Effectiveness of Semiocclusive Sodium Carboxymethyl Cellulose Fibers and Hydrocolloid Dressings for Irritant Peristomal Dermatitis: A Case Series.

ABSTRACT: The most common complication in individuals with ostomies is irritant contact dermatitis from the acidic stoma effluent coming into contact with the peristomal skin. Although protective powders are widely used for the treatment of peristomal skin, there is little scientific evidence to justify their use. The combined use of sodium carboxymethylcellulose cellulose fibers (SCCFs) together with a hydrocolloid dressing for fixation is an effective alternative in the management of these wounds. Here, the authors report a case series of three patients presenting at a stoma therapy clinic with peristomal skin lesions because of severe irritant contact dermatitis. Patients were men aged between 70 and 81 years, had been diagnosed with colon cancer (n = 2) or bladder cancer (n = 1), and had undergone a colostomy (n = 1), ileostomy (n = 1), or Bricker-type ureteroileostomy (n = 1). A semiocclusive care protocol was applied in a moist environment using SCCF and an extrathin hydrocolloid adhesive dressing, and the collection device was secured using adhesive resin and an ostomy belt. The combined use of SCCF and hydrocolloid dressings provided beneficial results to treat the dermatitis, with reduced discomfort after 7 days and lesions healing within 4 weeks.

A Comparison of Dressing Techniques for Presurgical Closure of Myelomeningocele in the Neonate.

BACKGROUND: Myelomeningoceles are routinely closed surgically within 24 to 48 hours after birth; the defect and exposed placode must be protected from further damage from excoriation and contamination until surgery. PURPOSE: Two methods to keep the defect moist and clean are used at our large Midwestern children's hospital: the occlusive and the drip. There was no agreement between the neonatal and neurosurgical teams as to which technique was superior, hence the need for a formal evaluation. METHODS: A prospective, randomized trial was conducted to compare the ease of nursing care, cost of supplies, neonatal temperature, and moisture of the placode at the time of closure in neonates with a myelomeningocele. RESULTS: Nurses categorized the occlusive group as easy care (100%) compared with 60% for the drip group, although the difference was not statistically significant (P = .18). The mean temperatures of the 2 groups before surgery were identical (36.9°C) in both groups. The cost of the drip was 6 times higher than that of the occlusive technique. The placode was assessed as moist in all 13 cases (100%). CONCLUSION: The occlusive technique was easier to care for by all the nurses and was 6 times more cost effective. Both methods kept the placode moist and did not affect the temperature of the baby.

Xenoenxerto (pele da Tilápia-do-Nilo) e hidrofibra com prata no tratamento das queimaduras de II grau em adultos / Nile tilapia skin xenograft versus silver-based hydrofiber dressing in the treatment of second-degree burns in adults

Introdução: Estudos recentes apontam a utilização do curativo biológico com base em animais aquáticos como biomaterial na medicina regenerativa, apresentando boa aderência ao leito das feridas. O objetivo foi avaliar a eficácia da utilização da pele da Tilápia-do-Nilo (Oreochromis niloticus) como curativo biológico oclusivo, no manejo/tratamento de queimaduras de 2º grau em adultos. Métodos: Estudo clínico com 30 pacientes aleatoriamente tratados com pele da Tilápia-do-Nilo (n = 15) e hidrofibra com prata Aquacel Ag® (n =1 5). Resultados: Em relação à duração, o tratamento com a pele da Tilápiado-Nilo obteve uma média de dias de tratamento (9,6 ± 2,4) similar ao material comparativo (10,7 ± 4,5). Quanto ao relato de dor durante a troca de curativos, não houve diferença estatisticamente significante (p > 0,68) entre os grupos. Após a troca do curativo, não houve inferioridade no registro do valor na escala analógica de dor, em que 66,7% dos tratados com pele da Tilápia-do-Nilo relataram diminuição dos eventos álgicos. Constatou-se ainda que 60% dos pacientes tratados com a pele da Tilápia-do-Nilo não tiveram seus curativos substituídos em qualquer momento do tratamento. Para o curativo Aquacel AG®, 53,3% dos pacientes tiveram mais de uma substituição de curativos. Conclusões: Com base na pesquisa, pode-se concluir que a pele da Tilápia-do-Nilo é eficaz como curativo biológico oclusivo. Houve similaridade entre os grupos para a média de dias de tratamento (completa cicatrização da ferida) e para o relato de dor durante a realização do curativo. Também, a não inferioridade relacionada a dor após os curativos e suas trocas (quando existentes) e na quantidade de substituições destes.

Introduction: Recent studies have suggested the use of biological dressings made of aquatic animals as biomaterials in regenerative medicine since they demonstrate good adherence to the wound bed. The objective of this study was to evaluate the efficacy of Nile tilapia skin (Oreochromis niloticus) as an occlusive biological dressing in the management and treatment of second-degree burns in adults. Methods: This clinical study included 30 patients randomly treated with Nile tilapia skin (n = 15) or Aquacel Ag® silver-based hydrofiber dressing (n = 15). Results: The Nile tilapia skin yielded a similar mean treatment time (9.6 ± 2.4 days) to that of the comparative material (10.7 ± 4.5 days). There was no statistically significant intergroup difference (p > 0.68) in pain during dressing changes. No disadvantage in pain was noted, as 66.7% of patients treated with Nile Tilapia skin reported a decrease in pain events. Moreover, 60% of the patients treated with the Nile Tilapia skin did not require dressing replacement at any time during treatment. For the Aquacel AG® dressing, 53.3% of the patients required more than one dressing replacement. Conclusions: Our findings suggest that the Nile tilapia skin is as effective as an occlusive biological dressing. The average treatment time (complete wound healing) and pain reports during dressing changes were similar between groups. Furthermore, pain after and number of dressing exchanges (when performed) were not worse.

General treatment and wound management in hereditary epidermolysis bullosa: indication and experience using silver hydrofiber dressing / Tratamento geral e das feridas na epidermólise bolhosa hereditária: indicação e experiência usando curativo de hidrofibra com prata

Introduction: Hereditary epidermolysis bullosa (EB) is a rare disorder characterized by cutaneomucous fragility, with formation of blisters during minimal trauma. Treatment consists of clinical and nutritional support and management of pain and skin lesions. Silver hydrofiber (Aquacel Ag®) is a type of carboxymethylcellulose fiber dressing with silver that can be used in selected cases of EB. Objective: To review the literature on the general treatment and management of cutaneous lesions in congenital EB and evaluate the indication and experience of using silver hydrofiber dressing. Methods: The review included original articles and systematic reviews published between 2009 and 2014. We also selected two patients with congenital EB treated at the Plastic Surgery Division of Hospital das Clínicas of the Faculty of Medicine of Ribeirão Preto at the University of São Paulo. Results: There is a shortage of scientific evidence related to the treatment of skin lesions in congenital EB, with most recommendations being based on expert opinions. Hydrofiber is indicated in most consensuses for wounds with some exudation and has been shown to be more absorbent than alginate. In our experience, there was apparent improved control of pain, bleeding, and hypothermia with the use of hydrofiber, which has the advantage of not requiring daily changes and can remain on the wound for up to two weeks. Conclusions: The general and lesion treatments in EB are challenging. Hydrofiber with silver is a treatment option for wounds in hereditary EB, without the need for daily dressing changes.

Introdução: Epidermólise bolhosa (EB) hereditária é uma desordem rara caracterizada pela fragilidade cutaneomucosa, com formação de bolhas ao mínimo trauma. O tratamento consiste em suporte clínico, nutricional, manejo da dor e das lesões cutâneas. A hidrofibra com prata (Aquacel Ag®) é um tipo de curativo de fibra de carboximetilcelulose e prata que pode ser utilizada em casos selecionados de EB. Objetivo: Revisão da literatura sobre o tratamento geral e o manejo das lesões cutâneas na EB congênita, além de avaliar a indicação e experiência usando curativo de hidrofibra com prata. Métodos: A revisão incluiu artigos originais e revisões sistemáticas, publicados entre 2009 e 2014. Selecionamos ainda dois pacientes com EB congênita tratados na Divisão de Cirurgia Plástica do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo. Resultados: Há escassez de evidências científicas relacionadas ao tratamento das lesões cutâneas na EB congênita, sendo a maioria das recomendações baseadas em opiniões de especialistas. A hidrofibra está indicada na maioria dos consensos para feridas com alguma exsudação e mostrou-se mais absorvente que o alginato. Em nossa experiência, houve aparente melhor controle da dor, do sangramento e da hipotermia com o uso da hidrofibra, que apresenta a vantagem de não necessitar de trocas diárias, podendo permanecer na ferida por até duas semanas. Conclusões: O tratamento geral e das lesões na EB é um desafio. A hidrofibra com prata é uma opção de tratamento para as feridas na EB hereditária, sem necessidade de trocas diárias de curativo.

Transporous hernia mesh fixation with fibrin sealant in an in vitro model of spray application.

BACKGROUND: The spray application of fibrin sealant (FS) is widely used for atraumatic mesh fixation in open and laparoscopic hernia surgery. Studies focusing on the optimization of sealant distribution are rare. This study elucidates the impact of spray distance and pressure, the thrombin concentration of the FS, as well as the mesh design on the spray process and the resulting sealant distribution. Furthermore, the effect of interrupting the spray process on sealant distribution was investigated. MATERIAL AND METHODS: Three different meshes were sprayed in a vertical test arrangement with 0.4 mL FS. Fibrin sealants containing 4 and 500 IU/mL thrombin (Tisseel and Artiss; Vienna, Austria) provided by Baxter Biosciences were used. The application distances varied from 5 to 8 cm. The relative fibrin sealant distribution on the individual mesh surfaces was evaluated and compared, as well as loss of FS and patterns of clot formation. RESULTS: Spray distances between 5 and 8 cm led to a homogenous sealant distribution. Lower thrombin concentrations led to significant losses of FS due to slower polymerization. Differences of the fibrin sealant distribution and mesh pore sizes were found. No differences between continuous and discontinuous application were observed. CONCLUSION: The spray application of FS provides a uniform sealant film in a defined range of distances. However, design and pore size of different meshes substantially impact sealant distribution. These findings should be considered when selecting prosthesis for hernia repair. In general, the amount of sealant should not exceed 0.08 mL per cm(2) to avoid obstruction of mesh pores.

The management of wound-related procedural pain (volitional incident pain) in advanced illness.

PURPOSE OF REVIEW: The prevention and treatment of wound-related procedural pain is one of the greatest areas of unmet need within wound management. Also referred to as 'Volitional Incident Pain', it is the most prevalent subtype of breakthrough pain experienced by patients afflicted with wounds. Novel formulations of existing analgesics are now available to address this challenge. RECENT FINDINGS: This review focuses on the principles of breakthrough pain assessment including those patients with cognitive impairment. Current management principles are discussed with an emphasis on the novel formulations of fentanyl citrate that may be delivered through the sublingual, buccal, and nasal mucosal routes. SUMMARY: Novel formulations of fentanyl citrate, delivered through an array of noninvasive routes, allow for rapid-onset and short-acting effects that better match the onset and duration of wound-related procedural pain.

Effects of negative pressure wound therapy on cellular energetics in fibroblasts grown in a provisional wound (fibrin) matrix.

Negative pressure wound therapy (NPWT) using reticulated open cell foam dressing (ROCF) is effective for treatment of recalcitrant wounds; however, the effects of this therapy on cellular metabolism remain to be elucidated. The effect of two different subatmospheric pressure applications on the cell energetics of human fibroblasts grown in a 3D fibrin matrix was studied using two different pressure-manifolding materials, an ROCF or gauze under suction (GUS). It was found that levels of cytochrome c oxidase, energy charge, and adenosine triphosphate/adenosine diphosphate were significantly increased following the application of NPWT using ROCF vs. GUS (p<0.05). Increases in these parameters likely reflect an improved energetic status. In addition, levels of transforming growth factor-beta and platelet-derived growth factor (alpha and beta isoforms) were significantly increased (80 and 53%, respectively; p<0.05) over static control cultures following treatment with NPWT using ROCF but not following GUS. These growth factors are known to be important during wound healing. Clearly, both the material used as the dressing to manifold the subatmospheric pressure and the pressure used have a dramatic effect on cellular response.

Split-thickness skin graft donor sites: a comparative study of two absorbent dressings.

OBJECTIVE: To identify the optimal dressing for split-thickness skin graft (SSG) donor sites. METHOD: This prospective randomised controlled trial compared two dressings - a new absorbent form of a polyurethane film dressing (Tegaderm Absorbent, 3M) and our standard alginate dressing (Kaltostat, ConvaTec) - on SSG donor sites in 40 patients. Primary outcome measures were: reduced time to full healing; reduced postoperative pain; reduced leakage rates from the dressing. Secondary outcome measures related to acceptability of the dressings to the patient. RESULTS: On removal of the dressings at the first assessment, 79% of the Tegaderm Absorbent donor sites had healed completely, compared with 16% of the Kaltostat ones (p<0.001).A significantly greater median area had healed with Tegaderm Absorbent (100%), when compared with Kaltostat (89%) (p<0.001). Mean time to complete healing was also significantly faster for Tegaderm Absorbent than Kaltostat (14 versus 21 days) (p<0.001). Significantly fewer subjects experienced postoperative pain with Tegaderm Absorbent on both day 1 (21% versus 67%, p=0.006, NNT=3) and day 2 (17% versus 75%, p<0.001, NNT=2). Leakage rates reduced by 48% with Tegaderm Absorbent, with no leakage in the smaller donor sites. Tegaderm Absorbent was significantly easier to apply than Kaltostat (89% versus 27% found it'very easy') as was ease of removal (84% versus 11% found it'very easy') (p<0.0001). Patients found Tegaderm Absorbent dressings significantly more convenient to manage and bathe with. At one month post-surgery, Vancouver scar scores showed thatTegaderm Absorbent donor sites were less red, flatter, softer and less itchy. CONCLUSION: Tegaderm Absorbent provides a significant improvement in terms of donor-site pain, healing and ease of management.

Membrana porosa de celulose no tratamento de queimaduras / Porous celulase membrane in burn's treatment

Introdução: curativos oclusivos devem ter algumas características para melhor cicatrização, como: permitir exsudação, manter umidade local, tratar a dor, estimular a epitalização e evitar contaminação.

Background: Occlusive dressing must have some properties, as: mantain a moisture gradient, manage pain, estimulate epithelization, prevent contamination, and allow exudates.

Comparing cost per use of 3M Cavilon No Sting Barrier Film with zinc oxide oil in incontinent patients.

OBJECTIVE: This study compares the total cost of treatment, skin-condition management and prevention of skin breakdown of perianal/buttock skin in incontinent patients receiving 3M Cavilon No Sting Barrier Film (Cavilon NSBF) and zinc oxide oil. METHOD: This single-centre open-label prospective randomised study involved 40 patients with at least moderate skin damage resulting from incontinence. Patients were randomised to receive either zinc oxide oil or Cavilon NSBF and were treated for 14 days. The study products and other treatment-related products used were recorded, as was the time needed to cleanse the application site and apply the product. RESULTS: Use of both products resulted in an improvement in skin condition after 14 days, but this was significantly better with Cavilon NSBF than zinc oxide oil. Cavilon NSBF was more cost-effective as fewer applications were required, less time was spent applying the skin barrier product and faster healing rates were achieved. The cost-effectiveness ratio per treatment group showed an improvement of one point in the total score of the skin-assessment scale costs: 28.36 Euro for Cavilon NSBF versus 98.06 Euro for zinc oxide oil. CONCLUSION: Both products resulted in an improvement in skin condition after 14 days, but Cavilon NSBF was found to be more cost-effective. DECLARATION OF INTEREST: This study was supported by an educational grant from 3M.

Central venous catheter dressings: a systematic review.

BACKGROUND: Gauze and tape or transparent polyurethane film dressings such as Tegaderm, Opsite or Opsite IV3000 are the most common types of dressing used to secure central venous catheters (CVCs). Currently, there are no clear guidelines as to which type of dressing is the most appropriate. AIMS: To identify whether there are any differences between gauze and tape and/or transparent polyurethane film dressings in the incidence of CVC-related infection, catheter-related sepsis, catheter security, tolerance to dressing material, dressing condition and ease of application in hospitalized patients. METHODS: The Cochrane Controlled Trials Register and Medline, Embase and CancerLit databases were searched to identify any controlled trials comparing the effects of gauze and tape and/or transparent polyurethane dressings on CVCs. Additional references were sought from published and non-published literature. Twenty-three studies were reviewed. Data were extracted independently from each paper by two members of the review team and results compared. Differences were resolved either by consensus or referral to a third person. Authors were contacted for missing information. RESULTS: Of the 23 studies reviewed, 15 were excluded. Of the remaining eight, data were available for meta-analysis from six studies. Of the six included studies, two compared gauze and tape with Opsite IV3000, two compared Opsite with Opsite IV3000, one compared Tegaderm with Opsite IV3000, and one compared Tegaderm with Opsite. CONCLUSIONS: There was no evidence of any difference in the incidence of infectious complications between any of the dressing types compared in this review. Each of these comparisons was based on no more than two studies and all of these studies reported data from a small patient sample. Therefore it is unlikely that any of these comparisons would have had sufficient power to detect any differences between groups.

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

Painful split-skin-graft donor sites remain a common problem for patients. We undertook a prospective randomised trial to examine the comparative comfort and ease of care of two different donor-site dressings. One dressing is the alginate Kaltostat, the standard plastic-surgical dressing in the UK and abroad, and the other is the adhesive retention tape Mefix, a novel use of a readily available dressing. We randomised 50 patients requiring split-skin grafts to receive either alginate (Kaltostat) or retention (Mefix) donor-site dressings. Dressings were assessed by interview and questionnaire at 24, 72 h and 2 weeks, and by wound review at 2 weeks. Retention dressings were found to be more comfortable, required less nursing intervention and allowed patients easier mobility with a greater range of daily activities, especially washing, without compromising wound healing. We recommend adhesive retention dressings as cost-effective comfortable dressings, which readily conform to any donor site.

TIELLE* hydropolymer dressings: wound responsive technology.

Wound healing may be compromised by many different factors. Certain underlying illnesses, for example diabetes and malignancy, and wound-specific factors such as critical colonization, infection and protease imbalance can all delay or impair healing. Moist wound healing is now generally accepted in clinical practice to facilitate optimum healing under the correct conditions of wound moisture. Johnson & Johnson Wound Management have provided a solution for the clinician by developing TIELLE* hydropolymer dressings, which provide wound-responsive technology for patient care. This unique mode of action achieves positive outcomes for the patient and clinician in terms of cost-effectiveness, patient compliance, healing rates and reduced rates of undesirable adverse effects such as allergic skin reactions, wound pain and maceration.

[Compression dressing after hip joint replacement reduces the need of allogeneic blood transfusion]. / Kompressionsförband minskar behovet av allogent blod vid höftproteskirurgi.

Allogeneic blood transfusion may increase the risk for postoperative infections, allergic reactions and transmission of diseases. The aim with the present study was to evaluate the effect on blood saving with a new type of compression dressing after hip joint replacement surgery. 50 patients undergoing after hip joint replacement surgery were prospectively allocated to postoperatively get a standard dressing (n = 24) or the new type of a compression dressing (n = 26). The peroperative bleeding was similar in both groups. The need for allogeneic blood transfusions were significantly higher in the group of patients that got standard dressing. This study indicates that the compression dressing reduces the need for allogeneic blood transfusions after after hip joint replacement surgery.

Occlusion versus air exposure on full-thickness biopsy wounds.

The benefits of moisture-retaining dressings on wound healing are well documented in experimental animal models but not in humans. To examine the effect of occlusion, the effects of three brands of synthetic occlusive dressings (Comfeel Plus, DuoDerm CGF, OpSite) were compared with air exposure in epithelial resurfacing and proliferation in acute, full-thickness skin wounds in humans. In 10 healthy males, four 4 mm standardised wounds were made with a sterile punch biopsy on each lower extremity. Epithelialisation of the wounds was assessed histologically and blindly postwounding on days 7 and 14. Wound margin epidermal proliferation was evaluated immunohistochemically with Ki67. Epithelial percentage coverage increased significantly (p = 0.007) with the occlusive dressings (62 +/- 6%, mean +/- SEM), compared with air exposure, (39 +/- 7%) on day 7 but not on day 14 (p = 0.500). Epidermal cell proliferation showed no significant intergroup difference on either day. Treatment with occlusive dressings increased early epithelial migration of acute full-thickness biopsy wounds compared with air exposure in healthy men.

[Case report about the combined use of 2 moist wound dressings in the treatment of a chronic diabetic foot ulcer]. / Caso clínico sobre la utilización combinada de dos apósitos que favorecen la cura húmeda en el tratamiento de una úlcera diabética de larga evolución.

INTRODUCTION: Approximately 4.5% of the Spanish population suffer from Diabetes Mellitus (that means around 1.8 million people). Currently, the main problem that diabetes treatment presents is controlling its chronic complications, being the diabetic foot one of them, which can end up causing an amputation. Prevalence of ulceration varies according to sex, age and population characteristics, oscillating between 2.4% and 5.6%. In Catalonia, in a community case study, the prevalence was of 7.9%. In the same way, it has been calculated that at least 15% of diabetics will suffer from foot ulcerations during their lives. MATERIAL AND METHODS: A clinical case regarding a diabetic neuropathic chronic ulcer highly exuding was made to analyze the effect of this new dressing in the daily clinical practice. CombiDERM is an absorbent dressing with an external polyurethane plate and a central part with absorbent hydroparticles, indicated for the management of the exudate and the protection of the surrounding skin. 64-year-old woman, who suffered from Diabetes Mellitus type I to 28 years evolution with Retinopathy grade II, Artropathy of Charcott and a neuropathic ulcer of 4 years evolution. She was admitted in the Vascular Surgery Service the 6th of May of 1995 presenting an ulcer with signs of local infection in the sole of her left foot. Different local treatments were established and improvement periods were alternated with non-improvement periods, giving as a result an unfavorable evolution of the wound. The treatment with CombiDERM was established, using AQUACEL Ribbon (Hydrofiber dressing) as filling material. To evaluate the continuation of the treatment photos and acetates were taken, and data was registered in a Case Report Form. RESULTS: At the beginning the ulcer presented a high level of exudate, no signs of infection, light pain and the skin surrounding the ulcer was lightly macerated. After nine days of treatment an improvement of the ulcer could be observed, with the presence of granulating tissue. On the twenty-fourth day, granulation in the bed of the wound was completed and the quantity of exudate had reduced significantly. Application and removal of the dressing was easy and without pain. The evolution of the lesion was very good, without signs of infection, and with a graded epithelization until the ulcer was completely healed, at the eleventh week of the treatment with the new dressing. (The surface of the ulcer decreased from 557.67 mm2 to 0 mm2). CONCLUSION: Having in mind the good evolution of this ulcer and the characteristics of CombiDERM, the new dressing is an optimal alternative in the treatment of highly exuding diabetic neuropathy ulcers.

Cica-Care: adhesive gel sheet.

Keloid and hypertrophic scars can be a complication of burns, surgery and other traumas. Cica-Care (Smith & Nephew) has been developed for the prevention and treatment of such scars. This product focus presents the clinical features of both types of scars, highlighting the difference between them, and outlines the treatment options which include surgery, pressure treatment and pharmacological treatments. The mechanism of action of Cica-Care is still uncertain, but it appears to soften, flatten and blanch scars. The specific care of the gel sheet, including skin acclimatization, is also described.

Dressings for treating cavity wounds.

Two treatment protocols for the management of patients with non-infected cavity wounds were studied, using data obtained from both the community and the outpatients clinic. Patients were treated with either a polyurethane foam hydrophilic dressing (Allevyn) or a calcium sodium alginate dressing (Kaltostat). Although alginate fibres were found to be incorporated in tissue, both dressing regimes were found to be easy to use, effective and acceptable to patients and clinicians.

A comparison of three wound dressings in patients undergoing heart surgery.

Two hundred fifty patients undergoing heart surgery were randomized in a prospective comparative study of a semiocclusive hydroactive wound dressing, an occlusive hydrocolloid dressing, and a conventional absorbent dressing. The wounds were evaluated during the 4 weeks after surgery. Color photographs were used for a blind evaluation of wound healing. The conventional absorbent dressing was more effective in wound healing, compared with the hydroactive dressing. Further, there were fewer skin changes and less redness in the wounds with the conventional dressing than with the hydroactive dressing; the differences were not significant with the hydrocolloid dressing. The conventional dressing was less painful to remove than the hydroactive and hydrocolloid dressings. More frequent dressing changes, however, were needed when using the conventional dressing. Despite this, it was the least expensive alternative.

Pilot study analysis of the histologic and bacteriologic effects of occlusive dressings in chemosurgical peel using a minipig model.

The histologic changes associated with chemosurgery are well documented, but the data concerning the effects of occlusive dressings (adhesive tape, gauze, or ointments) is largely anecdotal. Wide differences of opinion exist as to the best method of phenol application and postpeel wound care regimen. Using a Yucatan minipig as our animal model, we studied the histologic and bacteriologic differences that various commonly used occlusive dressings have upon the initial burn depth and the subsequent healing of peeled skin. We also compared chemical peel with dermabrasion and chemabrasion. Our results showed to statistical difference in peel depth between "wet" versus "moist" phenol application or between occluded versus nonoccluded dressings. Based upon this animal model, we recommend that phenol solutions be applied moist rather than wet and that an occlusive dressing other than adhesive tape be used and maintained for a minimum of four days.