|
 |
 |
 |
| |
Burns
First-degree burns affect only the outer layer of the skin and cause pain, redness, and swelling.
Second-degree (partial thickness) burns affect both the outer and underlying layer of skin and cause pain, redness, swelling, and blistering.
Third-degree (full thickness) burns extend into deeper tissues and cause white or blackened, charred skin that may be numb.
Evaluating the Use of Hydrogel Sheet Dressings in Comprehensive Burn Wound Care
Comprehensive burn wound management comprises a challenging spectrum of acute, chronic, traumatic, and surgical wounds with a wide range of anatomical locations and depth. When processing of porcine and cadaver skin ? items central to burn care management strategies ? became problematic at one Hong Kong hospital, a commercially available cost-effective substitute dressing was urgently needed. After reviewing the characteristics and availability of several dressings, hydrogel sheet dressings were evaluated in a range of burn wound applications. Fifty wounds, including skin graft donor sites, acute partial-thickness burns, and excised full-thickness wounds in 30 consecutive patients were managed with the dressing. It also was used as a temporary dressing over meshed autografts and cultured cell applications. When hydrogel is applied, it is nonadherent; nursing staff reported general ease of use. When applying hydrogel to awkward areas (eg, posterior thigh donor sites), assistance was required to stabilize the large sheets while securing retention dressings. Patients reported no pain during and between dressing changes. No adverse events occurred. Clinical outcomes met or exceeded expectations and guidelines for dressing application and removal were developed. Based on the results obtained, prospective, randomized, controlled clinical studies to ascertain the efficacy and effectiveness of this dressing were initiated. Broader exploration of the advantages of hydrogel use in burn wound care is warranted. KEYWORDS: hydrogel, burns, sandwich graft, wound healing, donor site
|
Restoration of Body Weight, Function, and Wound Healing after Severe Burns Using the Anabolic Agent Oxandrolone is Not Age Dependent
Loss of lean body mass both results from and impacts upon the body's mechanisms for healing. A randomized prospective study was conducted to determine the effect of age on the restoration of lost body weight and lean mass after severe burns using the anabolic steroid oxandrolone. Four groups of patients (N = 51) with deep burns of up to 55% of body surface were stratified by age (18 to 45 years [mean age 32 years] or >60 years [mean age 64 years]) and randomly assigned to two groups: optimum nutrition and exercise alone (control) or nutrition, exercise, and oxandrolone (treatment). All patients suffered at least a 10% loss of pre-burn body weight after injury. Study commenced when they entered the recovery phase of injury, defined as resolution of the hypermetabolic, catabolic state. The rate of body weight and lean mass gain and improvement in function were measured over a 4-week recovery period. In addition, the rate of healing of a standardized new skin donor graft site was assessed. The rate of body weight gain with the addition of oxandrolone was double that of standard care alone; 75% of weight gain in young and old patients was lean mass compared to only 55% lean mass without oxandrolone. These differences were statistically significant (P <0.05). No difference was observed in rate of lean mass gain between young and older burn patients on oxandrolone. The increase in the rate of weight gain with oxandrolone corresponded with a significant increase in the rate of healing of a donor site (P <0.05) and a 30% decrease in the time required to achieve sufficient function for discharge. The ability of an anabolic steroid to restore lean mass and physical function and improved healing after burn injury is not related to age.
|
Exploring the Effects of Wound Dressings and Patient Positioning on Skin Integrity in a Pediatric Burn Facility
Although literature on the subject is scant, in practice, pressure ulcers in the pediatric burn population remain a challenge. An interdisciplinary team at an urban pediatric burn institution treats a population (average age 8 years, range 1 month to 21 years) that includes children too young or unable to articulate pressure-related pain from dressings or positioning techniques. After pressure ulcer data collection procedures were instituted, it was observed that elastic bandages, wet operating room dressings, and positioning appeared to contribute to pressure ulcer occurrence. To better understand the patient?s experience and educate staff, an informal study was conducted by an interdisciplinary committee of clinicians to assess the amount of pressure in mm Hg created on bony prominences by care procedures. Three staff members volunteered and were placed in elastic dressings and various commonly used positions for several minutes and three pressure measurements were obtained. Pressure readings of 40 and 56 mm Hg were common, causing pain and placing a person at risk for skin ulceration. The information was used to educate staff on how to maintain therapeutic efficacy without compromising skin integrity and causing pain. Lectures and hands-on demonstrations elucidated correct dressing application. The committee continues to provide education to all staff members on methods to prevent pressure ulcers from occurring in the high-risk burn patient population and ways to reduce the use of elastic wraps and improve patient positioning. KEYWORDS: pediatric pressure ulcers, pediatric burns, pressure ulcers
|
A Scientific Perspective on the Use of Topical Silver Preparations
Silver Technologies The following is a summary of silver technologies available. Silver salts. Silver nitrate.
|
Adjuvant Dressing for Negative Pressure Wound Therapy in Burns
Because burns can be painful, placing a non-adherent dressing on the bum/wound bed before applying the NPWT dressing has been suggested. The actual dressing approach addressed several factors. Conclusion Negative pressure wound therapy can be an effective adjunct to burn treatment.
|
Epidermoid Cancers that Masquerade as Venous Ulcer Disease
Many lesions originally diagnosed as venous ulcers exhibit characteristics that are strikingly similar to skin cancers and might represent sites of primary carcinomas. To ascertain the frequency of malignancy in patients previously diagnosed with venous ulcer disease, a retrospective cohort review of patients evaluated at a Wound Healing Center in Florida was conducted. Charts of all patients with IDC-9 codes for varicose veins with stasis ulcer, varicose veins with ulcer and inflammation, and venous peripheral insufficiency were reviewed. Only charts of patients with one of these diagnoses and documented clinical varicosities, hemosiderosis, brawny edema, and lesions located at the medial or lateral lower leg were included. Sixty (60) patients were identified. Of these, 20 had lesions that were clinically suspicious for epidermoid skin cancers (ie, showing raised borders and chronic scaling). Biopsies confirmed malignancy in 15 of the 60 ulcers (25%). Of these, eight were squamous cell cancers. Given the high rate of malignancies in this cohort of patients, it is postulated that primary epidermoid cancers may mimic venous ulcers in appearance, location, and symptoms; that Marjolin's ulcers are rare despite their propensity to develop in many different types of wounds; and that patients with a history of venous ulcers and prolonged exposure to ultraviolet rays may benefit from lesion biopsies to test for epidermoid cancers.
|
Re-introducing Honey in the Management of Wounds and Ulcers - Theory and Practice
Dressing wounds with honey, a standard practice in past times, went out of fashion when antibiotics came into use. Because antibiotic-resistant bacteria have become a widespread clinical problem, a renaissance in honey use has occurred. Laboratory studies and clinical trials have shown that honey is an effective broad-spectrum antibacterial agent that has no adverse effects on wound tissues. As well as having an antibacterial action, honey also provides rapid autolytic debridement, deodorizes wounds, and stimulates the growth of wound tissues to hasten healing and start the healing process in dormant wounds. Its anti-inflammatory activity rapidly reduces pain, edema, and exudate and minimizes hypertrophic scarring. It also provides a moist healing environment for wound tissues with no risk of maceration of surrounding skin and completely prevents adherence of dressings to the wound bed so no pain or tissue damage is associated with dressing changes. Using appropriate dressing practice overcomes potential messiness and handling problems.
|
Silver Deposition and Tissue Staining Associated with Wound Dressings Containing Silver
Argyria is the general term used to denote a clinical condition in which excessive administration and deposition of silver causes a permanent irreversible gray-blue discoloration of the skin or mucous membranes. The amount of discoloration usually depends on the route of silver delivery (ie, oral or topical administration) along with the body?s ability to absorb and excrete the administered silver compound. Argyria is accepted as a rare dermatosis but once silver particles are deposited, they remain immobile and may accumulate during the aging process. Topical application of silver salts (eg, silver nitrate solution) may lead to transient skin staining. To investigate their potential to cause skin staining, two silver-containing dressings (Hydrofiber® and nanocrystalline) were applied to human skin samples taken from electively amputated lower limbs. The potential for skin discoloration was assayed using atomic absorption spectroscopy. When the dressings were hydrated with water, a significantly higher amount of silver was released from the nanocrystalline dressing compared to the Hydrofiber® dressing (P <0.005), which resulted in approximately 30 times more silver deposition. In contrast, when saline was used as the hydration medium, the release rates were low for both dressings and not significantly different (silver deposition was minimal). Controlling the amount of silver released from silver-containing dressings should help reduce excessive deposition of silver into wound tissue and minimize skin staining. KEYWORDS: silver-containing dressings, silver deposition, transient skin staining
|
Making the Case for Using a Silicone Dressing in Burn Wound Management
Historically, graft fixation has been achieved by suturing (which is time-consuming) or stapling (which is painful when removed). The dressing was removed down to the silicone dressing layer November 26, 2003, and the wound was assessed as healing normally without infection. The next dressing change was performed 48 hours later.
|
Research and Practice: Skin Tight
Although the responsibilities of Dr. Marcia Simon fall beyond the familiar scope of practice, the editors of Ostomy/Wound Management wanted to share her experiences as they relate to topics of concern to our readers.
|
|
|
 |
 |
 |
|
|
|
|
|
|
|
