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A study was undertaken of the effects of heterografts (lyophilized porcine skin or bovine dermis) on the healing of split-skin graft donor sites. When compared with a petrolatum gauze dressing, no advantages were found. Some disadvantages developed, however, which led us to discontinue their use.
BACKGROUND: Microporous polysaccharide hemospheres consist of controlled-porosity spherical particles manufactured from bioinert plant polysaccharide. Microporous polysaccharide hemospheres facilitate hemostasis by rapidly absorbing the fluid component of blood, concentrating platelets and clotting factors to accelerate blood clotting. OBJECTIVE: The objective was to compare a microporous polysaccharide hemosphere bandage and electrocautery in achieving hemostasis. METHODS: Twenty-four patients with a total of 48 stages of Mohs micrographic surgery were included. Patients were stratified by whether or not they were taking anticoagulant medications. Within each group, patients were randomized to receive either the microporous polysaccharide hemosphere bandage or electrocautery. Outcomes included bleeding through the dressing (early time point) and active bleeding upon dressing removal (late time point). RESULTS: Nineteen patients not taking anticoagulants had 40 stages, of which 18 received the study bandage and 22 received electrocautery. The remaining 5 patients on anticoagulants had 8 stages, of which 4 received the study bandage and 4 received electrocautery. In both total and subgroup analysis, there was a higher incidence of bleeding through the dressing with the study bandage (p<0.05), but no increase in the incidence of active bleeding upon dressing removal (p>0.05). CONCLUSION: The microporous polysaccharide hemosphere study bandage had an increased incidence of bleeding through the dressing compared to electrocautery, but did not have an increased incidence of active bleeding upon dressing removal.
BACKGROUND AND DESIGN: In uncontrolled studies, cultured keratinocytes derived from donor tissue (allografts) appear to accelerate healing in a variety of acute and chronic skin wounds ranging from burns to leg ulcers. A randomized clinical trial was undertaken to compare the healing time of split-thickness skin graft donor sites in elderly patients using cultured epidermal allografts vs nonadherent dressings. Fresh-cultured epidermal grafts were used in 10 split-thickness skin graft donor sites in nine patients ranging in age from 63 to 87 years. In each patient, half the donor site was allografted and the other half treated with nonadherent dressings. To provide information about allograft survival, biopsy specimens were taken from allografted areas in three patients 2 months after the grafting procedure, for multilocus DNA analysis. RESULTS: The mean time to complete healing was 8.4 days in allografted sites compared with 15.3 days in control sites. There was no evidence of survival of cultured allogeneic cells in allografted areas. CONCLUSION: Cultured allografts can accelerate healing in split-thickness skin graft donor sites in elderly patients compared with nonadherent dressings. Cultured allografts do not survive permanently on the wound bed.
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Single administration of collagen wound dressing (CAS) made from bovine derm in the form of finely ground powders was given to mice and rats via i.p., s.c. and p.o. routes and via i.v. route in the form of physiological saline extracts and it was continuously injected into mice for 28 days via s.c. route to study its acute and subacute toxicity. Examinations were made of on general conditions, body weight, food and water consumption, hematology, serum biochemistry, organ weight, and gross and microscopic findings. Results showed no marked toxicity except for local irritation which was seen only after parenteral administration. We concluded on the basis of these animal experiments that there should be no problem in regard to safety after somewhat more extensive therapeutic application of CAS as a wound dressing in clinical practice.
The permeation properties of dressings to gases are important to the healing processes. It is necessary that dressings are permeable to water vapour, oxygen and carbon dioxide. A series of commercially available dressings have been assessed in vitro in respect of their permeability characteristics to these gases.
The high treatment costs of inappropriate leg ulcer management are well referenced. Wide variations in practice have also been reported. A training programme for community nurses has been in place in Leicestershire and Rutland NHS Trust for five years. Its objective is to promote evidence-based leg ulcer management. The aim of this prospective audit was to assess and compare the effectiveness of the compression bandage systems used in the trust: the original Charing Cross system (August 1996 to September 1997) and Robinson's Ultra Four kit (October 1997 to December 1998). All patients with leg ulceration were assessed using the Leicestershire leg ulcer assessment form. This was submitted along with an audit tool to the tissue viability service in exchange for a 12-week supply of compression bandages. The audit form was resubmitted after each subsequent 12-week period until the patient either had healed or was withdrawn from the audit. Differences between the two groups in mobility, previous deep vein thrombosis, fixed ankle deformity, the male to female ratio, duration of ulcer and ulcer surface area were noted. Patients using the Ultra Four kit had faster healing times than those given the Charing Cross system, but this was not statistically significant. Cost comparisons between the previous dressing regimen and compression bandaging showed a significance difference (p < 0.001). There was also a significant reduction in nurse time (p < 0.001). The audit results showed that compression bandaging therapy was an effective method of achieving healing in patients with venous leg ulcers and that significant cost savings were made in terms of dressing cost and nurse time. Furthermore, there were potential benefits in continuing compression therapy for the group of non-healers.
A prospective, randomized trial of 32 patients with partial skin thickness burns is reported comparing E-Z Derm with Jelonet as a burn dressing. The bacterial colonization rate, need for surgical treatment, time for spontaneous healing, analgesic requirements and frequency of dressing changes were assessed in each group. No statistically significant differences were found between the two groups, for any of these factors.
Hypertrophic scars represent an abnormal, exaggerated healing response after skin injury. In addition to cosmetic concern, scars may cause pain, pruritus, contractures, and other functional impairments. Therapeutic modalities include topical medications, intralesional corticosteroids, laser therapy, and cryosurgery. Topical therapies, in particular, have become increasingly popular because of their ease of use, comfort, noninvasiveness, and relatively low cost. This review will discuss the properties and effectiveness of these agents, including pressure therapy, silicone gel sheeting and ointment, polyurethane dressing, onion extract, imiquimod 5% cream, and vitamins A and E in the prevention and treatment of hypertrophic scars.
The aim of the study was to determine the fate of cultured skin allografts in patients with burns. In situ DNA hybridisation with a Y probe (pHY 2.1) was used to detect cells carrying the Y chromosome (the probe being visualised by the alkaline phosphatase-antialkaline phosphatase method) in biopsy specimens taken from cultured allografts derived from donors of the opposite sex to the recipients (20 patients with burns). Specimens were taken within a week, between one and three weeks, between four and six weeks, and more than six weeks after grafting. Only two of the 27 biopsy specimens contained cells that were the same sex as the donor; both were taken within a week after grafting. In the 25 other specimens the epithelial cells were the same sex as the recipient. Cultured skin allografts showed no evidence of survival in patients with burns, which suggests that they are probably not suitable for long term management of burns but may be useful as short term biological dressings.
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Twenty-eight patients with partial thickness skin loss of the limbs, mainly due to burns, were treated on an out-patient basis in an occupational health centre. Thirteen patients were treated with porcine skin graft and the other 15 by the conventional method with paraffin gauze. The results showed that the median healing time was 13 days in the porcine skin graft group and 28 days in the control group. Other than healing time, the effects of porcine xenograft in reducing pain, infection and sickenss absence were far greater than those with conventional treatment. From a comparison of total dressing costs, it was estimated that for lesions of comparable size the cost of treatment with porcine xenograft was approximately one-third of that using paraffin gauze.
Man has dressed wounds since life began many millions of years ago. Since this time many materials have been devised for the intention of dressing wounds. This review indicates the vast range presently available, providing a starting point for those seeking information on this subject.
The observation and estimation of results of treatment of 145 patients with burns have shown high efficiency of a biological dressing of porcine skin treated with chemical anticeptics (formaldehyde).
Ten children aged seven months to eleven years with superficial burns involving (mean) 24% of total body surface were treated with amniotic membrane dressing in a general ward. The result of treatment was compared with that obtained during an earlier (12 months) period using non biological antimicrobial dressing on the same ward. One patient treated with amnion developed pseudomonas wound infection and another required skin grafting. These children spent an average of 31 days in hospital, as compared with 56 days for the control group. It is concluded that amniotic membrane dressing is to be preferred in the treatment of burns in hospitals in poorer countries, because of it's ready availability, ease of preparation and cheapness of storage.
Human amniotic membrane is a readily available biological dressing material used to treat burns. It not only prevents oozing of plasma from burn wounds but also relieves pain and controls sepsis. We used human amniotic membrane to treat fifteen burn patients, and this material was effective. The application of this cost-free dressing material warrants further study as it can be made use of in areas where expensive and specialized equipment is not available.
The preparation of human amniotic membrane obtained from cesarean delivery placentas for use in the treatment of acutely burned pediatric patients is presented. The technique of membrane harvesting and cleansing, bacteriological monitoring during various phases of preparation, and a method of ultracold long-term banking are described. A total of 187 membranes were stripped under aseptic conditions, cultured, treated in 0.025% sodium hypochlorite (NaOCl) for one minute and recultured. Fourteen organisms were recovered prior to NaOC1 treatment, and only 8 organisms after treatment. Amnions that grew any organism after hypochlorite treatment (23%) were deemed unsuitable for clinical use. Clinical experience with amniotic membranes in 36 acutely burned patients suggests that amnion is a cost-effective biological dressing, acceptable as an immediate dressing on superficial second-degree burns. It is also acceptable as an adjunct to meshed autograft over fascia, and as a temporary covering on recently excised wounds prior to autografting.