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Normal wound healing follows four distinct phases: haemostasis, inflammation, prolifération and finally, maturation. If any barriers to healing occur within these four phases, the healing process will be delayed or may even stall (Mitchell, 2021). One of the common barriers to healing is hyper or overgranulation, or 'proud flesh'. Hypergranulated wounds can cause concern to both patients and healthcare professionals, and, although common in wound care, there is a limited evidence base and currently no guidelines for management. This article discusses the causes of hypergranulation, with suggestions on how it can be managed. [ABSTRACT FROM AUTHOR]

AIM: The incidence of cancer is increasing on a daily basis. Chemotherapy is one of the methods used in cancer treatment. Chemotherapy is administrated through a peripheral venous catheter. During intravenous chemotherapy, the patient may experience pain and his comfort may deteriorate. This study aimed to determine the effect of two different catheter dressings on the patient's comfort, satisfaction, pain level, and nurse satisfaction. METHODS: A randomized controlled study was designed. Data of the study It was collected between March and June 2022. Participants were patients who were continuing chemotherapy treatment at a university hospital. The sample consisted of 70 (35 + 35) cancer patients. Sociodemographic information form and visual analog scale were used to collect data. RESULTS: There is no difference in the pain level of the masking tape and standard plaster groups. The patient's comfort, satisfaction, and the nurse's use satisfaction were higher in the group where masking tape was used. There is a very strong positive correlation between patient comfort and patient satisfaction in the masking tape group. The effect size of the applied intervention is very weak. (p > .05). CONCLUSION: Masking tape can be applied safely as a peripheral venous catheter dressing. (p < .05). [ABSTRACT FROM AUTHOR]

Pathological scars, including keloids and hypertrophic scars, are best managed by preventative strategies, such as occlusive silicone dressings or gels, or pressure therapies. For established lesions, intralesional corticosteroids, particularly triamcinolone acetonide (TAC) are first-line therapies. Combining TAC with intralesional 5-fluorouracil or non-pharmacological options such as lasers is generally more effective than monotherapy and may be better tolerated. Other treatments include cryotherapy, botulinum toxin type A, and more novel therapies including anti-cancer and anti-inflammatory agents. Well-designed clinical trials are needed to determine the optimal combinations and dosage regimens. [ABSTRACT FROM AUTHOR]

Objectives: Treatment of fingertip amputations is subject of controversial debates. Recently, semi-occlusive dressings have increased in popularity in these injuries. Aims: To compare clinical outcomes of conservative semi-occlusive dressing therapy versus surgical treatment of fingertip amputations. Methods: Eighty-four patients with fingertip amputations were re-examined clinically after a mean follow-up of 28.1 months (range 9.6–46.2). Sixty-six patients (79%) were treated with semi-occlusive dressings (group 1) and 18 (21%) underwent surgery (group 2). Range of motion, grip strength, and two-point discrimination were measured at the final follow-up. Furthermore, VAS score, Quick-DASH score, subjective aesthetic outcome and loss of working days were obtained. Results: Group 1 demonstrated healing in all 66 patients (100%) while in Group 2 5 out of 18 patients (28%) failed to achieve healing after a mean of 17 days (range 2–38) due to graft necrosis. Group 1 showed significantly lower VAS scores and significantly lower loss of two-point discrimination compared to Group 2. Work absence was significantly shorter in Group 1 versus Group 2. Trophic changes in finger (46%) and nail (30%) were significantly lower in Group 1 compared to Group 2 (44% and 70%, respectively). Disturbance during daily business activities (14%) and cold sensitivity (23%) were significantly lower in Group 1 compared to Group 2 (86% and 77%, respectively). Conclusions: Semi-occlusive dressing therapy for fingertip amputations demonstrated excellent healing rates. Compared to surgical treatment, it resulted in significantly better clinical outcomes, lower complication rates and significantly higher reported satisfaction rates. Therefore, semi-occlusive dressing for fingertip injuries is a very successful procedure and shall be preferred over surgical treatment in most cases. Level of evidence: III therapeutic. [ABSTRACT FROM AUTHOR]

Aim: To synthesise evidence related to medical adhesive tapes and supplementary securement products for peripheral intravenous catheters in adults, to prevent complications and device failure. Design: Integrative review informed by Whittemore and Knafl and reported in accordance with the PRISMA 2020 statement. Data sources. The Cochrane Central Register of Controlled Trials, US National Library of Medicine National Institutes of Health, EMBASE/MEDLINE and Cumulative Index to Nursing and Allied Health were searched from 2000–21 September 2020. Review Methods. Studies enrolling hospitalised participants >16 years with peripheral intravenous catheters secured by medical adhesive tapes, or supplementary products (bandage, splint and sutureless securement device), were eligible. Quality appraisal was performed using Critical Appraisal Skills Program checklists. Results: Nineteen studies met criteria, including 43,683 peripheral intravenous catheters. Quality appraisal identified high or unclear risk of bias in 58% of studies. Nonsterile tape was the most common intervention tested (14 studies), alone or in multiproduct combinations. Nonsterile tape directly over insertion sites was associated with increased PIVC failure and complications. Sutureless securement devices potentially reduce failure and complications. Multiproduct combinations were very common. Practice recommendations regarding other tapes and secondary securement products are challenging, due to conflicting, or lack of, evidence. Conclusion: Tapes and secondary securement product evidence are limited, and over half of the studies are of low methodological quality. This review found nonsterile tape was associated with increased failure and complications; multiproduct dressing and securement bundles were prevalent; and significant evidence gaps exist particularly regarding bandages and splints. The results provide nurses with evidence of medical adhesive tapes and supplementary product effectiveness for peripheral intravenous catheter securement, and future research directions to reduce unacceptably high failure and complication rates. Larger rigorously conducted randomised controlled trials are needed to add to current evidence. [ABSTRACT FROM AUTHOR]

Split‐thickness skin grafts (STSG) are widely used in wound reconstruction. However, donor site wounds are created as a result. Traditionally, moist wound healing and transparent film dressings have been used to promote donor site wound healing. This retrospective study evaluated the use of oxidised regenerated cellulose (ORC)/collagen/silver‐ORC dressing (ORC/C/Ag‐ORC) with an absorptive silicone adhesive border dressing and transparent film dressing (treatment) compared with petrolatum‐based gauze dressing (control) over donor site wounds. Patients underwent an STSG procedure between January and December 2020. Donor sites received treatment (n = 10) or control (n = 10) dressings. Dressing changes occurred as necessary. Time to epithelialisation, narcotic pain medication requirements, and the number of office/hospital visits were examined. Twenty patients were managed (9 males, 11 females, average age: 49.7 ± 13.9 y). Patient comorbidities included hypertension, diabetes, and hyperlipidemia. Wound types included traumatic and cancer excision. Time to epithelialisation was significantly reduced in the treatment group (11.1 ± 1.4 d vs 18 ± 2.4 d, P < 0.0001). The number of office visits for dressing changes was significantly lower in the treatment group (0.1 ± 0.3 vs 2 ± 0.7, P < 0.0001). No patients in the treatment group required a hospital visit, compared with 3 patients in the control group. One patient in the treatment group required narcotic pain medication, compared with 5 in the control group. In this patient population, the use of ORC/C/Ag‐ORC, an absorptive silicone adhesive border dressing, and transparent film dressing resulted in a shorter time to epithelialisation and less analgesic requirement compared with petrolatum‐based gauze dressing use. [ABSTRACT FROM AUTHOR]

In the diabetic foot, loss of autonomic nerve supply can alter the vascular perfusion and nerve supply of the skin. This affects the integrity of the skin and its resistance to mechanical and chemical trauma from pressure and wound exudate (Faber et al, 1993). Maceration is a common problem, particularly in the management of chronic wounds (Thomas, 1997). Moreover, diabetic foot ulceration continues to be synonymous with delayed healing, higher infection rates and an increased risk of lower-extremity amputation (Frykberg, 1998). Several factors can affect the local wound environment in diabetic foot ulceration, such as hyperglycaemia, macrovascular and microvascular disease, polyneuropathy, and impaired host immunological defence (Kamal et al, 1996). Maceration of the wound bed and surrounding skin in diabetic foot ulceration may be one of the least well-recognised factors contributing to impaired healing (Cullum et al, 2000). The impact of maceration on skin integrity, and its traditionally poor management and frequency, make it an obvious contender for inclusion as a risk factor in wound care (Cutting and White, 2002b). However, there is little research on the possible implications of maceration in diabetic foot ulceration (Bale et al, 2001). The aims of wound management are to address patient concerns, correct intrinsic and extrinsic factors where possible, and optimise the healing environment. It is also essential to include the periwound margins as an integral part of wound assessment (Cutting and White, 2002a). [ABSTRACT FROM AUTHOR]

Objective: To investigate the role of an adherent soft silicone antimicrobial occlusive foam silver-impregnated dressing for reduction of surgical site infections (SSI) in primary low-transverse caesarean section (1°LTCS) delivery. Method: Women aged 18–45 years admitted to the labour and delivery or the antepartum unit undergoing a 1°LTCS were recruited. Exclusion criteria included repeat caesarean, vertical skin incision, intrapartum fever and closure with staples. Consented participants delivered by scheduled or unscheduled 1°LTCS received the silver-impregnated dressing. Those who declined to participate and were delivered by scheduled or unscheduled caesarean received a standard gauze with tape dressing (controls). Surgical preparation and preoperative antibiotics were administered as per hospital policy. Results: A total of 362 participants were consented for use of the silver-impregnated dressing, with 190 participants undergoing 1°LTCS, of whom 185 were included in the final analysis. Of those who declined to participate, 190 ultimately underwent 1°LTCS during the same time period. Cases and controls were similar in demographics, body mass index, diabetes status, labour and procedure length, and tobacco use. The overall incidence of SSI was 3.7%. A 50% reduction in incidence of SSI was observed in the silver-impregnated dressing group compared with control group (2.7% versus 4.7%, respectively), but this was not statistically significant (p=0.08; odds ratio 0.55; 95% confidence interval: 0.18–1.67). Conclusion: Among women undergoing 1°LTCS with subcuticular closure of a transverse incision, use of a silver-impregnated dressing reduced the rate of SSI by >50% but was not statistically significant. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to explore the efficacy of the IV3000 semi-occlusive, transparent adhesive film dressing in the non-surgical management of simple as well as more complex fingertip injuries. Method: In this qualitative study, patients with fingertip injuries were prospectively recruited and treated conservatively with the dressing between 2015 and 2017. Inclusion criteria included any fingertip injury with tissue loss and patient consent for non-surgical treatment consistent with the study protocol. Exclusion criteria included injuries needing surgical intervention for tendon injury or exposure, joint dislocations, distal phalangeal fractures requiring fixation, bone exposure, isolated nail bed lacerations and any patients eligible for surgical repair who did not wish to be managed conservatively. Results: A total of 64 patients took part in the study. The patients treated with the dressing were asked to rate functional outcome, of whom 40 (62.5%) patients reported the outcome as 'excellent', 19 (29.7%) as 'satisfactory', five (7.8%) as 'indifferent' and none (0%) as 'unsatisfactory'. A reduced pulp volume at completion of healing was felt by 21 (32.8%) patients, but all patients were 'satisfied' with the aesthetic appearance of their fingertips at final clinical review. Average healing time was 4.5 weeks across the group, with the average time for return to work being just under one week. We estimate a 60% reduction in cost with the conservative versus the surgical management option. Conclusion: This study showed that, for participants, the IV3000 dressing was an affordable and effective option for the conservative treatment of simple fingertip injuries and in the management of more complex fingertip injuries. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine the cost-effectiveness of the most commonly used type of antimicrobial silver-impregnated occlusive dressing (Aquacel Ag, ConvaTec, Oklahoma City, OK, USA) for prosthetic shoulder infection (PSI) prevention after shoulder arthroplasty. Data regarding the cost of silver-impregnated occlusive dressing, cost to treat a PSI and initial infection rates after shoulder arthroplasty were calculated from available literature. Using a break-even economic analysis, we developed an equation that incorporated these variables to determine the absolute risk reduction (ARR) in infection rate required to make the use of this dressing cost-effective. To provide a widely applicable and reusable model, multiple simulations were performed at varying unit costs, infection rates, and PSI-related care costs. At a dressing cost of $34.00 and presuming a cost of $50,230 for treating a PSI, these dressings are considered cost-effective if their use prevents at least 1 infection in 1471 TSA (ARR of 0.068% from the initial infection rate of 0.7%). The cost-effectiveness of this dressing was maintained through a realistic range of dressing and PSI treatment costs, while initial infection rate was found not to influence cost-effectiveness. Antimicrobial silver-impregnated occlusive dressings represent a cost-effective infection prevention strategy after shoulder arthroplasty. The presented model serves as a useful resource to aid in weighing the economic effects of implementing any potential prophylactic measures aimed at minimizing infections after shoulder arthroplasty. Level IV; Economic Decision Analysis [ABSTRACT FROM AUTHOR]

Soft silicone’s flexibility, adhesive capacity and non-toxic, nonodourous and hypoallergenic nature have made it an established material for adhesive and protective therapeutic devices. In wound care, silicone is a component of contact layer dressings for superficial wounds and silicone gel sheeting for reducing the risk of scarring, as well as of barriers for incontinence-associated dermatitis. Regarding stoma accessories, silicone is established in barrier films to prevent contact dermatitis, adhesive removers to prevent skin stripping and filler gels to prevent appliance leaks. Until recently, silicone has not been used in stoma appliances flanges, as its hydrophobic nature has not allowed for moisture management to permit transepidermal water loss and prevent maceration. Traditional hydrocolloid appliances manage moisture by absorbing water, but this can lead to saturation and moisture associated skin damage (MASD), as well as increased adhesion and resultant skin tears on removal, known as medical adhesive related skin injury (MARSI). However, novel silicone compounds have been developed with a distinct evaporation-based mechanism of moisture management. This uses colloidal separation to allow the passage of water vapour at a rate equivalent to normal transepidermal water loss. It has been shown to minimise MASD, increase wear time and permit atraumatic removal without the use of adhesive solvents. Trio Healthcare has introduced this technology with a range of silicone-based flange extenders and is working with the University of Bradford Centre for Skin Sciences on prototype silicone-based stoma appliance flanges designed to significantly reduce the incidence of peristomal skin complications, such as MARSI and MASD. It is hoped that this will also increase appliance wear time, reduce costs and improve patient quality of life. [ABSTRACT FROM AUTHOR]

Each person with a stoma is an individual who may react differently when faced with similar situations and, as such, each patient needs to be considered on a person-by-person basis to address their needs, support their acceptance of living with a stoma, as well as to encourage their rehabilitation. This article discusses the benefits that a convex flange can offer ostomates to reduce and minimise leakage episodes and in doing so support peristomal skin integrity and, in particular, the benefits of a convex pouch with a hydrocolloid flange containing medical grade Manuka honey. It reports on the findings of an independent nurse study, which included discussions about the varying types of convexity offered to ostomates, following an assessment of patients' needs. [ABSTRACT FROM AUTHOR]

Skin substitutes are considered a useful alternative for occlusive dressings in the treatment of superficial burns as they reduce the frequency of dressing replacement. This phase II randomized controlled trial aimed to evaluate the efficacy of Nile tilapia (Oreochromis niloticus) skin as an occlusive xenograft dressing for the treatment of burn wounds in humans. In order to assess the use of tilapia skin, the following variables were evaluated: number of days for wound healing, the number of times the occlusive dressing was changed, use of anesthetics or analgesics, pain assessment using the Visual Analogue Scale, and evaluation of burn improvement on the day of dressing removal. In total, 62 participants completed the study. It was found that in participants treated with tilapia skin, complete reepithelialization occurred in significantly fewer days; reported pain intensity was lower (study arms B and C), the amount of anesthetics/analgesics required was lower (study arms B and C), and the necessity of dressing changes was significantly reduced in comparison with volunteers treated with silver sulfadiazine. In our study, the tilapia skin xenograft showed good efficacy as an occlusive biological dressing for burn wound treatment in humans. [ABSTRACT FROM AUTHOR]

Sinopsis: La región de América Latina y el Caribe tiene el mayor índice de partos por cesárea del mundo. El dato no es novedoso, pero los riesgos de infección relacionados con esta operación siguen generando preocupación. Sobre todo, en tiempos donde la resistencia a los antibióticos es considerada una de las mayores amenazas para la salud mundial. En Reino Unido, una conferencia sobre prevención de infecciones postparto resaltó esta problemática, presentó las últimas técnicas para el manejo y prevención de infecciones quirúrgicas después de una cesárea, y recomendó diferentes apósitos a la hora de elegir un tratamiento que no favorezca la resistencia a los antibióticos. La necesidad de enfrentar los desafíos que presentan las infecciones postparto, sumada a la importancia de contar con profesionales de la salud entrenados en el cuidado de las heridas y la selección de apósitos, fueron los mensajes claves. The Latin America and Caribbean region has the highest rates of caesarean deliveries in the world. The data is not new, but the risks of surgical site infection (SSI) associated with this practice continue to generate concern—especially, in times where antibiotic resistance is considered one of the greatest threats to global health. In the UK, a conference on prevention of postpartum infection highlighted this issue, presenting the latest techniques in the management of SSI and introducing different types of dressings when choosing a treatment that does not favour resistance to antibiotics. The need to take action and face the challenges around postpartum infection, coupled with the importance of having health professionals trained in wound care and dressing selection, were among the key takeaway messages. [ABSTRACT FROM AUTHOR]

Clinical practice must be based on evidence. When evidence suggests that a certain practice may be ineffective or even harmful, that practice should be discontinued. The Choosing Wisely campaign, an initiative of the ABIM (American Board of Internal Medicine) Foundation, is intended to bring attention to tradition-based practices, or "sacred cows," which lack evidence to support their ongoing use. The complex process of discontinuing or reducing the use of tradition-based practices is known as "de-implementation." Recognizing the importance of de-implementation is necessary to fully understand evidence-based practice. This article explores the de-implementation process, examining its barriers and facilitators. Three critical care exemplars of tradition-based practices are presented and examined through the lens of de-implementation. Barriers and facilitators related to de-implementing these tradition-based practices are described, with an emphasis on the roles of various stakeholders and the need to overcome cognitive dissonance and psychological bias. [ABSTRACT FROM AUTHOR]

The article discusses techniques for treating acute wounds. Methods for appropriate cleansing, debridement, and dressing of wounds are noted. The author suggests that wounds should be irrigated with saline or tap water, that dead, contaminated or adherent tissue or foreign material should be removed as soon as possible, and that semi-occlusive or occlusive dressings speed the healing process and reduce the risk of infection.

Objective: Negative pressure wound therapy (NPWT) is considered to be an effective technique to promote the healing of various wounds. The aim of this study was to evaluate different wound dressings combined with NPWT in treating wounds in Wuzhishan pigs. Method: Excisions were made in the backs of the pigs and were covered with polyvinyl alcohol (PVA) dressing, polyurethane (PU) dressing or PU dressing with non-adherent membrane (PU-non-ad). NPWT was applied to the wound site. In the control group, basic occlusive dressing (gauze) without NPWT was applied. On days 0, 3, 7, 14, 21 and 28 post-surgery, the wound size was measured during dressing change, and wound healing rate (WHR) was calculated. In addition, blood perfusion within 2cm of the surrounding wound was measured by laser doppler flowmetry. Dressing specimen was collected and microbiology was analysed. Granulation tissues from the central part of the wounds were analysed for histology, vascular endothelial growth factor (VEGF) and cluster of differentiation 31 (CD31) mRNA expression. Results: The PU-non-ad-NPWT significantly (p<0.01) accelerated wound healing in the pigs. Further pathological analysis revealed that the non-adherent membrane effectively protected granulation tissue formation in PU-NPWT treated wounds. The blood perfusion analysis suggested that the non-adherent membrane improved the blood supply to the wound area. Microbiological analysis showed that non-adherent membrane decreased the bacterial load in the PU-NPWT dressing. VEGF and CD31 mRNA expression was upregulated in the wound tissue from the PU-non-ad-NPWT treated groups. Conclusion: In this study, the PU dressing with non-adherent membrane was an ideal dressing in NPWT-assisted wound healing. [ABSTRACT FROM AUTHOR]

Burns represent the fifth most common cause of nonfatal childhood injuries in the world. The Nile tilapia skin (Oreochromis niloticus) is widely available in Brazil and demonstrated, in previous studies, noninfectious microbiota, morphological structure similar to that of human skin, and good outcomes when used as a xenograft for treatment of experimental burns in rats. A 3-year-old boy was admitted to a burn treatment center in Fortaleza, Brazil, with scalds in the left side of the face, neck, anterior thorax, abdomen, and left arm. Involvement of 18% of total body surface area with superficial partial thickness burns was calculated. After local Institutional Review Board approval and written permission from the patient's legal caregiver were obtained, application of tilapia skin as an occlusive dressing was performed. Good adherence of tilapia skin to the wound bed was detected. The patient was discharged from the hospital with a total of 10 days required for the complete re-epithelialization of his superficial partial thickness burn. No adverse effects were noted. We believe that further studies conducted by our researchers will allow this innovative, low-cost, widely available and easy to apply biomaterial to firm itself as a relevant option in the therapeutic arsenal of pediatric burns, producing significant social and financial impact for the health system. [ABSTRACT FROM AUTHOR]

This report describes the use of a transforming powder dressing to treat lower leg surgical wounds occurring in two older patients. Wounds in this location are difficult and slow to heal. Both of these wounds exhibited complete granulation within two weeks of powder application and total healing in under four weeks, all while requiring no patient or nursing wound care. [ABSTRACT FROM AUTHOR]

The article presents a study which evaluated a randomized trial, the incidence of central line-associated bloodstream infections (CLABSI) and the frequency of thrombolytic treatment (TT). Topics discussed include the rates of overall infections and antibiotic use, baseline characteristics of patients, and the ability of investigational medical device (IMD) to reduce CLABSI.

The article presents a case of isolated, non-occlusive necrosis of the distal duodenum and proximal jejunum in an elderly patient, burdened with chronic obstructive lung disease, but without concomitant vascular or gastrointestinal disease. Diagnostic investigations included endoscopy and angio-CT. Surgery was performed and treatment comprised resection of the necrotic parts of the duodenum and jejunum, followed by gastro-jejuno anastomosis and pyloroplasty. Post-operative course was complicated by upper gastrointestinal (GI) bleeding from multiple gastric ulcers, developed due to duodenal juice reflux into the stomach. The bleeding was successfully controlled by intensive conservative treatment with a proton pump inhibitor and somatostatin. Unfortunately, further complications developed, including urinary tract infection, respiratory failure, and sepsis, which eventually caused patient death in the intensive care unit, 2 months after the operation. [ABSTRACT FROM AUTHOR]

Is your patient's nosebleed a self-limiting occurrence, or a sign of something more worrisome? And which treatments are best in which situations? [ABSTRACT FROM AUTHOR]

Outlines the rationale, mechanisms and benefits of occlusive wound management in the U.S. Provision of an appropriate healing environment; Indications of the types of occlusive dressings for the use of transparent films; Characteristics between normal and abnormal symptoms in the wound site.

The correct and effective management of wounds still remains challenging in modern day-by-day practice despite the fact that much effort and attention has been directed toward novel technologies and advanced approaches. As wound healing takes place in four stages, the selection of the appropriate treatment, depending on the respective stage of the patient's wound, is crucial. This article discusses single product wound management by means of case studies, in an attempt to describe a simplified and effective way to manage wounds. [ABSTRACT FROM AUTHOR]

Purpose: In resource-limited settings, up to two-thirds of surgical patients develop surgical site infections (SSIs). Our aim was to implement a multimodal protocol including an occlusive dressing and parental engagement to achieve low SSI rates in patients undergoing elective ambulatory pediatric surgery at a tertiary center in Haiti.Methods: An observational retrospective review of pediatric patients who underwent elective ambulatory procedures from August 2015 to May 2016 following the implementation of a multimodal protocol consisting of: washing and prepping the operative site with chlorhexidine; review of the surgical safety checklist; one dose of cefazolin before incision; after wound closure application of steri strips, gauze, and tegaderm; and with parental engagement maintenance of the dressing until the follow-up visit.Results: We performed 119 procedures in 99 patients. Mean age was 6.2 years. The most common procedure was inguinal hernia repair (66%); 89% of parents returned to clinic with their children for the follow-up visit, which occurred on average on day 7.6 (range 3-40 days). The SSI rate was 1% (CI 0.00-0.03).Conclusion: Implementing a multimodal protocol including an occlusive dressing and parental engagement led to a 1% SSI rate in a resource-constrained setting. [ABSTRACT FROM AUTHOR]

We report successful treatment of a patient, who, during diagnostic angiography, developed an ostial left main coronary artery dissection with stump occlusion of the vessel. First, mechanical circulatory support with an Impella CP device was established. Then, patency of the left coronary system was achieved by placement of stents in the left anterior descending, left circumflex, and left main coronary arteries. On completion of the procedure, left ventricular systolic function, as assessed by echocardiography, was normal. At 24-month clinical follow-up, the patient remains angina-free and well. This is the first reported case of the use of an Impella device to support treatment of iatrogenic left main coronary artery dissection. [ABSTRACT FROM AUTHOR]

Background Heritable pulmonary veno-occlusive disease (PVOD) is linked to mutations in the eukaryotic initiation factor 2 alpha kinase 4 (EIF2AK4 ) gene, leading to a loss of general control nonderepressible 2 ( GCN2). The role of GCN2 expression in pulmonary vascular remodeling remains obscure. We sought to identify specific histologic and biologic features in heritable PVOD. Methods Clinical data and lung histology of 24 PVOD patients (12 EIF2AK4 mutation carriers, 12 non-carriers) were submitted to systematic histologic analysis and semiautomated morphometry. GCN2 expression was quantified by Western blotting in 24 PVOD patients, 44 patients with pulmonary arterial hypertension (PAH; 23 bone morphogenetic protein receptor type II [ BMPR2 ] mutation carriers, 21 non-carriers), and 3 experimental pulmonary hypertension models. Results PVOD patients showed a significant decrease of pulmonary arterial patency ( p < 0.0001) compared with healthy controls. Histology of EIF2AK4 mutation carriers was distinctive from non-carriers regarding (1) arterial remodeling, with significantly more severe intimal fibrosis ( p = 0.001), less severe medial hypertrophy ( p = 0.001), and (2) stronger muscular hyperplasia of interlobular septal veins ( p = 0.002). GCN2 expression was abolished in heritable PVOD ( p < 0.0001), but also importantly decreased in sporadic PVOD ( p = 0.03) as well as in heritable ( p = 0.002) and idiopathic PAH ( p = 0.003); moreover, GCN2 was abolished in 2 experimental pulmonary hypertension models and importantly decreased in 1 model ( p < 0.0001 for all models). Conclusions Pulmonary arterial remodeling in PVOD is present to an important extent. A significant decrease of GCN2 expression is a common denominator of all tested groups of PVOD and PAH, including their respective experimental models. Our results underline specific morphologic and biologic similarities between PAH and PVOD and let us consider both conditions rather in one large spectrum of disease than as two distinct and clear-cut entities. [ABSTRACT FROM AUTHOR]

In type II sockets, the soft-tissue level is at or coronal to the cementoenamel junction, and part of the buccal plate is missing. In the esthetic zone, a patient with this type of situation often is not a good candidate for immediate implant placement until the osseous defect is repaired. Therefore, use of a conservative regenerative procedure to repair such a defective socket would be advantageous. The Cytocone procedure utilizes a nonresorbable dense polytetrafluorethylene (d-PTFE) barrier and modifies the classic "ice cream cone" technique to restore a buccal osseous defect without raising a labial flap. This article describes and illustrates the Cytocone procedure. [ABSTRACT FROM AUTHOR]

Background: The concept of endovascular intervention has been well supported by the continuous advance in technology in long segment (superficial femoral artery) SFA occlusions. The rapid evolution of stent design, deployment approaches and adjunctive therapy made the practice of (percutaneous transluminal angioplasty) PTA safer and more predictable and has reduced superficial femoral artey surgery. Objectives: To compare the safety and effectiveness of endovascular treatment versus open surgical bypass in treatment of superficial femoral artery occlusive disease. Patients and Methods: This prospective study included 30 patients presenting to the Vascular Department in Cairo University Hospitals with femoropopliteal occlusive disease for whom percutaneous transluminal angioplasty with or without stenting was done for 15 cases. Femoropopliteal bypass surgery with saphenous or synthetic graft was done for 15 cases between March 2017 and January 2018. The procedure, possible complications, benefits, risks and other alternative interventions were all explained to the patients and an informed consent was obtained. Results: In endovascular cases: 1/15(6.66%) cases, developed small haematoma at the site of puncture which resolved by conservative management. After 6 months follow up, 6/15 cases (40%) had intact pedal pulsation, 6/15 cases (40%) had popliteal pulsation with marked improvement of their complaints (disappearance of rest pain in 3 cases, the other 3 cases which had gangrene, line of demarcation appeared). 1/15 case (6.66%) showed popliteal pulse at 3 months follow up which disappeared at 6 months but the patient had good circulation with improvement of rest pain. So, successful cases were 13/15(86.66%) at 6 months follow up. 2/15 cases(13.33%) showed occlusion, by Duplex 1 case of them showed occlusion of stent and 1 case showed return to original occlusion. In open surgical cases: Postoperative wound infection at groin incision developed in 3/15(20%) cases, 2 cases of them were managed conservatively by IV antibiotic and repeated dressing, and one developed secondary haemorrhage in which ligation of femoral artery was done and the limb became gangrenous and Above knee amputation was done. After 6 months follow up, 5/15 cases (33.33%) had intact pedal pulsation, 7/15 cases (46.66%) had popliteal pulsation with marked improvement of their complaints. Disappearance of rest pain occurred in 3 cases, while 3 cases which had gangrene, line of demarcation appeared and 1 case which had non healing ulcer, healing of ulcer started to occur. So successful cases 12/15(80%) at 6 months follow up. Thus, 3/15 cases (20%) failed, 1 case developed wound infection at groin incision followed by secondary haemorrhage in which ligation of the graft was done, the limb was worsen ended in above knee amputation. The other 2 cases showed occlusion of graft, 1 case ended in above knee amputation, the other below knee amputation was done in which the stump became gangrenous followed by above knee amputation. Conclusion: Percutaneous transluminal angioplasty (PTA) has obtained a definite place in the management of peripheral arterial occlusive disease of the lower limb. It was widely accepted as a first line of treatment for many patients with SFA occlusive disease. The low complication rate and relatively non-invasive nature of PTA made it an increasing popular intervention. [ABSTRACT FROM AUTHOR]

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Scopo: management of distal phalangeal amputations depends on its level. When the nail is intact, it's necessary to preserve it but when the lesion is more proximal, maintaining the nail is normally useless and hypersensitivity or pain may appear: so it's preferable to remove the small part of the nail with its root and cover it with a split thickness skin graft. Aim of this work is to demonstrate the effectiveness of Ozoile®-based dressings for the treatment of fifth finger distal phalanx amputation with nail residue preservation. Metodi: parcel amputation of the fifth finger distal phalanx including the nail (Allen 3) in a 7-year-old girl, due to a domestic accident; the amputated part had partial nail residue. After RX showing partial amputation of the distal phalanx bone as well, the patient underwent skin grafting with the amputated phalanx and preservation of a minimal residue of the nail root. Medication with spray and gauzes containing Ozoile®, a pool of stable ozonides derived from olive oil*. Dressing change every 48 hours. We evaluated infection signs onset, pain and Healing Time. Risultati: Complete healing within one month (HT 28 days); pain was greatly reduced already after the first medications (NRS <4). Once healed, a sensitivity check was performed which revealed a complete recovery of neurosensory activity. Conclusioni: Contrary to the surgical treatment indications, we observed the effectiveness of Ozoile®-based dressings in the treatment of the fifth finger distal phalanx amputation even if there's a nail residue. * Rigenoma Spray/Gauzes (Erbagil-Italy) [ABSTRACT FROM AUTHOR]

Introduction: Published experience describing the use of Biobrane® for wound management in Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis (SJS-TEN) is limited to case reports and case series involving ten or fewer patients. We have used Biobrane® in the care of SJS-TEN since 2000, and the purpose of this study was to review our experience with the application of Biobrane® for wound coverage in SJS-TEN.Methods: A retrospective review of all cases of SJS-TEN admitted to an adult regional ABA-verified burn center between January 1, 2000 and June 1, 2015 was conducted. Biobrane® application was performed at burn center admission. Values are presented as the median (IQR), or mean±SD where appropriate.Results: We identified 42 eligible subjects with SJS-TEN. Biobrane® was applied in 24 subjects. Biobrane®-treated subjects had an age of 51.4±21.7years, with a %TBSA epidermal detachment of 39.5 (30-46), 63% were female and the admission SCORTEN was 3 (2-4, range 1-5). Biobrane® was applied at burn center (BC) admission in 18/24 subjects (82%), and between post admission days 1-4 in four subjects. Biobrane® was applied to 35 (22-40) % of the TBSA (range 7-90) involving all anatomic areas including the head and neck. There were no complications, infections, premature removals, or Biobrane®-associated sepsis in 24/25 applications (96%). In one subject a sheet of the TBSS was removed due to sub-Biobrane® fluid collection, but with negative microbiological cultures. Time to healing was 13 (12-16) days, and burn center length of stay was 34 (15.3-62.3) days. Subjects treated with dressings only (n=18) had a significantly smaller %TBSA epidermal detachment [10 (5-22), p<0.001], and were predominantly diagnosed with SJS (50%) or SJS-TEN overlap (33%). Time to healing among dressing-only subjects was not significantly different [12 (10-14.5) days] than among the Biobrane®-treated subjects, (p=0.127).Conclusion: Biobrane® was applied to SJS-TEN subjects with more extensive epidermal detachment, had no significant complications, and generally facilitated epidermal healing in under 2 weeks from application. [ABSTRACT FROM AUTHOR]

Aims and objectives To investigate whether the type of dressing used (occlusive vs. semi-occlusive) impacts on exit-site infection. Background The exit-site infections are a major predisposing factor for peritoneal dialysis-related peritonitis, the main cause of technique failure and an important cause of mortality. The care taken in exit-site dressing is considered an important procedure for the prevention of trauma and contamination of this area. Nevertheless, to our knowledge, no study has yet analysed the impact of different dressing types on early exit-site infection (up to two months after catheter insertion). Design A prospective observational study involving the BRAZPD II (Brazilian Peritoneal Dialysis Multicenter Study) cohort. Methods All incident patients with data available for dressing type applied following peritoneal dialysis catheter insertion were included in the study. A multilevel logistic regression model was used to compare the log-odds of exit-site infections between groups. Results A total of 2460 incident patients were included. Occlusive and semi-occlusive dressings were applied in 82·6% (n = 2031) and 17·4% (n = 427) of patients, respectively. Exit-site infection incidence was not affected by the type of dressing used, with a logit for occlusive dressing of 2·15 (95% CI 0·81-5·70). The combined outcome of exit-site infection and tunnel infection also showed no significance between the groups (logit 1·46, 95% CI 0·72-2·97). Conclusion Our results indicate that the type of exit-site dressing used during the healing phase following peritoneal dialysis catheter insertion has no impact on early exit-site infection rates. Relevance to clinical practice Provides evidence to support the similarity between occlusive and semi-occlusive dressing regarding infection rates in exit site of peritoneal dialysis catheter, therefore allowing the choice to be made accordingly to routine or availability. [ABSTRACT FROM AUTHOR]

Cutaneous myiasis, the infestation of a parasite in the skin, is rarely considered in patients who have traveled solely within North America. While there have been case reports in other parts of Canada, this report outlines the first documented case treated in British Columbia. An 18-month-old toddler, initially misdiagnosed with preseptal cellulitis, was found to have a supraorbital lesion containing a larva of the genus Hypoderma. Relevant clinical history included recent contact with livestock, insect bites surrounding the affected area, and reports of movement within the lesion. On examination, inspecting for a central punctum and observing for larval protrusion was essential for diagnosis. Applying an occlusive dressing can aid in visualization and extraction. Practitioners should familiarize themselves with the signs and symptoms of myiasis and consider this diagnosis for patients in Canada. [ABSTRACT FROM AUTHOR]

ABSTRACT Proteinases are enzymes that can digest other proteins. In chronic wounds, a sub-class of these enzymes with the ability to degrade the extracellular matrix (matrix metalloproteinases, MMPs) have been found to both inhibit healing and to be able to aid in enzymatically debriding a wound. Enzymatic debridement using the enzymes present in a wound is generally called autolytic debridement. Clinicians seeking to employ autolytic debridement typically use occlusive materials such as medical honey, alginate dressings and other occlusive dressings. A relatively new class of gel dressings comprised of surfactants are now available for clinical use. A variety of surfactants are used in the study of MMP biochemistry. Surfactants can deactivate MMPs or can enhance their activity, depending on the surfactant. In order to begin to understand how the MMPs found in chronic wounds would respond to these new dressings, we tested a serial dilution series of two of the currently available surfactant-based dressings to determine their effects on four separate MMPs. The dose-response versus MMP activity of bacterial collagenase, host-derived MMP-8 and MMPs-2 and -9 was assessed using a simple mix-and-read fluorescent peptide activity assay. The enzyme's native activity in the absence of the gel was used to compare against the surfactant-treated samples. We found that the surfactant affected the proteinase activity differently for each enzyme. The activity of the bacterial collagenase was increased at low concentrations but slightly inhibited as the concentrations increased. The host MMP-8 collagenase responded similarly in that it was inhibited at higher concentrations. Interestingly, both MMP gelatinases presented with substantially increased activities, with MMP-2 increased to 200% of native activity, while MMP-9 presented with an increase of 300% activity over the same concentration range. MMPs appear to respond to a surfactant-based gel dressing differentially, with the MMP most commonly elevated in chronic wounds having the highest boost to activity. In wounds with elevated MMPs, our data suggest that the use of these surfactant-based dressings would be expected to enhance the activity of MMPs 2 and 9 gelatinases while simultaneously inhibiting MMP-8 collagenase. Hypothetically, this imbalanced effect would support a protection of the native dermal collagen and removal of denatured materials. However, the demonstration of these anticipated consequences is still being investigated. [ABSTRACT FROM AUTHOR]

Background: Traumatic lacerations to the skin represent a fairly common reason for seeking emergency department care. Although the incidence of lacerations has decreased over the past decades, traumatic cutaneous lacerations remain a common reason for patients to seek emergency department care.Objective: Innovations in laceration management have the potential to improve patient experience with this common presentation.Discussion: Studies have confirmed that delays in wound closure rarely confer increased rates of infection, although comorbidities such as diabetes, chronic renal failure, obesity, human immunodeficiency virus, smoking, and cancer should be considered. Antibiotics should be reserved for high-risk wounds, such as those with comorbidities, gross contamination, involvement of deeper structures, stellate wounds, and selected bite wounds. Topical anesthetics, which are painless to apply, have a role in select populations. In most studies, absorbable sutures perform similarly to nonabsorbable sutures and do not require revisit for removal. Novel atraumatic closure devices and expanded use of tissue adhesives for wounds under tension further erode the primacy of regular sutures in wound closure. Maintaining a moist wound environment with occlusive dressings is more important than previously thought. Most topical wound agents are of limited benefit.Conclusions: Recent innovations in wound closure are allowing emergency physicians to shift toward painless, atraumatic, and rapid closure of lacerations. [ABSTRACT FROM AUTHOR]

Introduction: Multidisciplinary burns care is constantly evolving to improve outcomes given the numerous modalities available. We examine the use of Biobrane, micrografting, early renal replacement therapy and a strict target time of surgery within 24h of burns on improving outcomes of length of stay, duration of surgery, mean number of surgeries and number of positive tissue cultures in a tertiary burns centre.Methods: A post-implementation prospective cohort of inpatient burns patients from 2014 to 2015 (n=137) was compared against a similar pre-implementation cohort from 2013 to 2014 (n=93) using REDCAP, an electronic database.Results: There was no statistically significant difference for comorbidities, age and percentage (%) TBSA between the new protocol and control groups. The protocol group had shorter mean time to surgery (23.5-38.5h) (p<0.002), 0.63 fewer operative sessions, shorter mean length of stay (11.8-16.8 days) (p<0.04), less positive tissue cultures (0.59-1.28) (p<0.03).Discussion/conclusion: The 4 measures of the new burns protocol improved burns care and validated the collective effort of a multi-disciplinary, multipronged burns management supported by surgeons, anesthetists, renal physicians, emergency physicians, nurses, and allied healthcare providers. Biobrane, single stage onlay micrograft/allograft, early CRRT and surgery within 24h were successfully introduced. These are useful adjuncts in the armamentarium to be considered for any burns centre. [ABSTRACT FROM AUTHOR]

Diabetic foot ulceration (DFU) is a particularly challenging wound group in today's healthcare arena, occurring across primary and secondary care settings, resulting in physical, psychological and financial burden to the patient and healthcare provider. According to Edmonds (2007), the most common occurrences that clinicians and patients experience are infection, tissue trauma and deterioration, amputation and resulting disability. Clinicians, healthcare stakeholders and industry, alongside patient focus groups, are constantly seeking new ways of preventing, managing and improving DFU outcomes through exploring new and exciting innovations, such as topical oxygenation therapy as an adjunct to standard care (Norris, 2014; Bateman, 2015; Tickle, 2015). This article will discuss the positive outcomes in relation to wound healing, pain reduction, slough reduction and exudate levels within an acute setting of 20 patients who presented with chronic DFU and who received topical haemoglobin therapy via a spray device, compared with a similar group who received standard care only by the same clinical teams in the same ward environment. [ABSTRACT FROM AUTHOR]

Background Occlusive body wrap using polyethylene plastic applied immediately after birth had been shown to reduce hypothermia among preterm infants. Various adjunct methods have been studied in an attempt to further reduce the incidence of hypothermia. This study was conducted to determine whether polyethylene cap is more effective than cotton cap as an adjunct to polyethylene occlusive body wrap in reducing hypothermia in preterm infants. Methods The subjects consisted of preterm infants 24-34 weeks' gestation born at Universiti Kebangsaan Malaysia Medical Centre. Infants were randomly assigned to NeoCap or control groups. Infants in both groups were wrapped in polyethylene sheets from the neck downwards immediately after birth without prior drying. Infants in the control group had their heads dried and subsequently covered with cotton caps while infants in the NeoCap group had polyethylene caps put on without drying. Axillary temperature was measured on admission to the neonatal intensive care unit ( NICU), and after having been stabilized in the incubator. Results Among the 80 infants recruited, admission hypothermia (axillary temperature <36.5°C) was present in 37 (92.5%) and in 40 (100%) in the NeoCap and control groups, respectively. There was no significant difference in mean temperature on NICU admission between the two groups (35.3 vs 35.1°C, P = 0.36). Mean post-stabilization temperature, however, was significantly higher in the NeoCap group (36.0 vs 35.5°C, P = 0.01). Conclusion Combined use of polyethylene body wrap and polyethylene cap was associated with a significantly higher mean post-stabilization temperature compared with polyethylene body wrap and cotton cap. [ABSTRACT FROM AUTHOR]

Conflicting medical literature suggests petroleum gauze dressings are necessary following chest tube placement. A retrospective record review of thoracic cases supported use of occlusive dry sterile dressings as an alternative to petroleum dressings because of the low incidence of air leaks and wound infections. [ABSTRACT FROM AUTHOR]

Background: Split-thickness skin grafts are widely used in reconstruction of large area defects. Conventional postoperative recipient site care includes saline-moistened gauze with a protective layer of petroleum gauze and splints for immobilization. This method causes pain while changing the dressing. We designed a better occlusive drainage system for split-thickness skin grafts. We compared the treatment effect and subjective evaluation of our occlusive drainage system with that of the conventional method for coverage of split-thickness skin grafts.Methods: A randomized controlled trial was carried out in patients who received split-thickness skin grafts. Patients aged 24-76 years were randomly assigned to the occlusive drainage system or the conventional indirect wet dressing method. The status of graft take, pain, and subjective evaluations were compared.Results: Twenty-eight participants were enrolled, with 14 in each group. The percentage of graft take was no difference between the 2 groups. No wound infection developed. Patients in the occlusive drainage system group experienced less pain and greater satisfaction. All patients followed up for at least 3 months, and no hypertrophic scar formation was noted.Conclusion: Comparing with the indirect wet dressing method, this new method is practical for covering split-thickness skin grafts, causes less pain, and provides a better experience for patients. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 47-year-old woman with toxic epidermal necrolysis and its risks of developing sepsis. The patient underwent dermatological examination which revealed with vesiculobullous lesions and erosions on body surface area and was treated with intravenous immunoglobulin. The article also discusses the preventive methods of wound infection in patients with toxic epidermal necrolysis.

Objective Study’s purpose was to compare wound healing properties of a topical healing agent (MediGel ® ) (moist environment) versus standard plaster (dry environment) versus well-established standard Bepanthen ® Wund- und Heilsalbe. Methods Healthy volunteers were enrolled into an observer-blind, randomized, controlled, intra-individual experimental comparison study. Three standardized abrasions were induced on each subject’s forearms. Treatments were randomly allocated; investigational product (promoting moist environment) (* combined with standard plaster), reference product (lipid occlusion by ointment base) (* combined with standard plaster) and standard plaster (control). Wound healing was assessed (digital photography, visual scoring) and analyzed via comparison of area under curve (** relative differences to baseline) (day 3 to day 15) and wound margin area ratio to baseline wound size and by counts/frequencies of visual scores. Results Evaluation showed significantly faster wound healing results (** relative differences to baseline) for investigational product vs. standard plaster (all time points) and with significant AUC difference and slightly faster results vs. reference product (day 5 to 10). Visible re-epithelialization was recorded from day 3 on. At day 15, wounds treated with investigational and reference product were completely or almost closed. Plaster-treated wounds remained open with markedly larger wound area/crusts. A significant difference between AUC values for wound margin area ratio to baseline wound size was seen for product and reference. Comparison of time points for wound margin area ratio revealed significant differences between investigational and reference product in favor of the investigational product (days 9, 10, 12, 15). Conclusion Clinically relevant accelerated wound healing and reduced wound contraction were measured for investigational product compared to traditional treatment indicating a superiority of moist wound environment. Although the investigational product performed only slightly better compared to reference product, differences by trend (area closure, area contraction) and data modelling by application of a logistic function strongly suggest advantages for moist wound environment over occlusive protection. [ABSTRACT FROM AUTHOR]

Objectives: The objective of the present study is to assess the potential of bull and boar spermatozoa and fluorescent beads to be used as a surrogate cell model to determine the cell occlusive potential in vitro using membranes of standardized porosities. Materials and methods: A two-chamber model system consisting of upper and lower chambers, which could be separated by membranes, was constructed. Isopore polycarbonate membranes with different standardized pore diameters were used to assess the mobile cellular penetration behavior of spermatozoa or the more passive non-cellular permeability of fluorescent particles (beads) of different diameter and color. In a first experiment, spermatozoa were placed in the lower chamber, whereas semen extender only was placed in the upper chamber. After 10 min of incubation at 37 °C, the sperm number was assessed in the latter. In a second experiment, a bead solution was drawn through resorbable collagen membranes from the upper into the lower chamber by vacuum using a syringe and bead number and size was analyzed by flow cytometry. All experiments were carried out in triplicates. A non-porous polyester membrane was used as negative control to assess the overall tightness of the setup. Results: Boar and bull spermatozoa had average cell body lengths and widths of 9 × 5 μm and were unable to pass through pores ≤2 μm, whereas they were detectable at pore sizes ≥3 μm. Their number increased with increasing pore diameters, i.e., from minimal concentrations of 0.1 × 10/ml for boar and 0.5 × 10/ml for bull spermatozoa at 3 μm to maximal concentrations of 2.1 × 10/ml for boar and 13.1 × 10/ml for bull spermatozoa at 8 μm. The fluorescent beads followed the expected pattern of permeability reliably correlating bead and pore diameter. Conclusions: Within the limitations of this laboratory study and the xenogeneic cell surrogate material, the model allows to easily assess cell and particle penetration through porous structures like membranes. We hope to further assess, improve, and validate this model, which we aim to use for the screening of dental membranes after being exposed to different degradation methods. Clinical relevance: Convenient and rapid test procedures to evaluate membranes for regenerative procedures are still warranted. [ABSTRACT FROM AUTHOR]

Chronic aortoiliac occlusive disease most often affects the common iliac arteries and distal aorta but can progress all the way to the renal arteries, occluding the inferior mesenteric artery. A compensatory collateral network typically develops to preserve lower body perfusion. Inadvertent compression or ligation of such collaterals during surgery can have catastrophic consequences. In this article, we present the case of a 63-year-old patient with aortoiliac occlusive disease, requiring surgery for an adenocarcinoma of the rectosigmoid junction. A CT angiography was performed in order to map out the collateral pathways that had developed and Doppler ultrasound was used to mark their positions. The surgical procedure was adapted to his specific anatomy. A successful anterior resection was performed, and the patient made an uneventful recovery. In cases of aortoiliac obliteration, the existence of collaterals must be kept in mind and investigated with a multidisciplinary approach before any surgery is considered. [ABSTRACT FROM AUTHOR]