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Burn injury remains a serious cause of morbidity and mortality worldwide. Severity of burns is determined by the percentage of burned area compared to the body surface area, age of patient, and by the depth of skin and soft tissue involvement; these factors determine management as well as prospective outcomes. The pathophysiology of partial- to full-thickness burn conversion remains poorly understood and is associated with a worse overall prognosis. Recent studies have demonstrated that an altered inflammatory response may play a significant role in this conversion and therefore a reduction in early inflammation is crucial to ultimately decreasing burn severity and morbidity. We hypothesize that the application of a microcapillary gelatin-alginate hydrogel loaded with anti-TNF-α (infliximab) monoclonal antibodies to a partial-thickness burn will reduce inflammation within partially burned skin and prevent further progression to a full-thickness burn.Assembly of the microfluidic hydrogels is achieved by embedding microfibers within a hydrogel scaffold composed of a gelatin-alginate blend, which is then soaked in a solution containing anti-TNF-α antibodies for drug loading. 12 young (2-4 months) and 12 old (16 months) mice were given partial thickness burns. The treatment cohort received the anti-TNF-α infused hydrogel with an occlusive dressing and the control cohort only received an occlusive dressing. Mice were euthanized at post-burn day 3 and skin samples were taken. Burn depth was evaluated using Vimentin immunostaining.All mice in the treatment cohort demonstrated decreased conversion of burn from partial to full thickness injury (old = p0.01, young = p0.001) as compared to the control group. Old mice had greater depth of burn than young mice (p0.001). There were greater eosinophils in the treatment cohort for both young and old mice, but it did not reach statistical significance.The application of a novel microcapillary gelatin-alginate hydrogel infused with anti-TNF-α antibody to partial thickness burns in mice showed reduction in partial to full thickness burn secondary progression as compared to controls using this murine model; this promising finding might help decrease the high morbidity and mortality associated with burn injuries.

Purpose The purpose of this study was to determine the cost-effectiveness of the most commonly used type of antimicrobial silver-impregnated occlusive dressing (Aquacel Ag, ConvaTec, Oklahoma City, OK, USA) for prosthetic shoulder infection (PSI) prevention after shoulder arthroplasty. Methods Data regarding the cost of silver-impregnated occlusive dressing, cost to treat a PSI and initial infection rates after shoulder arthroplasty were calculated from available literature. Using a break-even economic analysis, we developed an equation that incorporated these variables to determine the absolute risk reduction (ARR) in infection rate required to make the use of this dressing cost-effective. To provide a widely applicable and reusable model, multiple simulations were performed at varying unit costs, infection rates, and PSI-related care costs. Results At a dressing cost of $34.00 and presuming a cost of $50,230 for treating a PSI, these dressings are considered cost-effective if their use prevents at least 1 infection in 1471 TSA (ARR of 0.068% from the initial infection rate of 0.7%). The cost-effectiveness of this dressing was maintained through a realistic range of dressing and PSI treatment costs, while initial infection rate was found not to influence cost-effectiveness. Conclusions Antimicrobial silver-impregnated occlusive dressings represent a cost-effective infection prevention strategy after shoulder arthroplasty. The presented model serves as a useful resource to aid in weighing the economic effects of implementing any potential prophylactic measures aimed at minimizing infections after shoulder arthroplasty. Level of Evidence Level IV; Economic Decision Analysis

Percutaneous Endoscopic Gastrostomy (PEG) is a method that has been widely used as an alternative feeding method for patients who have impaired mastication and swallowing. The study aimed to verify whether the application of waterproof adhesive dressing is effective in preventing water infiltration at the site of the GEP feeding stoma in the therapeutic pool, simulating a real aquatic rehabilitation situation. This is a cross-sectional study in which cotton samples that were inside the dressing were tested and were compared in two weighings after the participant entered the therapeutic pool, the first weighing performed immediately after passive and active immersion and the second weighing after a period of drying in the oven. Ninety procedures were performed, with the participation of 45 healthy volunteers of both sexes, aged between 18 and 60 years. The weighing values ​​were statistically significant for the confirmation of water infiltration inside the dressing in 1/5 of the cases, with the participants in the active modality having the highest proportion of infiltration. When performing the analysis for BMI and presence of hair in the abdominal region, there was no statistically significant difference between the results previously obtained. The occlusive dressing is effective to prevent water infiltration during patient immersion in the therapeutic pool in 80% of cases. La gastrostomía endoscópica percutánea (PEG, por sus siglas en inglés) es un método que se ha utilizado ampliamente como método de alimentación alternativo para pacientes que tienen dificultad para masticar y tragar. El estudio tuvo como objetivo verificar si la aplicación de apósito adhesivo impermeable es eficaz para evitar la infiltración de agua en el sitio del estoma de alimentación del GEP en la piscina terapéutica, simulando una situación real de rehabilitación acuática. Se trata de un estudio transversal en el que se ensayaron muestras de algodón que se encontraban dentro del apósito y se compararon en dos pesajes después del ingreso del participante a la piscina terapéutica, el primer pesaje realizado inmediatamente después de la inmersión pasiva y activa y el segundo pesaje después de un período de secado en el horno. Se realizaron 90 procedimientos, con la participación de 45 voluntarios sanos de ambos sexos, con edades entre 18 y 60 años. Los valores de pesaje fueron estadísticamente significativos para la confirmación de la infiltración de agua en el interior del apósito en 1/5 de los casos, siendo los participantes en la modalidad activa los que presentaron mayor proporción de infiltración. Al realizar el análisis de IMC y presencia de pelo en la región abdominal, no hubo diferencia estadísticamente significativa entre los resultados obtenidos anteriormente. El apósito oclusivo es eficaz para evitar la infiltración de agua durante la inmersión del paciente en la piscina terapéutica en el 80% de los casos. A Gastrostomia Endoscópica Percutânea (GEP) é um método que vem sendo amplamente empregado como meio de alimentação alternativa para pacientes que tem a mastigação e a deglutição comprometidas. O estudo objetivou verificar se a aplicação do curativo adesivo impermeável é eficaz em impedir a infiltração de água no local do estoma de alimentação da GEP na piscina terapêutica, simulando uma situação real de reabilitação aquática. Trata-se de um estudo transversal no qual foram testadas amostras de algodão que estavam no interior do curativo e foram comparadas em duas pesagens após o participante entrar na piscina terapêutica, sendo a primeira pesagem realizada imediatamente depois da imersão passiva e ativa e a segunda pesagem após um período de secagem na estufa. Foram feitos 90 procedimentos, com a participação de 45 voluntários saudáveis de ambos os sexos, com idade entre 18 e 60 anos. Os valores das pesagens foram estatisticamente significantes para a confirmação de infiltração de água dentro do curativo em 1/5 dos casos, sendo os participantes da modalidade ativa os que tiveram maior proporção de infiltração. Ao realizar a análise para IMC e presença de pelo na região abdominal não houve diferença estatisticamente significante entre os resultados previamente obtidos. O curativo oclusivo é eficaz para impedir infiltração de água durante a imersão do paciente na piscina terapêutica em 80% dos casos.

Background Prosthetic joint infection (PJI) is a catastrophic complication after total joint arthroplasty that exacts a substantial economic burden on the health-care system. This study used break-even analysis to investigate whether the use of silver-impregnated occlusive dressings is a cost-effective measure for preventing PJI after primary total knee arthroplasty (TKA) and total hip arthroplasty (THA). Methods Baseline infection rates after TKA and THA, the cost of revision arthroplasty for PJI, and the cost of a silver-impregnated occlusive dressing were determined based on institutional data and the existing literature. A break-even analysis was then conducted to calculate the minimal absolute risk reduction needed for cost-effectiveness. Results The use of silver-impregnated occlusive dressings would be economically viable at an infection rate of 1.10%, treatment costs of $25,692 for TKA PJI, and $31,753 for THA PJI and our institutional dressing price of $38.05 if it reduces infection rates after TKA by 0.15% (the number needed to treat [NNT] = 676) and THA by 0.12% (NNT = 835). The absolute risk reduction needed to maintain cost-effectiveness did not change with varying initial infection rates and remained less than 0.40% (NNT = 263) for infection treatment costs as low as $10,000 and less than 0.80% (NNT = 129) for dressing prices as high as $200. Conclusion The use of silver-impregnated occlusive dressings is a cost-effective measure for infection prophylaxis after TKA and THA.

Background The available treatments for refractory hyperkeratotic eczema are inadequate with frustrating results. We, therefore, incorporated Calcipotriol and Betamethasone Dipropionate (Daivobet®), and Viaminate into the mainstay treatment to improve the clinical symptoms. The study aimed to evaluate the efficacy of Daivobet ® and Viaminate as a potential treatment alternative for refractory hyperkeratotic eczema. Patients and Methods Between 2013 and 2015, 61 patients diagnosed with refractory hyperkeratotic eczema (RHE) who had shown inadequate response to conventional therapies were pooled from a single center. Besides, they were all treated with Daivobet ® , Viaminate, and an occlusive dressing mixture containing 5% salicylic acid ointment and 25% zinc oxide paste following inadequate response to conventional therapies (corticosteroids plus 25% zinc oxide paste and 5% salicylic acid ointment). Investigators Global Assessment (IGA) and Patient-Oriented Eczema Measure (POEM) assessed baseline and outcome measures for the degree of hyperkeratinization (0-clear; 3-moderate; 4-severe). Results Of the 61 patients, 49 (80.3%) patients presented with moderate RHE and 12 (19.7%) with severe RHE. After 24 weeks of treatment, the period for loss of keratinization was significantly lower in patients with moderate RHE (3.9±1.9 weeks) than those with severe RHE (10.8±1.0 weeks) with a P-value

Background New dressings aimed at reducing surgical wound complications after knee arthroplasty continue to evolve. We compared wound complications and reoperations between 2 dressings: 2-octyl cyanoacrylate adhesive and polyester mesh (Dermabond® Prineo®, “mesh”) and silver-impregnated occlusive dressings and n-butyl-2-cyancacrylate adhesive (AQUACEL® Ag SURGICAL cover dressing with SwiftSet™, “standard"). Methods This retrospective cohort study reviewed 353 consecutive partial and total knee arthroplasties performed by a single surgeon; 6 were excluded for not using either dressing type. Thus, 347 cases were separated into 2 cohorts: mesh (n = 176) and standard dressing (n = 171). Demographics and risk factors were similar, except for age. Surgical and closure techniques were consistent in all patients. Delayed wound healing was assessed by the surgeon at the 2-week office visit for drainage, suture abscess, or wound edge separation. Secondary outcome measures include infection, office-based closure, and return to the operating room for reclosure. Results There were 2 instances of delayed wound healing in the mesh group and 16 in the standard dressing group (1.14% vs 9.36%, P ≤ .0001). There were significantly fewer reoperations in the mesh group than in the standard group (0 vs 2.33%, P = .04). There were no infections or office-based closures. Conclusions Mesh dressings were associated with fewer episodes of delayed wound healing and reoperations than the standard dressing. A possible mechanism may be that this brand of mesh distributes wound tension more evenly. In addition, because it remains in place longer during the immediate postoperative period, it may work via prolonged wound edge support.

Background New dressings purport to reduce surgical wound complications after total hip arthroplasty (THA). This study compared delayed wound healing rates and reoperations between 2 increasingly popular dressings: a silver-impregnated occlusive (standard) dressing and a 2-octyl cyanoacrylate adhesive with polyester mesh. Methods This retrospective cohort study reviewed 431 consecutive THAs performed by 2 surgeons between January 2017 and May 2019. One hundred and eight were excluded for not using standard or mesh dressings. A final 323 cases were separated into 2 cohorts: mesh (n = 186) and standard dressings (n = 137). Standard dressings were removed at 1 week. Mesh persisted until nonadherent, approximately 3-4 weeks. The surgeon assessed delayed wound healing at the 2-week postoperative visit. Secondary outcomes include deep infection and return to the operating room for a wound-related diagnosis. Differences were determined using the chi-square test. Results There were no demographic, comorbidity, or surgical differences between groups. There were 22 total cases of delayed wound healing with 7 (3.8%) in the mesh group and 15 (10.9%) in the standard dressing group (P = .01). There were no significant differences in reoperations (2 [1.1%] vs 2 [1.5%], P = .76) or deep infections (2 [1.1%] vs 1 [0.7%], P = .75). Conclusions Mesh dressings are a safe and reliable dressing type for THA and were associated with a decrease in early wound healing complications when compared with standard, silver-impregnated occlusive dressings in this retrospective series. The mesh tension sharing properties and longer duration of occlusive protection may explain this difference. Level of Evidence Level III.

BACKGROUND Application of collagen products to wounds has been shown to improve wound healing. Using a collagen-based hydrogel (cHG) capable of cellular support previously developed by our laboratory, we hypothesize that our hydrogel will increase the speed of wound healing by providing a 3-dimensional framework for cellular support, increasing angiogenesis and cell-proliferation at the wound bed. METHODS Two, 10-mm excisional wounds were created over the dorsum of 12 male, genetically modified Zucker diabetic rats. Wounds were splinted open to limit healing by wound contracture. One wound was treated with an occlusive dressing (OD), whereas the adjacent wound was treated with an OD plus cHG. Occlusive dressings were changed every other day. Hydrogel was applied on day 2 and every 4 days after until complete wound closure. Rate of wound closure was monitored with digital photography every other day. Wounds were harvested at days 10 and 16 for histological and immunohistochemical analysis. RESULTS Wound closure was significantly faster in cHG-treated wounds compared with OD-treated wounds. By day 10, cHG-treated wounds achieved 63% wound closure, compared with 55% wound closure in OD-treated wounds (P < 0.05). By day 16, cHG-treated wounds achieved 84% wound closure, compared with 68% wound closure in OD-treated wounds (P < 0.05).Histologically, wound depth was not different between the cHG and OD groups on days 10 and 16. However, wound length was significantly less in the cHG group compared with the OD group (P < 0.05) consistent with digital photographic analysis. Immunohistochemical analysis for RECA-1 demonstrated that blood vessel density in the wound bed was 2.3 times higher in the cHG group compared with the OD group (P = 0.01) on day 16. Cell proliferation was 3.8 times higher in the cHG group versus the OD group (P < 0.05) on day 10. CONCLUSIONS Collagen-based hydrogel-treated wounds demonstrated significantly improved healing compared with control. The thermoresponsive feature of collagen hydrogel and its structural stability at body temperature demonstrate promising clinical potential as a vehicle for the delivery of therapeutic cells to the wound bed.

Background Disease of the pilonidal sinus is a common condition that affects mainly young adults. Options for management include excision of the sinus tracts, leaving the wound open to heal by secondary intention. The aim of this study was to compare wound healing with dialkylcarbamoyl chloride (DACC)‐coated dressings versus alginate dressings. Methods This multicentre trial randomized consecutive patients undergoing surgery for pilonidal disease to postoperative wound care with either DACC‐coated or alginate dressings. The primary outcome was the proportion of wounds healed after 75 days. Secondary outcomes were the local status of wounds during the healing process, the quality assessment of the dressings by the patient, and the time needed to return to usual activities. Results A total of 246 patients were included: 120 in the DACC‐coated group and 126 in the alginate group. In per‐protocol analysis, there were significantly more patients with completely healed wounds after 75 days in the DACC group than in the alginate group: 78 of 103 (75·7 per cent) versus 58 of 97 (60 per cent) respectively (odds ratio 2·55, 95 per cent c.i. 1·12 to 5·92; P = 0·023). During follow‐up, wounds with alginate dressings had more fibrin than those with DACC‐coated dressings, but the difference was not significant (P = 0·079). There was no difference between the two arms in patients' assessment of the dressings. Conclusion The number of wounds completely healed at 75 days was significantly higher for DACC‐coated compared with alginate dressings. However, the preplanned, clinically significant improvement in healing of 20 per cent was not reached. Registration number: NCT02011802 ( https://clinicaltrials.gov/)., This multicentre RCT compared the efficacy of dialkylcarbamoyl chloride (DACC)‐coated dressings with alginate dressings for wound healing after pilonidal sinus excision. In per‐protocol analysis, significantly more patients had completely healed wounds at 75 days in the DACC group than in the alginate group: 78 of 103 (75·7 per cent) versus 58 of 97 (60 per cent) respectively (odds ratio 2·55, 95 per cent c.i. 1·12 to 5·92; P = 0·023). No clinically important difference

Background: Fingertip amputations are the most commontype of amputation injury in the upper extremity. Treatmentsavailable cover a broad range of techniques, surgical andconservative. Although there is no consensus on how theseinjuries should be treated, the goals of treatment should includeminimization of pain, optimization of healing time, preservationof sensibility and length, prevention of painful neuromas,avoidance or limiting of nail deformity, minimization of timelost from work, and provision of an acceptable cosmeticappearance.Patients and Methods: We have prospectively studied 20patients with fingertip amputations of all ages. Daily simplenon adherent non occlusive dressing, paraffin-impregnatedgause, with an ointment initially for debridement then forhealing was used. We used pinch gauge, finger goniometer,caliper and compass to measure pinch tip strength, distalphalanx range of motion and 2 point discrimination distance,respectively.Results: The mean age was (33±17.3) years old. The meanhealing time was (36.4±5.8) days and mean time off workwas (11.6±7.6) days. As regards sensibility 30% complainnumbness, 35% had hyper-sensibility, and 35% show normalsensibility. As regards two point discrimination in the correspondinghealthy fingertip, the mean distance was (4.7±1.5)mm, versus (8.6±2.5) mm in amputated fingertip. There wasno tenderness, cold intolerance, joint stiffness, neuroma ordisability. 50% expressed good aesthetic results, 40% ofpatients were accepted, and 10% had poor aesthetic results.Conclusion: The functional outcome was good, as therewere no tenderness, cold intolerance, joint stiffness, neuromaor disability. Although, longer healing time, time off workwas generally acceptable. Irrespective of that a 35% of patientshave hyper-sensibility and 30% complained of numbness,there were no significant bad impact on the function and earlyreturn to work. Aesthetically, hook nail deformity was theonly cause of poor aesthetic results. However, conservativemanagement of fingertip amputations using simple dailydressing changes, provides good and acceptable results outweighsthe poor results.

Skin adhesives have become standard in wound closure as alternatives to traditional sutures or as sterile occlusive dressings after surgery of all types. The literature is replete with case reports of contact dermatitis following exposure to cyanoacrylate-based adhesives, such as 2-octyl cyanoacrylate. Nonetheless, it has been the impression of the senior author and others that the incidence of allergic and/or contact dermatitis is much higher than commonly considered. The authors prospectively studied 102 consecutive patients who underwent breast surgery performed by the senior author with 2-octyl cyanoacrylate placed over incisions as an occlusive dressing. Two patients with a known glue allergy did not receive cyanoacrylate at surgery but were scratch tested to confirm the diagnosis. All patients were followed postoperatively. Twelve patients went on to develop significant dermatitis postoperatively after glue placement. Cyanoacrylate was confirmed as the cause of all rashes by allergy scratch testing for a total incidence of 14 percent (14 patients). Given the popularity of cyanoacrylate products across emergency rooms, clinics, and operating rooms, awareness of the true incidence of these reactions may caution against their use in the future. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, IV.

Optimal wound closure techniques following total knee arthroplasty (TKA) have focused on enhancing healing potential, preventing infection, yielding satisfactory cosmesis, and allowing early ambulation and functionality. An appropriate layered closure and management of the TKA typically involves addressing the (1) deep fascial layer; (2) subdermal layer; (3) intradermal layer, including the subcuticular region; and (4) final application of a specific aseptic dressing, each of which are covered here in detail. This focused critical review of the literature discusses traditional techniques used in all layers of wound closure following TKA while introducing several emerging popular techniques. For example, absorbable barbed skin sutures and occlusive dressings have the potential to reduce operative time, limit the need for early postoperative visits, obviate the need for suture or staple removal, and safely promote patient communication via telemedicine. As novel wound closure techniques continue to emerge and traditional approaches are improved upon, future comparative studies will assist in elucidating the key advantages of various options. In an extremely important field that has tremendous variability, these efforts may enable the reaching of a classically elusive standard of care for these techniques.

Over the past several decades, basic research has provided important information about the processes involved in wound healing. No longer is dry wound healing acceptable because it results in wound bed desiccation, which increases the wound depth and wound healing time. To preclude these events, occlusive dressings have become standard. An occlusive dressing not only protects the wound from outside trauma and prevents wound desiccation but also continuously keeps the locally produced growth factors in contact with the wound base to maximize their stimulatory effects on keratinocytes, fibroblasts, and blood vessels. An occlusive dressing minimizes the amount of wound care often required and reduces discomfort. The many benefits of occlusive wound dressings have led to the development of several new surgical dressings that speed wound healing and improve the final scar appearance. Occlusive or semi-occlusive dressings have demonstrated proven value in dermatologic surgery by reducing postoperative pain, speeding wound healing, and improving the final cosmetic result.

Background & Aim: Routine treatment of burn injuries is dressing with Nitrofurazone ointment. It has several complications, including sensitivity. Aloe Vera is a traditional treatment for wound healing. This study aimed to compare the effectiveness of Aloe Vera gel with Nitrofurazone ointment in the healing of superficial partial-thickness burns. Methods & Materials: The present study was a split body controlled clinical trial which was carried out on 30 patients with superficial partial-thickness burns. The study was conducted in the Shafa Hospital in Kerman, Iran, in 2016. The sample was recruited from patients who had at least two burns, each burn on an alternate side of the body. On their burns, samples were allocated to two groups that received Aloe Vera gel or 2% Nitrofurazone ointment. Bates-Jensen Wound assessment tool was used to evaluate the healing of burns. Statistical analysis was conducted by SPSS-16 and using the repeated measure ANOVA. Results: The repeated measure ANOVA showed that there was a significant change in the score of BWAT in all areas during the intervention period (p=0.001), but the trend of healing in the two groups during the intervention period was not significantly different (p=0.098). Conclusion: Based on this study, it looks like Aloe vera gel is as effective as 2% Nitrofurazone ointment in healing wounds.

Background: Chlorhexidine Gluconate (CHG), Hibiclens (4% CHG with 4% Isopropyl Alcohol Detergent), and Chloraprep (i.e. labeled CHG-based solutions), utilized as preoperative surgical preparatory solutions may all cause severe oculotoxicity and ototoxicity. Alternatively, 10% Povidone-Iodine (PI) solutions without detergent demonstrate minimal toxic effects on the eyes and ears. Methods: Based on studies from 1984 to 2021, we compared the safety/efficacy of CHG-based versus PI-based solutions utilized for presurgical skin preparation near the cornea/eyes and ears (i.e., predominantly for cranial or cervical spine surgery). Results: Some studies documented that even minimal exposure (i.e., “splash risk”) during face/neck skin preparation with CHG-based solutions could result in irreversible corneal injury and ototoxicity. Within minutes to hours, CHG-based non-detergent solutions posed the risks of; corneal epithelial edema, anterior stromal edema, conjunctival chemosis, bullous keratopathy, and de-epithelialization. Notably, even occlusive dressings like Tegaderm could not protect against CHG penetration. Alternatively, PI-based solutions posed no to minimal ocular and/or ototoxicity, while often demonstrating comparable protection against surgical site infections (SSI). Conclusion: Chlorhexidine Gluconate (CHG), Hibiclens, and Chloraprep (i.e. CHG-based solutions) are often used as skin preparations near the face/eyes/spine (i.e., particularly anterior/posterior cervical procedures). However, if these solutions come in contact with the eyes, corneal irritation, abrasions, and even blindness may result. Alternatively, PI non-detergent solutions demonstrate safety/minimal oculotoxicity/ototoxicity, while frequently showing comparable efficacy against SSI.

OBJECTIVE To assess the suitability of nanocrystalline-coated silver dressings versus standard wound dressings in patients with type 2 diabetes after coronary revascularization. METHODS The study involved 194 patients who were divided into two homogeneous groups. The control group (n = 97) received a standard sterile dressing. The intervention group (n = 97) received silver dressings. Glycosylated hemoglobin, fructosamine, and creatinine were assessed in all patients. The emergence of superficial wound infection within 30 days was the primary endpoint of the study, and deep wound infections were a secondary endpoint. MAIN RESULTS Superficial wound infections were documented in 26 patients: 11 patients in the study group and 15 in the control group. There were no statistically significant differences between the analyzed groups regarding the occurrence of the primary endpoint. No deep wound infections were found in either the study or control group. CONCLUSIONS The frequency of sternotomy wound infection in patients with type 2 diabetes is comparable between patients treated with traditional dressings and those receiving silver dressings; therefore, to maximize cost savings, providers should consider using standard wound dressings in this patient population.

Keloids are benign fibroproliferative growths that occur from an abnormal response to skin injury and can be disfiguring, functionally impairing, and have dramatic impacts on quality of life. Furthermore, treatment is notoriously challenging, and the rate of recurrence is high. Various treatment modalities have been proposed for keloids including occlusive dressings, compression therapy, silicone sheeting, intralesional corticosteroid injections, cryotherapy, surgical removal, pulsed dye laser, radiation, imiquimod cream, intralesional verapamil, 5-fluorouracil, bleomycin, and interferon-α2b injections.1, 2 Laser-assisted drug delivery is an evolving new treatment modality with many possible applications, including keloids and hypertrophic scars. Here we present a case of refractory keloids treated with laser-assisted drug delivery using fractional ablative laser followed by a combined treatment of topical application and intralesional injection of steroid suspension.

Surgical site infections (SSIs) are defined as infections of the tissues, organs, or spaces exposed by surgeons during performance of an invasive procedure. Motivation/Background: A lot of expense both with regards to nursing time and dressing material costs is invested in prevention of SSI using occlusive surgical incision site dressing. But to what extent is this beneficial over open wound treatment? In the present study, we have compared the incidence of SSIs in surgical wounds treated with occlusive dressings versus those treated with open wound treatment to find out the same. Method: The study was conducted on 860 patients of General Surgery wards. Patients were categorized under two groups of cases where (1) Dressing was opened after 24 hours and then only open wound treatment by cleaning with Betadine 12 hourly was done till stitch removal and (2) Dressing was opened after 48 hours and then again after every 2 days occlusive dressing was done until stitch removal. Result: A Chi-Square Test was performed to understand if Occlusive dressings have an added advantage over Open Wound Treatment in prevention of SSIs. Conclusion: Occlusive Dressings have no added advantage over Open Wound Treatment in the prevention of SSIs and hence Open wound treatment can be taken as an alternative for occlusive dressings.

There are several types of wounds with their own healing properties. The latest innovation in wound management by using occlusive dressings can prevent infections, improve healing time and patient’s comfort. Occlusive dressings are often used as an immediate wound hygiene control and also prevent blood loss until debridement is performed. They are used to protect wounds and surrounding tissue from pathogens and other harmful materials. A good cover depends on the condition around the wound, the person's skills, and the injury's nature. In this article, we provide an insight into the types of polymer materials used clinically in wound dressing and underlying mechanisms between the biomaterial dressings and the body tissue.

Clinical practice guidelines recommend using repeated wound surface area measurements to determine if a chronic ulcer is healing. This results in delays in determining the healing status. This study aimed to evaluate whether any of a panel of biomarkers can determine the healing status of chronic venous leg ulcers. Forty-two patients with chronic venous leg ulcers had their wound measured and wound fluid collected at weekly time points for 13 weeks. Wound fluid was analyzed using multiplex enzyme-linked immunosorbent assay to determine the concentration of biomarkers in the wound fluid at each weekly time point. Healing status was determined by examining the change in wound size at the previous and subsequent weeks. Predictive accuracy with 95% confidence intervals (CI) is reported. Of 42 patients, 105 evaluable weekly time points were obtained, with 32 classified as healing, 27 as nonhealing, and 46 as indeterminate. Thirteen biomarkers significantly differed between healing and nonhealing wounds (p < 0.1) and were included in a multivariate logistic regression model. Granulocyte macrophage-colony stimulating factor (p < 0.001) and matrix metalloprotease-13 (p = 0.004) were the best predictors of wound healing. Receiver operating characteristic curves indicated 92% accuracy (95% CI: 85%,100%) for granulocyte macrophage-colony stimulating factor, and 78% accuracy (95% CI: 65%,90%) for matrix metalloprotease-13 in discriminating between healing and nonhealing wounds. This study found that two biomarkers from wound fluid can predict healing status in chronic venous leg ulcers. These findings may lead to the ability to determine the future trajectory of a wound and the ability to modify treatment accordingly.

Nasal occlusive dressings are routine after nasal surgeries to arrest hemorrhage, to prevent septalhematoma, and to prevent postoperative adhesions. However, patients describe nasal packingand its removal as their worst experience. Various types of nasal packs are available. Medicatedribbon gauge is the traditional form of nasal pack which consists of an open-mesh cotton as a carrierwhereas “Polyvinyl Acetate’ sponge is a compressed dehydrated material, an improvised one whichincreases in size and compresses blood vessels when rehydrated with normal saline. As Polyvinylacetate sponge is smooth and spongy, it causes less pain and abrasion while in-situ and removal. Thiswas a prospective comparative study done in tertiary hospital of Nepal. Patients were subjected toeither polyvinyl acetate sponge or ribbon gauge nasal pack following nasal surgery. Comparisonswere made in terms of pain score, maintenance of hemostasis and wound healing. There were 154patients in the study with 104 males and 50 females. The pain score when nasal pack was in-situ wassimilar in both groups whereas it was lesser in the polyvinyl acetate group on its removal. However,bleeding and adhesion were found to be similar. Crust formation was less in polyvinyl acetate group.Six synaechia were noted in ribbon gauge group only. Pain was significantly less during removal ofpolyvinyl acetate pack. Keywords : bleeding, nasal packing, nasalpain, polyvinyl acetate, ribbongauze

Topical corticosteroids are known to be effective in the treatment of alopecia areata, but the potential effects on intraocular pressure are a concern. The purpose of this retrospective study is to evaluate the effect of clobetasol propionate 0.05% under occlusion on patients with active phase alopecia areata and to examine the effects on intraocular pressure. We also wished to see if reducing the frequency of application of clobetasol increased the safety with respect to intraocular pressure. Elevation of intraocular pressure due to topical corticosteroids is unlikely to occur at the dose of 9.8 g or less per week used in this study; however, ophthalmologic examination at the start of treatment was thought to be worthwhile in identifying patients with latent glaucoma.