Standard Gauze Research Articles

Evidence-based Cesarean Delivery: Intraoperative management following placental delivery until skin closure (Part 9): Evidence based care during cesarean delivery.

This expert review provides recommendations for the cesarean technique after placental delivery to skin closure. Following placental delivery during cesarean, sponge curettage may be omitted as it has not been shown to decrease the risk of retained products of conception. Uterine irrigation and mechanical cervical dilation cannot be recommended. Either intra-abdominal or extra-abdominal repair of the hysterotomy is acceptable with some possible benefits with decreased postoperative pain and nausea/vomiting with intra-abdominal repair. There is insufficient evidence to recommend one uterine closure technique over the other with regards to suture type, continuous versus interrupted, locking or non-locking, one versus two-layer closure. Double layer uterine closure has been shown to be more beneficial with regards to residual myometrial thickness and full thickness bites (including endometrium) should be considered. Glove change by the surgical team is recommended after placental delivery and prior to closure of the abdominal wall. The following techniques are not recommended: intra-abdominal irrigation, use of adhesion-prevention barriers, peritoneal closure, and rectus muscle re-approximation. Based on non-cesarean evidence, fascial closure bites should be at least 5 × 5 mm with monofilament suture for vertical incisions. As an adjunct to postoperative pain control, surgeons may consider wound infiltration with local anesthesia either supra- or sub-fascial. Prior to closure, subcutaneous irrigation may be performed with saline, and routine use of subcutaneous drains is not recommended. Though closure of the subcutaneous layer can be considered in all patients, it should occur when the depth is ≥ 2cm. A monofilament absorbable suture, such as poliglecaprone, should be used to close the CD skin incision. There is no level 1 evidence evaluating the potential benefit of additional skin adhesive or sterile strips after suture skin closure. If a dressing is preferred over the skin incision the following may be considered: a DACC-impregnated dressing if available, otherwise a standard gauze dressing is appropriate. Prophylactic negative pressure would therapy can be considered in patients with obesity. Vaginal seeding at CD is not recommended.

Application of Closed Incision Negative Pressure Wound Therapy in Ventral Hernia Repair Surgery Using a Polypropylene Mesh: A Randomized Clinical Trial.

Background and Objectives: Surgical site infections (SSIs) are a significant complication following ventral hernia repair, potentially leading to prolonged hospital stays and increased morbidity. This study aimed to evaluate whether closed incision negative pressure wound therapy (ciNPWT) reduces the incidence of SSI after ventral hernia repair with polypropylene mesh compared to standard wound care. Materials and Methods: A randomized study was conducted with 100 patients undergoing ventral hernia repair using a polypropylene mesh. Participants were divided into two groups: a control group (n=50), which received standard sterile gauze dressing with an iodine-based disinfectant, and an intervention group (n=50), treated with the ciNPWT system (Vivano® by HARTMANN) for 5 days postoperatively. The primary outcome was the incidence of SSI within one year after surgery. Secondary outcomes included the influence of factors such as age, sex, smoking status, and hernia size on SSI occurrence. The study was approved by the Ethics Committee at the University Hospital Ostrava, adhering to the ethical standards of the Helsinki Declaration. Results: The incidence of SSI was lower in the ciNPWT group compared to the standard care group (4% vs. 12%), though this difference did not reach statistical significance. No significant effect of sex or smoking status on SSI was observed. The control group had a shorter mean length of hospital stay. Larger hernias in the non-ciNPWT group were more prone to SSIs, as expected. Conclusions: Although limited by a small sample size, the findings suggest that ciNPWT may be associated with a reduced rate of SSI following ventral hernia repair. Further studies with larger populations are needed to confirm these results.

Antiadhesive, antibacterial, and anti-inflammatory sandwich-structured ZIF8-containing gauze for enhanced wound healing

Medical gauze is commonly used in clinical practice due to its low irritation, flexibility, and permeability. However, conventional gauze frequently lacks adequate antibacterial and anti-adhesion properties, and gauze that is only superhydrophobic or antibacterial seldom meets the full requirements of infected wound treatment. In this work, we report optimal air permeability, water and blood absorption, and biocompatibility, and effective antibacterial properties of a sandwich-structured gauze composed of a superhydrophobic outer layer, a zeolite imidazolate framework-8 (ZIF8) interlayer, and a superhydrophobic inner layer containing blood-drainage channels (denoted SZS gauze). Three ZIF8 interlayers, ZIF8-1, ZIF8-2, and ZIF8-3, were prepared by soaking medical gauze samples in a mixed solution of 50 mL methanol, 50 mL ethanol, and 0.25, 0.50, or 1.00 g zinc acetate before flat drying, and had Zn content of 0.28, 0.34, and 0.46at.%, respectively, and their corresponding SZS gauze samples are denoted SZS-1, SZS-2, and SZS-3, respectively. Among all gauze samples, the SZS-2 showed the highest cytocompatibility toward L929 cells and effective in vitro antibacterial ability against E.coli and S.aureus. In a rat subcutaneous inflammation model, the SZS-2 showed complete biosafety and the best antibacterial and anti-inflammatory effects against E.coli and S.aureus mixed bacteria among all gauze samples including standard medical gauze and a sandwich-structured gauze with a blank interlayer between two superhydrophobic layers. These findings indicate that the SZS-2 gauze is a promising candidate for advanced wound care, particularly in the management of infected wounds.

Prophylactic Negative Pressure Wound Therapy in Reducing Surgical Site Infections: An Evidence-Based Literature Review.

Surgical site infections (SSIs) are a frequent postoperative complication that nurses commonly need to provide asepsis-specific meticulous care for. The application of a closed-incisional negative pressure wound therapy (iNPWT) device is regarded as a novel technique that aims to lower the risk of external wound contamination. The purpose of this review was to evaluate the effectiveness of iNPWT on high-risk closed laparotomy incisions with the aim to inform nursing practitioners and physicians engaged in multieffort wound care practices. Nursing professionals play a crucial role in mitigating the incidence of SSIs, from the time of application, through ongoing assessment tissue condition, and ensuring asepsis, thereby enhancing patient care and safety. Is prophylactic negative pressure wound therapy effective in reducing the incidence of (closed) surgical site wound infections postlaparotomy? The population studied included patients undergoing laparotomy surgery. The intervention under review included the application of iNPWT, compared to the use of standard gauze dressing. The expected outcome was SSI reduction. A systematized literature search was conducted using various databases to identify published studies that address the PICO question. The PRISMA checklist and Critical Appraisal Skills Programme tools allowed to exclude irrelevant articles and to critically appraise the evidence, respectively. Eleven key articles were retrieved including four RCTs and seven systematic reviews and meta-analysis. The results indicated an overall positive association between iNPWT and a reduction in SSI in laparotomy surgeries when compared to standard dressings. Data across most studies reviewed support the benefits with the use of iNPWT as a preventive strategy to lower the rates of SSI, with some claiming no difference. Although heterogeneity in the studies precludes a definite conclusion, nurses may make a more informed decision when navigating the demands of SSI prevention targeted nursing care.

Comparative efficacy of silver alginate dressings versus standard gauze in enhancing wound healing post-mastectomy for triple-negative breast cancer: A systematic review and meta-analysis.

This meta-analysis evaluates the efficacy of silver alginate dressings (SAD) compared to standard gauze (SG) in enhancing wound healing and reducing scar formation post-mastectomy in patients with triple-negative breast cancer. From an initial pool of 1245 articles, five studies met the inclusion criteria. The analysis revealed that SAD significantly improve early wound healing 1 week post-mastectomy, as indicated by lower Redness, Edema, Ecchymosis, Discharge, and Approximation (REEDA) scales (I2 = 85%; Random: SMD: -7.08, 95% CI: -8.26 to -5.98, p < 0.01), compared to SG. Additionally, long-term scar outcomes measured by the Manchester Scar Scale (MSS) 5 months post-mastectomy showed a notable reduction in scar formation (I2 = 95%; Random: SMD: -12.97, 95% CI: -16.20 to -9.75, p < 0.01)) in the silver alginate group. The findings support the use of SAD in post-mastectomy care for triple-negative breast cancer patients but highlight the need for further research on long-term safety and cost-effectiveness.

A modified chain-based sponge dressing controls junctional hemorrhage in the tactical combat casualty care simulation of pigs

BackgroundHemorrhage has always been the focus of battlefield and pre-hospitalization treatment. With the increasing fatality rates associated with junctional bleeding, treatment of bleeding at junctional sites has gradually gained attention in battlefield trauma emergency care. We designed a modified chain-based sponge dressing with a medical polyvinyl alcohol sponge that can be used to treat junctional hemorrhage and tested its hemostatic efficacy and biocompatibility.MethodsTwenty adult Bama miniature pigs were randomly divided into the modified chain-based sponge dressing (MCSD) and standard gauze (SG) groups. The right femoral artery of the pigs was shot at after anesthesia. The Bama miniature pigs were moved to the safety zone immediately to assess the condition according to the MARCH strategy, which evaluates massive hemorrhaging, airway obstruction, respiratory status, circulatory status, head injury & hypothermia. Hemoglobin and coagulation status were checked during the experiment.Among the pigs in which the inguinal hemorrhagic model based on bullet penetrating wounds was successfully established, those in the MCSD group received a disinfected MCSD for hemostasis, while those in the SG group received standard gauze in an imbricate manner to pack the bullet exit and entrance wounds to stop bleeding until the wound was filled, followed by compression for 3 min at sufficient pressure. CT scanning, transmission electron microscopy, and HE staining were conducted after experiment.ResultsThe MCSD group showed lower hemostasis time and blood loss than the gauze group. The MCSD group also showed a higher success rate of treatment,more stable vital signs and hemoglobin level. The CT scanning results showed tighter packing without large gaps in the MCSD group. The histopathological assessments and the transmission electron microscopy and HE staining findings indicated good biocompatibility of the polyvinyl alcohol sponge.ConclusionThe MCSD met the battlefield’s requirements of speedy hemostasis and biosafety for junctional hemorrhage in Bama miniature pigs. Moreover, in comparison with the conventional approach for hemostasis, it showed more stable performance for deep wound hemostasis. These findings provide the theoretical and experimental basis for the application of MCSD in the treatment of hemorrhage in the battlefield in the future.

Antibacterial and hemostatic chitin sponge directly constructed from Pleurotus Eryngii via top-down approach

Chitin, the second most abundant polysaccharide on earth, possesses unique characteristics, including biosafety, biodegradability, and procoagulant activity, making it an attractive material for hemostasis. However, the conventional bottom-up construction of chitin-based materials is intricate and time-consuming. In this study, we have developed a top-down strategy to prepare a 3D porous chitin-based hemostatic sponge with exceptional hemostatic properties and antibacterial activity, directly from the spongy Pleurotus eryngii. The top-down method involves deproteinization, in situ quaternization, and tannin acid crosslinking. The obtained sponge has an interconnected microporous structure with high porosity (89.7 ± 3.2 %), endowing it with high water absorption (2047 ± 105 %) and rapid water-triggered shape-memory behavior (< 2 s). The sponge exhibits superior blood coagulant activity and outperforms standard medical gauze, gelatin sponge, and chitosan sponge in both topical artery and non-compressive liver puncture wound. In addition, the sponge exhibited significant antibacterial activity against both gram-positive Staphylococcus aureus and gram-negative Escherichia coli. In summary, this study provides a straightforward and practical approach for constructing an antibacterial and hemostatic chitin sponge that could be a valuable option for treating bleeding wounds.

Effectiveness of incisional negative pressure wound therapy after major lower extremity amputation: a randomised controlled trial.

The aim was to study the effect of incisional negative pressure wound therapy (iNPWT) in wound healing compared with standard sterile gauze dressings after major lower extremity amputation in patients with peripheral arterial disease (PAD). This prospective, randomised controlled trial included 50 patients undergoing major lower extremity amputations for PAD. Patients were randomised into iNPWT and standard dressing groups. The patency of blood vessels at the level of the stump was ensured with or without revascularisation. The primary outcome was wound-related complications such as surgical site infection (SSI), wound dehiscence, seroma/haematoma formation or the need for revision amputation. The secondary outcome was the time taken for the eligibility of prosthesis placement. It was found that only 12% of the patients in the iNPWT group had SSI compared with 36% in the standard dressing group (p = 0.047). Rates of wound dehiscence, seroma/haematoma formation and revision amputation were decreased in the iNPWT group but this was not statistically significant (p > 0.05). There was a significant reduction in the time taken for eligibility of prosthesis placement in the iNPWT group (5.12 ± 1.53 vs 6.8 ± 1.95 weeks, p = 0.002). iNPWT is effective in reducing the incidence of SSI and the time taken for rehabilitation in patients undergoing major lower limb amputation due to PAD.

Reducing Surgical Site Infections with Silver-impregnated Dressings in Lower Extremity Bypass Patients

Surgical site infection (SSI) after lower extremity (LE) bypass surgery is associated with longer length of stay, higher hospital cost, increased morbidity, and even graft loss. Silver-impregnated dressings have been used by other surgical subspecialties to decrease SSI with reported success. The National Surgical Quality Improvement Program (NSQIP) published a national expected rate of 7.9% for SSI after LE bypass surgery. In 2018, our institutional SSI rate was 12.8%. To reduce this rate, we transitioned to silver-impregnated dressings for all LE bypass procedures and studied the subsequent impact on SSIs. We used NSQIP data to retrospectively study two consecutive cohorts of vascular surgery patients at a single institution who underwent LE bypasses. Patients in 2019 underwent the standard of care surgery with standard sterile gauze postoperative dressings. Patients in 2020 underwent standard of care surgery and were treated with silver-impregnated dressings. NSQIP criteria were used to determine if patients developed SSIs within 30 days of surgery. The Fischer exact and χ2 tests were used to compare groups before and after the intervention. A total of 282 patients underwent LE bypass in 2019 and 2020. The standard of care cohort had 168 patients with sterile gauze dressings, whereas the cohort after intervention had 114 patients with silver-impregnated dressings. The groups were similar in terms of demographics and comorbidities (Table). When considering all classifications of SSI, there were significantly fewer infections in the silver dressing group compared with the sterile gauze group (9.6 % vs 20.8%; P = .014). There was a non-statistically significant reduction in readmissions and unplanned return to the operating room in the silver dressing group. This study demonstrated a significantly lower rate of SSIs in patients undergoing LE bypass with use of a silver-impregnated dressing when compared with a sterile gauze dressing. Although our study does not demonstrate a causal relationship, this relatively inexpensive and low-risk intervention's association with a significant decrease in an otherwise very serious postoperative complication argues for a change in clinical practice or prospective confirmatory studies to optimize patient outcomes after LE bypass.TableDemographic and comorbidity differences between groups of patients who underwent lower extremity (LE) bypass surgery using sterile gauze dressing (2019) and silver-impregnated dressing (2020), and NSQIP-collected outcomes regarding postoperative surgical site infection (SSI), wound dehiscence, unplanned return to operating room, and readmission within 30 daysSterile gauze (n = 168)Silver dressing (n = 114)P-valueMale gender109 (64.8)79 (69.3).5Age, years67.1 (10.8)66.0 (11.2).4Race.7 Asian1 (0.6)2 (1.8) Black or African American25 (14.9)13 (11.4) Unknown11 (6.5)7 (6.1) White131 (78.0)92 (80.7)Emergent surgery10 (5.9)4 (3.5).4Active smoker78 (46.4)52 (45.6).9Diabetes.4 Yes, insulin-dependent47 (28.0)39 (34.2) Yes, non-insulin-dependent32 (19.1)23 (20.2) No89 (53.0)52 (45.6)Hypertension133 (79.2)93 (81.6).6Chronic obstructive pulmonary disease26 (15.5)15 (13.2).6Dialysis10 (5.9)10 (8.8).4Superficial SSI35 (20.8)11 (9.7).014Deep SSI5 (3.0)2 (1.8).7Organ space SSI2 (1.2)6 (5.3).07Wound dehiscence6 (3.6)5 (4.4).8Unplanned return to operating room43 (25.6)32 (28.1).7Readmission39 (23.2)30 (26.3).2Data are presented as mean (standard deviation) or number (%). Open table in a new tab

Buruli-RifDACC: Evaluation of the efficacy and cost-effectiveness of high-dose versus standard-dose rifampicin on outcomes in Mycobacteriumulcerans disease, a protocol for a randomised controlled trial in Ghana.

Buruli ulcer (BU) can lead to disfiguring ulcers and permanent disability. The 2030 World Health Organization (WHO) road map for Neglected Tropical Diseases (NTDs) calls for major scaling up in diagnosis and management to eliminate disability due to the disease. Current treatment for BU is with daily oral rifampicin (10mg/kg dose) and clarithromycin (15mg/kg dose) for eight weeks, combined with standard gauze wound dressings. Dialkylcarbamoyl chloride (DACC)-coated dressings have been shown to irreversibly bind bacteria on wound surfaces resulting in their removal when dressings are changed. This trial aims to determine whether combining a high-dose oral rifampicin regimen with DACC dressings can improve the rate of wound healing relative to standard-dose oral rifampicin combined with DACC dressings. This is an individual, multi-centre Phase 3 randomised controlled trial, which will be conducted in three clinical sites in Ghana. The primary outcome measure will be the mean time to clearance of viable mycobacteria. Cost and health-related quality of life data will be collected, and a cost-effectiveness analysis will be performed. The findings from this trial could lead to a change in how BU is treated. A shorter but more efficacious regimen would lead to improved treatment outcomes and potentially substantial financial and economic savings. Pan African Clinical Trials Repository (registration number; PACTR202011867644311). Registered on 30 th November 2020.

Compare the Mean Duration of Healing with Sodium Carboxylic Methyl- Cellulose Silver Dressing Versus Standard Petroleum Gauze Dressing for Management of Second-Degree Burns

Introduction: Burn injury is one of the most devastating and serous form of trauma that man sustains. Millions of people all over the world are hospitalized each year for treatment of burns and thousands die. It is estimated that in UK alone 10000 burn victims are hospitalized each year and 700 die. Objective: To compare the mean duration of healing with sodium Carboxylic methyl- cellulose silver dressing versus standard petroleum gauze dressing for management of second-degree burns. Material and methods: A total of 100 patients of second-degree burns were selected for this study. Clinical examination of patients was done to find out the degree of burns. In group A, Aquacel Ag dressing was applied. In group B, petroleum gauze dressing was applied. Patients were evaluated on each visit when dressing was changed for complete healing. Results: The mean age of the patients was 33.4±19.2 years. Duration of healing when compared in both the groups its showed that average time of healing in group A was 10.38+2.71 while in Group B it was 13.48+5.26SD and it showed significant difference with p-value=0.000. Practical Implications: This study will help to find the best method used for healing in second-degree burns. Conclusion: Mean duration of healing with sodium Carboxylic methyl-cellulose silver dressing was less than petroleum gauze dressing for management of second-degree burns. Keywords: Burn, Injury, Tissue, Wound, Healing, Management, Dressing

A novel sodium polyacrylate-based stasis dressing to treat lethal hemorrhage in a penetrating trauma swine model.

Control of massive hemorrhage from penetrating wound sites is difficult in both combat and civilian settings. A new hemostatic dressing, sodium polyacrylate (PAAs)-based bag (PB), based on PAAs is designed for the first aid of massive penetrating hemorrhage. This study aimed to investigate the efficacy of PB in a penetrating trauma model in swine. A complex groin penetrating injury was produced in swine by completely excising the femoral vessels and surrounding muscles. After 15-second free bleeding, 18 healthy Guizhou female swine were administered PB (n = 6), CELOX-A (n = 6; Medtrade Products, Crewe, United Kingdom), or standard gauze (n = 6) for hemostatic intervention, followed by 3-minute compression if the bleeding persisted, with subsequent observation continuing for 1 hour. The primary outcomes included initial hemostasis, the incidence of applying manual pressure, and application time. Sodium polyacrylate could rapidly absorb the liquid to expand, crosslink with a large number of red blood cells, induce cellular morphological alteration, and promote blood coagulation. Sodium polyacrylate-based bag and CELOX-A initiated and sustained hemostasis for 60 minutes, whereas 0% of the standard gauze achieved initial hemostasis. Maximum number of manual compressions were applied in standard gauze (6 of 6 [100%]), followed by CELOX-A (5 of 6 [80%]), while no manual pressure was required in the case of PB (0 of 6 [0%]). Application time for PB (19.0 ± 4.6 seconds) was significantly less than CELOX-A (169.0 ± 73.5 seconds) and standard gauze (187.8 ± 1.7 seconds). We prepared a type of superabsorbent PAAs and made an original hemostatic dressing, PB. It can rapidly achieve durable hemostasis in the groin-penetrating trauma hemorrhage swine model without any external compression. The packet form makes PB easy to deploy and remove from wounds. Therefore, PB could be a promising hemostatic candidate for controlling penetrating hemorrhage.

Buruli-RifDACC: Evaluation of the efficacy and cost-effectiveness of high-dose versus standard-dose rifampicin on outcomes in Mycobacterium ulcerans disease, a protocol for a randomised controlled trial in Ghana [version 1; peer review: 2 approved

Buruli ulcer (BU) can lead to disfiguring ulcers and permanent disability. The 2030 World Health Organization (WHO) road map for Neglected Tropical Diseases (NTDs) calls for major scaling up in diagnosis and management to eliminate disability due to the disease. Current treatment for BU is with daily oral rifampicin (10mg/kg dose) and clarithromycin (15mg/kg dose) for eight weeks, combined with standard gauze wound dressings. Dialkylcarbamoyl chloride (DACC)-coated dressings have been shown to irreversibly bind bacteria on wound surfaces resulting in their removal when dressings are changed. This trial aims to determine whether combining a high-dose oral rifampicin regimen with DACC dressings can improve the rate of wound healing relative to standard-dose oral rifampicin combined with DACC dressings. This is an individual, multi-centre Phase 3 randomised controlled trial, which will be conducted in three clinical sites in Ghana. The primary outcome measure will be the mean time to clearance of viable mycobacteria. Cost and health-related quality of life data will be collected, and a cost-effectiveness analysis will be performed. The findings from this trial could lead to a change in how BU is treated. A shorter but more efficacious regimen would lead to improved treatment outcomes and potentially substantial financial and economic savings.

Preventing caesarean section wound complications: use of a silver-impregnated antimicrobial occlusive dressing.

To investigate the role of an adherent soft silicone antimicrobial occlusive foam silver-impregnated dressing for reduction of surgical site infections (SSI) in primary low-transverse caesarean section (1°LTCS) delivery. Women aged 18-45 years admitted to the labour and delivery or the antepartum unit undergoing a 1°LTCS were recruited. Exclusion criteria included repeat caesarean, vertical skin incision, intrapartum fever and closure with staples. Consented participants delivered by scheduled or unscheduled 1°LTCS received the silver-impregnated dressing. Those who declined to participate and were delivered by scheduled or unscheduled caesarean received a standard gauze with tape dressing (controls). Surgical preparation and preoperative antibiotics were administered as per hospital policy. A total of 362 participants were consented for use of the silver-impregnated dressing, with 190 participants undergoing 1°LTCS, of whom 185 were included in the final analysis. Of those who declined to participate, 190 ultimately underwent 1°LTCS during the same time period. Cases and controls were similar in demographics, body mass index, diabetes status, labour and procedure length, and tobacco use. The overall incidence of SSI was 3.7%. A 50% reduction in incidence of SSI was observed in the silver-impregnated dressing group compared with control group (2.7% versus 4.7%, respectively), but this was not statistically significant (p=0.08; odds ratio 0.55; 95% confidence interval: 0.18-1.67). Among women undergoing 1°LTCS with subcuticular closure of a transverse incision, use of a silver-impregnated dressing reduced the rate of SSI by >50% but was not statistically significant.

Efficacy of tilapia skin xenograft compared to paraffin-impregnated gauze as a full-thickness burn dressing after excisional debridement: A case series

Introduction and importanceDue to its high collagen, good adherence to wound bed, and great wound healing properties, Tilapia (Oreochromis niloticus) skin has been studied as a biomaterial in regenerative medicine, including as a burn dressing. This paper evaluated the efficacy of tilapia skin xenograft as a temporary full-thickness burn dressing.MethodsFour acute burn patients aged 23–48 years old with total body surface area ranging from 27.5 to 37% with a similar burn area on both sides of the limbs were included. Each limb was dressed in tilapia skin or paraffin-impregnated gauze. Two subjects passed away due to septic shock. All limbs treated with tilapia skin xenograft required fewer dressing changes compared to the limbs treated with paraffin-impregnated gauze. All remaining subjects underwent skin autograft transplantation surgery on the eleventh day after the debridement surgery. No allergic reaction was found in any of the subjects.OutcomesThe tilapia xenograft performed better in controlling and containing the exudates compared to the paraffin-impregnated gauze, as reflected in the fewer dressing changes needed. The cause of death of the two patients was questionable as both of them have severe pneumonia and COVID-19 still could not be ruled out yet.ConclusionThe tilapia skin xenograft was not inferior to the standard paraffin-impregnated gauze for full-thickness burn dressing in terms of time needed for wound bed preparation for autograft surgery.

Chitin-glucan composite sponge hemostat with rapid shape-memory from Pleurotus eryngii for puncture wound

Efficient hemostasis is a great challenge for treating the inaccessible hemorrhage wounds. A novel shape-memory chitin-glucan hemostatic sponge (ATC-Sponge) is constructed via sequentially in-situ removal of protein and glucan from Pleurotus eryngii fruiting body, TEMPO oxidation and Ca2+ crosslinking. The sponge displays interconnected microporous structure with high water absorption and robust mechanical properties. The sponge at dry state shows rapid blood-triggered shape-memory, allowing easy insertion into the puncture wound in a compressed fixed-shape and the subsequent quick volume expansion to conform wound shape to stop bleeding. Compared with standard medical gauze and gelatin sponge, ATC-Sponge demonstrates superior hemostatic performance in the rat femoral artery and non-compressive liver puncture injury models. Additionally, ATC-Sponge can effectively accelerate wound healing. This multi-functional shape-memory ATC-Sponge shows high potential in controlling the bleeding of inaccessible traumas.

Green hemostatic sponge-like scaffold composed of soy protein and chitin for the treatment of epistaxis.

Epistaxis is one of the most common otorhinolaryngology emergencies worldwide. Although there are currently several treatments available, they present several disadvantages. This, in addition to the increasing social need of being environmentally respectful, led us to investigate whether a sponge-like scaffold (SP–CH) produced from natural by-products of the food industry — soy protein and β-chitin — can be employed as a nasal pack for the treatment of epistaxis. To evaluate the potential of our material as a nasal pack, it was compared with two of the most commonly used nasal packs in the clinic: a basic gauze and the gold standard Merocel®. Our SP-CH presented great physicochemical and mechanical properties, lost weight in aqueous medium, and could even partially degrade when incubated in blood. It was shown to be both biocompatible and hemocompatible in vitro, clearing up any doubt about its safety. It showed increased blood clotting capacity in vitro, as well as increased capacity to bind both red blood cells and platelets, compared to the standard gauze and Merocel®. Finally, a rat-tail amputation model revealed that our SP-CH could even reduce bleeding time in vivo. This work, carried out from a circular economy approach, demonstrates that a green strategy can be followed to manufacture nasal packs using valorized by-products of the food industry, with equal or even better hemostatic properties than the gold standard in the clinic.

Negative pressure wound therapy versus gauze dressings in managing open fracture wound of lower limbs: A meta-analysis of randomized controlled trials

BackgroundThe superiority of negative pressure wound therapy (NPWT) to standard gauze dressings for managing open fractures of the lower limbs remains controversial. This study aimed to comprehensively compare their clinical efficacy through a meta-analysis using randomized controlled trials (RCTs) alone. We hypothesized that NPWT would be more superior against infections. MethodsA literature search was implemented in various databases, including PubMed, Web of Science, Medline, Clinicaltrial.gov, and Cochrane Library, etc, to screen eligible RCTs. All included RCTs were evaluated for risk of bias using the Cochrane Collaboration tool. In accordance with the heterogeneity assessment, a fixed-effect or random-effect model was chosen for the data analysis. ResultsTen RCTs, including 2780 patients, were eligible for the meta-analysis. We found that patients in the NPWT group showed a lower overall infection rate (MD=0.70, 95% CI: 0.54–0.90, P = 0.005), acute wound infection rate (MD = 0.35, 95% CI: 0.16–0.77, P = 0.009), and shorter hospital stay (MD = 24.00, 95% CI: 6.82–84.46, P < 0.00001) compared with the control group. The NPWT group showed a higher proportion of patients with wound coverage than the control group. No significant difference was found between the two groups in terms of function score and other complications, including deep infection rate, amputation, and bone nonunion. ConclusionsFrom the pooled results, we suggest that NPWT may be superior than traditional gauze dressings for managing open fractures of the lower limbs.

Applying a Silver-containing Dressing to the Incision Site and Its Effect on the Development of Surgical Site Infection After Ostomy Closure: A Prospective Randomized Clinical Pilot Study

BACKGROUND: Surgical site infections (SSIs) can occur after colorectal surgery. Ionic silver has been used to prevent the development of SSIs. New-generation dressings, defined as total occlusive ionic silver–containing dressings, have been shown to reduce bacterial colonization in SSIs. PURPOSE: To evalute the effect of a silver hydrofiber dressing on the development of SSIs at the abdominal incision after ostomy closure. METHODS: There was a total of 37 eligible patients who underwent temporary ostomy closure. Five patients required an associated intervention during ostomy closure and were excluded. One patient was lost to follow-up. Hence, 32 patients were included in the study. Silver-containing occlusive dressings and conventional dressings were used in patients who underwent ostomy closure. In the control group (n = 16), the wound area was covered with a standard sterile gauze dressing for 24 to 48 hours, and then wound cleansing was performed with 10% povidone iodine, followed by daily dressing replacement with sterile gauze for 5 days. The patients in the study group (n = 16) were treated with a silver-containing hydrofiber dressing, which was not changed for 5 days following application in the operating room. RESULTS: At the end of the 30-day follow-up period, no SSIs were observed in the study group. When the dressing methods applied to the patient groups with and without SSIs were compared, SSIs developed at a higher rate in the control group (n = 4; 26.7%) compared with the study group (n = 0); this result was statistically significant (P = .043). CONCLUSIONS: In this study, the use of a wound care product containing ionic silver reduced the rate of SSIs related to ostomy closure. Multicenter, randomized, clinical studies involving a larger number of patients are needed. In addition, occlusive wound dressings with and without silver should be investigated in further studies.

Efficient, biosafe and tissue adhesive hemostatic cotton gauze with controlled balance of hydrophilicity and hydrophobicity

Cotton gauze is a widely used topical hemostatic material for bleeding control, but its high blood absorption capacity tends to cause extra blood loss. Therefore, development of rapid hemostatic cotton gauze with less blood loss is of great significance. Here, we develop an efficient hemostatic cotton gauze whose surface is slightly modified with a catechol compound which features a flexible long hydrophobic alkyl chain terminated with a catechol group. Its hemostatic performance in animal injuries is superior to standard cotton gauze and Combat GauzeTM. Its biosafety is similar to cotton gauze and rebleeding hardly occurs when the gauze is removed. Here, we show its hemostatic capability is attributable to the rapid formation of big and thick primary erythrocyte clots, due to its effective controlling of blood movement through blocking effect from tissue adhesion by catechol, blood wicking in cotton, and the hydrophobic effect from long alkyl chains.