Wound care


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this is presentation talks about basic & updated advanced wounds care,,,,,,,2nd presentation in my internship..i hope you will get benefit from it ......Dr/ Wadie Madi

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Wound care

  1. 1. Wound Care Prepared & presented by: Dr :WADIE MADI ‫د‬:‫مادي‬ ‫وديع‬ General Surgery Department. Abosleem Trauma Hospital.  UNIT C. THURSDAY 24th/June/2014
  2. 2. Skin: structure and function: General Functions: Each skin layer has its own unique function: Epidermis = protection Dermis = nourishment of epidermis Hypodermis = Composed mostly of adipose tissue insulation.
  3. 3. Skin: structure and function Skin: structure and function: Protects deeper tissues from: Mechanical damage ( bumps & cuts). Chemical damage (acids & bases). Bacterial damage. Thermal damage (heat & cold). Ultraviolet radiation (sunlight).
  4. 4. Background: A wound can be defined as: “A cut or break in the continuity of any tissue, caused by injury or operation”
  5. 5. Classification of Wounds: Acute Wounds Cuts,Abrasion ,Lacerations Contusions Pucnture Skin flaps and Bites benbow ( 2005) They passes through the normal healing process readily Chronic Wound Wounds Fail to pass through normal healing process Any wound >3 months considered chronic wound
  6. 6. Wound Types and Characteristics CLOSED • Contusion ( Bruise) – Tissue injury without breaking of skin. Purple contusion 5x7 cm on left face(see figure) •Hematoma – Tissue injury that disrupts a blood vessels; pooling of blood under the unbroken skin hematoma on left face (see figure) •Sprain –twisting of a joint with partial rupture of its ligaments; causes swelling.
  7. 7. OPEND •Incision (Surgically) made separation of tissues with clean, smooth edges. (Approx.3-inch incision on R lower quadrant of abdomen well approximated clean and dry with sutures intact(see figure). •Laceration – Traumatic separation of tissues with clean, smooth edges 2 in jagged (pointy, uneven) laceration app 4 cm deep on Lt sole foot.(see figure)
  8. 8. . OPEND •Abrasion- Traumatic scraping away of surface layers of skin. (raw appearing abraded area diameter on lateral aspect of lower leg).(see figure) •Puncture – Wound made by sharp, pointed object through skin or mucous membranes and underlying tissue, (Small circular entry wound on Rt palm from sharp pointing nail see figure)
  9. 9. OPEND: Penetrating- Variable -size open wound through skin and underlying tissues made by a bullet , metal or wood fragment may extend deeply into body Jagged Deep wound 10cm in posterior on L leg(see figure). •Avulsion – Tearing away of a structure or a part, such as a fingertip, accidentally or surgically.(Avulsion of L leg from Vent Aspect. Attach only by skin.)
  10. 10. OPEND: •Ulceration – Excavation of skin and/or underlying tissue from injury or necrosis. (Ulceration on L sole foot 4 cm x 5 x 2 cm deep. Yellow drainage present. Wound edges reddened) see figure below:
  11. 11.  Wounds according to the depth: -Superficial Involves only the epidermis Injury is usually result from fiction, shearing (cut) or burn. -Partial Thickness Involves the epidermis and the dermis, Wounds heal more quickly. -Full Thickness Involves the epidermis, dermis, fat, fascia and exposes bone In order to heal, all dead tissue must be removed so that granulation tissue can gradually fill in the defect.
  12. 12. 1-serous -clean, watery. 2-Purulent - thick, yellow, green, tan or brown. 3-Sanguineous - bright red, indicative of active bleeding. 4-Serosanguineous -pale, red, watery mixture of serous and sanguineous. Types of wound drainage:
  13. 13. Wound Healing
  14. 14. Wound Healing: -All wounds heal following a a specific sequence of phases which may overlap. -The process of wound healing depends on the type of tissue which has been damaged and the nature of tissue disruption. -The phases are: 1-Inflammatory phase 2-Proliferative phase 3-Remodeling or maturation phase
  15. 15. injury Exposure of plasma to injured site Release of Histamine Capillary Permeability Edema Rubor (Redness) Tumor ( Swelling) Prostaglandin Dolor ( Pain) Vasodilatation Calor ( Heat) Inc bld Flow Activation of Hageman Factor
  16. 16. Phases of wound Healing: 1-INFLAMMATORY PHASE: Starts immediately after injury and lasts 3-6 days or 4-6 days. (2 major processes occur during this phase: A-Hemostatic and B-phagocytosis A- Haemostatic Tissue and capillaries are destroyed, plasma and blood leaks. Area blood vessels constrict, platelets aggregates and bleeding stops, scabs ( rough protective crust) forms, preventing entry of infectious organisms. B- Inflammation & Phagocytosis Characterized by oedema, erythema, pain, temperature increase blood flow, to wound resulting localized redness and edema, attracts WBC and wound growth factors. ( Wbc arrive-clear debris from wound).
  17. 17. 2- PROLIFERATIVE PHASE -extends from day 3 to about day 21 post injury. -Macrophages continue to clear the wound debris, Stimulates Fibroblast to synthesize collagen 9 main ingredient For tissue scaring) -(New capillary networks are formed). 3- REMODELLING OR MATURATION PHASE -final healing stage may continue for I year or more. -Remodelling of scar tissue to provide wound strength. Cont..Phases of wound Healing:
  18. 18. Natural wound healing process A B C
  19. 19. Acute Wounds Haemostasis & Inflammatory Phase Proliferative Phase Proliferation, Granulation Remodelling Phase Healed Wound
  20. 20. Types of wound healing: 1-first intention healing: partial thickness wounds. - a clean incision is made with primary closure, minimal scarring. -expected when the edges of clean surgical incisions are sutured together, tissue loss is minimal or absent if the wound is not contaminated with microorganism. e.g.-abrasion or skin tear. 2-second intention healing: -granulation. -accompanies traumatic open wounds with tissues loss or wounds with a high microorganisms count. -go through a process involving scar tissue formation a heal slowly because of the volume of tissue needed to fill the defect. e.g.-contaminated surgical wound, pressure ulcer.
  21. 21. Note also there is: (Delayed primary healing If there is high infection risk – patient is given antibiotics and closure is delayed for a few days e.g. Bites) 1-Immune status. 2-Blood glucose levels (impaired white cell function). 3-Hydration (slows metabolism). 4-Age. 5-Lifestyle- enhances bld circulation. 6-Nutrition . 7-Blood albumin levels (‘building blocks’ for repair, colloid osmotic pressure - oedema). 8-Oxygen and vascular supply. 9-Medication- Corticosteroids (depress immune function). Factors affecting wound healing:
  22. 22. A- Acute Wounds
  23. 23. -heal very easily. -It passes phases of wound healing. -Inflammatory phase. -Collagen building phase. -Remodelling Phase.  Aim of management: -Healing without complications such as infection and disfiguring. -(Wound care) includes: 1-Remove FB 2-Dry or wet to dry dressing to cover the wounds 3-Suturing if acute. 4-Bites -give Prophylaxis. A- Acute Wounds:
  24. 24. > Uses of ABO in Acute wounds Only indicated if contaminated or evidence of infection is demonstrated. >Evidence of infection (local) -Redness -Warmth -Swelling -Tenderness -Local Lymphadenopathy. Note: (Acute wounds with abscesses if they are large need to be drained, Smaller once – can manage with antibiotics).  Betadine*, Hydrogen Peroxide*, Saline, Spirit can be used to cleanse the wound . Acute Wounds
  25. 25.  Healing of acute wound : -Wounds with minimal gaping – heals readily with scarring. -Wounds with gaping or skin loss – heals with Scar tissue formation and retraction. Q1- if there is no improvement ??? Q2-When Does a Wound Become Chronic? (healthy individuals with no underlying factors an acute wound→ heal within three weeks remodelling → over the next year or so...) NOTE: When wound does not follow the normal trajectory it may become stuck in one of the stages and the wound becomes chronic. Acute Wounds
  26. 26. B- Chronic wounds
  27. 27. Chronic wounds Working Definition: wound lasting >3 months Chronic wound – Fail to heal due to various local and systemic causes. -Healing process arrests at different levels of healing. -Wound may appear at different colours. -Remains at same stage without progressing to wound healing. -Often an underlying cause remains undetected.
  28. 28. Chronic wounds The wound healing cascade impairs and arrests at different stages Hemostasis Platelet Aggregation Neutrophil Immigration Monocyte Immigration Granulation Re-epithelialization Wound Closure Scar Formation Minutes Hours Days Weeks Months Years Time CHRONIC WOUND
  29. 29. Local and systemic factors that impede wound healing • Local factors • Inadequate blood supply ** • Increased skin tension • Poor surgical apposition • Wound dehiscence • Poor venous drainage ** • Presence of foreign body and foreign body reactions • Continued presence of micro-organisms & Infection ** • Excess local mobility, such as over a joint • Systemic factors • Advancing age and general immobility ** • Obesity *** • Smoking • Malnutrition *** • Deficiency of vitamins and trace elements *** • Systemic malignancy and terminal illness Shock of any cause • Chemotherapy and radiotherapy • Immunosuppressant drugs, corticosteroids, anticoagulants • Diabetes and CRF***
  30. 30. Chronic Wounds Appearance approach has been criticised for being too simplistic as wound healing is a continuum and wounds often contain a mixture of tissue types.
  31. 31. Wound healing continuum Wound Healing Continuum (Gray et al. 2005) have been developed. This tool incorporates intermediate colour combinations between the four key colours
  32. 32. Common Chronic Wounds
  33. 33. Common Chronic Wounds Pressure Diabetic / Neuropathic Arterial Venous Surgical
  34. 34. Pressure Wounds
  35. 35. Pressure Wounds This staging system was developed by the NPUAP (National Pressure Ulcer Advisory Panel) and classifies only pressure ulcers based on anatomical depth of soft tissue damage.
  36. 36. Normal Skin
  37. 37. Stage 1 Appears as defined area of persistent redness in lightly pigmented skin, whereas in darker skin tones, this ulcer may appear with persistent red, blue or purple hues. If it doesn’t become pale with pressure aka blanch, this is considered a Stage I pressure ulcer.
  38. 38. Pressure on anterior tibialis tendon from compression wrap applied incorrectly Stage 1
  39. 39. Stage 2-Partial thickness skin loss involving epidermis, dermis, or both. The ulcer is superficial and presents clinically as an abrasion, blister or shallow crater. Pink Partial Painful No slough, eschar or undermining Stage 2
  40. 40. Stage 2
  41. 41. Stage 3- Full thickness skin loss involving damage to, or necrosis of, subcutaneous tissue that may extend down to but not through, underlying fascia. The ulcer presents clinically as deep crater with or without undermining of adjacent tissue. Stage 3
  42. 42. Stage 3
  43. 43. Stage 4  Stage IV—Full thickness skin loss with extensive destruction, tissue necrosis, or damage to muscle, bone or supporting structures (ie. Tendon, joint capsule) Undermining and sinus tracts may be associated w/ stage IV ulcers Can differentiate from stage III ulcers because it will go PAST the Fascia.
  44. 44. Stage 4 Plantar heel: past subcutaneous level and goes to the calcaneous bone Sacrum, eschar, past sub- cutaneos tendon exposed
  45. 45. Deep Tissue Injury Purple or very dark areas that are surrounded by profound redness, edema, or induration suggest that deep tissue damage has already occurred and additional deep tissue loss may occur.
  46. 46. Unstageable • The deepest level of tissue must be visible in order to stage a pressure wound.
  47. 47. Management of Pressure Ulcers Offload Dress Protect Nutrition Debride
  48. 48. Group 1 Pressure Relief Group 1 mattress overlays preventative (Qualifications): 1. Completely Immobile Or 2. Limited mobility 3. Any stage pressure ulcer on the trunk or pelvis. (plus 1 of the below) 4. Impaired nutritional status. 5. Fecal or urinary incontinence. 6. Altered sensory perception. 7. Compromised circulatory status.
  49. 49. Low Air Loss/Alternating Pressure Mattress (Aggressive pressure ulcer treatment) Qualifications: (1 large or multiple stage 3 or 4 pressure ulcer(s) on trunk or pelvis) Or (Recent flap or skin graft for pressure ulcer). Group 2 Pressure Relief
  50. 50. Wheelchair Cushion
  51. 51. Diabetic foot ulcer
  52. 52. Etiology: Diabetic Facts: Diabetic foot ulcer: 7th leading cause of death in the USA 16 million (6% of population) people in the USA have diabetes Each year: 798,000 new cases of DM diagnosed 15% of all diabetics will develop diabetic foot ulcers 14-20% patients with DFU require amputation
  53. 53. Wagner Staging
  54. 54. Wagner Staging Grade 0 Grade 1 Grade 2Pre-ulcerative callus, no open lesion Superficial diabetic Foot ulcer Penetrates to ligament tendon, bone, joint, fascia NO Abscess, NO Osteo
  55. 55. Wagner Staging Grade 3 Grade 4 Grade 5 Deep Ulcer With Abscess/Oste oarthritis Gangrene portion of Midfoot Extensive Gangrene of whole Foot. ONLY treatable with amputation
  56. 56. Etiology: Corns and Calluses Nails: Thickened or Atrophic, Ingrown ,Color of nail bed, Discharge, Fungal infections Edema: poor fitting shoes, impedes healing Pulses Color & temperature of feet HgbA1c Goal for HgbA1c of <7 Assessment
  57. 57. Etiology:Treatment of DFU Blood sugar CTRL Offload Dress Manage Bacteria HBOT (if criteria met) Debride Re- Vascularize
  58. 58. Lower Extremity Ulcers
  59. 59. Arterial Insufficiency
  60. 60. 1-Arterial
  61. 61. Etiology: Intermittent claudication to sharp, unrelenting pain. Diminished or absent pulses. Pallor and coolness. Loss of hair. Tight shiny skin. Thickened nails. Characteristics of Arterial Insufficiency
  62. 62. Characteristics of Arterial ULCER Located in areas of pressure, tips of toes Very painful. Deep, may involve joint. Usually circular in appearance. Wound base pale to black. Little, if any, edema
  63. 63. Pain Intermittent claudication – crampy pain associated with activity. Rest Pain. Pulses. Skin appearance. Skin temperature. Edema. Hair Growth on Toes. ABI’s, Waveforms. Assessment
  64. 64.  ABI 0.9-1.30 Normal Study  ABI 0.8 - 0.9 moderate PVD  ABI 0.5 - 0.8 claudication  ABI < 0.5 critical ischemia  Always check ABI with LE ulcers Ankle—Brachial Index (ABI)
  65. 65. Etiology:Treating Arterial ulcer Eliminate Cause Pain ControlMoist Wound Care Debridement
  66. 66. Medical treatment ACE Inhibitors—(Lisinopril, Captopril, etc). (Vasodilators & Decrease Plaque Formation) Pletal (Cilostazol). (Relaxes smooth muscle & vasodilators.).
  67. 67. Venous Insufficiency
  68. 68. Achy, cramping pain Pulses present Hyperpigmentation of skin Lots of edema Inverted Champagne Leg Lipodermatosclerosis— tissues become ´woody´ in texture and the leg narrows near the ankle Venous Insufficiency Characteristic
  69. 69. Irregular Wound Edges. Skin scaling. Moderate to heavy exudate. Partial to full thickness. Malleolus region. Venous Ulcer Characteristics
  70. 70. Elimination of Edema -Compression -Elevation.  Debridement.  Moist Wound Care. Skin Care—dermatitis. Management of Venous Disease
  71. 71. Non-Healing Surgical Wounds
  72. 72. Surgical Wound Complication Infection Dehiscence
  73. 73. Treatment of Surgical Wound Heal Debride Moist Wound Care Specialist Eliminate Cause sutures mesh infection
  74. 74. First…Listen to Your Patient…..
  75. 75. Aetiology Wound bed ,necrosis granulation Wound edges Surrounding skin: colour, moisture, Labs investigation Signs of infection Odour or exudate Size, depth Location WOUND ASSESSMENT Assessment
  76. 76. Lab Work – CBC, HgbA1C, Albumin. Vascular Testing - Doppler, Angiography, measures, Arteriogram. Infection Assessment - X-ray, Bone Scan, Tissue Biopsy, MRI.  Physical Assessment – Vital Signs, Pain, Weight, Psychological, Community Resources. In Addition to Wound Measurements…
  77. 77. Basic Wound Care Assessment. Cleaning &Covering. Dressings. Debridement. ABO ?
  78. 78. Wound Dressing
  79. 79. Holistic Care Treating the Whole patient versus treating the Hole in the patient
  80. 80. DRESSINGS - material applied to wound with or without medication, to give protection and assist in healing. (-what are the purposes?) Protect from contamination. Prevent trauma. Absorbs drainage. Debrides. Provides medication, moist healing environment, etc. When picking out your dressings, remember the Cardinal Rule: (Keep Moist tissue Moist and Dry tissue Dry!) Wound Dressing:
  81. 81. 1-DRY TO DRY DRESSINGS -used primarily for wounds closing by primary intention. -offers good protection, absorption & provide pressure -they adhere to the wound surface when drainage dries. - when remove can cause pain and disruption of granulation tissue. -What are the types of dressings?
  82. 82. 2-WET TO DRY DRESSINGS -used for untidy or infected wounds that must be debrided and closed by secondary intention.  how can it be done? - gauze saturated with sterile saline or antimicrobial sol's. is packed into the wound, the wet dressing are then covered by dry dressings (Q-when to changed?) (As-when it becomes dry.)
  83. 83. 3-WET TO WET DRESSINGS -used on clean open wounds or on granulating surfaces. -provide a more physiologic environment (warmth moisture) which can enhance the local healing processes and assure greater patient comfort. -surrounding tissues can become ulcerated. (high risk for infection).
  84. 84. Examples of methods used in dressing Hydrocolloid. Hydrogel. Calcium alginate. Foam. Collagenase. Antimicrobials.
  85. 85. Hydrogels are indicated for management of pressure ulcers, skin tears, surgical wounds, and burns, including radiation therapy burns. Because they contain up to 95% water, hydrogels cannot absorb much exudate and should be reserved for dry wounds or wounds with minimal to moderate drainage. 1-Hydrogel Dressings:
  86. 86. -Because they are occlusive, hydrocolloid dressings do not allow water, oxygen, or bacteria into the wound. This may help facilitate angiogenesis and granulation. Hydrocolloids also cause the pH of the wound surface to drop; the acidic environment can inhibit bacteria growth. Like hydrogels, hydrocolloids can help a clean wound to granulate or epithelialize and encourage autolytic ( distruction of cells by own enzymes) debridement in wounds with necrotic tissue. However, because of their occlusive nature, hydrocolloids cannot be used if the wound or surrounding skin is infected. 2-Hydrocolloid Dressings:
  87. 87. Hydrocolloid dressings
  88. 88. 3-Alginate Dressings : Used in wounds with moderate to heavy drainage, the alginate forms a gel when it comes in contact with wound fluid. Capable of absorbing up to 20 times its weight in fluid, an alginate can be used in infected and noninfected wounds. Because an alginate is highly absorbent, it should not be used with dry wounds or wounds with minimal drainage; it could dehydrate the wound, delaying healing.
  89. 89. Alginate Dressings
  90. 90. Indications: Highly exudative wound requiring a non-stick surface (e.g. venous stasis) Highly absorbent (20 times weight) Non-adherent wound contact layer, hydrocellular foam, waterproof outer layer. Allows for autolytic debridement and gaseous exchange. Can be left in place for 72 to 96 hours. 4-Foam:
  91. 91.  Explain the procedure to the patient.  Hand washing before and after the procedure.  Clean from least contaminated to the most contaminated area.  Use separate cotton for each stroke.  Start from the center going outward.  Observe aseptic technique. Wound dressing: A-Principles
  92. 92.  Sterile gloves  Picking forcep  Dressing forcep  Bandage scissor  Adhesive tapes  Dry cotton balls  Waste receptacle  sterile gauze B-Equipment:  Cotton balls with cleanser  Cotton balls with antiseptic  Normal Saline Solution (NSS) Wound dressing:
  93. 93. C-Procedures: include(14 steps) 1-Check physician's order for specific wound care and medication instructions.  Helps to plan for proper type and amount of supplies needed. Wounds dressing:
  94. 94. 2-Secure equipment and wash hands thoroughly. To save time and effort. Reduces transmission of pathogen
  95. 95. 3- Assess the existing dressing  Indicates types of dressing or applications to use.
  96. 96. 4-Explain the procedure to the patient and instruct Pt not to touch wound area or sterile supplies.  Decreases anxiety and to gain cooperation. Sudden unexpected movement on Pt‘s part could result in contamination of wound and supplies.
  97. 97. 5-Loosen and remove the dressing with the use of the dressing forcep.( If the dressing adheres to the wound, loosen it by moistening with sterile NSS). Microorganism can be transferred by direct contact from dressing to hands. An intact scab is a body defense and can be damage if not handled gently.
  98. 98. 6-Observe the dressing for the amount type, color and odor of the drainage.  Provides estimate of drainage amount and assessment of wound's condition.
  99. 99. 7. Discard the soiled dressing in the waste receptacle.  Reduces the transmission of microorganism.
  100. 100. 8-Clean the wound aseptically using the dressing forcep from the center going outward in circular motion with: A. Betadine cleanser B. Dry gauze C. Betadine antiseptic solution (use each gauze for only one stroke)
  101. 101. 9-Apply a new dressing by gently placing the gauze sponges at the wound center and moving progressively outward to the edges of the wound site.  Promotes proper absorption of drainage and protects wound from entrance of microorganism.
  102. 102. 10. Secure the edges of the dressing to the patient’s skin with strips of adhesive tapes.  Ensures that dressing remains intact and covers wound.
  103. 103. 11-Make the patient feel comfortable and tidy the unint.  Promotes Pt's sense of well-being. Enhances comfort.
  104. 104. 12-Do the aftercare of the equipment. Soak the dressing forceps in 5% lysol solution for 30 minutes, then wash them with soap and water, Rinse them then dry ,Send them for sterilization..
  105. 105. 13. Wash hands(Prevent spread of microorganism). 14-Chart: site of wound, character of wound/ discharges, treatment given if any(e.g. ointment used) and reaction of patient.  For proper documentation and legal purposes.
  106. 106. Growth Factors Bioengineered Tissue. Curative Surgery. Cellular Tissue Products. Hyperbaric Medicine. Advanced Wound Care
  107. 107. Growth Factors Indication: Diabetic foot ulcer Activates endothelial cells and fibroblasts Stimulates vascular proliferation, migration, new blood vessel formation People who use 3 or more tubes of REGRANEX® Gel may have an increased risk from cancer. Can be very effective Have a new “360” program to help patients obtain medication and monitor progress.
  108. 108. Oxidized Regenerated Cellulose (ORC) Indicated in Stalled Wounds ORC inactivates MMPs and Elastace Damaged tissue Cytokines Excess proteases
  109. 109. Day 1 -Prisma (O.R.C) -Silver Foam. -3 layer Compression. 4 Week Has decreased more than half in wound surface area with Continue same care 7 Week Resurfaced Measured for Compression Stockings (ORC) VSU
  110. 110. Cellular Tissue Products (CTP) So many, so little time Apligraf Dermagraf Oasis Graft Jacket Primatrix Integra And so many more….
  111. 111. Day of application 2 Days post Application 4 weeks post initial App 2 wks s/p 2nd Oasis Application Cellular Tissue Products (CTP) VSU
  112. 112. Hyperbaric Medicine (HBOT)
  113. 113. (HBOT) : Hyperbaric Oxygen Therapy (HBOT) is breathing 100% oxygen while the entire body is pressurized to a point greater than sea level What Is It? This is usually 2to 2.4 absolute atmospheres (the equivalent of the pressure exerted by a33-45 foot dive into sea water)
  114. 114. Monoplace Chambers
  115. 115. Multiplace Hyperbaric Chamber
  116. 116. UHMS Indications for HBOT 1-Air or Gas Embolism. 2-Carbon Monoxide Poisoning(Co Poisoning Complicated By Cyanide Poisoning). 3-Clostridial Myositis and Myonecrosis (Gas Gangrene). 4-Crush Injury, Compartment Syndrome and Other Acute Traumatic Ischemia. 5-Decompression Sickness. 6-Arterial Insufficiencies: Central Retinal Artery Occlusion. Enhancement of Healing In Selected Problem Wounds. 7-Severe Anemia. 8-Intracranial Abscess. 9-Necrotizing Soft Tissue Infections. 10 -Osteomyelitis (Refractory). 11 -Delayed Radiation Injury (Soft Tissue and Bony Necrosis). 12 -Compromised Grafts and Flaps. 13 -Acute Thermal Burn Injury .
  117. 117. Adjunctive HBOT and Problem Wounds HBOT is only one component of a comprehensive wound healing program. Non-healing wounds are evaluated to determine underlying conditions which might interfere with healing. More conservative measures should be tried first.
  118. 118. What We Will Cover Today? Radionecrosis. Failing Graft/Flap. Gas Gangrene. Diabetic Foot Ulcer. Arterial Insufficiency.
  119. 119. Radionecrosis:  Vascular Changes from Radiation:  Edema .  Medial thickening (progressively depletes the blood supply to the irradiated tissue).  Collagen deposition may also cause severe scarring and further blood vessel obliteration, resulting in tissue hypoxia and necrosis.  Effects of Ionizing Radiation on the Cell:  Rapid cell death with heavy doses.  DNA Synthesis impaired, mitosis delayed.
  120. 120. Soft Tissue Radionecrosis Radionecrosis from treatment for Cancer of Larynx 05/02/02 Same neck, 07/09/02 after 40 hyperbaric treatments
  121. 121. Failing Flap Long-term survival of skin grafts and flaps depend on angiogenesis. When the wound bed does not have enough oxygen supplied the graft may partially fail. HBO2 can help by assisting in the preparation and salvage of skin grafts and compromised flaps.
  122. 122. Gas gangrene infection Clostridium bacteria. High amounts of oxygen can inhibit the replication, migration, and production of endotoxin. Advantages of using HBOT as adjunct to for gas gangrene: life-saving because exotoxin production is rapidly halted. limb and tissue-saving. preventing limb amputation that might otherwise be necessary.
  123. 123. Diabetic Foot Ulcer: Wagner Grade 3. Used in conjunction with standard wound care, offloading. Improved results compared to routine wound care.
  124. 124. Tissue Hypoperfusion Hypoxia Infection Arterial Insufficiency
  125. 125. Arterial Insufficiency Left Lower Extremity Ulcer, before and after 40 treatments of HBOT
  126. 126. http://www.npuap.org/resources/educational- and-clinical-resources/pressure-ulcer- categorystaging-illustrations/ http://www.as.miami.edu/chemistry/20081MDC/2 085/Chap4_New/chap4.htm http://www.webmd.com/diabetes/guide/glycated- hemoglobin-test-hba1c http://sydney.edu.au/medicine/diabetes/foot/Pvd x1.html http://www.webmd.com/dvt/d-dimer-test-for- deep-vein-thrombosis http://rarediseases.info.nih.gov/gard/9671/lipoder matosclerosis/resources/1 References:
  127. 127. http://membership.uhms.org/default.asp? page=indications http://aawconline.org/ http://www.wocn.org/ http://www.nawccb.org/default.asp http://mkt.medline.com/clinical- blog/channels/clinical- solutions/understanding-the-role-of- outpatient-wound-centers/ http://www.medscape.com/viewarticle/56 6133_8 References continued :
  128. 128. http://www.bayareahyperbarics.com/files/UHMS-lay- language.pdf http://www.surgerysupplements.com/hydrocolloid- wound-dressings-reduce-incision-healing-time/ https://woundcare-today.com/categories- pyramid/hydrogel-dressings References continued :
  129. 129. THANK YOU