Wound Healing after Toenail Avulsion: Kaltostat and Melolin as Postoperative Dressings - Essay Example

"Wound healing after toenail avulsion". A comparison of Kaltostat and Melolin as postoperative dressings. A critique of the published research The title of this paper is highly informative, to the point, simple and drawing, meaning that it captures your attention directly and it clearly tells you what you are going to be reading. Summary It is of an acceptable length for its purpose. Very clear-cut and with sufficient information to state that research was made to know the difference between alginate wound dressing (Kaltostat) or with a non-adherent dry dressing (Melolin). The researched was based on the random postoperative dressing treatment of 70 patients of partial or total nail avulsion. The results stated up to this point suggest significant statistical differences between the two dressings. The statement for conclusion was rather vague and contradicts the previous statement of statistical differences. The conclusion at this point only suggests that moist wound healing has a place in the postoperative management of toenail surgery. That implication could be made with out doing the research. Introduction It has a sound base and well documented literary background. The research of percentages and data are well documented and noted, leading to the object of the study. It presents the necessity of the research, stating that "little attention has been paid to the influence of wound dressings upon subsequent healing". The basis of the study is presented and the reason why those two types of dressings were chosen. Along with the difference between alginate wound dressing and non-adherent dry dressing, other factors were studied, such as patient's ischaemic index, age, medical condition and current medication. Ethical approval is mentioned. Overall the introductions is well founded and it gives a sound general review of the entire paper. Materials and Methods The method to find the patients was by direct referral from their general practitioner and then underwent a series of exclusions to determine weather or not they were fit for the study. The patient was informed about the study and consent was obtained. As per the exclusions, the reason why those conditions were excluded in the study should have been more elaborated, why those particular affections would impede the study to be done correctly This part of the paper is divided in three parts; assessment, surgical technique and review and redressing. Assessment A very short explanation about the assessment of the patients for the research, such explanation included relevant medical history and smoking habits, ischaemic index of the limb requiring surgery. An explanation of the patient's age range, sex, medication if any should have been stated here, being a part of the evaluation of the patients. Such information was given later in the results. Surgical technique Very precise explanation of the surgical technique used for partial or total nail avulsion. The wound dressing explanation being the main reason of this research was specific and well defined, and it was determined previously in a random sequence. For the Melolin dressed group, a Smith & Nephew, cotton and acrylic fibre pad bonded to perforated low adherent polyester film 5 x 5 flat dressing was used. After haemostasis was achieved by applying pressure, all wounds were then dressed with a fresh Melolin covered with sterile gauze and tube gauze. For the Kaltostat a BritCair, calcium sodium alginate 5 x 5 cm flat dressing was used. Haemostasis was achieved applying a dry dressing, which was then replaced with Kaltostat moistened with sterile normal saline and covered with trimmed gauze swab and tube gauze. Review and Redressing In order for the study to have consistency and minimize variations several standardized procedures were adopted such as redressing, the use of topical antiseptics was discouraged and if used on two consecutive visits the patient was excluded. A defined criterion was established to assess the wound (Table 1). Melolin was reapplied throughout the trial for that group. As far as Kaltostat the procedure differed. In the first outpatient review the dressing was replaced with a moistened Kaltostat but at subsequent follow up visits the chiropodist was permitted to use dry sterile gauze in place of Kaltostat if the wound was no longer sufficiently moist for the alginate to be an appropriate choice. This fact was not documented in the outcome, so it is not known how many of the patients treated with this technique used dry sterile gauze and how early in the healing process was Kaltostat not used. In Table 3 Outcome of treatment, it shows the amount of dressing changes, and it shows 3.6(SD1.8) for Kaltostat but it does not show if in fact all of those dressings were made with it or if one or two perhaps were done with a dry sterile gauze. The question could arise on how fast the wound was no longer sufficiently moist for the alginate to be an appropriate choice. Result As previously stated in this part the particular information of the patients is given. There were a total of 70 patients; approximately twice as many were male, with an age range from 10 to 70 years old. In this particular study the age range is rather broad and even if no correlation was shown with age range or ischaemic index. It is stated in the conclusion that "advanced age and poor local blood supply are likely to retard healing". Due to the fact that the table of comparison No. 2 does not show exact age but just an average, it is not known if the older patients happened to be in the Melolin thus taking longer or if in fact the Kaltostat dressing helped in the rapid healing time of a 70 year old patient for example. Significant differences were found in several items of the research. 1. Healing was 8.6 days less in the alginate-treated group (Table 3). The statistical difference is, P Read More