Moist Dressings Research Articles

Accelerating the aesthetic benefit of wound healing by triterpene

Intention of the study (EudraCT No 2009-017418-56) is a proof of aesthetic benefit of triterpene treatment in superficial wounds. In an open, prospective, controlled, randomized, blindly evaluated multicentre phase II clinical trial a triterpene ointment (OG-S10) is compared intra individually with a state-of-the-art moist wound healing dressing (Mepilex®) in split thickness skin graft donor sites. The graft wound areas at the upper leg were divided into two equal halves, one proximal and one distal site. Decided by randomization the one site was treated with triterpene and the other in comparison with moist dressing. Triterpene treatment went on for 14days as covering the wound at every change of wound dressing with the ointment (100 mg/cm2). The comparative treatment went on as covering the site by this dressing alone. The outcome of these different treatments was evaluated by two blindly observing distant experts on the basis of photographs of the wound healing progress. Photographs were taken day 14, 3month and 1year after treatment. The only criterion for evaluation of the two sites was similarity of the wound area to the surrounding skin in terms of colour and texture: which of the two sites, the proximal or the distal, was aesthetically superior in normal skin appearance after 14days at the end of treatment, after 3month of follow up and 1year after treatment? The descriptive comparison is demonstrating quite a remarkable advantage of the ointment versus the moist wound dressing in promoting wound healing: even having in mind the small number of 24 patients within the protocol, the superiority of aesthetic benefit by triterpene treatment after 14days (22 out of 24 patients), after 3month (15 out of 19 patients) and after 1year (8 out of 10 patients) is obvious.

Die Nageltascheninfektionen der Finger – Behandlung der Paronychien

The procedure is selected based on the stage of infection with careful removal of the focal infection in the area of the nail fold. All infections of the periungual area. Herpes infections [1, 12]. All purulent infections of the periungual area should be eliminated. Opening of the abscess, excision of the eponychium, mobilization of the nail barrier away from the nail plate, inzision of the nail barrier at a defined place, necrosectomy, irrigation, and drainage. Moist dressings and fingerbaths in the first few days. In most cases, the infection heals completely without substantial scar formation.

Infektion der Fingerbeere

The goal of excision of a subcutaneous abscess in the distal pulp of the fingertip is the fast and complete removal of the infected and devitalized tissue. Every acute infection of the fingertip. Atypical infections, e.g., Herpes, Orf's disease, mycobacterial infections. Excision of the infected area in the fingertip without damaging the digital nerves and their branches. The wound is left open and is covered with a moist dressing. Early targeted incision brings good functional and cosmetic results.

Role of negative pressure wound therapy in healing of diabetic foot ulcers

Introduction:Foot disorders such as ulceration, infection and gangrene are the most common, complex and costly sequelae of diabetes mellitus.[1–3] Even for the most superficial wounds, treatment is often difficult with poor healing responses and high rates of complications. The purpose of this study is to compare the rate of ulcer healing with the negative pressure dressing technique to conventional moist dressings in the treatment of diabetic foot ulcers.Materials and Methods:The study was conducted on 30 patients, which were divided into two groups. One group received negative pressure dressing while other group received conventional saline moistened gauze dressing. Results were compared for rate of wound healing.Results:There was a statistically significant difference in the rate of appearance of granulation tissue between the two groups; with granulation tissue appearing earlier in the study group. The study group promised a better outcome (80% complete responders) as compared to the control group (60% complete responders).Conclusions:Negative pressure wound therapy has a definitive role in healing of diabetic foot ulcers.

Silver sulfadiazine for the treatment of partial-thickness burns and venous stasis ulcers

For decades silver-containing antibiotics such as silver sulfadiazine (SSD) have been applied as standard topical therapy for patients with partial-thickness burns and venous stasis ulcers. This evidence-based review intends to answer the following research question: in ambulatory patients with partial-thickness burns or stasis dermatitis ulcers, does the use of topical SSD compared with nonantibiotic dressings improve mortality, wound healing, re-epithelialization, or infection rates? MEDLINE, EMBASE, Cochrane Library, and other databases were searched. We considered trials that enrolled patients of any age with partial-thickness burns or venous stasis ulcers and randomized them to either topical SSD or placebo, saline-soaked gauze, paraffin gauze, sterile dry dressing, or nonantibiotic moist dressing. Outcomes included mortality, wound healing, speed of re-epithelialization, and infection rates. For burns, our search revealed 400 potential articles. No human studies met the inclusion criteria. Only 7 animal studies (1 mouse, 4 rat, and 2 pig) were relevant to the proposed question. These animal studies provided conflicting results. Whereas some support the use of SSD for treatment of partial-thickness burns, others question its effectiveness. For stasis dermatitis ulcer, the search identified 50 articles for review, of which 20 abstracts were reviewed, and one article met the inclusion criteria. This study did not show any significant improvement in the rate of complete healing in SSD group compared with placebo either at 4 weeks (relative risk 6.2, 95% confidence interval 0.8-48) or at 1 year (relative risk 5.2, 95% confidence interval 0.6-41.6) of follow-up. There is insufficient evidence to either support or refute the routine use of SSD for ambulatory patients with either partial-thickness burns or stasis dermatitis ulcers to decrease mortality, prevent infection, or augment wound healing in human beings.

Systematic Review of Skin Graft Donor-Site Dressings

Debate continues about what split-thickness skin graft donor-site dressing provides the best outcomes for patients at the lowest cost. The goal of this systematic review was to determine which donor-site dressings are associated with the best outcomes for the following: pain, infection rate, healing quality, healing rate, quality of life, and cost. A comprehensive literature review and assessment was undertaken by two independent reviewers. Articles were selected using specific inclusion criteria. Split-thickness skin graft donor-site dressings were classified as either moist or nonmoist based on the state of the dressing upon initial application. Methodological quality of randomized controlled trials was assessed using the Jadad scale. Seventy-five relevant articles were included in the final analysis, three of which were review articles. The most commonly measured outcome was healing rate (64 of 72), followed by pain (58 of 72), infection rate (40 of 72), healing quality (40 of 72), and cost (15 of 72). No studies measured quality of life. The majority of articles were randomized controlled trials (35 of 75), followed by observational studies (22 of 75), unsystematic clinical observations (15 of 75), and review articles (three of 75). It was difficult to compare moist and nonmoist dressings in this review because of the methodological heterogeneity of the included articles. The available evidence suggests, however, that moist dressings are superior in terms of pain. Some weak evidence exists that supports "wet dressings." To determine the best split-thickness skin graft donor-site dressing, more methodologically sound randomized controlled trials are needed. Trials with parallel economic evaluations should be undertaken to answer this question.

Successful treatment of pyoderma gangrenosum associated with juvenile idiopathic arthritis with a combination of topical tacrolimus and oral prednisolone

Dear Editor, A 16-year-old boy, known to have Juvenile Idiopathic Arthritis–extended oligo-articular (JIA), presented with a pustule over the left leg rapidly progressing to a large, exceedingly painful ulcer. On examination he had pallor, flexion deformity of right elbow and active arthritis of both wrists. An ulcer measuring 10×5 cm was there over left shin with central necrosis and undermined erythematous edges (Fig. 1a). A diagnosis of pyoderma gangrenosum (PG) was made and a biopsy from ulcer margin was consistent with this diagnosis. There was no evidence of malignancy or infection. He was initiated on oral prednisolone (1 mg/kg/day), methotrexate (10 mg/week) and topical tacrolimus (0.03% w/w) twice a day under occlusive dressing. After 3 weeks, the ulcer had significantly healed with complete resolution of pain (Fig. 1b). PG is a rare and a serious ulcerating disease of the skin of unknown cause [1]. Abnormal neutrophil chemotaxis has been implicated [2]. Affection for children is rare [3]. About a quarter of patients with PG have arthritis the severity of which is unrelated to PG [4]. PG has been more commonly reported in context of seropositive RA and spondyloarthropathies and rarely in JIA [1, 5]. Extra-cutaneous lesion may involve lungs and bones (multifocal sterile recurrent osteomyelitis) and can precede cutaneous lesions [6, 7]. The timing and site of the biopsy determine the histopathology of PG [8]. The principle of biopsy is to exclude other conditions such as malignancy and infections. Treatment includes local care with moist dressings. Various topical and systemic therapies have been tried with varying success. Initial response to treatment can be seen within days to weeks but complete remission may require months to years [1]. In our patient, methotrexate was initiated primarily for the treatment of JIA and also because of reports of its efficacy in PG. The ulcer however responded dramatically to corticosteroid and topical tacrolimus. To the best of our knowledge, this is the first report of JIAassociated PG to be successfully treated in such a short span of time with a combination of topical tacrolimus and oral corticosteroid. Clin Rheumatol (2009) 28:489–490 DOI 10.1007/s10067-008-1066-y

036 MIST Ultrasound: The results of a multicenter, randomized, double-blind, sham-controlled trial of the healing of diabetic foot ulcers

A prospective, randomized, sham-controlled, double-blinded study of diabetic foot ulcers was conducted to answer questions of safety and impact on wound healing of a noncontact ultrasound device. Standard of care included moist dressings, debridement, offloading, and adequacy vascular supply for both groups. Patients were randomized to receive a saline mist or 40 KHz ultrasound therapy delivered to the wound bed using the spray as the coupler. The study was 12 weeks in duration or until the wound closed. Sixty-six patients were entered with intent to treat. Fifty-five patients were evaluable and constitute the outcomes of the study. MIST therapy resulted in 42.3% rate of healing versus 14.3% for sham treated significant at 0.028 Chi square. Kaplan Meier survival plots resulted in p < 0.0087 log rank and p < 0.011 Wilcoxon. Rate of wound closure was 22% faster with MIST compared to sham treated patients. There was no statistically significant difference with regard to adverse events in any category (mild, moderate, or severe) MIST ultrasound therapy is a new, safe, novel FDA-cleared device that improves diabetic foot ulcer healing compared to standard of care. Details of the study will be presented. Acknowledgments: This study was funded by Celleration Inc. Eden Prairie, MN.

Rezidivraten des venösen Ulkus unter chirurgischer Therapie

Venous insufficiency may lead to recurrent leg ulcers. The reason for this observation remains still unclear. In this study we tried to underline the influence of surgical treatment on recurrence rate of venous leg ulcers. In this study 69 patients were treated in a special wound care centre. Before treatment the angiological status was evaluated using phlebography or duplex scan. Afterwards, patients were scored according to the "Venous Clinical Severity Score" of the American Venous Forum. During the observation period compression therapy was performed and wounds were treated with moist dressings. Necroses were removed by radical debridement and large ulcers were covered by mesh graft tissue transfer. When indicated incompetent veins were treated surgically. The follow-up revealed an overall recurrence rate of 21 % after 30 months. Ulcers treated by radical wound debridement or mesh graft tissue transfer demonstrated a significant lower recurrence rate (p = 0.02 and p = 0.03). According to duplex sonography a correlation was evident among severity of venous insufficiency, the "clinical scoring" (p = 0.04), and the recurrence rate (p = 0.023). After surgical intervention by venous stripping, the insufficiency was improved but the recurrence rate was comparable to that of patients treated without venous surgery (p = 0.44). Surgical treatment of venous leg ulcers in modern wound care centres can reduce its recurrence rates. Herein this study a correlation among venous insufficiency evidenced by duplex scan and recurrence rate for leg ulcers could be demonstrated.

Major Developments in Wound Care: A Critical Appraisal

In human history, new ideas and concepts in science may result in new achievements for the benfit of patients, but in some instances, these achievements may produce contrary results, such as disadvantages or hazards. One such idea is the concept of faster and more comfortable wound healing under a moist dressing. Every nursing school in the developed world will teach this as one of modern dogmas. The truth is that Winter in 1962 published an article in Nature on faster epithelialization of superficial wound in the domestic pig when covered by a foil dressing. He investigated acute and superficial wounds of hairy skin. The situation in chronic, nonhealing, inflamed, and deep wounds on hairy and nonhairy skin is not the same. This has been forgotten widely in marketing the concept of moist wound healing. Indeed, in many chronic type wounds, such as diabetic foot ulcers or venous leg ulcers, there is such an amount of moisture (discharge) that it threatens the epidermal integrity of the surrounding skin. A number of positive effects of moist wound healing have been described, which are of potential interest in chronic wounds:

The Subcutaneous Pulp Flap for Fingertip Defects

Various reconstruction procedures are now available for the treatment of fingertip defects with exposure of the phalanx. Herein we report a subcutaneous pulp flap (SPF) technique, involving use of the adjacent fatty tissue of the wound to form a rotated fatty tissue flap that covers the exposed bone. The SPF was then treated postoperatively with repeated moist dressings. This SPF treatment had minimal donor site defect and morbidity. In brief, the technique is a simple and safe alternative for the reconstruction of fingertip defects. The shortcoming of this flap is that the healing period is longer than for other methods.

Shock Wave Therapy for Acute and Chronic Soft Tissue Wounds: A Feasibility Study

Nonhealing wounds are a major, functionally-limiting medical problem impairing quality of life for millions of people each year. Various studies report complete wound epithelialization of 48 to 56% over 30 to 65 d with different treatment modalities including ultrasound, topical rPDGF-BB, and composite acellular matrix. This is in contrast to comparison control patients treated with standard wound care, demonstrating complete epithelialization rates of 25 to 39%. Extracorporeal shock wave therapy (ESWT) may accelerate and improve wound repair. This study assesses the feasibility and safety of ESWT for acute and chronic soft-tissue wounds. Two hundred and eight patients with complicated, nonhealing, acute and chronic soft-tissue wounds were prospectively enrolled onto this trial between August 2004 and June 2006. Treatment consisted of debridement, outpatient ESWT [100 to 1000 shocks/cm(2) at 0.1 mJ/mm(2), according to wound size, every 1 to 2 wk over mean three treatments], and moist dressings. Thirty-two (15.4%) patients dropped out of the study following first ESWT and were analyzed on an intent-to-treat basis as incomplete healing. Of 208 patients enrolled, 156 (75%) had 100% wound epithelialization. During mean follow-up period of 44 d, there was no treatment-related toxicity, infection, or deterioration of any ESWT-treated wound. Intent-to-treat multivariate analysis identified age (P = 0.01), wound size < or =10 cm(2) (P = 0.01; OR = 0.36; 95% CI, 0.16 to 0.80), and duration < or =1 mo (P < 0.001; OR = 0.25; 95% CI, 0.11 to 0.55) as independent predictors of complete healing. The ESWT strategy is feasible and well tolerated by patients with acute and chronic soft tissue wounds. Shock wave therapy is being evaluated in a Phase III trial for acute traumatic wounds.

A comparative study of the efficacy of topical negative pressure moist dressings and conventional moist dressings in chronic wounds

ABSTRACT Aim: To assess the efficacy of topical negative pressure moist wound dressing as compared to conventional moist wound dressings in improving the healing process in chronic wounds and to prove that negative pressure dressings can be used as a much better treatment option in the management of chronic wounds. Materials and Methods: This is a prospective comparative study of data from 112 patients with chronic wounds, of which 56 patients underwent topical negative pressure dressings (17 diabetic, 10 pressure sores, nine ischemic, two varicose, 10 post-infective raw areas and eight traumatic - six had bone exposed, two orthopaedic prosthesis exposed). The remaining 56 patients underwent conventional moist dressings (20 diabetic, two ischemic, 15 pressure sores, three varicose, eight post-infective raw areas and eight traumatic - five had bone exposed, three orthopaedic prosthesis exposed). The results were compared after 10 days. The variables compared were, rate of granulation tissue formation as a percentage of ulcer area covered, skin graft take up as the percentage of ulcer surface area and duration of hospital stay. The variables were compared using Unpaired Student′s t test. A " P" value &lt; 0.05 was considered significant. Results: Out of 56 patients who underwent topical negative pressure dressings, six (10.71%) were failures, due to failure in maintaining topical negative pressure due to defective sealing technique; these were included into the study group. After 10 days, the mean rate of granulation tissue formation was 71.43% of ulcer surface area. All these 56 cases underwent split-thickness skin grafting. The mean graft take-up was 79.29%. The mean hospital stay was 32.64 days. In the remaining 56 patients, the mean rate of granulation tissue formation was 52.85% of ulcer surface area. The mean graft take-up was only 60.45% of the total ulcer surface area. The mean hospital stay was 60.45 days. Conclusion: To conclude, topical negative pressure dressings help in faster healing of chronic wounds and better graft take-up and reduce hospital stay of these patients.

Die sechs Behandlungsprinzipien des Basler Dekubituskonzepts

The treatment of pressure sores has gained importance due to the increase of geriatric patients and general life expectancy as well as improved therapeutic options in patients with spinal cord injuries. The aetiology of pressure sores is multifactorial. Risk factors such as immobility, malnutrition, and other co-morbidities have to be considered. Therapy of pressure sores is time- and cost-consuming and recurrence rates are high. Successful treatment is based on the interdisciplinary cooperation between conservative and surgical disciplines, nursing, as well as on continuous patient education. The Basle pressure sore concept consists of six principles. Over a total treatment period of approximately three months usually two operative interventions are performed. For effective relief of pressure (1st principle) patients are placed on low-airloss beds. Operative debridement of pressure sores is performed early and systemic or local infection is treated (2nd principle). The wound is then conditioned with moist dressings or VAC (3rd principle). Simultaneously concomitant malnutrition is quantified clinically and chemically and treated by oral or, if necessary, parenteral nutrition. Other risk factors are optimised as well as possible (4th principle). Hereby optimal conditions for plastic-surgical coverage are provided (5th principle). Postoperatively a standardised concept of pressure relief and mobilisation is adhered to (6th principle). This multimodal treatment concept is well established at the University Hospital of Basle for many years. Combined with an effective prevention, the rate of pressure sores could be significantly reduced, wounds could be healed, and the number of recurrences diminished. In a two-year period between January 2004 and December 2005 the Basle plastic surgery team treated 170 pressure sores in 142 patients according to this concept in the Swiss paraplegic centre in Nottwil. In 2006, 78 % of these patients (111 patients) were followed up and recurrence rates of 23 % (26 pressure sores) were found. The Basle pressure sore concept is well established for an interdisciplinary and structured treatment of geriatric and paraplegic patients with pressure sores and provides a reliable basis for effective treatment for this complex disease.

A comparative study of the efficacy of topical negative pressure moist dressings and conventional moist dressings in chronic wounds

Aim: To assess the efficacy of topical negative pressure moist wound dressing as compared to conventional moist wound dressings in improving the healing process in chronic wounds and to prove that negative pressure dressings can be used as a much better treatment option in the management of chronic wounds. Materials and Methods: This is a prospective comparative study of data from 112 patients with chronic wounds, of which 56 patients underwent topical negative pressure dressings (17 diabetic, 10 pressure sores, nine ischemic, two varicose, 10 post-infective raw areas and eight traumatic - six had bone exposed, two orthopaedic prosthesis exposed). The remaining 56 patients underwent conventional moist dressings (20 diabetic, two ischemic, 15 pressure sores, three varicose, eight post-infective raw areas and eight traumatic - five had bone exposed, three orthopaedic prosthesis exposed). The results were compared after 10 days. The variables compared were, rate of granulation tissue formation as a percentage of ulcer area covered, skin graft take up as the percentage of ulcer surface area and duration of hospital stay. The variables were compared using Unpaired Student's t test. A P value <0.05 was considered significant. Results: Out of 56 patients who underwent topical negative pressure dressings, six (10.71%) were failures, due to failure in maintaining topical negative pressure due to defective sealing technique; these were included into the study group. After 10 days, the mean rate of granulation tissue formation was 71.43% of ulcer surface area. All these 56 cases underwent split-thickness skin grafting. The mean graft take-up was 79.29%. The mean hospital stay was 32.64 days. In the remaining 56 patients, the mean rate of granulation tissue formation was 52.85% of ulcer surface area. The mean graft take-up was only 60.45% of the total ulcer surface area. The mean hospital stay was 60.45 days. Conclusion: To conclude, topical negative pressure dressings help in faster healing of chronic wounds and better graft take-up and reduce hospital stay of these patients.

Bacterial decontamination of surgical wounds treated with Lavasept ®

In a prospective randomized controlled double-blind study in 50 acutely injured patients, bacterially contaminated type 2–4 soft tissue wounds were treated with moist dressings of 0.2% Lavasept ® (fractionated polyhexamethylenbiguanide and macrogolum 4000) solution ( n=28) in comparison with Ringer solution ( n=22). Standardized swabs were taken on days 0, 2, 8 and 15 and investigated for microorganisms. For a quantitative evaluation, the number of colony forming units (CFU) was determined by a serial dilution technique. The tissue compatibility and anti-inflammatory effect were rated on a scale of 0 (=bad) to 3 (=very good). The most frequently found microorganism was Staphylococcus aureus, which was isolated from 13 wounds. Use of Lavasept ® led to a faster and significant reduction in microorganisms on the wound surfaces. The number of CFU per wound remained constant or decreased, in contrast to the wounds treated with Ringer solution. This was true for both Gram-positive and Gram-negative bacteria. There was no evidence of impaired wound healing in either group. The anti-inflammatory effect and the tissue compatibility of Lavasept ® were rated significantly better than that of Ringer solution. It is concluded that Lavasept ® combines antiseptic action with good tissue compatibility.

Vakuumtherapie in der Behandlung desaströser Wundverhältnisse bei Morbus Madelung

A 54 year old patient presented with a Madelung disease. Symmetrically fatty deposits were present on both upper arms, at the abdomen and both thighs. Dermatitis was seen in the axillary fold at the skin bearing surfaces. Shoulder movement was impaired. Liposuction of both upper arms has already been performed, but no significant improvement was obtained. We performed a dermolipectomy of both upper arms. Postoperatively the patient suffered from a severe wound dehiscence with fulminant wound infection and septic clinical condition. Because of the large wound surface ((1/3) of the upper arm circumference) anemia occurred and had to be treated with blood transfusions. Wound exsudation caused a general hypoproteinemia. Multiple surgical debridements were necessary in order to clean the wound from necrotic tissue and afterwards moist dressings were applied. Furthermore the patient received intravenous antibiotic treatment. After stabilisation of the general condition of the patient and the wound situation a polyvinyl sponge and a vacuum-sealing were applied and continuous suction was performed (125 mm Hg). This resulted in a significant improvement of the wound situation in regards to wound cleaning, induction of granulation tissue, diminished wound size, reduction of oedema and pain reduction. After four weeks of vacuum therapy defect coverage was possible and split thickness skin grafting was performed. The skin graft was attached to the wound using a vacuum-dressing. After removal of the vacuum dressing on the fifth day the skin graft has completely healed. Vacuum therapy is suitable for disastrous wound conditions in order to achieve a defect size reduction, pain reduction and create a clean wound with granulation tissue for further surgical defect coverage using skin grafts or flaps.

The debridement of hard to heal leg ulcers by means of a new device based on Fluidjet technology

Debridement plays an essential role in the wound-bed preparation of necrotic and sloughy ulcers, being a mandatory step to achieve a well-debrided bed, proceeding towards healing. This study reports our experience with Versajet [Versajet Hydrosurgery System (Smith & Nephew, Hull, UK)], a new device for the debridement of exudating ulcers, based on Fluidjet technology, which excises and aspirates the unwanted tissue by using the Venturi effect. In a 10-month time period, a total of 68 patients, out of a setting of 167 patients, hospitalised as affected by chronic, hard-to-heal leg ulcers, stuck in the inflammatory phase, were treated with Versajet. Based on ulcer characteristics and clinical conditions, the remaining 99 patients underwent traditional debridement with moist dressings (controls). In the majority of Versajet-treated cases (46), an adequately debrided wound bed was achieved with one operative procedure; two and three procedures were required in 17 and 5 patients, respectively. Almost all the procedures were performed in the ward at the patient's bedside. This procedure is quick (mean time per treatment is about 5 minutes); when compared with a traditional treatment with moist dressings, Versajet considerably shortens the in-hospital stay and promotes a quicker healing process. When used by an experienced surgeon, Versajet allows a selective debridement, as it makes it possible to remove only the tissue centred in the working end and spare the healthy tissue. Debriding with Versajet is highly effective in reducing the bacterial load of the ulcer bed. The pain caused by Versajet is well tolerated, especially when set for gentle debridement. If multiple treatments are required, the combined use with moist dressings is synergistic, as the dressings soften the necrotic tissue, thus facilitating the following Versajet debridement. The results indicate that Versajet offers more precision than standard mechanical debridement and, at high settings, offers an alternative to surgical debridement.

The National Pressure Ulcer Long‐Term Care Study: Outcomes of Pressure Ulcer Treatments in Long‐Term Care

To identify resident, wound, and treatment characteristics associated with pressure ulcer (PrU) healing in long-term care residents. Retrospective cohort study with convenience sampling. Ninety-five long-term care facilities participating in the National Pressure Ulcer Long-Term Care Study throughout the United States. Eight hundred eighty-two residents, aged 18 and older, with length of stay of 14 days or longer, who had at least one Stage II to IV PrU. Data collected for each resident over a 12-week period included resident characteristics, treatment characteristics, and change in PrU area. Data were obtained from medical records, Minimum Data Set, and other records. Two multiple regression models, one for each stage grouping (Stage II, Stage III and IV), were completed. The area of Stage II PrU was reduced more with moist (F=21.91, P<.001) than with dry (F=13.41, P<.001) dressings. PrUs cleaned with saline or soap showed less decrease in area (F=12.34, P<.001) than PrUs cleaned with other cleansers such as antiseptic, antibiotic, or commercial cleansers. Change in area of Stage III and IV PrUs was related to sufficient enteral feeding (F=5.23, P=.02), enteral feeding without higher acuity levels (F=3.94, P=.048), size of PrU (very large (F=120.89, P=.001) and large (F=27.82, P=.001)), and type of dressing (moist (F=14.70, P<.001) and dry (F=5.88, P=.02)). Stage III and IV PrUs increased in area when debrided (F=5.97, P=.02). The overall models were significant (Stage III and IV, F=20.30, coefficient of determination (R2)=0.06, P<.001; Stage II, F=40.28, R2=0.13, P<.001) but explained little of the variation in change in PrU area. In this sample of nursing facility residents, use of moist dressings (Stage II, Stage III and IV) and adequate nutritional support (Stage III and IV) are strong predictors of PrU healing.

Avoiding Free Nipple Grafts During Reduction Mammaplasty in Patients With Gigantomastia

Excessive breast hypertrophy or gigantomastia (>2000 g excision of tissue per breast) has traditionally been approached with breast amputation and free nipple grafting during reduction mammaplasty procedures. Disadvantages of free nipple grafts include loss of sensation, poor projection, uneven nipple-areolar complex pigmentation, and loss of lactation. We report our experiences utilizing the inferior pedicle technique of reduction mammaplasty with successful preservation of the nipple-areola complex for patients with gigantomastia. Between 2001 and 2003, 15 patients (ages 19--45) were identified with gigantomastia through review of pathology and operative reports. The inferior pedicle technique was performed in all cases by the attending staff assisted by plastic surgery residents. Patients were followed regularly from 1 week up to 1 year postoperatively. All patients reported relief from the physical sequelae of breast hypertrophy. One patient experienced bilateral partial nipple desquamation; she maintained sensation throughout and healed well with moist dressings. Otherwise, there were no complications and all patients achieved satisfactory esthetic outcomes. Our results suggest that inferior pedicle technique can be successfully performed in patients with gigantomastia. Breast amputation with free nipple grafting need not be considered standard practice for this patient population. Maintaining a wider pedicle base and meticulous intraoperative handling of the pedicle may contribute to the increased viability of the nipple-areolar complex during these cases.