International wound journal
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Randomized Controlled Trial Multicenter Study
Intralesional injections of Citoprot-P (recombinant human epidermal growth factor) in advanced diabetic foot ulcers with risk of amputation.
To investigate the efficacy and safety of recombinant human epidermal growth factor (rhEGF) in advanced diabetic foot ulcers (DFU) A double-blind trial was carried out to test two rhEGF dose levels in type 1 or 2 diabetes patients with Wagner's grade 3 or 4 ulcers, with high risk of amputation. Subjects were randomised to receive 75 (group I) or 25 mug (group II) rhEGF through intralesional injections, three times per week for 5-8 weeks together with standardised good wound care. Endpoints were granulation tissue formation, complete healing and need of amputation. ⋯ The AEs rates were similar. The most frequent were sepsis (33%), burning sensation (29%), tremors, chills and local pain (25% each). rhEGF local injection enhances advanced DFU healing and reduces the risk of major amputation. No dose dependency was observed.
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Wound dressings containing silver as antimicrobial agents are available in various forms and formulations; however, little is understood concerning their comparative efficacy as antimicrobial agents. Eight commercially available silver-containing dressings, Acticoat 7, Acticoat Moisture Control, Acticoat Absorbent, Silvercel, Aquacel Ag, Contreet F, Urgotol SSD and Actisorb, were tested to determine their comparative antimicrobial effectiveness in vitro and compared against three commercially available topical antimicrobial creams, a non treatment control, and a topical silver-containing antimicrobial gel, Silvasorb. Zone of inhibition and quantitative testing was performed by standard methods using Escherichia coli, Pseudomonas aeruginosa, Streptococcus faecalis and Staphylococcus aureus. ⋯ Concreet F and the Acticoat dressings tended to have greater antimicrobial activity than did the others. Topical antimicrobial creams, including silver sulfadiazine, Sulfamylon and gentamicin sulfate, and the topical antimicrobial gel Silvasorb exhibited superior bacterial inhibition and bactericidal properties, essentially eliminating all bacterial growth at 24 hours. Silver-containing dressings are likely to provide a barrier to and treatment for infection; however, their bactericidal and bacteriostatic properties are inferior to commonly used topical antimicrobial agents.
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Antimicrobial dressings such as those containing silver are now being used widely to control wound bioburden, and tests to demonstrate their efficacy predominantly involve in vitro models using free-living or planktonic bacteria. In this present study a wide range of antibiotic-sensitive and resistant bacteria were tested in their quasi-sessile state using a standard agar assay and a second method used a poloxamer gel (true biofilm state - poloxamer encourages microorganisms to exhibit a more clinically relevant biofilm phenotype) technique. The antimicrobial activity of two silver dressings, a silver-containing Hydrofiber (SCH) dressing and a nanocrystalline silver-containing dressing (NCS), were evaluated on a variety of microorganisms, using a zone-of-inhibition (ZOI) test. ⋯ ZOI range: 1-2.8 mm). Similarly to the antibiotic-susceptible microorganisms, nine of ten antibiotic-resistant bacterial strains when grown on agar were more susceptible to the SCH dressing compared with the NCS. Although the microorganisms tested were universally less susceptible to the silver dressings when in their biofilm state, in the majority of cases, the SCH dressing demonstrated greater biofilm-inhibiting activity than the NCS.
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The article critically analyses the role of Biobrane, one of the widely used modern biosynthetic dressings, in paediatric partial-thickness scald burns. Most of the studies, available in the literature, confirmed that Biobrane has significantly reduced the hospital stay, wound healing time and requirements of pain medications. However, very few studies with long-term follow up are available. Further randomised controlled trials are required to challenge the supremacy of Biobrane in paediatric partial-thickness burns.
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Topical negative pressure (TNP) is a mode of therapy used to encourage wound healing. It can be used as a primary treatment for chronic/complex wounds or as an adjunct to surgery. Based on the evidence to date, the clinical effectiveness of negative-pressure therapy is still unclear. ⋯ There have been, as yet, no quality-of-life studies available for negative-pressure therapy. Despite this, the usage of TNP has increased. This review provides an overview of clinical studies using TNP and proposes avenues for further research to elucidate the exact mechanism of TNP, in addition to large randomised controlled clinical trials of patients undergoing this therapy.