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Dressings for Chronic wounds Dr. Joel ArudchelvamConsultant Vascular and Transplant Surgeon

Dressings for Chronic wounds Definition of chronic wound / dressingTypes of dressingsSummary of use of various dressingsWhen to changeWhat not to do

Chronic ( non healing ) ulcer / woundWounds / ulcers not showing signs of healing after 6 weeks.

Wound dressings The material which is applied to the surface of the wound to cover 1ry dressing which touches the wound2ry dressing used to cover the primary dressing

Ideal wound dressing Dressings are applied to wounds for To provide a protective cover To maintain moisture To absorb exudates

In addition an ideal dressing

Does not induce pain or itching Easy to change Allows gaseous exchange Cheap Freely available

Types of Wound DressingsGauze Tulle Hydrocolloid Hydrogel Alginate Foam Transparent film Etc.

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GauzeCheap Freely available

DryPainful on removingDamages epithelium

Tulle Cheap Freely availableEasy removalE.g : Vaseline

Hydrocolloid DressingsMade up of pectin based materialAbsorb exudateCome in various shapes and sizes

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Hydrogel DressingsMade up of water in a polymer Used in dry wounds

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Alginate DressingsMade from seaweed Absorb moderate amounts of drainagebecomes a gel when it comes into contact with wound fluid

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Foam DressingsMade up of polyurethane foamAbsorbs large amounts of fluidAvailable in various sizes and shapes

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Silver DressingsReduce bio burden - through slow release of silver ion into the wound

e.g. Acticoat, Biatin Ag, Atruman Ag

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Vacuum Assisted Closure VAC

Vacuum Assisted Closure VACMechanisms of actionMacro strainMicro strain

Macrostrain - visible contraction which occurs when negative pressure is applied.

Draws wound edges together Provides direct and complete wound bed contact Removes exudate

Vacuum Assisted Closure VAC

Microstrain - micro deformation at the cellular level

Reduces edema Promotes granulation tissue formation by facilitating cell migration and proliferation

Indications for useLarge woundsCavities Large amount of exudate

Vacuum Assisted Closure VAC

Summary Wound with slough , dead tissue needs wound toilet.Wound typeDressing Dry Hydrocolloid, HydrogelExudating woundHydrocolloid, foamDead space / cavityAlginate, foam, VACGauze, tulle and gelMost wounds

When to change dressingsWhen there is an indication to change

Soaking / smelling Need to inspect pain , swelling , fever, ect.

Discuss with doctor before changing

Avoid in chronic wounds Iodine (Betadine)Hydrogen peroxideOther toxic agents

Avoid

Do not tie gauze bandage tightly around limbs, digits causes ischaemiaUse plaster , crepe instead

Thank You