BACKGROUND: Skin grafting is a commonly performed operation in plastic and reconstructive surgery. The tie-over dressing is an effective technique to secure the grafted skin by delivering persistent downward pressure. However, if an additional dressing is required due to incomplete graft healing, the process of re-implementing the tie-over dressing may be frustrating for both patients and surgeons. Therefore, we introduce the double tie-over dressing, which readily allows for an additional tie-over dressing after the first dressing, and we present a comparison of its effectiveness with that of the simpler bolster dressing. METHODS: Of 128 patients with a skin defect, 69 received a double tie-over dressing and 59 patients received a simple bolster dressing. Using the independent t-test, the mean healing time, which was defined as the mean time it took for the wound to heal completely so that no additional dressing was required and it was washable with tap water, was compared between the 2 groups in both the head and neck region and in other areas. RESULTS: The mean healing time for the head and neck region in the double tie-over dressing group was 9.19±1.78 days, while it was 11.05±3.85 days in the bolster dressing group. The comparison of the 2 groups by the independent t-test revealed a P-value of 0.003 for the mean healing time. CONCLUSIONS: In the head and neck area, the double tie-over dressing required less time to heal than the simple bolster dressing.
Bandages* ; Dermatologic Surgical Procedures ; Head ; Humans ; Neck ; Occlusive Dressings ; Plastics ; Skin ; Skin Transplantation ; Surgeons ; Transplants ; Water ; Wounds and Injuries

BACKGROUND: A tie-over dressing is the accepted method to secure skin grafts in order to prevent haematoma or seroma formation. We describe the novel application of a barbed suture tie-over for skin graft dressing. The barbs act as anchors in the skin so constant tensioning of the suture is not required. METHODS: From January 2014 to August 2014 we used the technique in 30 patients with skin defects requiring split-thickness or full-thickness grafts. Patient demographics, clinicopathological details and graft outcome were collected prospectively. RESULTS: The majority of cases were carried out for split-thickness skin grafts (n=19) used on the lower limb (n=20). The results of this novel technique were excellent with complete (100%) graft take in all patients. CONCLUSIONS: Our results demonstrate the clinical application of a barbed device for securing skin grafts with excellent results. We find the technique quick to perform and the barbed device easy to handle, which can be applied without the need for an assistant.
Bandages* ; Demography ; Graft Survival ; Humans ; Lower Extremity ; Occlusive Dressings ; Prospective Studies ; Seroma ; Skin Transplantation ; Skin* ; Sutures* ; Transplants*

BACKGROUNDSelf and mutual-aiding occlusive dressing is a novel method to treat with the wounds in special circumstances. This study aims to prepare a new antimicrobial adhesive for the dressing and evaluate the application effects of the adhesive.

METHODSThe main component of the new antimicrobial adhesive was 5% triclosan / cyanoacrylate (CA) antimicrobial adhesive. The adhesive was modified with carboxylic multi-walled carbon nanotubes (MWCNTs-COOH), multi-walled carbon nanotubes (MWCNTs), hydrophobic nano-silica, nitrile rubber, epoxy resin and polymethyl methacrylate (PMMA) respectively. The bond strength, toughness and viscosity of the modified adhesive in different concentrations were examined to select the optimal modifying material and the best ratio to prepare the new antimicrobial adhesive according to the results. After that, the antimicrobial property of the new antimicrobial adhesive was tested by filter paper method. At last, we disposed the injury models in rats using the new antimicrobial adhesive to examine the application effects.

RESULTSIn individual tests, the bond strength modification performance of 0.064% MWCNTS-COOH is the best, the bond strength is (14.71 ± 1.48) Mpa. 8% nano-silica shows the best toughness modification performance, the Tg is (1.10 ± 0.24)°C. The viscosity modification performance of 8% nano-silica is the best, the viscosity is (15 536.68 ± 28.4) cP. However, consolidating three test results, 6% nano-silica/antimicrobial adhesive has the balanced bond strength, toughness and viscosity. Its bond strength is (14.03±1.92) Mpa, the Tg is (3.60 ± 0.68)°C, and the viscosity is (5 278.87 ± 31.68) cP. The inhibition zone diameter of 6% nano-silica/antimicrobial adhesive and antimicrobial adhesive group in Day 5 is (28.61 ± 0.91) mm versus (28.24 ± 2.69) mm (P > 0.05). In animal studies, both in blood routine test and pathological section, 6% nano-silica/antimicrobial adhesive group shows lower white blood cells count than gauze bandage group (P < 0.05).

CONCLUSIONS6% nano-silica has the optimal effect of bond strength modification, toughness modification and viscosity modification, and the antimicrobial adhesive modified with it has a good antimicrobial property (resistant staphylococcus aureus).

Animals ; Anti-Bacterial Agents ; chemistry ; therapeutic use ; Cyanoacrylates ; chemistry ; therapeutic use ; Male ; Nanostructures ; chemistry ; therapeutic use ; Occlusive Dressings ; Rats ; Rats, Sprague-Dawley ; Triclosan ; chemistry ; therapeutic use

BACKGROUND: The most common cause of skin graft failure is the collection of blood or serous fluid underneath the graft. In our study, we describe the use of silicone tube for tie-over dressing to secure the skin graft margins with the aim of decreasing loss of the skin graft, particularly in grafting of deep wounds. METHODS: Between March 2008 and July 2011, we used this technique in 17 patients with skin defects with depths ranging from 3.5 to 8 mm (mean, 5.5 mm). First, the skin graft was sutured with 3/0 silk suture material from its corners. Then, a silicone round drain tube was sutured with 3/0 absorbable polyglactin 910 over the margins of the graft. Finally, long silk threads were tied over the bolus dressing, and the tie-over dressing was completed in the usual fashion. RESULTS: The mean follow-up was 7 months (range, 2-10 months) in the outpatient clinic. Graft loss on the graft margins due to hematoma or seroma was not developed. The results of adhesion between the graft and wound bed peripherally was excellent. CONCLUSIONS: In our study, we suggest that use of a silicone tube for additional pressure on the edges of skin grafts in case of reconstruction of deep skin defects.
Ambulatory Care Facilities ; Bandages* ; Blood ; Follow-Up Studies ; Hematoma ; Humans ; Occlusive Dressings ; Polyglactin 910 ; Seroma ; Silicones* ; Silk ; Skin ; Skin Transplantation ; Sutures ; Transplants* ; Wounds and Injuries*

Vacuum-assisted wound healing has been proven to be more efficacious than conventional dressings. Vacuum dressing has been frequently modified given the restrictions in resources available. Here we present a modified method of vacuum dressing by using surgical or gynaecological gloves for lower and upper limb wounds. Vacuum dressing was applied with parts of a surgical or gynaecological glove and Opsite with T-tailing of the suction outlet. Vacuum-assisted wound healing using the surgical gloves showed relatively good wound healing in the amputation stump, finger, arm, and leg in the cases studied.
Amputation Stumps ; Arm ; Bandages ; Fingers ; Gloves, Surgical ; Leg ; Occlusive Dressings ; Polyurethanes ; Suction ; Upper Extremity ; Vacuum ; Wound Healing

OBJECTIVETo compare the properties of water-absorption, water-locking, and air permeability among several foam dressings, and to provide references for clinician in choosing dressings for different types of wounds.

METHODSThe comparison was made among Allevyn foam dressing, Mepilex foam dressing, and Biatain foam dressing that were commonly used in clinic. NaCl and CaCl2·H2O respectively in the weight of 8.3 g and 0.367 g were diluted with distilled water to the volume of 1 L to simulate wound exudation. The simulated wound exudation was used to test the water-absorbing rate of dressings at post immersion hour (PIH) 24, water-absorbing speed of dressings at post immersion minute (PIM) 1, 5, 10, and 20, the diffusion diameter of exudation dripped on the surface of dressings for 5 min to reflect the water-locking capacity of dressings, and the water evaporation capacity of exudation after being sealed up by dressings for 24 h to reflect the air permeability of dressings. Five samples of each dressing were used for each index. Data were processed with one-way analysis of variance and analysis of variance of repeated measurement, and LSD method was applied in paired comparison.

RESULTS(1) The water-absorbing rate at PIH 24 of Allevyn foam dressing, Mepilex foam dressing, and Biatain foam dressing were respectively (646 ± 18)%, (616 ± 19)%, and (499 ± 11)% (F = 423.854, P < 0.01). The differences between each two dressings in water-absorbing rate were statistically significant (with P values all below 0.01). (2) The water-absorbing speed of Allevyn foam dressing at PIM 1, 5, 10, and 20 were (35.20 ± 2.31), (12.48 ± 0.37), (6.63 ± 0.23), and (3.39 ± 0.08) g×s(-1)×m(-2), which were obviously lower than those of Mepilex foam dressing [(119.68 ± 2.59), (24.39 ± 0.62), (12.33 ± 0.29), and (6.18 ± 0.13) g×s(-1)×m(-2)] and Biatain foam dressing [(121.09 ± 3.41), (24.73 ± 0.52), (12.37 ± 0.25), (6.18 ± 0.13) g×s(-1)×m(-2)], with P values all below 0.01. The water-absorbing speed of each dressing showed the trend of declination among three dressings with prolongation of time. The differences between two adjacent time points within each dressing in water-absorbing speed were statistically significant (with P values below 0.01). (3) Diffusion diameters of exudation dripped on the surface of Allevyn foam dressing, Mepilex foam dressing, and Biatain foam dressing were respectively (5.66 ± 0.15), (4.84 ± 0.15), (3.94 ± 0.21) cm (F = 124.742, P < 0.01). The differences between each two of the three dressings in diffusion diameter were statistically significant (with P values all below 0.01). (4) The water evaporation capacity of exudation after being sealed up by each dressing for 24 h decreased in succession for Allevyn foam dressing, Mepilex foam dressing, and Biatain foam dressing, which were respectively (31.2 ± 3.1), (29.7 ± 8.7), (5.6 ± 2.8) g×h(-1)×m(-2) (F = 24.324, P < 0.01). The water evaporation capacity of exudation sealed with Biatain foam dressing was significantly lower than that of exudation sealed with Allevyn foam dressing and Mepilex foam dressing (with P values below 0.01).

CONCLUSIONSAmong the three kinds of foam dressings, Allevyn performs best in water-absorbing rate, water-locking capacity, and air permeability, while Mepilex and Biatain perform best in water-absorbing speed. For selecting foam dressing in clinic, the properties of foam dressings and wound characteristics should be considered at the same time.

Absorption ; Materials Testing ; Occlusive Dressings ; Permeability ; Water

PURPOSE: Split thickness skin graft is a frequently used reconstructive technique in burn wound, but the ideal dressing material of the donor site is yet to be developed. The donor sites have been managed with various dressing materials. The aim of this study is to compare four different dressing materials for management of the donor site in a prospective trial. METHODS: This study is based on 85 patients who had undergone split thickness skin graft from September 2011 to February 2012. The grafts harvested with a same manner and the donor sites were managed with one of the four dressing materials: Aquacel Ag(R), Mepitel(R), Bactigra(R), Op-Site(R). We compared post-operative pain scale, the time required epithelialization, ease of application, post-operative infection and number of dressings. RESULTS: Aquacel Ag(R) was the more painless dressing materials in post-operative day 1, 4, 7, 10 than Mepitel(R), Bactigra(R), Op-Site(R). Number of dressings was more lower for Aquacel Ag(R) with Mepitel(R). Ease of application was more higher for Aquacel Ag(R) with Mepitel(R). But Aquacel Ag(R) was not earliest epithelialization. The incidence of infection was not low in Aquacel Ag(R). CONCLUSION: Aquacel Ag(R) dressing is better than other dressing materials for split thickness skin graft donor site in the number of dressings, ease of application, post-operative pain.
Bandages ; Burns ; Carboxymethylcellulose Sodium ; Humans ; Incidence ; Occlusive Dressings ; Prospective Studies ; Skin ; Skin Transplantation ; Tissue Donors ; Transplant Donor Site ; Transplants

PURPOSE: Facial abrasions have been treated by moist occlusive dressing for many years. But previous dressing methods have several disadvantages such as difficulty of fixation due to varied contours, too frequent dressing changes with pain, discomfort due to volume of the dressing materials. The authors applied dried bovine amniotic membrane (Amnisite BA(R)) to facial abrasions as a new therapeutic option and compared its efficacy with previous foam dressing treatments. METHODS: From June 2010 to May 2011, thirty two patients suffering from facial abrasions were included in this study, with a mean age of 32.4. Patients were divided into two groups by patient preference. One group was treated with dried bovine amniotic membrane while the other group was treated with ointment and foam dressings. Subjects were followed by regular outpatient clinic visits until complete epithelization. Healing time, treatment costs, scar formation, skin elasticity and moisture content were evaluated to compare the efficacy of dried bovine amniotic membrane in comparison to foam dressing groups. RESULTS: All of thirty two patients were well healed after appliance of dried bovine amniotic membrane or foam dressing without any complication. The healing time for patients treated with dried bovine amniotic membrane was significantly shorter (P<0.05) and no significant difference between the two groups regarding treatment costs, scar formation, skin elasticity or moisture content was shown. CONCLUSION: Facial abrasion can be effectively treated with dried bovine amniotic membrane with a shortening of epithelization period and similar effectiveness as previous foam dressings. In addition, dried bovine amniotic membranes have several benefits. easy appliance to any parts of face, reducing the frequency of dressing changes, early adaptation to social life and so on, These presented benefits make this material a new standard for treatment of facial abrasion.
Ambulatory Care Facilities ; Amnion ; Bandages ; Biological Dressings ; Cicatrix ; Elasticity ; Health Care Costs ; Humans ; Occlusive Dressings ; Patient Preference ; Skin ; Stress, Psychological ; Treatment Outcome

Gluteoplasty is getting more concerns among female population with their rather flat contour of upper hips. We experienced a case of wound infection after intramuscular gluteal augmentation and cured with several steps of treatment protocol. We hereby report the case with treating devices and treatment protocol. A 38-year-old female who underwent gluteal augmentation with silicone implant 9 days ago, presented with prulent discharge at the suture site with general myalgia. Under IV general anesthesia, the wound was explored and more than 50 cc of prulent discharge was evacuated from the right gluteal pocket and subcutaneous tunnel. Massive irrigation and wound debridement was done with the help of Water-jet device and left the wound open for drainage. Several cautious steps are applied for reoperation including isolation of perianal skin, protection from skin maceration and contamination, Water-jet debridement, tight bleeding control with endoscope, progressive tension sutures, negative suction drains, occlusive dressings and stabilizing the buttock with Fixmull cotton tape splints. Wound infection is not a rare complication in gluteal augmentation surgery but if it is not treated properly, that would lead to a disastrous result. Therefore surgeons must be well accustomed to the treatment protocol for treating gluteal infection.
Adult ; Anesthesia, General ; Buttocks ; Clinical Protocols ; Debridement ; Drainage ; Endoscopes ; Female ; Hemorrhage ; Hip ; Humans ; Occlusive Dressings ; Reoperation ; Silicones ; Skin ; Splints ; Suction ; Sutures ; Wound Infection

PURPOSE: The purpose of this study was to identify the effects of EMLA cream (eutectic mixture of local anesthetics, lidocaine and prilocaine) on pain during ampicillin sodium intradermal (ID) skin test, and also to assess skin reaction after the skin test. METHODS: Forty-three nurse-volunteers had skin tests with 0.01ml-0.05ml ampicillin sodium antibiotics. Skin tests were done on each forearm to compare the pain level of the skin test site after application of EMLA cream with the pain level when no EMLA cream was applied. EMLA cream was applied at the ID skin test site with an occlusive dressing for one hour. Pain was evaluated using a visual analogue scale and pain sensation using the short form McGill Pain Questionnaire. The transverse diameter of the wheal and redness was read right after and at 15 minutes after the skin test. The results were compared using independent t-tests. RESULTS: Pain score and sensation with EMLA cream treatment were significantly lower than when EMLA cream was not applied. There was no difference in skin reactions; reading of the skin test was not affected by EMLA cream. CONCLUSIONS: EMLA cream was found to be an effective local anesthetic to relieve the pain of clients having ampicillin sodium antibiotics ID skin tests.
Ampicillin ; Anesthetics, Local ; Anti-Bacterial Agents ; Forearm ; Intradermal Tests ; Lidocaine ; Occlusive Dressings ; Pain Measurement ; Prilocaine ; Sensation ; Skin ; Skin Tests