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Study About the Efficacy of an Aerosol Plastic Dressing in Wound

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Study About the Efficacy of an Aerosol Plastic Dressing in Wound 1.0 ANCC CE Contact Hours Study About the Effi cacy of an Aerosol Plastic Dressing in Wound Prevention After Compressive Adhesive Dressing Application in Plastic Surgery Procedures Enrique Salmerón-González , MD Elena García-Vilariño , MD Pilar Vilariño-López , MD Cristina García-Pons , MD Cristina Escalante-Ibáñez , MD Alfonso A. Valverde-Navarro , MD The use of compressive adhesive bandages is widely men placed over a layer of an aerosol plastic dressing and extended in the fi eld of plastic, aesthetic, and reconstruc- another bandage placed directly over the skin. A statisti- tive surgery, and the apparition of skin damage after its cally signifi cant decrease in skin damage incidence was removal is a relatively frequent complication. The aim observed in areas in which the aerosol plastic dressing of this study was to evaluate the capacity of an aerosol was applied as a layer between the adhesive dressing and plastic dressing for protecting the skin from the apparition the skin. Furthermore, a reduction in symptoms associ- of damage caused by adhesive dressings. A prospective, ated with the use of these adhesive dressings was found. randomized, simple-blind study was performed, evaluating The results of this study support the use of aerosol plastic skin damage incidence after removal of adhesive compres- dressings as a barrier for skin protection in patients in sive bandages in 80 subjects. The patients carried for whom an adhesive compressive dressing is applied to 48 hr an adhesive compressive dressing on their abdo- reduce the incidence of skin damage. he use of adhesive compressive dressings is established seromas ( Rogliani, Gentile, & Cervelli, 2008 ). widely extended in the fi eld of aesthetic and re- The apparition of skin damage after removal of adhesive T constructive surgery, being frequently utilized for dressings is a common complication that causes blisters, coverage of the intervened area in abdominoplasties, erythema, skin irritation, itching, and pain ( Becerra Maya breast reduction and augmentation procedures, liposuc- et al., 2015 ; Esparza Imas et al., 2015 ). tions, and other procedures. Compressive bandages are The aim of this study was to evaluate the effect of utilized with the aim of reducing hematoma and hemor- an aerosol plastic dressing when utilized as a protec- rhage incidence after surgical procedures or vascular ma- tive barrier prior to the application of a compressive nipulations ( Epstein, Epstein, & Gutowski, 2015 ); to con- adhesive dressing, focusing on the incidence of skin trol postsurgical edema ( Lowell et al., 2003 ) and to treat damage, pain, and itching. Enrique Salmerón-González, MD, is a plastic surgeon, Department of Alfonso A. Valverde-Navarro, MD, is Head of the Department of Human Plastic Surgery and Burns, University and Polytechnic Hospital La Fe, Anatomy and Embriology, University of Valencia, Valencia, Spain. Valencia, Spain. None of the authors have a fi nancial interest in any of the products, de- Elena García-Vilariño, MD, is a plastic surgeon, Department of Plastic vices, or drugs mentioned in this article. The authors report no confl icts Surgery and Burns, University and Polytechnic Hospital La Fe, Valen- of interest . cia, Spain. Address correspondence to Enrique Salmerón-González, MD, Avenida de Pilar Vilariño-López, MD, is a general nurse, El Ventorrillo Medical Center, Fernando Abril Martorell, Number 106, 5th Floor, Block E, Secretary of A Coruña, Spain. Plastic Surgery, Valencia Post Code 46026, Comunidad Valenciana, Spain Cristina García-Pons, MD, is a plastic surgical nurse, Department of (e-mail: [email protected]). Plastic Surgery and Burns, University and Polytechnic Hospital La Fe, Copyright © 2018 International Society of Plastic and Aesthetic Nurses. Valencia, Spain. All rights reserved. Cristina Escalante-Ibáñez, MD, is a plastic surgical nurse, Servicio de Cirugía Plástica y Quemados, Hospital Universitario y Politécnico La Fe, Valencia, Spain. DOI: 10.1097/PSN.0000000000000229 Plastic Surgical Nursing www.psnjournalonline.com 101 Copyright © 2018 International Society of Plastic and Aesthetic Nurses. Unauthorized reproduction of this article is prohibited. MATERIALS AND METHODS Procedure After accepting their inclusion in the study, participants The study was conducted from July 2017 to August 2017 were assigned an ordinal number, corresponding with in two different health care centers: “El Ventorrillo” medi- the order in which they had been recruited. Following cal center, in A Coruña, Spain; and the University and this, the researchers in charge of the experimental part Polytechnic Hospital La Fe, in Valencia, Spain. It was de- of the study reviewed the computer application to check veloped in collaboration between general nurses from the order of the intervention and control zones in those the “El Ventorrillo” medical center and nurses and plas- subjects. If needed, the two abdominal zones in which tic surgeons from the Department of Plastic Surgery of the dressings would be applied were shaved with an the Hospital La Fe. The study consisted of a prospective, electric shaver. A layer of 1–2 mm of Plastospray was randomized, simple-blind study conducted on 80 healthy applied in the zone indicated by the randomization al- volunteers. The intervention consisted of the application gorithm, and after waiting for it to dry for 1 min, two of two adhesive compressive dressings (Tensoplast) on adhesive compressive dressings (Tensoplast) measuring the abdominal region of every subject, with one ban- 15 cm in length were applied vertically over each side dage placed vertically on either side of the abdomen. The of the abdomen. The distal part was fi xed fi rst, sticking aerosol plastic dressing was applied only on one side of the rest of the bandage progressively, while more ten- the abdomen before placing the dressing. The side on sion was applied, compressing the skin (Figure 1A) . The which the aerosol plastic dressing was applied had been participant was evaluated 48 hr later. During evaluation, previously randomized through a computer program that the dressings were removed and the existence of skin assigned the right side as the intervention zone for 40 damage and symptoms caused by bandage wearing were participants and the left side for the other 40 volunteers, assessed ( Figure 1B ). according to an algorithm that remained unknown for the researchers in charge of the evaluation of the results. Every volunteer was evaluated 48 hr after dressing ap- RESULTS plication. Inclusion criteria included people older than 18 years and able to voluntarily participate in the proj- Eighty volunteers participated in this study, of which ect. People who suffered from systemic skin conditions 44 were females and 36 males. The average age or who were undergoing corticoid treatment were also was 54 years 3 months, with a standard deviation included in the study despite skin frailty that is caused of 8 years 2 months. All the participants attended by these conditions. The reason for their inclusion was the revision 2 days after the intervention. Forty-fi ve that every subject had an intervention zone and a control percent of the patients were shaved before the appli- zone, thus eliminating the possibilities of bias related to cation of the aerosol plastic dressing and the adhe- interpersonal variations. After dressing removal, the ex- sive bandage. Relevant comorbidities related to skin istence of skin damage and the apparition of symptoms conditions and healing conditioning factors are sum- such as itching or pain were assessed. Pain was evalu- marized in Table 1 . ated through a visual analogue scale, and it was consid- The results observed after removing the compressive ered signifi cant when the value was equal or higher than adhesive dressing are summarized in Table 2 . The only 4. The statistical analysis tool utilized for evaluation of allergic reaction reported was related to the adhesive sub- our results was the 2 test. Institutional review board ap- stance present in the adhesive dressing and not with the proval was provided from our institution. Informed con- aerosol plastic dressing, which was verifi ed after evalu- sent was obtained from all patients included in this study. ation of that participant by an allergologist. Symptom FIGURE 1. (A) Dressing placement. (B) Aspect 48 hr after removal of the dressing: Cutaneous erythema in the control zone can be observed. 102 www.psnjournalonline.com Volume 38 Number 3 July–September 2018 Copyright © 2018 International Society of Plastic and Aesthetic Nurses. Unauthorized reproduction of this article is prohibited. TABLE 1 Subjects’ Comorbidities TABLE 3 Symptoms Reported After Wearing the Comorbidities n Adhesive Dressing for 48 hr Diabetes mellitus 18 Control zone Intervention zone p Smoking 22 No symptoms 57 (71.25%) 68 (85%) .0354 Corticoid intake 8 Pruritus 16 (20%) 9 (11.25%) .1274 Psoriasis 3 Pain 7 (8.75%) 3 (3.75%) .1892 Allergic dermatitis 6 Seborrheic dermatitis 1 rier after oncological-gynecological interventions. Becerra Atopic dermatitis 4 Maya et al. (2015) also published a case–control study in which a reduction in pain was reported in the group that Chemotherapy 2 utilized an aerosol plastic dressing for coverage of episi- otomies or vaginal wounds after birth. incidence related to the intervention and control zones is summarized in Table 3. LIMITATIONS Despite that the design of this study guarantees that every DISCUSSION subject has an intervention and a control zone, a better The results of
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