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At least 469 records · Page 26Linked to original sources
PubMed1985

The role of sampling in the detection of microbial contamination on cadaveric allograft skin used as a biological wound dressing.

The availability of cryopreservation and low temperature storage techniques for cadaveric allograft skin allows it to be preserved while microbial assessments are made before its use as a temporary biological dressing on burn wounds. In a 300-donor, 5-year prospective study, we tested ten skin samples from defined areas on each donor for microbiological contamination. Although the skin from 52.3 per cent of the donors possessed some detectable residual microbial contamination after surgical body preparation and skin removal, such contamination was limited to an average of 1.4 areas per body, leaving 86 per cent of all skin obtained free from detectable contamination and suitable for use as biological wound dressings. The number of skin samples tested per donor body determined the accuracy of detection of the presence of contamination. Testing one skin sample per donor body yielded a correct skin assessment 92 per cent of the time, while testing five skin samples increased the accuracy to 96 per cent, and testing ten skin samples yielded a 99.9 per cent accuracy in detection of skin contamination. Thus, it is within the ability of a skin bank to set the limits of microbiological risk to patients receiving processed cadaveric allograft skin.

Bacteria↗
PubMed1996

Advances in burn wound care.

The development of effective topical chemotherapy, the reintroduction of burn wound excision, and the use of biologic dressings have significantly decreased the incidence of invasive burn wound infection and have contributed to the improvement in the survival that has occurred over the past four decades. The currently available skin substitutes are imperfect, and research endeavors continue in the effort to develop a nonantigenic disease-free, readily available, physiologically effective tissue that will promptly effect wound closure, reduce scar formation and thereby improve cosmetic results, and reduce the need for reconstructive surgery. As monitoring and physiologic support techniques improve and additional advances in wound care occur, the morbidity and mortality of burn patients will be further reduced.

Bandages↗
PubMed1986

"Dermodress", a new temporary skin substitute: pilot study on donor sites.

"Dermodress" is a new temporary biological dressing (heterograft) composed of a pure neonatal bovine collagen I. The authors present their first trial with this skin substitute. Ten consecutive patients who required skin grafts were included in the pilot test group. The "Dermodress" was tested on their donor sites and compared with "Furacin" gauze. It was found that "Dermodress" provided a covering that adhered excellently to debrided surfaces, without disturbing the healing processes underneath, for up to three weeks after application. The results point to the potential value of the "Dermodress" for open wounds.

Adolescent↗
PubMed1979

Burn wound dressing with human amniotic membrane.

The use of amniotic membrane as a biological dressing for thermal injury is simple and cheap and has been found to be superior to allograft and xenograft. The membrane prevents heat and water loss from the wound surface and acts as a barrier against bacterial contamination, thus aiding the healing process and reducing morbidity. Another clinically significant and important property of the membrane is its ability to offer marked relief from pain. Over a period of 30 months amniotic membrane was used to treat 15 cases of burn in a small hospital, with uniformly satisfactory results. The practical aspects of this method of treatment can easily be adopted by any hospital regardless of its available facilities.

Adolescent↗
PubMed1980

Biological dressings and evaporative water loss from burn wounds.

Increased evaporative water loss following thermal injury sometimes results in electrolyte abnormalities, negative nitrogen balance, and hypothermia. Because different biological dressings have been claimed effective in diminishing evaporative loss, a prospective study was designed to compare them. Cadaver allograft, porcine xenograft (sheet and meshed), and amnion were placed on 28 granulating wounds for twenty-four hours. Water loss was then measured with an Evaporimeter, revealing that in both full-thickness and partial thickness wounds, allograft was twice as effective as sheet porcine and five times as effective as meshed porcine or amnion. In the absence of available cadaver allografts, sheet porcine xenograft is a satisfactory substitute for use on granulating wounds to diminish evaporative water loss, while amnion and meshed porcine are less effective.

Animals↗
PubMedDate not supplied

The possible use of amniotic membrane in chronic leg ulcers.

UNLABELLED: A trial of living amniotic membrane is suggested as a suitable dressing for certain indolent ulcers. The type of ulcer which is large and chronic both in rate of healing as well as time since onset is well known to everyone. After eliminating any venous defect, oedema, cellulitis, correction of stiff joints, anaemia, we are left with a local indolent problem. What is the ideal dressing? Comfortable or relieves pain; harmless to the tissues and encourages removal of slough; encourages vascularity of the granulation tissue. Method of application: Amnion is applied for five days prior to skin grafting. RESULTS: Better results in those ulcers which have a venous origin rather than arterial. In most cases a clean delicate layer of granulation tissue forms. Histopathology: biopsy of the ulcer base: before application of amnion - dense fibrous tissue, few thick-walled vessels; after application of amnion - more delicate connective tissue, numerous vessels, with thinner walls. The formation of an amnion bank: To facilitate the availability of living amnion. To investigate the possibility of an extract of amnion which would produce the same results as the membrane itself.

Bandages↗
PubMed1984

Improved treatment of the Stevens-Johnson syndrome.

The Stevens-Johnson syndrome (SJS), a disease resulting in greater than 30% body surface area epidermal and mucosal desquamation, is reported to have a mortality of greater than 50%. Recommended treatment has included steroids, prophylactic antibiotics, nutritional support, and application of topical antibacterials. Since the lesions represent only epidermal loss without dermal necrosis, rapid reepithelialization should occur if the dermis is protected from desiccation with a biological dressing. Five nonburned patients with severe SJS were treated in the University of Washington burn center, Seattle, with urgent operative debridement of their wounds and application of porcine xenograft immediately after admission. Steroid administration was stopped. Antibiotics were used only for culture-proved infections. All patients completely re-epithelialized within a mean of 18 days. There was one death, a 9-year-old boy who was completely re-epithelialized when sudden fatal sepsis that originated from a ventriculovenous shunt placed when he was an infant developed. In this group of patients, rapid wound closure with xenograft and supportive care permitted rapid reepithelialization and decreased mortality and morbidity.

Adult↗
PubMed1989

Treatment of scleroderma skin ulcers with a hydrocolloid membrane.

The purpose of this study was to determine the usefulness of hydrocolloid membrane dressings in the treatment of finger and hand ulcers of scleroderma (progressive systemic sclerosis). Ten pairs of ulcers occurring in seven patients were studied. The ulcers in each patient were treated in a paired comparison trial: one ulcer in each pair was treated with a hydrocolloid membrane; the other was a control. Treatment was continued until at least one ulcer of each pair was healed. The rate of healing of the hydrocolloid membrane-treated ulcers was significantly faster than that of the control ulcers. Pain was rapidly and dramatically reduced in all hydrocolloid membrane-treated ulcers. An infection caused by Pseudomonas aeruginosa occurred in a hydrocolloid membrane-treated ulcer but rapidly responded to topical therapy. Hydrocolloid membrane treatment of sclerodermatous hand ulcers appears to be an effective method of accelerating healing and reducing pain.

Adult↗
PubMed1987

Immunological safety evaluation of a haemostatic agent and wound dressing made of horse collagen fibrils.

A haemostatic agent and wound dressing made of horse collagen (Tachotop) was applied to guinea-pigs in such a way that the intended use of this material in humans was simulated, and cell-mediated and humoral immune responses of the animals were investigated. In addition, immune reactions were forcefully induced in guinea-pigs in order to validate the methodical approach and quantitate the observed reactions. Cell-mediated immunity was measured as delayed-type hypersensitivity skin reactions, and antibodies were detected by an enzyme-linked immunosorbent assay (ELISA). Simulation of the intended application of this haemostyptic material did not induce immune reactions in guinea-pigs even under critical conditions. The animals could only be immunized when the antigen was administered in solution or finely dispersed and together with adjuvant. Immune reactions thus induced were specific for collagen, no reaction was obtained against possible impurities such as albumin, immunoglobulin or fibronectin. It is concluded--in accordance with clinical experience--that this material is very unlikely to induce immune reactions upon clinical application to humans.

Animals↗
PubMed1988

Cultured keratinocytes as biological wound dressings.

Human epidermal keratinocytes now can be grown reliably and reproducibly in vitro to form multilayered epithelium. These sheets of cultured keratinocytes have been used successfully to autograft patients with severe burns, leg ulcers and following excision of extensive congenital naevi. Whilst the technique carries the obvious advantage of huge expansion of the initial skin biopsy, thus removing the need for painful and slow healing donor sites, problems have been encountered. The take rate has been lower than with conventional split skin grafts. The take rate can be increased by the provision of a dermis. This may be achieved by providing an allodermis or by the use of a highly meshed autologous split skin graft. The wound is then covered with autologous cultured keratinocyte grafts. Manufactured dermis has been under investigation for some years and animal work suggests this may be an alternative approach. There is a delay of 2 to 3 weeks for culture of the autologous sheets of keratinocytes. This has led to the use of allogeneic grafts in a number of patients. The long term survival of these grafts has been attributed to the loss of antigen presenting cells during tissue culture. However some grafts have been rejected. Studies currently in progress may help resolve these anomalies. Whilst a number of problems remain to be solved the technique of cultured keratinocyte grafting takes wound care into an exciting new era. Skin banks may now become more than a surgeon's dream.

Bandages↗
PubMedDate not supplied

Evaluation of Acti-Wrap: a new cohesive retention bandage.

Retention bandages are designed to keep dressings, devices and creams in place without causing discomfort to the patient. They should be lightweight, soft and comfortable and should not cause unwanted compression. Acti-Wrap retention bandage (Activa Healthcare) is a new, conforming bandage which is easy to apply and because of its cohesive nature stays in place. This product focus looks at the ways in which the bandage can be used effectively and the cost-effectiveness of using this type of bandage. The simple evaluation described in this article compares Acti-Wrap with two other frequently used retention bandages.

Evaluation Studies as Topic↗
PubMed1985

Variables determining the amount of microbial contamination on cadaveric allograft skin used as a biological wound dressing.

The increased availability and use of cadaveric allograft skin as a temporary burn wound dressing has emphasized the need for a complete understanding of the parameters affecting the contamination level of this material. We undertook a prospective evaluation of the allograft skin obtained from 300 cadaveric donors over 5 years. We evaluated the contribution to skin contamination of eight parameters: sex, age, race, cause of death, elapsed time postmortem before skin removal, total refrigerated storage time of the skin prior to cryopreservation, donor body area from which the skin was removed, and choice of surgical operators or teams. The only parameters significantly related to skin contamination level were the choice of surgical operator or team which prepared the body and removed the skin (P = 0.0001) and the acceptance of skin from donors when the cause of death was unknown but presumed to be from natural causes (PNC) such as myocardial infarction or cerebral vascular accident (P = 0.006). In the case of the PNC deaths, there was only a small 3.4 per cent increase in bacterial contamination and no increase in fungi or yeast, while some surgical operators were associated with five-fold more bacterial contamination and nearly 13-fold more fungal contamination than other surgical operators. We conclude that the performance of surgical operators appears to be the major determinant of the microbiological cleanliness of skin from cadaveric allograft donors.

Age Factors↗
PubMed1990

Collagen shield heparin delivery for prevention of postoperative fibrin.

We studied collagen shield heparin delivery to the rabbit eye utilizing radiolabeled heparin as well as a fibrin inhibition assay. Radiolabeled heparin studies revealed significant tritium delivery to the cornea, aqueous, and iris, with only trace levels detectable for the lens, vitreous, and sclera. An aqueous fibrin inhibition assay revealed that a single collagen shield soaked in heparin achieved anterior chamber anticoagulant levels that paralleled the time course of the radiolabeled heparin delivery and resulted in fibrin inhibition during the 6-hour study period. Subconjunctival heparin injection did not alter baseline aqueous anticoagulant activity. No complications related to collagen shield heparin delivery were encountered. These studies suggest that a heparin-hydrated collagen shield may prevent postoperative fibrin formation in eyes at risk for this complication, including eyes undergoing surgery for the complications of proliferative diabetic retinopathy proliferative vitreoretinopathy, and glaucoma filtration surgery.

Animals↗
PubMed1987

New technique for pancreaticojejunostomy using a biological adhesive.

A new technique of pancreaticojejunostomy using a fibrin glue biological adhesive system (BAS) after pancreaticoduodenectomy is reported. Pancreaticojejunostomy was performed on 112 patients between 1971 and 1985. Forty-two of the patients received BAS application (Group I), but the remaining seventy did not (Group II). To evaluate more precisely the effectiveness of BAS, 22 patients in Group I (Group I-ST) and 26 patients in Group II (Group II-ST) who were operated upon by the same surgeon during the same period were reviewed retrospectively. The selection of patients for the use of BAS was randomized. In Group I-ST, one patient had a minor leak; no major leaks or operative deaths occurred. Two of the twenty-six patients in Group II-ST had minor leaks and one patient had a major leak causing death. This new technique for pancreaticojejunostomy using a biological adhesive system may be useful for preventing anastomotic leaks, especially in a patient with a normal pancreas.

Bandages↗