Does the Application of a Semiocclusive Dressing Alter the Microflora of Healthy Intact Skin on the Foot?

Background The skin on human feet presents unique environments for the proliferation of potentially pathogenic commensals. This study examined microflora changes on healthy intact skin under a semiocclusive dressing on the medial longitudinal arch of the foot to determine changes in growth, distribution, and frequency of microflora under the dressing. Methods Nine human participants wore a low-adherent, absorbent, semiocclusive dressing on the medial longitudinal arch of the left foot for 2 weeks. An identical location on the right foot was swabbed and used as a control. Each foot was swabbed at baseline, week 1, and week 2. The swabs were cultured for 48 hours. Visual identification, Gram staining, DNase test agar, and a latex slide agglutination test were used to identify genera and species. Results Microflora growth was categorized as scant (0–10 colony-forming units [CFU]), light (11–50 CFU), moderate (51–100 CFU), or heavy (>100 CFU). Scant and light growth decreased and moderate and heavy growth increased under the dressing compared with the control. Seven different genera of bacteria were identified. Coagulase-negative Staphylococcus spp appeared most frequently, followed by Corynebacterium spp. Conclusions Changes in microflora distribution, frequency, and growth were found under the dressing, supporting historical studies. Microflora changes were identified as an increase in bioburden and reduction in diversity. The application of similar methods, using more sophisticated identification and analysis techniques and a variety of dressings, could lead to a better understanding of bacterial and fungal growth under dressings, informing better dressing selection to assist the healing process of wounds and prevent infection.

Comment on “Topically Applied Connective Tissue Growth Factor/CCN2 Improves Diabetic Preclinical Cutaneous Wound Healing: Potential Role for CTGF in Human Diabetic Foot Ulcer Healing”

A recent paper in this journal, presented a novel method by topical application of growth factors in stimulating diabetic cutaneous wound healing that caught our attention. We believe that the experimental method in the article is efficient and creative, but it also has some controversies and shortcomings to be discussed. We noted that the authors used “Tegaderm” as a semiocclusive dressing film and stated that it exerted a “splinting effect” on the wound margins and controlled contraction. Indeed, the “Tegaderm” itself can serve as a dressing film to isolate the wound bed with outside environments while the “splinting effect” is mainly achieved by adding silicone splints around the wound. Considering the unique properties of silicone splints and “Tegaderm,” our experimental group propose an alternative method named “combined-suturing” technique that is not only suturing the silicone splints but also securing the “Tegaderm” around the wound. The specific reasons and operative procedures are explained in detail in this letter.

Rejuvenation of the Acne-Scarred Face

Since the 1950s, dermaplaning has been used to improve acne scars. However, global improvement is often limited and remains about 50%. By combining the techniques of subcision, subcutaneous filling, laser shrinkage of collagen, dermabrasion, and excision of acne scars, we hoped to achieve a more pleasing aesthetic result. After preconditioning the skin of 62 patients (ages 17—47, mean age 32; 22 men and 40 women) with vitamin A/glycolic conditioning lotions, a Jessner/TCA peel was performed on the neck and décolletage area. The periorbital areas were also peeled if they were not photoaged. The acne valleys were subcised with a semiblunt needle, and the developed pockets were filled with adipose tissue. Then, the surface skin was vaporized with three passes of a CO2 laser, and the deeper acne scars in the midface region were sanded with a diamond fraise abrasion. Remaining scars were relasered, excised, or both, and sutured or grafted. To facilitate healing, a semiocclusive dressing was used for 5 days, then replaced with an ointment-based moisturizer for another 5 days. After 10 days, a moisturizer–sunscreen was used, followed by a bleaching cream at 15 days, if necessary. Patients were usually back to work in 2 weeks. By combining these multiple modalities of dermal subcision and augmentation, collagen shrinkage, and dermal sanding, dramatic improvement of the acne-scarred face was possible.

Fingertip Injuries Management with Semiocclusive Dressing

We have developed a simple, cheap and efficient method of management of fingertip injury using a semi-occlusive dressing (“Opsite”—Smith and Nephew). The fingertip is covered with the “Opsite” once a week only. The dressing provides a temporary “skin”, making the finger painless. This semi-occlusive “skin” allows the healing environment to reach an optimal milieu (e.g. pH, oxygen, tension, immunoagents) actively promoting granulation tissue formation and epithelization. The result of 200 fingertip injuries treated with this method proves the development of a near normal pulp shape and useful epithelium within an average of 20 days.