Dressings For Ulcers Research Articles

Electrospun PEG–PLA nanofibrous membrane for sustained release of hydrophilic antibiotics

AbstractReported in this study is the successful incorporation of a hydrophilic antibiotic drug, tetracycline hydrochloride (TCH), into electrospun PEG–PLA nanofibrous membrane without loss of its bioactivity. Degradation behavior of the copolymer was studied in vitro. Release behavior of TCH from the electrospun membrane and antimicrobial effects of the TCH‐loaded membrane against Staphylococcus aureus culture were investigated. The medicated nanofibrous membrane demonstrated sustained release of TCH over 6 days and was found to be effective in inhibiting growth of S. aureus. In addition, increasing the antibiotic drug content in the electrospun membranes was found to enhance the anti‐bacterial effectiveness of the medicated fiber mats. And the combination of mechanical barriers provided by the electrospun biodegradable nanofibrous membranes and their capability of local sustained delivery of antibiotics made these membranes more useful in biomedical applications, particularly as new wound dressings for ulcers caused by diabetes or other diseases, and to provide a better means of treatment for these malignant wounds and ulcers. © 2010 Wiley Periodicals, Inc. J Appl Polym Sci, 2010

A prospective randomised controlled trial and economic modelling of antimicrobial silver dressings versus non-adherent control dressings for venous leg ulcers: the VULCAN trial

A prospective randomised controlled trial and economic modelling of antimicrobial silver dressings versus non-adherent control dressings for venous leg ulcers: the VULCAN trial

Novel biodegradable composite wound dressings with controlled release of antibiotics: Microstructure, mechanical and physical properties

Wound dressings aim to restore the milieu required for skin regeneration and protect the wound from environmental threats, including penetration of bacteria. The dressings should be easy to apply and remove and maintain a moist healing environment. In this study, novel biodegradable composite wound dressings based on a polyglyconate mesh and a porous PDLGA binding matrix were developed and studied. These novel dressings were prepared by dip-coating woven meshes in inverted emulsions, followed by freeze-drying. Their investigation focused on the microstructure, mechanical and physical properties, and the release profile of the antibiotic drug ceftazidime from the binding matrix. The mechanical properties of our wound-dressing structures were found to be superior, combining relatively high tensile strength and ductility, which changed only slightly during 3 weeks of incubation in an aqueous medium. The parameters of the inverted emulsion, the organic-aqueous phase ratio, and the type of surfactant used for stabilizing the emulsion were found to affect the microstructure of the binding matrix and the resulting properties, i.e., water absorbance, water vapor transmission rate, and drug-release profile from the binding matrix. Appropriate selection of these parameters can yield composite structures that have the desired physical properties and drug release behavior. Thus, these unique structures are potentially very useful as burn and ulcer dressings.

Common Skin Problems in Children with Special Healthcare Needs

CME EDUCATIONAL OBJECTIVES 1. Describe the risk factors for developing pressure ulcers. 2. Discuss the rationale for choosing specific dressings for pressure ulcers. 3. Identify the appearance of, and causes for, skin irritation and breakdown around gastrostomy tubes, ilieostomies, and colostomies.

Local dressings for pressure ulcers: what is the best tool to apply in primary and second care?

A vast range of dressings can be used on pressure ulcers, but despite this and the high expense often involved, there is no gold standard for the local treatment of these wounds. This literature review therefore set out to examine the evidence.

Cheaper dressings for diabetic foot ulcers advocated

Cheaper dressings for diabetic foot ulcers advocated

Randomized controlled trial and cost-effectiveness analysis of silver-donating antimicrobial dressings for venous leg ulcers (VULCAN trial) (Br J Surg 2009; 96: 1147–1156)

Randomized controlled trial and cost-effectiveness analysis of silver-donating antimicrobial dressings for venous leg ulcers (VULCAN trial) (<i>Br J Surg</i> 2009; 96: 1147–1156)

Authors' reply: Randomized controlled trial and cost-effectiveness analysis of silver-donating antimicrobial dressings for venous leg ulcers (VULCAN trial) (Br J Surg 2009; 96: 1147–1156)

Authors' reply: Randomized controlled trial and cost-effectiveness analysis of silver-donating antimicrobial dressings for venous leg ulcers (VULCAN trial) (<i>Br J Surg</i> 2009; 96: 1147–1156)

Randomized controlled trial and cost-effectiveness analysis of silver-donating antimicrobial dressings for venous leg ulcers (VULCAN trial)

Randomized controlled trial and cost-effectiveness analysis of silver-donating antimicrobial dressings for venous leg ulcers (VULCAN trial)

Avaliação da analgesia de opioide tópico em úlcera de perna de paciente falcêmico

A doenca falciforme e caracterizada por apresentar varias alteracoes clinicas e fisiopatologicas nos pacientes que por ela sao acometidos. Uma dessas alteracoes e presenca de ulceras de perna dolorosas e de dificil cicatrizacao, sendo necessario o apoio de equipe multiprofissional no seu manejo e tratamento. Com o objetivo de reduzir a dor associada a ulcera de perna, o paciente falcemico faz uso de opioides parenterais e enterais que normalmente estao associados a efeitos colaterais indesejados. Com o objetivo de reduzir o uso desses opioides sistemicos, avaliamos um gel de morfina, de facil manipulacao e baixo custo, que foi utilizado antes e apos o processo de troca de curativo das ulceras de perna dos pacientes falcemicos atendidos em nossa instituicao. Baseados na escala analogica da dor foi avaliado o efeito analgesico do gel em 28 pacientes. Todos apresentavam dor grau 7 ou 8 antes da aplicacao do gel. Vinte e quatro pacientes (85,7%) apresentaram total ausencia de dor por um periodo de 24 horas, nao sendo necessario o uso de analgesicos sistemicos. Em tres pacientes (10,7%) a ausencia de dor durou um periodo de 12horas. Somente um paciente (3,6%) nao relatou analgesia apos o uso do gel. Os resultados demonstraram que o gel e altamente eficaz no controle da dor das ulceras de perna de pacientes falcemicos.

A prospective randomised controlled trial and economic modelling of antimicrobial silver dressings versus non-adherent control dressings for venous leg ulcers: the VULCAN trial

To examine the effectiveness and cost-effectiveness of antimicrobial silver-donating dressings for venous leg ulcers compared with simple non-adherent (also known as low-adherent) dressings. A pragmatic, prospective randomised controlled trial (RCT) and cost-effectiveness analysis of silver-donating versus low-adherent dressings in the treatment of venous leg ulcers. A non-randomised observational group was also recruited. Primary and secondary care services in the north and south of England (Sheffield and Exeter). Consenting patients with active ulceration of the lower leg that had been present for a period of greater than 6 weeks. Patients were randomised to receive either a silver-donating or non-silver low-adherent dressing applied beneath compression bandages or hosiery. The choice of dressing within these groups was left to clinician preference. Evaluation was by clinical assessment, supplemented by evaluation of quality of life and cost-effectiveness. The primary outcome measure was complete ulcer healing at 12 weeks in the index limb. Secondary measures were costs and quality-adjusted life-years (QALYs), cost-effectiveness, time to healing, and recurrence rate at 6 months and 1 year. In total, 304 participants were recruited to the clinical trial: 213 to the RCT and 91 to the observational arm. Within the RCT 107 were randomised to antimicrobial dressings and 106 to the control dressings. There were no significant differences (p > 0.05) between the two groups for the primary outcome measure of proportion of ulcers healed at 12 weeks (59.6% for silver and 56.7% for control dressings). The overall median time to healing was also not significantly different between the two groups (p = 0.408). A total of 24 patients had recurrent ulcers within 1 year; the recurrence rates of 11.6% (n = 11) for the antimicrobial and 14.4% (n = 13) for the control dressings were not significant. Mean utility valuations for both the EuroQol 5 dimensions (EQ-5D) quality of life questionnaire and Short Form 6 dimensions (SF-6D) utility index showed no differences for either group at 1, 3, 6 or 12 months. Compared with the control group, the antimicrobial group had an incremental cost of 97.85 pounds and an incremental QALY gain of 0.0002, giving an incremental cost-effectiveness ratio for the antimicrobial dressings of 489,250 pounds. Cost-effectiveness modelling of the results of the RCT showed that antimicrobial dressings were not cost-effective. No significant differences in either primary or secondary end points were found between the use of antimicrobial silver-donating dressings and the control group of low-adherent dressings. Modelling showed that antimicrobial silver dressings were not cost-effective. Current Controlled Trials ISRCTN72485131.

Randomized controlled trial and cost-effectiveness analysis of silver-donating antimicrobial dressings for venous leg ulcers (VULCAN trial)

Antimicrobial silver dressings are used beneath graduated compression in the treatment of venous ulceration. There is little information on whether their use is effective. This was a prospective randomized trial and cost-effectiveness analysis of silver-donating versus non-silver low-adherence dressings in the treatment of venous leg ulcers. Patients were randomized between the two types of dressing. The primary outcome measure was complete ulcer healing at 12 weeks. Secondary outcomes included time to healing, quality of life and cost-effectiveness. A total of 213 patients were recruited. There was no difference between the dressings in the proportion of ulcers healed at 12 weeks (59.6 per cent for silver and 56.7 per cent for control dressings). Mean utility scores for the EuroQol 5D and Short Form 6D were similar in both groups at 1, 3, 6 and 12 months. Compared with the control group the antimicrobial group had an incremental cost of pounds sterling 97.85 and an incremental quality-adjusted life year gain of 0.0002, giving an incremental cost-effectiveness ratio of pounds sterling 489 250 for the antimicrobial dressings. No significant differences were found in either primary or secondary endpoints. There was no evidence to support the routine use of silver-donating dressings beneath compression for venous ulceration. ISRCTN 72485131 (http://www.controlled-trials.com).

Primary dressings for venous ulcers

Honey as a primary dressing under compression bandaging may aid ulcer healing.

Efficacy of topical application of eosin for ulcerated hemangiomas

To the Editor: Ulceration is the most common complication of infantile hemangiomas.1Chamlin S.L. Haggstrom A.N. Drolet B.A. Baselga E. Frieden I.J. Garzon M.C. et al.Multicenter prospective study of ulcerated hemangiomas.J Pediatr. 2007; 151: 684-689Abstract Full Text Full Text PDF PubMed Scopus (166) Google Scholar Recent studies suggest that ulceration may arise because of an imbalance between angiopoietin-2 (Ang-2) and vascular endothelial growth factor (VEGF), because Ang-2 promotes angiogenesis in the presence of VEGF but causes endothelial cell death in the absence of VEGF.2Reiss Y. Scharpfenecker M. Grunow V. Koidl S. Thurston G. Gale N.W. et al.Angiopoietin-2 sensitizes endothelial cells to TNF-alpha and has a crucial role in the induction of inflammation.Nat Med. 2006; 12: 235-239Crossref PubMed Scopus (713) Google Scholar Agents that decrease the production of Ang-2 might promote ulcer healing. Recently, we showed that triphenylmethane dyes including gentian violet and brilliant green are potent inhibitors of nicotinamide adenine dinucleotide phosphate oxidases, which are highly expressed in endothelial cells and downregulate Ang-2 production.3Perry B.N. Govindarajan B. Bhandarkar S.S. Knaus U.G. Valo M. Sturk C. et al.Pharmacologic blockade of angiopoietin-2 is efficacious against model hemangiomas in mice.J Invest Dermatol. 2006; 126: 2316-2322Crossref PubMed Scopus (106) Google Scholar Eosin, which is also a triphenylmethane dye, is used in many countries for the treatment of diaper dermatitis and as a topical antibiotic.4Arad A. Mimouni D. Ben-Amitai D. Zeharia A. Mimouni M. Efficacy of topical application of eosin compared with zinc oxide paste and corticosteroid cream for diaper dermatitis.Dermatology. 1999; 199: 319-322Crossref PubMed Scopus (30) Google Scholar We tested whether eosin is efficacious in the treatment of ulcerated hemangiomas of infancy. Approval was obtained from the Institutional Review Board of the Schneider Children's Medical Center. Eosin 2% solution was applied three times a day unoccluded for superficial ulcers and once a day under hydrocolloid wound dressings for deep ulcers. Eighteen patients who had 21 well-documented photos of their hemangiomas were included in the study. The mean duration of treatment was 7 weeks (range, 3-14 weeks). Four ulcerated hemangiomas needed adjuvant therapy for complete reepithelialization (pulsed dye laser treatment in two cases and hydrocolloid dressings, with or without topical antibiotics, in four cases). One hemangioma required surgical excision. Complete ulcer healing was achieved in 16 hemangiomas after 4 weeks of treatment (Fig 1). There was no recurrence in any case. In order to determine whether eosin has the same mechanism of activity as gentian violet and brilliant green, we treated bend3 endothelial cells in tissue culture with eosin and demonstrated that eosin causes a significant suppression of Ang-2 mRNA in bend3 cells3Perry B.N. Govindarajan B. Bhandarkar S.S. Knaus U.G. Valo M. Sturk C. et al.Pharmacologic blockade of angiopoietin-2 is efficacious against model hemangiomas in mice.J Invest Dermatol. 2006; 126: 2316-2322Crossref PubMed Scopus (106) Google Scholar (Fig 2). In this study, we show that eosin inhibits production of Ang-2 in endothelial cells and may be efficacious in accelerating the healing of ulcerated hemangiomas of infancy. While eosin has also been shown to have photodynamic properties, it is unlikely that a photodynamic effect played a role, because the sites were not exposed to therapeutic light sources and were often occluded. Eosin offers several advantages in terms of treatment of infantile hemangiomas. First, it has a long record of human safety, including in infants.4Arad A. Mimouni D. Ben-Amitai D. Zeharia A. Mimouni M. Efficacy of topical application of eosin compared with zinc oxide paste and corticosteroid cream for diaper dermatitis.Dermatology. 1999; 199: 319-322Crossref PubMed Scopus (30) Google Scholar Second, in addition to being antiangiogenic, it has antibacterial properties. Third, it is less expensive than many other therapies, and is therefore amenable for use in the developing and the developed world. We believe that our pilot study demonstrates the efficacy of eosin in a pilot study of human hemangiomas of infancy, and provides a rationale for larger scale clinical trials of eosin in the treatment of hemangiomas of infancy and other angiogenic disorders.

Agar/collagen membrane as skin dressing for wounds

Agar, a highly hydrophilic polymer, has a special gel property and favorable biocompatibility, but moderate intension strength in an aqueous condition and a low degradation rate. In order to tailor both properties of mechanical intension and degradation, type I collagen was composited with agar in a certain ratio by drying at 50 °C or by a freeze-dry process. Glutaraldehyde was chosen as a crosslinking agent, and the most favorable condition for crosslinking was that the weight ratio of agar to glutaraldehyde was 66.7 and the pH value about 5. Dynamic mechanical analysis results showed that the single agar membrane had a modulus value between 640 MPa and 1064 MPa, but it was between 340 MPa and 819 MPa after being composited with type I collagen. It was discovered under an optical microscope that the pores were interconnected in the composite scaffolds instead of the honeycomb-like pores in a single type I collagen scaffold or the laminated gaps in a single agar scaffold. The results of an acute toxicity test disclosed that the composites were not toxic to mice although the composites were crosslinked with a certain concentration of glutaraldehyde. The results of gross examinations showed that when the composite membranes or scaffolds were applied to a repair rabbit skin lesion, the composites had a good repair effect without infection, liquid exudation or visible scar in the lesion covered with them. But in the control group, the autologous skin showed necrosis and there were a lot of scar tissues in the lesion site. H&E staining results showed that the repair tissue was similar to the normal one and very few scaffolds or membranes were left without degradation after 2 or 3 weeks. In conclusion, it is proved that type I collagen increases the toughness of the agar membrane, and the agar/type I collagen composites are promising biomaterials as wound dressings for healing burns or ulcers.

Choosing appropriate dressings for leg ulcers

Rachael Smithdale discusses an evidence-based approach to the management of leg ulcers

Effectiveness of acupuncture, special dressings and simple, low-adherence dressings for healing venous leg ulcers in primary healthcare: study protocol for a cluster-randomized open-labeled trial

BackgroundVenous leg ulcers constitute a chronic recurring complaint that affects 1.0–1.3% of the adult population at some time in life, and which corresponds to approximately 75% of all chronic ulcers of the leg. Multilayer compression bandaging is, at present, the only treatment that has been proved to be effective in treating this type of ulcer. There is no consensus, however, about the dressings that may be applied, beneath the compression, to promote the healing of this type of ulcer, as there does not seem to be any added benefit from using special dressings rather than simple, low-adherence ones. As well as analgesia, acupuncture provokes peripheral vasodilation, in skin and muscles – which has been demonstrated both experimentally and in clinical practice – probably due to the axon reflex, among other mechanisms. The aim of the present study is to measure the effectiveness and cost of compression treatment for venous leg ulcers combined with special dressings, in comparison with low-adherence ones and acupuncture.Methods/designCluster-randomized open-labeled trial, at 15 primary healthcare clinics in the Sevilla-Sur Healthcare District, with a control group treated with compression bandaging and low-adherence dressings; the experiment will consist, on the one hand, of the compression treatment applied in combination with special dressings (Treatment 1), and on the other, the compression treatment applied in association with low-adherence dressings, together with acupuncture (Treatment 2).DiscussionThe results will be measured and recorded in terms of the median time elapsed until complete healing of the ulcer, and the rate of complete healing at 3 months after beginning the treatment. An economic analysis will also be made.This study, carried out in the context of real clinical practice, will provide information for decision-taking concerning the effectiveness of special dressings. Moreover, for the first time a high-quality study will evaluate the effectiveness of acupuncture in the process of healing venous leg ulcers.Trial registrationCurrent Controlled Trials ISRCTN26438275.

Gentamicin‐eluting bioresorbable composite fibers for wound healing applications

New gentamicin-eluting bioresorbable core/shell fiber structures were developed and studied. These structures were composed of a polyglyconate core and a porous poly(DL-lactic-co-glycolic acid) (PDLGA) shell loaded with the antibiotic agent gentamicin, prepared using freeze drying of inverted emulsions. These unique fibers are designed to be used as basic elements of bioresorbable burn and ulcer dressings. The investigation focused on the effects of the emulsion's composition (formulation) on the shell's microstructure, on the drug release profile from the fibers, and on bacterial inhibition. The release profiles generally exhibited an initial burst effect accompanied by a decrease in release rates with time. Albumin was found to be the most effective surfactant for stabilizing the inverted emulsions. All three formulation parameters had a significant effect on gentamicin's release profile. An increase in the polymer and organic:aqueous phase ratio or a decrease in the drug content resulted in a lower burst release and a more moderate release profile. The released gentamicin also resulted in a significant decrease in bacterial viability and practically no bacteria survived after 2 days when using bacterial concentrations of 1 x 10(7) CFU/mL. Thus, our new fiber structures are effective against the relevant bacterial strains and can be used as basic elements of bioresorbable drug-eluting wound dressings.

Randomized clinical trial of honey-impregnated dressings for venous leg ulcers

The efficacy of honey as a treatment for venous ulcers has not been evaluated, despite widespread interest. This trial aimed to evaluate the safety and effectiveness of honey as a dressing for venous ulcers. This community-based open-label randomized trial allocated people with a venous ulcer to calcium alginate dressings impregnated with manuka honey or usual care. All participants received compression bandaging. The primary outcome was the proportion of ulcers healed after 12 weeks. Secondary outcomes were: time to healing, change in ulcer area, incidence of infection, costs per healed ulcer, adverse events and quality of life. Analysis was by intention to treat. Of 368 participants, 187 were randomized to honey and 181 to usual care. At 12 weeks, 104 ulcers (55.6 per cent) in the honey-treated group and 90 (49.7 per cent) in the usual care group had healed (absolute increase 5.9 (95 per cent confidence interval (c.i.) -4.3 to 15.7) per cent; P = 0.258). Treatment with honey was probably more expensive and associated with more adverse events (relative risk 1.3 (95 per cent c.i. 1.1 to 1.6); P = 0.013). There were no significant differences between the groups for other outcomes. Honey-impregnated dressings did not significantly improve venous ulcer healing at 12 weeks compared with usual care. ISRCTN 06161544 (http://www.controlled-trials.com).

Dressings for venous leg ulcers: systematic review and meta-analysis

Dressings for venous leg ulcers: systematic review and meta-analysis