidence that the catheter is the source of the fever. Quantitative blood cultures drawn through the catheter and from a peripheral vein may lead to a better understanding of the role the catheter plays in the septic episodes in these patients but has yet to be definitive in identifying patients who absolutely require catheter removal to cure their infection. Surveillance cultures have not proved helpful in defining an "at risk" group for catheter-related infection and, due to cost and possible added risk of inducing an infectious complication, should not be routinely performed outside of an investigational setting. Instruction of patients in proper catheter care both before and after placement is of critical importance. To date there is no proved standard of catheter care and maintenance. There is a need for careful investigation in this area. We recommend that routine handling of the catheter be done with aseptic technique, which usually requires use of Betadine swabs when manipulating the catheter tip and use of a sterile dressing (e.g. E. Med IV Strip) or Op-Site (a transparent occlusive dressing) at the exit site. Continued dressings with either daily, every other day or biweekly changes may protect the catheter from gross contamination but do not protect it from catheter-associated infections. Controlled studies are needed to compare the numerous methods of postplacement catheter management and to determine the rate of infectious complications with the recently available double and triple lumen Silastic catheters and the subcutaneous implantable port-type catheters. We are presently pursuing such an investigation.

Anti-Bacterial Agents↗
PubMed1998

[Local surgical measures in chronic wounds].

The treatment of chronic wounds is initiated by resection of gangrenous tissue, drainage of abscess formations, and--if necessary--primary resection of necrotic bone and joint structures in the phalanxes. The restoration of arterial blood perfusion in the periphery is a central part of wound management. Several surgical procedures such as necrosectomy, topical application of antiseptic solutions, and hydrocolloid wound dressings serve to create well-vascularized granulative tissue. The application of vacuum occlusive dressings promotes the proliferation of fibroblasts that result in a dense granulative tissue. In the majority of cases, wound closure can be performed by suture traction or with the help of autologous skin grafts.

Abscess↗
PubMed1983

Stomahesive as a tracheostomy dressing.

Seven patients had occlusive stomahesive dressings placed on their tracheostomies. These patients were compared with four patients managed with standard tracheostomy care. Stomahesive was applied using a defined technique and all seven patients were followed until tracheostomy closure. The average duration of stomahesive care was 26 days and the dressings remained occlusive for an average of 4 days. Photographic evidence revealed that skin changes were less in patients treated with stomahesive dressings.

Humans↗
PubMedDate not supplied

Inhibition of tissue transglutaminase and epsilon (gamma-glutamyl) lysine cross-linking in human hypertrophic scar.

Immunohistochemical staining with monoclonal antibody to tissue transglutaminase was used to study cryostat sections of human skin wounds. The enzyme was found in acute wounds and chronic hypertrophic scars but not in normal mature scars. Because tissue transglutaminase is responsible for the formation of isopeptide cross-links, a two-stage high-performance liquid chromatographic analysis was used to quantitate the epsilon (gamma-glutamyl) lysine cross-link produced by various types of wound tissues. Eighteen patients with hypertrophic scars between 6 months' and 10 years' duration after injury underwent a double-blind trial with putrescine 50 mmol/L in a eutectic vehicle for 2 months under nonocclusive dressings (Biofill). For the control portion of the same or different scar, sham vehicle and non-occlusive dressing were simultaneously applied. Both scars were harvested at biopsy or elective revision surgery 2 months later. After homogenization and exhaustive proteolysis, digests were studied with the use of high-performance liquid chromatography analysis. The results of treatment were a significant decrease in the levels of isopeptide cross-link formation from 0.018 +/- .006 nmol/micromol amino acids in untreated scars to 0.008 +/- .001 nmol/micromol amino acid in the treated group (p < 0.05). The isopeptide cross-link content in treated scars was nearly as low as that in normal mature scars (0.003 +/- 0.001 nmol/micromol amino acid). These results show that cross-link formation by tissue transglutaminase activity is inhibited during treatment of hypertrophic scar by putrescine. These results support the possible therapeutic use of topical putrescine in the treatment of hypertrophic scar formation.

Journal Article↗
PubMed1976

Experimental cutaneous candidiasis in rodents.

Epicutaneous application of viable Candida albicans or Candida stellatoidea under an occlusive dressing resulted in subcorneal microabscesses in newborn rats and mice. Neither heat-killed C. albicans nor occlusion alone resulted in epidermal micropustules. These results were dependent upon the number of organisms applied and the duration of application. Four additional species of Candida tested did not produce epidermal micropustules. The microscopic pathology of the abscesses revealed penetration of the epidermis by Candida pseudohyphae; the tips of the hyphal processes were seen within the pustules when sections were stained by the periodic acid-Schiff method. The resident flora of the newborn mouse or rat was not substantially altered by occlusion with or without C. albicans during the interval tested. The animal model of cutaneous candidiasis with permit greater manipulation and control in investigations of cutaneous candidiasis and the factors influencing neutrophil accumulation in the epidermis.

Animals↗
PubMed1992

Occlusive versus semi-open dressings in the management of skin graft donor sites.

In a prospective, randomised study we compared the efficacy of a new occlusive dressing (Granuflex-E) with a semi-open dressing (tulle gras) in the management of skin-graft donor sites. The study examined 10 patients with burns, each with two donor sites. Each patient acted as his or her own control. The donor sites were mirror images of each other, the anterior surface of the thighs. One donor site was dressed with Granuflex-E and the other with tulle gras. The sites dressed with the occlusive dressing healed significantly faster and were more comfortable than the sites with the semi-open dressing.

Bandages↗
PubMed1993

Pressure ulcers in nursing home patients.

Pressure, moisture, shear forces and friction lead to skin ulcer formation. Nursing home and home-bound patients with restricted mobility, poor nutrition, incontinence and chronic conditions such as anemia, diabetes and dementia are at risk for ulcer formation. Bedridden patients should be turned from side to side at 30-degree angles at least every two hours. Mattress and chair cushions, splints and cradle boots may reduce pressure. Good hygiene and barrier ointments, condom catheters, absorptive products and scheduled toileting for incontinence may control moisture. Calorie and protein supplements, feeding assistance and serial weight measurements are essential in the management of malnourished patients. Treatment should be based on the stage of the ulcer and the presence of conditions such as necrotic debris, infection and drainage. Saline wet-to-dry dressings and enzymatic and surgical debridement are necessary to remove necrotic tissue. Saline-soaked gauze, hydrogel preparations and occlusive dressings provide the physiologic environment for fibroblasts to grow and form granulation tissue. Patients with sepsis may require hospital admission for both further evaluation and systemic antibiotic therapy.

Aged↗
PubMed2002

Photocrosslinkable chitosan as a dressing for wound occlusion and accelerator in healing process.

Application of ultraviolet light (UV-) irradiation to a photocrosslinkable chitosan (Az-CH-LA) aqueous solution resulted in an insoluble, flexible hydrogel like soft rubber within 60 s. The chitosan hydrogel could completely stop bleeding from a cut mouse tail within 30 s of UV-irradiation and could firmly adhere two pieces of sliced skins of mouse to each other. In order to evaluate its accelerating effect on wound healing, full thickness-skin incisions were made on the back of mice and subsequently an Az-CH-LA aqueous solution was added into the wound and irradiated with UV light for 90 s. Application of the chitosan hydrogel significantly induced wound contraction and accelerated wound closure and healing. Histological examinations also have demonstrated an advanced granulation tissue formation and epithelialization in the chitosan hydrogel treated wounds. The chitosan hydrogel due to its accelerating healing ability is considered to become an excellent dressing for wound occlusion and tissue adhesive in urgent hemostasis situations.

Animals↗