This prospective, randomised clinical trial compared pain, comfort, exudate management, wound healing and safety with Hydrofiber dressing with ionic silver (Hydrofiber Ag dressing) and with povidone-iodine gauze for the treatment of open surgical and traumatic wounds. Patients were treated with Hydrofiber Ag dressing or povidone-iodine gauze for up to 2 weeks. Pain severity was measured with a 10-cm visual analogue scale (VAS). Other parameters were assessed clinically with various scales. Pain VAS scores decreased during dressing removal in both groups, and decreased while the dressing was in place in the Hydrofiber Ag dressing group (n = 35) but not in the povidone-iodine gauze group (n = 32). Pain VAS scores were similar between treatment groups. At final evaluation, Hydrofiber Ag dressing was significantly better than povidone-iodine gauze for overall ability to manage pain (P < 0.001), overall comfort (P < or = 0.001), wound trauma on dressing removal (P = 0.001), exudate handling (P < 0.001) and ease of use (P < or = 0.001). Rates of complete healing at study completion were 23% for Hydrofiber Ag dressing and 9% for povidone-iodine gauze (P = ns). No adverse events were reported with Hydrofiber Ag dressing; one subject discontinued povidone-iodine gauze due to adverse skin reaction. Hydrofiber Ag dressing supported wound healing and reduced overall pain compared with povidone-iodine gauze in the treatment of open surgical wounds requiring an antimicrobial dressing.
In cases of congenital lymphoedema the finding of ulceration, violaceous nodules or papules, or apparent traumatic ecchymoses should act as a diagnostic beacon warning of dangers. A case is reported of a high-grade angiosarcoma developing in a patient with congenital hereditary lymphoedema (Milroy's disease). This is the second paper to report this complication, the third case report and the first case in which the diagnosis is substantiated by immunohistochemistry and lectin histochemistry. A review of cases of angiosarcoma complicating congenital hereditary and non-hereditary lymphoedema is also presented.
INTRODUCTION Creation of gastrointestinal stomas is a common colorectal procedure associated with early or late complications, some of which demand advanced technical skills and expertise for optimal management. CASE HISTORY A 63-year-old male underwent a defunctioning loop colostomy for locally advanced rectal cancer with liver metastasis. Three months later, he had developed a skinfold over his stoma that resulted in a horizontal skin crease traversing through the stoma, causing the stoma to 'sink' leading to obliteration of the stomal opening. This scenario led to ineffective attachment of a stoma appliance, resulting in painful peristomal ulcers. After excision of the anterior abdominal wall, assessment of colostomy opening was carried out, followed by closure of the subcutaneous tissues and drain fixation. An elevated colostomy with an adequate functional opening was seen after wound closure. The patient made an uneventful recovery and was discharged home. After 3 weeks, he had a fully opened, normally functioning colostomy and peristomal ulcers were almost healed. CONCLUSIONS This case highlights the challenges of stoma management, its related risks, avoidance of delay in chemotherapy, a patient wish for early return to work, and the novel approach we adopted to deal with these issues.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.