Gauze Roll Research Articles

Comparison of Efficacy and Safety of Intrauterine Balloon Tamponade Versus Uterovaginal Packing in Females Presenting with Postpartum Hemorrhage after Normal Vaginal Delivery

To compare the efficacy and safety of intrauterine balloon tamponade with uterovaginal roll gauze packing in patients presenting with primary postpartum hemorrhage after normal vaginal delivery. This randomized controlled trial, conducted at Department of Obstetrics and Gynecology, Lady Willingdon Hospital, Lahore, from December 2015 to November 2016. Two hundred and twelve patients presenting with primary postpartum hemorrhage who did not respond to medical treatment following normal vaginal delivery were included. They were randomly divided in two groups. The first group underwent balloon tamponade using condom and second group underwent intrauterine packing using roll gauze. Both interventions were removed after 24 hours. All females were kept under observation with antibiotic coverage in ward to prevent infection. If bleeding was stopped within 15 minutes and the patient remained hemodynamically stable, then efficacy was labeled and if no complications occur while applying or removing, safety was labeled. Mean age group of women using balloon tamponade and intrauterine packing was used was 28.25±4.672 and 28.30±4.613 years. The mean gestational age of patients using balloon tamponade and intrauterine packing was 38.57±1.36 and 38.63±0.62 years. Mean blood loss in patients using balloon tamponade and intrauterine packing was 600.28±25.338 and 699.21±70.176 ml. Efficacy of intrauterine packing was 94 (88.7%) and balloon tamponade was 104 (98.1%). Safety of intrauterine packing was 83 (78.3%) and that of balloon tamponade was 97 (91.5%). Thus, treatment of balloon tamponade was more effective and safer than intrauterine packing in female presenting with postpartum hemorrhage after normal vaginal delivery.

795 Autologous skin cell suspension application for toxic epidermal necrolysis: a case report

IntroductionToxic epidermal necrolysis (TEN) is a drug-mediated disease which occurs at the same level of a partial thickness thermal injury. It has been treated with frequent dressing changes and supportive care as there are no definitive therapies. The pathophysiology involves necrosis of keratinocytes at the dermal-epidermal junction leading to sloughing of the epidermis and sub-epidermal bullae. Patients have massive fluid and electrolyte dysregulation due to chronic wounds that are susceptible to infection. This case report describes the application of autologous skin cell suspension (ASCS) to a patient with TEN. His hospital course included arrest of the disease process, timely closure of the wound, and minimal wound care. To our knowledge, this is the first case of TEN treated with ASCS.MethodsThe patient was mechanically debrided with a water scalpel hydrosurgery system to remove all devitalized tissue. A donor graft for ASCS was then obtained at standard depth from unaffected skin at the ankle and was processed in the standard fashion and applied to the wound. Clear plastic dressing with a non-adherent, antibiotic impregnated cloth dressing followed by dry non-shear dressing were then applied to the torso. Extremities were dressed in clear plastic dressing, antibiotic impregnated cloth dressing, zinc paste impregnated cloth, dry gauze roll, and elastic compression bandage. This was performed over the patient’s anterior surface and subsequently on the posterior one week later. Dressings were taken down on post-operative day (POD) 6 and replaced as appropriate.ResultsThe patient demonstrated 60% closure of wounds on his anterior torso at POD 6. By POD 8, the patient's anterior torso and face were completely closed. His second application of ASCS to his posterior closed in a similar timeline. The patient was discharged on POD 16 from his initial intervention with 2% total body surface area open. At POD 30, his wounds were healed with the return of a large portion of pigmentation.ConclusionsTEN is a rare, high-mortality disease without efficacious therapy. Given that the wounds are at a similar level to a partial thickness burn, ASCS could be a new intervention which could mitigate open wounds, frequent dressing changes, prolonged hospital stays, and mortality.

Simultaneous Use of Bioabsorbable and Nonbioabsorbable Packing Materials During Closed Reduction of a Nasal Bone Fractures.

The nasal packing material after closed reduction of nasal bone fracture may be bioabsorbable or nonbioabsorbable. To investigate the usefulness of the packing method using bioabsorbable and nonbioabsorbable materials simultaneously, a chart review was retrospectively performed involving 255 patients. Group A (n = 119), Nasopore (bioabsorbable) was cut appropriately and packed, and subsequently, supportive packing with Merocel (nonbioabsorbable) was performed. Group B (n = 78), nasal packing was performed with Vaseline roll gauze. Group C (n = 49), packed only Merocel. Pain and rhinorrhea were significantly lower in Merocel + Nasopore group (P < 0.05). It is thought that rhinorrhea is reduced by less mucosal irritation and maximizing the discharge absorption capacity by using Merocel and Nasopore simultaneously. By packing Nasopore first, pain is thought to be reduced by reducing the contact surface between Merocel and the injured mucosa and preventing a direct force to the fracture site. Therefore, our packing method, which uses Merocel and Nasopore simultaneously, can be recommended because it can provide sufficient support for the reduced fracture site, cause less pain, and maximize discharge absorption.

Exploring Tourniquet Conversion in Simulation to Develop Concepts and Hypotheses.

Compared with those of tourniquet application, tourniquet conversion concepts are underdeveloped. The purpose of this project was to develop tourniquet conversion concepts and generate hypotheses. One person performed 100 tests of tourniquet application and conversion. Testing varied by conversion types, materials, and assessments. Conversions were from improvised or Combat Application Tourniquets (C-A-T) to another C-A-T, a new site (with initial C-A-T only), a pneumatic Emergency and Military Tourniquet (EMT), or a pressure dressing (compression bandage or a roll gauze and an elastic wrap). Simulated limbs were created using plastic bottle-based manikins, pool noodle-based manikins, plastic pipes, glass bottles, a rain downspout, and a cardboard poster tube. Tourniquet application, conversion, and total times averaged 105, 132, and 237 seconds, respectively. Improvised tourniquet time was longer than that of C-A-T (p ≤ .05, all three). By initial tourniquet site, the 2-3 inches site had longer conversion and total time (p ≤ .02, both) compared with highest site. By whether initial tourniquets placed were also used in conversion, total time was shorter if yes (p = .05). Conversion to a pressure dressing was longer in conversion and total time (p ≤ .02, both) compared with conversion to a tourniquet. One wrap was short; we switched to those longer to cover limbs better. Limb types varied for indentation. Conversion communications improved when we used abbreviations and symbols. This preliminary project simulated tourniquet conversion to develop clinical concepts and research hypotheses to build a better basis for later research.

Endotracheal tube fixation time: a comparison of three fixation methods in a military field scenario

IntroductionEndotracheal intubation is required in many emergency, trauma and prehospital scenarios. Endotracheal tube (ETT) fixation must be stable and quick to apply to enable rapid evacuation and patient transport. This...

Nasal Adhesions – A New Perspective

Objective: The objective of the study is to explore various causes of adhesions or faults what different surgeons commonly do and how to combat this problem. Study design: Randomized Control Trial. Settings: ENT Unit-I, Allied Hospital, Faisalabad. Duration: July, 2016 to June, 2018. Methodology: 500 patients undergoing septoplasty and SMR, over a period of 2 years were included in this study. Those requiring combination procedures were excluded. The study involved 400 males and 100 females. The age range was 15-75 years with a mean age of 34 years. All patients had a pre-operative nasal packing by undertraining medical officers using a roll gauze soaked in 4% Xylocaine with Topical Adrenaline 1:1000 in a ratio of 50:50 half an hour before surgery. 300 cases were operated under local anesthesia with no intravenous supplement and the remaining 200 under General Anesthesia. Results: 20 patients (04%) presented with adhesions out of which 15 were operated under General Anesthesia and 5 under local anesthesia. All these patients belonged to the non-splinted group. 07 patients (1.4%) complained of slight discomfort due to splints particularly those made of the cut drips. 03 patients (0.6%) complained of the unsightly look of the anterior ends of the splints as they were secured with stitches over the columella. Crust formation was the main problem encountered during the splinting period. Conclusion: Splints have been found to be very effective in preventing adhesion formation which are sometimes very troublesome. However, because of the very low incidence, (04%) in our studies compared to (8.1%) in other series after a single procedure on the nose, one must be very cautious in placing splints and should be placed where the surgeon strongly fears the formation of adhesions, such as in difficult cases. Suggestions: Prevention from unwanted adhesions is the best strategy to avoid adhesions.

Efficacy and Safety of Intrauterine Balloon Tamponadeversus Uterovaginal Roll Gauze Packing in Patient Presenting with Primary Postpartum Hemorrhage after Normal Vaginal Delivery.

Objective| To compare the effectiveness and safety profile of intrauterine balloon tamponade with uterovaginal roll gauze packing among patient of primary postpartum hemorrhage after normal vaginal delivery. Duration of Study| This study was conducted in the Department of Obstetrics &amp; Gynaecology, of a Tertiary Care Hospital, Lahore from December 2015 to November 2016. Patients and Methods| In this Randomized controlled trial,212 patients of age range 20 to 40 years who presented with postpartum hemorrhage after a normal vaginal delivery (NVD) those who did not responded to medical treatment were included. Cases of PPH due to perineal, cervical or vaginal tear, episiotomy, retained placenta, coagulation disorder, secondary PPH and PPH with normal vaginal delivery after previous cesarean section were excluded from this study. Subjects were randomly assigned to either intrauterine balloon tamponade or uterovaginal roll gauze packing. Intrauterine packing (IP) was removed after 24 hours and balloon tamponade after 24 hours of insertion. Antibiotic coverage was also given to prevent intrauterine infection. All females were kept under observation in ward. Effectiveness was labeled if bleeding was stopped within 15 minutes after uterovaginal packing or balloon tamponade (BT) and patient remain hemodynamically stable and if no complications occur after applying or removing balloon tamponade or intrauterine packing safety was labeled. Data was analyzed by SPSS version 20.2.Frequencies and percentage of complications were calculated along with rate of successful cessation of bleeding were calculated. Result| Mean age group of woman in whom balloon tamponade and intrauterine packing was used was 29.22+6.52 and 29.05+ 6.802 years. Mean gestational age of woman in BT and IP group and was 39.95+1.304 and 38.98+ 1.428 years. Mean blood loss in woman in BT and IP group was 600.28+ 25.338 and 669.21+70.176 ml. Efficacy of group BT was 78(73.6%) and in IP was 63(59.4%).Safety of BT group was 97(91.51%) and IP group was 55(51.88%). Treatment of balloon tamponade was more effective and safe than intrauterine packing in female presented with PPH after normal vaginal delivery (p &lt; .05). Conclusion| This study concluded that balloon tamponade is an effective and safe method than intrauterine packing for the management of PPH after normal vaginal delivery.

Efficacy Of Gauze-based Negative Pressure Wound Therapy After Split-thickness Skin Graft In The Care Of Large Wounds

Background: Negative-pressure wound therapy (NPWT) or vacuum dressings involve the application of a controlled negative pressure on the wound. Traditionally, STSGs were fixed with bolster technique, where sutures are used to fix pressure dressings over the top of recently placed grafts. Taking it a step further in our study we applied an effective and user friendly filler material (surgical roll gauze) on very large defects. The objective of this study was to assess the clinical efficacy of gauze-based negative pressure wound therapy as an adjunctive therapy to STSG, over complex and very large wounds. Material &amp; Methods: This descriptive study was conducted at Army Burn Center, Combined Military Hospital Kharian and PNS Shifa Hospital Karachi from January 2016 to June 2017. Gauze based VAC system used. Negative pressure was applied at -80 mm Hg. Evaluation was carried out to assess the performance of gauze-based NPWT. Results: Total of 63 patients, 42 males and 21 females, with mean age of 32 years SD+15 were included in the study. The wound size included in the study ranged from 12x10 cm to 88x66 cm. Mean duration of NPWT dressings was 15 days and 313 dressings were employed in total with satisfactory healing achieved in 3 to 4 VAC dressings in most of the cases. Mean duration of hospital stay was 23.92 days at which point graft uptake percentage was in the range of 90% (n=7) to 100% (n=20). Only 3.2% (n=2) cases required partial re-grafting for complete coverage of residual wounds. Conclusion: Gauze-based Negative-pressure wound therapy over split thickness skin graft is a cost-effective addition to the care and management of large and complex wounds

Underactive bladder may be caused by uterosacral ligament laxity - a critical review of two paradigms.

IntroductionThe aim of this study was to compare the posterior fornix syndrome (PFS), (abnormal bladder emptying, urge, frequency, nocturia, chronic pelvic pain) cured/improved by uterosacral ligament (USL) ligation, with ‘underactive bladder’ (UAB) [2], whose cause and cure of UAB are said to be unknown [2].Material and methodsA limited literature search was carried out for the words posterior fornix syndrome; obstructed micturition; post-void residual.ResultsWe found the diagnostic criteria used for UAB to be identical with PFS. Also, individual symptoms could be improved in the short term with squatting-based pelvic floor exercises, native tissue cardinal/uterosacral ligament repair, but requiring posterior ligament slings for a long term cure.ConclusionsBecause the similarity in symptoms may not be sufficient in the first instance to recommend surgery for UAB, we advise the use of a roll gauze or large tampon placed in the posterior fornix to support USLs ('simulated operation'), always with a full bladder, then observe any changes in PFS symptoms such as urge, pain, urine flow and post-void residual as a screening test before proceeding to surgery.

Cost-Effective, Custom-Designed Wet Wrap Garments for Children: Experience at Cardinal Glennon Children’s Hospital

Wet wrap therapy is a well-known, effective short-term treatment for inflammatory skin conditions such as atopic dermatitis and psoriasis. The traditional wet wrap technique involves application of a corticosteroid ointment and emollient followed by a 2-layer mummy-style wrap using roll gauze and vinyl wrap. However, this method is time consuming and labor intensive. On the other hand, commercially-available eczema clothing are expensive. Ordering difficulties and barriers to maintaining a bulk supply resulted in frequent stock depletion, leaving patients and staff no choices other than roll gauze and vinyl wrap. With a grant from the Cardinal Glennon Foundation we designed cost-effective, allergen-free wet wrap garments for pediatric patients. The inner layer garments were made from white cotton, chosen for its natural abundance, folding endurance, conduction of heat, cost effectiveness and low allergenicity risk. Nylon was used for the outer layer, chosen for its light weight and moisture retention. All the garments were made without dye, metal, elastic or other allergens. Plain cotton strings were used to secure the waist. The garments were half the cost of branded eczema clothing, based on internal online market research.Hospital staff members involved in directly providing wet wrap treatments have appreciated these garments for ease of use, patient comfort, and durable supply. Future Quality Assessment and Quality Improvement studies to compare the advantages of this treatment with traditional wraps will allow better evaluation of this custom designed clothing

Wound dressing following debridement for Fournier's gangrene.

The aggressive debridement of necrotic tissue required in Fournier’s gangrene often leaves a substantial skin defect around the scrotum and perineal area (Fig 1). These patients may return to theatre multiple times for ‘relook’ surgery and further debridement. Temporarily covering the open wound in the perineal area pending definitive reconstruction presents a challenge and faecal contamination is a risk. We demonstrate a technique using lengths of povidone-iodine soaked 90cm × 5m gauze roll (Synergy Health, Swindon, UK). Each testis is wrapped individually before a length of gauze is folded across the site 3–4 times and secured to the wound edges with skin staples (Figs 2–4). Figure 1 Skin defect following debridement Figure 2 Each testis is wrapped individually. Figure 3 A length of gauze roll is folded across the wound 3–4 times. Figure 4 The dressing is secured with staples.

A consistent and reliable technique for tensioning a suture button syndesmosis fixation system.

covering the open wound in the perineal area pending definitive reconstruction presents a challenge and faecal contamination is a risk. We demonstrate a technique using lengths of povidone-iodine soaked 90cm 5m gauze roll (Synergy Health, Swindon, UK). Each testis is wrapped individually before a length of gauze is folded across the site 3–4 times and secured to the wound edges with skin staples (Figs 2–4).

MRI “row of dots sign” in gossypiboma: an enlarging mass 8 months after sarcoma resection

The retention of foreign bodies after surgery is rare, but carries significant morbidity and mortality as well as financial and legal implications. Such retained items cause a foreign-body reaction, which in the case of cotton-based materials are called gossypibomas. We present the case of an 84-year-old woman with a pseudotumor secondary to a retained dressing gauze roll, presenting 5 months after resection of a gluteal sarcoma, which had raised concerns of local recurrence. We also outline the imaging modalities that may assist in diagnosis of a retained foreign body, and suggest the MRI "row of dots" sign as a useful radiological feature associated with gossypiboma. Awareness of the imaging appearances of retained foreign bodies allows the inclusion of this possibility in differential diagnosis of a mass in patients with a surgical history.

Efficacy of Biodegradable Synthetic Polyurethane Foam for Packing Nasal Bone Fractures

Nasal bone fracture is the most common traumatic disease among facial bone fractures. General treatment of this trauma is closed reduction, followed by intranasal packing. Vaseline or Furacin roll gauze, and Merocel are commonly used packing materials, but the pain produced while removing the packing is fearful for the patients. To compensate for this shortcoming, there has been an increased use of biodegradable synthetic polyurethane foam (SPF) recently. We performed a retrospective review to analyze the effectiveness of SPF after the closed reduction of nasal bone fracture. A retrospective review was conducted in 109 patients who underwent closed reduction for pure nasal bone fracture. One group was packed with Furacin roll gauze and the other was packed with SPF. Postoperative pain, hemostatic effect, supporting ability on the fractured segment, and healing of the injured nasal mucosa were compared between the 2 groups. A total of 109 patients were reviewed, with 61 patients packed with Furacin roll gauze (group A) and 48 patients packed with SPF (group B). Between the 2 groups, only visual analogue scale of pain at postoperative fourth day was statistically low in group B (P = 0.045) with other parameters showing no statistical difference. Nasal packing after closed reduction of nasal bone fractures support the reduced fractured bony segment and also has the main role on hemostasis and healing of mucosal injury. Removal of the packing is painful and fearful to the patients. SPF as nasal packing material provides superior outcome in terms of pain and satisfaction and, at the same time, is not inferior to the conventional packing materials with regard to bleeding control, mucosal wound healing, toxicity, and stability of reduced fracture segment.

Graftskin therapy in epidermolysis bullosa

Background: Epidermolysis bullosa (EB) is a family of 23 genetic skin disorders for which treatments are mainly supportive. Graftskin is a bilayered living human skin construct characterized by a normal expression profile of all the genes reported as mutant in EB. Objective: The objective of this study was to evaluate the efficiency and durability of graftskin in the treatment of EB. Methods: A total of 9 children with EB were treated with graftskin. These include EB simplex: Dowling-Meara type (n = 2); Weber-Cockayne type (n = 1); junctional EB-Herlitz type (n = 1); and recessive dystrophic EB (n = 5). Lesions were debrided of epidermis and crusts followed by application of fenestrated graftskin under sterile conditions. Syndactyly hand release for “mitten deformity” was performed after removal of all epidermis under general anesthesia. All treatment sites were dressed with a nonadherent contact layer followed by absorbent foam dressing, roll gauze, and a compression wrap covering and were left intact for 1 week. Graft take was assessed clinically at weeks 1, 2, 4, 12, and 20 to 28. Graft persistence was assessed by electron microscopy and polymerase chain reaction analysis at weeks 4 and 12, and between weeks 20 and 28 on selected cases. Results: A total of 96 sites were treated with 90% to 100% healing observed by 5 to 7 days, and many sites appearing as normal skin by 10 to 14 days. Finger and hand lesions showed 50% to 90% improvement in range of motion over baseline. Two children learned to walk after graftskin treatment of chronic plantar lesions. Two children had improvement in their chronic anemia after graftskin treatment. All patients and/or parents reported rapid pain resolution. Immunologic and genetic studies of graft persistence revealed evidence of donor DNA up to 28 weeks after graftskin application. None of the samples from female patients demonstrated Y chromosome-specific sequence when analyzed by the method of short tandem repeat. Conclusion: The encouraging results reported herein support the hypothesis that graftskin is more than a simple bandage or a source of growth factors to stimulate autologous closure of EB wounds. The improved quality of life and rapid achievement of growth/development milestones we have observed makes this an exciting step forward in the care of the patient with EB. (J Am Acad Dermatol 2003;48:886-92.)

Practical treatment of body and open leg wounds of horses with bovine collagen, biosynthetic wound dressing and cyanoacrylate

Horses with severe and deep lacerations are represented by ten cases in which treatment emphasized the use of bovine collagen preparations to promote controlled second-degree repair. Traumatized areas were tarsal, metatarsal, neck, forearm, metacarpal and pastern. Wound size changes were recorded. Depending on the wound type, the site was treated with antibiotic-steroid ointment, organic acid cream, sterile collagen particles, suspension or dressings protected by hydrogel dressing, non-adherent pads, occlusive skin dressings, roll gauze and elastic tape. In three cases, a fiberglas cast was applied over a hind leg wound and lacerated tendon for stability. When controlled granulation of the deeper wounds reached skin level, the area often was stabilized by only cyanoacrylate spray. As these cases presented a wide range of trauma each with a unique history, healing rates were based on initial measurements. An overall progression of wound reduction occurred at a predictable rate. The exogenous collagen formulations were used to stimulate controlled granulation, ie. to “jump start” the healing process. Collagen particles, suspension or dressings were packed into depressions, placed under suture lines, secured over abraded tissue, and placed under protective bandage or cast. To further evaluate the use of cyanoacrylate tissue spray in wound treatments, an additional ten cases are presented. The variety of wounds were produced experimentally in Center-owned ponies or provided as clinical cases. Wound size changes and healing progress were recorded. Wounds occurred on the neck, abdomen, metacarpal, metatarsal, fetlock and pastern areas. Depending on wound type, the site was treated with cyanoacrylate only; or treated as above until controlled granulation attained skin level. In one case punch grafts of skin were transferred from one foreleg to the opposite with the horse standing. Cyanoacrylate spray provided a water proof barrier protecting the wound from dirt, debris and insects as well as stabilizing full-thickness skin lacerations by bridging normal to traumatized skin allowing uninterrupted granulation and epithelialization. The use of a neck cradle prevented wound disturbance and stall confinement aided stabilization.

THE LAPAROSCOPIC CIGARETTE SPONGE

Minor hemorrhage during laparoscopic procedures may obscure the operative field. We describe the use of an especially designed, 4 x 4 absorbent sponge for multiple laparoscopic applications. The cigarette sponge, also known as the Kittner roll gauze, was routinely used for laparoscopic upper tract procedures. The sponge may be placed easily through ports 5 mm. or greater. The cigarette sponge was excellent for absorbing minor but bothersome bleeding, facilitating suction and blunt dissection, and assisting with retraction. This especially designed laparoscopic sponge dramatically eases laparoscopic procedures, especially for controlling bothersome hemorrhage and blunt dissection. It may decrease operative time and facilitate difficult laparoscopic procedures.

The buccal mucosal bleeding time.

289 Steven L. Marks, BVSc, MS, MRCVS, Diplomate ACVIM Bleeding occurs when vascular integrity is disrupted. Hemostasis is accomplished by vascular reaction, formation of a platelet plug, and activation of the coagulation cascade. In general, hemostasis can be divided into primary and secondary systems. The primary hemostasis system relies on the dynamic interaction between the vessel wall, vascular endothelium, and platelets. Exposure of vascular subendothelium triggers activation of von Willebrand’s factor, which links platelets to the site of vessel injury. Once platelets have adhered to the area and form the platelet plug, they assist in activation of the intrinsic pathway of the coagulation cascade or secondary hemostasis. Several commonly used “bleeding times” are utilized in veterinary medicine to evaluate patients for hemostatic disorders. The one-stage prothrombin time (OSPT), activated partial thromboplastin time (APTT), activated clotting time (ACT), and the buccal mucosal bleeding time (BMBT) are parameters that provide the veterinary clinician with critical information about the bleeding or at-risk patient. All of the tests mentioned, other than the BMBT, are used to evaluate secondary hemostasis. The BMBT is used along with the platelet count to evaluate primary hemostasis. The BMBT is a valuable diagnostic tool that is cost effective and easy to use in the general practice setting. The BMBT is used to evaluate hemorrhage from a standardized incision on the oral mucosa. It is performed using a disposable, single-use, spring-loaded lancet [Figure 1]. The procedure is performed with the dog restrained in lateral recumbency. The upper lip is everted and held in place by a length of roll gauze [Figure 2]. The gauze acts to maintain the eversion of the lip and to cause some vascular congestion. The lancet is placed against the buccal mucosa in a vertical direction directly above the maxillary canine tooth. Depressing the trigger [Figure 1] then activates the lancet. The lancet causes a controlled incision, which will readily bleed. Once the incision is made, the time should be noted and monitored. Circular filter paper is used to blot the blood as it drips from the incision. The filter paper should be held approximately 1 to 2 mm away from the incision, using care not to disrupt the clot formation. It is important to not allow the blood to drip into the animal’s mouth, as this may lead to agitation and movement. The end point of this test is when the incision stops bleeding. The published normal range for the BMBT in the dog is less than three minutes. Prolongation of the BMBT can occur with thrombocytopenia, thrombocytopathy, and von Willebrand’s disease. Clinical findings associated with abnormalities of primary hemostasis include superficial cutaneous bleeding, petechiation, ecchymosis, epistaxis, and mucosal bleeding of the gastrointestinal tract and urogenital tract (hematuria). If The Buccal Mucosal Bleeding Time

An alternative material for maxillofacial compression dressings

Edema is the most common sequel after oral and maxillofacial surgical procedures. Although a transient phenomenon, it is associated with patient discomfort and may lead to hematoma formation and infection. Multiple approaches have been used to prevent or decrease postoperative edema. The most frequently used modalities are systemic corticoids,’ local thermal therapy,2 and the application of pressure dressings or bandages.3 Compressive dressings limit postsurgical edema during the frrst 24 to 48 hours, when the acute phase of inflammation takes place. This phase is associated with an increase in local tissue pressure, local venous flow return, and deep venous blood flow velocity.* Pressure produced by such dressings also limits the development of postoperative hematomas or seromas. A common dressing used in the maxillofacial region is the Barton bandage, originally described for the treatment of mandibular fractures by J.R. Barton in 1819.5 The Barton bandage subsequently has been widely used as a postoperative compression dressing after oral and maxillofacial surgical procedures. Because of the special anatomic configuration of the face and the presence of multiple sense organs and vital structures, bandage application can be di@cult6 Typically, roll gauze and adhesive tape are used to fabricate a Barton bandage. The roll gauze, positioned over fluffed gauze that is in contact with the wound, is applied in several layers around the head and mandible and then dressing secured with the adhesive tape. However, the traditional Barton bandage occasionally slips or loosens and then no longer applies the desired compression. This report describes an alternative material (Coban; 3M Company,

Analysis of Pressure Achieved by Various Materials Used for Pressure Dressings

To minimize the risk of complications, pressure dressings are frequently applied to wounds. The actual pressures yielded by different dressing materials and application techniques have not been documented. To measure and compare pressures produced using various types of dressing tapes with and without a gauze roll. An infant blood pressure cuff was adapted for use in a pressure dressing model. Investigators independently applied four strips of each of five different types of tape to the cuff when it was located in three settings: a hard inanimate surface, a subject's distal volar forearm, and the subject's forehead. Foam and plastic tapes produced more pressure under a simple dressing than three other commonly used tapes. Higher, more consistent pressures were achieved on the forearm than the forehead. Adding a gauze roll to the dressing consistently increased the pressure. The experimental model demonstrated substantial differences in pressures yielded by various pressure dressing materials.