[Dressings for local treatment of leg ulcers]. / Pansements utilisés dans le traitement local des ulcères de jambe.

The beneficial effect of a moist wound environment has been well established for healing rate of acute wounds, pain relief and debridement of chronic wounds. Modern dressings are occlusive or semi occlusive, classified according to their physical composition and to their performances such as absorbent capacity, hydrating ability, adhesive components and debridement capacity. They are used to control the exudates and to maintain the wound in a moist environment. Published systematic reviews of the value of different types of dressings in the management of chronic wounds provide only weak levels of evidence of their clinical efficacy, in terms of healing rate. Nevertheless, the indications of modern dressings were recently determined according to a systematic review of the literature and to a formal consensus process. Despite the lack of appropriate studies, modern dressings remains a part of the standard of care and are widely used according to the experience of the clinicians, in larger indications than what may be recommended by evidence-based medicine.

Standardized antibacterial honey (Medihoney) with standard therapy in wound care: randomized clinical trial.

AIM: This paper is a report of a study to compare a medical grade honey with conventional treatments on the healing rates of wounds healing by secondary intention. BACKGROUND: There is an increasing body of evidence to support the use of honey to treat wounds, but there is a lack of robust randomized trials on which clinicians can base their clinical judgement. METHOD: A sample of 105 patients were involved in a single centre, open-label randomized controlled trial in which patients received either a conventional wound dressing or honey. Data were collected between September 2004 and May 2007. RESULTS: The median time to healing in the honey group was 100 days compared with 140 days in the control group. The healing rate at 12 weeks was equal to 46.2% in the honey group compared with 34.0% in the conventional group, and the difference in the healing rates (95% confidence interval, CI) at 12 weeks between the two groups was 12.2% (-13.6%, 37.9%). The unadjusted hazard ratio (95% CI) from a Cox regression was equal to 1.30 (0.77, 2.19), P = 0.321. When the treatment effect was adjusted for confounding factors (sex, wound type, age and wound area at start of treatment), the hazard ratio increased to 1.51 but was again not statistically significant. CONCLUSION: Wound area at start of treatment and sex are both highly statistically significant predictors of time to healing. These results support the proposition that there are clinical benefits from using honey in wound care, but further research is needed.

Waterproofing EMG Instrumentation.

While still experimental, measurement of external uterine electromyographic (EMG) activity is a more sensitive and noninvasive method for measuring uterine contractility in human labor than the methods currently used in clinical practice. Hydrotherapy is purported to improve contractility in labor, yet there have been no reports of abdominal uterine EMG activity measured during immersion. To test telemetric EMG equipment and different waterproofing techniques under dry and immersed conditions, the authors recorded surface EMG activity from the abdominal muscles of 11 healthy, nonpregnant women, 22 to 51 years of age. After attaching one pair of electrodes to the skin on either side of the umbilicus and applying the waterproofing material, the authors tested the signal by asking participants to perform a short series of leg lifts while seated in a chair to evoke abdominal muscle contractions. They were then immersed to the chest in a hydrotherapy tub while performing two to three leg lifts over 60 s every 5 min for 60 min with 20 lb of weight suspended from their ankles to counteract the buoyancy effect of water. EMG activity was continuously recorded. They then repeated the dry-measures sequence. While waterproofing remained intact, EMG signals were essentially unchanged between dry and wet conditions. Of the 11 waterproofing applications tested, 10 failed at some point. In the data from the successful application, EMG signals in both channels exhibited stable baselines throughout and an absence of low-frequency artifact. The development of this technique allows for the recording of external uterine EMG activity during hydrotherapy. The authors have begun using it to investigate the effects of hydrotherapy on uterine contractility during human labor.

Efficacy of a skin-protection powder for use as a dressing for intractable ulcers.

OBJECTIVE: Stomahesive skin-protection powder has been reported to be useful as a skin-care and skin-barrier product for the management of stomas. This study aimed to evaluate its efficacy, in terms of wound healing, moisture retention and pain management, as an alternative to conventional dressing materials. Both clinical and animal studies were undertaken. METHOD: The efficacy of the Stomahesive powder was tested by measuring the thickness of granulation tissue formed in a total skin defect in a db/db mouse model. We then compared the healing process using either the skin-protection powder or a conventional film dressing material. In the clinical study 17 patients with various intractable ulcers were treated with Stomahesive powder, and healing was evaluated. RESULTS: In the mouse model, granulation tissue in the wounds treated with the powder was 2.86 times thicker than that of the wounds treated with the film dressing. In the clinical study, 16 out of 17 wounds healed completely. CONCLUSION: The Stomahesive powder could be an effective treatment modality for contact ulceration, superficial ulcers with complex contours and morphology, and superficial ulcers contaminated by liquid faeces or vaginal discharge that have not responded to conventional dressings. DECLARATION OF INTEREST: None.

Results of the clinical examination of an ointment with marigold (Calendula officinalis) extract in the treatment of venous leg ulcers.

The aim of this study was to determine the therapeutic efficacy of marigold (Calendula officinalis) extract on the epithelialization of lower leg venous ulcers. The experiment was carried out in 34 patients with venous leg ulcers. The patients were divided into two groups. In the first (experimental) group, patients were treated with an ointment containing marigold extract, which was prepared in an apparatus devised by Soxleth and was incorporated into a neutral base. Twenty-one patients with 33 venous ulcers were treated. Therapy was applied twice a day for 3 weeks. The second group was a control group that consisted of 13 patients with 22 venous ulcers. In the control group, saline solution dressings were applied to ulcers for 3 weeks. In the experimental group the total surface of all the ulcers at the beginning of the therapy was 67,544 mm2. After the third week the total surface of all the ulcers was 39,373 mm2 (a decrease of 41.71%). In seven patients, complete epithelialization was achieved. In the control group the total surface of all the ulcers at the beginning of the therapy was 69,722 mm2. After the third week the total surface of all the ulcers was 58,743 mm2 (a decrease of 14.52%). In four patients, complete epithelialization was achieved. There was a statistically significant acceleration of wound healing in the experimental group (p < 0.05). The results obtained are preliminary, but they suggest the positive effects of the ointment with marigold extract on venous ulcer epithelialization.

[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.

Intrasite Gel and Intrasite Conformable: the hydrogel range.

Wound management can be a confusing area of nursing practice. Even when an holistic patient assessment has been undertaken healthcare professionals frequently ask for guidance when faced with choosing the most appropriate wound management product. This article reviews two hydrogels from Smith & Nephew Healthcare--Intrasite Gel and Intrasite Conformable, which is the latest addition to the hydrogel range.

Hydrogels and hydrocolloids: an objective product comparison.

It is difficult for providers to make selections from the vast array of currently available wound care products. There has been a paucity of objective data generated by a non-biased source comparing one product to another. In order for our Wound Care Team to recommend products for system-wide formulary purchase and patient use, we needed to develop a process for product comparison. A strategy for objective evaluation of hydrocolloid and amorphous hydrogel products was created, and these products were assessed clinically by experienced wound care providers. Laboratory testing included measurement of each product's ability to absorb water versus normal saline versus actual patient wound fluid. There were major differences in various products' abilities to absorb the fluids. These objective data from the laboratory, along with the subjective comparison of clinical performance, allowed our Wound Care Team to objectively rank the hydrocolloids and hydrogels and include those preferred products in our Wound Care Product Formulary.

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.