Foam Dressings Research Articles

Evaluation of dressings preventing facial medical device-related pressure injury in medical staff during the COVID-19 pandemic: A systematic review and network meta-analysis.

This study systematically compared the efficacy of various dressings that may prevent facial medical device-related pressure injury (MRDPI) in medical staff during the COVID-19 pandemic. During the COVID-19 pandemic, medical staff who are required to wear masks, goggles and other personal protective equipment (PPE) are susceptible to facial MRDPI, which exacerbates working conditions. Dressings can effectively prevent or alleviate MRDPI, but it is unclear which dressings are most effective. A systematic review and network meta-analysis, in accordance with PRISMA. A comprehensive literature search was conducted in four English and four Chinese databases to identify relevant studies published up to 8 September 2022. The selected studies were randomised controlled trials, with populations comprising medical staff who wore PPE during the COVID-19 pandemic and included an observation and control group. The network meta-analysis of the 12 selected articles showed that foam dressing, hydrocolloid dressing and petrolatum gauze were better than conventional protection for preventing MRDPI. The surface under the cumulative ranking curve indicated that foam dressing was the best preventative. Foam dressing is more effective than other dressings in preventing facial MRDPI in medical staff. When PPE must be worn for many hours, such as during the COVID-19 pandemic, medical staff can use foam dressings to prevent MRDPI. The results support the use of dressings, especially foam dressings, to prevent MRDPI in healthcare workers. The appropriate dressings are recommended to prevent MRDPI associated with wearing PPE.

Orbital wall restoration with primary bone fragments in complex orbital fractures.

Complex orbital fractures are impure orbital fractures because they involve the orbital walls and mid-facial bones. The author reported an orbital wall restoration technique in which the primary orbital wall fragments were restored to their prior position in complex orbital fractures in 2020. As a follow-up to a previous preliminary study, this study retrospectively reviewed the surgical results of complex orbital wall fractures over a 4-year period and compared the surgical outcomes by dividing them into groups with and without balloon restoration. Data of 939 patients with facial bone fractures between August 2018 and August 2022 were reviewed. Of these, 154 had complex orbital fractures. Among them, 44 and 110 underwent reduction with and without the balloon technique respectively. Pre- and postoperative Naugle exophthalmometer (Good-Lite Co.) scales were evaluated. The orbital volume and orbital volume ratio were calculated from preoperative and 6 months postoperative computed tomography images. Among 154 patients with complex orbital fractures, 44 patients underwent restoration with the balloon technique, and 110 patients underwent restoration without it. The Naugle scale did not differ significantly between the two groups, but the orbital volume ratio significantly decreased by 3.32% and 2.39% in groups with and without the balloon technique and the difference in OVR was significantly greater in patients in the balloon restoration group compared with the control group. Postoperative balloon rupture occurred in six out of 44 cases (13.64%). None of the six patients with balloon rupture showed significant enophthalmos at 6 months of follow-up. The balloon rupture rate was 13.64% (6/44 cases) with marginal screw fixation, blunt screws, and extra protection with a resorbable foam dressing. Furthermore, we restored the orbital wall with primary orbital fragments using balloon support in complex orbital wall fractures.

ROLE OF RING EXTERNAL FIXATOR IN OPEN INTRA-ARTICULAR DISTAL HUMERUS FRACTURE

Standard fixation for intra-articular distal humerus fracture is open reduction and internal fixation (ORIF). However, high energy fractures of the distal humerus are often accompanied with soft tissue injuries and or vascular injuries which limits the use of internal fixation. In our report, we describe a highly complex distal humerus fracture that showed promising healing via a ring external fixator.A 26-year-old man sustained a Gustillo Anderson Grade IIIB intra-articular distal humerus fracture of the non-dominant limb with bone loss at the lateral column. The injury was managed with aggressive wound debridement and cross elbow stabilization via a hinged ring external fixator. Post operative wound managed with foam dressing. Post-operatively, early controlled mobilization of elbow commenced. Fracture union achieved by 9 weeks and frame removed once fracture united. No surgical site infection or non-union observed throughout follow up. At 2 years follow up, flexion - extension of elbow is 20°- 100°, forearm supination 65°, forearm pronation 60° with no significant valgus or varus deformity.The extent of normal anatomic restoration in elbow fracture fixation determines the quality of elbow function with most common complication being elbow stiffness. Ring fixator is a non-invasive external device which provides firm stabilization of fracture while allowing for adequate soft tissue management. It provides continuous axial micro-movements in the frame which promotes callus formation while avoiding translation or angulation between the fragments. In appropriate frame design, they allow for early rehabilitation of joint where normal range of motion can be allowed in controlled manner immediately post-fixation.Functional outcome of elbow fracture from ring external fixation is comparable to ORIF due to better rehabilitation and lower complications. Ring external fixator in our patient achieved acceptable functional outcome and fracture alignment meanwhile the fracture was not complicated with common complications seen in ORIF.In conclusion, ring external fixator is as effective as ORIF in treating complex distal humeral fractures and should be considered for definitive fixation in such fractures.

A Systematic Review of Pressure Ulcers Prevention

Introduction: Pressure ulcers in high-risk patients are contributes to patient burden and cost financially. Identifying strategies on the prevention of high ulcers among those with high risk is necessity. Nevertheless, an intense study exploring those issues is scarce. The study aimed to analyze the prevention method and their effectiveness in pressure ulcer prevention. Method: This study used PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) to guide the systematic review process. The article searches were conducted on Web of Science (WOS), ScienceDirect, Wiley Online Library, and Scopus using the keywords used Decubitus Ulcer, Pressure Ulcer, Management, and Prevention, and any possible combinations. Results: A total of 18 studies met the inclusion criteria for this review and show some different prevention for a pressure ulcer. The findings of the present study are foam dressings, support surfaces, repositioning, topical-based interventions, wearable patient sensors, and two distinct endotracheal tube fixations affect the incidence of pressure ulcers. Conclusions: This current review emphasized a bundle care consisted of two methods or more are effective to reduce the incidence of pressure ulcers rather than a single treatment. Nurses should consider intervention to prevent ulcers among high-risk patients by way analyses of each single treatment prior bundling. Further study investigating factors associated wound’s ulcer healing is necessary.

Shared Experiences

Shared Experiences

Predictive application of foam dressing on preventing of auricle pressure injury caused by ear dressing

ObjectiveThe use of foam dressings has been regarded as part of the individualized care plan in clinical practice. Our study aimed to compare the predictive application of foam dressing and conventional nursing method in the prevention of auricle pressure injury (PI) caused by ear dressing. MethodsTwo hundred and four patients undergoing ear dressing after the operation in the Affiliated Hospital of Southwest Medical University in Sichuan, China from January 2021 to September 2021 were recruited as research objects. Patients were randomized into intervention group (n = 102) and control group (n = 102) using double-blind method. ResultResults showed that patients in the intervention group showed significantly lower incidence of auricle PI and higher comfort and satisfaction levels than those in the control group (P < 0.05). ConclusionOur study reflected effective predictive application of foam dressing in reducing the incidence of auricle PI in ear dressing, which was suitable for clinical application.

Managing No-Drain Mastectomy with Closed Incision Negative Pressure Wound Therapy using Full-Coverage Foam Dressings

Managing No-Drain Mastectomy with Closed Incision Negative Pressure Wound Therapy using Full-Coverage Foam Dressings

EffEctiveness of Prophylactic fOam dressings in the prevention of saCral pressure injuries in at-risk hospitalised patients: the EEPOC trial

BackgroundProphylactic dressings are increasingly used to prevent pressure injuries in hospitalised patients. However, evidence regarding the effectiveness of these dressings is still emerging. This trial aims to determine the clinical and cost-effectiveness of a prophylactic silicone foam border dressing in preventing sacral pressure injuries in medical-surgical patients.MethodsThis is a multicentre, pragmatic, parallel group, randomised controlled trial. A sample size of 1320 was calculated to have >90% power to detect a 5% difference in the primary outcome at an alpha of 0.05. Adult patients admitted to participating medical-surgical wards are screened for eligibility: ≥18 years, admitted to hospital within the previous 36 h, expected length of stay of ≥24 h, and assessed high risk for hospital-acquired pressure injury. Consenting participants are randomly allocated to either prophylactic silicone foam dressing intervention or usual care without any dressing as the control group via a web-based randomisation service independent of the trial. Patients are enrolled across three Australian hospitals. The primary outcome is the cumulative incidence of patients who develop a sacral pressure injury. Secondary outcomes include the time to sacral pressure injury, incidence of severity (stage) of sacral pressure injury, cost-effectiveness of dressings, and process evaluation. Participant outcomes are assessed daily for up to 14 days by blinded independent outcome assessors using de-identified, digitally modified sacral photographs. Those who develop a sacral pressure injury are followed for an additional 14 days to estimate costs of pressure injury treatment. Analysis of clinical outcomes will be based on intention-to-treat, per-protocol, and sensitivity analyses.DiscussionThis trial aims to provide definitive evidence on the effect prophylactic dressings have on the development of hospital-acquired sacral pressure injuries in medical-surgical patients. A parallel economic evaluation of pressure injury prevention and treatment will enable evidence-informed decisions and policy. The inclusion of a process evaluation will help to explain the contextual factors that may have a bearing on trial results including the acceptability of the dressings to patients and staff. The trial commenced 5 March 2020 and has been significantly delayed due to COVID-19.Trial registrationANZCTR ACTRN12619000763145. Prospectively registered on 22 May 2019

High porosity PEG-based hydrogel foams with self-tuning moisture balance as chronic wound dressings.

A major challenge in chronic wound treatment is maintaining an appropriate wound moisture balance throughout the healing process. Wound dehydration hinders wound healing due to impeded molecule transport and cell migration with associated tissue necrosis. In contrast, wounds that produce excess fluid contain high levels of reactive oxygen species and matrix metalloproteases that impede cell recruitment, extracellular matrix reconstruction, and angiogenesis. Dressings are currently selected based on the relative amount of wound exudate with no universal dressing available that can maintain appropriate wound moisture balance to enhance healing. This work aimed to develop a high porosity poly(ethylene glycol) diacrylate hydrogel foam that can both rapidly remove exudate and provide self-tuning moisture control to prevent wound dehydration. A custom foaming device was used to vary hydrogel foam porosity from 25% to 75% by adjusting the initial air-to-solution volume ratio. Hydrogel foams demonstrated substantial improvements in water uptake volume and rate as compared to bulk hydrogels while maintaining similar hydration benefits with slow dehydration rates. The hydrogel foam with the highest porosity (~75%) demonstrated the greatest water uptake and rate, which outperformed commercial dressing products, Curafoam® and Silvercel®, in water absorption, moisture retention, and exudate management. Investigation of the water vapor transmission rates of each dressing at varied hydration levels was characterized and demonstrated the dynamic moisture-controlling capability of the hydrogel foam dressing. Overall, the self-tuning moisture control of this hydrogel foam dressing holds great promise to improve healing outcomes for both dry and exudative chronic wounds.

A comparison of commercially available synthetic skin substitutes for surgical simulation training.

Simulation training provides an important opportunity to accelerate surgical skills acquisition whilst safeguarding patients. This study compares the suitability of different synthetic skin substitutes for use in surgical simulation training. Data was collected for eight commercially available synthetic skin substitutes and included cost, delivery time, subjective assessment of fidelity by surgeons and trainees, and objective comparison with the biomechanics of human skin was made through cutometry and durometry measurements. Cutometry and durometry data was collected from three healthy adults from the forearm, forehead and back, with measurements being repeated in triplicate. Subjective assessment of skin pad quality was collected using an 8-criteria questionnaire, graded using a 5-point Likert scale for fidelity to normal skin. The questionnaire assessment was completed by 30 trainees and practitioners. Overall, felt pads received the poorest outcomes in all criteria; cutometry and durometry results demonstrate poor similarity to skin, and felt received the lowest scores in the questionnaire, although the cheapest. Foam dressings were similar in both cutometric and durometric properties to skin of the face, back and arm. Clinical outcomes of foam dressings were similar to the most expensive commercial skin pad. Bilaminar foam-based dressings provide a low cost, high fidelity non-biological simulation of skin for surgical training, which is non-inferior to more expensive specifically designed products. Many products designed to act as skin substitutes for surgical simulation fail to adequately replicate the anatomical and mechanical properties of skin.

Effects of soft silicone polyurethane foam dressings for the prevention of pressure ulcers in high-risk patients: Factors associated with pressure injury

Effects of soft silicone polyurethane foam dressings for the prevention of pressure ulcers in high-risk patients: Factors associated with pressure injury

Vasopressors and Pressure Injury Risk in the Critically Ill

We have not done any further analysis; therefore, we still do not know the exact etiological factor (vasopressor vs shock sequelae vs overall severity of illness) that places the patient at increased risk for PI. We strongly suspect that vasopressors and especially vasopressin play a significant role in PI development. Although we know that cutaneous manifestations associated with vasopressor medications exist, the evidence is not strong as to whether the associated gangrene is related to vasopressors or to the sequelae of shock that the vasopressors were administered to treat.When patients are receiving vasopressors, PI interventions such as more frequent repositioning or small repositioning shifts may be indicated, depending on the support surface in use and the patient’s individual tissue tolerance. For example, in patients with anasarca, tissue tolerance is severely compromised and increased frequency of repositioning/off-loading may be necessary. The use of prophylactic multilayer silicone foam dressings, if they are not already in use, should be considered as well.Interestingly, in the International Pressure Injury Guidelines published in 2019, skin temperature is mentioned as a potential PI risk factor because it can affect tissue tolerance to mechanical loads. In addition, patients who are diaphoretic may be more susceptible to pressure.Lateral rotation should not be used for repositioning patients because the lateral movement can actually increase shear and thus increase PI risk. Foam wedges are effective if you can use them to off-load pressure adequately. Pillows can be effective, as well, as long as these devices are used to prop the patient in a 30° side-lying position.

A Self-Pumping Dressing with Multiple Liquid Transport Channels for Wound Microclimate Management.

A microclimate with ventilation and proper wettability near the wound is vital for wound healing. In the case of pressure or absorption of large amounts of wound exudate, maintaining air circulation around the wound is currently a challenge for wound dressings. In this study, a novel self-pumping dressing (FAED) with multiple liquid transport channels is designed by combining a 3D spacer fabric, sodium alginate aerogel, and electrospun membrane. This unique structural design allows FAED to unidirectionally rapidly remove excess biofluid from the wound and transfer it through a special liquid transport channel to a liquid storage layer with a high absorption ratio. Importantly, the air circulation layer of FAED composed of liquid transport channels and spacer yarns provides excellent air permeability in both the horizontal (12.3 L min-1 ) and vertical (272.02 mm s-1 ) directions. Additionally, a lower compression modulus (0.14MPa) and higher compression strength (0.15MPa) enable the novel dressing to adapt to body contours and provide good supporting performance, as compared to foam dressings. Combined with its high biocompatibility, this unique dressing has significant potential for wound treatment and intensive care.

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.

A Comparison of Two Multi-Layer Sacral Foam Dressings for the Prevention of Hospital-Acquired Pressure Injuries.

Hospital-acquired pressure injuries (HAPIs) represent a significant detriment to patient health by increasing mortality risk, negatively impacting quality of life, and increasing risk of complications such as infection. Prophylactic use of sacral foam dressings is known to decrease the occurrence of HAPIs in various patient populations. This retrospective study compared the effect of two multi-layer sacral foam dressings on HAPI incidence in patients admitted to a short-term, acute care hospital during the years 2015 (dressing one: Mepilex® Border Protect sacral dressing [Mölnlycke Healthcare AB, Göteborg, Sweden]) and 2017 (dressing two: Optifoam® Gentle LQ silicone faced foam < border sacral dressing [Medline Industries, LP, Northfield, Illinois]). Patient medical charts were examined for full sample (n=297) and subsample (n=284) analysis, respectively. The HAPI incidence for dressing two was found to be significantly less than dressing one (full sample: 5.12% compared to 10.79% [p=0.0001], and subsample: 4.07% compared to 9.31% [p=0.0001]). The incidence rate ratio (IRR) for dressing two was 0.39 for the full sample and 0.35 for the subsample, indicating that compared to dressing one, the HAPI count was approximately 40% lower for dressing two for the full sample and approximately 35% lower for dressing two for the subsample. These results demonstrate that dressing two performed better than dressing one in HAPI prevention. The results of this study may inform clinicians in their choice of prophylactic dressings.

Early Compression Therapy for Deep Skin Defects: A New Treatment Option to Prevent Hypertrophic Scars or Contractures

Background: Conservative treatment of deep dermal or full-thickness skin defects often results in hypertrophic scars or contractures; thus, compressive therapy has been used after wound closure to prevent or treat scar deformities. However, wound contraction begins in the early proliferative phase and peaks after 2 weeks. We therefore attempted early compression therapy as a means of conservative treatment of deep-skin defects and evaluated its clinical outcomes. Methods: In 21 cases of deep skin defects (19 patients), early compressive therapy was started the second week after injury. Saline-moistened gauze or foam dressings were placed on open wounds, and foam dressings or silastic plates were used after epithelialization. The compression materials included elastic bandages, adhesive tapes, or garments. The final scars were assessed using the Vancouver Scar Scale (VSS) and satisfaction degree.Results: Defect size ranged from 1.4×0.7 to 5×5 cm. The duration of compression was 4 to 12 months. The follow-up periods were 4 to 61 months. Mild scar hypertrophy or contracture occurred in 15 cases and subsided after application of topical corticosteroid or triamcinolone injection. The final scar shapes were linear (n=12), geographic (n=5), and oval (n=4). The mean VSS score was 2.3. The degrees of satisfaction were excellent (61.9%) and good (23.8%). In most cases, aesthetically and functionally satisfactory outcomes without pathologic scars were demonstrated with minimal scar size, high scar quality, and high satisfaction.Conclusion: Early compression therapy might be a good option to prevent pathologic scars in the conservative treatment of deep skin defects.

Effectiveness of four topical treatment methods in a rat model of superficial partial-thickness burn injury: the advantages of combining zinc-hyaluronan gel with silver foam dressing

BackgroundThere are several options available for conservative treatment of partial-thickness burns, however, reliable, affordable, and easily obtainable animal testing models are hard to find for the comparison of the different treatment methods. We aimed at developing a preclinical testing model and at comparing four treatment methods for superficial partial-thickness burns. MethodsBurn injury was induced in 90 adult male Wistar rats by placing the 130°C hot tip of a commercially obtainable soldering device for 30 s on the clipped skin of the interscapular region at a steady pressure. Skin histology was studied on days 5, 10, and 22 after the induction of the burn injury, on which days, respectively, the ratio of the not epithelialized wound (%), the extent of re-epithelialization (score), and the scar thickness (µm) were assessed. We compared 4 groups: silver-sulfadiazine cream, zinc-hyaluronan gel, silver foam dressing, and the combination of zinc-hyaluronan gel with a silver foam dressing. ResultsOn day 5, the induction of superficial partial-thickness burn injury was confirmed histologically in the rats. The zinc-hyaluronan gel and the combination treatment resulted in a markedly smaller ratio of the non-epithelialized area (29 ± 10% and 28 ± 13%, respectively) than silver-sulfadiazine cream (69 ± 4%; p < 0.01). On day 10, the extent of re-epithelialization was the lowest (∼0.2) in the silver-sulfadiazine cream group, while the other 3 treatments performed significantly better. The combination treatment lead to the maximal score of 2 in all rats, which was higher than in the other 3 treatment groups. On day 22, the scar thickness was the smallest in the combination treatment group (560 ± 42 µm), which was significantly less than in the silver-sulfadiazine cream group (712 ± 38 µm; p < 0.05). ConclusionsWe designed and histologically confirmed a reproducible method for induction of superficial partial-thickness burns in rats for preclinical testing. In our model, the combination of zinc-hyaluronan gel with silver foam dressing was more effective than either of its components alone or than silver-sulfadiazine cream.

Securing Endotracheal Tubes During Prone Positioning.

Securing Endotracheal Tubes During Prone Positioning.

Evaluation of wound healing effects of micronized acellular dermal matrix in combination with negative pressure wound therapy: In vivo study.

Acellular dermal matrix (ADM) grafts can provide coverage for full-thickness skin defects and substitute for dermal defects. We tested the effectiveness of micronized ADM (mADM) as a dressing material, combined with negative pressure wound therapy (NPWT), for managing superficial wounds. We compared the wound healing effect of mADM in combination with NPWT with those of gelatin and mADM applied with a foam dressing. These therapeutic materials were applied to 36 cm2 excisional wounds in a porcine full-thickness skin defect model. Wound healing kinetics and new tissue formation were assessed 10 days after the initial treatment by measuring the wound area. Collagen deposition and neovascularization were histologically evaluated. Compared with the other two groups, mADM plus NPWT combination group had a significantly larger wound area at the baseline (P=.0040), but the smallest on the 7th day (P=.0093). In addition, collagen formation and neovascularization were more histologically promoted than in the other two groups. mADM showed better results than the gelatin group but less collagen and revascularization than the combination group, and there was no significant difference in wound area. Our results show that the combination of mADM and NPWT has a synergistic wound healing effect.

Study protocol for the development of a core outcome set (COS) for clinical effectiveness trials of bordered foam dressings in the treatment of complex wounds

Study protocol for the development of a core outcome set (COS) for clinical effectiveness trials of bordered foam dressings in the treatment of complex wounds