Date post: | 22-Aug-2014 |
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Omer hashmH.O
WOUND management andtypes of DRESSINGS
Sugical wound
Traumatic wound
Tidy(incisional)
Untidy(penetrating, lacerating. Degloving)
How is wound being produced most commonly
Untidy wound
Tidy wound which heal themselves by primary intensin
Othervise they undergoScarsContracturesSevere infections
GOALTidy wound <6hrs.. Primarily closed or delayed primary closure after 3-5 days
…untidy wound dealt with secondary closure, culture sensitivty done, antibitics and dressing
WOUND ASSESMEN
T
Lab tests:HISTORY
examination
SURROUNDING skin
Wound assessment
WOUND BED
Size, depth & location
1.Sloughy woundCLINICAL APEARENCE
2.Necrotic wound
• Dead cells accumulated in exudateAim:
to liquefy slough and aid its removal• Aims:
• to debride and remove eschar
3. Infected wound
Aims: support granulation, protect new tissue, keep moist
4.Granulating wound
• Aims: reduce exudate,odour and promote
healing
PRIORITIES-Correct Etiology-Provide Systemic Support-Use appropriate therapy
• GOAL-Healing-Maintenance
Types of dressings
TYPES OF DRESSINGSWhere we’re going…
Traditional dressings:• Gauze, lint and fiber products• Hydrocolloids
Modern Moist Wound Dressings:• Foams• Films• Alginates/Hydrofibers• Collagen• Hydrogels• Topical Antimicrobials• Silicone
Look how far we’ve come!!!
How should we select dressings?
Hydrating
Absorbing
Fillers
Active
Secondary
Primary
Autolytic
Enzymatic
Non-adhesive
Need to be compatible with the wound: May be hydrating or absorptive
Promote/maintain moist, healing environment
Provide insulation Impermeable to microrganisms
Atraumatic to the wound/periwound area Cost effective
In conventional terms: dry, or wet In technical terms we have:
PRIMARY dressingsSECONDARY dressingsIdeal Primary Dressings
TYPES OF SURGICAL DRESSINGS
Some modern types in detail
Indications:Superficial and full thickness woundsSkin grafts, donor sites, burns, skin tearsUnder compression for ulcers
Contraindications:Dry wounds
Examples: Mepilex (Border), Allevyn (Plus Adhesive), Polymem, Biatain
Foams
Indications:Minor injuries (abrasions)Post-op dressing over suturesIV sites
Contraindications:High exudate woundsFragile skin
Examples: Tegaderm, Opsite
Films
Indications:Highly exuding woundsInfected wounds (change daily)
Contraindications:Dry wounds or wound with eschar
Aquacel, Melgisorb, Seasorb, Kaltostat
Alginates/Hydrofibers
Regranex® Growth Factor Preparations
PDGF preparation in a hydrogel
Dermagraft® Single-Layered Tissue Human fibroblasts on matrix meshBilayered Tissue
Apligraf® Human fibroblasts and
keratinocytes in a bovine collagen matrix.
Bioengineered Products
Processed Tissue Primatrix® Acellular collagen dermis
(fetal bovine origin)
Oasis® Acellular bovine graft (Bovine Small Intestinal
Submucosa)
Bioengineered Products
Some important products used along dressings
HydrogelsIndications:
Dry woundsWounds with slough woundsWounds with escharOver tissues and tendons to prevent
dryingContraindications:
High exudate woundsExamples: Solosite, Woun’ Dress,
SkinTegrity
Chemically inert, adverse effects rareDesigned to be removed without trauma or
painProtect friable or newly healed tissue from
injuryLess trauma to periwoundExamples: Mepilex, Allevyn Gentle
Silicone
EnzymaticViridine-strptokinase
biologicalmaggots
Debriders
Bacteriocidal:SilverHoneyCadexomer iodine
Bacteriostatic: Methylene Blue and Gentian VioletXeroform
Antimicrobials
Antimicrobial action through (+) silver ion
Effective when in contact with wound fluidConsider:
Kill rate AND sustained release rateTesting Methods: Simulated wound fluid,
salineDelivery methods: foams, gels, alginates,
hydrofibers, creams (SSD - approved for burns, only)
Silver
Hydrogen peroxide Acetic acid
Effective against Pseudomonas aeruginosaDiguanides (Chlorhexidine)Sodium hypochlorite (Dakin’s)
Not recommended unless suitable are unavailable
Povidone Iodine
Antiseptics
Usually Type I bovine or avian or type IIIporcine collagen
Indications: Partial & full thickness wounds Minimal to moderate drainage
Contraindications: Eschar covered Full thickness burns Sensitivity to contents
Collagen
Based on amount of drainage and presence of infection
Infected wounds need to be monitored dailyHeavily draining wounds may need to be
changed 2-3 times a dayAs drainage decreases, increase time
between dressing changes