orabase and Pressure-Ulcer

Pressure ulcers are a major healthcare problem and caused by pressure and shear-forces. Although shear-force is understood to be a major contributing factor, no preventive interventions are specifically aimed at relieving the effect of shear on skin to improve skin viability.. A physical model was used to apply a combined loading of 2.4kPa pressure and 14.5N shear-force on skin in humans. Loading was applied on the volar aspect of both forearms for 30min in ten healthy volunteers. One arm received loading on skin with a wound dressing, the other arm (control) received loading directly on skin. The following parameters were determined before and after loading: IL-1α/Total Protein-ratio (used as a measure of skin damage); Cutaneous blood cell flux ((CBF) measure of reactive hyperaemia); Lactate concentration (measure of tissue ischemia). Three different dressings were tested on three different days. The order of dressing application, dressing arm and start of the intervention were randomized.. Participants mean age was 22.5±1.6 year with a BMI of 22.3±2.4kg/m(2). IL-1α/Total Protein-ratio of the skin was significantly lower after the application of pressure and shear when the Mepilex® (P<0.01), Allevyn (P<0.05) or Aquacel(TM) dressing (P<0.01) was used compared with the control measurement. The Mepilex® dressing was more effective in reducing post-load IL-1α/Total Protein-ratio compared to the Allevyn dressing (P<0.01). Post-load CBF was significantly lower when the Mepilex® or Aquacel dressing was used (P<0.001). Both dressings induced significantly less post-load CBF than the Allevyn dressing (P<0.01 and P<0.001, respectively). The concentration of lactate was not significantly increased after the application of pressure and shear and could not be used as a measure with this model.. This is the first in vivo study to demonstrate that the effects of pressure in combination with shear on skin viability can be improved with foam dressings. In this study, the multi-layered dressings perform better than the single-layered dressing.

Topics: Carboxymethylcellulose Sodium; Humans; Interleukin-1alpha; Male; Occlusive Dressings; Pressure; Pressure Ulcer; Skin; Wound Healing; Young Adult

The aim of this study was to observe both the clinical signs and symptoms of wounds at risk of infection, that is critically colonised (biofilm infected) and antimicrobial-performance of an ionic silver alginate/carboxymethylcellulose (SACMC) dressing, in comparison with a non silver calcium alginate fibre (AF) dressing, on chronic venous leg and pressure ulcers. Thirty-six patients with venous or pressure ulcers, considered clinically to be critically colonised (biofilm infected), were randomly chosen to receive either an SACMC dressing or a non silver calcium AF dressing. The efficacy of each wound dressing was evaluated over a 4-week period. The primary study endpoints were prevention of infection and progression to wound healing. The SACMC group showed a statistically significant (P = 0.017) improvement to healing as indicated by a reduction in the surface area of the wound, over the 4-week study period, compared with AF controls. In conclusion, the SACMC dressing showed a greater ability to prevent wounds progressing to infection when compared with the AF control dressing. In addition, the results of this study also showed an improvement in wound healing for SACMC when compared with a non silver dressing.

Topics: Adult; Aged; Aged, 80 and over; Alginates; Bandages, Hydrocolloid; Biofilms; Carboxymethylcellulose Sodium; Chi-Square Distribution; Female; Glucuronic Acid; Hexuronic Acids; Humans; Male; Middle Aged; Pressure Ulcer; Prospective Studies; Silver Compounds; Treatment Outcome; Varicose Ulcer; Wound Healing; Wound Infection; Zirconium

This prospective, non comparative study evaluated the safety and effectiveness of an adhesive gelling foam dressing in pressure ulcer management. Twenty-three subjects with exuding pressure ulcers were recruited from seven centres in the USA and Canada. Study treatment included an adhesive gelling foam dressing, optional tape/roll bandaging and mandatory pressure-reducing/relieving devices. Subjects were followed until ulcer healing, for up to 28 days, or on patient withdrawal from the study, whichever came first. Dressings were changed at least once every 7 days. Mean percentage change in ulcer area from baseline to final measurement was -13%. Investigators reported healing or subjective improvement of ulcer condition in 61% of patients. Mean dressing wear time was 4.2 days. Subjects found the dressing was comfortable, soothing and cushioning in situ at 80%, 64% and 70% of dressing changes, respectively. Subjects reported pain severity of none or mild for every dressing change. Fourteen subjects experienced adverse events, including seven subjects with study-related maceration, erythema, wound enlargement, blister or infection. A regimen including an adhesive gelling foam dressing proved to be safe and effective for managing exudate, protecting the surrounding skin, minimising pain and supporting healing of pressure ulcers with exudate.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bandages, Hydrocolloid; Carboxymethylcellulose Sodium; Female; Follow-Up Studies; Gels; Humans; Male; Middle Aged; Polyurethanes; Pressure Ulcer; Prospective Studies; Treatment Outcome; Wound Healing

To investigate the effect of alternating air cells of a newly developed dynamic cushion on interface pressure and tissue oxygenation levels.. This cross-over experimental study included 19 healthy volunteers. The dynamic cushion used has an automatic self-regulating alternating pressure air-cell system with 35 small and four large air cells for maintaining posture while seated. This cushion also has 17 bottoming-out detectors that automatically inflate the air cells to release a high interface pressure. To assess the effect of this alternating system, participants sat on the new cushion with an alternating system or static system for 30 min and then performed push-ups. The interface pressure was monitored by pressure-sensitive and conductive ink film sensors and tissue oxygenation levels were monitored by near-infrared spectroscopy. A reactive hyperaemia indicator was calculated using tissue oxygenation levels as an outcome measure.. The peak interface pressure was not significantly different between the groups. The reactive hyperaemia indicator was significantly higher in the static group than in the alternating group.. An alternating system has beneficial effects on blood oxygenation levels without increasing interface pressure. Therefore, our new cushion is promising for preventing pressure ulcers with patients with limited ability to perform push-ups. Implications for Rehabilitation A dynamic cushion was developed, which consists of a uniquely-designed air-cell layout, detectors for bottoming out, and an alternating system with multiple air-cell lines. The alternating system did not increase interface pressure and it significantly reduced reactive hyperaemia after 30 min of sitting in healthy volunteers. This cushion is a new option for individuals who require stable posture but have limitations in performing scheduled push-ups for prevention of pressure ulcers.

Topics: Adult; Body Mass Index; Buttocks; Carboxymethylcellulose Sodium; Equipment Design; Female; Humans; Hyperemia; Male; Posture; Pressure; Pressure Ulcer; Spectroscopy, Near-Infrared; Wheelchairs

Topics: Bandages; Carboxymethylcellulose Sodium; Female; Humans; Male; Middle Aged; Pressure Ulcer

The management of patients with highly-exuding wounds can often lead to the use of unreliable and costly treatments. Patients are frequently found to be at increased risk of infection and delayed healing, which results in a huge negative impact on their quality of life. In the political and health arena, reducing health-care costs yet maintaining high quality and productivity is high on the list. With current economic, health-care and political targets, it is crucial to address the importance of effective wound management, particularly the importance of managing exudate. Inappropriate management of wound exudate can lead to prolonged wound healing, peri-wound maceration and excoriation, and can result in deterioration of the wound.

Topics: Absorption; Aged; Aged, 80 and over; Bandages; Carboxymethylcellulose Sodium; Chronic Disease; Exudates and Transudates; Female; Humans; Male; Middle Aged; Pressure Ulcer; Rectal Diseases; Skin Ulcer; Surgical Wound Dehiscence; Wounds and Injuries

Topics: Aged; Carboxymethylcellulose Sodium; Dermatologic Agents; Drug Combinations; Female; Gelatin; Humans; Ileostomy; Pectins; Polyenes; Pressure Ulcer