Dressings and Wound Intendance Supplies for Hidradenitis Suppurativa

Maximillian A. Weigelt , ... Hadar Lev-Tov , in A Comprehensive Guide to Hidradenitis Suppurativa, 2022

Alginates for Post-Surgical Wounds in Hidradenitis Suppurativa

Alginate dressings are light, nonwoven fabrics derived from algae or seaweed. 13 Designed for moderately to heavily exudating wounds, they are highly absorbent, have mild hemostatic properties, reduce bacterial infections, and can stay on the wound bed for days. 13,16,27 Alginates have been used in combination with silicone dressings for postal service-surgical wound care of surgically deroofed HS cysts and sinuses, 28 as well every bit for Peel Tissue-Sparing Excision with Electrosurgical Peeling (STEEP) procedures for patients in advanced stages of HS. 29 Alginate dressings tend to fall autonomously faster than other dressings, which may present a significant limitation in use for primary HS lesions, as parts of the dressing may gild in sinuses. Use of a contact layer as a primary dressing may improve the overall performance of an alginate dressing.

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Wound Intendance

Christine M. Wietlisbach , in Cooper's Fundamentals of Paw Therapy, 2020

Alginates

Alginate dressings are nonocclusive to semiocclusive, highly absorptive, and made to manage moderate to large amounts of exudate ( Fig. 17.5). These dressings are made primarily of seaweed derivatives, and the fibers are spun into ropes or sheets. Equally the alginate absorbs fluid, it is converted to a gel that provides moisture to the wound bed. Alginates e'er crave a secondary dressing to continue them in place. Alginates adapt well to the contours of the hand. In rope form, they are also great for filling small, draining wound cavities.

During dressing changes, yous must be sure to irrigate the wound thoroughly to remove all of the alginate before applying a new dressing. If you find that non all the alginate has gelled, yous are either changing the dressing too before long or the wound is non draining enough to warrant an alginate dressing. Information technology is important to reserve alginates only for moderately to severely draining wounds. Using an alginate on a wound with minimal exudate will dry the wound bed.

Brand names include AlgiSite M (Smith & Nephew), Sorbsan (Bertek), and SeaSorb (Coloplast).

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Skin Resurfacing with Ablative Lasers

Alex S. Carcamo , Mitchel P. Goldman , in Cutaneous and Corrective Laser Surgery, 2006

Alginate Dressings

The alginate dressings are very absorptive and because they are nonadherent, crave a secondary dressing. The dressing is easily removed with saline irrigation considering information technology is soluble in solutions containing sodium ions. 372 Alginates have been used in the food and pharmaceutical industries since 1881 and are salts of alginic acid, derived from brown seaweeds. They are unique every bit dressings considering of their action as hemostatic agents 373, 374 and have not been shown to induce adverse tissue changes. 375 They may be ideal dressings for resurfacing, especially erbium laser therapy, in regard to the capillary oozing that occurs postoperatively. Liu et al. found that the pop alginate dressing Kaltostat (ConvaTec, Princeton, NJ) left backside difficult-to-remove fibers on the laser wound surface. 371 Other pop, commercially available alginate dressings for light amplification by stimulated emission of radiation resurfacing wound care include Sorbsan (Bertek Pharmaceuticals), Restore Calcicare (Hollister), Tegagen HG (high gelling) and Tegagen Hello (high integrity) (3M Health Care) and Comfeel Plus (Alginate-hydrocolloid dressing) (Coloplast).

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Polymeric materials for chronic wound and fire dressings

A. Agarwal , ... N.L. Abbott , in Advanced Wound Repair Therapies, 2011

8.iii.vi Calcium alginate

Calcium alginate dressings are fabricated from salts of alginic acrid obtained from algae (Phaeophyceae sp.j found in seaweed. They are known for absorbing excess wound exudate and forming a not-adherent gel, which accelerates wound healing by promoting a moist wound healing environment, facilitating debridement, and helping to forbid trauma to the wound bed and the surrounding pare (Fanucci and Seese, 1991).

Alginic acid is a polysaccharide consisting of mannuronic and galuronic acid residues. The sodium and calcium salts of alginic acrid are prepared past the alkali metal extraction of seaweed jail cell walls. The resultant colloidal solution of sodium alginate is precipitated by improver of calcium chloride, and the precipitate is re-dissolved using sodium carbonate to generate alginate with a mixture of sodium and calcium counter ions (Thomas, 2000). Various alginate dressings are available and differ in chemical and physical properties, depending on the proportion of mannuronic and galuronic acid residues (which depends on its botanical source) and the content of calcium and sodium ions (Seymour, 1997). A high content of mannuronic acrid promotes gelling, and high galuronic acid content promotes cobweb integrity for packing.

Originally, alginate dressings were bachelor as a loose fleece formed from calcium alginate fibers. More than recently, they accept also been made with fibers woven to form a more than cohesive structure, which increases the fabric's strength when soaked with wound fluid. Other dressings accept been produced from freeze-dried alginate (Thomas, 2000).

Alginate fibers absorb wound exudate to class a gel matrix. Ion exchange occurs betwixt the calcium ions of the alginate fibers and sodium ions in the exudate. When a pregnant proportion of the calcium ions in the fibers have been replaced by sodium, the fibers smashing to form a gel on the wound surface. The gellation of the fibers also permits piece of cake removal of the dressing (Thomas, 2000). Some dressing formulations besides incorporate a significant proportion of sodium alginate to ameliorate the gelling properties of the dressing. Alginate fibers have been shown to absorb and retain bacteria during formation of the gel matrix, which can be removed during dressing changes (Fanucci and Seese, 1991). The gel absorbs moisture and maintains an appropriately moist environs for optimal healing. Alginate dressings can absorb up to twenty to 30 times their weight in wound fluid (Seymour, 1997).

Calcium alginate dressings are used on moderate to heavily exudative wounds during the transition from debridement to repair phase of wound healing (Seymour, 1997, Joël et al., 2002). Dry wounds should non be treated with these dressings because they have no hydrating properties.

Calcium alginate dressings have also been demonstrated to have haemostatic holding. The dressings amend clotting in wounds and are likewise used to promote hemostasis during various surgical procedures (Segal et al., 1998). The calcium ions released from the dressings are known to promote the activation of prothrombin in the clotting cascade (Segal et al., 1998). The entangled fibrous structure of the dressing further contributes to the effectiveness in blood coagulation. Zinc has been added to some alginate dressings to increment their hemostatic qualities.

In addition to their moisture handling capabilities, alginate dressings have besides been suggested to promote healing via a direct modulatory event on wound macrophages. Some dressing have the potential to activate homo macrophages to secrete pro-inflammatory cytokines within the chronic wound bed that is hypothesized to generate a pro-inflammatory signal which may initiate a stalled inflammatory phase of wound healing in chronic wounds (Thomas et al., 2000). Reportedly, dressings increase epithelialization and granulation tissue formation (Sayag et al., 1996). Considering of these attributes, calcium alginate dressings are considered bioactive.

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Antimicrobial dressings

M. Ip , in Avant-garde Wound Repair Therapies, 2011

Alginate

Fibre dressings such every bit the calcium alginate dressings are absorbent, biodegradable and are derived from seaweed ( Wiegand, 2009). Alginate is often obtained from three genera of marine brownish algae, Phaeophyceae (Macrocystis pyrifera, Laminaria digitata, and Laminaria saccharina) (Thomas, 2000; Thomas et al., 2000). A strong antimicrobial action (>   3 log bacterial growth reduction) against Pseudomonas aeruginosa, E. coli, and Klebsiella pneumoniae was demonstrated in an alginate just dressing, whereas inhibition was incomplete with S. aureus, and only slight with Candida albicans (Wiegand, 2009). The alginate molecule is a polysaccharide consisting of (D)-mannuronic and (Fifty)-guluronic acrid, and ionized with calcium and sodium ions. Various alginate dressings are available that possess different chemical and physical properties, depending on the proportion and organisation of these acrid residues and content of calcium and sodium ions (Thomas, 2000; Thomas et al., 2000). Some examples of alginate dressings are: Algosteril (Johnson &Johnson), Comfeel Alginate Dressing (Coloplast), CarrasorbH(Carrington Laboratories), Kaltostat (ConvaTec). In some, alginate dressings are incorporated with nanocrystalline silver, e.yard. Suprasorb A (+   Ag) (Lohmann & Rauscher GmbH and Co. KG), and Acticoat Absorbent with SILCRYST (Smith & Nephew Healthcare).

Alginate dressings are widely used in the handling of exuding wounds. In addition to antibacterial activeness, alginate takes upwards wound exudates, through creation of a gel surface that absorbs wet and maintains a moist environment (Winter, 1962). Information technology likewise has haemostatic backdrop (Piacquaio, 1992) and has been shown to reduce pain associated with wounds (Lallau, 2002). Thus, alginate dressings may assistance to maintain a moist microenvironment conducive to healing, whilst limiting wound secretions and minimising bacterial contagion.

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Dressings and Postoperative Intendance

May Leveriza-Oh Doc , Tania J Phillips Doctor FRCPC , in Surgery of the Skin, 2005

Technique

Before the awarding of an alginate dressing, the wound is cleaned with saline and left moisture while the surrounding skin is stale. The alginate is practical in a dry status to the wound surface with a margin of at least 2 mm around the wound edges. 23 When ribbons or ropes are to be used, they are wound in a loose spiral mode into the wound, doubling back on themselves until the entire wound is covered. A secondary dressing is placed over the dressing.

For removal, the gel formed by the alginate is simply lifted advisedly from the wound surface. Irrigation with saline solution and the utilize of forceps afterward moistening may remove whatsoever components of the dressing left behind after lifting.

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Dressings and postoperative carea

May Leveriza-Oh , Tania J. Phillips , in Lower Extremity Soft Tissue & Cutaneous Plastic Surgery (Second Edition), 2012

Alginates

Alginate dressings consist of the soft non-woven fibers of a cellulose-like polysaccharide derived from the calcium salts of seaweed. 26 They are biodegradable, hydrophilic, non-adherent, and highly absorbent. When the insoluble calcium alginate of this type of dressing comes into contact with wound exudate, a soluble sodium table salt is produced, and a hydrophilic gel is formed equally a byproduct in the procedure. Alginates are commercially available as pads (Fig. 32.five), ropes, or ribbons.

Examples are: Algiderm (Bard); Algisite (Smith & Nephew); Algisorb (Calgon-Vestal, St Louis, MO); Algosteril (Johnson & Johnson Medical); Kaltostat (ConvaTec); Curasorb (The Kendall Visitor); Carasorb (Carrington Lab); Dermacea (Sherwood Medical Co, St Louis, MO); Melgisorb (Molnlycke Health Care); SeaSorb (Coloplast, Holtedam, Denmark); Kalginate (DeRoyal), and Sorbsan (Dow B. Hickam, Inc).

Because of their exceptional absorptive qualities, alginates are primarily used for heavily exuding wounds. 21 They tin as well be utilized for deep wounds, sinuses, and cavities. The rope and ribbon forms can be used for packing narrow wounds and sinuses. They are to be avoided in dry out or mildly exuding wounds because they may dry out out these types of wounds. Their use in deep narrow sinuses is also contraindicated because removal may be difficult. 27

Also as their absorptive ability, alginates also have hemostatic properties. This sometimes lessens the number of dressing changes needed. Their disadvantages are that the gel formed may exist foul-smelling or misleadingly appear purulent, and considering they are non-adherent, a secondary dressing is needed.

Technique

Before the application of an alginate dressing, the wound is cleaned with saline and left moisture while the surrounding skin is dried. The alginate is applied in a dry condition to the wound surface, with a margin of at to the lowest degree 2 mm around the wound edges. 23 When ribbons or ropes are to be used, they are rolled in a loose screw fashion into the wound, doubling back on themselves until the entire wound is covered. A secondary dressing is placed over the dressing.

For removal, the gel formed by the alginate is simply lifted advisedly from the wound surface. Irrigation with saline solution and the use of forceps after moistening may remove any components of the dressing left behind after lifting.

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Decubitus ulcers

Joseph A. Witkowski , ... Jennifer L. Parish , in Treatment of Skin Disease (Fifth Edition), 2018

Successful treatment of unstageable force per unit area ulcers by using avant-garde wound dressing

Sunarti S. Med Indones 2015; 47: 251–2.

The stages of healing are cleaning, granulation, and epithelialization. Alginate dressing, dextranomer dressing, hydrofiber dressing, flax dressing, silver-supplemented dressing, or enzyme-supplemented dressing are the proposed dressings for the cleaning phase, whereas for the granulation stage, alginate dressing, hydrocolloid dressing, flax dressing, polyurethane foam dressing, or tender moisture dressing should be utilized. For the epithelization phase, hydrofiber dressing, hydrocolloid dressing, hydrogel dressing, flax dressing, and semipermeable dressing may be used.

Second-Line Therapies

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Hydrocolloid wafer dressing

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Hydrogel

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Constructed dressing

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Novel textiles in managing burns and other chronic wounds

H. Onishi , Y. Machida , in Advanced Textiles for Wound Care, 2009

Cross-linked alginate dressings

Not-woven calcium alginate fiber dressings accept been used on deep skin wounds. Kaltostat and Sorbsan are typical non-woven cobweb alginate dressings and provide wounds with good absorption of the exudates and an occlusive environment. However, these dressings have been shown to cause cytotoxicity and foreign-body reaction owing to remaining dressing droppings, leading to severe chronic inflammation ( Matthew et al., 1995; Suzuki et al., 1998). Non-woven cobweb alginate dressings are biodegraded, but the deposition charge per unit is very irksome. Suzuki et al. showed that calcium alginate fibers remained afterward implantation in the muscle of rabbits, and severe chronic inflammation continued (Suzuki et al., 1999). This was considered to be caused by strange-body reaction to the debris of dressings. However, an alginate gel prepared by cross-linking with ethylenediamine, using the amide coupling reagent h2o-soluble carbodiimide, showed no cytotoxic-ity and reduced foreign-torso reaction to a great extent (Suzuki et al., 1999). In experiments using pigs, cross-linked alginate gel showed a significantly higher wound closure rate in a total-thickness wound than Kalto-stat and Sorbsan (Fig. 8.2). Furthermore, the biodegradation charge per unit of crosslinked alginate gel was much faster than Kaltostat and Sorbsan, i.due east. information technology was absorbed completely within a few months without inflammation. Since the crosslinked alginate gel has a non-fibrous structure, it is considered to be easily biodegraded because of its high-swelling with biological fluid. The crosslinked alginate gel appears to overcome the disadvantages of the conventional dressings Kalostat and Sorbsan. However, weakness of the gel forcefulness may be a drawback of crosslinked alginate gel, and this needs to be improved.

8.two. Wound closure rate after 15 days. Mean ± SD (n = 10) (Suzuki Y et al., 1999).

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Complications of Nail Surgery

Bertrand Richert , Maurice Dahdah , in Complications in Dermatologic Surgery, 2008

Handling options

For express bleeding, application of a cotton-tipped applicator dipped in 35% aluminum chloride will suffice. For moderate bleeding, oxidized cellulose or calcium alginate dressings work nicely. For severe postoperative bleeding, injection of anesthetic (0.5 cc) as a wing block will human activity every bit a chemic tourniquet until clotting occurs. The best anesthetic is bupivacaine equally information technology will act after 40 min and concluding upwards to 8 h. The utilize of a beefy dressing for at to the lowest degree 48 h, combined with summit of the limb, limits the hazard of excessive postoperative haemorrhage, and absorbs it if it occurs.

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