Predictive factors for the formation of tape blisters: An observational, prognostic prospective study.

BACKGROUND: Tape blisters are common complications in the peri-lesional area of the surgical incision, forming below the layer of dressing adhesive applied and causing numerous complications for patients. OBJECTIVES: The purpose of this study was to investigate the incidence of the phenomenon, and to identify and quantify the main prognostic factors associated. DESIGN: Multicentric, prognostic prospective cohort study. SETTING: Shoulder Orthopaedic surgery, General surgery, Advanced Oncology therapies, Gastro-entero mininvasive surgery and Endocrine surgery. PARTICIPANTS: One thousand and two patients who underwent chest, abdominal, upper limb and joint laparotomic surgery consecutively admitted to the surgical units involved, were included. METHODS: Data regarding individual and patient care variables, such as intrinsic (e.g. age and gender) and extrinsic (e.g. surgery type and time) data were collected. A multivariate logistic regression model was used to identify the variables which independently influenced the onset of the tape blister. RESULTS: In the multivariate analysis, patients who underwent chest (Odds Ratio = 8.99, 95% CI 5.33-15.13), and upper limb and joint surgery (Odds Ratio = 2.09, 95% CI 1.22-3.58) were more likely to develop tape blisters in the postoperative period, At the same time, having drainage (Odds Ratio = 1.98, 95% CI 1.11-3.53), being female (Odds Ratio = 1.56, 95% CI 1.01-2.44) and having a high Body Mass Index (BMI) score (Odds Ratio: 1.06, 95% CI 1.02-1.11) were also predictors of tape blister formation. CONCLUSIONS: A higher BMI score, chest, upper limb and joint surgery, female gender and the presence of drainage were predictive factors of the tape blister event while, in contrast with the literature, the type of dressing used in this study was not significantly associated with the event.

Complications of laser and light-based devices therapy in patients with skin of color.

Lasers and light-based devices are indispensable to an aesthetic dermatology practice. The growing popularity of lasers has been matched by a sharp increase in the incidence of complications. The Indian skin with its high melanin content is more prone to injury and careful setting of laser parameters, early detection of complications and immediate therapy are vital to avoiding permanent sequelae. We review the various complications that occur during laser procedures and their management.

Evaluation of Absorbent Versus Conventional Wound Dressing.

BACKGROUND: Lower-limb endoprosthetic operations and spinal operations are among the more common types of orthopedic procedures. Postoperative woundhealing disturbances and infections can lead to longer periods of hospital stay and recovery as well as to higher morbidity and mortality. METHODS: 209 patients who had been judged to have an indication for a primary knee or hip endoprosthesis or for a primary spinal operation were included in this randomized trial (ClinicalTrials.gov: NCT01988818) over the period June 2014- February 2015. After randomization, patients in the intervention group were given a trial dressing (Mepilex-Border Post-Op) and those in the control group were given a conventional adhesive dressing (Cosmopor). The primary endpoint was blister formation. RESULTS: In the overall study population, only a single case of blister formation was seen. The affected patient belonged to the intervention group but was mistakenly given a control dressing and developed blisters on the 6th day after surgery. Dressings were changed less frequently in the intervention group, and this difference was statistically significant (p<0.001). The patients, nurses, and physicians all expressed greater satisfaction with the trial dressings than with the control dressings (p<0.001). CONCLUSION: The intervention group did not differ from the control group with respect to the primary endpoint, postoperative blister formation. The patients, nurses, and physicians all judged the dressing used in the intervention group more favorably than the conventional dressing.

Clinical trial to evaluate the performance of a flexible self-adherent absorbent dressing coated with a soft silicone layer compared to a standard wound dressing after orthopedic or spinal surgery: study protocol for a randomized controlled trial.

BACKGROUND: Postoperative wound infection is a preventable risk. One potential postoperative complication is blistering, which leads to increased pain, delayed healing, and higher care costs. The incidence of wound blisters has been reported to be between 6 and 24%. The aim of this study is to assess whether the risks of postoperative blistering and wound infections within the first 6 days postsurgery will be reduced using a special dressing compared to a standard one. METHODS/DESIGN: This is a randomized clinical trial in a University hospital. Patients presenting for knee or hip arthroplasty or spine procedures will be assessed against study inclusion and exclusion criteria. After giving written informed consent, patients will be randomized to participate in the 7-day study during hospitalization. One hundred patients will be randomized per group. The primary outcome measure is blistering incidence from day 0 to day 6 postsurgery. Photo documentation will be evaluated in a blinded manner by the Clinical Evaluation Committee (CEC). DISCUSSION: A new dressing will be compared to the standard wound dressing regarding the risk of postoperative blistering, wound infection, and patient comfort. This study will assess the potential advantages of a modern wound dressing. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT01988818 (Entered 13 November 2011).

Analysis of incidence of bulla formation after tattoo treatment using the combination of the picosecond Alexandrite laser and fractionated CO2 ablation.

BACKGROUND: The picosecond Alexandrite laser has shown increased efficacy in tattoo removal in comparison to Q-switched lasers. However, bulla formation is a well-known and expected side effect of this novel treatment and causes patient discomfort. OBJECTIVE: To analyze the incidence of bulla formation after tattoo treatment using the combination of the picosecond Alexandrite laser and fractionated CO2 ablation. MATERIALS AND METHODS: This is a retrospective chart review to determine the incidence of bulla formation after laser tattoo removal in 95 patients who were treated with either with the picosecond Alexandrite laser alone or in combination with fractional CO2 ablation. RESULTS: Twenty-six patients (32%) treated with the picosecond laser alone experienced blistering, whereas none of the patients treated with the combination of the picosecond laser and fractionated CO2 ablation experienced blistering. The difference in incidence of bulla formation between the 2 groups was found to be statistically significant (p < .05). CONCLUSION: This study shows a significant decrease in bulla formation associated with tattoo treatment when fractionated CO2 ablation is added to the picosecond Alexandrite laser, which is consistent with observations from a previous case series. This is important because decreasing extensive blistering likely results in increased patient satisfaction and willingness to return for future treatments.

Injuries and injury prevention during foot marching.

Since the beginning of recorded history, Soldiers have carried arms and equipment on their bodies. More recently, loads have substantially increased, driven by improvements in weapons technology and personal protection. As Soldier loads increase, there are increases in energy cost, altered gait mechanics, increased stress on the musculoskeletal system, and more rapid fatigue, factors that may increase the risk of injury. Common injuries and symptoms experienced by Soldiers on load-carriage missions include foot blisters, metatarsalgia, knee problems, and back problems. This article discusses these problems, providing diagnoses, injury mechanisms, and preventive measures. In general, lighter loads, improving load distribution, using appropriate physical training, selecting proper equipment, and using specific prevention techniques will facilitate load carriage and provide Special Operations Forces with a higher probability of mission success.

Achieving international consensus for the prevention of orthopaedic wound blistering: results of a Delphi survey.

This article presents the results of an international 2 stage Delphi survey carried out via e-mail to achieve consensus as to the most effective postoperative wound management to prevent blistering and other complications. Seventeen prospective participants were invited to be members of the Delphi Panel of which 13 agreed to be involved. The panel suggested that an ideal wound dressing would conform easily to the wound, be easy to apply and remove, allow for swelling and minimise pain on removal. Participants were in agreement that the primary wound dressing should be left in situ for as long as possible, providing there was no excessive oozing or signs of infection. The authors recognise that the Delphi Panel was relatively compact; however, the study arguably provides some useful data that can be used to identify the consequences of wound blistering and important factors that need to be considered when choosing a wound dressing to prevent blistering.

Inhibition of FAK prevents blister formation in the neonatal mouse model of pemphigus vulgaris.

Pemphigus vulgaris (PV) is an autoimmune blistering skin disease characterized by suprabasal acantholysis and by autoantibodies against desmoglein 3 localized on desmosomes. In addition, caspases also seem to participate in this blistering disease. Focal adhesion kinase (FAK) is a non-receptor tyrosine kinase involved in cytoskeleton remodelling and formation and disassembly of cell adhesion structures. We have previously demonstrated that HER (human epidermal growth factor receptor related) isoforms, Src (Rous sarcoma) and mammalian target of rapamycin (mTOR), three molecules implicated in signalling processes, take part in suprabasal acantholysis and apoptosis induced by PV-IgG in a mouse model. Our aim was to investigate whether upregulation of FAK is implicated in the development of PV lesions. Herein, using a mouse model, PV-IgG administration showed an increased level of FAK phosphorylated on 397 and 925 tyrosine residues in the basal layer of epidermis. When mice were pretreated with a FAK inhibitor (FI), the acantholysis of the basal layer of epidermis was absent. More interestingly, we observed that phosphorylated FAK (Y397/925) decreased when HER isoforms, Src, mTOR and pan-caspases inhibitors were employed before PV-IgG administration. In addition, pretreatment with the FI before PV-IgG injection prevented the changes in both Bax and Bcl-2 expression and caspase-9 and caspase-3 activities induced by PV-IgG. Finally, FI reduced the expression of phosphorylated Src and mTOR in the basal cells of epidermis. In conclusion, our data reveal a novel role of phosphorylated FAK (Y397/925) in PV development involving HER isoforms, Src and mTOR kinases.

Effects of postoperative cyclosporine ophthalmic emulsion 0.05% (Restasis) following glaucoma surgery.

PURPOSE: To determine if postoperative topical cyclosporine 0.05% has any beneficial effect following trabeculectomy. METHODS: This was an interventional, randomized, prospective, double-masked clinical trial of 44 consecutive patients with uncontrolled glaucoma requiring filtration surgery. Ocular surface disease index questionnaire and comprehensive ocular exam, including Schirmer's tear test 1, were performed. Patients underwent routine trabeculectomy, with or without phacoemulsification. The study group (n = 22) received cyclosporine 0.05%, and the control group (n = 22) received artificial tears. Patients were evaluated at 1 and 6 months post surgery. Outcome measures were intraocular pressure, success rate, bleb appearance, ocular surface disease index, Schirmer's tear test 1 and conjunctival inflammation. RESULTS: Thirty-nine patients completed the study (19 in the study group, 20 in the control group). The mean baseline intraocular pressure was 23.8 +/- 12.6 mmHg in the study group and 25.9 +/- 10.6 mmHg in the control group (P = 0.513). Mean intraocular pressure at postoperative month 6 was 14.88 +/- 6.2 and 14.62 +/- 5.46 mmHg in the study group and control group, respectively (P = 0.837). There was no statistically significant difference in the mean values of Schirmer's tear test 1 and the level of conjunctival hyperaemia between the two groups at baseline, months 1 and 6 post surgery. The treatment group had a statistically significant decrease in ocular surface disease index score at 6 months (P = 0.003), indicating less severity of dry eye symptoms and significant reduction in ocular pain. CONCLUSIONS: Topical cyclosporine 0.05% had no effect on postoperative bleb function and intraocular pressure following trabeculectomy, but improved subjective ocular surface symptoms in these patients.

Patient perceptions of 595 nm pulsed dye laser through glass compression in the treatment of thick port wine stains and superficial venous malformations.

In treating thickened port wine stains and superficial venous malformations with the 595 nm pulse dye laser, we have sometimes compressed the lesion with a glass slide to enable the laser beam to penetrate more deeply. In order to evaluate the patients' perception of this modality, 54 subjects were treated with glass compression using ice applications to cool the skin surface and without glass compression using a cryospray to cool the surface. The subjects were asked to rate the difference in 2 questionnaires after the first and second treatments as to effectiveness, pain of procedure, and overall preference. Of those subjects who perceived a difference between modalities, a significant number perceived treatments with glass compression to be more effective than without (p=0.0002 and p=0.0006), but more painful (p<0.0001). There was no significant difference in overall preference. Blistering occurred in 5 subjects when the glass slide was left on the skin more than 1 minute between ice applications.

[Late needling with 5-fluorouracil when scarring of filtering bleb seems imminent]. / Late Needling mit 5-Fluorouracil bei drohender Sickerkissenvernarbung.

BACKGROUND: Evaluation of needling and 5-fluorouracil (5-FU) injections more than 4 months after preceding filtration surgery. PATIENTS AND METHOD: Retrospective analysis of 17 eyes in 14 patients who underwent needling of the filtering bleb and administration of 5-FU by injection at least 4 months after trabeculectomy (TE) with mitomycin C (MMC; same surgeon throughout). Complete success was defined as a reduction of intraocular pressure (IOP) by >30% from the baseline value without further medication and, in cases of primary open-angle glaucoma, IOP of 18 mmHg. The mean period of follow-up was 8.1 months (3-24 months). RESULTS: One to four needlings (Ø 1.6) with one to five injections (Ø 3.1) of 5-FU were performed as required according to clinical need an average of 31.3 months (4-108 m) after TE. The mean baseline IOP was 25 mmHg (+/-SD 6.02; median 25 mmHg). After needling and 5-FU injection the mean IOD at the last hospital visit was 13.64 mmHg (+/-SD 5.2, median 13 mmHg; p<0,001). Complete success was achieved in 82.4% of these cases. The mean reduction in IOP was 11.2 mmHg (0-22 mmHg). In the cases with successful outcome (14 of 17 eyes) the mean IOP reduction from baseline was 55%. Three eyes required further treatment. Complications encountered were hyphaema (2 cases), subconjunctival bleeding (1 case) and corneal erosion (3 cases). CONCLUSION: Late needling and injections of 5-FU can restore filtering bleb function even over 4 months after initial surgery. The high success rate and low incidence of complications together with the simple procedure justify regarding this approach as an alternative that can be used before passing on to more invasive interventions.

External tissue expansion using negative pressure in upper-extremity reconstruction.

Soft-tissue expansion in the upper extremities is a valuable technique with increasing indications, which means that using of tissue expansion in reconstruction of upper limb increases day after day. Tissue expansion with implantable balloons is a fairly standard method in reconstructive surgery. This article describes the use of external tissue expansion by using negative pressure in soft-tissue reconstruction of the upper extremities in 40 patients. Valved cups (external expanders) were applied to the skin on one or both sides of the lesion. With the subsequent application of a negative pressure source to the valves, gradual tissue expansion occurred inside the external expanders. When there was enough surface area of the expanded skin to cover the exposed area after lesion excision, the expansion process was stopped and surgery was performed. The upper limit of negative pressure must not exceed -200 mbar. The complications were mild and mainly involved skin blistering. External tissue expansion using a negative pressure technique is simple, safe, cost effective, and associated with good results in the reconstruction of soft-tissue injuries.

Heparin-induced thrombocytopenia syndrome bullous lesions treated with trypsin-balsam of peru-castor oil ointment: a case study.

Heparin-induced thrombocytopenia syndrome is a serious, potentially life-threatening adverse reaction to the use of heparin anticoagulation therapy that can result in significant skin damage and organ morbidity. A case study design is used to describe the innovative use of a topical wound treatment (trypsin-balsam of Peru-castor oil ointment) on bullous lesions related to the effects of this syndrome. An elderly, morbidly obese woman was treated for 2 weeks with twice-daily applications of the product along with non-adherent oil emulsion dressings. Oozing decreased substantially within a few days and open blisters closed within 1 week. After 2 weeks of therapy, the bullous skin reaction was fully resolved with no recurrence. The results of this case study suggest that this topical product may have had a positive effect on the bullous lesions and should be considered for use in other similar significant integumentary reactions.

Choice of dressing has a major impact on blistering and healing outcomes in orthopaedic patients.

OBJECTIVE: To investigate the effect of three postoperative dressings on orthopaedic wound healing. METHOD: Three hundred orthopaedic patients were divided into three treatment groups and allocated to management with one of three dressings: Primapore, Tegaderm with pad, and OpSite Post-Op. Staff completed a questionnaire to evaluate the wound progression. Outcome measures were the presence of infection, blistering and the number of dressing changes required. RESULTS: There was a significantly lower incidence of blistering with OpSite Post-Op (6%) than Tegaderm with pad (16%) and Primapore (24%) (p<0.001). Patients in the OpSite Post-Op group had the lowest exudate levels. CONCLUSION: Dressings that employ a clear film and have a high moisture vapour transmission rate have been shown to reduce both the rate of blistering and wound discharge. The additional expense inherent in using such dressings may, in reality, prove cost-effective because of the reduced need for dressings changes and the subsequent earlier discharge of these patients from hospital with an uncomplicated wound.

Wound blisters post hip surgery: a prospective trial comparing dressings.

INTRODUCTION: Wound blisters are formed in the epidermis adjacent to surgical incisions and are a significant cause of morbidity following hip surgery. This study was designed to compare two commonly used primary dressings, namely a nonadherent absorbable (NAA) dressing and paraffin tulle gras (PTG). Monitoring for the subsequent development of wound blisters in the epidermis adjacent to the surgical incision was then undertaken. METHODS: The present study was performed in the setting of a prospective, randomised trial of 50 consecutive patients undergoing hip surgery. It was assumed there would be no difference in the development of blisters between the dressing groups. The alternative hypothesis was that PTG would, because of its properties, provide less friction in the epidermis and contribute to fewer wound blisters. RESULTS: A statistically significant difference (P = 0.0028) between the two dressing groups was observed with the NAA group developing blisters in 17 (64%) patients and the PTG group in only two (8%) of the patients. CONCLUSION: The present study would suggest that PTG produces fewer wound blisters following hip surgery when compared to the NAA type as a primary dressing.

Surgical hip dressings: a comparison of taping methods.

PURPOSE: To examine the effectiveness of two methods of preventing blister formation under the taped portion of postoperative hip surgical dressings. DESIGN: Comparative intervention study. SAMPLE: Convenience sample of 148 consecutive hip surgery patients in two Connecticut community hospitals. METHODS: Patients were preoperatively assigned to one of two postoperative surgical hip dressing taping methods or to the control group. The experimental group had the surgical dressing taped to either a hydrocolloid barrier or a nonhydrocolloid barrier 1-inch circumferentially around the surgical incision with the control group having the dressing taped directly to the skin. FINDINGS: The research results found that taping the surgical dressing to a hydrocolloid barrier prevented blister formation. There were no blisters in either experimental group, but evidence of nonblanchable erythema on two patients in the nonhydrocolloid barrier group. CONCLUSION: Taping of postoperative surgical hip dressings to a hydrocolloid barrier is superior to taping directly to skin or to a nonhydrocolloid barrier. IMPLICATIONS FOR NURSING RESEARCH: A larger scale study to examine potential factors that might place patients at high risk for blister formation is needed. This would aid in identification of patients that would benefit from different surgical dressing taping methods.

Wound complications after hip surgery using a tapeless compressive support.

PURPOSE: To compare the incidence of wound complications after hip surgery in patients treated with a compressive spica wrap dressing to those using traditional taping methods. DESIGN: Retrospective, descriptive, comparative, intervention study. SAMPLE: 457 hip surgery patients, including primary arthroplasty, revision surgery and fracture with ORIF. METHOD: A compressive wrap dressing was used on hip surgery patients in the study group while tape was used on patients in the control group. A retrospective chart review was conducted noting postoperative wound complications. FINDINGS: There was a significantly lower incidence of blisters and drainage in the study group using a compressive wrap dressing. There was not a higher incidence of DVT or infection using the wrap dressing when compared to published studies. CONCLUSION: Use of a compressive wrap dressing after hip surgery is recommended to reduce the risk of wound complications. IMPLICATIONS FOR NURSING RESEARCH: A prospective, randomized study with multiple surgeons using both compressive wraps and traditional taping techniques would substantiate the advantage of using a hip spica dressing after hip surgery.

Influence of boot-sock systems on frequency and severity of foot blisters.

This study examined the infleunce of three types of boot-sock systems on incidence and severity of foot blisters. Participants were 357 men undergoing U.S. Marine recruit training at Parris Island, South Carolina. Each participant was assigned to one of three treatment groups. The first group wore the standard military boot sock consisting of a wool-cotton-nylon-Spandex combination. The second group wore the standard military boot sock with a thin inner or liner sock consisting of polyester. The third group wore a very thick, dense, prototype outer sock consisting of a wool-polypropylene combination over the same liner sock as the second group. Foot blister incidence was lower among participants who wore the the prototype boot sock and liner than among those wearing the standard military sock (40 vs. 69%, p < 0.001) or among subjects wearing the standard military sock with liner (40 vs. 77%, p < 0.001). Foot blisters and cellulitis severe enough to require medical attention occurred with greater frequency in the standard military sock group compared to both the prototype boot-sock group (24 vs. 11%, p = 0.02) and the standard military sock with liner group (24 vs. 9%, p < 0.01); there was no difference between the latter two groups. Blister reduction was most apparent in the early weeks of recruit training. The standard military sock with a polyester liner reduced the incidence of severe blisters, but the dense sock with the polyester liner reduced the overall incidence of blisters as well as the incidence of severe blisters.

Friction blisters. Pathophysiology, prevention and treatment.

Blisters occur frequently, especially in vigorously active populations. Studies using respective rubbing techniques show that blisters result from frictional forces that mechanically separate epidermal cells at level of the stratum spinosum. Hydrostatic pressure causes the area of the separation to fill with a fluid that is similar in composition to plasma but has a lower protein level. About 6 hours after formation of the blister, cells in the blister base begin to take amino acids and nucleosides; at 24 hours, there is high mitotic activity in the basal cells; at 48 and 120 hours, new stratum granulosum and stratum corneum, respectively, can be seen. The magnitude of frictional forces (Ff) and the number of times that an object cycles across the skin determine the probability of blister development - the higher the Ff, the fewer the cycles necessary to produce a blister. Moist skin increases Ff, but very dry or very wet skin necessary to produce a blister. Moist skin increases Ff, but very dry or very wet skin decreases Ff. Blisters are more likely in skin areas that have a thick horny layer held tightly to underlying structures (e.g. palms of the hands or soles of the feet). More vigorous activity and the carrying of heavy loads during locomotion both appear to increase the likelihood of foot blisters. Antiperspirants with emollients and drying powders applied to the foot do not appear to decrease the probability of friction blisters. There is some evidence that foot blister incidence can be reduced by closed cell neoprene insoles. Wearing foot socks composed of acrylic results in fewer foot blisters in runners. A thin polyester sock, combined with a thick wool or polypropylene sock that maintains its bulk when exposed to sweat and compression reduces blister incidence in Marine recruits. Recent exposure of the skin to repeated low intensity Ff results in a number of adaptations including cellular proliferation and epidermal thickening, which may reduce the likelihood of blisters. More well-designed studies are necessary to determine which prevention strategies actually decrease blister probability. Clinical experience suggests draining intact blisters and maintaining the blister roof results in the least patient discomfort and may reduce the possibility of secondary infection. Treating deroofed blisters with hydrocolloid dressings provides pain relief and may allow patients to continue physical activity if necessary. There is no evidence that antibiotics influence blister healing. Clinical trials are needed to determine the efficacy of various blister treatment methods.(ABSTRACT TRUNCATED AT 250 WORDS)