Ointment Dressings Research Articles

The impact of an open-label design on human amniotic membranes vs. silver sulfadiazine dressings for second-degree burns: a randomized controlled clinical trial

BackgroundBurn wounds require optimal medical management due to associated psycho-emotional and socioeconomic impacts and severe pain. The use of synthetic and biological dressings improves healing and reduces burn wound complications. The present study aimed to compare the outcomes of using human amniotic membrane (hAM) dressings and conventional silver sulfadiazine (SSDZ) ointment dressings in the management of second-degree burn wounds.MethodsFifty patients who participated in this clinical trial were divided into two groups via simple randomization. All the enrolled patients, who had burnt in the last 24 h, had thermal damage mechanisms and were suffering from less than 20% second-degree heat-burn wounds on the skin surface. The target group (n = 25) was treated with hAM, and the control group (n = 25) was treated with SSDZ ointment. The researcher-designed checklist was used to determine the clinical performance in the follow-up assessments on days 7, 14, and 30.ResultsNo significant differences were detected in terms of sex, age, or percentage of burn wounds (p > 0.05). Wound epithelialization at days 7, 14, and 30, scar formation, wound pigmentation, pain severity, analgesia requirements, and hospital stay length (on day 30) were significantly lower in the target group (treated with hAM) than in the control group (treated with SSDZ ointment) (p < 0.05). However, treatment costs in the target group ($170) were significantly higher than those in the control group ($71) (p < 0.001).ConclusionDespite its higher cost, hAM, as a technology-based therapy dressing, demonstrates superiority over SSDZ ointment in terms of wound healing and pain management.

Effect evaluation of new dressing URGOTULRANGE in the treatment of pressure injury.

Pressure injury (PI) is a local injury of the skin and/or soft tissue located at the bone caused by medical or other equipment and is common in long-term bedridden patients. To investigate the clinical effect of Urgotul foam dressing in the treatment of stage 3 ∼ 4 PI and deep tissue PI. A total of 38 patients with stage 3 ∼ 4 PI and deep tissue PI admitted to Jinan Central Hospital from January 2016 to December 2018 were selected and randomly divided into a control group (dressing change plus silver ion cream dressing) and an observation group (dressing change plus Urgotul Absorb non-border foam dressing), with 19 cases in each group. After 4weeks of treatment, the pain intensity during dressing change and the treatment efficacy for PI wounds were compared between the two groups. There were no differences in gender (P= 0.740), age (P= 0.130), single wound area (P= 0.673), consultation department (P= 0.972), stage (P= 0.740), presence of undermining (P= 0.721), deep tissue PI (P= 0.721), and systemic antibiotic therapy (P= 1.000) between the two groups, which were comparable. The treatment effect of the observation group was better than that of the control group (P= 0.003), and the pain score of the observation group was lower than that of the control group (P< 0.001). Urgotul Absorb non-border foam dressing has a good effect in the treatment of stage 3 ∼ 4 PI and deep tissue PI and can relieve patients' pain, and is thus worth promoting.

Clinical efficacy of blood derivatives on wound healing: Asystematic review and network meta-analysis.

This study aims to evaluate the clinical effects of different blood derivatives on wound healing using network meta-analysis. PubMed, Embase, OVID, Web of Science, SCOPUS and Cochrane Central were searched to obtain studies about blood derivatives on wound healing until October 2023. R 4.2.0 and Stata 15.0 softwares were used for data analysis. Forty-four studies comprising 5164 patients were included. The results of network meta-analysis showed that the healing area from high to low was GF + ORCCB, ORCCB, GF, PRF, Unnas paste dressing, APG, PRP injection, PRP, PRP + thrombin gel, PPP, HPL, CT. The healing time from low to high was PRP + thrombin gel, GF, PRP, PC + K, PC, APG, PRF, CT, Silver sulfadiazine ointment. The number of patients cured from high to low was APG, PRP injection, PRP, Aurix, PRF, Leucopatch, HPL, Antimicrobial Ointment Dressing, CT, 60 μg/cm2 repifermin, 120 μg/cm2 repifermin, AFG, PPP. The order of analgesic effect from high to low was AFG, Aminogam gel, PRF, PRP, Oxidised oil, APG, GF, CT. The order of the number of wound infection cases from low to high is APG, 20 μg/cm2 repifermin, 60 μg/cm2 repifermin, PRP, LeucoPatch, CT, PPP, Antiseptic ointment dressing. Healing area: GF + ORCCB had the best effect; Healing time: PRP + thrombin gel took the shortest time. The number of cured patients and the reduction of wound infection: APG has the best effect. Analgesic effect: AFG has the best effect. More studies with large sample sizes are needed to confirm the above findings.

Homeopathic Treatment of snakebite in dog – case report

Snakebite accidents are very common nearby forest areas. The majority of these incidents are caused by snakes of the genus Bothrops, which comprises over 45 species distributed in Central and South America. These snakes usually hunt small mammals and lizards at dusk. Snakebites from this genus generally occur in the head, limbs, and neck regions. Bothrops snakes are considered aggressive animals, characterized by inverted "V" markings along their bodies, triangular heads, smooth tails, and length ranging from 0.5m to 2m. They exhibit color variations of brown, green, and gray. Bothrops venom has necrotic, coagulating, vasculotoxic, and nephrotoxic effects, which can cause extensive necrosis at the bite site, tissue loss, and limb dysfunction, sometimes resulting in amputation. The bitten animal may experience prostration, tachypnea, localized edema and pain, petechiae, hemorrhages, and extensive necrotic areas. Hematuria, hypotension, pulmonary edema, and even death, as well as various laboratory abnormalities, may also occur. The case reported herein was attended at a veterinary clinic in Campos Altos, Minas Gerais, Brazil. It involved a mixed-breed female dog, 3 years old, weighing 4.5 kg, which had been bitten by a Bothrops snake approximately 90 minutes before. The animal presented edema and pain at the site of the bite (pelvic limb), as well as tachycardia. At once, it was administered intravenous polyvalent antiophidic serum, dexamethasone, serum, furosemide, tramadol, and ceftriaxone (antibiotic). Local treatment included corticosteroid and antibiotic ointment dressings. The animal remained stable, but after 24 hours, an extensive area with edema, hematoma, bleeding, and early necrosis at the bite site was observed, worsening with each passing hour. After 48 hours, therapy with Bothrops CH6 (5 globules every 8 hours) was initiated to reduce local effects (edema, hemorrhage, and necrosis). The animal showed rapid improvement in the appearance of the lesion, and after 5 days of treatment, there was no longer edema or bleeding, only a circumscribed cutaneous injury, which was managed with local dressings (cleaning and healing ointment). The animal recovered well without any sequelae.

Features of laser therapy of venous trophic ulcers of the lower extremities in outpatient surgery

Introduction. Trophic ulcers of venous etiology are a severe complication of chronic venous insufficiency of the lower extremities. At the same time, in most cases, ulcerative defects do not heal for a long time and are prone to recurrence, which leads to a significant deterioration in the quality of life of patients.Aim. To clarify the features of the effect of low-intensity laser radiation to determine the optimal conditions for conservative treatment of venous ulcerative defects.Materials and methods. A randomized prospective clinical trial was performed in which 126 patients with chronic venous insufficiency were monitored. During the conservative treatment of 44 patients of the comparison group, phlebotropic drugs, compression therapy, wound coverings and ointment dressings were used in the conservative treatment of trophic ulcers. In 82 patients of the main group, lowintensity laser radiation was used along with the methods described above.Results. Laser therapy in the complex treatment of venous trophic ulcers helps to reduce the number of microbial bodies vegetating on the surface of ulcerative defects, but does not significantly affect the sensitivity of microflora to antibacterial drugs. Low-intensity laser radiation certainly contributed to a significant and earlier increase in the number of neutrophils, monocytes and macrophages on the surface of trophic ulcers, as well as activation of phagocytic activity of cells.Conclusion. Low-intensity laser radiation improves the results of conservative treatment of venous trophic ulcers, does not adversely affect the sensitivity of the isolated microflora to antibiotics and does not have a “direct” bactericidal effect.

Підходи до хірургічного лікування глибоких опіків кисті, обтяжених синдромом субфасціальної гіпертензії

The problem of treatment of subfascial hypertension syndrome in burn injury of the hand remains relevant due to lack of vigilance about its possible development. Purpose - to improve the results of treatment of deep burns of the hand by using the tactics of early surgery. Materials and methods. The clinical material consisted of 195 patients with burn lesions of the hand. The main group consisted of 83 victims, who used the tactics of active early surgery, followed by recovery and reconstruction. The comparison group consisted of 112 patients - in the treatment of which the tactics of gradual necrectomies were used after the formation of demarcation lines with the subsequent healing of wounds with the use of ointment dressings. Results. The data obtained showed that timely diagnosis, which consisted of the right treatment tactics, reduced the number of amputations and prevented the disability of victims with burns. This was achieved through timely and technically correct method of performing open decompression fasciotomies, which managed to reduce the subfascial pressure in each affected case, which prevented critical ischemia of muscle fibers and the development of Folkman’s contracture. It is extremely important to perform open fasciotomies in the syndrome of subfascial hypertension, because only in this way a complete decompression of tissues was achieved, and a timely verified diagnosis ensured a good treatment result. Early active surgical tactics for deep burns became a priority, compared to industry standards, which was expressed in an increase in the number of early surgical interventions (54.2% vs 23.2%; p&lt;0.02), which reduced the proportion of wound infectious complications (4.8% vs 18.2; p&lt;0.01), reduce the number of cicatricial contractures (14.5% vs 50.9%; р&lt;0.02). Conclusions. Timely diagnosis of subfascial hypertension of the hand, active early surgical tactics, the proposed technique of decompression fasciotomies significantly improved the results of treatment, which manifested itself in the restoration of motor function of the hand. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors. Keywords: burns, hand’s burns, subfascial hypertension syndrome, open decompression fasciotomies, wounds.

Evaluation of wound healing effect of colostrum and curcumin cream in rat excision wound model

Background: Proper wound healing is very crucial for the reconstruction of injured tissues. Compared to the conventional dressings, currently there are many novel biological wound dressings and healing agents containing colostrum which has many advantages. Aim &amp; Objective: This experimental study was done to evaluate the effect of colostrum and curcumin cream dressing and compare it with that of conventional Povidone iodine dressing. Methods: The rats were anesthetized and excision wounds were created. Wounds were then measured with a standard measuring scale on the day of wounding and then subsequently at a time interval of 4 days till day 20, then on alternate days. After tracing the wound area was treated with the Test and Standard drugs on Day 1,4,8,12,16 and 20. The data was then analysed using Chi square, one-way ANOVA and two tailed t test using Graph pad prism software version 5.0. Results: Efficacy of Colostrum 10% &amp;Curcumin 1% cream (test) was equal to that of povidone iodine 10% (standard) cream with respect to wound contraction and wound healing. But, with respect to the rate of wound healing, Colostrum 10% &amp; Curcumin 1% cream treated group was better compared to the povidone iodine 10% cream treated group. Conclusion: Colostrum plus Curcumin cream has shown a better wound healing at a short time span in excisional wound model in rats, when compared to the conventional povidone iodine cream. Thus, the Colostrum plus curcumin cream appear to be an economical and safe alternative to costly therapies like growth factors for wound healing

Удосконалення хірургічної техніки ампутації пальців та лікування хворих із синдромом діабетичної стопи

Здійснені хірургічні втручання у 31 хворого на цукровий діабет, ускладнений синдромом діабетичної стопи нейропатичної та нейроішемічної форм. Групу спостереження становили 11 чоловіків віком 60,50 ± 1,50 року та 20 жінок віком 70,95 ± 1,45 року у середньому. До контрольної групи увійшло 30 пацієнтів. За віком, статтю та супутньою патологією групи були репрезентативні. Усім хворим проведена ампутація фаланг пальців за запропонованою методикою. В лікуванні ран хворих основної групи використовували сорбентні препарати в комбінації із застосуванням ультразвукової кавітації та накладанням на рану апаратної вакуумної пов’язки. У контрольній групі хворих в лікуванні ран використовували пов’язки з розчинами антисептиків та мазьові пов’язки. Тривалість перебування у стаціонарі до пластичного закриття ранового дефекту становила в середньому 15,50 ± 1,12 дня у хворих основної групи та 24,42 ± 0,13 дня у хворих контрольної групи.

Randomized Controlled Trial Comparing Silver-Impregnated Fibrous Hydrocolloid Dressings With Silver Sulfadiazine Cream Dressings for the Treatment of Fracture Blisters to Determine Time to Surgical Readiness.

To investigate, in patients with fracture blisters, the time to surgical readiness in those treated with silver-impregnated fibrous hydrocolloid (SFH) dressings compared with those treated with topical silver sulfadiazine (SS) cream and to determine the direct costs associated with both treatments. A single-blind, randomized controlled trial. The study was conducted at Tygerberg Hospital, a tertiary care facility, and Worcester Provincial Hospital, a secondary care facility, Western Cape, South Africa. Patients >18 years of age with one or more fracture blisters overlying fractures requiring surgical fixation were considered for inclusion. The main outcome was the time to surgical readiness, after complete re-epithelialization of the affected site, in both groups. The direct cost associated with each treatment and the daily cost associated with hospital stay per day were recorded. At an interim analysis, 70 patients had been enrolled and completed the study protocol with 35 patients per group. Groups were balanced across patient and clinical demographic characteristics. A significant difference of 4 days (95% confidence interval: 2.9-5.1 days, P < 0.001) in the mean time to surgical readiness (SFH group, 5.3 days vs. SS group, 9.3 days) was observed. No difference between the time to surgical procedure as well as the total length of hospital stay between the 2 groups was observed. This study reports that SFH dressings are a cost-effective treatment option for the management of fracture blisters evidenced by a significant accelerated time to blister re-epithelialization compared with a commonly described method of SS cream dressings. Therapeutic Level 1. See Instructions for Authors for a complete description of levels of evidence. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Comparative study of Negative Pressure Wound therapy Vs. Local antibiotic cream dressings in acute hand burns second-degree superficial to deep

Background: The hand is one of the most common parts of the body involved in burns, i.e., 80%. Even minor burns in the hand may result in severe limitations of function. Early initiation of physiotherapy, topical antibiotic cream treatment, collagen application, splintage, passive exercise for second-degree superficial burns. Materials and methods: A prospective comparative study was conducted in 10 patients with acute hand burns due to thermal burns (scald, flame). All patients with second-degree superficial to intermediate thickness burns were given Negative pressure wound therapy (indigenous NPWT Kit) to one hand and local antibiotic cream to the other hand or other parts of the body to study clinical profile and outcome. Results: A total of 10 patients were studied. The majority of patients were in 19 to 30 years of age group 6 patients (60%), five females, and one male. Pediatric patients account for 4 patients (40%), two female and two male children. Incidence of burns in females 70% and males’ group 30%. Significant reduction in postburn edema in NPWT hand compared to topical antibiotic cream dressing. Healing is fast in NPWT applied hand/part. Conclusion: Negative Pressure Wound Therapy for Acute second-degree superficial burns showed promising results in wound healing and reduced post-burn edema burn in hand in our study.

Терапія ран від’ємним тиском в лікуванні вогнепальних ран м’яких тканин кінцівок

SummaryPurpose – to analyze the results of the treatment of wounded with soft tissuegunshot wounds of extremities using negative pressure wound therapy.Materials and methods. The total number of patients studied with combat surgicaltrauma was 52 people, allocated to groups depending on the treatment performed. Thefirst group (n=27) included wounded with soft tissue defects after combat surgicaltrauma treated by the method of wound therapy with negative pressure. The secondgroup (n=25) included wounded with soft tissue defects as a consequence of combatsurgical trauma treated with traditional methods (staged surgical treatments, dailydressings with antiseptic solutions, ointment dressings).Results and discussion. A comparative analysis of the results of the treatment of52 wounded anti-terrorist operation (ATO) participants with bullet and shrapnelwounds of soft tissues of extremities who were admitted to the National Military MedicalClinical Center «Main Military Clinical Hospital» during the hostilities in easternUkraine during 2016–2018 was carried out. Of these, 27 wounded were treated usingvacuum therapy. The course of vacuum therapy ranged from 7 to 15 days of constantexposure, the average duration of applying one dressing was from 1 to 3 days. Theduration of hospital stay, peculiarities of clinical manifestations, dynamics of microbialcontamination of wounds, and cellular composition in wound prints were assessed.Vacuum therapy accelerated the cleaning of wounds and the beginning of tissueregeneration, promoted epithelialization of wounds.The data obtained indicate a significant improvement in the course of the woundprocess; during treatment using the method of vacuum therapy, it was possible to carryout the plastic stages of wound closure almost 1.5–2 times faster than using the method.The method reduces the number of planned necrectomies, increases the rate ofelimination of purulent microflora in group 1 almost twice, which ensures woundpreparation before closure.In addition, the installation of a vacuum dressing for a period of 3 days greatlysimplifies patient care, reduces the pain and traumatic factor of daily dressings, and atthe same time is the prevention of intra-hospital infection due to the absence ofcontamination from the wound.Conclusions:1. A protracted course of the disease is observed with traditional treatment ofgunshot wounds of soft tissues of the extremities with a pronounced general reaction toinflammation, which is characterized by an average length of hospital stay of up to(24.8±3.09) bed-days.2. The clinical effect of negative pressure wound therapy in the treatment of surgicalinfection of soft tissues is based on the enhancement of microcirculatory bloodcirculation in the inflammation focus, which leads to the normalization of localmetabolic processes and activation of local sanitation and regenerative reactions.3. With the simultaneous use of low-dose vacuum and antibacterial therapy, asynergistic interaction is observed due to their total antibacterial effect, as well as theability of vacuum therapy to influence the concentration of the antibacterial drug in thepathological focus.4. Negative pressure wound therapy is an effective method of treating soft tissuegunshot wounds, which allows to reduce by 2.5 times the number of repeated operations(mainly staged surgical treatments), thereby reducing the length of hospital stay by 1.7times to (17,8 ± 2.7) bed-days

Non-operative treatment versus suture refixation of the nail plate in paediatric fingernail avulsion injuries.

The study compared a non-operative treatment, consisting of ointment dressing only, with the standard surgical nail plate refixation for simple fingernail avulsion injuries in children. A non-inferiority hypothesis was tested in a single-centre, prospective cohort study. The quality of the new nail was the primary outcome and was assessed with the Nail Appearance Score. The secondary outcome was patient and parental satisfaction, which was assessed with the Patients' and Parental Nail Satisfaction Score. Fifty-one patients were enrolled; 39 (76%) chose the non-operative treatment and 12 (24%) the standard operative therapy. Comparison of the two groups confirmed the non-inferiority hypothesis with a risk difference for the new nail of -0.02 with a 95% confidence interval of (-0.05, 0.01). The outcome was excellent in all fingers with no significant differences regarding either the primary or secondary outcome. In view of associated risks and costs for surgery, we recommend ointment dressings for such injuries.Level of evidence: II.

Evaluation of the efficacy of modern wound care dressings in the complex treatment of purulent wounds

Objective. Evaluate the efficacy of the treatment of purulent skin and soft tissue wounds using modern interactive dressings and conventional wound care dressings. Material and methods. The study included 160 patients, who were treated at the outpatient department of the Clinic of the SamGMU for the period from September 2018 to January 2019 after an autopsy, necrosectomy and drainage of purulent foci in the surgical hospital. Group I (n = 82) included patients, who applied Sorbalgon® interactive dressing (Paul Hartmann, Germany) during the first phase of the wound healing and Branolind® N atraumatic mesh dressing (Paul Hartmann, Germany) during the second phase of the wound healing for topical treatment of wounds in the postoperative period. Patients of Group II (n = 78) applied ointment dressings using Levomekol ointment during the first phase of the wound healing and Methyluracil ointment during the second phase of the wound healing. Patients in both groups received the same broad spectrum antibacterial therapy. In Group I, the dressings were applied once per 2 days, in Group II the dressings were applied on a daily basis. The researchers studied the following indicators: the nature of the wound discharge; the presence of edema and hyperemia of tissues; timing of the wound defect cleansing; temperature and leukocyte reactions of the body; crops on microflora and sensitivity to antibiotic therapy. Results. The study showed more pronounced dynamics of the temperature reaction normalization, reduction of the local inflammatory reaction and the leukocytosis level in patients of Group I. The wound cleansing from pus and fibrin, the development of granulation tissue on Day 5 were reported in 87.8% of patients of Group I and in 35.9% of patients of Group II, on Day 10 in 100% and 88.5% of patients, respectively. Conclusion. The use of Sorbalgon® and Branolind® N dressings improves the results of treatment of patients with purulent soft tissues pathology and reduces the risk for secondary infection, and improves the quality of life due to increase of interval between the dressings.

Nail bed defect reconstruction using a thenar fascial flap and subsequent nail bed grafting.

BackgroundFull-thickness nail bed defects with significant exposure of the distal phalanx are typically challenging to reconstruct. We describe a novel method of nail bed defect reconstruction using a thenar fascial flap combined with nail bed grafting.MethodsFull-thickness nail bed defects were reconstructed in a 2-stage operation involving the placement of a thenar fascial flap and subsequent nail bed grafting. A proximally-based skin flap was designed on the thenar eminence. The flap was elevated distally to proximally, and the fascial layer covering the thenar muscle was dissected proximally to distally. The skin flap was then closed and the dissected fascial flap was turned over (proximal to distal) and inset onto the defect. The finger was immobilized for 2 weeks, and the flap was dressed with wet and ointment dressings. After 2 weeks, the flap was divided and covered with a split-thickness nail bed graft from the great toe. Subsequent nail growth was evaluated on follow-up. ResultsNine patients (9 fingers) treated with the novel procedure were evaluated at follow-up examinations. Complete flap survival was noted in all cases, and all nail bed grafts took successfully. Five outcomes (55.6%) were graded as excellent, three (33.3%) as very good, and one (11.1%) as fair. No donor site morbidities of the thenar area or great toe were observed. ConclusionsWhen used in combination with a nail bed graft, the thenar fascial flap provides an excellent means of nail bed reconstruction.

A randomized clinical trial comparing a collagen-based composite dressing versus topical antibiotic ointment on healing full-thickness skin wounds to promote epithelialization

Background: Acute traumatic wounds are a common and distressing event for patients presenting to plastic surgery clinics. There are no definitive conclusions regarding the benefits of collagen-based wound care products toward the application on full-thickness wounds compared to traditional ointment or gauze care. In this clinical trial, we aimed to define the potential benefits of collagen-based dressings on healing through the comparison of collagen-based composite dressings with antibiotic ointment dressings. Methods: This was a randomized two-tailed controlled clinical trial. The acute full-thickness wounds underwent wound cleansing, debridement, and were secured with different dressings in both experimental and control groups. The wounds were subsequently photographed weekly, and the wound areas were calculated using ImageJ software to evaluate wound healing rate. Results: The results demonstrate that the collagen-based triple layer composite dressings which consisted of silver sheet, collagen sponge, and foam films promoted better epithelialization and healing than antibiotic ointment treatment. Collagen supplementation improved wound healing and epithelialization by providing a dry environment during the late stage of wound healing. Conclusion: We demonstrated that the collagen-based triple layer wound dressing could potentially increase the healing rate when used for traumatic full-thickness wound care compared to the conventional antibiotic ointment dressing, providing a new prospective in the future applications of wound care.

DYNAMICS OF MORPHOLOGICAL CHARACTERISTICS OF THE WOUND PROCESS IN PATIENTS WITH ODONTOGENIC FLEGMONS IN ANTIOXIDANT THERAPY

Aim. This research was designed to conduct a morphological analysis of the purulent wound exudate in the complex treatment of patients with odontogenic phlegmon of maxillofacial area (MA) by the antioxidant “Rexod” and antihypoxant “Mafusol”.Materials and methods. The objects of the study were 62 patients (aged 18 to 50 years) with odontogenic phlegmon who were divided into 3 groups. Group I (n=20) – the traditional treatment was supplemented by the intravenous drip injection of the antioxidant "Rexod"; group II (n=21) – the traditional treatment was combined with the intravenous injection of the antioxidant "Rexod" and antihypoxicant "Mafusol"; Group III (n=21) had the traditional treatment. The debridement of the purulent wound included a treatment with 0.06% sodium hypochlorite solution in all groups of patients in the first phase of the wound process; in the second phase the patients in all main groups were treated with the "Soderm" ointment dressings; in the comparison group were used the bandages with methyluracil ointment. In the third phase the gel "Kontraktubeks" was used to prevent the formation of rough scar tissue. There was carried out a morphological examination of smearsimprints of the wound exudate.Results. The microscopic analysis of the cellular landscape of the exudate revealed a significant number of polynuclears which are probably the segmented neutrophilic leukocytes and typical eosinophils; the number of mononuclear cells represented by typical lymphocytes was 4 times less; a single presence of macrophages, plasmocytes, fibroblast-like and epithelioid cells. The signs of degeneration were identified in the cells of histiogenic origin.Conclusion. As a result, there was revealed a gradual increase of overall amount of cells in the wound exudate in all study groups during the treatment, however, this process was pronounced to a greater extent in the patients of group I and II. The obtained result indicates the direct dependence of the activation of reparative processes in the wound from the applied medicines.

Antibiotic ointment versus a silver-based dressing for children with extremity burns: A randomized controlled study

IntroductionAntibiotic or silver-based dressings are widely used in burn wound care. Our standard method of dressing pediatric extremity burn wounds consists of an antibiotic ointment or nystatin ointment-impregnated nonadherent gauze (primary layer), followed by rolled gauze, soft cast pad, plaster and soft casting tape (3M™ Scotchcast™, St. Paul, MN). The aim of this study was to compare our standard ointment-based primary layer versus Mepitel Ag® (Mölnlycke Health Care, Gothenburg, Sweden) in the management of pediatric upper and lower extremity burn wounds. MethodsChildren with a new burn injury to the upper or lower extremities, who presented to the burn clinic were eligible. Eligible children were enrolled and randomized, stratified by burn thickness, to be dressed in an ointment-based dressing or Mepitel Ag®. Study personnel and participants were not blinded to the dressing assignment after randomization. Dressings were changed approximately once or twice per week, until the burn wound was healed or skin-grafted. The primary outcome was time to wound healing and p-value < 0.05 was considered significant. ResultsNinety-six children with 113 upper or lower extremity burns were included in the analysis. Mepitel Ag® (hazard ratio [HR] 0.57 (95% Confidence Interval (CI) 0.40–0.82); p = 0.002) significantly reduced the rate of wound healing, adjusting for burn thickness and fungal wound infection. The incidence of fungal wound infections and skin grafting was similar between the two groups. Children randomized to standard ointment dressings were significantly less likely to require four or more burn clinic visits than those in the Mepitel Ag® (4% versus 27%; p = 0.004). ConclusionOur study shows that our standard ointment-based dressing significantly increases the rate of wound healing compared to Mepitel Ag® for pediatric extremity burn injuries. Level of evidenceTreatment study; Level 1.

Results evaluation of the modern surgical treatment methods for pressure ulsers in patients with the spinal cord injuries consequences

The aim — to evaluate the effectiveness of modern preoperative methods for pressure ulcers in patients with the spinal cord injuries consequences.Materials and methods. A comparative analysis of 178 patients’ records with the spinal cord injuries consequences, which were complicated by bedsores in the rehabilitation period of the traumatic disease was carried out. The patients were divided into three groups, depending on the method of preoperative preparation. Mud therapy and ozonotherapy were used in the first group (n = 76), ultrasonic­assisted wound debridement and VAC­therapy were applied in the second group (n = 44). Preoperative preparation was performed with ointment dressings, wound dressings and antiseptic solutions in the comparison group (n = 58). Closure of soft tissue defects was performed by the method of autodermoplasty, local plastics or displaced grafts.Results and discussion. The regularity of the pressure ulcers appearance was determined according to the level of damage. In patients with cervical injuries, pressure ulcers were localized in the sacral region at 48.9 %, in cases of thoracic and lumbar levels of injuries, localization in the ischial area (32.1 %) prevailed. The use of ozonotherapy and peloidotherapy in the first group, ultrasonic­assisted wound debridement and VAC­therapy in the second group reduced the preoperative period to 12.1 ± 1.1 and 10.4 ± 0.9 days, respectively. Them the routine methods were applied, the pressure ulcers were ready for plasty by 15.9 ± 1.4 day. Auto­skin­grafting was used in 11 (6.2 %) patients, local flaps in 46 (25.9 %), regional flaps in 121 (67.9 %) cases. The early postoperative period was complicated by suppuration in 19.1 %, wound breakdowns in 10.7 %, and the marginal necrosis of the flap in 10.1 %. In the second group, the smallest proportion of early complications was observed due to a decrease in the number of wound breakdowns to 4.5 % and suppurations to 11.4 %.Conclusions. VAC­therapy and ultrasonic­assisted wound debridement allows for a short period of time to achieve the readiness of tissues among pressure ulcers for the plastic surgery. The optimal method for closing pressure ulcers is the plastic with distant axial muscle flaps, combined with anatomically­functional resection of the subordinate bones.

APPLICATION OF NEGATIVE PRESSURE IN THE LOCAL TOPICAL TREATMENT OF OPEN SURGICAL WOUNDS IN PATIENTS WITH PYLONIDAL DISEASE

AIM to improve results of treatment of patients pylonidal disease. PATIENTS AND METHODS. Thirty two patients with pylonidal disease had a wide excision with postoperative wounds left open. The patients were allocated into 2 groups: in the main group a local negative pressure was used for management of postoperative wounds, while in the control group ointment dressings was used only. Groups were well matched by age, stage of the process and the area of the surgical wound. RESULTS. The use of local negative pressure in the topical treatment of open surgical wounds allowed to reach complete recovery in the main group on 32 ± 5 POD, while in the control group it lasted 41 ± 7 days. No recurrences of the disease in both group were detected. CONCLUSION. Application of the negative pressure in the local topical treatment of open surgical wounds after excision of pylonidal disease accelerates wound healing, helps to avoid the development of suppuration and provide an earlier recovery.

VACUUM THERAPY IN TREATMENT OF THE PILONIDAL SINUS DISEASE

AIM. To improve results of complex treatment of the pilonidal disease (PD). PATIENTSS AND METHODS. 31 patients with the PD were included into study. Of them in 16 patients postoperative wound was left open and vacuum therapy was applied. In 15 patients postoperative wound was left open and managed by ointment dressing. Groups of patients were well matched in terms of age, gender, degree of inflammation and co-morbidity RESULTS. Application ofvacuum therapy reduced the time of wound healing to 27,5±3,6 days comparing to 79±6,6 days of wounds managed routinely. The mean decrease of wounds' area at POD14 treated by vacuum therapy and without was 60 % vs. 20 % correspondingly. Reduction of pain intensity according to a visual analog scale in group with vacuum therapy (1,5/2,2 vs. 1,8/2,8) and earlier return to original occupation (31±3,9 vs. 39±5,7) was noted. Wound infection developed only in 3/15 (20 %) patients managed by ointment dressing. There was no recurrence of the disease regardless wound management. CONCLUSION. Management of postoperative wound by vacuum therapy in patients after surgery for PD improved results of treatment.