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Wheeless' Textbook of Orthopaedics

Wound Dressings


- See: Wound Management Menu / Dressings.org

- Optimization of Wound Dressing:
    - purpose of a dressing is to protect the wound from diseccation and prevent postoperative contamination;
    - normal dry skin contains up 10 to 1000 bacteria per gram of tissue while skin in exposed and moist areas contains up to 100,000 bacteria per gram of tissue;
           - dryness limits staphylococcal proliferation, but when skin becomes excessively dry it can crack and allow bacterial invasion;
           - staph proliferates rapidly in macerated skin or other moist environments;
    - however, dessication is counterproductive for wound healing;
    - mitotic rate of regenerating epidermal cells increased 5-10 fold in a moist, oxygen rich environment in contradistinction to a desiccated wound environment;
           - human epidermal healing occurs faster under the protection of an intact vesicle than when the wound is allowed to desiccate;

- Type of Dressings:
    - some academic plastic surgeons argue that any dressing that is wound friendly will promote wound healing;  
           - references:
                  - Acceleration of wound healing by topical application of honey. An animal model.                                                                      
                  - Successful treatment of chronically infected wounds with sugar paste.   
                  - Honey in the Money
    - modern dressings are characterized as permeable or immpermiable to water vapor, free water, oxygen, or bacteria;
    - semipermiable films:
           - are permeable to water vapor and oxygen but are impermeable to liquids and bacteria;
           - opsite, tegaderm;
           - these dressings have no ability to absorb exudate;
    - hydogels
    - calcium alginate dressings: (kaltostat)
           - derived from processed seaweed;
           - substance is highly absorbent and is ideal for exudative wounds;
    - xeroform dressings: (Bismuth Tribromophenate)
           - A prospective trial comparing Biobrane, Duoderm and xeroform for skin graft donor sites.
           - Comparison of donor-site healing under Xeroform and Jelonet dressings: unexpected findings.
           - Management of STSG burn wounds with Xeroform and layers of dry coarse-mesh gauze dressing results in excellent graft take and minimal nursing time.
    - silver impregnated dressings:
           - references:
                   - Clinical Comparison of Nanocrystalline Silver Delivery with Other Silver Compounds, in Burns
    - occlusive hydrocolloids:
           - are impermeable to liquids and bacteria and partially to water vapor and oxygen;
           - wound exudate is absorbed by the hydrocolloids and Epigard matrix;
           - hydrocolloids has best re-epitheliazation followed by polyurethane film, desication by air exposure, and wet to dry dressings;
           - main disadvantage is that these agents may become excessively adherent and can cause skin damage if removed prematurely;
           - duoderm is an example of an impermeable hydrocolloid;
                   - it has an outer impermeable polyurethane foam and an inner adherent surface;
           - comfeel plus:
    - role of recombinant growth factors:
           - regranex gel 0.01%
                   - Enhancement of wound healing by topical treatment with epidermal growth factor.
                   - The safety and effect of topically applied recombinant basic fibroblast growth factor on the healing of chronic pressure sores.
    - synthetic skin substitutes:
           - synthetic wound dressings are superior to saline soaked gauze dressings in this setting in that they prevent wound dessication with further soft tissue necroioisotope
                        may actually be impaired and result in a negative bonescan.
           - relative disadvantage of these synthetic wound dressings is the potential for accumulation of exudate, hematoma, or seroma;
           - epigard:
                   - 2 layer, non textile, epen matrix polyerethane, backed by microporous film;
                   - wound exudate is absorbed by the hydrocolloids and Epigard matrix;
                   - newly developing microcirculation grows into the matrix interstices of the epigard matrix;
           - allografts:
                   - artificial skin developed by Burke and associates consists of a dermal layer of enzymatically digested bovine collagen crosslinked w/ chondroitin-6 sulfate;
                   - this dermal framework, covered by a thin adherent Silastic sheet, has been used successfully both clinically and experimentally as a skin substitute;
                   - this form of xenogenic transplant is nonviable, and appears likely that the bovine collagen framework is replaced by host collagen using the
                            xenogenic transplant as a scaffold or template;
                   - to achieve permanent closure of the wound, the Silastic layer must be removed after vascularization of the dermal component, and a
                            thin (4/1000 in) autograft of epithelium should be applied;
           - references:
                   - The use of Biobrane for coverage of the pediatric donor site.
                   - Bacterial clearance capability of living skin equivalent, living dermal equivalent, saline dressing, and xenograft dressing in the rabbit.
                   - Silver-impregnated porcine xenografts for treatment of meshed autografts.
    - Wound Vac:
    - Closed Suction Dressings w/ Hospital Suction
    - Graftjacket tissue matrix:
           - ref: Effective management of major lower extremity wounds using an acellular regenerative tissue matrix: a pilot study.
    - sugar:
           - Use of Sugar on the Healing of Diabetic Ulcers: A Review

 - Accuzyme:
 - Santyl
 - Panafil
 - Biafine 
 - Promogran
 - Dermagraft
 - Oasis Wound Dressing
        - tissue-engineered collagen matrix derived from the porcine small intestinal submucosa (SIS), was cleared by the FDA in 2000 for the management of full-thickness skin injuries
                 - burns, abrasions, lacerations and skin tears; pressure, venous, diabetic, and chronic vascular ulcers;
                 - surgical wounds such as autograft donor sites; tunneled/undermined wounds; as well as draining wounds;
        - dressing is provided in single sheets (7 cm wide by 10 or 20 cm long) intended for one-time use only;
        - references:
                 - Effectiveness of an extracellular matrix graft (OASIS Wound Matrix) in the treatment of chronic leg ulcers: a randomized clinical trial 
                 - Randomized clinical trial comparing OASIS Wound Matrix to Regranex Gel for diabetic ulcers.

 

 



 - Apligraf
 - Integra
 - Regranex
 - Hyalofill
 - Epicel



Occlusive versus semi-open dressings in the management of skin graft donor sites.

Comparative study of four wound dressings on epithelization of partial-thickness wounds in pigs

Rationale for and results from a randomised, double-blind trial of tetrachlorodecaoxygen anion complex in wound healing.

Degloving injuries of the extremities and torso.

Evaluation of dressing regimens for prevention of infection with peripheral intravenous catheters. Gauze, a transparent polyurethane dressing, and an iodophor-transparent dressing.



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Monday, December 2, 2013 1:37 pm