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