Role of limited access dressing in achieving improved aesthetic results during resurfacing of wounds

With refinement and better understanding of Plastic Surgery,there is increasing expectation of aesthetic outcomes after resurfacing of wounds.The major problems in resurfacing procedures are tissue bulk,donor site issues,excessive scarring and distal edema due to damaged lymphatics and veins after flap harvest from adjacent areas in the extremities.Ultra-conservative debridement simplifies reconstruction by reducing the need for flaps and improves the chances of skin graft take through limited access dressing,which can improve the final aesthetic result following reconstruction.In this paper,we describe three representative cases treated under limited access dressing.

Secondary damage in trauma and limited access dressing: a review

Secondary damage in trauma may increase morbidity,mortality and the cost of treatment considerably.This article reviews the literature of 46 relevant articles on this topic.We hope to provide a better understanding of the various mechanisms that can lead to secondary damage following major trauma and aim to improve the management of such in trauma patients.We also explore the utility of limited access dressing and its ability to minimize and treat secondary musculoskeletal trauma.Four interdependent cellular mechanisms have been described that contribute and perpetuate secondary tissue damage-lysosomal,protein/enzyme denaturation,membrane permeability and mitochondrial.Systemic changes are mainly due to systemic hypoxia and the systemic inflammatory response syndrome.Limited access dressing appears to be an efficient and cost-effective method for the management of secondary damage,as evidenced by the reduced number of debridements,shorter wound coverage time,and reduction in total length of hospital stay while lowering treatment costs and improving quality of care.

Effect of limited access dressing on surface pH of chronic wounds

Aim:Changes in the pH of chronic wounds can inhibit the optimal activity of various enzymes in the wound environment,thereby delaying wound healing.The aim of the present study is to monitor the effect of limited access dressing(LAD)on the pH on the surface of chronic wounds.Methods:A total of 140 patients with chronic wounds of more than 4 weeks duration were divided into two groups by simple randomization:a LAD group(n=64)and a conventional dressing group(n=76).Fifty-six participants(22 in the LAD group and 34 in the conventional dressing group)were lost to follow-up or withdrawn from the study.Results:In the LAD group(n=42),the mean age was 38.3±10.56 years(range:12-60 years),and the mean wound size at the time of admission was 28 cm^(2)(range:19-40 cm^(2)).In the conventional dressing group(n=42),the mean age was 35.3±14.0 years(range:17-65 years),and the mean wound size at the time of admission was 26 cm^(2)(range:18-39 cm^(2)).Patients treated with LAD showed a significant decrease in the mean±standard deviation pH when compared with the conventional dressing group(0.83±0.52 vs.0.41±0.26,P=0.048).Conclusion:LAD reduces the chronic wound surface pH to a level required for the optimal function of various enzymes.This could be a factor that exerts a beneficial effect on wound healing.

Histopathological study of chronic wounds modulated by intermittent negative pressure therapy under limited access dressing

Aim:Negative pressure wound therapy(NPWT)has achieved widespread success in the treatment of chronic wounds.However,its effects have been only partially explored,and investigations have generally concentrated on the wound-dressing interface;a detailed histopathological description of the evolution of wounds under NPWT is still lacking.The present study was performed to investigate the effect of a limited access dressing(LAD)which exerts intermittent NPWT in a moist environment on chronic wounds.Methods:A total of 140 patients were randomized into 2 groups:LAD group(n=64)and conventional dressing group(n=76).By histopathological analysis of the granulation tissue,the amount of inflammatory infiltrate,necrotic tissue,angiogenesis,and extracellular matrix(ECM)deposition was studied and compared to determine healing between the 2 groups.Results:After 10 days of treatment,histopathological analysis showed a significant decrease in necrotic tissue with LAD compared to the conventional dressing group(mean±standard error,11.5±0.48 vs.10.1±0.30,P=0.007),the number of inflammatory cells(12.6±0.60 vs.8.63±0.35,P=0.018),a significant increase in new blood vessels(12.8±0.58 vs.9.3±0.29,P=0.005)and ECM deposit(13.3±0.50 vs.9.6±0.24,P=0.001).Conclusion:LAD exerts its beneficial effects on chronic wound healing by decreasing the amount of necrotic tissue and inflammatory cells while increasing the amount of ECM deposition and angiogenesis.

A comparative study to evaluate the effect of limited access dressing on diabetic ulcers

Aim:Emerging evidence favors the important role of antioxidants,matrix metalloproteinases(MMPs),and nitric oxide(NO)in the healing of diabetic wounds.There is a lack of substantial evidence regarding the effects of negative pressure on antioxidants,MMPs and NO in chronic wounds associated with diabetes.Methods:A total of 55 type 2 diabetic patients with leg ulcers were divided into 2 groups:a limited access dressing(LAD)group(n=27)and a conventional dressing group(n=28).Levels of hydroxyproline,total protein,MMP-2 and MMP-9,NO and antioxidants including reduced glutathione(GSH)and the oxidative biomarker malondialdehyde(MDA)were measured in the granulation tissue at days 0 and 10.Changes in levels between the LAD and conventional groups were determined by the Student’s t-test.Results:After 10 days of treatment,the LAD vs.conventional dressing group showed increase in the levels of hydroxyproline(mean±standard deviation=55.2±25.1 vs.29.2±1,P<0.05),total protein(12.8±6.5 vs.8.34±3.2,P<0.05),NO(1.13±0.52 vs.0.66±0.43,P<0.05),GSH(7.0±2.4 vs.6.6±2.2,P<0.05)and decrease in MMP-2(0.47±0.33 vs.0.62±0.30,P<0.05),MMP-9(0.32±0.20 vs.0.53±0.39,P<0.05)and MDA(6.8±2.3 vs.10.4±3.4,P<0.05).Conclusion:When compared to conventional dressings,LAD induces biochemical changes by significantly increasing the levels of hydroxyproline,total protein,NO and antioxidants levels,and significantly reducing MMPs(MMP-2 and MMP-9)and an oxidative biomarker in diabetic wounds.These biochemical changes are thought to favor diabetic wound healing.