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.

"Sandwich" wound dressing to reduce surgical site infections during sacrococcygeal surgery: A retrospective analysis.

OBJECTIVE: To explore whether the "sandwich" wound dressing method with a hydrocolloid dressing can effectively reduce surgical site infection rates in sacrococcygeal aseptic operations. METHODS: A retrospective cohort of patients with sacrococcygeal aseptic operations (class I incision category) from January 2017 to March 2018 were divided into intervention (sandwich dressing) and control groups (conventional dressing). The surgical site infections (SSI) rate, wound healing course, hospitalization time, and medical costs in the two groups were determined. To exclude the influence of other factors, operation time, blood loss, age, sex ratio, the distance of the incision from the distal edge to the anus, and initial defecation times were compared between the groups. RESULTS: The SSI rates and medical costs in the interventional group were significantly lower than the control group (0% vs 78.57%, P < 0.0001; 3.27 ±â€¯0.98 vs 5.83 ±â€¯1.66 ¥10,000, p < 0.0001). Hospitalization times were also lower in the intervention compared to the control group (17.05 ±â€¯4.77 vs 34.50 ±â€¯15.47 day, P = 0.001). CONCLUSIONS: The sandwich wound dressing method with a hydrocolloid dressing can effectively prevent SSI during sacrococcygeal aseptic surgery.

A recombinant human collagen hydrogel for the treatment of partial-thickness burns: A prospective, self-controlled clinical study.

INTRODUCTION: Allogeneic and xenogeneic skin are recognized as the best coverings for skin burn wounds, but currently face a supply shortage. To solve this problem, our research group developed a standardized manufactured hydrogel dressing based on a new type of highly bioactive recombinant human collagen. STUDY DESIGN: Prospective self-controlled trial. OBJECTIVE: To evaluate the efficacy and safety of recombinant human collagen hydrogel in the treatment of partial burn wounds to the skin compared to those of xenogeneic skin. METHODS: This study included twenty-one patients admitted to Shanghai Changhai Hospital within 48 h after receiving partial-thickness skin burns. The wounds were symmetrically separated along the axis and treated with recombinant human collagen hydrogel (RHCH) or a human-CTLA4-Ig gene-transferred pig skin xenotransplant. The condition of the wound surfaces was recorded on days 0 (of enrollment), 5, 10, 15, and 20, and bacterial drug sensitivity testing, hematuria examination, and electrocardiographic tests were conducted on days 0, 10, 20, or on the day of wound healing. RESULTS: There were no statistically significant differences in wound healing time between the two groups. The median number of days to healing was 11.00 ± 0.56 for xenogeneic skin vs. 11.00 ± 1.72 for RHCH. CONCLUSION: During the observation period, the therapeutic effect of the RHCH developed by our group on partial-thickness burn wounds was not significantly different from that of gene-transferred xenogeneic skin. Thus, our designed RHCH shows potential for clinical use to treat burn wounds on the skin.

In Vitro Characterization of Pressure Redistribution Among Commercially Available Wound Dressings.

OBJECTIVE: Recent clinical evidence has suggested that certain wound dressings may play a significant role in protocols to prevent or reduce pressure injury (PI) in patients at risk by modifying the pressure, friction, and shear forces that can contribute to PI. The aim of this study was to investigate the pressure reduction properties of commercially available wound dressings in vitro. METHODS: Using a standardized protocol (1.7 kg, 7.5-cm sphere), testing was performed in a controlled environment by the same clinician using a pressure mapping device (XSENSOR LX205; XSENSOR Technology Corporation, Calgary, Alberta, Canada) to measure and compare the pressure mitigation properties in a variety of wound dressings. RESULTS: A total of 13 different commercially available dressings were tested in triplicate for changes in pressure redistribution as compared with the control. One dressing demonstrated the greatest reduction of pressure forces (OxyBand PR; 50.33 ± 1.45 mm Hg) compared with the control (302.7 ± 0.33 mm Hg) and the greatest surface area of all the study dressings tested. There was a negative correlation (R2 = 0.73) between the average pressure distribution of a wound dressing and its contact area. Further, the peak pressure for OxyBand PR (P ≤ .05) was significantly different from all other tested dressings. CONCLUSIONS: One dressing (OxyBand PR) provided superior pressure redistribution and significantly reduced peak pressure in this study when compared with currently available standard foam and silicone dressings that are marketed for the purpose of PI prevention.

Clinical and Economic Impact of Wound Care Using a Polyurethane Foam Multilayer Dressing.

OBJECTIVE: To study the impact of a newly introduced dressing on efficiency and quality of care in routine clinical practice in a Spanish community setting. DESIGN AND SETTING: An ambispective multicenter observational study was conducted in 24 primary care centers and 6 nursing homes in 4 different Spanish regions. The study was carried out between November 2017 and March 2019. PATIENTS AND INTERVENTION: A total of 128 wounds in 94 patients (primary care, n = 79; nursing home, n = 15) were analyzed before and 4 weeks after switching to the study dressing. OUTCOME MEASURES: Frequency of dressing changes; secondary outcomes were change in the mean wound area and weekly cost and patient and provider satisfaction. MAIN RESULTS: The mean number of dressing changes was significantly reduced with the study dressing from 3.14 ± 1.77 changes per week to 1.66 ± 0.87 (P < .001), a 47.1% reduction in frequency. Wound area significantly reduced from 9.90 ± 19.62 cm to 7.10 ± 24.33 cm. In addition, a 58.7% reduction in weekly costs was achieved with the intervention. Patients and providers agreed that their satisfaction with wound care improved. CONCLUSIONS: The use of the study dressing in routine clinical practice could lead to a major improvement in both efficiency and quality of wound care. Its use could reduce wound care-related costs through improvements in healing and a reduced frequency of dressing changes. It also enhanced the wound care experience from the perspective of both patients and providers.

The Effect of Chitosan in Wound Healing: A Systematic Review.

OBJECTIVE: To systematically review the effectiveness of chitosan in wound healing. DATA SOURCES: References were retrieved from PubMed, EMBASE, the Cochrane library, and Web of Science based on Medical Subject Headings and keywords ("chitosan" OR "chitin" OR "poliglusam" AND "wound healing"). STUDY SELECTION: Eligible articles were randomized controlled trials (RCTs) that required interventions for chitosan and its derivative dressings and included endpoints associated with wound healing. In summary, five RCTs (N = 319) were included in the final analysis. DATA SYNTHESIS: Only two RCTS (40%) reported significant beneficial effects of chitosan on wound healing compared with conventional gauze dressings (eg, tulle gras, petroleum jelly). The remaining three studies reported that chitosan had no significant effect on clinical wound healing compared with other biologic dressings (eg, alginate, hydrocolloid). CONCLUSIONS: Although the number of trials of new chitosan dressings has been increasing, studies on the relationship between chitosan and wound healing have been limited. Current data suggest that chitosan does not slow wound healing. However, the small number of available trials restricted adequate interpretation of the existing results. Future research needs to be rigorously designed to confirm any clinically relevant effect of chitosan in wound healing.

A bio-degradable synthetic membrane to treat superficial and deep second degree burn wounds in adults and children - 4 year experience.

INTRODUCTION: A new bio-degradable synthetic membrane was recently introduced to treat second degree burns in adults and pediatric patients. OBJECTIVE: To assess complications and outcomes using this absorbable synthetic membrane to treat second degree burns. METHODS: 229 burn patients, 138 pediatric, with superficial and deep second -degree wounds, treated with the absorbable synthetic membrane (Suprathel®, Polymedics, Denkendorf, Germany) were included in this study. Patients were treated under anesthesia or moderate sedation. The wound bed was prepared by using either rough debridement or dermabrasion excision. After hemostasis, the membrane was applied to the wound with an outer layer dressing of fatty gauze, bridal veil, absorptive gauze and an ACE® wrap. The outer dressing was removed every one to four days, depending on exudate, in order to closely follow the wound through the translucent membrane and fatty gauze layers. After complete epithelialization, the dressing separated and could be removed. The study focused on the need for subsequent grafting, healing time, patient pain level, hypertrophic scarring and rate of infection. RESULTS: All wounds in this study that were treated with Suprathel® healed without grafting. The average TBSA (Total Body Surface Area) was 8.9% (1%-60%). Average time to healing was 13.7 days for ≥ 90% epithelialization with 11.9 days for pediatric patients versus 14.7 days for adults. Throughout the treatment period, the average pain level was 1.9 on a 10-point scale. 27 patients developed hypertrophic scarring in some areas (11.7%). Average Length of stay (LOS) was 6.9 days. The rate of infection was 3.8% (8/229). Failure or progression to full thickness in part of the wounds was 5.2% (12/229). CONCLUSION: In treating second degree burn wounds, this membrane provides a simple, effective solution alternative with good outcomes and less pain than conventional and previously studied treatment options in the same institution. Fewer dressing changes and easier overall management of the wounds contribute to its favorable profile.

Cost-effectiveness of TLC-sucrose octasulfate versus control dressings in the treatment of diabetic foot ulcers.

OBJECTIVE: Diabetes is one of the most widespread diseases in Germany. Common complications are diabetic foot ulcers (DFU), which are associated with a cost-intensive treatment and serious adverse events, such as infections, amputations. This cost-effectiveness analysis compares two treatment options for patients with DFU: a TLC-NOSF dressing versus a neutral dressing, assessed through a European double-blind randomised controlled trial (RCT), Explorer. METHODS: The evaluation of the clinical outcomes was associated to direct costs (costs for dressings, nursing time, hospitalisation etc.) of both dressings, from the perspective of the statutory health insurance in Germany. Due to the long mean healing time of a DFU, the observation period was extended from 20 to 100 weeks in a Markov model. RESULTS: After 20 weeks, and with complete closure as a primary endpoint, the model revealed direct treatment costs for DFU of €2,864.21 when treated with a TLC-NOSF dressing compared with €2,958.69 with the neutral control dressing (cost-effectiveness: €6,017.25 versus €9,928.49). In the Markov model (100 weeks) the costs for the TLC-NOSF dressing were €5,882.87 compared with €8,449.39 with the neutral dressing (cost-effectiveness: €6,277.58 versus €10,375.56). The robustness of results was underlined by several sensitivity analyses for varying assumptions. The frequency of weekly dressing changes had the most significant influence in terms of parameter uncertainty. CONCLUSION: Overall, the treatment of DFU with a TLC-NOSF dressing is supported from a health economic perspective, because both the treatment costs and the cost-effectiveness were superior compared with the neutral wound dressing.

Use of a Hydrocolloid Dressing in the Prevention of Device-related Pressure Ulcers During Noninvasive Ventilation: A Meta-analysis of Randomized Controlled Trials.

Use of a hydrocolloid dressing (HCD) is generally recommended to help prevent pressure ulcers (PUs) in high-risk patients, including ulcers caused by noninvasive ventilation (NIV). PURPOSE: The study was conducted to compare the effect of preventive use of HCD to other methods in the rate of facial PUs caused by NIV. METHODS: PubMed, Web of Science, China National Knowledge Infrastructure, and Wanfang Data were searched from date of index inception to August 2018 without language restrictions to identify randomized controlled trials (RCTs) that compared HCD use to other NIV-related PU prevention measures. Publications were systematically reviewed, data were extracted, and study quality was assessed using the Jadad scale. Odds ratio (OR) with 95% confidence intervals (CIs) for PU incidence in patients using HCD versus patients managed with gauze or standard skin care procedures (control) were calculated using a fixed-effects model. RESULTS: The search yielded 80 publications; 40 met the study criteria for full-text and 22 met the meta-analysis inclusion criteria (total study participants = 2519). Patients who used a HCD (n = 1260) had a significantly decreased incidence of PU (OR = 0.15; 95% CI: 0.11-0.20) compared with control group patients (n = 1259). Subgroup analysis by age showed a lower incidence in children (OR = 0.09; 95% CI: 0.01-0.81) and adults (OR = 0.16; 95% CI: 0.12-0.22) in the HCD group than in the control group. PU incidence using HCD was lower compared to gauze (OR = 0.17; 95% CI: 0.10-0.28) and regular skin care (OR = 0.13; 95% CI: 0.09-0.19). Funnel plot diagrams suggested a risk of bias. Sensitivity analysis using a random-effects model did not change the result of the main meta-analysis. CONCLUSION: Using a HCD significantly decreased the incidence of facial PUs caused by NIV. Additional high-quality, prospective research to confirm the effectiveness of HCD in preventing NIV-related PUs is warranted.

Absorption Capacity of Wound Dressings: A Comparative Experimental Study.

In this study, absorption capacity of the most commonly used types of wound dressings was measured with an objective, quantifiable, and easily reproducible method. The use of objective measurements allowed us to perform an objective comparison of the capacity of the different types of dressings. An experimental study was performed, in which the absorptive capacity of polyurethane foams, alginate, hidrofiber, and hydrocolloid dressings was measured by using a methodology designed by the researchers. Polyurethane foams showed a higher absorption capacity than hidrofibers, alginates, and hydrocolloids when using a similar surface of dressing. A modification of dressing size after saturation was also observed, increasing its size in the case of foams and decreasing or maintaining it in the case of hidrofibers, alginates, and hydrocolloids. The results of this study show a better wound exudate management for polyurethane foams. However, when deciding which dressing to use for a specific wound, absorption capacity is not the only quality that should be taken into account, as other properties should also be considered.

Pilot study of homologous platelet gel in venous ulcers.

BACKGROUND:: Venous ulcers represent 70% of the lower limb ulcers. They are difficult to heal, requiring a correct diagnostic and therapeutic approach. Many products have been developed to healing, such as homologous platelet gel obtained from the platelet concentrate exceeding from blood transfusion. OBJECTIVE:: To evaluate the safety and efficacy of homologous platelet gel in venous ulcers compared with hydrocolloid dressing. METHOD:: A pilot randomized clinical trial in patients with venous ulcers. Randomized groups (homologous platelet gel and hydrocolloid groups) were followed for 90 days and were assessed through the evolution of ulcerated area, qualitative analysis of vascularization and adverse events. Both groups used elastic compression. RESULTS:: We included 16 participants, with a total of 21 venous ulcers. Both treatments promoted a reduction of the areas of the ulcers in 90 days (mean 69%), there was significant difference between the groups concerning the gradual reduction of the ulcers areas, favorably to the hydrocolloid (70% vs 64%; p <0.01). There were some mild adverse events in both groups. STUDY LIMITATIONS:: Single-center study with a small number of patients, preventing more accurate assessment of the effects of platelet gel. CONCLUSION:: The homologous platelet gel associated with the elastic compression can be an alternative to the venous ulcer treatment and is safe due to the occurrence of a few mild local adverse events and no serious adverse events. Clinical trials with larger numbers of patients must be performed to maintain the indication of this treatment for venous ulcer.

Pilot study of homologous platelet gel in venous ulcers

Abstract: Background: Venous ulcers represent 70% of the lower limb ulcers. They are difficult to heal, requiring a correct diagnostic and therapeutic approach. Many products have been developed to healing, such as homologous platelet gel obtained from the platelet concentrate exceeding from blood transfusion. Objective: To evaluate the safety and efficacy of homologous platelet gel in venous ulcers compared with hydrocolloid dressing. Method: A pilot randomized clinical trial in patients with venous ulcers. Randomized groups (homologous platelet gel and hydrocolloid groups) were followed for 90 days and were assessed through the evolution of ulcerated area, qualitative analysis of vascularization and adverse events. Both groups used elastic compression. Results: We included 16 participants, with a total of 21 venous ulcers. Both treatments promoted a reduction of the areas of the ulcers in 90 days (mean 69%), there was significant difference between the groups concerning the gradual reduction of the ulcers areas, favorably to the hydrocolloid (70% vs 64%; p <0.01). There were some mild adverse events in both groups. Study limitations: Single-center study with a small number of patients, preventing more accurate assessment of the effects of platelet gel. Conclusion: The homologous platelet gel associated with the elastic compression can be an alternative to the venous ulcer treatment and is safe due to the occurrence of a few mild local adverse events and no serious adverse events. Clinical trials with larger numbers of patients must be performed to maintain the indication of this treatment for venous ulcer.

Quality of wound dressings: a first step in establishing shared criteria and objective procedures to evaluate their performance.

OBJECTIVE: There are no well-defined criteria for assessing the efficacy and quality of wound dressings, and evaluation is often simplistic and based on the subjective opinion of the health-care professional. The aim of this study was to identify specific parameters suitable for measuring dressings' performance, and to recommend laboratory tests able to evaluate these specific criteria in an objective manner. METHOD: After reviewing all tests currently used in Italy and examining the criteria for evaluating the quality of dressings, the authors selected 12 clinically significant parameters. These parameters were measured using standard and non-standard tests, and in some cases, these tests were modified and improved to simulate real-life conditions more accurately. RESULTS: Most of the tests used were able to discriminate well between dressings belonging to different brands, with some tests being more suitable than others for the assessment of specific dressings. CONCLUSION: These results highlighted some issues in the standard testing procedures, such as the need of a suitable fluid that mimics the real exudate, and the importance of standard temperature and humidity conditions during testing. Our study paves the way for a larger project aimed at a systematic evaluation of dressing quality able to assess every wound dressing on the market.

Clinical acceptability of a dressing with matrix technology: a multisite evaluation of acute and chronic wounds.

OBJECTIVE: This article will describe the findings of an evaluation on the performance and clinical acceptability of Urgotul Absorb Border (Urgo Medical), a silicone border adhesive foam dressing containing technology lipidocolloid (TLC) healing matrix technology, as either a primary or secondary dressing in the management of acute and chronic wounds in a multisite evaluation. The purpose of the evaluation was to establish the effectiveness of the silicone border dressing for managing exudate, ease of use, patient comfort and acceptability of the clinician for the dressing to meet with treatment objectives Method: The patient experiences given through verbal or written feedback were also documented. Local Health Board evaluation forms were used to capture data and the authors of this article created a data evaluation tool to collate and subsequently report all study findings. RESULTS: A total of 100 patients with wounds considered suitable for the application of the dressing were selected to take part in the study. In less than a four week period, 38 patients achieved wound healing with a further 36 patients demonstrating wound improvements within the same time period. CONCLUSION: The dressing was found to have met both the clinicians and patients aims when used as either a primary or secondary dressing and was considered suitable for use in both acute and chronic wounds of varying duration.

Evaluation of effectiveness of hydrocolloid dressing vs ceramide containing dressing against pressure ulcers.

OBJECTIVE: Pressure Ulcers (PUs) often is an indication of quality of nursing care as it remains as severe manifestation of the integrity of impaired skin. Our study designed to evaluate the effectiveness of hydrocolloid dressings and ceramide dressings in healing of PU. PATIENTS AND METHODS: The study was done at Chinese hospital between Feb 2014-November 2014. 72 study group patients and 25 control group patients were included in the study. The study group patients were divided into Group A with 24 patients received only ordinary hydrocolloid dressings, Group B with 24 patients who ceramide containing hydrocolloid dressings and Group C with 24 patients received both hydrocolloid and ceramide dressings. Dressings were applied for 4 weeks. The dressings were changed every 10 days and skin conditions such as pH of the skin, hydration are measured by capacitive method. RESULTS: Among 72 study population 48 (66.7%) were male and 24 (33.3%) were females. Group A with 18 (75%) males and 6 (25%) females, group B with 20 (83.3%) males and 4 (16.7%) females, and group C with 10 (41.7%) males and 14 (58.3%) females. 25 Control group patients with 8 (32%) males and 16 (68%) females. Erythema seen in 4/24 (16.67%) group A patients, group B and C patients had 1/24 (4.17%) erythema. In control group patients 6/25(24%) developed erythema. CONCLUSIONS: In our study, we evaluated the effectiveness of the hydrocolloid dressings and ceramide containing dressings in which ceramide containing dressings showed effective prevention and water holding capacity. Our study highlights that ceramide containing dressings found to be more effective in reducing erythema and improving the healing of PU.

Enhancing pressure ulcer prevention using wound dressings: what are the modes of action?

Recent clinical research has generated interest in the use of sacral wound dressings as preventive devices for patients at risk of ulceration. This study was conducted to identify the modes of action through which dressings can add to pressure ulcer prevention, for example, shear and friction force redistribution and pressure distribution. Bench testing was performed using nine commercially available dressings. The use of dressings can reduce the amplitude of shear stress and friction reaching the skin of patients at risk. They can also effectively redirect these forces to wider areas which minimises the mechanical loads upon skeletal prominences. Dressings can redistribute pressure based upon their effective Poisson ratio and larger deflection areas, providing greater load redistribution.

Curativo da área doadora de enxerto de pele parcial com curativo de colágeno e alginato (Fibracol®): uma experiência de 35 pacientes / Wound management of partial-thickness skin-graft donor areas with a collagen and alginate dressing (Fibracol®): findings in 35 patients

INTRODUÇÃO: O objetivo deste estudo é relatar a nossa experiência com curativo de colágeno e alginato (Fibracol®) para cobrir áreas doadoras de enxerto de pele de espessura parcial. MÉTODO: Estudamos, retrospectivamente, 35 prontuários de pacientes que utilizaram o Fibracol® em áreas doadoras. Nossa rotina para cobrir a área doadora é a seguinte: cobertura da área com uma ou mais unidades de Fibracol® e, em seguida, com uma película à prova de água. Depois de três ou quatro dias, remover o curativo, limpar delicadamente com soro fisiológico e gaze e, quando julgava-se necessário, cobria-se novamente. A idade média foi de 25,52 anos (1-65). RESULTADOS: A coxa foi usada como área doadora em 29 pacientes, o braço em 2, a perna em 4 e tronco em 3 (2 pacientes tiveram mais de uma área doadora). O tempo médio necessário para epitelização foi de 4,51 dias (3-8). O valor de R do coeficiente de correlação de Pearson correlacionando a idade e tempo de epitelização foi -0,0755, com p = 0,6685. Nenhum dos pacientes teve infecção na área doadora. O curativo ideal para a área doadora do enxerto de pele de espessura parcial teria muitas características, incluindo: preço baixo, bom conforto do paciente, baixa taxa de infecção, período curto de tempo para epitelização, etc. CONCLUSÃO: Os autores relatam uma boa experiência usando Fibracol® em 35 pacientes, durante um período de 22 meses. O tempo para epitelização foi de 4,51 dias, mais curta do que a maioria dos trabalhos publicados, e não tinha correlação com a idade do paciente.

INTRODUCTION: The objective of this study was to report our findings with a collagen and alginate dressing (Fibracol®) used to cover donor areas of partial-thickness skin grafts. METHOD: We retrospectively evaluated the medical records of 35 patients in whom Fibracol® was used on donor areas. The routine used to manage the donor area is as follows: The area is covered with one or more units of Fibracol®, followed by application of a waterproof film. After three or four days, the dressing is removed and the area cleaned gently with saline and gauze; the area is dressed again if necessary. The mean patient age was 25.52 years (range, 1-65 years). RESULTS: The thigh was used as the donor area in 29 patients, the arm in 2, the leg in 4, and the trunk in 3. Two patients had more than one donor area. The mean time needed for epithelization was 4.51 days (range, 3-8 days). The Pearson correlation coefficient value correlating age and time of epithelization was -0.0755; p = 0.6685. None of the patients experienced an infection in the donor area. The ideal dressing for the donor area of split-thickness skin grafts would have multiple characteristics including low price, good patient comfort, low infection rate, and a short epithelization period. CONCLUSION: The authors report a positive experience with the use of Fibracol® in 35 patients over a period of 22 months. The mean epithelization period was 4.51 days, shorter than that in the majority of published studies, and had no correlation with the age of the patient.

Sodium carboxymethylcellulose scaffolds and their physicochemical effects on partial thickness wound healing.

This study investigated critical physicochemical attributes of low (LV), medium (MV) and high molecular weight (HV) sodium carboxymethylcellulose (SCMC) scaffolds in partial thickness wound healing. SCMC scaffolds were prepared by solvent-evaporation technique. Their in vitro erosion, moisture affinity, morphology, tensile strength, polymer molecular weight and carboxymethyl substitution, and in vivo wound healing profiles were determined. Inferring from rat wound size, re-epithelialization and histological profiles, wound healing progressed with HV scaffold>LV-MV scaffold>control with no scaffold. The transepidermal water loss (TEWL) from wound of rats treated by control>HV scaffold>LV-MV scaffold. HV scaffold had the highest tensile strength of all matrices and was resistant to erosion in simulated wound fluid. In spite of constituting small nanopores, it afforded a substantial TEWL than MV and LV scaffolds from wound across an intact matrix through its low moisture affinity characteristics. The HV scaffold can protect moisture loss without its excessive accumulation at wound bed which hindered re-epithelialization process. Regulation of transepidermal water movement and wound healing by scaffolds was governed by SCMC molecular weight instead of its carboxymethyl substitution degree or matrix pore size distribution, with large molecular weight HV preferred over lower molecular weight samples.

[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.

Clinical experience with an antimicrobial hydrogel dressing on recalcitrant wounds.

OBJECTIVE: To assess the performance of a newly-introduced, iodine-based antimicrobial wound dressing (Iodozyme) within normal clinical practice. METHOD: 51 case records were collected from 30 wound care locations in England. Reporting clinicians used Iodozyme on one or more difficult wounds of their own choice (of various aetiologies) from their current case loads. Basic patient-specific data were collected, relating to both their own and their patients' experience with the product over a 6-week period of treatment (or less, if healing was achieved earlier). In every case, the wound continued to be treated in accordance with local 'best practice', in accordance with the manufacturer's instructions and by the same clinician. Each wound was assessed in terms of size, condition (margins and wound bed), exudate (type and amount), comfort/pain, overall satisfaction (by patient and clinician) and healing status (in terms of healed, improved, static or deteriorated). In addition, clinicians were asked to use their own local criteria and parameters where possible, with general guidance as and when it was needed. RESULTS: The mean duration of all wounds was 25.8 months (median 13 and range 1-312). Nine patients had a wound of less than six months' duration, and 17 had one of two years' or more duration. Within the 6-week study period, 6 wounds healed fully, 37 were judged to have improved, 7 remained static and 1 deteriorated. Overall, the majority of clinicians and patients were 'satisfied' or 'very satisfied' with product performance and 77% of clinicians concluded that the dressing was 'better' or 'much better' than other dressings they had previously used on similar wounds. CONCLUSION: While we cannot generalise from this study, the encouraging clinical results and positive patient and clinician feedback lead us to believe that Iodozyme is a dressing worthy of consideration when treating chronic wounds. These encouraging preliminary findings are now to be followed up with a randomised control trial.