Hydroactive Dressings Research Articles

OPTIMAL APPROACHES FOR LOCAL TREATMENT OF GUNSHOT WOUNDS TO FACILITATE EARLY WOUND HEALING

Gunshot wounds comprise a significant category of injuries resulting from firearm use, involving not only the impact of the blast wave but also damage from metal and secondary tissue fragments. This topic remains highly relevant today, as the appropriateness of local and surgical treatments plays a crucial role in the prompt regeneration of damaged tissues, prevention of purulent complications, swift closure of wound defects, and the optimal restoration of organ function, thereby reducing disability rates for patients.
 This study aims to compare and determine the clinical effectiveness of traditional dressings with antiseptic (Study Group I), hydroactive superabsorbent dressings (Group II), and Vacuum-Assisted Closure (VAC-therapy) (Group III) to provide cleansing of gunshot wounds, prepare the wound surface for skin plastic surgery, prevent secondary necrosis, purulent complications, and ensure the rapid rehabilitation of patients.
 The study included 154 wounded individuals, divided into three groups, with an age range spanning 18 to 50 years. Following our study, it can be inferred that the use of Vacuum-Assisted Closure (VAC-therapy) proves most effective in treating gunshot wounds. This method stimulates the early growth of granulation tissue, with mature granulation tissue evident as early as the 4th day, in contrast to the use of hydroactive dressings (on the 6th day) and traditional gauze material with an antiseptic (on the 7th day). VAC-therapy facilitates marginal epithelization and wound contraction, preventing the development of secondary necrosis and severe purulent complications. Moreover, this approach requires shorter-term antibiotic therapy, exhibits the lowest rate of complications post-repair of a wound defect, and reduces the rehabilitation period for the wounded.

Bacterial Cellulose-Adaptation of a Nature-Identical Material to the Needs of Advanced Chronic Wound Care.

Modern wound treatment calls for hydroactive dressings. Among the variety of materials that have entered the field of wound care in recent years, the carbohydrate polymer bacterial cellulose (BC) represents one of the most promising candidates as the biomaterial features a high moisture-loading and donation capacity, mechanical stability, moldability, and breathability. Although BC has already gained increasing relevance in the treatment of burn wounds, its potential and clinical performance for “chronic wound” indications have not yet been sufficiently investigated. This article focuses on experimental and clinical data regarding the application of BC within the indications of chronic, non-healing wounds, especially venous and diabetic ulcers. A recent clinical observation study in a chronic wound setting clearly demonstrated its wound-cleansing properties and ability to induce healing in stalling wounds. Furthermore, the material parameters of BC dressings obtained through the static cultivation of Komagataeibacter xylinus were investigated for the first time in standardized tests and compared to various advanced wound-care products. Surprisingly, a free swell absorptive capacity of a BC dressing variant containing 97% moisture was found, which was higher than that of alginate or even hydrofiber dressings. We hypothesize that the fine-structured, open porous network and the resulting capillary forces are among the main reasons for this unexpected result.

Experience of using hydroactive wound dressings in outpatient practice

The modern tactics of conservative treatment of trophic ulcers and skin wounds imply the staged use of hydroactive wound dressings whose task is to activate and create optimal conditions for the natural regenerative process. This publication presents an actual clinical case of an effective sequential administration of hydroactive wound dressings HydroClean and HydroTac in a 76-year-old patient with a history of deep vein thrombosis and pulmonary embolism. Two weeks after discharge from the hospital for treatment of severe coronavirus infection (COVID-19) with 70% lung involvement, the patient developed a bubble filled with clear fluid on the anterior surface of the shin. A surgeon at the place of the residence opened the blister and administered occlusive dressings with povidone-iodine, as a result of which the wound surface was covered with a necrotic scab. The patient went to a specialized phlebology clinic due to deterioration of the wound condition and pronounced pain both at rest and during dressings. In order to remove necrotic tissues, a hydroactive dressing HydroClean was prescribed, which was fixed on the limb using cohesive bandage Peha-haft. The authors emphasize the high efficiency and safety of these hydroactive dressings, as well as the possibility of their use at home, which is especially relevant during the COVID-19 pandemic. This clinical case demonstrates the effectiveness of modern hydroactive wound dressings, the use of which in a short time allowed to close a large skin wound in a patient with an extremely negative comorbid background and demonstrates the possibility of remote management of treatment using modern means of communication.

Prevention of Nasal Ala Pressure Injuries With Use of Hydroactive Dressings in Patients With Nasotracheal Intubation of Orthognathic Surgery: A Randomized Controlled Trial.

To compare a hydroactive dressing to an adhesive tape standard of care in the prevention of nasal ala pressure injuries associated with nasotracheal intubation during orthognathic surgery. Randomized controlled trial. The study took place in a tertiary hospital of stomatology in China. Patients undergoing general anesthesia with nasotracheal intubation during orthognathic surgical procedures were invited to participate. Participants were divided into 2 groups: in the experimental group, a hydroactive dressing was applied to the nasal ala before the surgical procedures; the control group received standard prevention with a type of tape. Skin assessments were performed on the wards up to 72 hours after the procedures. Demographic information and potential contributing factors associated the development of nasal ala pressure injuries were collected from patients' electronic medical records. Pressure injury development was staged using National Pressure Injury Advisory staging guidelines. Pressure injury incidence was compared between groups using the χ test and odds ratio. The sample comprised 450 participants, 225 in each group. The incidence of nasal ala pressure injuries development was 14.222% and 4.444% in the 2 groups, respectively (P = .000). The odds ratio was 3.565 (95% confidence interval, 1.707-7.443). The study findings indicate that the incidence of pressure injuries of nasal ala skin protected by hydroactive dressings was lower than the standard preventive method. Hydroactive dressings should be considered as a prevention method to reduce device-related skin injuries associated with nasotracheal intubation.

Wound dressings for leg ulcers in Germany: Distribution, regional variations and health care providers

Abstract Background Although there are standards in guideline-compliant treatment of chronic wounds, little is known about the use of wound dressings in Germany. Objective The objective of the longitudinal study was to analyze the use of wound dressings, to explore regional differences and to characterize prescriptions by different physician specialties in patients with leg ulcers in Germany. Methods Wound dressing rates for incident leg ulcers were analyzed from a German statutory health insurance between 2010 and 2012. Results From 2010 to 2012, out of 7,248,644 insured persons 0.52% [95%-CI 0.51–0.52%] were identified as having an incident ulcer. 76.0% were treated with hydroactive wound dressings. By contrast, in 23.7% only non-hydroactive dressings were used, and more often prescribed in venous (24.0%) than in mixed leg ulcers (20.8%). Most frequently used products were foam dressings (49.7%), followed by gauze compresses (29.5%). Wound specialized physicians had the highest overall proportion of prescriptions (60.2%) and a slightly higher proportion of non-hydroactive wound dressings. Large regional variations were observed. Conclusion In Germany, a high level of use of hydroactive wound dressings in leg ulcers and marked regional variations were found.

The effect of wound dressings on the pH stability of fuids

Wound healing is a complex process that is influenced by both intrinsic and extrinsic factors, and it is becoming increasingly complex with the latest treatment methods and investigations of wound nature. The term 'wound healing' covers all types of wounds, burns and ulcerations. There is a considerable global variation in the treatment of acute and chronic wounds, therefore, establishing a standardised, best way to manage wounds may not be possible. Complete wound healing, which includes restoration of function, is hardly ever achieved in those disfigured by wounds, especially when one includes the appearance of scarred skin or an amputation.

Ökonomische Effekte der Standardisierung in der modernen Wundversorgung

Despite the advantages of modern wound management, it is still employed too rarely because of higher costs and lack of information available to the medical staff. At the University Hospital Jena, the assortment of hydroactive wound dressings has been optimized, in order to increase acceptance and attain cost advantages. The defined target sizes were differentiated according to economic and qualitative parameters. The economic parameters included the reduction in the total costs for wound management, adjusted for the case mix and the number of cases. Among the qualitative parameters were reducing the number of suppliers and the number of orders outside the standard offerings. Via standardization, the average expenses per case for hydroactive wound applications could be reduced by 10.3% and the average expenses per weighted German DRG by 15.9%. As a result of the reorganization of the assortment, the number of suppliers was reduced by 57.1% and two main and one secondary supplier were designated. The number of orders outside the standard assortment was reduced from 173 to 21 (87.8%). The standardization of the assortment of hydroactive wound applications has led to an increase in procedural efficiency and effectiveness at the University Hospital Jena, in addition to a reduction in the cost of material and in the number of suppliers.

Effect of Three Wound Dressings on Infection, Healing Comfort, and Cost in Patients With Sternotomy Wounds: A Randomized Trial

To compare three dressing types in terms of their ability to protect against infection and promote healing, patient comfort, and cost-effectiveness. Prospective, randomized controlled trial. Major metropolitan, academically affiliated, tertiary referral center. Seven hundred thirty-seven patients were randomized to receive a dry absorbent dressing (n = 243) [Primapore; Smith & Nephew; Sydney, NSW, Australia], a hydrocolloid dressing (n = 267) [Duoderm Thin ConvaTec; Mulgrave, VIC, Australia], or a hydroactive dressing (n = 227) [Opsite; Smith & Nephew] in the operating theater on skin closure. There was no difference in the rate of wound infection or wound healing between treatment groups. The Primapore dressing was the most comfortable and cost-effective dressing option for the sternotomy wound. Duoderm Thin dressings were associated with increased wound exudate (p < 0.001), poor dressing integrity (p < 0.001), more frequent dressing changes (p < 0.001), more discomfort with removal (p < 0.05), and increased cost (p < 0.001). In the context of no additional benefit for the prevention of wound infection or the rate of wound healing for any of the three dressing products examined, dry absorbent dressings are the most comfortable and cost-effective products for sternotomy wounds following cardiac surgery.

Development of new hydroactive dressings based on chitosan membranes: characterization and in vivo behavior.

Different poly(vinyl alcohol) (PVA)/chitosan lactate (ChL)-blended hydrogels containing nitrofurazone as a local anti-infective drug were prepared by the phase-inversion technique. The swelling degree, surface free energy, mechanical properties, and nitrofurazone release of these membranes were determined. Blood compatibility of these systems was evaluated by the open-static platelet adhesion test with whole human blood. The results showed that water absorption into the PVA/ChL membranes slowed down, governed by the rate at which the dressing interacted with the physiological fluid. Swelling degree values up to 200% were observed. The rate of release of nitrofurazone seemed to depend on the ChL percentage on the blend as well as the pH of the solution. The surface free energy values were in the range of 20-30 dynes/cm, which was appropriate for a favorable interaction with blood. From the Young's module curve, it could be seen that elastic hydrogels were obtained with increment of ChL in the PVA/ChL blends. Values of platelet adhesion and whole blood clotting times for the PVA/ChL blends as well as the increase of ChL, which appears to reduce the fibrinogen adsorption on the PVA/ChL membranes, demonstrated that the blood compatibility of PVP/ChL blends is superior to that separated polymers. The results of in vivo experiments in rats were in very good agreement with these observations, suggesting that PVA/ChL may serve as a new type of potential wound-dressing material.

Einsatz der gestielten Omentum-majus-Plastik als thoracoabdomineller Defektersatz nach großflächiger Tumorresektion

Patients suffering from long-untreated malignomas of the chest or abdominal wall may require plastic surgery due to extensive defects after tumor resection. Despite a variety of pedicled or free myocutaneous flaps, there are defects in which these reconstructional options may not be indicated. In these patients, the omental flaps are a valid alternative. Since a secondary split skin graft is mandatory with the omentum flap, antibacterial and granulation-enhancing xerodressings are required for wound bed conditioning. We report one patient in whom the omentum flap was used for coverage of an extensive defect after resection of a widespread basal cell carcinoma at the lateral thorax and abdominal wall. After wound conditioning with silver-impregnated activated charcoal xerodressing (Actisorb) in combination with a hydroactive polymer dressing (Allevyn), secondary skin grafting was performed. In this patient fibrosis and calcification of the omentum led to stable abdominal wall coverage even without the application of a synthetic mesh.

Interleukin-1α and Collagenase Activity Are Elevated in Chronic Wounds

Interleukin-1-alpha (IL-1alpha) is a member of a family of proinflammatory polypeptide mediators that has been shown in vitro to stimulate collagenase production. Collagenase is a proteolytic enzyme classified as one of the matrix metalloproteinases (MMP-1) that specifically recognizes and cleaves collagen. Therefore, the objective of this study was to compare the levels of these two proteins in chronic wounds as possible factors in the pathogenesis of chronic wounds. Fluids from 10 chronic wounds were collected before and after a 1-week treatment with a hydroactive dressing (Cutinova cavity). In addition, fluids were collected from 20 acute wounds for comparison. IL-1alpha and MMP-1 levels were quantified using sandwich ELISA. Collagenase activity was measured using a radiolabeled collagen as substrate. Clinically, the chronic wounds showed decreased area (-21.0 cm2) and reduced volume (-134.5 cm3) by 4 weeks after treatment with the hydroactive dressing. There were no significant differences in the protein concentrations between acute wound fluids (21.0 +/- 3.0 mg/ml) and chronic wound fluids before and after treatment with the hydroactive dressing (18.3 +/- 5.5 and 25.2 +/- 7.6 mg/ml, respectively). Levels of IL-1alpha in the acute wound fluids were low (0.019 pg/mg), whereas in the chronic wound fluid before treatment they had been significantly elevated (44.9 + 21.8 pg/mg). Following treatment with the hydroactive dressing, the IL-1alpha levels dropped to 10.3 + 3.3 pg/mg (p < 0.05). Collagenase activity was not detectable in acute wound fluid, elevated in pretreatment chronic wounds (12.9 + 3.4 units), and decreased in chronic wounds after treatment (11.4 + 3.3 units). This study correlated clinical healing of chronic wounds with biochemical changes in the ulcer microenvironment. As the chronic wounds began to heal, there was a significant decrease in the IL-1alpha levels and collagenase activity, thus suggesting that these two proteins may contribute to the lack of healing characteristic of chronic wounds.

Interleukin-1α and Collagenase Activity Are Elevated in Chronic Wounds

Interleukin-1-alpha (IL-1alpha) is a member of a family of proinflammatory polypeptide mediators that has been shown in vitro to stimulate collagenase production. Collagenase is a proteolytic enzyme classified as one of the matrix metalloproteinases (MMP-1) that specifically recognizes and cleaves collagen. Therefore, the objective of this study was to compare the levels of these two proteins in chronic wounds as possible factors in the pathogenesis of chronic wounds. Fluids from 10 chronic wounds were collected before and after a 1-week treatment with a hydroactive dressing (Cutinova cavity). In addition, fluids were collected from 20 acute wounds for comparison. IL-1alpha and MMP-1 levels were quantified using sandwich ELISA. Collagenase activity was measured using a radiolabeled collagen as substrate. Clinically, the chronic wounds showed decreased area (-21.0 cm2) and reduced volume (-134.5 cm3) by 4 weeks after treatment with the hydroactive dressing. There were no significant differences in the protein concentrations between acute wound fluids (21.0 +/- 3.0 mg/ml) and chronic wound fluids before and after treatment with the hydroactive dressing (18.3 +/- 5.5 and 25.2 +/- 7.6 mg/ml, respectively). Levels of IL-1alpha in the acute wound fluids were low (0.019 pg/mg), whereas in the chronic wound fluid before treatment they had been significantly elevated (44.9 + 21.8 pg/mg). Following treatment with the hydroactive dressing, the IL-1alpha levels dropped to 10.3 + 3.3 pg/mg (p < 0.05). Collagenase activity was not detectable in acute wound fluid, elevated in pretreatment chronic wounds (12.9 + 3.4 units), and decreased in chronic wounds after treatment (11.4 + 3.3 units). This study correlated clinical healing of chronic wounds with biochemical changes in the ulcer microenvironment. As the chronic wounds began to heal, there was a significant decrease in the IL-1alpha levels and collagenase activity, thus suggesting that these two proteins may contribute to the lack of healing characteristic of chronic wounds.

Hydroactive dressings and serum proteins: an in vitro study.

An in vitro approach was used to obtain information about the compatibility of hydroactive dressing materials with the serum proteins which are thought to be relevant to wound healing. Artificial wound fluid was incubated with different hydroactive dressings (Cutinova hydro, Varihesive E, Comfeel Ulcer Dressing and Allevyn), and concentrations of total protein, albumin, immunoglobulin and growth factors were measured after one day of incubation. Cutinova hydro and Allevyn absorbed considerable amounts of fluid. Fluid uptake was lower for the hydrocolloid dressings. An unexpected finding was that Cutinova hydro showed an approximately two-fold increase over control values in the concentration of all proteins tested, indicating a selective absorption of water by this dressing. For the other dressings tested, zero or very low absorption of proteins was found, indicating a basically satisfactory protein compatibility.

A Randomized Prospective Study of a Hydroactive Dressing vs Conventional Treatment After Shave Biopsy Excision

Fifty shave biopsy sites were prospectively randomized to treatment with either a hydroactive dressing or conventional therapy (bacitracin plus Band-Aid). Time to complete epithelialization, pain, infection, and convenience of the therapy were assessed. There was no significant difference between the two dressings with regard to time to heal, wound infection rate, or pain. However, patients preferred the hydroactive dressing because of convenience. Hydroactive dressings did not accelerate healing compared with conventional therapy, but may facilitate wound management because of convenience and time savings in dressing changes.

DuoDERM hydroactive dressing versus silver sulphadiazine/Bactigras in the emergency treatment of partial skin thickness burns

The study compared DuoDERM Burn Pack Hydroactive Dressings (DHD) with silver sulphadiazine/Bactigras dressings (SSD/Bactigras) in the outpatient management of small partial skin thickness burns. Forty-eight patients were entered into the study, and randomly allocated into either the DHD or SSD/Bactigras group. Burn wounds were followed until complete re-epithelialization occurred. There were no statistical differences between the groups, either with respect to their composition or characteristics of healing in days, and patients' subjective responses to treatment. However, application was easier in the DHD group (93 per cent), compared with 71 per cent in the SSD/Bactigras group ( P = 0.0009), and the SSD/Bactigras were easier to remove (96 per cent) versus DHD (66 per cent, P = 0.0004). Furthermore, the DHD group had significantly less dressing changes; a mean of three changes per subject in the DHD group compared with eight in the SSD/Bactigras group ( P = 0.117). Two burn wounds became infected in the DHD group, and one in the SSD/Bactigras group. In this study both modalities were found to be equally suitable and effective for small partial skin thickness burns.

A prospective, randomized trial of Unna's boots versus hydroactive dressing in the treatment of venous stasis ulcers

In many centers the standard treatment for venous stasis ulcers consists of UB dressings. A new dressing, DuoDERM hydroactive dressing (HD), has recently been used extensively for the treatment of venous stasis ulcers. Because of this trend, a prospective, randomized trial of these two dressings was undertaken. Sixty-nine ulcers (39 HD and 30 UB) were randomized. End points were complete healing and development of complications necessitating cessation of treatment. Time to healing, cost of treatment, and patient convenience were also evaluated.Twenty-one of 30 ulcers (70%) healed with UB therapy compared with 15 of 39 ulcers (38%) treated with HD (p < 0.01, CST). Life-table healing rates at 15 weeks were 64% for UB compared with 35% for HD (p = 0.01, log rank test). Ten of 39 patients (26%) receiving HD had complications compared with no complications in the UB group (p = 0.004, FET). For those patients whose ulcers healed, there was no significant difference (p = 0.51, STT) in the mean time required for healing or the average weekly cost of dressing materials between the HD group (7.0 weeks at $11.50 per week) and the UB group (8.4 weeks at $12.60 per week). Those patients treated with HD reported a significantly greater level of convenience than those patients with UB (p = 0.004, STT).Although treatment with HD led to better patient acceptance, those patients receiving UB therapy had a significantly greater rate of healing and a significantly lesser incidence of complications than those patients treated with HD.