David W. Brett, BS, Biology, BS, Chemistry, MS, Organic, Chemistry, Smith & Nephew, Wound Management Division, Science and Technology Manager, 11775 Starkey Rd., Largo, FL 33773
One of the primary functions of the skin is protection. Protection is accomplished via a two-way barrier function whereby the loss of water to the external environment is reduced and the risk of contamination from external substances and organisms is decreased. Maintaining this barrier is essential for health of the patient. Damage to the skin can upset the biochemical balance and barrier capacity of skin. Skin stripping is always a concern in removing adhesive dressings. A great deal of research has gone into developing adhesives with adequate tack, yet not so that the associated dressing damages the peri-wound area upon removal. Another strategy has been the development of skin preparations (film forming polymeric material dissolved in a volatile solvent. The repeated application and removal of adhesive dressings to the can cause a change in the skin barrier function, most noticeable by an increase in the trans-epidermal water loss (TEWL). This in turn leads to a burst of mitosis in the basal epidermal cells (wound healing response), which is proportional to the extent of the damage. An inflammatory skin reaction may develop, typically erythemous, oedemoatous and vesicular changes. Pain can also be associated with the removal of adhesive dressings. The purpose of this study is to evaluate the damage (and associated pain) upon the repeated application and removal of two adhesive foam dressings. In this study, dye will be placed on the skin, dressings applied, then removed in a controlled fashion. The force necessary to remove the dressings was recorded via Instron. TEWL levels were also recorded. The relative level of pain experienced upon removal was also determined. It was found that low levels of peel force were not always associated with low damage and low pain scores in this model; however, TEWL data was more consistent with peel force data.
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