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For Big E .... carrying on from the cut foot thread a while back I have located one of the summary sheets on wound management in an electronic format....

RGH Pharmacy E-Bulletin Volume 13 (7): March 22, 2004 A joint initiative of the Patient Services Section and the Drug and Therapeutics Information Service of the Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia. The RGH Pharmacy E-Bulletin is distributed in electronic format on a weekly basis, and aims to present concise, factual information on issues of current interest in therapeutics, drug safety and cost-effective use of medications. Editor: Assoc. Prof. Chris Alderman, University of South Australia – Director of Pharmacy, RGH © Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia 5041 Selected wound dressings – part three This E-Bulletin covers antibacterial wound dressings and other medicated dressings that were not previously covered in parts one and two. In the management of chronic wounds the presence of bacteria may delay healing in some cases. Where appropriate, oral antibiotics should be used to treat infection as indicated. A wound may be contaminated with bacteria, but not delay healing, or invade the surrounding tissue: the presence of bacteria in a wound may not require active treatment Iodine preparations. Povidone Iodine is not currently used to treat non-contaminated, granulating wounds as it has been shown to be cytotoxic to leukocytes; fibroblasts and keratinocytes, causing delayed healing. Povidone Iodine products also have short duration of activity. Cadexomer Iodine is available in ointment and dressing. This compound has been shown to reduce the presence of MRSA and Pseudomonas Aeruginosa in chronic wounds. Clinical reports indicate good healing with the available products, and in vitro tests have demonstrated a lack of toxicity for human fibroblasts. The antimicrobial activity is long acting, suggesting that the product is suitable for use on chronic wounds. Cadexomer Iodine is available as Iodasorb* Silver preparations Silver has a long history as an antimicrobial, especially in the treatment of burns, with silver sulphadiazine cream used for many years for this indication. The newer preparations of silver ions in a wound dressing generally appear to stimulate wound healing, as well as inhibiting the growth of bacteria. The available dressings have variable silver concentrations and different modes of delivery of silver, which make direct comparison inappropriate. Acticoat* has a novel silver coating with a dressing of polyethylene mesh and a rayon/polyester core. The dressing controls bacterial growth with 70 ppm available silver, and can be regarded as bactericidal. It is reported to have improved antimicrobial performance compared to existing silver based products. Aquacel Ag* is a silver impregnated dressing composed of sodium carboxymethycellulose, which absorbs exudate. The silver content of this product is 1.2% silver ions with 1 ppm available silver. This dressing is regarded as bacteriostatic. The available silver is reported to be lower than Acticoat, but will improve healing in a wound by controlling the bacterial count. Zinc Zinc paste bandages are presented as an open weave bandage impregnated with zinc oxide. Zinc is thought to stimulate epithelization and is beneficial in the management of venous eczema. These products are applied on chronic venous ulcers that are in the final stages of epithelialization and are covered by a secondary dressing such as foam to absorb exudate. Compression bandaging is used over the limb. In the case of venous eczema, the zinc bandaging is applied over the entire affected area with wrapped bandages. Examples of zinc-based dressings include viscopaste* and zipzocs*, Topical cyclosporin Although this is not a product that is commercially available, there is an extemporaneous product prepared in sterile castor oil. The solution is used for individual patients diagnosed with pyoderma gangrenosum, a very painful condition that is difficult to heal by other means. The use of cyclosporin in combination with oral prednisolone appears to be associated with some success for these cases. Tacrolimus ointment has also been reported to be useful for this condition, and a number of other treatments have also been described in the literature.