Wound and Advanced Wound Material

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TX 9159 MEDICAL TEXTILES

UNIT IV

Wound ± types, healing process; requirement of

wound dressing; an overview of wound care

materials - study of various kinds of wound caredressing and advanced wound dressings;



Wounds

Definition:

An injury to any part of the body

External injury in which the skin is torn, cut, or

pierced



Classification of wounds

1. Intentional Vs. Unintentional.

2. Open Vs.C

losed.3. Degree of contamination.

4. Depth of the wound.



Open Vs. Closed wounds

Open wound: the mucous membrane or skin surface is

broken.

Closed wound: the tissue are traumatized without a

break in the skin.



Degree of contamination

Clean wounds: are uninfected wounds in which minimal

inflammation exist, are primarily closed wounds.

Clean ²contaminated wound: are surgical wounds in

which the respiratory, alimentary, genital, or urinary

tract has been entered. There is no evidence ofinfection.



Degree of contamination

Contaminated wounds: include open, fresh,

accidental wounds. There is evidence of

inflammation.

Dirty or infected wounds: includes old, accidental

wounds containing dead tissue and evidence ofinfection such as pus drainage.



Depth of the wound

Partial thickness: the wound involves dermis and

epidermis.

Full thickness: involving the dermis, epidermis,

subcutaneous tissue, and possibly muscle and bone.



Anatomy of Skin

Dermis:

composed of a thick layer of skin that containscollagen and elastic fibers, nerve fibers, blood

vessels, sweat and sebaceous glands, and hairfollicles.

Subcutaneous Tissue:

composed of a fatty layer of skin that containsblood vessels, nerves, lymph, and looseconnective tissue filled with fat cells.



Stage I



Stage II



Stage III



Stage IV



Wound Healing Process



Exact biologic process that takes place in orderly

sequence

An exudate containing blood, lymph, and fibrin beginsclotting and loosely binds the cut edges together

Blood supply to the area is increased, and the basic

process of inflammation is set in motion Leukocytes increase in number to fight bacteria in the

wound area and by phagocytosis help to removedamaged tissues

The served tissue is quickly glued together by strandsof fibrin and a thin layer of clotted blood, forming ascab



Wound Healing

Plasma seals to the surface to form a dry protectivecrust

This seal helps to prevent fluid loss and bacterial

invasion During the first few days of wound healing, the seal

has little tensile (The resistance of a material to aforce tending to tear it apart) strength

After 3-4 days , connective tissue cells(fibroblasts)rapidly proliferate and give strength tothe wound by producing collagen, a tough fibrousprotein responsible for the structural integrity of theskin



Wound Healing

At the same time small blood vessels regenerate andbuild new blood channels, granulation tissue (fibrousconnective tissue)includes blood vessels and

lymphatics that proliferate from the base of thewoind

Rapidly growing and multiple epithelial cells begin torestore the epithelial continuity of the skin

At this stage the wound appears healed, healing isnot complete until the granulation tissue organizes intoscar tissue



Wound Healing

By the ninth or tenth day, the wound is moderately

well healed and then becomes progressively stronger

The whole process of repair takes 2 weeks or more

depending on factors such as physical condition of thepatient, size and location of the wound, and stresses

put on the incisional area

During this time the scar (cicatrix)strengthens as the

connective tissue shrinks



Wound healing phases

Inflammatory phase

Proliferative phase

Maturational phase



Inflammatory phase

The body·s defenses are aimed at limiting the

amount of damage and preventing further injury



At the initial time of tissue

disruption, platelets

release coagulation factors

and cytokines to initiate

the healing process

Inflammatory phase



Within the first day

following tissue injury,

neutrophils attatch to

surrounding vessel walls

and then move through the

vessel walls to migrate to

the wound site

Inflammatory phase



Angiogenesis

The process of new blood vessel formation to

support a healing wound environment

Stimulants ;

tissue hypoxia ² major stimulus

TNF-, heparin, VEGF, FGF-1, FGF-2



The fibroplasia phase is

characterized by

movement of wound

macrophages into the site

of injury, which in turn

attract fibroblasts. The

fibroblasts then repair the

site by producing new

connective tissue matrix.



Maturational phase ( = remodeling )

The period of scar contracture with collagen

cross-linking, shrinking, and a loss of edema



The remodeling phase is

characterized by an

equilibrium between

collagen synthesis and

collagen degradation in an

effort to reestablish the

connective tissue matrix.



Factors influencing wound healing

Other factors pat age, stress level, presxisting

condition as diabete, anemia, malnutriion, cancer ,

obesity, advanced age, cardiovascular, respiratory

impairments. Overall physiacal and psychologicalcondition



Study of Various Kinds of WoundCare Dressing and Advanced

Wound Dressings



Dressing Choice

Wound Type Goal Superficial

Wound

Cavity

Black/ lowexudate

Rehydrate/debride HydrogelHydrocolloid

HydrogelHydrocolloid

Yellow/ high

Exudate

Remove slough

Control exudate

Hydrocolloid

Exudate

Absorbers

Hydrocolloid

Exudate Absorbers

Foam dressing

Yellow / low

exudate

Remove slough

Control exudate

Hydrogel

Hydrocolloid

Film

Hydrocolloid

Exudate Absorbers

Foam dressing



Dressing Choice

Wound type Goal Superficial Cavity

Red/ high

exudate

Absorb exudate

Maintain moist

environment

Promote

granulation

Foams

Hydrocolloid

Exudate

absorbers

Hydrocolloids

Exudate

Absorbers

Foam cavity

dressing

Red/ low exudate Maintain moist

environmentPromote

granulation

Hydrogel

Hydrocolloid(thin)

Film

Hydrogel

HydrocolloidFoam dressing



Wound Dressings-Hydrogels

Used to keep woundsmoist

Clear viscous gelsprotect wound fromdesiccating

Not used if wound isproducing heavyexudate.

If wound is infected,hydrogel serves no purpose.

Used as primary dressing

with wounds substantially orfully granulated

If there is black eschar oryellow slough, the necrotic

tissue should be removed.



Wound Dressing-Hydrogel Sheets

Non-adhesive and will not stick wound base

Keeps wound moist

Protects against contamination

Capable of absorbing exudate

Promotes healing

Secured to wound: gauze or tubular bandage



Wound Dressing-Hydrogel gauze

Combination of gauze

and hydrogel in same

package

Should be used on

wounds free of necrotic

tissue and /or infection



Wound Dressings-Hydrogel

Applications

Used daily for 30 days

3 ounces of gel per wound depending

on how large the wound is.



Wound Dressing - Alginates

Made from seaweed

Formed into flat squares or sheets ofunwoven fibers into twisted robes or pads.

Fibers are soft in texture and easily pulledapart.

Primary dressing for wounds that havemoderate to heavy exudate.

Applied to wound beds to absorb exudateand transudate ² keeping the wound moist.



WoundDressings-Alginates

Form a gel like plug which absorbs 20

times its weight

Held in place by secondary

dressing(MVPF, hydrogel sheet, gauze)

Doesn·t cause infection or inflammation



Wound Dressings-MVPF

Moisture Vapor Permeable Film

Adhesive film dressing, waterproof but allow

passage of O2 and H2O vapor from site

Prevent desiccation and bacterial contamination

Moist healing environment, retain growth factors

Promotes autolysins of necrotic tissue in bed

Translucent, help clinician visualize wound



Wound Dressings-MVPF

Uses:

Secondary dressing over wounds with

high shear

Adhere better to protect light to medium

exudate

May be left in place for days withuninfected wounds

Hold primary dressing in place



Wound Dressings-Cleansers

Solutions contain water, surfactants, salt

Wash and irrigate wounds with mild pressure

Wet wound to wash out exudate

Makes debridement easier



Wound Dressings-Hydrofiber

Exudate Absorber

Held in place by secondary dressing

Keeps wound moist yet absorbs excessive

exudate



Wound Dressings-Foams

Highly absorbent primary

dressings composed ofhydrophilic polyurethane

foam



Wound Dressings-Foams

Keeps wound environment

moist, absorbs exudate

Can be placed in wound tofill bed while absorbing

continuous exudate

Remains in wound for 3-4days



Wound Dressings-Hydrocolloid

Placed on wet wounds and wet

surrounding skin, remains intact

because it can adhere to WET

TRACK

Do not use on infected wounds

May have foul odor after

2-4 days



Advanced wound dressings



Wound Dressings-Tissue Engineering

Science of creating functional tissues or organs

Potentially has a dramatic effect on medicine

by providing physiologic implants for tissueregeneration

Products

Dermagraft

TransCyte

Apligraft



Wound Dressings-Dermagraft

Human living dermal replacement

Designed for the treatment of skin ulcers

Provides a living metabolically activehuman dermal tissue that interacts with

the wound bed

Produced by seeding dermal fibroblasts onto scaffold of bioabsorbable

material

Advantages:

Accelerates healing bye introducing collagens, matrix proteins,growthfactor.



Wound Dressings TransCyte

Human based temporary skin substitute

Treatment for second and third degree burns

Advantages:

Easy application and removal

Faster healing time with lessinflammation

One time applications

Decreased hospital periods



Wound Dressings: TransCyte

Consists of dermal tissue and synthetic epidermal layer

Provides a temporary covering to protect wound from fluidloss and infection

Remains in place until sufficent skin grafting is available or

until healed

http://www.advancedtissue.com/transcyte.html

Players dealing in innovative/ advance



Players dealing in innovative/ advance

Wound Dressings

Quick- Med Technologies,

US

Comvita, NewZeland.

Imedex Biomateriaux,

France.

3M

Kimberly clark

Smith & Nephew

Area Labs, US

Johnson & Johnson

Nycomed Pharma,

Norway

Wound and Advanced Wound Material

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