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C commonly performed under general anesthetic with difficulties in managing postoperative analgesia requirements resulting in slow LC mobilization and recovery. In-patient stays of 2 weeks are commonplace and care is often disjointed with limited interaction between the LC different groups of health care providers. Changing demographics and an ever-increasing demand for joint replacement dictate that the LLC processes be streamlined to maximize efficiency. Rapid Recovery is an evidence-based means of providing the best possible patient care, LL while at the same time optimizing the use of resources. It promotes patient centered care with a focus on patient education and LL prehabilitation. The preoperative, intraoperative, and postoperative stages of Rapid Recovery are described. The significant reduction in the L length of in-patient stay, the considerable cost savings, and the low complication rates are discussed as well as the favorable patient L satisfaction scores. Rapid Recovery should now be thought of as the gold standard for the treatment of all patients undergoing hip and knee replacement. C There is traditionally an unnecessary ‘‘medicalization’’ of the orthopedic patient undergoing total knee arthroplasty. Such procedures are

Aims: The objective of this prospective randomised comparative study was to assess the effects of two different cellulose-based dressings and their influence on venous leg ulcer cleansing and debridement over a four-week observation period. Methods: After ethics committee approval was obtained, both in and outpatients at the trial centres were recruited to the study after giving written informed consent. Forty patients (n=20/20) were included on an intention to treat basis. Results: Forty patients completed the study (n=20/n=20) and were included in the analysis. The ulcers in the study group (SG) showed a 43.53% reduction in wound area, whereas the ulcers in the control group (CG) had a 17.94% reduction. The reduction of yellow tissue was significantly larger in the SG (t=0.020 at day 7 and t=0.45 at day 14; 75.2% at baseline, 16.5% at 28 days) than in the CG (80.2% at baseline, 34.5% at 28 days). Pain reduction was faster and better in the SG (visual analogue scale [VAS] 1.30) at 28 days than in the CG (VAS 3.20). Conclusions: Both cellulose-based dressings were found to be successful in wound cleansing. Pain reduction was faster and better in the SG, contributing to an improved quality of life. Conflict of interest: This study was supported by Lohmann & Rauscher GmbH.

Materials in contact with liquids on the human skin surface may dissolve and permeate into skin. Release and permeation of chemicals in contact with skin is often estimated in vitro using artificial skin liquids, although sebum lipids are generally not included in these models. The purposes of this research were to develop a representative artificial sebum that contains the appropriate types of lipids at levels that match human values and quantitatively characterize the model to understand its utility for in vitro testing. Artificial sebum that consisted of 10 lipids at proportions that closely resembled human sebum was characterized using thin layer chromatography under a variety of storage and use conditions (dry and liquid, 4 degrees C and 32 degrees C, with and without vitamin E) for 28 days. Levels of sebum constituents maintained in solution and dry at 4 degrees C were stable through the duration of the test period. Levels of all sebum lipids maintained dry at 32 degrees C were stable in the presence of vitamin E; however, squalene oxidized rapidly in the absence of vitamin E. Liquids on the human skin surface consist of sebum and sweat with minor amounts of cellular debris and intercellular lipid from the stratum corneum. The relative importance of each component for release of chemicals from materials in contact with skin will depend upon the type of material (metal, organic, etc.). A model artificial sebum was formulated and characterized to aid researchers in understanding potential release of chemicals from materials in contact with skin and subsequent partitioning and absorption.

Die konsequente und adäquate Durchführung einer Reinigung oder eines Debridements von Wunden ist neben der Behandlung der Grunderkrankung eine grundlegende Voraussetzung für die Überwindung der Exsudationsphase, die Reduzierung des Infektionsrisikos und den Anstoß von reparativen Prozessen.

Introduction:

Infection of the wound site can lead to the formation of a chronic wound. Pathogenecity and density of the colonizing microbes influence infection severity. However, when host defense mechanisms are impaired the risk of infection increases. Nosocomial infections have multiplied dramatically in the last years. Important pathogens of nosocomial infections are Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeruginosa, Escherichia coli and Candida albicans. The spread of these pathogens can only be inhibited through consistent hygiene sanctions and preventive disinfectant actions. Polyacrylate-superabsorber containing wound dressings are able to take up large quantities of exudates while keeping the wound environment moist; an additional inhibition of bacterial and fungal growth would be a beneficial attribute. We have tested three different polyacrylate-superabsorber containing wound dressings according to the JIS L 1902for antibacterial and antifungal activity.

Material & Methods:

Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeruginosa, Escherichia coli and Candida albicans were chosen to monitor the antimicrobial effect. According to the JIS L 1902 norm samples of 400 mg of the polyacrylate-superabsorber containing wound dressings (Vliwasorb, Lohmann & Rauscher; Zetuvit plus, Hartmann; Sorbion sachet, Sorbion AG) were used for testing. The samples were incubated with the experimental pathogens(Staphylococcus aureus: 6,3·105cfu/mL, Klebsiella pneumoniae: 5,9·105cfu/mL,Pseudomonas aeruginosa: 9,1·105cfu/mL, Escherichia coli: 6,2·105cfu/mL und Candida albicans: 1,5·104cfu/mL) up to 24 h at 37C under aerobic conditions.

Results:

The polyacrylate-superabsorber containing wound dressings showed a strong inhibitory effect on Klebsiella pneumoniae, Pseudomonas aeruginos and Escherichia coli. They were also able to inhibit the growth of Staphylococcus aureus and Candida albicans significantly.

Conclusions:

The polyacrylate-superabsorber containing wound dressing exhibit a distinct antibacterial and antifungal activity. Its use should help to treat wound infections by entrapment of the microorganisms in the forming gel on exudates’ uptake and inhibition of their growth.

Introduction:

The exudates of chronic wounds contain elevated levels of reactive oxygen and nitrogen species (ROS/RNS). This overproduction of free radicals perpetuates the inflammatory phase and results in severe tissue damage. Therefore, the reduction of these active speates while keeping the wound environment moist; an additional binding of matrix degrading proteases by the super absorbers has been shown. A further anti-oxidative effect would be another beneficial attribute of polyacrylate superabsorbers.

Materials & Methods:

Antioxidant potential of a polyacrylate-superabsorber containing wound dressing (Vliwasorb, Lohmann & Rauscher) was measured using the chemiluminescent ABEL Antioxidant test kits containing Pholasin specific for superoxide and peroxynitrite (Knight Scientific Limited, UK).

Results:

The polyacrylate-superabsorber exhibited a significant concentration dependent antioxidant potential. The wound dressing samples were equally effective in inhibiting the formation of ROS and RNS.

Conclusions:

It is believed, that the overproduction of reactive nitrogen and oxygen species in chronic wounds results in an elongated inflammatory phase and severe tissue damage. Hence, the reduction of these active species seems to be a suitable way to promote normal wound-healing. Polyacrylate-superabsorber inhibits the formation of free radicals in vitro. Therefore, wound dressings containing Polyacrylate-superabsorbers should have an auxiliary influence on the healing of chronic wounds besides the binding of exudates.

Physiological wound repair is a highly regulated, complex process, which leads to formation of new tissue after injury. However, the healing process is not perfect and healing impairments can occur. Delayed healing and formation of chronic wounds has been linked to the excessive production of proteolytic enzymes leading to reduced amounts of growth factors and successive destruction of the extracellular matrix. It has been implied that there is an alteration in the normal control mechanisms regulating the levels of these enzymes. The study presented provides data on the concentration of proteases and cytokines in wound fluid from chronic when compared with acute wounds. Levels of proteases such as PMN elastase, matrix metalloproteinases-2 (MMP-2), and MMP-13 were found to be profoundly elevated in chronic when compared with acute wound fluids. In addition, concentrations of IL-1beta, IL-6, and IL-8 were shown to be significantly higher in chronic than in acute wounds. Furthermore, the ability of a wound dressing, consisting of bovine collagen type I, to bind pro-inflammatory cytokines was investigated. Collagen type I was able to bind significant amounts of the pro-inflammatory cytokines in vitro. Thus, it should be able to establish a more physiological wound milieu in vivo and promote healing.