Wound management & dressings
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Wound management & dressings

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wound management, dressings type, dirty and clean wounds, presents plan to manage different types of wounds and options of available dressings.

wound management, dressings type, dirty and clean wounds, presents plan to manage different types of wounds and options of available dressings.

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  • When health care providers are seeking the “ideal dressing”, the following questions should be considered:- Does the dressing protect from secondary infection?- Does it provide a moist wound environment?- Does it provide thermal insulation?- Can it be removed without causing trauma to the skin?- Does the dressing remove/absorb drainage and debris?- Is it free from particulates and toxic products?

Wound management & dressings Wound management & dressings Presentation Transcript

  • Omer hashm H.O
  • Sugical wound Traumatic wound Untidy Tidy (incisional) (penetrating, lacerating. Degloving)
  • Untidy wound Tidy wound which heal themselves by primary intensin Othervise they undergo  Scars  Contractures  Severe infections Tidy wound <6hrs.. Primarily closed or delayed primary closure after 3-5 days …untidy wound dealt with secondary closure, culture sensitivty done, antibitics and dressing
  • Size, dep th & location Lab tests: HISTORY examination WOUND ASSESMENT WOUND BED SURROUNDING skin
  • 1.Sloughy wound • Dead cells accumulated in exudate Aim: to liquefy slough and aid its removal 2.Necrotic wound •Aims: • to debride and remove eschar
  • 3. Infected wound •Aims: reduce exudate, odour and promote healing 4.Granulating wound  Aims: support granulation, protect new tissue, keep moist
  •  PRIORITIES -Correct Etiology -Provide Systemic Support -Use appropriate therapy • GOAL -Healing -Maintenance
  • Traditional dressings: Modern Moist Wound Dressings: • Gauze, lint and fiber products • Hydrocolloids • • • • • • • Foams Films Alginates/Hydrofibers Collagen Hydrogels Topical Antimicrobials Silicone Look how far we’ve come!!!
  • Autolytic Fillers Hydrating Primary Non-adhesive Active Absorbing Secondary Enzymatic
  • 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:
  •  Indications:  Superficial and full thickness wounds  Skin grafts, donor sites, burns, skin tears  Under compression for ulcers  Contraindications:  Dry wounds  Examples: Mepilex (Border), Allevyn (Plus Adhesive), Polymem, Biatain
  •  Indications:  Minor injuries (abrasions)  Post-op dressing over sutures  IV sites  Contraindications:  High exudate wounds  Fragile skin  Examples: Tegaderm, Opsite
  •  Indications:  Highly exuding wounds  Infected wounds (change daily)  Contraindications:  Dry wounds or wound with eschar  Aquacel, Melgisorb, Seasorb, Kaltostat
  • 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.
  • Processed Tissue  Primatrix®  Oasis® Acellular collagen dermis (fetal bovine origin) Acellular bovine graft (Bovine Small Intestinal Submucosa)
  •  Indications:  Dry wounds  Wounds with slough wounds  Wounds with eschar  Over tissues and tendons to prevent drying  Contraindications:  High exudate wounds  Examples: Solosite, Woun’ Dress, SkinTegrity
  •  Chemically inert, adverse effects rare  Designed to be removed without trauma or pain  Protect friable or newly healed tissue from injury  Less trauma to periwound  Examples: Mepilex, Allevyn Gentle
  •  Enzymatic Viridine-strptokinase  biological maggots
  •  Bacteriocidal:  Silver  Honey  Cadexomer iodine  Bacteriostatic:  Methylene Blue and Gentian Violet  Xeroform
  •  Antimicrobial action through (+) silver ion  Effective when in contact with wound fluid  Consider:  Kill rate AND sustained release rate  Testing Methods: Simulated wound fluid, saline  Delivery methods: foams, gels, alginates, hydrofibers, creams  (SSD - approved for burns, only)
  •  Hydrogen peroxide  Acetic acid  Effective against Pseudomonas aeruginosa  Diguanides (Chlorhexidine)  Sodium hypochlorite (Dakin’s)  Not recommended unless suitable are unavailable  Povidone Iodine
  • Usually Type I bovine or avian or type III porcine collagen Indications:   Partial & full thickness wounds Minimal to moderate drainage  Contraindications:    Eschar covered Full thickness burns Sensitivity to contents
  • Based on amount of drainage and presence of infection  Infected wounds need to be monitored daily  Heavily draining wounds may need to be changed 2-3 times a day  As drainage decreases, increase time between dressing changes