Evaluation of the effectiveness of a polyhexanide and propyl betaine-based gel in the treatment of chronic wounds.

AIM: The objective of this multicenter observational clinical study was to evaluate the therapeutic effects of a polyhexanide and propyl betaine-based gel in the treatment of patients of every age, affected by chronic skin wounds. METHODS: One hundred twenty-four patients (60% females, from 4-day-old to 91-year-old, mean age 59) were treated with polyhexanide/propyl betaine (Prontosan® Wound Gel, B. Braun) applied directly on the surface of the wound and in the possible undermining, in combination with a secondary dressing. At the baseline visit and at subsequent checks were evaluated the wound diameter and characteristics (the wound bed and the surrounding skin and edges appearance, level and type of exudate) and local pain at dressing change. RESULTS: The assessment and analysis between the initial visit and the final one showed the following results: the wound size and pain characteristics have decreased substantially and significantly (P<0.001) both in the size of the wounds (length: -17.5 ± 21.4 cm, width: -15.5 ± 21.1 cm; area: -8.3 ± 16.7 cm²) and in the intensity of pain perceived by the patient (Visual Analogue Scale [VAS]: -4.67 ± 2.7; Face, Legs, Activity, Cry, Consolability [FLACC] Scale <1 ± 4); for patients younger than 3 years, the scale used was FLACC. Wound bed: it was found a significant increase in the percentage of improvement in patients; 90% of them showed a reduction in the wound size, while 80% of them showed a relative reduction in pain compared with that observed during the baseline visit, with the wound bed cleansed, granulating or re-epithelializing. Just as significant was the decrease in percentage of subjects with wounds with fibrinous and partially necrotic bed, and/or with biofilm. Edges of the wound and periwound skin: the percentage of patients who have shown during the treatment an improvement in the clinical condition both of the wound edges and the surrounding skin has significantly increased, with a number of cases (75%) who have reached complete skin integrity. In a smaller percentage, already at the initial visit, the wound edges (28%) or the peristomal skin (18%) have been found undamaged. Exudate: there was a reduction in the level of exudate, with 74% of patients who showed no exudate at the final visit, compared with 15% of patients with non-exudative wounds at baseline. CONCLUSION: The treatment of chronic skin wounds through the use of a polyhexanide/propyl betaine-based gel, in combination with a secondary dressing, showed significant improvements, such as a 30% reduction of pain at dressing change, the reduction in the size and characteristics of the wounds and a reduction in the levels of exudate. All these factors have contributed to a reduction in the number of dressings, thus reducing the overall cost of treatment.

An open label non-comparative case series on the efficacy of an enzyme alginogel.

OBJECTIVE: To evaluate the efficacy of an enzyme alginogel in outpatients with chronic or acute wounds left to heal by secondary intention. METHOD: This evaluation was a single-centre, single-arm, case series involving 23 patients with wounds of diverse aetiologies treated with the enzyme alginogel (Flaminal; Flen Pharma). The product was applied in accordance with the manufacturer's instructions and wounds were covered with secondary dressings. Treatment was based on a scheduled protocol and patients were assessed at days 14, 30 and 60. RESULTS: Median baseline dimensions for the wounds were surface area 2.6cm2 and volume 2.8cm3. Median wound duration before application of the enzyme alginogel was 292 days, with 16 chronic wounds (78%). Three wounds were clinically infected at baseline; two were negative by day 14 and the third by day 30. After 2 months, wound surface area and volume had decreased, as could be expected. Two adverse events were reported: an allergic reaction in the skin surrounding the wound and transient maceration. CONCLUSION: The enzyme alginogel facilitated healing in chronic and acute wounds of diverse aetiologies. Additional research is warranted to confirm the clinical utility of the dressings in the management of chronic or acute wounds left to heal by secondary intention.

Operative guidelines in burns emergencies in a battle environment.

An account is presented of the current rules to be followed in the approach to burn patient treatment, in the light of the experience gained by the Italian Army Medical Corps in the numerous humanitarian missions performed outside Italy's national borders.

Short-term patency of 1 mm diameter PTFE prosthesis: an angiographic, Doppler-flowmetric and morphological experimental study.

Expanded polytetrafluoroethylene (PTFE) prostheses may be used in peripheral vascular surgery. Due to contradictory results on patency rate and neointimal formation, the effectiveness of this kind of prosthesis in small caliber artery reconstruction is still under discussion. In order to evaluate the effectiveness of this technique 1 mm internal diameter PTFE prosthesis (fibril length 35 microm) interposed in rabbit femoral artery, for 15 and 30 days, were studied functionally and morphologically. Doppler was performed during surgery, at day 2, 15 and 30. Arteriography was carried out at day 1. Light microscopy and scanning electron microscopy were performed on prosthesis sampled at day 15 and 30. Doppler flowmetry showed the full patency in all PTFE prosthesis. Angiography confirmed that all PTFE grafts were patent after 24 h. Doppler flowmetry, performed after 15 and 30 days, showed a reducing patency rate respectively at 70% (21 grafts) and 60% (18 grafts). Morphological studies showed that endothelial lining was not present at 15 day. After 30 days proliferation of blood cells occurred in the graft wall. Lumina presented a fibrous lining and did not show significant endothelial cell growths. These results confirm that PTFE prosthesis represents a suitable alternative to biological graft for the repair of small caliber artery when the latter are not available. Autologous vein is the vascular substitute of choice for peripheral vascular reconstruction, and PTFE prosthesis may be quite successfully used as a secondary choice, when multiple reconstruction are needed and biological grafts are not sufficient.

[Persistent varicocele: experience with prophilaxis and microsurgical treatment]. / Il varicocele persistente: nostra esperienza di profilassi e trattamento microchirurgico.

Persisting varicocele is still a rather hard clinical and therapeutical problem requiring a good level of surgical and microsurgical capability. In order to prevent and to treat postsurgical persistence, our trend is to resort to a correct and rational etiopathogenetical framing allowing us to choose the most appropriate surgical treatment. Relying on such procedure we perform all sorts of traditional and microsurgical interventions. We can say that the microsurgical techniques are the most appropriate ones to solve the problems of the second surgical intervention.

[Aneurysm of the popliteal artery: diagnostic and therapeutic considerations]. / In tema di aneurisma dell'arteria poplitea: considerazioni diagnostiche e terapeutiche.

The authors settle the roles of the most recent diagnostic methodologies useful to frame the popliteal aneurysm pathology namely digital arteriography, N.M.R., and doppler-flowmetry. They emphasize, in an observed case, the adopted therapeutic criteria, that is basically interventional. The thinness of saphenous veins draws toward the employing of "Goretex".