Dr. Muhammad Muzzammil Sangani
Wound-definitions(Manley, Bellman, 2000)
- A loss of continuity of the skin or mucous membrane which may involve soft tissues, muscles, bone and other anatomical structure.
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- Any disruption to layers of the skin and underlying tissues due to multiple causes including trauma, surgery, or a specific disease state.
Wounds - Classification Intentional – results from planned treatment Unintentional wounds- results from unexpected
trauma…accident/ burns/ shooting Open -skin broken, portal of entry Closed – trauma from force, skin intact, soft tissue
damage, internal injury, possible bleeding Acute – goes through normal/timely healing process Chronic – fails to go through normal stages of
healing; no timely progress in healing
Wounds –Classification Superficial Penetrating Perforating
Laceration Puncture Abrasion Contusion
Clean Contaminated Infected Colonized
Pressure UlcersStage IStage IIStage IIIStage IV
Classification of surgical wounds according to the degree of contamination
Clean wounds: Operations in which a viscus is not opened. This category includes non- traumatic, uninfected wounds where is no inflammation encountered and no break in technique has occurred.
Clean-contaminated: A viscus is entered but without spillage of contents. This category included non- traumatic wounds where a minor break in technique has occurred.
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Classification of surgical wounds cont’d (Altmeire 1997, Ayliffe & Lowbury 1992, NAS 1996)
Contaminated: Gross spillage has occurred or a fresh traumatic wound from a relatively clean source. Acute non-purulent inflammation may also be encountered.
Dirty or infected : Old traumatic wounds from a dirty source, with delayed treatment, devitalised tissue, clinical infection, faecal contamination or a foreign body.
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Classification of wounds by depth
I. Partial-thickness: Confined to the skin, the dermis and epidermis.
II. Full-thickness : Involve the dermis, epidermis, subcutaneous tissue, and possibly muscle and bone
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Partial Thickness Full Thickness
Wound Assessment Appearance: granulation tissue, eschar,
slough, edema, tunneling, undermining, sinus tracts, color
Drainage: serous, serosanguineous, sanguineous, purulent and amount
Pain Size & location on body Presence of sutures/staples Presence of drains/tubes Wound edges
Wound assessment cont’d(Hahn,Olsen,Tomaselli, Goldberg ,2004)
1.Location2.Dimensions/Size3.Tissue viability4.Exudate/Drainage5.Periwound condition6.Pain7.Stage or extent of tissue damage , dictates
how often a wound is reassessed8.Swelling
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??Other Factors to Assess??
ODOUR LAB VALUES WHAT CAUSED THE WOUND? NEED FOR TETANUS? WHEN DID WOUND OCCUR? WHAT (IF ANY) TREATMENTS HAVE
BEEN TRIED?
Wound - Healing
Healthy body has the ability to restore itself, it depends on the amount of damage and state of health of the individual.
Referred to as regeneration (renewal) of tissue.
There are (3) phases of regeneration
PHASES OF WOUND HEALING
Healing is a quality of living tissue; it is also referred to
as regeneration (renewal) of tissue.
A. The inflammatory phase (3-6 days)
B. The regenerative (Proliferative) phase (day 4-day21)
C. The maturation (Remodeling) phase (day 21- 1 or
2yrs) (Manley, Bellman, 2000)
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Phase I Wound Healing Inflammatory phase- begins immediately after injury.
Includes Hemostasis (cessation of bleeding) due to vasoconstriction and platelet aggregation
Release of histamine, increasing capillary permeability (plasma leaking) and vasodilation
Also phagocytosis ( process when macrophages engulf microbes and secrete growth factors that promote angiogenesis) stimulates epithelial buds at the end of injured tissue resulting in increased circulation which sustains the healing process
The inflammatory phase (Initiated immediately after injury and last 3-6 days
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Injury /damage Cells
Blood Clot
Uniting the wound edges
Histamine
Vasodilation Permeability
Neutrophils& Monocytes
Oedema& Engorgement 0-3 days
Dry
-Dilated blood vessels-Microcirculation slow down
Phase ICONTINUED Wound Healing Inflammatory Response 4 Cardinal S/S
PainRednessHeatEdema
Phase I Inflammatory Response
SYSTEMIC RESPONSE
Elevated temperature Elevated WBC ( norms 5000-
10000 ) Malaise
Phase II Wound Healing
Proliferation (Fibroplasia) Phase - second phase , fibroblasts synthesize collagens which add strength to the wound. Begins 2-3 days after injury.
Thin layer of epithelial cells forms, blood flow is reinstituted. Tissue forms - known as granulation tissue. Translucent red color/fragile/bleeds easily.
The Regenerative (Proliferative) phase
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Blood vessels near the edge of the wound become porous
- Resultant tissue filling is referredTo as granulation tissue- process of wound contraction begins
Traps other blood cells & damaged blood vesselsBegin to regenerate within the wound margins
Allowing excess moisture to escape
Macrophage activity
Formation& multiplication of fibroblasts
migrate along fibrin threads
- Laying down of a ground substance- Beginning the synthesis of collagen fibers (granulation tissue )
Stimulates
WhichThis fibrous network
Resulting
Begins 2-3 days of injuryLasting up to 2-3 weeks
Phase III Wound Healing Maturation (Remodeling) Phase- final phase begins about 3 weeks after the injury and can extend up to 6 months up to one or two years after the injury.
Collagen originally in haphazard order remodels and reorganizes into a more orderly structure.
Scar (cicatrix) forms - avascular tissue , doesn’t sweat, grow hair, or tan.
Keloid- abnormal amount of collagen laid down, hypertrophic scar. ( common in dark skin).
Types of Wound Healing Primary Intention: clean, straight line, edges
well approximated with sutures, rapid healing
Secondary Intention: larger wounds with tissue loss, edges not approximated, heals from the inside out, granulation tissue fills in the wound, longer healing time, larger scars
Tertiary Intention: delay 3-5 days before injury is sutured, greater access for pathogens to invade, greater inflammation, more granulation, larger scars .
Healing GI tract- scar tissue can cause ADHESIONS which
may lead to pain and alteration in bowel elimination
Bone healing-1st stage is soft tissue healing. Blood clots occur between the ends of the bones. Granulation tissue then forms called procallus. 2nd stage-osteoblast enter the area and form cartilaginous tissue called callus.(similar to bone except it does not have calcium salt. Tends to be softer). 3rd stage-tissue remodels and calcium salt is laid down resulting in stronger bone.
Healing Nerve tissue healing: Central nerves do not heal Peripheral nerves have shown to regenerate. Schwann cells form a sheath around the nerve fiber
which is the key to regeneration. The avg regeneration is 2mm/day.
If the connective tissue growth occurs over the path of the nerve fibers, the growth will be stopped. Hence there needs to be careful alignment of the nerve fibers at the close of a surgery to ensure healing.
Factors influencing healing of a wound Site of the wound Structures involved Mechanism of wounding
IncisionCrushCrush avulsion
Contamination (foreign bodies/bacteria) Loss of tissue Other local factors
Vascular insufficiency (arterial or venous)Previous radiationPressure
Factors influencing healing of a wound con’t Systemic factors
Malnutrition or vitamin and mineral deficienciesDisease (e.g. diabetes mellitus)Medications (e.g. steroids)Immune deficiencies [e.g. chemotherapy, acquired
immunodeficiency syndrome (AIDS)]Smoking(ref: Bailey and Love)
Risk Factors Which Increase Patient Susceptibility to infection (Manley.K, Bellman. L,2000)
A- Intrinsic risk factors:1. Extremes age: Defined as “ Children aged 1 year
and under, and people aged 65 years and over’.2. Underling Conditions/Disorders
A. DiabetesB. Respiratory disordersC. Blood disorders
3. Smoking4. Nutrition and build
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Risk Factors Which Increase Patient Susceptibility to infection cont’d (Manley.K, Bellman. L,2000)
B- Extrinsic risk factors:1. Drug therapy as a risk factor: e.g. Cytotoxic
drugs2. Break in the integrity of the skin3. Items such as foreign bodies4. Bypassing of defense mechanisms through
devices e.g. Intubations
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S&S of Presence of Infection Wound is swollen. Wound is deep red in color. Wound feels hot on palpation. Drainage is increased and possibly purulent. Foul odour may be noted. Wound edges may be separated with dehiscence
present.
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Wound Complications Infection- S/S purulent drainage, pain, redness
around wound, edema, increased temp, elevated WBC
Hemorrhage – S/S large amts sanquineous drainage + other symptoms of hypovolemic shock.
Dehiscence- S/S wound edges pulling away; not well-approximated. Early sign = increasing serosanquineous drainage
Evisceration- S/S wound opens revealing internal organs. Emergency rx = sterile NS gauze to cover; prepare for OR
Psychosocial impact – Encourage verbalization of feelings; encourage self-care as tolerated
EviscerationDehisence
Types of Wound DrainageExudate is material, such as fluid and cells, that has
escaped from blood vessels during the inflammatory process and deposited in or on tissue surfaces. The Nature and amount of exudate vary according to: Tissue involved, Intensity and duration of the inflammation, and the presence of microorganisms.
1. Serous Exudate Mostly serum Watery, clear of cells E.g., fluid in a blister
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2. A purulent Exudate Is thicker than serous exudate because of the
presence of pus. It consists of leukocytes, liquefied dead tissue
debris, dead and living bacteria. The Process of pus formation is referred to as
suppuration, and the bacteria that produce pus are called pyogenic bacteria.
Purulent exudate vary in color, some acquiring tinges of blue, green, or yellow. The color may depend on the causative organism.
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3. A sanguineous (hemorrhagic) Exudate It consists of large amount or blood cells,
indicating damage to capillaries that is very severe enough to allow the escape of RBCs from plasma
This type of exudate is frequently seen in open wounds.
Distinguish whether the exudate is dark or bright. Bright indicate fresh blood, whereas dark exudate denotes older bleeding.
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Wound Drains Drains are used to keep body fluid away from the
wound so that effective healing can occur
There are several different types of drains
Drainage Tube Dressing (AV)
Penrose Drain Looks like a floppy macaroni noodle This drain is usually covered loosley with a topper
dressing Change the topper dressing frequently and weighs
the gauze and records this as output
Safety pinkeeps drainfrom slippinginto wound
Drain sponge
Jackson-Pratt Drain This drain looks like a gernade There is a plastic ball that is squeezed and the
end is closed. The drain will inflate itself (the squeezed ball opens up) and as it does, it pulls drainage away from the patient
This drain must be empties frequently in order to keep working
Hemovac Drain This drain looks similar to a frisby or a disc
pull the tab to empty the drain and then squeeze the disc down and plug it up.
Again, when the drain inflates, it pulls drainage away from the pt
This must be emptied several times to work effectively
Hemovac
The RYB color code(Stotts,1999)
This concept is based on the color of the open wound rather than the depth or size of the wound.
On this scheme, the goal of wound care is to protect ( cover) red, cleanse yellow, and debride black.
The RYB code can be applied to any wound allowed to heal by secondary intention.
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R=Red Y=Yellow B= Black
Red woundsRed wounds Usually in the late regeneration phase of tissue
repair (ie, developing granulation tissue) and are clean and uniformly pink in appearance
They need to be protected to avoid disturbance to regenerating tissue. Examples are superficial wounds, skin donor sites, and partial- thickness or second – degree burns.
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How to protect red wounds:Gentle cleansingAvoid the use of dry gauze or wet- to-dry saline
dressings.Applying a topical antimicrobial agent.Appling a transparent film or hydrocolloid
dressing.Changing the dressing as infrequently as
possible.49
Yellow wounds
Characterized primarily by liquid to semiliquid ”slough” that is often accompanied by purulent drainage.
Cleanses yellow wounds to absorb drainage and remove nonviable tissue. Methods used may include .Applying wet-to-wet dressing; irrigating the wound;
using absorbent dressing material such as impregnated nonadherent, hydrogel dressing, or other exudate absorbers; and a topical antimicrobial to minimize bacterial growth.
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Black WoundBlack Wound Covered with thick necrotic tissue or Eschar. e.g.. third degree burns and gangrenous
ulcer. Required debridement . When the eschar is removed, the wound is
treated as yellow, then red.
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Promotion of Wound Healing
Dressings: keep wound covered & clean Wound bed moist / Surrounding skin dry Debridement when necessary Remove exudate:
Drains, Wound VAC, Irrigation Pack wounds loosely Nutritional interventions
Debridement Methods
Surgical Mechanical Enzymatic ( proteolytic enzymes) Autolytic
Sharp Debridement This is the removal of necrotic tissue (non-living tissue) The use of sterile scissors, forceps or other
instruments are used This method is preferred when the wound is infected
because it helps the wound heal quickly This can be painful and the wound may bleed
afterward Can be done in the O.R. or at the bedside
Enzymatic Debridement This involves the use of topically applied chemical
substance that break down and liquefy wound debris
A dressing is used to keep the enzyme in contact with the wound and to help absorb drainage
This is used for people who can’t take the pain from the sharp debridement
Panafil Ointment is an enzymatic debriding-healing ointment which contains standardized Papain, Urea and Chlorophyllin Copper Complex Sodium in a hydrophilic base.
Enzymatic debridement
Autolytic Debridement This is a painless
physiologic process that allows the body’s enzymes to soften, liquefy and release devitalized tissue
It is used for people who have small infections
An occlusive dressing keeps the wound moist
Removal of tissue debris is slow in this process
Mechanical Debridement – 3 types of this
Type 1. This involves physical removal of debris This is done by applying wet-dry dressings The wound is packed with wet gauze and then 6-8 hrs
later, the gauze dries. Debris attaches itself to the wet and then dry gauze and is removed when the dressing is changed
This procedure can be painful and at times, it disrupts the new formation of granulation tissue
Mechanical Debridement 2. Hydrotherapy – the use of agitating water
contains antiseptic and softens the dead skin. Loose debris that remains attached, is then
removed by sharp debridement
Mechanical Debridement, type 3
3. Irrigation – technique for flushing debris
This technique is best used when granulation tissue has formed
Wound Dressing Principles
If exudate is present - Select one that absorbs exudate.
Keep wound bed moist but surrounding skin dry Pack wounds loosely to avoid pressure on new
granulation tissue Fasten securely using tape, binders etc…
OR self-adhesive type dressing materials.
Purposes of wound dressing1. To protect the wound from mechanical injuries2. To protect the wound from microbial
contamination3. To provide or maintain high humidity of the
wound4. To provide thermal insulation5. To absorb drainage and /or debride a wound
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6. To prevent hemorrhage (when applied as a pressure dressing or with elastic bandages).
7. To splint or immobilize the wound site and thereby facilitate healing and prevent injury.
8. To provide psychological (aesthetic) comfort.
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1980 2000
AdvancedMoist Wound HealingChronic & Acute
BC 1980
TraditionalGauze & TapeFirst Aid Dressings
2000+
AdvancedMoist Wound
HealingChronic & Acute
ActiveTissue
EngineeringGrowth FactorsAntimicrobials
Enzymatics
IN 1962 WINTER DEMONSTRATED THAT WHEN WOUNDS ON PIGS ARE KEPT MOIST, EPETHELIZATION IS ABOUT TWICE AS RAPID AS IN WOUNDS ALLOWED TO DRY BY DIRECT EXPOSURE TO AIR.
IN 1963 HINMAN AND MAIBACH CONFIRMED WINTER’S WORK ON HUMAN BEINGS.
MOIST WOUND HEALING IS TWICE AS FAST AS DRY WOUND HEALING
UNTIL MID 20TH CENTURY, DRESSING THAT PROMOTED DRYWOUNDS HAD BEEN THE MAINSTAT OF THE TREATMENT. STUDIES HAVE SHOWN THAT A MOIST WOUND ENVOIRMENT PROMOTE MORE RAPID HEALING.MOLECULAR AND CELL BIOLOGY IS PLAYING A MORE IMPORTANT ROLE IN DEVELOPMENT OF TISSUE REPAIRS METHOD.
Effect of air drying and dressings on the Effect of air drying and dressings on the surface of woundsurface of wound
Porcin modelPorcin model2.5 cm2.5 cm2 2 woundswoundsAfter 3 daysAfter 3 days
99 %99 %
41 %41 %
18 %18 %
Occlusiv dressingOcclusiv dressing
Air dryer (hot)Air dryer (hot)
Without any dressing (air exposed)Without any dressing (air exposed)
Dehydrated dermisDehydrated dermis
epidermisepidermis
exsudateexsudate
Wound Wound healinghealing
Moist wound healingMoist wound healing
Dry dermis
Dry exudate
Moist wound bed
Slow epithelial migrationBelow crust
dermisFast epithelial migration
On moist wound bed
epidermis
Occlusive dressing
Exposed woundStratum corneum
No crust or scabCrust
Or scrab
The Principal Reasons for Applying a Dressing
To produce rapid and cosmetically acceptable healing,
To remove or contain odour, To reduce pain, To prevent or combat infection, To contain exudate, To cause minimum distress or disturbance to the
patient, To hide or cover a wound for cosmetic reasons. A combination of two or more of the above.
Wound Wound DressingsDressings
Types of DressingALGINATEHYDROGELFOAM OINTMENT / CREAM / PASTE / LIQUID / SPRAY / POWDERCOLLAGENBIOLOGICSHYDROCOLLOID / HYDROFIBERCOTTON / ABSORBENT / GAUZE
Dressings for DRY wounds
Transparent: gas exchanged between wound & environment but bacteria prevented from entering. Creates moist healing environment Example: Tegaderm
Hydrogels: High water content enhances epithelialization and autolytic debridment.Needs cover dressing and wound edge barrierExample: Carrasyn
Wet – to- Moist Gauze dressings: keeps wound bed moist. Minimizes trauma to granulation tissues
Dressings for DRY wounds
Wet – to Moist Gauze
Dressings for MOIST wounds
Hydrocolloid: hydrophilic particles mix with water to from a gel... wound stays moist. DO NOT use in infected wounds.Example: Duoderm
Absorption Materials: beads, powders, rope or sheets that absorb large amount of exudateExample: Calcium Alginate
Foam: Made of hydrophilic material. Highly absorbent.Example: Allevyn
Dry Gauze: Can absorb wound drainage. Can be impregnated with agents to promote healing
Dressings for MOIST wounds
Wound colorBlack
)Eschar(Yellow
)Slough(Red
)Granulation(
HydrocolloidExduateQuantityHydrogeland transparent Film
Heavy Exduate
Moderat Exdudate
Little
Alginate and Absorbent Foam
Hydrogell and Absorbent Foam
Hydrocolloid
Selecting the correct dressing as Selecting the correct dressing as the wound changesthe wound changes
Wound conditionProduct selected why
Moist red
Pink/red
Exuding yellow
Hard dry black
Absorb exudate,autolytic Debridement
Hydrate,separate Eschar
Alginate xerogel
Amorphous Hydrogel
Hydrocolloid
Transparent
Film
Provide barrier &control humidity
Allow Epithelialization, Reduce shear
Wound Wound DressingsDressings Types of Dressing
Wound Wound DressingsDressings Composition of the dressing
Sodium CarboxymethylcelluloseGelatin, Pectin and Carboxy-methylcellulose Sea WeedPolyurethane, Polyacrylate Fibers, Soft SiliconeAnti-Microbial : Silver based, Polyhexanide, Betaine, Iodine etc.Collagen: Bovine, Porcine, Human and Type I, II, IV etc
Wound Wound Management Management Strategies - Strategies - DressingsDressings
Hydrogels
HydrogelsPlain Hydrogel is generally clear viscous gel made with condensed water or glycerin. Glycerin based Hydrogels are also available in a non-adhesive sheet or impregnated gauze form. Hydrogels are used on wounds with low to moderate exudates. A secondary dressing is always required when applying a gel or impregnated gauze. Hydrogel sheets are commonly used on the Radiation skin irritations.
Products classified as hydrating gels include DuoDERM Gel, Intrasite Gel, Comfeel Purilon Gel and Aquasorb Hydro Gel.
Purpose• Keep wound moist, prevent and protect it from desiccating• To promote autolytic debridement• Barrier against wound contamination from external sources
Hydrogels
Alginates
AlginatesAlginate is a naturally occurring polysaccharide found in brown seaweed. Alginate are non-toxic and soluble in body fluids, which interacts with the exudates from the wound to form a hydrophilic gel. Alginate dressings vary in absorbency but typically they will absorb up to 15-20 times their own weight in exudates. Alginate dressings are commonly used in moderate to high exudating wounds.
Products in the alginate category are Kaltostat and Kaltostat Fortex (Convatec), Biataine (Coloplast), Kalginate (DeRoyal).
Purpose:• Fill wound cavities• Absorb exudates in highly exudating wounds• Promote moist wound healing/manage moisture /prevent
maceration• Permit gaseous exchange
Alginates
Alginate : Indication• For moderate to heavily
exudating wounds• Help to debride (in addition
with mechanical debridement)
Alginate : Indication
•For moderate to heavily exudating wounds
• Help to debride (in addition with mechanical debridement
Foams
FoamsMost of the foam dressings are made of hydrophilic polyurethane, viscose and acrylate fibers or particles of superabsorbent poly-acrylate, or which are silicone-coated for non-traumatic removal. Foams are recommended for wounds producing low, moderate to heavy exudate.
Allevyn (Smith & Nephew) Baitain (Coloplast) are all foams Dressing.
Purpose:• Fill wound cavities• Absorb exudates in highly exudating wounds• Promote moist wound healing /manage moisture/prevent
maceration• Permit gaseous exchange • Provide thermal insulation • Barrier against wound contamination from external sources.
Foams
• For light to medium exuding wounds
• Granulating and epithelializating wounds
Foam dressing : Indication
For Cavity Wounds
Cavity Wounds(Healthy Granulation )
Hydrocolloids
HydrocolloidsHydrocolloids are a type of dressing containing gel-forming agents, such as sodium carboxymethylcellulose (NaCMC) and gelatin. The hydrocolloid dressing is occlusive or semi occlusive. impermeable to fluids and bacteria. Hydrocolloids are semi-permeable to gas and water vapor. Hydrocolloids are appropriate for wounds with light to medium exudates. Hydrocolloids should not be applied to infected wound or wounds with moderate to heavy exudates.
Products which are considered to be hydrocolloid include Comfeel (Coloplast), Restore (Hollister), Duoderm( ConvaTec).
Purpose• Hydrocolloids absorb liquid and form gels to
promote moist wound healing.• Barrier against wound contamination from
external sources.• To promote autolytic debridement• Require changing only every 2-4 days• Protect skin against shear & friction
Hydrocolloids
Hydrocolloid : Indication
For low to moderate exuding wounds
For clean, granulating, superficial wounds
With safe surrounding skin
Hydrocolloids : Advantage• Require changing only every
3 - 7 days• Provide effective occlusion
and barrier (prevent the spread of Infection
• Cost effective • More effective than
traditional dressings
1 week1 week
Extra-thinExtra-thin hydrocolloidhydrocolloid
Occlusive dressing
21 days
Diabetic ulcer for 5 month
Hydrocolloid
loids
Hydrocolloid
Semi-Permeable Membranesor Films
Semi-permeable membranes / FilmsSemi-permeable film dressings are synthetic adhesive film dressings that are waterproof but which are also permeable to limited oxygen and water vapor to and from the wound site.
Films are frequently used as IV dressing and for skin tears. Opsite (Smith & Nephew) and Tegaderm (3M) are all film dressing.
Purpose:• Promote moist wound healing• Promote autolytic debridement• Protect skin against shear & friction• Require changing only every 24-72 hrs.• Barrier against wound contamination from external sources.
Semi-Permeable Membranesor Films
.
- For low exuding superficial wounds. - Decrease pain at dressing removal.
URGOTUL
SILICONE DRESSING
Mepitel
Mepilex
CollagenCollagen Dressing / Extracellular Matrix (ECM)Collagen is one of the most abundant with its essential role in the wound management. Several different collagen dressings are available utilizing sources including porcine, bovine, equine or human. Collagen plays a critical role in all phases of wound healing homeostasis, inflammation, proliferation, and remodeling.
Purpose:• Promotes fibroblast production• Organize collagen fibers in the wound• Help preserve leukocytes, macrophages, fibroblasts, and
epithelial cells.• Assist in the maintenance of the chemical and thermostatic
microenvironment Regulate proteases (MMPs). Promotes granulation
Collagen
HydrofibersHydrofibers
Hydrofiber dressing is composed of sodium carboxy-methylcellulose fibers. Hydrofiber dressing is conformable, and capable of absorbing a large amount of drainage. Hydrofiber dressing transforms into a soft gel form after absorbing fluids, which creates a moist environment to support the body's healing process. Silver-impregnated hydrofiber dressings are commonly used due to their antimicrobial action.
Purpose:• Fill wound cavities• Absorb exudates in highly exudating wounds• Promote moist wound healing / manage moisture / prevent
maceration• Permit gaseous exchange • Antimicrobial effect
Hydrofibers
Hydrofibre : Aquacel• CMC fiber : gel formation• Same indications than
alginate• Non haemostatic
Impregnated GauzeImpregnated / Petrolatum/Antimicrobial
Gauze DressingGauze dressings infused with a variety of substances are also commonly used for the management of different types of wounds. Most commonly; Gauze saturated with the petroleum-derived, gelatinous substance petrolatum blend with 3% Bismuth Tribromophenate (Antimicrobial) is used to prevent, infection, unnecessary dressing adherence (stickiness) to the wound bed, and maintain a healthy and moist wound environment. This type of dressing is recommended for light exudative wounds.
Purpose:• Protective layer i.e. cover fascia, bone, tendon etc.• Absorb exudates in lightly exudating wounds• Promote moist wound healing • Permit gaseous exchange • Antimicrobial effect• Prevent dryness of the affected area
Impregnated Gauze
Impregnated Gauze
« Traditional dressing » Contact dermatitis
are frequent
• Adherent• Pain and bleeding at
removal
Impregnated Impregnated GauzeGauze
Silver DressingSilver Dressing
•SilverceSilvercell (Alginate+sliver) (Alginate+sliver)
•AquacelAquacel((Ag(hydrofibre+silvAg(hydrofibre+silver)er)
•ActicoatActicoat (Nanocrystalline (Nanocrystalline silver-based dressing)silver-based dressing)
Platelet-Derived Growth Factors(pdGF)• Activates endothelial cells and fibroblasts• Stimulates vascular proliferation, migration,
new blood vessel formation• Recruits smooth muscle cells and pericytes to
stabilize newly formed vessels
Oxidized Regenerated Cellulose (ORC)/Collagen
Modulates protease activity
Growth factor remains active while bound
Growth factors delivered back to wound over time
Modifies hostile proteolytic environment
of chronic wound Applied every 2-3 days
Wound Wound Management Management Strategies - Strategies - IrrigationIrrigation
Irrigations Cleanses a wound using pressure Sterile Normal Saline = usually prescribed Avoid caustic agents ie: peroxide, iodine etc. Pressure between 4-15 pounds per square inch
(psi) i.e. 60ml syringe with catheter tip
Wound Wound Management Management Strategies – Strategies –
Other therapiesOther therapies
Other Therapies Wound V.A.C. – negative pressure vacuum
assisted closure system. Removes drainage and helps wounds close.
Hydrotherapy – Pulse lavage, WhirlpoolAids in debridement and cleansing, warm water vasodilation.
Hyperbaric Oxygen Electrical Stimulation
Other Therapies
Electrical Stimulation:- electrical signals direct cell migration in wound healing
Bandages & Binders Secures dressings in place
Determine size needed
Outer covering must cover entire wound
Tape to secure (initial,date time)
Comfort Measures for Wound care patients
Heat & Cold Applications Ice Bag & Ice Collar Chemical Packs Compresses Aqua-thermia pads Soaks & Moist packs Therapeutic Baths
Heat & Cold Therapy Heat- reduces pain & promotes healing
through vasodilation Increases oxygen and nutrients to aid in
inflammatory response Reduces edema by promoting removal
of excessive interstitial fluid Promotes muscle relaxation
Heat & Cold Therapy Cold- decreases pain by vasoconstriction Decreased blood flow to the area decreases
inflammation and edema Raises the threshold of pain receptors thereby
decreasing pain Decreases muscle tension
Safety Precautions Heat & Cold Therapy
Very young and very old Peripheral vascular disease Decreased LOC Spinal cord injury Presence of edema and/or scar tissue NO LONGER than 20-30minutes at a time.
Rebound phenomena
Heat vs. Cold Heat Cold Provides warmth reduces fever Promotes circulation prevents swelling Speeds healing controls bleeding Relieves muscle spasms relieves pain Reduces pain numbs sensation
Cold Treatment (Ice Packs)
Come as disposable sacs that can fill, empty out and re-fill
These provide comfort to pts and have various uses
Moist Heat
Sitz Bath
A container is placed under the rim of the toilet seat to allow warm water to squirt onto the pt’s underside for example to alleviate hemorrhoids or vaginal tear after delivery
The water soothes the perineum, or anus
Heating Pad (K-Pad) This is a device used to provide comfort The machine is filled with water that heats and the the
water filters into a blanket and the pt can either sit on the blanket or lay the blanket over them
Temperature is pre-programmed to deliver one temperature, the water never seems to get warm enough
Heating Blanket Again, usually the pt can lay on this to
provide comfort
Chemical warm or cool packs
These provide temporary relief and may decrease swelling
These can be used if an IV falls out of place and the fluid is in between spaces causing pain
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