Film Dressings Research Articles

The Effect of Chitosan and Polyvinyl Alcohol Combination on Physical Characteristics and Mechanical Properties of Chitosan-PVA-Aloe vera Film

Background: Wound is a condition where there is damage or disruption to the anatomical structure and function of the skin. Wounds that are not treated properly can lead to infection. As wound dressings, film dressings have many advantages such as being elastic, flexible, transparent, and can adapt to the wound shape. Film’s characteristics of are affected by the plasticizer and the polymer. Combination of chitosan and polyvinyl alcohol (PVA) is able to improve the mechanical properties of the film such as its swelling capacity, tensile strength, and elongation at break. Objective: This study aims to determine the effects of chitosan and PVA in various concentrations on the physical characteristics and mechanical properties of the film. Methods: Film was prepared by solvent casting method, using chitosan and alginate in various concentrations of 0% to 1.5%, 1.5% Aloe vera, and 6% propylene glycol. Films’ characteristics and mechanical properties were evaluated, such as swelling index, tensile strength, elongation at break, and Young’s modulus. Results: The result showed that chitosan and PVA polymers had a significant effect on the swelling index, tensile strength, elongation at break, and Young’s modulus. The effect of chitosan and PVA combination on the swelling index, tensile strength, and elongation at break is due to the hydrogen bonding between the hydroxyl group of PVA and the amine group of chitosan. Conclusion: The combination of chitosan and polyvinyl alcohol influenced the film's physical and mechanical properties. Film with chitosan and polyvinyl alcohol ratio of 1.5%:1.5% have best characteristics compared to others.

3D printed composite dressings loaded with human epidermal growth factor for potential chronic wound healing applications

This study formulated and characterized functional properties of 3D printed composite polymer-based film dressings comprising chitosan (CH) crosslinked with genipin (GE) or CH combined with collagen (COL) and loaded with epidermal growth factor (EGF). The films were characterized using texture analyzer (tensile, adhesion), swelling capacity, X-ray diffraction-XRD, Fourier transform infrared (FTIR) spectroscopy, scanning electron microscopy-SEM, drug dissolution, and MTT assay using human dermal fibroblasts. FTIR confirmed crosslinking between CH and GE, CH and COL as well as between CH and EGF while XRD showed amorphous matrix of the films. Mucoadhesion studies showed the films’ ability to adhere to a model simulated wound surface. SEM demonstrated a smooth, homogenous surface indicating content uniformity. The swelling was higher for CH-GE than the CH-COL films while the blank films swelled better than the EGF loaded films. EGF was initially released rapidly, reaching 100% in 2 h, subsequent sharp reduction till 5 h followed by sustained release till 72 h, while MTT assay showed greater than 90% cell viability after 48 h, confirming their biocompatibility. EGF loaded films showed higher cell proliferation than blank equivalents. Overall, the results showed the potential of CH based 3D printed films as suitable dressing platforms to deliver EGF directly to chronic wounds.

Ambulation of Patients With In Situ Femoral Intraaortic Balloon Pump While Awaiting Heart Transplantation.

Ambulation of Patients With In Situ Femoral Intraaortic Balloon Pump While Awaiting Heart Transplantation.

Delayed-onset contact dermatitis caused by olanexidine gluconate antiseptic solution: effect of wiping off the remaining drug solution in two cases

BackgroundOlanexidine glucuronide (Olanedine®), an antiseptic solution may cause skin dermatitis around one week after disinfection. Although removal after the procedure is recommended to avoid skin dermatitis, whether it is effective for preventing skin dermatitis has not been documented in detail in the literature.Case presentationWe encountered two cases of delayed-onset contact dermatitis by Olanedine®. In both cases, the patient’s back was disinfected with Olanedine® and was covered with a surgical drape for epidural catheterization. After catheterization and removal of the surgical drape, the insertion site of the catheter was covered with a film dressing, then the epidural catheter was taped to the back. On the third postoperative day, the epidural catheter was removed. On the seventh postoperative day, the patients reported pruritus on the back, where an erythematous papule rash was observed. However, it was not observed at the site covered by the tape to secure the epidural catheter or by the tape of the surgical drape. Symptoms were relieved with oral or topical steroids by the time of discharge.ConclusionWiping off the remaining Olanedine® even a few days after disinfection may be helpful not only for reducing symptoms but also for preventing the development of contact dermatitis.

Film Dressing Reduces Acute Radiation Dermatitis in Breast Cancer

Film Dressing Reduces Acute Radiation Dermatitis in Breast Cancer

Experimental Investigation of Subcutaneous Pressure and Shear Force Changes Using a Bone Protrusion Model as a Risk Factor for Pressure Ulcer Development

Objectives: Subcutaneous pressure and subcutaneous shear force were investigated using a bone protrusion model to investigate a polyurethane film dressing (hereinafter referred to as adhesive film) for preventing shear force. Our hypothesis was that when pressure or shear force was applied to the body surface, the adhesive film would 1) decrease the shear force on the skin surface and 2) decrease the effect of the external force on the subcutaneous layer.

Hydrocolloid Wound Dressing for Sealing Periwound With Poor Normal Skin: Negative Pressure Wound Therapy for Deep Limb Burns With Extensive Burns

BACKGROUND: Negative pressure wound therapy (NPWT) is effective for wounds with exposed bones and tendons, but when the wound is accompanied by extensive burns, sealing is difficult. We performed sealing with a hydrocolloid wound dressing on limb burns. CASE REPORT: A 61-year-old woman was burned in a fire at her home. Split-thickness skin grafting was performed 14 and 35 days post injury, but exposure of the right patella and patellar tendon became apparent. The hydrocolloid wound dressing was wrapped around the proximal and distal aspects of a deep wound. The limb was sandwiched from the front and back surfaces and sealed with 2 film dressings, including the hydrocolloid, according to the sandwich method. Using this method, NPWT could be performed without leakage, the exposed tendons and bones were covered with granulation, and skin grafts were performed on day 88 after injury. CONCLUSION: Our method allows NPWT to be easily and effectively performed for deep limb burns with poor normal skin periwound area.

The use of occlusive dressings: influence on excisional wound healing in animal model.

To analyze the influence of occlusive dressing on the healing of excisional skin wounds in mice. Pre-clinical, comparative, and translational study. Mice were divided into three experimental groups: wounds occluded with hydrocolloid (HD) dressings, transparent polyurethane film (TF) dressings, and without occlusion (WO), monitored at three, six and 14 days, with eight animals each. Closure rate, infiltration of neutrophils and macrophages, measurement of tumor necrosis factor-α (TNF-α) and vascular endothelial growth factor (VEGF) and, histologically, angiogenesis were evaluated. Wound closure was accelerated in the occlusive groups. There was a decrease in TNF-α levels in the HD group when compared to the WO and TF groups. Neutrophils accumulation decreased in the HD group. Increased dosages of macrophages were evidenced in the HD group, compared to the WO and TF groups. Levels of VEGF were increased in the TF and HD groups. It is suggested that the occlusion of wounds modulates the inflammatory response.

629 Validation of a wound fluid collection method for subsequent identification of prognostic biomarkers for healing

Several matrix metalloproteinases (MMPs) are hypothesized to play key roles in the wound healing process due, to their ability to break down various extracellular matrix components. Expression levels of MMPs, or their inhibitors, may be useful for predicting the risk of wound healing or non-healing. However, methods used to collect human wound fluid are diverse with little evidence of rigorous method validation in the literature. Therefore, we aimed to develop a robust method for the collection of fluid from wound dressings. We have validated this method using both human serum and wound fluid samples. Serum was acquired commercially whilst wound dressings were collected from ten patients undergoing treatment of leg or foot ulcers. Total protein concentrations and relative protein abundances were measured for extracted and control samples. The developed method gave normalised total protein recoveries (arbitrary units, a.u.) of 0.64, 0.85, 0.60 and 0.56 a.u. when extracting serum from alginate (Kaltostat), foam (Mepilex), surgical (Softpore) and film (Tegaderm) dressings respectively in comparison to serum controls (1.00 a.u.). Fluid extracted from patient dressings had a mean total protein concentration of 21.5 mg/ml and gave consistent identification and quantification of several MMPs and their inhibitors via Western blot. The developed method therefore facilitated consistent recovery of serum with minimal protein loss, specifically when using foam dressings. However, these data show the variability in total protein recovery between dressing materials. This method’s suitability was further demonstrated with the successful extraction of wound fluid from patient dressings and quantification of proteins involved in wound healing. This method is therefore suitable for further wound fluid collection procedures and development of prognostic biomarker studies.

Preparation and evaluation of chitosan- and hyaluronic acid-grafted pullulan succinate films for skin wound healing

A novel wound dressing that possesses antibacterial properties and accelerates skin wound repair was developed by physically blending hyaluronic acid-grafted pullulan succinate (HA-st-Pu) with chitosan (CS). The HA-st-Pu polymer was synthesized and characterized, and then CS/HA-st-Pu film dressings were prepared by a freeze-drying method. The novel film wound dressings exhibited a three-dimensional cavity structure under scanning electron microscopy (SEM) and a better swelling ratio than CS, HA and Pu alone, absorbing a large amount of liquid and effectively maintaining the moist environment of the wound. CS/HA-st-Pu materials had no cytotoxicity and increased cell proliferation when coincubated with L929 cells. Moreover, CS/HA-st-Pu wound dressings exhibited a certain antibacterial capability against E. coli and S. aureus. In rat skin wound healing, CS/HA-st-Pu film dressings outperformed both the control and market band-aid groups with respect to the reduction of inflammation and acceleration of wound closure.

A simplified method for monitoring cytokines in wound fluid.

Cytokines in wound fluid are used as surrogates for wound healing in clinical research. The current methods used to collect and process wound fluid are noninvasive but not optimal. The aim of this prospective study was to evaluate a method (NovaSwab) by which wound fluid is collected by a surface swab and eluted in a physiological buffer for subsequent cytokine analysis. Wound fluid from 12 patients with leg ulcers was assessed by NovaSwab at the start (Day 0) and at the end of a 23-h collection period of wound fluid retained by foam oblates beneath an occlusive film dressing (Day 1). GM-CSF, IL-1α, IL-1β, IL-6, IL-8, PDGF-AA, TNF-α and VEGF levels were measured by multiplex and electrochemiluminescence assays. IL-1α (2.4×), IL-1β (2.0×) and IL-8 (1.8×) levels increased from Day 0 to Day 1 as detected by NovaSwab, indicating local production of these polypeptides in the wounds. On Day 1, the NovaSwab method yielded higher levels of IL-1α (4.0×), IL-1β (2.7×) and IL-6 (2.7×), and 35% lower levels of VEGF than those in wound fluid accumulated for 23 h in foam oblates (on average, 5ml of wound fluid). In vitro experiments showed that the investigated cytokines in cell-free wound fluid were recovered in a quantitative manner by the NovaSwab method. We conclude that the method presented here is a promising research tool to study the kinetics of soluble cytokines over the course of wound healing. More studies are needed to determine the interobserver variation and reproducibility of the NovaSwab method.

Comparison of skin graft donor site management using oxidised regenerated cellulose (ORC)/collagen/silver-ORC with absorptive silicone adhesive border and transparent film dressing vs semi-occlusive dressings.

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± 13.9y). 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± 1.4d vs 18 ± 2.4d, 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.

A novel 1,3,4-thiadiazole modified chitosan: synthesis, characterization, antimicrobial activity, and release study from film dressings

Herein, two new polymers designated as Cs-EATT and Cs-BATT have been synthesized via linking the chitosan with the synthesized 1,3,4-thiadiazole compounds. They were characterized using 1H,13C-NMR, FT-IR, TGA, Elemental analysis, Mass spectrum, and UV–vis spectrophotometer. The synthesized polymers exhibit high activity to control the growth of pathogenic bacteria (S. aureus, B. subtilis, E. coli, and P. aeruginosa), and unicellular fungi (C. albicans). The MIC values were in the range of 25–100 µg mL–1 for Cs-EATT and 25–200 µg mL–1 for Cs-BATT with varied clear zones. The new polymers were mixed with three film-forming agents: polyvinyl alcohol, hydroxyethyl cellulose, and carboxymethyl cellulose to form six film dressings designated as E1, E2, and E3 for Cs-EATT, and B1, B2, and B3 for Cs-BATT, respectively. The evaluation of film dressings showed that the formed films had transparency, uniformity, homogeneity, elasticity, and non-irritation pH values for skin within the normal range. The maximum percentages of Cs-E/B-ATT content were recorded for film dressings E2 and B2, with values of 92.5% and 94.9%, respectively. Also, the release percentages varied according to film dressing formulation, with values in the ranges of 83.88–93.2% for Cs-EATT and (87.7–97.35%) for Cs-EATT after 9 h.

Semi-occlusive management of fingertip injuries with finger caps: A randomized controlled trial in children and adults.

Background:Human fingertips can regenerate functionally and cosmetically excellent skin and soft tissues. Physiological conditions suppress scar formation and are thus a prerequisite for regenerative healing. Self-adhesive film dressings can provide such favorable conditions. The semi-occlusive treatment is superior to surgery. However, standard dressings leak malodorous wound fluid eventually until the wound is dry. Therefore, we developed and tested a silicone finger cap that forms a mechanically protected, wet chamber around the injury. Its puncturable reservoir allows access to the wound fluid for diagnostic and research purposes and the delivery of pro-regenerative drugs in the future.Methods:Patients >2 years with full-thickness fingertip injuries unsuitable for simple primary closure were randomized to start treatment with either the film dressing or the silicone finger cap. After 2 weeks, we changed to the other treatment. Patients’ choice on the preferred treatment after 4 weeks was the primary outcome parameter. Additionally, we monitored adverse events, unplanned visits, tissue gain, functionality, cosmetic outcome, and quality of life.Results:We randomized 11 patients 2 to 72 years to each group. Eighteen to 20 (90%, intention-to-treat) patients preferred the finger cap. All patients were satisfied with the cosmetic outcome, 88.9% had no disturbing sensibility changes, and 73.7% could report no distortion in the finger’s daily use. Epithelialization took between 5 weeks for Allen II and up to 9 weeks in Allen IV injuries. There were 19 device-related adverse events under film dressing and 13 under the finger cap. There were neither severe adverse device effects nor unexpected severe adverse device effects.Conclusion:Employing the summative or synthetic primary endpoint "patient decision for one or the other procedure," our pseudocross-over-designed RCT succeeded in statistically significantly demonstrating the superiority of the silicone finger cap over conventional film therapy. The finger cap was safe and effective, reaching excellent results on all treated injuries without any need for disinfection, antibiotics, shortening of protruding bones, or treatment of hypergranulations. Distal to the tendon insertions, we did not see any limitations regarding injury mechanism, amputation plane, or patients' age.

Modern Dressings in Prevention and Therapy of Acute and Chronic Radiation Dermatitis-A Literature Review.

Radiotherapy is an integral part of modern oncology, applied to more than half of all patients diagnosed with cancer. It can be used alone or in combination with surgery or chemotherapy. However, despite the high precision of radiation delivery, irradiation may affect surrounding healthy tissues leading to the development of toxicity. The most common and clinically significant toxicity of radiotherapy is acute and chronic radiation dermatitis, which could result in desquamation, wounds, nonhealing ulcers, and radionecrosis. Moreover, preoperative radiotherapy impairs wound healing after surgery and may lead to severe wound complications. In this review, we comprehensively discuss available types of dressings used in the management of acute and chronic radiation dermatitis and address their efficacy. The most effective ways of preventing acute radiation dermatitis are film dressings, whereas foam dressings were found effective in its treatment. Data regarding dressings in chronic radiation dermatitis are scarce. This manuscript also contains authors’ consensus.

Solvent Casting and UV Photocuring for Easy and Safe Fabrication of Nanocomposite Film Dressings.

The aim of this work was to optimize and characterize nanocomposite films based on gellan gum methacrylate (GG-MA) and silver nanoparticles (AgNPs) for application in the field of wound dressing. The films were produced using the solvent casting technique coupled with a photocuring process. The UV irradiation of GG-MA solutions containing glycerol as a plasticizer and different amounts of silver nitrate resulted in the concurrent crosslinking of the photocurable polymer and a reduction of Ag ions with consequent in situ generation of AgNPs. In the first part of the work, the composition of the films was optimized, varying the concentration of the different components, the GG-MA/glycerol and GG-MA/silver nitrate weight ratios as well as the volume of the film-forming mixture. Rheological analyses were performed on the starting solutions, whereas the obtained films were characterized for their mechanical properties. Colorimetric analyses and swelling studies were also performed in order to determine the AgNPs release and the water uptake capacity of the films. Finally, microbiological tests were carried out to evaluate the antimicrobial efficacy of the optimized films, in order to demonstrate their possible application as dressings for the treatment of infected hard-to-heal wounds, which is a demanding task for public healthcare.

Eliminating tattoos for short course palliative radiation therapy: Set-up error, satisfaction and cost

PurposePalliative patients are living longer thanks to advancements in systemic therapies and radiotherapy technologies. Prior to image guided radiotherapy, permanent ink tattoos were used to ensure set up accuracy. Permanent marks can cause psychological damage, physical pain and can reduce a patient’s quality of life. In recent years, image guided radiation therapy (IGRT) has become standard practice and may eliminate the need for permanent tattoos in this patient population. MethodsTwenty-five patients were consecutively chosen from the Palliative Radiation Oncology Program (PROP). Each received 5 fractions of radiotherapy commencing within 72 hours of CT simulation. In place of permanent tattoos, patients were marked with permanent marker and an adherent transparent film dressing (Tegaderm TM ) was placed over the mark. Patients were educated on maintaining the marks and dressing. Daily cone beam CT (CBCT) isocentre mismatch values were compared with 25 patients who received tattoos for radiotherapy to similar body regions. Radiation therapist concerns, cost, variations in isocentre shift values and additional imaging requirements were obtained. ResultsIsocentre shift values were similar (p<0.05) for Tegaderm TM vs. tattoo patients in the anterior-posterior (AP) and right-left (RL) directions. The mean shift value in the superior-inferior (SI) direction was larger for Tegaderm TM than for tattoos (p=0.01), however the magnitude was only 2 mm, which is clinically insignificant as these shifts were prior to IGRT guided correction. No patient required a repeat CBCT or a resimulation. The cost of the Tegaderm TM dressing was substantially less than the tattoo group. Radiation Therapists' satifaction with Tegaderm TM was overall high, however some expressed concerns with their durability and longevity. ConclusionsWe found that the use of Tegaderm TM dressing did not result in increased set-up time, mismatch error or additional imaging procedures (CBCT or CTsimulation) and moreover cost substantially less than permanent ink tattoos.

Arabinoxylan-Carboxymethylcellulose Composite Films for Antibiotic Delivery to Infected Wounds.

Modern dressings should provide for local delivery of antibiotics and protect the wound from bacterial infection, dehydration and environmental factors to achieve optimal healing. The local delivery of antibiotics can reduce adverse effects and resistance challenges. In this study, we fabricated film dressings composed of arabinoxylan (AX) from Plantago ovata seed husks and carboxymethylcellulose (CMC) by a solvent cast method for the delivery of the antibiotic amikacin (AMK). To determine the suitability of the prepared AX-CMC composite films as wound dressings and drug delivery materials, their physical, chemical, mechanical, morphological, thermal, pharmaceutical, antimicrobial, cytocompatible, and drug delivery properties were investigated. The results demonstrated that the dressings were suitable for delivering the drug at the wound site in a sustained manner and keeping the environment moist for rapid healing. The AMK-loaded AX-CMC films exhibited controlled release of AMK, excellent antibacterial activity, and cytocompatibility. Thus, the AX-CMC composite films appear to be promising bioactive dressing materials for the prevention of wound infections.

新生児の末梢静脈カテーテル固定における透明フィルムと非滅菌テープの輸液トラブル発症比較

Centers for Disease Control and Prevention（CDC）ガイドラインでは末梢静脈カテーテルの挿入部位を観察するため，滅菌透明フィルムドレッシング材を使用することが推奨されているが，輸液漏れを起こしやすい新生児への滅菌透明フィルムドレッシング使用に関する研究は少ない．透明フィルム固定と非滅菌テープ固定における輸液トラブル発症を比較し，透明フィルム固定が輸液トラブル発症のリスク因子になり得るかを解析した．新生児病棟入院児を対象とし前期（4か月）は非滅菌テープ固定，後期（4か月）は透明フィルム固定とし，固定から1週間以内に発生した輸液トラブルを記録した．治療終了前のカテーテル抜去をカテーテル不全とし主要評価項目とした．カテーテル挿入例は延べ239例で内77例（32%）は透明フィルム，162例（68%）がテープであった．カテーテル不全はフィルム群43例（56%），テープ群95例（59%）でほぼ同等の発症率であった．Cox比例ハザード分析にて，カテーテル不全発症リスク因子は高張輸液（ハザード比［95%信頼区間］8.31［3.03-22.80］），輸液速度3 mL/時以上（2.61［1.75-3.91］）で，フィルム固定は有意なリスク因子ではなかった．新生児においても透明フィルムドレッシングは安全に使用できる可能性がある．

53 Use of Polylactic-acid-membrane in Split-thickness Skin Graft Donor Sites: A Prospective, Comparative, Randomized Study

IntroductionPolyurethane film (PU) dressings are commonly applied for coverage of split-thickness skin graft (SSG) donor sites, while previous studies have suggested reduced morbidity using a polylactic acid membrane (PLM). To further investigate the optimal treatment approach, the presented study compared outcome of donor sites in patients receiving either PLM or PU.MethodsThis randomized clinical trial allocated patients requiring SSG to receive either PLM or PU at the donor-site. Primary endpoint was difference in donor site scar appearance between groups 3 months postoperatively (Vancouver Scar Scale – VSS). Secondary endpoints included pain, the number of and time required for wound dressing changes, and costs related to the wound dressing.Results30 patients were allocated to each group. The median VSS scored lower for patients receiving PLM (PU: 3 (Q1: 2; Q3: 4) vs. PLM: 2 (Q1: 1; Q3: 3); p=0.049). Pain during change of wound dressing (PU: 2.0 ± 0.2 vs. PLM: 0.5 ± 0.2; p< 0.001) and mobilization (PU: 0.8 ± 0.2 vs. PLM: 0.3 ± 0.1; p=0.032) was reduced in the PLM group. Patients with PLM required less dressing changes per day of hospital stay (PU: 0.44 ± 0.06 vs. PLM: 0.28 ± 0.02; p=0.015). Mean time for wound dressing changes per patient was higher in the PU group (PU: 74.50 ± 5.72 vs. PLM: 21.43 ± 2.61 min; p< 0.001). Costs were higher in the PLM group (PU: 67.83 ± 5.56 vs. PLM: 162.79 ± 21.76 €; p< 0.001).ConclusionsPLM improves outcome of SSG donor sites, however, higher treatment costs must be taken into consideration.