Post on 16-Jul-2015
Dr. MUHIBULLAH BANGASHPG-1 ResidentSurgical-E UnitKTH, Peshawar
Definitions History of Surgical Dressings Properties of Ideal wound Dressings Types of Surgical Dressings Commonly used Surgical Dressings Miscellaneous Dressings Conclusion Videos
SURGICAL DRESSING:A dressing is a sterile pad or compress appliedto a wound to promote healing and preventfurther harm.
BANDAGE:A bandage is a piece of material used either tosupport a medical device such as a dressing orsplint, or on its own to provide support to thebody.
Historically, a dressing was usually a piece ofmaterial, sometimes cloth, but the use ofcobwebs, dung, leaves and honey have alsobeen described.
Previously, the accepted wisdom was that toprevent infection of a wound, the woundshould be kept as dry as possible.
1860, English surgeon, Joseph Lister, began treating his surgical gauze with carbolic acid, known today as phenol, and subsequently dropped his surgical team's mortality rate by 45%.
1870, Robert Wood Johnson, co-founder of“Johnson & Johnson”, began producinggauze and wound dressings treated withiodine.
1960, George Winter published hiscontroversial research on moist healing. Hedemonstrated that wounds kept moisthealed faster.
1990, the surgical dressings expanded into thewell-recognized groups of products, such asvapor-permeable adhesive films, hydrogels,hydrocolloids, alginates, and synthetic foamdressings. Additionally, new groups of products,such as antiadhesive, mostly silicone meshes;tissue adhesives; barrier films; and silver- orcollagen-containing dressings, were introduced.Finally, combination products and engineeredskin substitutes were developed.
Primary Dressing: A dressing that touches thewound
Secondary Dressing (Bandage): Keeps theprimary dressing in site
Some dressings function as primary dressingonly. However some could function both asprimary as well as secondary dressing
Provide mechanical and bacterial protection Maintain a moist environment at the
wound/dressing interface Allow gaseous and fluid exchange Remain nonadherent to the wound Nontoxic, nonsensitizing, and nonallergic Well acceptable to the patient (e.g., providing
PAIN RELIEF and not influencing movement) Cost effective
Highly absorbable (for exuding wounds) Absorb wound odor Sterile Easy to use (can be applied by medical
personnel or the patient) Require infrequent changing Available in a suitable range of forms and
sizes
CLASSIFICATION: Dry dressings Moisture-keeping dressings Bioactive Dressings Skin Substitutes
Most commonly available dressings Tend to absorb wound moisture. Tightly Adherent to granulation Tissue – will
break upon removal
EXAMPLES: Gauze and bandages Membranes and foils Foams Tissue adhesives
Nonadherent to the wound Heals faster Do not break granulation tissue on removal Comparatively less painful
EXAMPLES: Pastes, creams and ointments Nonpermeable, semipermeable membranes
or foils, Hydrocolloids Hydrogels Combination products.
They play a significant active role in wound healing because
enhance granulation tissue formation Reduce slough formation Inhibits bacteria Some provide growth factors
EXAMPLES: Antimicrobial dressings Interactive dressings Single-component biologic dressings Combination products
Skin substitutes are heterogeneous group of wound coverage materials that aid in would closure and replace the functions of the skin, either temporarily or permanently, depending on the product characteristics.
EXAMPLES: Epidermal substitutes
(autologous or allogenic)
Acellular skin (dermis) substitutes(allogenic or xenogenic)
Autologous and Allogenic skin Skin substitutes containing living cells.
Gauzes Foams Polymeric films
(Opsite) Tissue adhesives Tulles Hydrocolloids Hydrogels Debriding agents
Enzymatic dressings Bead dressings Silicone dressings Human Amniotic
Membrane Porcine skin
Most readily available simple wound dressings Non-adherent coating Absorbs exudate Promote desiccation in wounds Can be used as a primary or secondary dressing Inexpensive Highly permeable Relatively non-occlusive FORMS: squares, sheets, rolls, and packing strips.
polyurethane porous sponges or polyurethanefoam films
Light-to-medium exuding wounds (Absorbent) Left on the wound surface for up to 7 days,
depending on exudate volume. Not recommended for any kind of dry
wounds!! Can be shaped to fit deep cavities and
granulating wounds.
Semipermeable film dressings Primary adhesive transparent Waterproof Impermeable to bacteria Breathable Ultra thin & high elasticity
Examples: Opsite Bioclusive Tegaderm
Uses: General wound care Skin biopsies Donor sites Superficial partial thickness burns Surgical incisions Securing of peripheral IV lines central venous catheters
Contraindicted in highly exudative wounds
contain CYANOACRYLATE which polymerize in an exothermic reaction on contact with either a fluid or a basic substance
Used for SIMPLE LACERATIONS, which otherwise might require the use of fine sutures, staples, or skin strips
cosmetic results similar/better than traditional suturing
Needleless & Painless method of wound repair
Does not require follow-up visits for suture removal
Strength of healed tissue seen at 7 days Ensure that wound edges are appropriately
adapted and that no adhesive passes between wound borders
Tulle: A light, thin type of cloth that is like anet
They comprise a gauze cloth impregnatedwith paraffin for non-traumatic removal
Antiseptics/Antibiotics are added forprevention or treatment of infection.
Does not stick to wound surface Suitable for flat, shallow wound Useful in patient with sensitive skin Require a secondary dressing
Soft paraffin dressing Contains chlorhexidine which is an ANTISEPTIC Allows the wound to drain freely into an
absorbent secondary dressing Used for covering wounds such as superficial
burns, lacerations, abrasions, graft sites and legulcers.
It consists of a cotton fabric, impregnatedwith a base composed of white soft paraffin,anhydrous lanolin, and 1.0% FramycetinSulphate
Framycetin is an antibiotic of theaminoglycoside group
It is used for Infected wounds, combining lowadherence with antimicrobial activity.
Hydrocolloids slowly absorb fluids, leading to achange in the physical state of the dressing &the formation of gel covering the wound.Thus, they are called interactive dressings
Provide moist wound environment Promote the formation of granulation tissue Provide PAIN RELIEF by covering nerve endings
with both gel and exudate. Constituents are methylcellulose, pectin,
gelatin, and polyisobutylene.
USES: Both acute wounds and chronic wounds Desloughing purpose For different stages of light-to-heavily exuding
wounds
Initially, dressings need to be changed daily,but once the exudate has diminished, dressingsmay be left for up to 7 days
Do not use on infected wounds!!
Brand: DueDERM®
Contain WATER i.e., > 70-90%They have some important characteristics of an IDEAL DRESSING Cool the surface of the wound, resulting in
MARKED PAIN REDUCTION Maintain the moist wound environment For use on dry or necrotic wounds or on
lightly exuding wounds Can be used at all stages of wound healing
except for infected or heavily exuding wounds
May MACERATE the healthy skin (mostly wound border areas), decreasing the keratinocyte reepithelialization ratio or leading to over wetting of split-skin donor sites.
Available as sheet dressings or gels. Brands: Tegagel®, Intrasite®
GEL FORM
SHEET FORM
Provide acidic environment Enhance healing via debriding action Only used in Necrotic sloughing skin ulcers
EXAMPLE: Benoxyl-benzoic acid
Activate fibrinolysis and liquefy pus on CHRONIC SKIN ULCERS
Example: Varidase-streptokinase/streptodornase
Remove bacteria and excess moisture by CAPILLARY ACTION
Useful in Deep Granulating Wounds
EXAMPLES: Debrisan® Iodosorb®
Available as Sheeths & Pastes
May reduce Hypertrophic scarring andKeloid formation
Work as Antiadhesives useful in covering split-skin donor sites or
fresh meshgrafts
MAKING THE SCARS MORE COSMETICALLY ACCEPTABLE via: flattening of scarring tissue increasing elasticity reducing discoloration
An ALGINATE dressing is a natural wounddressing derived from different types of algaeand seaweeds.
Best used on wounds that have a LARGEAMOUNT OF EXUDATE
Can absorb Exudate upto 20 times their ownweight
Available as Sheaths and Ropes
BRANDS: Kaltostat® Sorbsan®
Obtained from the placenta after delivery To cover burn wounds. Can be prepared relatively inexpensively
CHARACTERISTICS OF AN IDEAL SKIN SUBSTITUTE: Excellent adherence to the wound Very low immunogenicity Decrease of pain Bacterial control Stimulation of healing
It is translucent, allowing inspection of thewound.
Can be applied on superficial second-degreeburns, deep second-degree burns after earlydebridement and donor sites
To cover 1:3 meshed autografts Extremely effective in sterilizing contaminated
wounds and cleaning burns of bacteria within3-5 days.
Have to be changed DAILY Need to be covered with gauze to prevent
desiccation Can be kept refrigerated for 6 weeks They can be frozen for longer storage
Porcine skin is the most common source of xenograft because of its high similarity to human skin.
Well-suited temporary dressing for the coverage of second-degree burns, especially after early excision.
It usually promotes scar-free healing Average healing period of about 10 days. suitable overlay to cover widely meshed (1:8
to 1:12) autografts
Promote the deposit of newly formed collagenin the wound bed
These dressings chemically bind to MatrixMetalloproteinases (MMPS) found in theextracellular fluid of wounds. MMPs normallyattack and break down collagen, so dressingscontaining collagen give MMPs an alternativecollagen source, leaving the body’s naturalcollagen available for normal wound healing.
Mainly used for Chronic Nonhealing Wounds
Bilayer Skin Substitute Constructed of a Silicon Film with a Nylon
fabric partially imbedded into the film towhich Collagen has been chemically boundand cross-linked
Used in Severe burns and Donor sites significantly reduce local wound pain speed up the healing process
Tissue engineering is the use of a combination of cells, engineering and materials methods to improve or replace biological functions
Engineered skin substitutes have been developed to address the need for wound coverage and tissue repair as conventional wound dressings have significant limitations for skin regeneration
EXAMPLES: TransCyte® was the first human-based,
bioengineered, temporary skin substitute for the treatment of Full and Partial thickness burns
Integra® serves to prepare the wound bed in preparation for transplantation with autologous split-thickness skin three weeks later
Currently, NO engineered skin substitute can replace all of the functions of intact human skin
Determine and address cause of wound Establish plan of care that includes dressings
that will address principles of moist wound healing
Keep dressings as simple as possible Assure Pain is addressed