A Systematic Review on

THE COMPARISION BETWEEN DRY DRESSINGS AND WET TO DRY DRESSINGS

A DISSERTATION FOR THE DEPARTMENT OF NURSING OF THE

UNIVERSITY OF SUNDERLAND AS A REQUIREMENT TO

OBTAIN A BSC (HONS) DEGREE IN NURSING

NAME: S.D. Kandanearachchie

STUDENT NUMBER: 169136732

SUPERVISED BY: Mr B Sunil S De Silva

WORD COUNT: 8874

I declare that this is my own work and it has not been submitted for another assignment

S. D. Kandanearachchie

Signed

31/07/2018

Dated
Acknowledgements
I want to thank my supervisor for giving me an immense support and encourage to complete
this successfully, also for pushing me until the end which I appreciates very much.

In addition, I want to thank my parents and my husband, as they supported me a lot by looking
after my kid, also encouraging me towards the success, which helped me to finish this
programme well.

University of Sunderland- The best

Thank you All. God Bless.

 ABSTRACT
Background: A wound is defined as an interruption in the continuity of the skin or mucosal
epithelial lining due to physical or thermal damage. Wounds are classified as acute and chronic,
depending on the duration and nature of the healing process. Acute wounds are sudden skin
lesions due to accidents or surgical injuries. It cures within a predictable and predictable time
frame, usually within 8-12 weeks, depending on the magnitude, depth and extent of damage to
the epidermis and dermis. On the other hand, chronic wounds do not heal properly and can not
be repaired in a timely and effective manner.

Aim: The aim of this study is to explore the difference between wound dressings by comparing
the dry and wet to dry dressings.

Study Question: What are the main differences between dry dressings and wet to dry
dressings?

Methodology: The purpose of this descriptive study is to order these bandages, determine the
type of moist wounds, order dried bandages, and pay attention to the veterinarians: this is
because the caregivers they ordered It is to prevent being in the form of wound care. The
relevant data indicate whether the clinical condition of these wounds indicates the need for
mechanical debridement under dry and wet conditions..

Results: There is a difference between those two dressing types.

Conclusion: According to the wound type dressings are changed

Keywords: Wound, Dressing, Dry dressing, Wet to dry dressing

 Table of Contents
Acknowledgements .................................................................................................................... 3

ABSTRACT ............................................................................................................................... 4

Table of Contents ....................................................................................................................... 5

CHAPTER 1 .............................................................................................................................. 7

1.0 Introduction .......................................................................................................................... 7

1.1 Introduction ...................................................................................................................... 7

1.2 Justification ...................................................................................................................... 8

1.3 Aim .................................................................................................................................. 8

1.4 Objectives ........................................................................................................................ 8

1.4 Research Question ........................................................................................................... 8

1.5 Significance of the Study ................................................................................................. 8

1.6 Definition of Terms.......................................................................................................... 9

CHAPTER 2 ............................................................................................................................ 10

2.0 Literature Review............................................................................................................... 10

2.1 Introduction .................................................................................................................... 10

2.2 Types of Wounds ........................................................................................................... 10

2.3 Factors affecting wound healing process ....................................................................... 11

2.3.1 Syndromes associated with abnormal healing ........................................................ 11

2.4 Characteristics of an ideal wound dressing .................................................................... 12

2.5 Purpose of Dressings...................................................................................................... 13

2.6 Advantages of Not Using Dressings .............................................................................. 13

2.7 Types of Dressings ......................................................................................................... 13

2.8 Development of Advanced Dressing Modalities ........................................................... 14

2.8.1 Features of Dressings .............................................................................................. 14

Chapter 3 .................................................................................................................................. 21

3.0 Methodology ...................................................................................................................... 21

3.1 Introduction .................................................................................................................... 21

3.2 Search Strategy .............................................................................................................. 21

3.3 Inclusion Criteria ........................................................................................................... 21

3.4 Exclusion Criteria .......................................................................................................... 21

3.5 Flow Chart of Study Selection ....................................................................................... 23

3.6 Critical Appraisal and Quality Assessment ................................................................... 24

3.7 Data Extraction .............................................................................................................. 24

Chapter 4 .................................................................................................................................. 25

4.0 Results ................................................................................................................................ 25

4.1 Selecting appropriate dressing ................................................................................... 26

CHAPTER 5 ............................................................................................................................ 28

5.0 Discussion of Results ......................................................................................................... 28

5.1 Introduction .................................................................................................................... 28

5.2 Surgical Wounds ............................................................................................................ 28

5.3 Comparison between Dry dressings and Wet to dry dressings ...................................... 29

Chapter 6 .................................................................................................................................. 31

6.0 Conclusion and Recommendation ..................................................................................... 31

References ................................................................................................................................ 32
CHAPTER 1

1.0 Introduction
1.1 Introduction
Until the 1960s, doctors often thought that the perfect environment for wound healing
was dry, and the bandage only covered the hidden wound. However, in past decades of
research, wetlands have been identified in which bandages can interact with wounds, promote
healing, reduce the risk of pain and infection, and increase outcomes (Fleck.C, 2009).
Depending on the model, the gauze can be a dry or non-woven material, a sponge and a wrapper
with different absorbency. The composition of the fabric may comprise cotton, polyester or
rayon. They may be sterile or non-sterile, bulky, glued or non-sterile. The gauze can be
impregnated with other products such as hydrogels (hydrates) or sodium chloride (absorption
and absorption) (Fleck.C, 2009). In the United States, the primary moist dressing remains
behind and the gauze dry dressings are used more often (McCallon.SK et al,2000). The
persistence of gauze and saline as a weapon carrier includes the lack of knowledge and function
between doctors and other older doctors, the confusion caused by a large number of complex
products and the incorrect belief in advanced medicines. The most common reason is that gauze
is considered a "one size fits all" model that is immediately available and cheap. Moreover,
these links have been used throughout history because they have been promoted in medical and
surgical training (Ovingtin LG, 2001). Recent articles from magazines and articles, and the
opinion of experts, but to support the principle of healing in a humid environment, in fact the
use of gauze as a condiment for wet condition, is intended to ensure a humid
environment.(Bolton LL et al, 2000)

Armstrong and Price have discovered that many doctors have opened various wet dry
gauze bandages rather than advanced forms such as alginates, foams, hydrocolloids, hydrogels
and the like. This survey included questionnaires sent to 127 general practitioners with
responserates of over 50%. In addition to venous leg ulcers, most of the gauze bandages are
used as a substitute for all wounds. Almost half of the respondents chose the dry and wet
dressing as an option for surgical wounds that can be left open by secondary treatment. The
data also show that 75% of respondents can use advanced therapies, but do not use
them(Armstrong M.H et al, 2004). Ovington says that gauze is the most commonly used wound
dressing and can be regarded as a wrong standard of care. In his article, it often changes from
a wet state to a wet state, from a wet state to a wet state, and a wet state to a wet state. status.
It describes the healing of local tissue cooling, the destruction of angiogenesis through
elimination of dressings, frequent dressing changes, strikes and increased risk of infection due
to prolonged inflammation. Ovington also offers cost-effective change themes. I will explain
the comparison of salt and gauze costs with a 4-week tipdressing (Tielle, Johnson & Johnson
Wound Management, Somerville, NJ), performed by Home Care Nurse 2. The recovery time,
even when taking care of the patient and / or the family has little change in the relationship and
the results are good (short closing time) and as the relationship progresses, the costs also
decrease (Ovingtin LG, 2001).
1.2 Justification

There is sufficient evidence on how to provide a wound healing by providing a moist

physiological environment for the cells that work in therapy. However, practitioners mistakenly
applied the wounded tissue to the desert environment and dried the healing cells and destroyed
them. This dry tissue is accompanied by a gauze residue, usually as a foreign object, susceptible
to infection and pain, heals more slowly than when wet, and is exposed to the patient or exposed
to prolonged admission. Health workers expel polio and smallpox, but often overlook the most
basic evidence on how to treat the wound. Most healthcare workers continue to use dry wet
dressings, not evidence-based wound care practices.

1.3 Aim

The aim of this study is to explore the difference between wound dressings by
comparing the dry and wet to dry dressings.

1.4 Objectives
Discuss the use of wound dressings

Discuss about Dry dressings

Discuss about wet to dry dressings

Discuss the difference between wet to dry and dry dressings

1.4 Research Question

What are the main differences between dry dressings and wet to dry dressings?

1.5 Significance of the Study

The wounds have been studied for the last 30 years. Many improvements have been
made to understand the optimal environment for cell regeneration and tissue repair.
Microporous systems and biological models have been described in more detail over the past
20 years. (Bryant, 2000; Chen et al., 1999; Clark, 1988; Parks, 1999; Pilcher et al., 1999;
Schultz et al., 2003; Trengrove et al., 1999; Wysocki et al., 1990, 1992, 1993, 1996, 1999), yet
we continue to see great variation in approaches to common wounds. Injuries are
discriminatory, affecting all peoples regardless of sex, age, wealth. Scratches are a global trend.
Perhaps nurses can pave the way for health care workers, standardize the practice of wound
care, use evidence-based protocols, and move us beyond the dark ages of wound care I can do
it. Using standard wound therapy with existing cost-effective treatment, the incidence of
diabetic foot ulcer infection decreases by only 10% and over 6,000 limb amputations per year
decreases It is prevented.
1.6 Definition of Terms

CWS – Certified Wound Specialist – Certification from the national commission obtained
through the American Wound Management Association. Care for nurses, physiotherapists,
doctors.

Fibroblast – Protein collagen secreting cells and other protein fibres from connective tissue.
Fibroblasts are responsible for the formation of collagen, also known as granulation tissue, in
a matrix like the wound beds tent.

HMO – Health Maintenance Organization. Health insurance usually does not benefit the patient
through the employer.

Outcomes – It is usually a "result" of the measurement of medical and / or health interventions

for the disease process or the conditions or costs of care.

Wound care –A health care provider for wound healing.

CHAPTER 2

2.0 Literature Review

2.1 Introduction
A wound is defined as an interruption in the continuity of the skin or mucosal epithelial
lining due to physical or thermal damage. Wounds are classified as acute and chronic,
depending on the duration and nature of the healing process. Acute wounds are sudden skin
lesions due to accidents or surgical injuries. It cures within a predictable and predictable time
frame, usually within 8-12 weeks, depending on the magnitude, depth and extent of damage to
the epidermis and dermis. On the other hand, chronic wounds do not heal properly and can not
be repaired in a timely and effective manner. Chronic wounds are usually the result of acne,
leg ulcers and burns. Wound healing is a dynamic and complicated process of regeneration and
progression of tissue growth at four different stages.

 the coagulation and haemostasis phase (immediately after injury)

 the inflammatory phase, (shortly after injury to tissue) during which swelling takes
place
 the proliferation period, where new tissues and blood vessels are formed and
 the maturation phase, in which remodelling of new tissues takes place.

These phases occur superimposed and ordered in interconnected cascades. The

promotion of these steps depends largely on the type of wound and the associated disease
condition and the type of dressing. At present, it is possible to use different wound dressings
for different wounds due to technological advances. However, selecting materials for a specific
wound is important for achieving faster healing. Various types of wound dressing materials
and their functions have been tested in this review to integrate into the healing process.

2.2 Types of Wounds

Acute Surgical Wounds

Use a sharp tool to clean the incision and intentionally cut or puncture the skin during surgery.
Acute surgical wounds are usually performed by an orderly and timely recovery process,
resulting in sustained recovery of anatomical and functional integrity. If the acute wound does
not heal within 6 weeks, the acute wound will be a chronic wound.

Trauma Wounds

Stress condition caused by tissue damage caused by mechanical or chemical damage. At this
level, trauma can have serious consequences in short term and long term.

Burns

Fabrics may be damaged by heat, friction, electricity, radiation or chemicals. A brief exposure
of 49 ° C (120 ° F) or higher will cause heat generation. Such heat sources are the sun, hot
liquid, steam, fire, electricity, friction (which causes burns caused by Lager Bourne and ropes),
and chemicals (which cause corrosion on contact).

Chronic Wounds

The chronic wound environment is different from the acute wound environment. The clinical
signs of chronic wounds may include:

• Non-viable wound tissue (loss and / or necrosis)

• Lack of healthy granulation tissue (the wound tissue can be thin, gray and avascular)
• The size of the wound does not decrease over time
• Repetitive lesions

Pressure Injuries

Lesions that are localized in tissues that are typically under skin and / or bone ridges due to
pressure, cutting and / or friction, or a combination of these factors.

Infected Wounds

Proliferation and subsequent tissue damage of pathogenic microorganisms that cause the
penetration of pathogenic microorganisms in damaged tissues and progress towards different
diseases through different cellular or toxic mechanisms

2.3 Factors affecting wound healing process

Wound healing is the result of interactions between cytokines, growth factors, blood
and extracellular matrix. Cytokines promote healing through various pathways such as
stimulation of basement membrane components, prevention of dehydration, increased
inflammation, and formation of granulation tissue. These paths are affected by different local
and system factors. Local factors, including hypothermia, pain, infection, radiation, and tissue
oxygen tension, directly affect the characteristics of the wound if the systemic factors are
general health or disease of the individual affecting the wound Exert. About the healing ability
of an individual. In addition to these factors, malnutrition, age and lack of protein, vitamins
and minerals can also prolong recovery time.

2.3.1 Syndromes associated with abnormal healing

Ehlers-Danlos syndrome (EDS) is a hereditary connective tissue disease characterized

by a lack of important structural proteins of collagen. Autosomal dominant and autosomal
recessive EDS also affect men and women. Collagen is the main structural protein and provides
elasticity to the cells and tissues of the body so that the lesion leads to hyperactivity of the joint
and leads to a partial or complete dislocation of the joints and elastic skin. Based on the pattern
of defects and inheritance, the EDS is classified into 6 main subtypes with different influences
on individuals.

Cutis Laxa is characterized by an enzyme deficiency (lysyl oxidase) that causes

abnormality in copper metabolism, causing abnormalities in skin, muscle organ and bone
abnormality. Wrinkled skin, especially neck and mild mental retardation, is also a feature of
this condition. X-linked skin relaxation, also known as hind limb horn syndrome (OHS), is a
rare disorder classified as a subtype of EDS so far. Based on its genetic model, Cutis laxa is
further divided into four genotypes. These include two autosomal recessive genetic defects,
which are sex-related disorders on the X chromosome on the chromosome, autosomal
autosomal dominant defects, and autosomal recessive forms are more severe than others.

2.4 Characteristics of an ideal wound dressing

Depending on the type of wound, a suitable dressing should be used. The dressing is
selected on the basis of: a) supply or maintenance of a humid environment b) promotion of the
epidermal movement c) promotion of angiogenesis and synthesis of the connective tissue d)
activation of the gaseous exchange between damaged tissue and environment maintaining the
correct temperature of the tissue to improve blood flow e) promotes epidermal migration, f)
provides protection against bacterial infections, g) non-adherent to wounds and easy to remove
after healing, h) improves leukocyte migration, must be sterile, non-toxic and non-allergic.

Wounds, whether small incisions or large incisions, are important wounds in treating
wounds. Part of this process includes wound dressings. The dressing is designed to touch the
wound and is different from the dressing where the dressing is held in place. In the past, wet
drying dressings have been widely used in wounds requiring necrotic tissue resection. In 1600
BC, the linen was soaked in ointment or grease to cover the wound. Clay tablets are used to
treat wounds in Mesopotamia around 2,500 BC. They wash their wounds with water or milk
before dressing with honey or resin. In Hippocrates of ancient Greece in Greece from 460 to
370 BC, we cleaned wounds with wine and vinegar using honey, oil, wine and so on. They use
wool as a bandage for water and wine. In the 19th century, antimicrobial technology has made
major progress, antibiotics that reduce infection and reduce mortality have been introduced.
The arrival of modern clothes took place in the 20th century.

When the wound is closed with a dressing, they are constantly exposed to proteases,
chemotherapy, complement and growth factors, which are lost in the exposed wound. That's
why the production of closed dressings began to protect the wound and create a damp
environment by the end of the 20th century. These dressings reduce wound infection by aiding
rapid re-epithelialization, collagen synthesis, hypoxia and wound bed pH to promote
angiogenesis. "The closed wound healed faster than the" open wound "written in the Egyptian
medical text - the wound healed faster until the middle of the 20th century, except for the
papyrus surgery astronaut which I believed in 1615 BC. Oscar Gilje described the effect of wet
room on ulcer healing in 1948. In the mid-1980's, the first modern wound dressing that
provided important functions by providing hygroscopic fluids such as polyurethane foam,
hydrocolloid, iodine-containing gel was introduced. In the mid 1990's, synthetic wound
dressings evolved into a variety of product groups including hydrogels, hydrocolloids,
alginates, synthetic foam dressings, silicone meshes, tissue adhesives, breathable adhesive
films and other materials. Silver dressing / collagen.
2.5 Purpose of Dressings

• Protect the wound from mechanical damage.

• Scratch or repair.
• Absorb water.
• Prevent the drainage of contamination (of the body) by the body.
• It promotes haemostasis as an oppressive connection.
• The wound is eliminated by combining the action of the capillaries with the
interweaving of the necrotic fabric in the gauze.
• Fight or kill microorganisms with sterile or antibacterial dressings.
• Provides a physiological environment that is useful for healing.
• Providing physical and mental comfort for patients.

2.6 Advantages of Not Using Dressings

The first dressing of a completely clean and dry incision is not usually exchanged. This
can be done within 24 hours after surgery. It can show better wounds. Remove the conditions
(heat, humidity, dark) necessary for biological growth. Minimize tape response.

2.7 Types of Dressings

Dry dressings

First used for wound closure. Offers good wound protection for patients, drain absorption,
beauty and blood supply (if needed).

Disadvantage: When the drainage is dry, they stick to the wound surface. (Removal can cause
pain or damage to the granulation tissue).

Wet-to-dry dressings

These are particularly useful for wounds requiring dysregulation or infection via
secondary intent of rewinding and closing. To eliminate the dead space, antimicrobial solution
of sterile saline (preferably) or saturated gauze is wrapped in the wound. The moist bandage is
then covered with a dry bandage (gauze sponge or absorbent pad). During drying, wound debris
and necrotic tissue are absorbed into the gauze bandage by the action of capillaries. The
dressing changes as (or before) it dries. If there is excessive necrotic waste on the dressing, the
dressing needs to be replaced more frequently.

Wet-to-wet dressings

Used to clean open wounds and granular surfaces. To saturate the dressing, it is possible
to use a sterile saline solution or an antibacterial agent. Provides a healthier environment
(warm, moisturizing), improves local healing and improves patient comfort. Thick secretions
are easier to remove.

Disadvantage: It can macerate surrounding tissues, increase the risk of infection and paper can
get wet.
Traditional wound dressing

Conventional wound dressing products include mesh, gauze, patch, dressing (natural or
synthetic) and fluff are dry and are used as a primary or secondary dressing to protect the wound
from contamination. Cotton net, rayon, polyester fabric, non-woven fiber bandage to prevent
bacterial infections. Some sterile gauze pads are used to absorb body exudates and to open
wound fluids with fibers from these dressings. These dressings are usually replaced to prevent
healthy tissues from being impregnated. The gauze bandage gives no information. Because of
the excessive discharge of the wound, the dressing tends to get wet and adhere to the wound
and is difficult to remove. Conventional wound dressing products include mesh, gauze, patch,
dressing (natural or synthetic) and quilt dried and used as a primary or secondary dressing to
protect the wound from contamination. Cotton dressings made of natural cotton and cellulose
or synthetic dressings made of polyamide materials have different functions. Cotton bandages
are used, for example, for holding light bandages, high compression bandages and short elastic
bandages to ensure long compressions in the case of venous ulcers. Xeroform ™ (non-blocking
dressing) is a Vaseline mesh with 3% tribromide for use in wounds that do not stir the de
aeration fluid. Fabric mesh dressings such as Bactigras, Jelonet, Paratulle are some examples
of gauze dressings that are commercially available as paraffin impregnated dressings and are
suitable for clean superficial wounds. In general, conventional dressings are suitable for clean
and dry wounds with a small exudate or as an aid dressing. Modern dressings have been
replaced by more advanced formulations because traditional dressings have not dampened the
wound. And, rayon, polyester fabric, non-woven fiber bandage to prevent bacterial infection.
Some sterile gauze pads are used to absorb body exudates and to open wound fluids with fibers
from these dressings. These dressings are usually replaced to prevent healthy tissue from being
impregnated. Gauze bandages give no information. Due to excessive fatigue of the wound, the
dressing tends to become wet and adhere to the wound and is difficult to remove.

2.8 Development of Advanced Dressing Modalities

The accepted and traditional method of wound healing 40-50 years ago is that if treated
optimally, the wound or the skin ulcer should be kept dry, preferably in the air. In 1962, winter
and others. An internal pig model has been suggested that indicates that a moist environment
is ideal for healing wounds or skin ulcers. These results were confirmed in 1963 by Hinman
and Maibach on subjects who demonstrated the positive effects of a moist environment on
wounds in human volunteers (compared to wounds carried by the air). The right amount of
fluid in the ulcer environment creates an ideal biological medium that provides optimal
conditions for the complex wound healing process. Provides more efficient metabolic activity
per cell and completes the interaction between tissue, cells and growth factor that does not
occur in dry tissues. All of these advanced bandages can achieve the classic bandage effect (as
described above) better than traditional bandage bandages. In most cases, they provide better
mechanical trauma and / or protection from external contamination. The latest drugs are usually
easy to use, they are elastic and adapt to different body parts. Nowadays, the use of some types
of modern dressings can be more effectively achieved when it is desired to absorb secretions.

2.8.1 Features of Dressings

In each of the high-level relationships discussed below, different subtypes are introduced based
on certain physical characteristics.

Transparency: The transparent dressing visually controls the surface of the ulcer. Ulcers
covered with opaque dressings can gradually become infected without being noticed. When
using a covering bandage, the bandage must be removed and replaced regularly.

Adhesiveness

The adhesive adheres the dressing to the surface of the wound. The bandage can then
be removed to remove the newly formed epithelium. On the other hand, the potential for
epithelial damage using hydrogel or hydrocolloid dressing is relatively low due to the formation
of gelatinous material interposed between the dressing material and the wound surface. You
need to consider the clinical aspects of the surrounding ulcers. It should be noted that newly
formed epithelial damage and injury to healing granular tissue from which dressings have been
removed can also occur in no adhesive dressings. The dressing adheres to the wound surface
due to the presence of exudate and its gradual drying.

Form of Dressing

Current dressings materials appear in a variety of forms, the main ones being sheet
forms and spreadable forms (such as gels or pastes).Other forms of dressings do exist, for
example, alginate dressings marketed in a rope form. A sheet-form dressing should be placed
2–3 cm beyond the ulcer margin. When using a spreadable form of advanced dressing modality,
a secondary dressing is needed to affix it and to ensure that it is well attached to the ulcer bed.

Absorptive Capacity

The absorptive capacity of each dressing type varies greatly, according to the type of dressing
and manufacturer.

Permeability/ Conclusiveness

The degree of permeability of liquids, gases, vapors and bacteria varies according to
the nature of the dressing and the manufacturer. As the secretion rate increases, a more
permeable relationship should be used. Thomas et al. The advantages of polyurethane foam,
high water permeability and hydrocolloid dressings were compared for 100 patients with leg
ulcers and 99 patients with pressure ulcers. There was no statistically significant difference in
the cure rates between the two groups. However, it was found that the foam dressings better
controlled the spillage of the dressing and the formation of odors. It can be assumed that these
results are independent of the type of dressing (hydrocolloid and foam), but rather of the degree
of penetration depending on the specific production of each dressing. In general, occlusive
dressings are primarily used to maintain a moist environment around the ulcer. The importance
of a humid environment for all complex wound healing processes is already mentioned in this
chapter. This method has been confirmed by numerous studies to demonstrate the beneficial
effects of occlusal dressings on surgical wounds and chronic dermal ulcers. In most of these
studies, more effective healing was achieved through better granulation tissue formation and
better epithelialization. However, "excessive" skin ulcers should be avoided as they can lead
to maceration, skin tears and infections.
Note that some degree of autolytic debridement may be achieved by using occlusive dressings,
as a result of the moist environment they produce.

Antimicrobial Effect

The problem of antimicrobial action of dressing is discussed below. This applies to

products such as cadoxomer iodon (Iodosorb) and dressing combining activated carbon and
silver (Actisorb). It is also possible to obtain certain antimicrobial effects by creating an
environment that is not suitable for bacterial infection by other means, for example by
absorbing secretions with a hydrophilic dressing. You need to consider a comparison of
different types of coating materials and some scientific criticisms. In some papers, the authors
suggest that the type of ulcer being examined (eg, venous ulcers or acne), without providing
important data (eg, the presence of the integument, its color, the presence of effluents in the
ulcer bed) Ulcers) that are commonly found in patients.

Dressings for occlusion or hydration are dressings that maintain good moisture transmission in
a gastric ulcer environment and provide ideal conditions for wound healing.

The subtypes of occlusal dressings classified according to the FDA are:

-Thin Films

- Hydrocolloid dressing

- foot dressing

In its basic form, the closed bandage is composed of a synthetic polymer such as
polyethylene or polyurethane and is constructed with or without an adhesive. This film is the
first developed closure dressing, followed by more complex products such as hydrocolloid
dressings and foam dressings. As noted above, the occlusive dressing is used to maintain a
moist environment in the ulcerated area. As mentioned above, its "classic" FDA classification
becomes less and less relevant. The boundaries of different relationships are confused. For
example, not all foams are obstructive. Likewise, some hydrogel dressings that are not part of
the occlusion group are actually obstructive according to the FDA classification.

Thin Films

These films consist of a thin layer of polyurethane that is permeable to water vapor and
moisture (to a different degree depending on type and manufacturer, but not liquid and
bacteria). They stay in a humid environment, but they are not absorbed and are not used for
ulcer separation. The first commercial relationship (Opsite®) is designed for extensive injuries
including burns, donors, skin ulcers and surgical wounds. According to textbooks, films can be
used for many types of ulcers and wounds. The film is impenetrable to bacteria and liquids,
making it ideal for cleaning and fixing surgical wounds. Nowadays, doctors tend to use thin
film dressings to treat chronic skin ulcers rather than advanced advanced dressings. Since most
films are adhesive, they can also be used as secondary dressings for other local formulations.
Some dressings are made of a combination of a polyurethane film and other coating materials
such as alginate or hydrogel.

Examples of film dressing:

 • -Bioclusive transparent dressing® – Johnson & Johnson
• -Blisterfilm transparent dressing® – Kendall
• -Carrafilm transparent film dressing® – Carrington Laboratories
• -Cutifilm – Beiersdorf-Jobst
• -Dermafilm intelligent film dressing® – Derma Sciences
• -Epiview® – Convatec
• -Mefilm® – Mölnlycke Health Care
• -Opsite® – Smith & Nephew
• -Orifilm transparent film dressing® – Orion Medical Products
• -Polyskin® – Kendall
• -3M Tegaderm transparent dressing® – 3M Health Care

Hydrocolloid Dressings

The hydrocolloidal dressing contains gel which forms hydrophilic hydrocolloid

particles (predominantly sodium carboxymethyl cellulose). Other substances can be added as
gelatin or pectin. Each composition and quantity. The ingredients vary from manufacturer to
manufacturer. The hydrocolloid material can be obtained in a smearable form or sheet form.
The shape of the sheet consists of an internal hydrophilic colloid lining and an external
hydrophobic coating (usually polyurethane) which is gas impermeable, water and bacteria. The
dressing of the sheet is an adhesive. When a dressing with a hydrocolloid is applied to the
surface of an ulcer, there is an interaction between the hydrocolloid material and the ulcer fluid,
thereby producing a characteristic yellow gel-like substance on the ulcer. This gelatinous
substance helps to form a moist environment and promotes autolytic debridement, granulation
tissue formation and epithelialization. Hydrocolloids absorb necrotic and body fluids, as well
as wound fluid in ulcerative environments. There are indications that components of chronic
body fluids for prolonged ulcers (as opposed to acute wound fluids) may reduce the
proliferative capacity of keratinocytes. The gel block is located between the dressing and the
ulcer bed. Therefore, when the dressing is removed or changed, the superficial tissue within
the ulcer bed, ie the granulation tissue and the new regenerative epithelium, is not damaged.

Further possible advantages of hydrocolloid dressings have been documented:

It is said that the hypoxic environment induced by hydrocolloid dressing stimulates

fibroblast proliferation and angiogenesis, possibly due to the formation of growth factors.
However, this information should not be taken for granted, especially for chronic skin ulcers
that usually occur in the elderly population. In 1972, Hunt et al. said that the wound healing
process may be delayed and hindered by relative hypoxia. It is currently believed that, in
addition to the initial healing phases, hypoxia is not essential for the general healing process.
In most cases it can hinder healing in chronic ulcers. Xia et al. It has been recently reported
that keratinocytes from elderly donors exhibit delayed migration activity under hypoxia, while
younger keratinocytes show improved migratory activity.

The acidic microenvironment initiated by hydrocolloids can be active against bacteria

including P. aeruginosa strains.
 Indications for hydrocolloid dressings are mild to moderate exudative ulcers, burns and
donor sites. This recommendation is based on clinical findings indicating that treated chronic
skin ulcers are improved by occluding the hydrocolloid dressing, although swab culture
confirmed the presence of bacteria on the ulcer bed. The use of hydrocolloid dressings in
infected or necrotic wounds is absolutely contraindicated. The presence of pus in the ulcer bed
is a unique sign of infection, in which case hydrocolloid wound dressings should not be used.

The question as to the level of turbidity of discharge and the cut-off point above which
it would be reasonable to avoid the use of occlusive dressings remains under debate and subject
to the clinical judgement of the treating physician. It has been suggested that the presence of
seropurulent/turbid discharge on a non-healing ulcer may indeed reflect local infection. This
being the case, placing such an ulcer under occlusive conditions may aggravate the infection.
Based on our experience, the application of hydrocolloid dressings should be limited only to
relatively clean ulcers and ulcers with minimal serous (clear) secretion.

Mode of Use.

After the hydrocolloidal dressing (along with other types of occlusive bandages in the tablet)
has been applied to the ulcer dressing, the folds in the dressing should be smoothed. The
following should have a slight pressure of about 20 seconds to adjust the dressing on the ulcer
bed. These recommendations may vary depending on the type of dressing and the
manufacturer's instructions.

-Changing Dressings.

Hydrocolloid wound dressings are typically placed for 5 to 7 days prior to replacement.
However, there is room for discussion. The main argument is the fact that the sticker is
cancelled. In addition, frequent replacement and purification are recommended to cause some
trauma to granulation tissue and newly formed epithelium.

On the other hand, the main reason for replacing the link more often is to get enough visual
control. Even the transparent bandages can not thoroughly investigate ulcers. In fact, I found
some sores that got worse during prolonged occlusion. In any case, the frequency of changes
is related to the occurrence of ulcers. If the ulcer is not clean, it is necessary to check it
regularly. In this case the dressing must be replaced every 48 hours, in some cases every 24
hours.

It should be noted that using a hydrocolloid dressing gelled material with a characteristic
appearance is formed on the surface of the ulcer. It is not a cosmetic item. However, some
patients were not conscious of the increase in secretion from gastric ulcers after informed by
medical staff, and there was a possibility that they developed severe ulceration at the next visit.
Examples of hydrocolloid dressings:

• -Comfeel® – Coloplast
• -Cutinova® – Beiersdorf-Jobst
• -Dermacol® – Derma Sciences
• -Dermatell® – Gentell
• -Duoderm® – Convatec
• -Exuderm® – Medline Industries
• -Granuflex® – Convatec
• -Hydrocol® – Bertek Pharmaceuticals
• -Hydrocoll® – Hartmann
• -Nu-derm (hydrocolloid)® – Johnson & Johnson
• -Oriderm® – Orion Medical Products
• -Replicare® – Smith & Nephew
• -Restore® – Hollister Incorporated
• -Tegasorb® – 3M Health Care
• -Ultec® – Kendall

Being manufactured by many different companies, hydrocolloid dressings are not uniform in
their quality and features. There is wide variation between the properties of different dressings.
Further research studies are required to determine the exact type of ulcer or wound for which
each type of dressing is ideally intended.

Foam Dressings

The foam dressing is made of a polymer material such as polyurethane and is made to
contain air bubbles. The space embedded in the dressing material can absorb the liquid. Most
of these dressings are occlusive or semi-occlusive and permeable to gases and water vapor.The
absorption capacity depends on the thickness of the dressing and the impregnating material and
the type and the manufacturer. The foam dressings are generally opaque and non-sticky.

The foam bandage can be used as a sheet or as a smearable foam. In the flaky form,
they have a hydrophilic side that contacts the wound surface and absorbs secretions. The outer
hydrophobic side contributes to the humid environment. Foam can be applied to the cavity. In
this case, a second dressing is required to secure the formulation to the ulcer bed. Since most
foam dressings are obstructive, they are in principle suitable for hydrocolloids. Because of their
absorption capacity, it is thought to be used for the treatment of secretory ulcers. However, we
propose other methods besides the degree of turbidity.

Examples of foam dressings:

• -Allevyn® – Smith & Nephew

• -Biatain® – Coloplast
• -Carrasmart foam® – Carrington Lab
 • -Curafoam plus® – Kendall
• -Cutinova foam® – Beiersdorf-Jobst
• -Flexzan® – Bertek Pharmaceuticals
• -Hydrasorb® – Convatec
• -Lyofoam® – Convatec
• -Mepilex® – Mölnlycke Health Care
• -3M Foam® – 3M Health Care
• -Orifoam® – Orion Medical Products
• -Sof-foam® – Johnson & Johnson
• -Reston foam® – 3M Health Care
• -Tielle® – Johnson & Johnson
• -Vigifoam® – Bard Med.DivisioN

Hydrogels

The hydrogel consists of a three-dimensional array of hydrophilic polymers, such as

carboxymethylcellulose (Intrasite gel) or polyethylene oxide (Vigilon), combined with a high
content (usually higher than 90%) of water. The hydrogel formulation may also contain
glycerine and pectin. The same as other medications: they have a viscous gel that is flaky or
spreadable.
Chapter 3

3.0 Methodology
3.1 Introduction
The purpose of this descriptive study is to order these bandages, determine the type of
moist wounds, order dried bandages, and pay attention to the veterinarians: this is because the
caregivers they ordered It is to prevent being in the form of wound care. The relevant data
indicate whether the clinical condition of these wounds indicates the need for mechanical
debridement under dry and wet conditions.

3.2 Search Strategy

Data base searched from Google scholar, Discover and PubMed within 10 years of
research journal articles. The search articles limited by English language. And also included
Randomised Control Trial. Prospective observational studies from well-designed databases
were also included. Full range of available literature creating the direction for the literature
search when using PICO (Greenhalgh, 2014). PICO represents an acronym for Population,
Intervention, Comparison and Outcome which are four components that essential elements of
the research question. Research question is construct using the PICO strategy (Bergin &
Wraight, 2006).

P – Population who use Cyclosporine as immunosuppressive agent

I – Effectiveness for prevent allograft rejection, ideal uses, adverse effects and variability

C – Tacrolimus as a another immunosuppressive agent

O – Safety of the patient, reliable outcomes from patients

3.3 Inclusion Criteria

I take research on human subjects. I have included studies on patients with chronic
wounds of any cause (venous, arterial, diabetic, oppressive or mixed). I have held a count,
regardless of age or obstacle. I included the study to evaluate one of the following outcomes:
clinical outcome, complete wound healing, wound completion time, preparation time for
wound bed surgery, mortality, healing of wound healing, patient-oriented outcome, pain and
related health quality. Quality of life, adverse events, degree of infection, extreme disturbances,
NPWT-related first-aid visits or treated wounds, unplanned / planned surgical interventions not
related to NPWT or treated wounds, transfusion / bleeding, abandonment rates and causes

3.4 Exclusion Criteria

I have excluded studies of patients with surgical or traumatic wounds. I excluded the
study without a comparative group. I have excluded studies reporting wound healing rates
without reporting complete wound healing. I excluded projects that do not have raw data
(comments, edits, comments etc). I excluded it in less than 20 studies. I excluded studies
published in languages other than English. I denied the abstraction of meetings and meetings.
I excluded studies conducted at hospitals, hospitals, or long-term care facilities.

In addition, searches have been discovered by Google Scholar, PubMed, Discover. In

several hands there are several articles with different organizations and repeated explanations.
All duplicates are excluded. Most of the articles can be found in Google Scholar, but Dawes et
al. (2005) point out that Google is not a valid site for searching for articles. In short, between
1980 and 2017, 21,580 articles were retrieved from various databases.
3.5 Flow Chart of Study Selection

Discover Google Scholar

PubMed

Total Combined

Irrelevant Discarded

Then Combined

Discarded
Duplicated

964

Final Combined

Eliminated by
Discarded inclusion criteria

Included Studies

Figure 3. 1 Flow chart of Study

3.6 Critical Appraisal and Quality Assessment

Critical assessment defines all relevant studies as a primary assessment from selective
assessment and statistical methods (Abalos et al., 2001). Per Petticrew and Roberts (2008),
critical evaluation also defines the assessment of the quality of research. There is a big
difference between these studies, between magazines and short descriptions. This critical
assessment can be an important part of this study as it implements the strategy per standard
requirements.

3.7 Data Extraction

Researchers are responsible for extracting the basic data needed for the research,
otherwise the research will produce errors (Dawes et al., 2005). Receiving incorrect data will
result in incorrect searches, so it is useful to get relevant data for a successful search. The
process of extracting the relevant information and the summary of the collected data leads to a
successful search (Godfrey and Harrison, 2010).
Chapter 4

4.0 Results
The purpose of this descriptive study was to observe the beginning of those who ordered
wet and dry bandages as the main form of wound care and to note the special circumstances of
the health care providers who ordered these dressings more often. The relevant data were
examined to demonstrate whether the clinical condition of these wounds requires mechanical
resection of necrotic tissue during dry and wet dressings. This part of the result is divided into
two subsections of the example characteristics and the collected data to answer the research
questions.

Figure 4. 1 Sample Characteristics and Wound Characteristics

 Figure 4. 2 Types of Dressings and Amounts of Granulation Tissue

4.1 Selecting appropriate dressing

A wound will require different management and treatment at various stages of healing. No
dressing is suitable for all wounds; therefore frequent assessment of the wound is required.
Considerations when choosing dressing products -

Maintain a moist environment at the wound/dressing interface

Be able to control (remove) excess exudates. A moist wound environment is good, a wet
environment is not beneficial

Not stick to the wound, shed fibres or cause trauma to the wound or surrounding tissue on
removal

Protect the wound from the outside environment - bacterial barrier

Good adhesion to skin

Sterile

Aid debridement if there is necrotic or sloughy tissue in the wound (caution with ischemic
lesions)
Keep the wound close to normal

Body temperature

Conformable to body parts and doesn't interfere with body function

Be cost-effective

Diabetes - choose dressings which allow frequent inspection

Non-flammable and non-toxic

CHAPTER 5

5.0 Discussion of Results

5.1 Introduction
The purpose of this descriptive study is to observe the incidence of dried herbs and dry
seasonings as medical professionals in the primary model of wound care and to pay attention
to specialized caregivers who usually ordered these relationships to assess whether it was
necessary to condiment dry wet. Wounds and types of data were examined to show if the
clinical conditions of these wounds provided evidence of dry and wet mechanical cleaning
conditions. In this chapter, the data obtained in the study pay attention to the use of dry gauze,
wound dressing of wounds, dressing and drying of dry wounds, evaluation of surgical wounds,
study of the use of cytotoxic wound solutions and the principle of mechanical cleaning . After
discussing and discussing the limits of the conclusions and studies, practices and future
professors, we will give an overview at the end of this chapter.

5.2 Surgical Wounds

As mentioned above, most wet dry dressings are ordered for surgical wounds. Of 84 wet
dressings, 58 were surgical wounds and 69% of dry bandages were ranked in the study. These
are not closed sculptures, but open wounds such as abdominal hysterectomy, laparotomy,
gastric bypass surgery or GI surgery, incision and abscess drainage, most of which have a
common wound bed granularity. In addition, 78 (93%) injuries out of 84 cases in wet and dry
dressings were full-thickness wounds. Only 6 out of 84 dry wet bandages were associated with
partial thickness wounds. It is important to know what you need to do to heal wounds of partial
thickness and full thickness. The healing of partial-thickness lesions involves regression of the
inflammatory response followed by re-surfacing of the epithelial surface. Recovery of the skin
occurs simultaneously with the migration of epithelial cells. A moist wound bed is needed to
optimize this (Bryant, 2000; Doughty, 2004; Winter, 1962). On the other hand, healing of full-
thickness wounds is more complicated. The repair of full-thickness wounds requires the
production of protein fibers (mainly collagen), an increase in the number of fibroblasts
(proliferation) and the need for thin scaffolds or fibrous matrices (granular tissue) to fill defect
defects, including elimination of the inflammatory process, followed by a proliferative phase.
Furthermore, the process involves a new and accurate formation of blood vessels
(angiogenesis).

The entire process requires a sufficient amount of oxygen, food protein, ascorbic acid and zinc,
as well as wounds and protection from wounds, infections, foreign bodies and dehydration
(Kobe, 2000; Ti, 2004). The wet-dry dressing literature brief indicates that the practice used
for the lack of significant research base wet-dry general dressings or gauze. Many studies have
been wet to dry for use as a control dressing for dressing, but they are not explained or because
of the best uithardings percentages of the test product compared to the gauze bandage compared
to the test product's positive impact or potential adverse effects wet to dry or gauze (Whitney
& Wickline, 2003, see Banks et al, 1997; Xakellis & Chrischilles, 1992. Cohn et al, 2004;
Eginton et al, 2003). Other studies have also shown that dry dressings are often inaccurate or
inconsistent even when wet (sometimes twice a day, three times a day, before removing
moisturizing gauze before moisturizing) (Armstrong and Price, 2004 Ovington, 2001).
Obviously, the principle of healing wet injuries is often misunderstood.
5.3 Comparison between Dry dressings and Wet to dry dressings

Wet dressings Dry Dressings

Used on clean open wounds or on Used in primarily for wounds closing by
granulating surfaces, particularly useful for primary intension
untidy or infected wounds that must be
debrided and closed by secondary intention

Layer of wide mesh cotton gauze saturated Layer of wide mesh cotton gauze lies next to
with saline next to wound surface ,second the wound surface , second layer of dry
layer of moist absorbent with same solution absorbent cotton to protect the wound
to debride the wound or Layer of wide mesh
gauze saturated with antibacterial solution
next to the wound surface, second layer of
absorbent material saturated with the same
solution to dilutes viscous exudates

Expensive than dry dressing, need use of

medication or solution

Not available widely

Inexpensive

Contains medication or solution

Provides a more physiologic environment Widely available

(warmth, moisture), which can enhance the
local healing processes

Not adhere to wound surface Most of time containing no medication

Cause bed linen become damp Offers good protection, absorption & provide
pressure

Easy to remove, less pain ensure greater

patient comfort.
Not causing disruption of granulation tissue Adhere to wound surface when drainage
dries

Not causing bed linen get damp when thick

Not permeable to exogenous bacteria. dressing layer applied as necessary

When remove can cause pain cause less

patient comfort
surrounding tissues can become macerated,
When removing can cause disruption of
there is an risk for infection granulation tissue

Need specialized knowledge and skills when Permeable to exogenous bacteria and is
changing dressing and caring associated with a higher infectious rate

Dressing is more absorbable, contamination

of surrounding tissue is limited

No need of specialized knowledge or skills

Table 5. 1 Comparison between wet dressings and dry dressings

Chapter 6

6.0 Conclusion and Recommendation

A chronic wound is a serious burden of medical expenses. The doctor must understand the
cause of the wound and the type of dressing that is most commonly used. With the help of the
basic wound characteristics, the doctor can supervise the selection of the dressing. Identifying
the best dressing for a wound is an important factor in wound healing.

Recently, wound dressings have been designed to optimize each step of the healing process. In
addition, dressing is intended to kill and kill bacteria that cause infection by absorbing
antimicrobial agents. Chronic wounds are often dynamic, and many wound dressings challenge
doctors for drug selection. By choosing the right medicine you can shorten the healing time,
provide economic care and improve the quality of life for the patient.

Studies of wound healing mechanisms have improved the ability to treat chronic wounds faster
using a wet bandage. Because the moisturizer facilitates the removal of the dressing, the
patient's comfort is superior to the dry dressing. In most cases, moist dressings contain
medicines, disinfectants or antimicrobials that control or kill microorganisms and promote the
healing process. The wet compress can provide a more physiological environment (warm,
moisturizing), can improve the local healing process and increase patient comfort. Wet
bandages also protect the wound against foreign microbes and prevent the body exudates (face,
urine) from being infected. .
References
Ameen, H., Moore, K., Lawrence, J. C., & Harding, K. G. (2000). Investigating the bacterial
barrier properties of four contemporary wound dressings. Journal of Wound Care, 9(8), 385-
388.

Apelqvist, J., & Larsson, J. (2000). What is the most effective way to reduce incidence of
amputation in the diabetic foot? Diabetes/Metabolism Research and Reviews, 16 Supplement
1, S75-83.

Armstrong, M. H., & Price, P. (2004, 03/03/2004). Wet-to-dry gauze dressings: Fact and
fiction. Retrieved July 17, 2004, from http://www.medscape.com/viewarticle/470257

Bale, S. (1997). A guide to wound debridement. Journal of Wound Care, 6(4), 179-182.

Banks, V., Bale, S., Harding, K., & Harding, E. F. (1997). Evaluation of a new polyurethane
foam dressing. Journal of Wound Care, 6(6), 266-269.

Bethell, E. (2003). Why gauze dressings should not be the first choice to manage most acute
surgical cavity wounds. Journal of Wound Care, 12(6), 237-239.

Bolton, L. L. (2004). Moist wound healing from past to present. In D. M. Rovee, Howard (Ed.),
The epidermis in wound healing (pp. 89-101). Boca Raton, FL: CRC Press.

Boyce, J. M., Potter-Bynoe, G., Chenevert, C., & King, T. (1997). Environmental
contamination due to methicillin-resistant Staphylococcus aureus: possible

infection control implications. Infection Control and Hospital Epidemiology: The Official
Journal of the Society of Hospital Epidemiologists of America, 18(9), 622- 627.

Boyce, S. T., Supp, A. P., Swope, V. B., & Warden, G. D. (1999). Topical sulfamylon reduces
engraftment of cultured skin substitutes on athymic mice. The Journal of Burn Care &
Rehabilitation, 20(1 Pt 1), 33-36.

Bradley, M., Cullum, N., Nelson, E. A., Petticrew, M., Sheldon, T., & Torgerson, D. (1999).
Systematic reviews of wound care management: (2). Dressings and topical agents used in the
healing of chronic wounds. Health Technology Assessment, 3(17 Pt 2), 1-75.

Bradley, M., Cullum, N., & Sheldon, T. (1999). The debridement of chronic wounds: a
systematic review. Health Technology Assessment, 3(17 Pt 1), iii-iv, 1-78.

Brem, H., Kirsner, R. S., & Falanga, V. (2004). Protocol for the successful treatment of venous
ulcers. American Journal of Surgery, 188(1A Suppl), 1-8.

Brenner, Z. R., & Johns, P. E. (2002, October 29). Revising a health care system protocol from
a risk management perspective. Journal of Nursing Risk Management 2002. Retrieved October
18, 2004, from http://www.afip.org/Departments/legalmed/jnrm2002/brenner.htm

Brown, G. S. (2000). Reporting outcomes for stage IV pressure ulcer healing: A proposal.
Advances in Skin and Wound Care, 13(6), 277-283.
Bryant, R. A. (2000). Acute and chronic wounds. St. Louis, MO: Mosby. Capasso, V. A., &
Munro, B. H. (2003). The cost and efficacy of two wound treatments. AORN Journal, 77(5),
984-992, 995-987, 1000-1004.

CDC. (1996). Ambulatory and inpatient procedures in the United States, 1996. Retrieved June
14, 2004, from http://www.cdc.gov/nchs/products/pubs/pubd/series/sr13/140-
131/sr13_139.htm

CDC. (2002). Inpatient surgery, 2002. Retrieved October 18, 2004, from
http://www.cdc.gov/nchs/fastats/insurg.htm

CDC. (2003). Disease surveillance: Diabetes and cardiovascular disease. Retrieved October
18, 2004, from http://www.cdc.gov/diabetes/statistics/

CDC. (2004). Disease surveillance: Faststats. Retrieved October 18, 2004, from
http://www.cdc.gov/nchs/fastats/Default.htm

Chen, C., Schultz, G. S., Bloch, M., Edwards, P. D., Tebes, S., & Mast, B. A. (1999). Molecular
and mechanistic validation of delayed healing rat wounds as a model for human chronic
wounds. Wound Repair and Regeneration: Official Publication of the Wound Healing Society
and the European Tissue Repair Society, 7(6), 486-494.

Cho, C. Y., & Lo, J. S. (1998). Dressing the part. Dermatologic Clinics, 16(1), 25-47.

Clark, R. A. F. (1988). The molecular and cellular biology of wound repair (Second ed.):
Kluwer Academic/Plenum Publishers.

Cohn, S. M., Lopez, P. P., Brown, M., Namias, N., Jackowski, J., Li, P., et al. (2004). Open
surgical wounds: How does Aquacel compare with wet-to-dry gauze? Journal of Wound Care,
13(1), 10-12.

Collier, M., & Hollinworth, H. (2000). Pain and tissue trauma during dressing change. Nursing
Standard: Official Newspaper of the Royal College of Nursing, 14(40), 71- 73.

Cooper, M. L., Boyce, S. T., Hansbrough, J. F., Foreman, T. J., & Frank, D. H. (1990).
Cytotoxicity to cultured human keratinocytes of topical antimicrobial agents. The Journal of
Surgical Research, 48(3), 190-195.

Courtenay, M., Church, J. C., & Ryan, T. J. (2000). Larva therapy in wound management.
Journal of the Royal Society of Medicine, 93(2), 72-74.

Damour, O., Hua, S. Z., Lasne, F., Villain, M., Rousselle, P., & Collombel, C. (1992).
Cytotoxicity evaluation of antiseptics and antibiotics on cultured human fibroblasts and
keratinocytes. Burns: Journal of the International Society for Burn Injuries, 18(6), 479-485.

Danbolt, N. (1967). Oscar Gilje (1903-1966). Acta Dermato-Venereologica, 47(4), 201.

Davies, G. (1999). The timechart history of medicine. Rickmansworth: Timechart.

Dealey, C. (1998). Obtaining the evidence for clinically effective wound care. British Journal
of Nursing, 7(20), 1236-1238, 1240, 1242 passim.

Doughty, D. (1994). A rational approach to the use of topical antiseptics. Journal of Wound,
Ostomy, and Continence Nursing: Official Publication of The Wound, Ostomy and Continence
Nurses Society / WOCN, 21(6), 224-231.

Doughty, D. (2004, May 23, 2004). Basics of wound care symposium: moist wound care. Paper
presented at the 14th Annual meeting and exhibition of the Wound Healing Society, Atlanta,
GA.

Doughty, D. (Writer) (2004). State of science in wound care management [Multimedia

broadcast]. United States: Center for Medicare and Medicaid Services.

Dowsett, C. (2002). The role of the nurse in wound bed preparation. Nursing Standard: Official
Newspaper of the Royal College of Nursing, 16(44), 69-72, 74, 76.

Eginton, M. T., Brown, K. R., Seabrook, G. R., Towne, J. B., & Cambria, R. A. (2003). A
prospective randomized evaluation of negative-pressure wound dressings for diabetic foot
wounds. Annals of Vascular Surgery, 17(6), 645-649.

Ennis, W. J., Valdes, W., & Meneses, P. (2004). Wound care specialization: a proposal for a
comprehensive fellowship program. Wound Repair and Regeneration: Official Publication of
the Wound Healing Society and the European Tissue Repair Society, 12(2), 120-128.

Gates, J. L., & Holloway, G. A. (1992). A comparison of wound environments. Ostomy/Wound

Management, 38(8), 34-37.

Goldman, M. P., & Fronek, A. (1989). Anatomy and pathophysiology of varicose veins. The
Journal of Dermatolic Surgery and Oncology, 15(2), 138-145.