Wound management

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The Basics of Wound Management Care

Transcript of Wound management

  • 1. Dr Yap Gaik ChinWound Care TeamSurgical Department

2. Management of non healing wound is acomplex process and requires amultidisciplinary approach Starts from the first assessment uponinspection of patient by making a generalassessment and further local assessment of thewound 3. Assessment ( General & local ) TIME wound bed preparation Wound cleansing Types of debridement Types of dressing 4. Age Psychosocial health Complicating conditions vascular problem, diabetic, smoking,immunosuppressive Nutritional status Pain/Comfort Hygiene 5. Wound etiology Pressure, trauma, shearing, friction Size Wound edges Wound Bed necrotic, granulation tissue, odour, exudate Surrounding skin ( colour, moisture) 6. In early 1980s, Lars Hellgrens, a Sweedendermatologist was the first to claim thatwounds could be categorised according to thecolour of the wound surface Red-Granulation Yellow-Slough Pink-Epithelialization Black-Necrotic 7. Mnemonic for Principles of Wound BedPreparation What is wound bed preparation? Management of wound to accelerateendogenous healing or facilitate theeffectiveness of other therapeutic measures 8. T : Tissue Viability I : Inflammation, Infection M : Moisture Imbalance E : Epidermal Margin/ Edge of Wound 9. Viable ( Granulation, Epithelialising) Non viable ( Necrotic, Sloughly, Eschar) How does non viable tissue impede healing? Prolongs inflammation Impedes epitheliazation Medium for bacteria growth 10. Clear away dead or necrotic tissue Debridement Always ensure adequate tissue oxygenationfor angiogenesis and granulation process 11. The bacterial continuum What is infection? End spectrum of bacterial continuum , moreinfected than critically colonized wound Assessing of wound infection1. Contamination2. Colonized3. Critically colonized4. Infection ( Local, Systemic) 12. Classic Presentation of infection of local wound1. Advancing erythema2. Fever3. Warmth4. Oedema/ Swelling5. Pain6. Purulence 13. Secondary clinical presentation of local wound1. Delayed healing2. Change in colour of wound bed3. Absent/abnormal granulation tissue4. or abnormal odour5. drainage/exudate6. pain @ wound site 14. Too much moisture impede wound healing Cause Dessication / Maceration of skin Need to match exudate volume with productabsorbency for optimal moisture balance 15. Non advancing wound edge Also known as non healing wound Undermining of edge is either criticallycolonised or infected 16. Reconsider the principles of wound bedpreparation and the acronym TIME,1. Has necrotic tissue been debrided?2. Is there a well vascularised wound bed?3. Has infection been adequately controlled?4. What is the status of inflammation orinfection in this patient?5. How well is moisture balance optimized?6. What dressings have been applied before? 17. Removing foreign debris & necrotic tissue The process of removing inflammatorycontaminants from the wound surface sincenecrotic tissue, excess exudate and foreignobjects impede healing & the risk of infection Routine cleansing ( Fluid irrigation, mild scrub) Debridement 18. Antibiotic should be used to reduce bacteriallevel within the wound Selection of antibiotic is based upon provenefficiency against microorganisms obtainedfrom culture. 19. Saline Octanisept Superoxide solution Water for irrigation PHMB with Betaine 20. Antiseptics should not be used to cleanwounds Topical antiseptics:1. Betadine2. Povidone-Iodine3. Dakins Solution ( Eusol)4. Acetic Acid-> effective against PseudomonasA organisms5. Hydrogen Peroxide 21. A method of high pressure irrigation which is agentle mechanical action to loosen debris andnecrotic tissue 22. Wound healing is impaired due to prolonginflammation Necrotic tissue culture medium for bacteria Amtibiotics do not reach the wound milieu Dressings especially antimicrobial or silver donot reach wound bed For staging of undetermined stage pressureulcer 23. Surgical Mechanical Autolytic Enzymatic Biological Maggot Debridement Therapy( MDT) 24. Wound bed utilizes phagocytes and proteolyticenzymes to remove non viable tissueining amoist environment This process can be promoted and enhanced bymaintaining a moist environment 25. Recommended for removal of thick, adherenteschar and devitalized tissue in large wounds Not recommended in severely compromisedpatients Analgesia / anaesthesia may be required 26. The use of topically applied enzymatic agentsto stimulate the breakdown of non viable tissue Faster debridement process compared toautolytic Eg: Honey, Prolase dressing 27. Used for decades where dressings are allowedto proceed from moist to dry Manually removing the dressing causes a formof non selective debridement Works best on wounds with moderateamounts of necrotic debris 28. Small maggots are introduced to a wound toconsume necrotic tissue Able to debride a wound within 1-2/7 The maggots derive nutrients through aprocess called ` extracorporeal digestion 29. Protect wound from trauma or microbialcontamination Absorb drainage and debride wound Control & prevent haemorrhage ( pressuredressing) Reduce pain Maintain temperature and moisture of wound Provide psychological comfort 30. Traditional Conventional Leaves, herbs, Honey, Gauze Advanced/ environmental dressingsI. more expensiveII. Can be left in situ for several daysIII. Films, Alginates, Silver, Hydrogels, Foams,Hydrocolloids, Charcoals 31. Safe and easy to use Remove excess exudate Provide thermal insulation Trauma protection Provide barrier to pathogens Allow gaseous exchange Water proof Non adherent Maintain moist wound healing environment 32. The Compendium of Wound Care Dressings inMalaysia, Volume 2 , Harikrishna K.R Nair