orabase and Wounds-and-Injuries

Effective management of wound healing is a considerable challenge for clinicians. Patients underlying condition, accurate assessment of the wound and exudates, as well as selection of an appropriate dressing is all important factors for success. A variety of dressings are available to the clinician for the management of exudates. Hydrofiber dressings are a relatively new concept, and can be very cost effective because they can be worn for several days at a time. This report will review clinical evidences on the use of Hydrofiber dressing for the management of epithelial lesions, deal with current knowledge on the mechanism of action of this compound towards the epithelial wound healing process, immunological aspects and will also discuss relevant patents.

Topics: Animals; Bandages, Hydrocolloid; Carboxymethylcellulose Sodium; Exudates and Transudates; Humans; Patents as Topic; Treatment Outcome; Wound Healing; Wounds and Injuries

Use of silver containing dressings has become prevalent in clinical practice to manage chronic wounds at risk for infections. This literature review examines the evidence for the efficacy of using silver dressings in the chronic wound management.. Relevant in vitro articles on antimicrobial activity of silver dressings, relevant randomized controlled studies (RCTs), and one retrospective cohort study were selected to assess the effectiveness of silver dressings on human chronic wounds.. The emerging evidence base for this use of silver dressings in clinical practice on chronic wounds does not provide absolute evidence of antimicrobial efficacy because there are limited large, well-designed RCTs. To supplement this gap, more rigorously controlled long-term, randomized studies of human subjects with chronic wounds are needed.. It is essential that advanced practice nurses (APNs) be knowledgeable of the wound bacterial balance continuum. For deciding appropriate wound healing strategies, they also need to critically appraise the current literature as it changes for the latest information on antimicrobial efficacy of silver dressings. Until research clarifies the inconclusive evidence, APNs must provide holistic and accurate assessments of both the patient and the wound before selecting silver dressings.

Topics: Anti-Infective Agents, Local; Bandages; Biofilms; Carboxymethylcellulose Sodium; Chronic Disease; Evidence-Based Nursing; Humans; Nanoparticles; Polyesters; Polyethylenes; Silver; Wounds and Injuries

Within the last 3 to 5 years, many silver-based antimicrobial dressings have become available and more are on the way. However, sometimes dressing manufacturers and authors make claims and send messages that conflict with data and conclusions in the literature, creating confusion for clinicians. A literature review of six relevant and frequently discussed topics was conducted. Pre-clinical and clinical study data suggest that: a) bacterial resistance to silver may occur, b) silver dissociation is affected by the test medium used, c) bactericidal activity differences may be a function of the bacterial strain used for testing, d) higher rather than lower levels of silver may be needed because Ag+ binds to proteins and nucleic acids, e) rapid delivery of silver (ie, rate of kill) may be a positive factor when considering prevention of silver resistance and biofilm formation, and f) based on the vast majority of in vivo studies available, silver does not adversely effect viable cells; thus, is not cytototoxic. Continued research into the implications of the data is warranted.

Topics: Anti-Infective Agents, Local; Bandages; Biofilms; Carboxymethylcellulose Sodium; Carrier Proteins; Cell Survival; Drug Resistance, Bacterial; Evidence-Based Medicine; Humans; Hydrogels; Polyesters; Polyethylenes; Research Design; Silver Compounds; Skin Care; Time Factors; Treatment Outcome; Wound Healing; Wounds and Injuries

This study was conducted to compare pain, healing time, infection rate, and cosmetic outcome between Aquacel Ag (convatec) and Alginate Silver (coloplast) as donor site dressings.. We conducted a prospective randomized controlled trial of donor site dressings, comparing Aquacel Ag with Alginate Silver. Patients were randomly allocated to donor site dressing with one of these materials. Outcome measures included pain scores at rest and during dressing changes, time to re-epithelialization, cosmetic outcome and infection rate. Results were assessed for significance using the independent t-test (non-parametric data) and the chi-square test (parametric data).. A total of 20 subjects were enrolled in this study. Subjects included in both groups were comparable with no significant differences in demographic data of age, gender, location of burn and type of burns (P > 0.05 evaluated by paired t-test) between both group. The pain scores were found to be higher in Aquacel Ag group than in Alginate Silver group. Time to re-epithelialization was longer in Aquacel Ag group than in Alginate Silver group. There were no significant differences between the two treatment groups with respect to cosmetic outcome and infection rate.. Based on these results, we find that Alginate Silver is better than Aquacel Ag to cover the skin graft donor site.

Topics: Adult; Alginates; Burns; Carboxymethylcellulose Sodium; Drug Carriers; Female; Humans; Incidence; Male; Middle Aged; Occlusive Dressings; Pain Measurement; Prospective Studies; Silver Compounds; Surgical Wound Infection; Transplant Donor Site; Wounds and Injuries

The almost single disadvantage of conventional polyurethane film dressings, uncontrolled leakage, is probably as often described as its numerous advantages for split-thickness skin graft donor sites. This shortcoming can be overcome by perforating the polyurethane dressing, which permits controlled leakage into a secondary absorbent dressing. The study was conducted to compare the polyurethane dressing system and Aquacel, a hydrofiber wound dressing, which also seems to fulfill all criteria of an ideal donor-site dressing.. This prospective, randomized, double-blind clinical trial included 50 adult patients. Skin graft donor sites were divided equally for the application of Aquacel and polyurethane dressing. The dressings were kept unchanged for 10 days. After removal of the dressing at day 10, the epithelialization rate of both sites was evaluated. Pain scores were assessed according to a 0 to 5 numeric pain scale every postoperative day and during dressing removal.. On postoperative day 10, 86.4 percent of the polyurethane dressing donor sites showed complete reepithelialization compared with 54.5 percent of the Aquacel-treated donor sites (p<0.001). Polyurethane dressing was significantly less painful until and during removal of the dressing (p<0.001). There was no significant difference with respect to scar formation.. Overall, polyurethane dressing was superior to Aquacel. Further attributes of the polyurethane dressing such as ease of application, low labor input, high patient comfort, and protection against secondary wound infection qualify this dressing system as an ideal wound covering for donor sites.. Therapeutic, II.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Carboxymethylcellulose Sodium; Double-Blind Method; Female; Follow-Up Studies; Humans; Male; Middle Aged; Occlusive Dressings; Polyurethanes; Prospective Studies; Risk Assessment; Skin Transplantation; Tissue Donors; Treatment Outcome; Wound Healing; Wounds and Injuries; Young Adult

This randomized, open-label study evaluated Aquacel Ag Hydrofiber dressing with silver (HDS; ConvaTec, Skillman, NJ, USA) with an adherent or gelled protocol in the management of split-thickness donor sites.. HDS was the primary dressing in the adherent group (gauze as secondary covering) and gelled group (transparent film as secondary covering). Dressings were changed on study day 1 or 2 and study days 5 (optional), 10 (optional), and 14. The primary outcome was healing (>or=90% re-epithelialization) at study day 14.. Seventy subjects were treated (36 adherent, 34 gelled). By study day 14, 77% of donor sites had healed (67% adherent, 88% gelled). Pain scores decreased over time in both treatment groups. Investigators were "very satisfied" or "satisfied" with (adherent, gelled) time required to manage dressing change (89%, 79% of subjects), minimization of donor-site pain (64%, 82%), ease of application (97%, 94%), management of drainage (92%, 82%), ease of removal (77%, 85%), and ability of dressing to remain in place (69%, 76%). Thirty-nine (56%) subjects had adverse events, most commonly non-donor-site infection (11%) and gastrointestinal events (11%).. In this randomized, open-label study, HDS was well-tolerated, versatile, and effective in the management of split-thickness donor sites.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bandages; Carboxymethylcellulose Sodium; Child; Child, Preschool; Drug Carriers; Epithelium; Female; Humans; Male; Middle Aged; Pain, Postoperative; Silver Compounds; Skin Transplantation; Wound Healing; Wounds and Injuries; Young Adult

This prospective, randomised clinical trial compared pain, comfort, exudate management, wound healing and safety with Hydrofiber dressing with ionic silver (Hydrofiber Ag dressing) and with povidone-iodine gauze for the treatment of open surgical and traumatic wounds. Patients were treated with Hydrofiber Ag dressing or povidone-iodine gauze for up to 2 weeks. Pain severity was measured with a 10-cm visual analogue scale (VAS). Other parameters were assessed clinically with various scales. Pain VAS scores decreased during dressing removal in both groups, and decreased while the dressing was in place in the Hydrofiber Ag dressing group (n = 35) but not in the povidone-iodine gauze group (n = 32). Pain VAS scores were similar between treatment groups. At final evaluation, Hydrofiber Ag dressing was significantly better than povidone-iodine gauze for overall ability to manage pain (P < 0.001), overall comfort (P < or = 0.001), wound trauma on dressing removal (P = 0.001), exudate handling (P < 0.001) and ease of use (P < or = 0.001). Rates of complete healing at study completion were 23% for Hydrofiber Ag dressing and 9% for povidone-iodine gauze (P = ns). No adverse events were reported with Hydrofiber Ag dressing; one subject discontinued povidone-iodine gauze due to adverse skin reaction. Hydrofiber Ag dressing supported wound healing and reduced overall pain compared with povidone-iodine gauze in the treatment of open surgical wounds requiring an antimicrobial dressing.

Topics: Adolescent; Adult; Aged; Anti-Infective Agents, Local; Carboxymethylcellulose Sodium; Female; Humans; Male; Middle Aged; Occlusive Dressings; Pain Measurement; Povidone-Iodine; Prospective Studies; Silver Sulfadiazine; Wound Healing; Wounds and Injuries

To compare the healing rates of a hydrofibre dressing (Aquacel) and normal wet-to-dry gauze in the treatment of open surgical wounds.. Fifty patients with open surgical wounds were randomized to receive either saline-moistened gauze or Aquacel. The rate of wound healing was measured as ml/day (deep wounds) or cm2/day (superficial wounds) at each dressing change until an investigator blinded to the patient group diagnosed the wounds as having healed or the patient was withdrawn from the study.. Of the 50 patients, seven were withdrawn from the study after the first evaluation. Of the remaining 43 patients, 21 had been randomly allocated to the gauze group and 22 to the Aquacel group. For deep wounds, a mean change in the wound healing rate of 1.9 +/- 1.3 cm3/day was reported for the gauze group and 2.9 +/- 2.3 cm3/day for the Aquacel group. These results approach statistical significance (p = 0.082). For superficial wounds, the mean change in the healing rate was 1.6 +/- 1.5 cm2/day for the gauze group and 1.9 +/- 2.2 cm2/day for the Aquacel group, but this was not statistically significant.. Aquacel appears to be at least as effective as wet-to-dry gauze in the healing of open surgical wounds.

Topics: Bandages; Carboxymethylcellulose Sodium; Exudates and Transudates; Female; Humans; Male; Middle Aged; Pilot Projects; Postoperative Care; Sodium Chloride; Wound Healing; Wounds and Injuries

All fibrous wound dressings are considered to have the same action and value to the support of wound healing. Although clear distinction has been accepted between cotton gauze and calcium alginates, there is still no formally recognised distinction between calcium alginates and the more rapidly gelling fibre dressings.. Scientific and clinical evaluations were used to differentiate two different fibrous wound care products. One is derived from polymer extraction of algae (alginate dressings); the other has been manufactured from a uniquely patented carboxymethylation process that produces 100% carboxymethyl cellulose (CMC)-based dressings. Structural differences between these dressings were evaluated with respect to three important areas of wound care management: optimal wound moisture control; the ability to reduce risk of complication by locking away harmful components (e.g. bacteria); and reducing the overall cost of wound care by promoting more efficient use of nursing time.. Clear differentiation was illustrated through both scientific and clinical evaluations.. This study supports the potential advantages of using a technically advanced fibrous wound dressing over the traditional fibrous alginate wound care product.

Topics: Alginates; Bandages; Bandages, Hydrocolloid; Carboxymethylcellulose Sodium; Diabetic Foot; Gels; Hexuronic Acids; Humans; Wound Healing; Wounds and Injuries

Designing an antibacterial agent with a suitable water vapor permeability, good mechanical properties, and controlled antibiotic release is a promising method for stopping bacterial infection in wound tissue. In this respect, this work aims to prepare novel flexible polymeric hydrogel films via integrating UiO-66 into the polymeric carboxymethyl cellulose (CMC) hydrogel for improving the mechanical and antibiotic release performances. First, we performed a green hydrothermal synthetic method to synthesis UiO-66 and followed by encapsulating Tetracycline (TC) through immersion in its aqueous solution. Also, the casting technique was utilized to integrate different concentrations of the TC-encapsulated UiO-66 (TC@UiO-66, 5% to 15%) in the polymeric CMC matrix (CMC/TC@UiO-66) cross-linked by citric acid and plasticized by glycerol. The release performance showed a low initial burst release with a controlled release over 72 h in the artificial sweat and simulated wound exudate (PBS, pH 7.4) media. The in vitro cytotoxicity and antibacterial activity results revealed a good cytocompatibility toward Human skin fibroblast (HFF-1) cells and a significant activity against both E. coli and S. aureus with 1.3 and 1.7 cm inhibition zone, respectively. The obtained results recommend CMC/TC@UiO-66 films as a potential antibacterial wound dressing.

Topics: Anti-Bacterial Agents; Bandages; Carboxymethylcellulose Sodium; Cell Death; Cell Line; Cell Survival; Drug Liberation; Escherichia coli; Humans; Hydrogels; Hydrogen-Ion Concentration; Microbial Sensitivity Tests; Nanocomposites; Organometallic Compounds; Phthalic Acids; Spectroscopy, Fourier Transform Infrared; Staphylococcus aureus; Tensile Strength; Tetracycline; Wounds and Injuries

The immense burden imposed by chronic wounds-those persisting over 6 weeks despite active intervention-on patients and health services is well recognised. There are various reasons for why a wound fails to progress towards closure, and clinicians must investigate the underlying cause of wound chronicity, as this information guides the management of such wounds. The TIME framework (T=tissue; I=infection/inflammation; M=moisture balance; E=wound edges) is a useful tool for practitioners to systematically undertake wound assessment and product selection. This article discusses chronic wound management based on the TIME framework, examining the aspects to be considered when managing chronic wounds. It also describes the process of dressing selection for overcoming the various barriers to wound healing, specifically discussing the AQUACEL family of dressings.

Topics: Bandages; Carboxymethylcellulose Sodium; Chronic Disease; Humans; Inflammation; Tissue Survival; Wound Healing; Wound Infection; Wounds and Injuries

Topics: Aged; Carboxymethylcellulose Sodium; Humans; Leg Ulcer; Male; Wound Healing; Wounds and Injuries

Few burn dressings can self-regulate the optimal humidity levels that are required for wound healing, while also providing good anti-adhesive properties to prevent damage that can occur when wound dressings are changed. Consequently, a water-soluble carboxymethylcellulose sodium/sodium alginate/chitosan (CMC-Na/SA/CS) composite hydrogel has been developed as a potential burn wound dressing, with orthogonal testing revealing an optimal ratio of CMC-Na, SA, and CS as 2, 3, and 1 wt % for hydrogel preparation, respectively. The resultant hydrogel has been formulated into composite wound dressings that were then used for the treatment of deep second degree burn wounds in Sprague-Dawley (SD) rats. Analysis of the physical properties of this dressing revealed that it exhibits good water vapor permeability properties that promote the healing of deep second-degree burn wounds. The pro-healing mechanism of the dressing has been investigated Vascular endothelial growth factor (VEGF) expression was upregulated and basic fibroblast growth factor (bFGF) expression was downregulated in the early periods of wound healing, with upregulation of bFGF then occurring at a later stage of wound healing. At the same time, the wound dressing decreased the levels of tumor necrosis factor-α and interleukin-6, thus validating its beneficial effect on the wound healing process at a biomolecular level. In conclusion, this new hydrogel dressing was shown to exhibit excellent self-regulatory and anti-adhesive properties that synergistically promote the healing of burn wounds in rats, thus providing promising results that may have clinical applications. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 1471-1482, 2019.

Topics: Alginates; Animals; Burns; Carboxymethylcellulose Sodium; Chitosan; Disease Models, Animal; Hydrogels; Male; Rats; Rats, Sprague-Dawley; Tissue Adhesions; Wound Healing; Wounds and Injuries

This article describes a single-centre, non-comparative evaluation set out to assess the clinical performance and patient acceptability of a new carboxymethyl cellulose (CMC) wound dressing. Twenty patients in a community setting, aged between 34-97 years, were recruited. The progression of various types of wounds with different levels of exudate was documented over 4 weeks. No adherence to the wound bed or painful removal was reported in 18 patients, and the peri-wound skin was the same or had improved in all patients. When compared with the previous CMC dressing used by the authors, the new CMC dressing reported a longer wear time. These findings show a positive clinical performance and suggest a potential financial advantage when using the new dressing.

Topics: Adult; Aged; Aged, 80 and over; Bandages; Carboxymethylcellulose Sodium; Cost-Benefit Analysis; Exudates and Transudates; Female; Humans; Male; Middle Aged; State Medicine; Time Factors; United Kingdom; Wound Healing; Wounds and Injuries

The objective of this work was to evaluate the safety and effectiveness of a next-generation antimicrobial wound dressing (NGAD; AQUACEL

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Infective Agents; Bandages; Biofilms; Carboxymethylcellulose Sodium; Exudates and Transudates; Female; Humans; Male; Middle Aged; Silver; Treatment Outcome; United Kingdom; Wound Healing; Wounds and Injuries; Young Adult

To assess the effectiveness of a new, next-generation antimicrobial dressing (NGAD; AQUACEL Ag+ EXTRA dressing) in managing wound exudate, infection and biofilm, and facilitating progression toward healing.. Clinicians from the UK and Ireland selected stalled or deteriorating wounds that were considered to be compromised by infection and/or biofilm. Only the primary dressing was replaced by the NGAD, for up to 4 weeks or as deemed clinically appropriate; otherwise, standard protocols of care were used. Evaluation forms captured the baseline and final assessment characteristics of wound status, exudate levels, skin health, wound bed appearance, signs of infection and biofilm, and wound dimensions.. In all, 29 wounds were suitable for inclusion in the final analysis. Following the NGAD evaluation, wound statuses were shifted from stagnant/deteriorating to mainly improved, exudate levels were shifted from moderate/high to moderate/low, and skin health was improved in 20 wounds (69%). Wound bed tissue types were shifted from largely suspected biofilm/sloughy tissue (76%) to largely granulation tissue (53%). All signs of clinical infection were reduced in average frequency, with biofilm suspicion falling from 76% to 45% of the cases. The median management period with the NGAD was 4.5 weeks, after which 26 wounds (90%) became smaller in size and 10 wounds (34%) completely healed.. This real-life clinical evaluation of the NGAD suggests that its successful management of exudate, infection and biofilm is generally accompanied by notable improvements in wound health and size, and in some cases, complete healing.. The authors are all employed by ConvaTec Ltd. but have no other conflict of interest to declare. Dressings were provided to the clinicians free of charge.

Topics: Adult; Aged; Aged, 80 and over; Anti-Infective Agents; Bandages; Biofilms; Carboxymethylcellulose Sodium; Diabetic Foot; Female; Granulation Tissue; Humans; Ireland; Male; Middle Aged; Silver; Treatment Outcome; United Kingdom; Varicose Ulcer; Wound Healing; Wounds and Injuries

Silver-containing dressings are commonly used on healing wounds, including diabetic ulcers. Some studies have shown that dressing materials with silver have negative effects on wound healing, specifically, that the wound healing process is inhibited by deposited silver. Therefore, the authors treated wounds infected with methicillin-resistant Staphylococcus aureus (MRSA) in Sprague-Dawley (SD) rats and streptozotocin (STZ)-induced diabetic rats with silver dressings to evaluate the risks of silver.. The study used 54 SD rats and 54 STZ-induced diabetic rats. Full-thickness skin defects were created in all animals and then infected with MRSA. The rats were divided into 6 groups according to the dressing materials: nanocrystalline silver (Ac) (ACTICOAT, Smith and Nephew Healthcare, Hull, UK), silver carboxymethylcellulose (Aq) (AQUACEL Ag, ConvaTec, Bristol-Myers Squibb, Skillman, NJ), silver sulfadiazine (M) (Medifoam Silver, Biopol Global Co, Ltd, Seoul, Korea), nanocrystalline silver (P) (PolyMem Silver, Ferris Mfg Corp, Fort Worth, TX), Ilvadon cream (I) (Ildong Pharaceutical Co, Ltd, Seoul, Korea), and 10% povidone iodine (B) (Betadine, Sung Kwang Pharmaceutical Co Ltd, Gyeonggi-Do, Korea) as a control agent. Blood was collected from all animals to measure the hematological effects. The skin, spleen, liver, and kidneys of each rat were biopsied and used to make paraffin sections in which the silver deposition was measured using energy-dispersive spectrometry (EDS).. Fifteen days after wounding, only the Ac, P, and I groups differed significantly (P < 0.05) from the B group. The glutamic-oxaloacetic transaminase, blood urea nitrogen, and alkaline phosphatase levels differed significantly (P < 0.05) between the SD and STZ rats. No silver deposition was found in any organ.. The silver dressings induced slight liver damage in the STZ-rats. Although changes in serum chemistry caused by silver were seen, this did not indicate silver deposition in the organ as the EDS did not show excess levels. The risk of silver deposition appears to be low. The hazards of silver-containing dressing products in MRSA-infected wounds were insignificant.

Topics: Animals; Anti-Infective Agents, Local; Bandages; Carboxymethylcellulose Sodium; Diabetes Mellitus, Experimental; Metal Nanoparticles; Methicillin-Resistant Staphylococcus aureus; Rats; Rats, Sprague-Dawley; Silver; Silver Sulfadiazine; Staphylococcal Infections; Wound Healing; Wounds and Injuries

Topics: Arthroplasty; Biological Dressings; Carboxymethylcellulose Sodium; Humans; Ulcer; Wound Healing; Wounds and Injuries

Tissue engineering is aiming to build an artificial environment or biological scaffold material that imitates the living environment of cells in the body. In this work, carboxymethyl cellulose sulfates were prepared by reacting carboxymethyl cellulose with N(SO3Na)3 which was synthesized by sodium bisulfite and sodium nitrite in aqueous solution. The reaction conditions affected the degree of substitution (DS) were measured by the barium sulfate nephelometry method. And the anticoagulant activity of carboxymethyl cellulose sulfates with different DS, concentration and molecular weights were investigated by the activated partial thromboplastin time (APTT), thrombin time (TT) and prothrombin time (PT). In addition, the effect of carboxymethyl cellulose sulfates on wound healing had been evaluated by the rate of wound healing and the histological examinations. The results indicated that the introduction of sulfate groups into the carboxymethyl cellulose sulfates improved its anticoagulant activity, and the wound dressings treated with carboxymethyl cellulose sulfates obviously promoted wound healing.

Topics: Animals; Anticoagulants; Carboxymethylcellulose Sodium; Mice; Molecular Weight; Partial Thromboplastin Time; Prothrombin Time; Sodium Nitrite; Sulfates; Sulfites; Thrombin Time; Wound Healing; Wounds and Injuries

Lesions with great loss of skin and extensive burns are usually treated with heterologous skin grafts, which may lead rejection. Cell therapy with mesenchymal stem cells is arising as a new proposal to accelerate the healing process. We tested a new therapy consisting of sodium carboxymethylcellulose (CMC) as a biomaterial, in combination with adipose-derived stem cells (ADSCs), to treat skin lesions in an in vivo rat model. This biomaterial did not affect membrane viability and induced a small and transient genotoxicity, only at the highest concentration tested (40 mg/mL). In a rat wound model, CMC at 10 mg/mL associated with ADSCs increased the rate of cell proliferation of the granulation tissue and epithelium thickness when compared to untreated lesions (Sham), but did not increase collagen fibers nor alter the overall speed of wound closure. Taken together, the results show that the CMC is capable to allow the growth of ADSCs and is safe for this biological application up to the concentration of 20 mg/mL. These findings suggest that CMC is a promising biomaterial to be used in cell therapy.

Topics: Adipose Tissue; Animals; Carboxymethylcellulose Sodium; Cell Proliferation; Cell Survival; Cell- and Tissue-Based Therapy; Cells, Cultured; Collagen; Disease Models, Animal; Immunohistochemistry; Keratins; Male; Mesenchymal Stem Cell Transplantation; Mesenchymal Stem Cells; Rats, Wistar; Skin; Tissue Engineering; Tissue Scaffolds; Wound Healing; Wounds and Injuries

Broad-spectrum antimicrobial agents, such as silver, are increasingly being formulated into medicated wound dressings in order to control colonization of wounds by opportunistic pathogens. Medicated wound dressings have been shown in-vitro to be effective against planktonic cultures, but in-vivo bacteria are likely to be present in biofilms, which makes their control and eradication more challenging. Recently, a functional wound dressing (AQUACEL(®) Ag+ Extra™ (AAg + E)) has been developed that in addition to silver contains two agents (ethylenediaminetetraacetic acid (EDTA) and benzethonium chloride (BC)) designed to disrupt biofilms. Here, the efficacy of AAg + E is demonstrated using a biofilm model developed in an isothermal microcalorimeter. The biofilm was seen to remain viable in the presence of unmedicated dressing, silver-containing dressing or silver nitrate solution. In the presence of AAg + E, however, the biofilm was eradicated. Control experiments showed that neither EDTA nor BC alone had a bactericidal effect, which means it is the synergistic action of EDTA and BC disrupting the biofilm with silver being bactericidal that leads to the product's efficacy.

Topics: Anti-Bacterial Agents; Benzethonium; Biofilms; Carboxymethylcellulose Sodium; Edetic Acid; Microbial Sensitivity Tests; Occlusive Dressings; Silver; Staphylococcus aureus; Wound Infection; Wounds and Injuries

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

Injectable scaffolds present compelling opportunities for wound repair and regeneration because of their ability to fill irregularly shaped defects and deliver biologics such as growth factors. In this study, we investigated the properties of injectable polyurethane (PUR) biocomposite scaffolds and their application in cutaneous wound repair using a rat excisional model. The scaffolds have a minimal reaction exotherm and clinically relevant working and setting times. Moreover, the biocomposites have mechanical and thermal properties consistent with rubbery elastomers. In the rat excisional wound model, injection of settable biocomposite scaffolds stented the wounds at early time points, resulting in a regenerative rather than a scarring phenotype at later time points. Measurements of wound length and thickness revealed that the treated wounds were less contracted at day 7 compared to blank wounds. Analysis of cell proliferation and apoptosis showed that the scaffolds were biocompatible and supported tissue ingrowth. Myofibroblast formation and collagen fiber organization provided evidence that the scaffolds have a positive effect on extracellular matrix remodeling by disrupting the formation of an aligned matrix under elevated tension. In summary, we have developed an injectable biodegradable PUR biocomposite scaffold that enhances cutaneous wound healing in a rat model.

Topics: Animals; Apoptosis; Carboxymethylcellulose Sodium; Cell Proliferation; Collagen; Disease Models, Animal; Hyaluronic Acid; Immunohistochemistry; Injections; Isocyanates; Ki-67 Antigen; Lysine; Male; Polyethylene Glycols; Polyurethanes; Rats, Sprague-Dawley; Rheology; Tissue Scaffolds; Wound Healing; Wounds and Injuries

Topics: Carboxymethylcellulose Sodium; Female; Humans; Male; Polyurethanes; Skin Transplantation; Wound Healing; Wounds and Injuries

Freeze-dried (lyophilised) wafers and solvent cast films from sodium alginate (ALG) and sodium carboxymethylcellulose (CMC) have been developed as potential drug delivery systems for mucosal surfaces including wounds. The wafers (ALG, CMC) and films (CMC) were prepared by freeze-drying and drying in air (solvent evaporation) respectively, aqueous gels of the polymers containing paracetamol as a model drug. Microscopic architecture was examined using scanning electron microscopy, hydration characteristics with confocal laser scanning microscopy and dynamic vapour sorption. Texture analysis was employed to investigate mechanical characteristics of the wafers during compression. Differential scanning calorimetry was used to investigate polymorphic changes of paracetamol occurring during formulation of the wafers and films. The porous freeze-dried wafers exhibited higher drug loading and water absorption capacity than the corresponding solvent evaporated films. Moisture absorption, ease of hydration and mechanical behaviour were affected by the polymer and drug concentration. Two polymorphs of paracetamol were observed in the wafers and films, due to partial conversion of the original monoclinic to the orthorhombic polymorph during the formulation process. The results showed the potential of employing the freeze-dried wafers and solvent evaporated films in diverse mucosal applications due to their ease of hydration and based on different physical mechanical properties exhibited by both type of formulations.

Topics: Acetaminophen; Alginates; Carboxymethylcellulose Sodium; Chemistry, Pharmaceutical; Crystallization; Drug Carriers; Drug Delivery Systems; Freeze Drying; Gels; Glucuronic Acid; Hexuronic Acids; Microscopy, Confocal; Microscopy, Electron, Scanning; Mucous Membrane; Solvents; Water; Wounds and Injuries

The split-thickness skin graft (STSG) donor site dressing has been an inconclusive topic. Each of the Hydrofiber (Aquacel, ConvaTec A Bristol-Myers Squibb Company, Deeside, UK) and silver dressings have applied in many types of wound care with favorable outcomes. Our study compared the ionic silver-containing Hydrofiber dressing and paraffin gauze dressing. The subjects were randomized into group A: ionic silver-containing Hydrofiber and group B: paraffin gauze. From February 2006 to 2007, 20 donor sites were recorded. The mean donor site surface area was 145.5 cm2 (group A) and 135.8 cm2 (group B). The completed re-epithelization day was 7.90 and 11.20 days, respectively (P = 0.031). The average pain score at rest were 0.74 and 0.80, respectively (P = 0.894). The average pain score on dressing removal were 3.12 and 4.70, respectively (P = 0.027). There was no infection or seroma in both groups. In conclusion, ionic silver-containing Hydrofiber dressing can reduce STSG donor site pain and promote re-epithelization compared to paraffin gauze dressing.

Topics: Adult; Aged; Carboxymethylcellulose Sodium; Female; Humans; Male; Middle Aged; Occlusive Dressings; Paraffin; Silver Compounds; Skin Transplantation; Wound Healing; Wounds and Injuries; Young Adult

Topics: Alginates; Animals; Carboxymethylcellulose Sodium; Disease Models, Animal; Exudates and Transudates; Glucuronic Acid; Hexuronic Acids; Materials Testing; Occlusive Dressings; Silver Compounds; Swine; Time Factors; Treatment Outcome; Wound Healing; Wounds and Injuries

Excess or "uncontrolled" proteinase activity in the wound bed has been implicated as one factor that may delay or compromise wound healing. One proteinase group--matrix metalloproteinases--includes collagenases, elastase, and gelatinases and can be endogenous (cell) or exogenous (bacterial) in origin. A study was conducted to assess the ability of five silver-containing wound care products to reduce a known matrix metalloproteinase supernatant concentration in vitro. Four silver-containing wound dressings (a carboxy-methyl cellulose, a nanocrystalline, a hydro-alginate, and a collagen/oxidized regenerated cellulose composite dressing), along with a 0.5% aqueous silver nitrate [w/v] solution and controls for matrix metalloproteinase-2 and matrix metalloproteinase-9 sourced from ex vivo dermal tissue and blood monocytes, respectively, were used. Extracts were separated and purified using gelatine-Sepharose column chromatography and dialysis and polyacrylamide gel electrophoretic zymography was used to analyze specific matrix metalloproteinase activity. All dressings and the solution were shown to sequester both matrix metalloproteinases. The silver-containing carboxy-methyl cellulose dressing showed significantly greater sequestration for matrix metalloproteinase-2 at 6 and 24 hours (P< 0.001) compared to the other treatments. For matrix metalloproteinase-9, both the carboxy-methyl cellulose dressing and the oxidized regenerated cellulose dressing achieved significant sequestration when compared to the other treatments at 24 hours (P <0.001), which was maintained to 48 hours (P < 0.001). Results from this study show that silver-containing dressings are effective in sequestering matrix metalloproteinase-2 and -9 and that this can be achieved without a sacrificial protein (eg, collagen). Although the varying ability of wound dressings to sequester matrix metalloproteinases has been shown in vitro, further in vivo evidence is required to confirm these findings.

Topics: Alginates; Analysis of Variance; Animals; Anti-Infective Agents, Local; Bandages; Carboxymethylcellulose Sodium; Cell Culture Techniques; Chromatography, Agarose; Debridement; Drug Evaluation, Preclinical; Electrophoresis, Polyacrylamide Gel; Exudates and Transudates; Horses; Inflammation; Matrix Metalloproteinase Inhibitors; Matrix Metalloproteinases; Phagocytosis; Polyesters; Polyethylenes; Silver Nitrate; Skin Care; Wound Healing; Wounds and Injuries

To investigate and compare the performance of two widely used silver-containing, fibre-based dressings (Silvercel and Aquacel Ag) in terms of exudate management, wound-site adherence, dressing integrity, retention of dressing debris within wounds, frequency of debris-associated foreign body reactions and the impact of both debris and tissue reactions on wound-tissue integrity.. The dressings were evaluated in a porcine partial-thickness exudating wound model (an in vivo model of moderate to high exudation up to post-wounding day 4, and low exudation from days 4 to 7). Dressing performance was assessed using a panel of semi-quantitative scales.Wound-exudate retention, dressing structure following exposure to exudate, and adherence to wound tissues were compared macroscopically; the extent of trapped dressing debris, any ensuing tissue reactions and the level of resulting tissue disruption were compared histologically.. Silvercel was found to be significantly more effective in terms of wound exudate management than Aquacel Ag. On exposure to high levels of wound exudate, Silvercel retained its shape and mechanical strength, and remained at the site of application. In contrast, Aquacel Ag formed a fluid (semi-fibrous) gel, with minimal mechanical integrity and variable retention at the wound site. Silvercel was significantly more adherent to wound tissues than Aquacel Ag, but the level of trapped dressing debris, the frequency of ensuing foreign body reactions and the level of consequent wound-tissue disruption was lower, although not statistically, in the Silvercel-treated wounds.. These results suggest that the potential adverse clinical consequences of unmanaged wound exudate may be less likely in Silvercel than Aquacel Ag-treated wounds. In addition, the adverse effects of dressing adherence may be less likely in Aquacel Ag-treated wounds, although such benefits may be negated by the potentially deleterious effects of elevated dressing debris deposition. In view of these findings, further development of absorbent fibre-based dressings should be directed at maximising exudate management, minimising dressing adherence and preventing dressing-debris entrapment.

Topics: Alginates; Animals; Carboxymethylcellulose Sodium; Disease Models, Animal; Exudates and Transudates; Glucuronic Acid; Hexuronic Acids; Materials Testing; Occlusive Dressings; Silver Compounds; Statistics, Nonparametric; Swine; Time Factors; Treatment Outcome; Wound Healing; Wounds and Injuries

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.

Topics: Administration, Cutaneous; Analysis of Variance; Argyria; Carboxymethylcellulose Sodium; Drug Evaluation, Preclinical; Humans; Ion Transport; Ions; Nanostructures; Oxidation-Reduction; Polyesters; Polyethylenes; Silver Nitrate; Skin Care; Sodium Chloride; Spectrophotometry, Atomic; Tissue Distribution; Water; Wounds and Injuries

The goal of nerve repair in the peripheral nervous system is to increase the number of axons passing from proximal to distal stump, and to enable the regenerated axons to reach the end organ as soon as possible. In the present study, the effect of the membrane formed by a mixture of hyaluronic acid and carboxymethylcellulose (HA-CMC) on nerve regeneration and perineurial scar formation was investigated. Eighteen New Zealand rabbits were allocated into control (n = 9) and experimental groups (n = 9). In the control group, conventional nerve repair was carried out following the transection of the sciatic nerve, while in the experimental group, following repair of the nerve, the repair line was covered by HA-CMC membrane extending 1 cm beyond the distal and proximal ends. Nerve regeneration and extraneurial adhesion formation were compared between the two groups 3 months later. It was observed that adhesion in the surrounding tissues was significantly less in the experimental group than in the control group. Furthermore, morphometric analysis of specimens obtained from the distal parts of nerves showed that the number of axons with myelin was higher in the experimental group than in the control group, with a statistically significant difference. Histologic sections obtained from the nerve repair line demonstrated that extraneural and intraneural fibrosis was significantly lower in the experimental group. It was concluded that HA-CMC membrane had a favorable effect on nerve regeneration, as well as extraneural scar formation, encouraging the clinical application of HA-CMC following nerve injuries.

Topics: Animals; Axons; Carboxymethylcellulose Sodium; Fibrosis; Hyaluronic Acid; Membranes, Artificial; Myelin Sheath; Nerve Regeneration; Rabbits; Sciatic Nerve; Tissue Adhesions; Wounds and Injuries

Acute surgical wounds left to heal by secondary intention are often routinely managed with gauze fabric dressings. This paper reviews research that suggests newer, modern dressings are more cost-effective and cause less pain on removal.

Topics: Alginates; Carboxymethylcellulose Sodium; Contraindications; Cost-Benefit Analysis; Humans; Occlusive Dressings; Pain; Surgical Wound Infection; Wounds and Injuries

Topics: Carboxymethylcellulose Sodium; Humans; Occlusive Dressings; Postoperative Care; Treatment Outcome; Wound Healing; Wounds and Injuries