Foam dressing and micropower vacuum dressing promote diabetic foot ulcer wound healing by activating the PI3K/AKT/mTOR pathway in rats.

Foam dressing (FD) and micropower vacuum dressing (MVD) have been applied in the treatment of diabetic foot ulcer (DFU). However, research about the mode of action on the efficacy of the two dressings is extremely rare. This study proposed to explore the mechanism involved in diabetic wound healing under FD or MVD treatment. Macroscopical study was performed to evaluate the effectiveness of FD and MVD on wound healing in a rat model of DFU. Morphological analysis in the wound skin tissue was conducted by hematoxylin and eosin staining. Meanwhile, inflammatory cytokines in serum were measured by enzyme linked immunosorbent assay. The protein expression of phosphatidylinositol 3 kinase, protein kinase B and mammalian target of rapamycin (PI3K/AKT/mTOR) and their phosphorylation levels were determined by western blotting. We found that wound healing in rats with DFU was enhanced with the application of FD and MVD. The therapeutic efficacy of FD was superior to MVD. Compared with diabetic foot group, the concentrations of inflammatory cytokines, tumor necrosis factor alpha, interleukin-1ß and interleukin-6, were significantly down-regulated. Besides, the phosphorylation levels of PI3K, AKT and mTOR were up-regulated under FD or MVD treatment. We demonstrated that the treatment of FD and MVD effectively promoted the wound skin healing through activating the PI3K/AKT/mTOR pathway. Our research may provide a new idea for exploring the mode of action of dressing application in healing of DFU.

Antiadhesive Hyaluronic Acid-Based Wound Dressings Promote Wound Healing by Preventing Re-Injury: An In Vivo Investigation.

Wound dressings are widely used to protect wounds and promote healing. The water absorption and antifriction properties of dressings are important for regulating the moisture balance and reducing secondary damages during dressing changes. Herein, we developed a hyaluronic acid (HA)-based foam dressing prepared via the lyophilization of photocrosslinked HA hydrogels with high water absorption and antiadhesion properties. To fabricate the HA-based foam dressing (HA foam), the hydroxyl groups of the HA were modified with methacrylate groups, enabling rapid photocuring. The resulting photocured HA solution was freeze-dried to form a porous structure, enhancing its exudate absorption capacity. Compared with conventional biopolymer-based foam dressings, this HA foam exhibited superior water absorption and antifriction properties. To assess the wound-healing potential of HA foam, animal experiments involving SD rats were conducted. Full-thickness defects measuring 2 × 2 cm2 were created on the skin of 36 rats, divided into four groups with 9 individuals each. The groups were treated with gauze, HA foam, CollaDerm®, and CollaHeal® Plus, respectively. The rats were closely monitored for a period of 24 days. In vivo testing demonstrated that the HA foam facilitated wound healing without causing inflammatory reactions and minimized secondary damages during dressing changes. This research presents a promising biocompatible foam wound dressing based on modified HA, which offers enhanced wound-healing capabilities and improved patient comfort and addresses the challenges associated with conventional dressings.

Effect of prophylactic dressings to reduce pressure injuries: a polymer-based skin model.

OBJECTIVE: This study evaluated the effect of pressure injury (PI) prophylactic dressings used for patients at high risk of PI development to reduce friction, shear force and pressure, and their combined force, in an original polymer-based skin model. METHOD: A low-friction outer-layer hydrocolloid (LFH) dressing and a multilayered silicone foam (MSF) dressing were used. Before application, compression and friction properties were measured. Our original experimental model-the 'simulated skin-shearing test'-consisted of: a weight; a polyurethane-based skin model containing a three-axis tactile sensor; dressings; a table covered with bedsheets; and a mechanical tester, by which the interface friction force, internal shear force and pressure were measured continuously during skin model movements. An estimated combined force generated by internal shear and pressure was represented as a vector. A model with no dressing was used as a control. RESULTS: The LFH dressing had significantly higher compression strength versus the MSF dressing. In contrast, the dynamic coefficient of friction was lower for the LFH dressing versus the MSF dressing (p<0.05). In simulated skin-shearing test results, shear forces were 0.45N and 0.42N for LFH and MSF dressings, respectively, with no significant difference. The estimated combined force was lower for the MSF dressing compared with that of the LFH dressing and control. CONCLUSION: The shear force-reducing effect in the skin model was equivalent between the LFH and MSF dressings. However, the MSF dressing significantly reduced the force generated by a combination of internal shear force and pressure compared with the LFH dressing.

In vitro prevention and inactivation of biofilms using controlled-release iodine foam dressings for wound healing.

Microbial biofilms are a major hindrance in the wound healing process, prolonging the inflammatory response phase, thus making them a target in treatment. The aim of this study is to assess the antibacterial properties of commercially available wound dressings, of various material composition and antibacterial agents, towards multiple in vitro microbial and biofilm models. A variety of in vitro microbial and biofilm models were utilised to evaluate the ability of wound dressing materials to sequester microbes, prevent dissemination and manage bioburden. Sequestering and dissemination models were used to evaluate the ability of wound dressing materials to prevent the biofilm-forming bacterium, Pseudomonas aeruginosa, from migrating through dressing materials over a 24-72 h challenge period. Additionally, Centre for Disease Control (CDC) Bioreactor and Drip Flow models were used to evaluate antibacterial killing efficacy towards established P. aeruginosa and Staphylococcus aureus biofilms using more challenging, wound-like models. Controlled-release iodine foam and silver-impregnated carboxymethylcellulose (CMC) wound dressing materials demonstrated potent biofilm management properties in comparison to a methylene blue and gentian violet-containing foam dressing. Both the iodine-containing foam and silver-impregnated CMC materials effectively prevented viable P. aeruginosa dissemination for up to 72 h. In addition, the controlled-release iodine foam and silver-impregnated CMC materials reduced P. aeruginosa bioburden in the Drip Flow model. The controlled-release iodine foam demonstrated superiority in the CDC Bioreactor model, as both the silver- and iodine-containing materials reduced S. aureus to the limit of detection, but P. aeruginosa growth was only completely reduced by controlled-release iodine foam dressing materials. The data generated within the in vitro biofilm models supports the clinical data available in the public domain for the implementation of iodine foam dressings for effective biofilm management and control in wound care.

Effect evaluation of new dressing URGOTULRANGE in the treatment of pressure injury.

BACKGROUND: Pressure injury (PI) is a local injury of the skin and/or soft tissue located at the bone caused by medical or other equipment and is common in long-term bedridden patients. OBJECTIVE: To investigate the clinical effect of Urgotul foam dressing in the treatment of stage 3 ∼ 4 PI and deep tissue PI. METHODS: A total of 38 patients with stage 3 ∼ 4 PI and deep tissue PI admitted to Jinan Central Hospital from January 2016 to December 2018 were selected and randomly divided into a control group (dressing change plus silver ion cream dressing) and an observation group (dressing change plus Urgotul Absorb non-border foam dressing), with 19 cases in each group. After 4 weeks of treatment, the pain intensity during dressing change and the treatment efficacy for PI wounds were compared between the two groups. RESULTS: There were no differences in gender (P= 0.740), age (P= 0.130), single wound area (P= 0.673), consultation department (P= 0.972), stage (P= 0.740), presence of undermining (P= 0.721), deep tissue PI (P= 0.721), and systemic antibiotic therapy (P= 1.000) between the two groups, which were comparable. The treatment effect of the observation group was better than that of the control group (P= 0.003), and the pain score of the observation group was lower than that of the control group (P< 0.001). CONCLUSION: Urgotul Absorb non-border foam dressing has a good effect in the treatment of stage 3 ∼ 4 PI and deep tissue PI and can relieve patients' pain, and is thus worth promoting.

The incidence of intraoperatively acquired pressure injuries in the park-bench position was reduced by applying soft silicone multilayer foam dressings.

The Park-Bench Position (PBP) is associated with a high incidence rate of intraoperatively acquired pressure injuries (IAPIs). Preventive measures must be established to prevent the development of IAPIs. We investigated the risk factors for PBP by applying a soft silicone multilayered foam dressing (SMD) under core temperature management to prevent IAPIs. We conducted a prospective, single-centre, open-label observational study of patients undergoing elective neurosurgery operations using PBP in a university hospital in Japan. The incidence rate of IAPIs in this study was compared with that in our two previous studies, in which a film dressing was applied and core temperature management was not performed. IAPIs developed in 90 patients (6.7%); in the lateral thoracic region in five patients and the iliac crest region in one patient. The operative time (every 1 h: p = 0.0001, OR: odds ratio 3.62, 95% CI: confidence interval 1.73-11.42) was significantly associated with the incidence of IAPIs. In our two previous studies, the incidence rate of IAPIs was 11.0% and 24.1%, respectively, when film dressing was used. SMD may weaken the involvement of risk factors in IAPIs.

Evaluation of an Evidence-Based Care Bundle for Preventing Hospital-Acquired Pressure Injuries in High-Risk Surgical Patients.

The aim of this study was to evaluate the effectiveness of an evidence-based care bundle to prevent perioperative pressure injuries. In a single facility, using a preintervention and postintervention quasi-experimental design, we compared the pressure injury incidence rate for two patient groups (ie, before and after care bundle implementation). The bundle included a variety of elements, such as educating patients, applying protection, controlling skin moisture, and using pressure-relieving devices according to the patient's risk. Before the intervention, patients received standard care before procedures that did not address risk for pressure injury development. The study involved a total of 944 patients, and the incidence of pressure injury was lower in the postintervention group than in the preintervention group (1.6% versus 4.8%; P < .001). However, the odds ratio was nonsignificant and therefore the clinical relevance of the bundle is unclear. Additional research with a control group and multiple sites is needed.

Outcomes of Two Different Negative Pressure Therapy Systems for Closed Incision Management in Knee and Hip Arthroplasty: A Systematic Review and Meta-Analysis.

Closed incision negative pressure therapy (ciNPT) has been adopted into practices of diverse surgical specialties to help reduce postsurgical complication risks. There are two primary commercially available systems that deliver ciNPT through different mechanisms. The purpose of this meta-analysis is to compare the potential effects of two different ciNPT systems on clinical outcomes following hip and knee arthroplasty. A systematic literature search was conducted to identify hip and knee arthroplasty studies comparing the incidence of surgical site infections (SSIs) and surgical site complications (SSCs) versus standard of care (SOC) following the use of two different ciNPT systems. Four meta-analyses were performed by calculating risk ratios (RR) to assess the effect of (1) ciNPT with foam dressing (ciNPT-F) versus SOC and (2) ciNPT with multilayer absorbent dressing (ciNPT-MLA) versus SOC. Comprehensive Meta-Analysis Version 3.0 (Biostat Inc., Englewood, NJ) software was used to perform the analyses. Twelve studies comparing ciNPT-F to SOC and six studies comparing ciNPT-MLAto SOC were analyzed. SSI rates were reported in seven of 12 studies involving ciNPT-F. In those, ciNPT-F significantly reduced the incidence of SSI (RR = .401, 95% confidence interval (CI) = .190, .844; p = .016). Across four of six studies that reported SSI rates, there was no significant difference in SSI rates between ciNPT-MLAvs SOC (RR = .580, 95% CI = .222, 1.513; p = .265). SSC rates were evaluated in eight of 12 ciNPT-F studies that reported SSC rates. This meta-analysis of the eight ciNPT-F studies showed significantly reduced SSC rates with ciNPT-F vs SOC (RR = .332, 95% CI = .236, .467; p < 0.001). For ciNPT-MLA, five of six studies reported SSC rates. In those, there was no significant difference in SSC rates between ciNPT-MLA vs SOC (RR = .798, 95% CI = .458, 1.398; p = .425). These meta-analyses results showed a significant reduction in SSI and SSC rates in the ciNPT-F group vs SOC and no difference in SSI and SSC rates in the ciNPT-MLA group vs SOC. The reasons for these observed differences were not evaluated as part of this study. Future controlled clinical studies comparing outcomes between different ciNPT systems over closed orthopedic incisions would help to validate these study results.

Physical Properties and pH Environment of Foam Dressing Containing Eclipta prostrata Leaf Extract and Gelatin.

Eclipta prostrata (E. prostrata) has several biological activities, including antibacterial and anti-inflammatory activities, that improve wound healing. It is well known that physical properties and pH environment are crucial considerations when developing wound dressings containing medicinal plant extracts in order to create an appropriate environment for wound healing. In this study, we prepared a foam dressing containing E. prostrata leaf extract and gelatin. Chemical composition was verified using Fourier-transform infrared spectroscopy (FTIR) and pore structure was obtained using scanning electron microscopy (SEM). The physical properties of the dressing, including absorption and dehydration properties, were also evaluated. The chemical properties were measured to determine the pH environment after the dressing was suspended in water. The results revealed that the E. prostrata dressings had a pore structure with an appropriate pore size (313.25 ± 76.51 µm and 383.26 ± 64.45 µm for the E. prostrata A and E. prostrata B dressings, respectively). The E. prostrata B dressings showed a higher percentage of weight increase in the first hour and a faster dehydration rate in the first 4 h. Furthermore, the E. prostrata dressings had a slightly acidic environment (5.28 ± 0.02 and 5.38 ± 0.02 for the E. prostrata A and E. prostrata B dressings at 48 h, respectively).

Predictive application of foam dressing on preventing of auricle pressure injury caused by ear dressing.

Objective: The use of foam dressings has been regarded as part of the individualized care plan in clinical practice. Our study aimed to compare the predictive application of foam dressing and conventional nursing method in the prevention of auricle pressure injury (PI) caused by ear dressing. Methods: Two hundred and four patients undergoing ear dressing after the operation in the Affiliated Hospital of Southwest Medical University in Sichuan, China from January 2021 to September 2021 were recruited as research objects. Patients were randomized into intervention group (n = 102) and control group (n = 102) using double-blind method. Result: Results showed that patients in the intervention group showed significantly lower incidence of auricle PI and higher comfort and satisfaction levels than those in the control group (P < 0.05). Conclusion: Our study reflected effective predictive application of foam dressing in reducing the incidence of auricle PI in ear dressing, which was suitable for clinical application.

Comparative study of various dressing techniques in diabetic foot ulcers in the Indian population: a single-center experience.

Introduction: A prospective randomized study was conducted to evaluate and compare the efficacy of conventional dressing, foam dressing, and vacuum-assisted closure (VAC) in the management of diabetic foot ulcers (DFUs). Material and methods: Ninety patients with DFU were included in the study conducted between 2018 and 2021 at a tertiary care center. Group 1 patients (n = 30) were treated with conventional dressing, group 2 patients (n = 30) with foam dressing, and group 3 patients (n = 30) with VAC dressing. The duration of treatment, number of debridement, need for the secondary procedure, cost of treatment, and duration of hospital stay were compared between the three groups. Results: There was a significant difference in the duration of treatment among the three groups with VAC being the least (group 1, 31.17 days; group 2, 24.13 days; group 3, 15.17 days). The mean number of debridement was also significantly less in the VAC group (2.37, 2.43, and 1.60, respectively). The need for the secondary procedure, like flap or skin graft, was also the least in the VAC group, although insignificant. The mean hospital stay of the study subjects was 31.17 days, 24.13 days, and 15.17 days in the 3 groups, respectively. The mean cost of the treatment was 3076.67 INR, 3717.33 INR, and 10,680 INR, respectively. Conclusion: VAC dressing is the best option amongst the available dressing modalities in terms of faster healing and a short hospital stay. Foam dressing does provide an economically viable option with better results than conventional dressing.

Mechanical and contact characteristics of foam materials within wound dressings: Theoretical and practical considerations in treatment.

In the treatment of acute and chronic wounds, the clinical performance of a given foam-based dressing, and, ultimately, the wound healing and cost of care outcomes are strongly influenced by the mechanical performance of the foam material/s within that dressing. Most aspects of the mechanical performance of foam materials, for example, their stiffness, frictional properties, conformability, swelling characteristics and durability, and the overall mechanical protection provided by a foam-based dressing to a wound strongly depend on the microstructure of the foam components, particularly on their microtopography, density and porosity. This article, therefore, provides, for the first time, a comprehensive, self-inclusive compilation of clinically relevant theoretical and practical considerations, based on published analytical and experimental research as well as clinical experience related to the mechanical performance of foams in foam-based wound dressings. The current bioengineering information is useful for establishing understanding of the importance of mechanical properties of foams in foam-based dressings among clinicians and researchers in industry and academia, and other potential stakeholders in the wound care field, for example, regulators and buyers. This information is also particularly important for the development of standardised test methods for the evaluation of foam-based wound dressings and resulting standard mechanical performance metrics for these dressings.

Feasibility of nasal bridge pressure injury prevention using a protective dressing and the Halyard Fluidshield® N95 mask in a COVID-positive environment.

The purpose of this study was to prevent nasal bridge pressure injury among fit-tested employees, secondary to long-term wear of the N95 mask during working hours. A prospective, single-blinded, experimental cohort design. Participants were enrolled using the convenience sampling methods and randomisation was utilised for group assignment. Eligibility was determined by a COVID Anxiety Scale score and non-COVID clinical assignment. Participants with a history of previous skin injury or related condition were excluded. The experimental group was assigned Mepilex Lite® and the control group used Band- Aid®. Formal skin evaluations were done by Nurse Specialists who are certified in wound and ostomy care by the Wound, Ostomy, Continence, Nursing Certification Board (WOCNCB®). Fit test logs were provided to participants to measure subjective user feedback regarding mask fit and level of comfort. The results of this feasibility trial are promising in supporting the use of a thin polyurethane foam dressing as a safe and effective dressing to apply beneath the N95 mask. Additional research is needed to validate results due to limited data on efficacy and safety of the various barrier dressings as a potential intervention to prevent skin breakdown to the nasal bridge.

Secondary Intention Healing of Nasal Ala and Tip Defects: A Simple and Valuable Treatment Option.

Purpose: To investigate the cosmetic outcomes of secondary intention healing of small (<1.5cm) nasal ala and tip defects. Patients and Methods: From August 2017 to October 2020, 42 patients with nasal reconstructions using secondary intention healing were included. Defects after excision ranged from 0.5cm×0.7cm to 1.2cm×1.5cm in size. Foam dressing covering the wounds was changed every 3 to 5 days. Wound esthetic outcomes were graded as excellent, good, acceptable, and poor based on definitions described in the literature. Results: All 42 wounds healed in 3 to 4 weeks, with uniform color, no obvious adverse reactions and high patient satisfaction. Esthetic evaluation: 16 excellent cases (38.1%), 19 good cases (45.2%), 7 acceptable cases (16.7%) and 0 poor cases. Conclusion: Secondary intention healing of small nasal tip and ala defects in Chinese yielded satisfactory esthetic outcomes and should be an integral part of the surgeon's reconstructive algorithm.

Controlled-release iodine foam dressings demonstrate broad-spectrum biofilm management in several in vitro models.

Multiple in vitro models were utilised to evaluate the biofilm management capabilities of seven commercially-available wound dressings, varying in composition and antibacterial ingredients, to reduce common aerobic, anaerobic, and multispecies biofilms. The Center for Disease Control bioreactor was used to evaluate single species Pseudomonas aeruginosa (P. aeruginosa) and Staphylococcus aureus (S. aureus) 24 and 48 hours biofilms, as well as a multispecies biofilm consisting of these two organisms in addition to Enterococcus faecalis (E. faecalis). As wound biofilms often exist in hypoxic wound environments, a direct contact anaerobic model system was used to evaluate efficacy on Bacteroides fragilis (B. fragilis). Biofilm control was evaluated against P. aeruginosa in the drip flow bioreactor model, where a constant flow of proteinaceous media is used to create a more challenging and wound-like model. The results demonstrated that biofilm management capabilities varied amongst wound dressings. Two dressings, a controlled-release iodine foam dressing and a silver nanocrystalline dressing, showed potent >4 log reductions in recovered organisms compared with untreated controls in all biofilm models evaluated. The effectiveness of other dressings to manage bioburden varied between dressing, test organism, and model system. A silver foam dressing showed moderate biofilm control in some models. However, biofilm exposure to methylene blue and gentian violet-containing foam dressings showed negligible log reductions in all in vitro biofilm methods examined. The data outlined in this in vitro study support the use of the iodine foam dressing for wounds with infection and biofilm.

Superabsorbent charcoal dressing versus silver foam dressing in wound area reduction: a randomised controlled trial.

AIM: This study aimed to compare the effect of a novel sterile polyacrylate wound pad with activated carbon cloth treatment with a standard non-adhesive hydrocellular foam dressing with silver in reducing wound area. METHOD: A multicentre randomised controlled open-label wound-dressing trial was conducted in two wound care outpatient clinics in western Switzerland from November 2018 to March 2020. RESULTS: A total of 77 successive patients were randomised to receive either a sterile polyacrylate wound pad with activated carbon cloth treatment (n=38) or the standard non-adhesive hydrocellular foam dressing with silver (n=39). Reduction in wound area was the primary outcome, whereas the application period of the dressing, odour, maceration and pain were the secondary outcomes. Wound area was measured at baseline and during each wound dressing change until the dressings were no longer indicated. Wound area reduced faster in the intervention group than in the control group (0.45cm2 per day vs. 0.2cm2 per day), although the application period was longer in the intervention group compared with the control group (9.5 days vs. 8.1 days). Maceration reduction was more pronounced in the intervention group (-2.07cm2) than in the control group (-0.71cm2). Odour, pain and infection were similar in both groups. CONCLUSION: Sterile polyacrylate wound pad dressings with activated carbon cloth reduced the wound area, as well as the maceration area, faster than the non-adhesive hydrocellular foam dressing with silver.

Polyurethane foam dressings ameliorating local adverse effects of azacitidine: a randomized controlled trial.

This study investigated the use of polyurethane foam dressings to prevent local adverse reactions of subcutaneous azacitidine injection. Patients receiving a subcutaneous azacitidine injection were randomly divided into experimental and control groups. A total of 55 patients were included in each group. A polyurethane foam dressing was used to cover the injection site of patients in the experimental group. Conventional treatment was used in the control group. Injection site pain and local skin reactions were assessed after the intervention in both groups. The score and duration of pain, the incidence and duration of local skin adverse reactions, and the incidence of severe reactions in the experimental group were significantly lower than in the control group (p < 0.05). Polyurethane foam dressing can effectively reduce local adverse reactions of subcutaneous injection of azacitidine, relieve pain, shorten the duration of local pain and adverse reactions, and improve the quality of nursing.

A soft silicone foam dressing that aids healing and comfort in oncology care.

Maintaining skin integrity plays a key role in the ongoing care and comfort of patients at the end of life. Unfortunately, patients receiving cancer treatments are at higher risk of altered skin integrity. Cancer treatments involve multiple modalities, all of which impair wound healing. Excess exudate can be distressing to patients, resulting in catastrophic damage to the wound bed and surrounding skin, reducing quality of life and increasing the need for specialist services. This article describes the use of the Kliniderm foam silicone range of dressings, in combination with best practice, in the treatment of wounds in the oncology setting. The case study evidence presented indicates that this range of dressings is useful in the management of radiotherapy and oncology wounds. It had a positive effect on the exudate level, wound-association pain and the peri-wound skin in these patients, aiding the management of the wound bed.

Polyurethane foam for skin graft fixation in clinical-relevant ovine burn wound model for wound repair and regeneration research.

The availability of clinical-relevant large animal models for research in wound healing study is limited. Although a few reports described the wound dressing fixation method using polyurethane foam in patients, no animal studies were conducted to investigate efficacy of the polyurethane foam in grafted burn wounds. In the present study, we report a simple fixation method of grafted burned skin using polyurethane foam dressing (Allevyn Non-Adhesive, smith & nephew, UK) in a clinically relevant ovine grafted burn wound model. The dressing was removed at postoperative day 7 after skin graft. The grafted skin was completely engrafted without any complications. This method was safe and easy to perform and associated with good engraftment without any complications. We believe that the polyurethane foam fixation method may be successfully used in clinical practice as well as in preclinical studies for grafted burn wound repair and regeneration research.