While there is still no superior substitute for reconstruction using patients own tissues and carefully thought-out reconstructive procedures; new products can help facilitate eventual healing by providing prophylaxis against barriers to healing, augmentation of wound healing factors, assistance in temporizing and bridging time to definitive repair, and optimization of the ultimate results of wound reconstruction. Advantages: Hydrogels rehydrate the wound bed and reduce wound pain. Patrick S. Murphy, Gregory R. D. Evans, "Advances in Wound Healing: A Review of Current Wound Healing Products", Plastic Surgery International, vol. Wright et al. Disadvantages: Because they're nonadherent, a secondary dressing is needed. TransCyte is a biosynthetic dressing of a semipermeable silicone membrane on a nylon mesh coated with porcine collagen and newborn human fibroblast cells [29]. If you are an author contributing to an RSC publication, you do not need to request permission
Eicosanoids are arachadonic acid metabolites including prostaglandins, prostacyclines, thromboxane, and leukotrienes. Alginates also can be used for hemostasis on postoperative wounds. This review highlights the therapeutic approaches of using wound dressings functionalized with Ag-NPs and their potential role in revolutionizing wound healing. The protocol is altered to include more frequent dressing changes with serial debridement as necessary. International Journal of Biological Macromolecules, https://doi.org/10.1016/j.ijbiomac.2020.01.156. However, traditional wound dressings have disadvantages, such as easily adhering to wounds, poor barrier effects, and poor haemostasis. This suggests that in addition to immediate assistance in healing, hyperbaric oxygen also has a role in long-term wound improvement, perhaps as the full effects of neovascularization are realized. Nanocrystalline silver dressings were developed and introduced in the late 1990s and are the latest forms of silver wound dressings. Baranoski S, Ayello E. Wound Care Essentials: Practice Principles. Neovascularization in wounds is dependent upon two main processes [52]. Silver has a very broad spectrum of microbial coverage, including yeast, fungi, mold, and even antibiotic-resistant bacteria such as methicillin-resistant Staph aureus (MRSA) and vancomycin-resistant enterococci (VRE) when used at appropriate concentrations. Disadvantages: Because hydrogels are nonadherent, they may need to be secured by a secondary dressing. Studies on nanocrystalline silver show inhibition of keratinocyte growth [18] and delay in reepithelialization [19], leading to recommendations against using topical silver as a dressing on cultured skin grafts. This appears to be mediated through nitric oxide pathways [57]. There are several descriptions of the sponge being placed over vital structures such as vessels, nerves, viscera, or even heart or lung [21, 22]. The advances in temporary and permanent coverage of wounds have made significant gains with advancing technology in biomaterials and tissue engineering. %PDF-1.5
Ovington L. Wound dressings, form, function, feasibility, and facts. Read more about how to correctly acknowledge RSC content. There have been encouraging results in a prospective randomized control study involving patients with venous stasis ulcers [42], as well as studies on diabetic-foot ulcers [43]. Hyperbaric oxygen is shown to stimulate EPCs and stem cell release from bone marrow both by increased cell proliferation within the marrow, as well as by rapid mobilization via matrix metalloprotease mechanisms [5658]. Hydrocolloids also can be used under compression wraps or stockings, as a secondary dressing, or as a preventive dressing for areas at high risk for friction. In summary, the silver-loaded hydrogel is an ideal wound dressing. The mechanism of action of hyperbaric oxygen is not clearly understood, but several studies are currently ongoing. Ideally, muscle or soft tissue should be placed between the structure and the sponge, but if this is not possible Vaseline or silicone mesh should be used. Biobrane is a temporary dressing composed of knitted nylon mesh bonded to a thin silicone membrane and coated with porcine polypeptides [29]. hbbd``b`S(`b] lQ@$/@\" .:Fe $#dFr |9
The first paper describing the use of a negative pressure wound device (NPWD) in a series of patients was published thirteen years ago [20]. Diabetic patients have been shown to have decreased numbers and impaired function of bone-marrow-derived EPCs [53, 54], and impaired EPC recruitment [55]. The dressing also is self-adherent, conformable, and provides thermal insulation. [6] express a word of caution. This may take some time to load.
See the specific product information for details. The use of silver to prevent and treat infection is both one of the earliest forms of wound care, documented as early as 69BC, and one of the latest technologies in the realm of antimicrobial prophylaxis. Though there are some reports of developing resistance, with continued appropriate use it should remain effective against even multi-antibiotic-resistant microorganisms. Indications: Moderate to heavily draining wounds, partial- and full-thickness wounds, pressure ulcers (Stages III and IV), surgical wounds, donor sites, dehisced wounds, cavity wounds, and wounds with sinus tracts or tunnels. We will also review some of the latest literature on emerging bacterial resistance to these products. ScienceDirect is a registered trademark of Elsevier B.V. ScienceDirect is a registered trademark of Elsevier B.V. They aren't recommended for heavily draining wounds, and their absorptive properties mean they may macerate periwound skin. In addition, there are some specific indications for HBO therapy in chronic wounds [49]. Integra is a semibiologic bilayered dressing composed of a matrix of type I bovine collagen, chondroitin-6-sulfate, a glycosaminoglycan from shark cartilage, under a temporary silicone epidermal sheet [29, 37]. Burn wounds are the major indication for these products. LLyF!q8:PQ0F`$|^cT&am
D(G6@IvE'tg$z}:JEA@"Cv!@! In normal wound healing there is an orderly, predictable sequence passing through the inflammatory, proliferation, and remodeling/maturation phases. They primarily affect the early stages of wound healing including initial vasoconstriction and later vasodilation, vascular permeability, and inflammatory cell chemotaxis and adhesion.
They have had overall good results and feel they have potentially saved several extremities that otherwise would require amputation. Some of these patients are now being treated with NPWDs with good results. k.kalantari@northeastern.edu, th.webster@neu.edu, b
The typical products currently in use contain two layers of high-density polyethylene net sandwiching a layer of rayon/polyester gauze [6]. Initial theories focused on increases in oxygen availability at the tissue level [49]. It is the only current FDA-approved product in the growth factor family. By supporting the wound with growth factors and biologic substances, we can help augment or modulate the wound healing process itself. The antibacterial and biocompatibility were excellent. endobj
Though these results do appear very promising, Khundkar et al. x=GHC
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7-y8e|tFrN)8#g,`K9y^3r69sF9r8+]BgY,BgG p:&x7CQ Aside from a more consistent therapeutic dose of silver, an additional benefit of nanocrystalline dressings is less frequent dressing changes, on the order of days as compared to standard, twice daily dressing changes for silver sulfadiazine and up to twelve times per day for silver nitrate. Advances in the actual device include smaller size, allowing for portable units for home use, increased ability to remove large amounts of fluid, the ability to instill fluids in the wound for continuous irrigation, refinements in the foam with more consistent pore sizes, different sponge materials including silver, and increased safety and alarm systems [21]. Hydrofibers are contraindicated for dry eschar, nonexudating wounds, third-degree burns, and heavy bleeding. endstream
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Clinical Guide to Wound Care, 6th edition. Advanced wound dressing products can help alter the wound environment to optimize healing conditions. Trauma patients undergoing damage-control laparotomy and abdominal compartment syndrome patients are also being temporized by allowing an open abdomen with the NPWD in place. The US Centers for Disease Control have predicted more deaths from antimicrobial-resistant bacteria than from all types of cancers combined by 2050. By continuing you agree to the use of cookies.
Traditional silver preparations, silver nitrate and silver sulfadiazine, both are able to provide a high enough initial concentration (3176mg/L and 3025mg/L, resp. Exposed tendon, bone, or joints are no longer a contraindication as granulation tissue will form over these structures, allowing a bed for skin grafting if necessary [26, 27]. )_W6x;x;>~8^,ruD;Y!WsQHW}u]#yjz 8H]J~T~o]1}?{,}Zg4DU,3;mI{F_5&+ {8-^}-o_F uog7,J$$ }$[$KDZ?F5)T_7l endstream
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This article is part of the themed collection. Several studies have shown it to be superior to antibiotic creams or silver sulfadiazine in terms of healing time, infections, and scar formation, especially on facial burns [31, 32]. Silver dressings are time honored in wound care, but new forms of delivery aim to increase the efficacy while minimizing side effects. Newer products are currently being used to replace or augment various substrates in the wound healing cascade. Disadvantages: A secondary dressing may be needed to secure an alginate, and the dressing tends to have a distinctive odor noticeable during dressing changes. :L &G|CH}
,D m6 ,(Q{I(?$l Z")- Disadvantages: Because the dressing is nonadherent, you'll need a secondary dressing to secure it. I\^?G$G?!k%lHpB'Y"!!u$+_#Y$#Q/ m)=yO6Wdw8Lqg"^?0ZO
By knowing about the major types of wound dressings and how to select the right one, you can help your patient heal faster. This randomized, double-blinded, placebo-controlled study compared between Wagner grade 2, 3, or 4 chronic ulcers treated with hyperbaric oxygen or hyperbaric air. Results show it to be comparable to allograft for wound infection, healing time, exudates, and graft take, with higher patient satisfaction [33, 34]. Qv'4{\4B?JJd0M>(rS;DNmUO@Qlg >B&|SXn%r.O$EdcsU#4)e2|LQ-3(.Xy s`"BQe_8ah?L0P26Wl`?7v&z,{V8'Law@H1 A. Berlin, Effectiveness of recombinant human platelet-derived growth factor for the treatment of diabetic neuropathic foot ulcers,, D. P. Shackelford, E. Fackler, M. K. Hoffman, and S. Atkinson, Use of topical recombinant human platelet-derived growth factor BB in abdominal wound separation,, D. B. Hom and J. C. Manivel, Promoting healing with recombinant human platelet-derived growth factor-BB in a previously irradiated problem wound,, S. Hunter, D. K. Langemo, J. Anderson, D. Hanson, and P. Thompson, Hyperbaric oxygen therapy for chronic wounds,, J. V. Boykin, Hyperbaric oxygen therapy: a physiological approach to selected problem wound healing,, S. M. Bauer, R. J. Bauer, and O. C. Velazquez, Angiogenesis, vasculogenesis, and induction of healing in chronic wounds,, O. C. Velazquez, Angiogenesis and vasculogenesis: inducing the growth of new blood vessels and wound healing by stimulation of bone marrow-derived progenitor cell mobilization and homing,, O. M. Tepper, R. D. Galiano, J. M. Capla et al., Human endothelial progenitor cells from type II diabetics exhibit impaired proliferation, adhesion, and incorporation into vascular structures,, C. J. M. Loomans, E. J. P. De Koning, F. J. T. Staal et al., Endothelial progenitor cell dysfunction: a novel concept in the pathogenesis of vascular complications of type 1 diabetes,, M. Ii, H. Takenaka, J. Asai et al., Endothelial progenitor thrombospondin-1 mediates diabetes-induced delay in reendothelialization following arterial injury,, S. R. Thom, V. M. Bhopale, O. C. Velazquez, L. J. Goldstein, L. H. Thom, and D. G. Buerk, Stem cell mobilization by hyperbaric oxygen,, L. J. Goldstein, K. A. Gallagher, S. M. Bauer et al., Endothelial progenitor cell release into circulation is triggered by hyperoxia-induced increases in bone marrow nitric oxide,, K. A. Gallagher, L. J. Goldstein, S. R. Thom, and O. C. Velazquez, Hyperbaric oxygen and bone marrow-derived endothelial progenitor cells in diabetic wound healing,, S. R. Jones, K. M. Carpin, S. M. Woodward et al., Hyperbaric oxygen inhibits ischemia-reperfusion-induced neutrophil CD18 polarization by a nitric oxide mechanism,, K. T. Khiabani, S. A. Bellister, S. S. Skaggs, L. L. Stephenson, C. Nataraj, and W. A. Zamboni, Reperfusion-induced neutrophil CD18 polarization: effect of hyperbaric oxygen,, A. Gabriel, M. L. Porrino, L. L. Stephenson, and W. A. Zamboni, Effect of L-arginine on leukocyte adhesion in ischemia-reperfusion injury,, W. A. Zamboni, H. P. Wong, L. L. Stephenson, and M. A. Pfeifer, Evaluation of hyperbaric oxygen for diabetic wounds: a prospective study,, P. Kranke, M. Bennett, I. Roeckl-Wiedmann, and S. Debus, Hyperbaric oxygen therapy for chronic wounds,, M. Lndahl, P. Katzman, A. Nilsson, and C. Hammarlund, Hyperbaric oxygen therapy facilitates healing of chronic foot ulcers in patients with diabetes,, A. Abidia, G. Laden, G. Kuhan et al., The role of hyperbaric oxygen therapy in ischaemic diabetic lower extremity ulcers: a double-blind randomized-controlled trial,. This can lead to unanswered questions regarding appropriate use and indications. While bacterial resistance to silver is exceedingly low, it has been reported in the literature since 1975 [7, 8]. B. Wright, K. Lam, and R. E. Burrell, Wound management in an era of increasing bacterial antibiotic resistance: a role for topical silver treatment,, Y. Huang, X. Li, Z. Liao et al., A randomized comparative trial between Acticoat and SD-Ag in the treatment of residual burn wounds, including safety analysis,, J. Fong, F. Wood, and B. Fowler, A silver coated dressing reduces the incidence of early burn wound cellulitis and associated costs of inpatient treatment: comparative patient care audits,, E. E. Tredget, H. A. Shankowsky, A. Groeneveld, and R. Burrell, A matched-pair, randomized study evaluating the efficacy and safety of acticoat silver-coated dressing for the treatment of burn wounds,, H. Liedberg and T. Lundeberg, Assessment of silver-coated urinary catheter toxicity by cell culture,, P. K. Lam, E. S. Y. Chan, W. S. Ho, and C. T. Liew, In vitro cytotoxicity testing of a nanocrystalline silver dressing (Acticoat) on cultured keratinocytes,, M. E. Innes, N. Umraw, J. S. Fish, M. Gomez, and R. C. Cartotto, The use of silver coated dressings on donor site wounds: a prospective, controlled matched pair study,, L. C. Argenta and M. J. Morykwas, Vacuum-assisted closure: a new method for wound control and treatment: clinical experience,, L. C. Argenta, M. J. Morykwas, M. W. Marks, A. J. DeFranzo, J. Growth factors stimulate mainly fibroblasts and keratinocytes via transmembrane glycoproteins [44]. Enterocutaneous fistulas were initially a contraindication for NPWD closure. In this article, I'll look at several more types of dressings and when they're used. Traumatic orthopedic injuries have seen bold advances with the advent of NPWD closure. Join NursingCenter on Social Media to find out the latest news and special offers. While the device itself has undergone some minor advances in technology, the most significant changes have come from the indications for use. Indications: Any type of infected wound, including colonized chronic nonhealing wounds. The proportion of PVA, CMCS, SA and AgNPs was introduced. Similar to an alginate, a hydrofiber consists of sodium carbomethylcellulose that interacts with wound exudate to form a gel. ), with even better results in those patients completing >35 sessions (61% versus 27%, A meta-analysis,, S. A. L. Bennett and H. C. Birnboim, Receptor-mediated and protein kinase-dependent growth enhancement of primary human fibroblasts by platelet activating factor,, D. L. Steed, M. W. Webster, J. J. Ricotta et al., Clinical evaluation of recombinant human platelet-derived growth factor for the treatment of lower extremity diabetic ulcers,, D. J. Margolis, C. Bartus, O. Hoffstad, S. Malay, and J. 2022 Wolters Kluwer Health, Inc. and/or its subsidiaries. Many delivery systems exist, with the key to the most effective product being one that can maintain an adequate concentration of silver with long enough residual activity. In vitro studies on silver nitrate show a negative impact on fibroblasts [17]. please go to the Copyright Clearance Center request page. To demonstrate the effectiveness of these dressings, Yin et al. Its effects are to stimulate neutrophils, macrophages, keratinocytes, and fibroblasts and increase VEGF production, rendering it a very promising molecule in wound healing [41]. The dressing has variable absorptive properties. In Krasner D, et al. These dressings also promote autolytic debridement. Contraindicated for Stage I pressure ulcers, third-degree burns, and nonexudating wounds. Angiogenesis refers to the ingrowth of new vessels into a wound from the surrounding tissue. They obtained similar results with VRE. Hyperbaric oxygen has few absolute contraindications. Because of this ability to modulate inflammation and vasodilate, its use in chronic vascular ulcers has been evaluated with some significant decrease in size and healing time compared to controls [38, 39]. They are divided into five superfamilies, the most known being the platelet-derived growth factors. Because hydrocolloids can be worn for 3 to 5 days, fewer dressing changes are needed. E-mail:
DOI: 10.1039/C9NR08234D. %
Hess CT (ed). The most well known is prostaglandin E1 which inhibits platelet and neutrophil activation, reduces blood viscosity, stimulates tissue plasminogen activator production, and causes vasodilation by relaxing vascular smooth muscle [38]. Nanocrystalline silver technology is able to more consistently maintain adequate concentrations (at least 70mg/L) with good residual activity, keeping levels elevated over longer periods of time. 655 0 obj
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Introduced in 1968, silver sulfadiazine (Flammazine, Silvadene) is silver complexed to various glycols and alcohols and combined with an antibiotic, sulphadiazine [3]. 2 0 obj
Lippincott Williams & Wilkins, 2007. These products were designed to overcome some of the shortcomings of previous silver dressings. They found a total of 5 studies that met inclusion criteria. An additional study comparing lower-extremity wounds treated by HBO, standard wound care, growth factor therapy, or HBO plus growth factor therapy showed a significant increase in healing at 8 weeks in the HBO group compared to the standard care and growth factor groups, with no additional benefit being seen by the HBO plus growth factor group [63]. Dermagraft contains neonatal fibroblasts on a bioabsorbable polyglactin mesh. stream
These products range from occlusive films such as Tegaderm, which are permeable to air and water vapor, but impermeable to fluid and microorganisms to hydrocolloids such as DuoDERM, which are also occlusive but provide absorption of exudates in addition to maintaining a moist environment for autolysis. A study with 10-year followup shows excellent cosmesis, with higher patient satisfaction than autologous skin grafting alone and with excellent mobility when placed over joints [35]. 3 0 obj
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qoaa,3m=o`9EUP)n>Hse .vSMgn-F,%e|k/svK. [13] showed that nanocrystalline dressings killed MRSA in 30 minutes, whereas other silver preparations had no effect. Serial debridements are performed, with definitive reconstruction occurring in a stable wound on an elective basis [25]. H\00Q(x / X/|_\@/d&LoM95zmoRssYb_].C~w6* hb```n/B cbGVO}`b2}ADGGFtFV"ZJ;9 A0t40D 13Jt40@
8,ZM \w56~xXD>L.`dU_"G@cl Biologic wound products have been an area of tremendous growth as our understanding of the details of the wound healing response has increased. Nonadherent, they're easy to remove, and usually are changed daily. These structures are ideally reconstructed with protective flaps, but skin grafting over this granulation tissue is an option in patients that are not flap candidates. This paper will discuss several new technologies in burn and wound care. 0
It is used as a dressing in superficial burns that do not require skin grafting, or as a temporary cover for excised burns prior to grafting. Though these products are more expensive than traditional gauze, recent studies seem to indicate an overall cost savings due to decreased labor costs: advanced dressings typically are changed every 1 to 3 days, as opposed to gauze, which is often changed multiple times per day [28]. Silver is a bactericidal material that kills on contact by inhibiting the respiratory chain at the cytochrome level, as well as, interfering with electron transport [6], denaturing nucleic acids, inhibiting DNA replication, and altering cell membrane permeability [5]. 4 0 obj
The antibacterial hydrogel exhibited good mechanical properties, antibacterial activity and biocompatibility. 673 0 obj
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Silver nanoparticles (Ag-NPs) have been categorized as metal-based nanoparticles and are intriguing materials for wound healing because of their excellent antimicrobial properties. This decreases patient discomfort as well as provides less disruption to the healing wound bed. 1 0 obj
Advantages: Antimicrobial dressings reduce the risk of infection. Available in sheets, ropes, and in other composite dressings, alginates can be used on infected wounds. endstream
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This vasoconstriction on the arterial end reduces capillary pressure, which promotes fluid absorption into the venous system thereby reducing edema, as well as causing an increase in hyperoxygenated plasma to the tissues.
Originally designed for use in decompression illness in deep sea divers, it has indications for use for carbon monoxide poisoning, crush injuries, compartment syndrome, acute traumatic ischemia, ischemia-reperfusion injury, radiation injury, compromised skin grafts, infections with anaerobic organisms, and refractory osteomyelitis. They're minimally to moderately absorptive, reduce pain, and facilitate autolytic debridement. 687 0 obj
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The field of biologic wound products aims to accelerate healing by augmenting or modulating these inflammatory mediators. Impregnated gauze improves upon this by adding zinc, iodine, or petrolatum to help prevent desiccation and provide nonadherent coverage. Corresponding authors, a
Indications: Moderate to heavily draining wounds, partial- and full-thickness wounds, pressure ulcers (Stages III and IV), dermal wounds, surgical incisions or dehisced wounds, sinus tracts, tunnels, cavity wounds, and infected wounds. The field of wound care is ever expanding with advances in technology. Water- or glycerin-based, this dressing can consist of 80% to 99% water on a nonadherent, cross-linked polymer. Some silver dressings can be used under compression wraps or stockings. Copyright 2022 Elsevier B.V. or its licensors or contributors. If you want to reproduce the whole article
However, there have been several recent disadvantages of using Ag-NPs to fight infections, such as bacterial resistance. If an occlusive dressing is provided as a barrier to the outside environment, the bodys own phagocytic processes will provide debridement of wounds. Hydrocolloids aren't recommended for heavily draining wounds, sinus tracts, or fragile skin. Copyright 2012 Patrick S. Murphy and Gregory R. D. Evans. This review of the current state of the art in wound-healing products looks at the latest applications of silver in microbial prophylaxis and treatment, including issues involving resistance and side effects, the latest uses of negative pressure wound devices, advanced dressings and skin substitutes, biologic wound products including growth factor applications, and hyperbaric oxygen as an adjunct in wound healing. The suggested concentration of silver in any preparation is greater than 30 to 40mg/L to be effective. Advances in Wound Healing: A Review of Current Wound Healing Products, Aesthetic and Plastic Surgery Institute, University of California Irvine Medical Center, 200 S. Manchester Avenue, Suite 650, Orange, CA 92868, USA, Absorbent; not for use with thyroid disorders, Many forms; broad spectrum; low resistance, M. Trop, M. Novak, S. Rodl, B. Hellbom, W. Kroell, and W. Goessler, Silver-coated dressing acticoat caused raised liver enzymes and argyria-like symptoms in burn patient,, E. K. Mooney, C. Lippitt, and J. Friedman, Silver dressings [safety and efficacy reports],, W. Stanford, B. W. Rappole, and C. L. Fox, Clinical experience with silver sulfadiazine, a new topical agent for control of pseudomonas infections in burns,, R. Warriner and R. Burrell, Infection and the chronic wound: a focus on silver,, B. S. Atiyeh, M. Costagliola, S. N. Hayek, and S. A. Dibo, Effect of silver on burn wound infection control and healing: review of the literature,, R. Khundkar, C. Malic, and T. Burge, Use of Acticoat dressings in burns: what is the evidence?, G. L. McHugh, R. C. Moellering, C. C. Hopkins, and M. N. Swartz, Salmonella typhimurium resistant to silver nitrate, chloramphenicol, and ampicillin,, L. M. Deshpande and B. Therefore, it is of great significance to design a new wound dressing that does not cause further injury, has good antibacterial effect and promotes wound healing in view of the disadvantages of traditional wound dressings. Additionally, in nonburn wounds it is used in complex traumatic soft tissue reconstruction over exposed tendons, joints, and bone, as well as wounds from vascular and pressure ulcers [38].
Infections are the main reason why most people die from burns and diabetic wounds. A. Lipsky, C. Mengoli, and F. De Lalla, Are granulocyte colony-stimulating factors beneficial in treating diabetic foot infections? In this paper, silver nanoparticles (AgNPs) were reduced by in situ reduction with sodium alginate (SA), and construct a silver-loaded PVA/SA/CMCS hydrogel antibacterial wound dressing. The challenge is to keep a high enough concentration of agent with a long enough residual activity to prevent developing resistance. For heavily exudative wounds, there are a range of absorptive products including various hydrophilic foam dressings, hydrogels, hydrofibers, and alginates, which can absorb up to 20 times their weight.
When beginning treatment, change alginates daily; thereafter, they can be changed every other day or when saturated. This provides temporary coverage and, more importantly, provides a mechanism for removal of intraabdominal contamination and exudates while relieving visceral edema [23, 24]. X5^16DZ?p;seq
N}]ZGe(OL*FY@/bQ %_*M,dOQem9 In situ reduction of silver nanoparticles by sodium alginate to obtain silver-loaded composite wound dressing with enhanced mechanical and antimicrobial property.
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