Basic information to clean and dress the wound. Assessment and deciding on suitable dressing items need more experience and knowledge.

1. CURRENT CONCEPTS IN
WOUND CARE

2. OUTLINE:
• Moist Wound Healing
• Acute vs. Chronic Wound
• Wound Bed Prep
• Pressure Ulcers
• Leg Ulcers
• Dressing Selection
• Cases

3. Moist Wound Healing:
• George Winter 1960’s
Advantages:
-inc.rate reepithelialization
-inc. production collagen
-inc. angiogenesis
-allows autolytic debridement
-Decrease pain
-Dry dressings peel off healing layers
-accelerates healing 50% vs.air dry

4. Acute vs. Chronic wound
Healing:

5. Acute Wound Healing:
• Orderly sequence Repair
• 4 Phases:
Hemostasis,Inflammation,Proliferation,
Maturation.
• Each Phase=Cell Type dominate
• Hemostasis=Plt.,Inflamm.=Neutrophil,
Prolif.=Fibroblast,Maturation
• All regulated by growth
factors,cytokines,&chemokines

6. Chronic Wound:
• Stuck in the Inflammatory Phase,defective
remodeling of ECM,fail to reepithelialize.

7. CHRONIC WOUND
• Usual Molecular & Cellular processes
disrupted
• Neutrophils dominate: release MMP’s in
excess-digest extracellular matrix
• Leaky capillaries- release excess
Fibronectin binds & inactivates growth
factors

8. Chronic Wound:
• Fibroblasts become senescent fail to
respond to normal wound healing signals
• Neutrophils continue to stimulated (by
systemic or local factors) and wound is left
in a viscous circle of inflammation.
• Other Chronic wounds are stuck in the
proliferative phase again due to
unresponsive cells

9. Wound Bed Prep

10. Wound Bed Prep.:
Goal: Convert the Chronic wound into an
Acute wound and allow normal healing to
take place.

11. Wound Bed Prep.:
Three Pronged Attack
1. Debridement
2. Decrease Bacterial Burden
3. Manage wound Exudate

12. Debridement:
Purpose: 1. To remove “Necrotic Burden”and
restore acute wound healing.
2. To allow proper wound
assessment.

13. Surgical Debridement:
Advantages:
• Remove large amounts
necrotic tissue fast.
• Allows bone, tissue cultures
• Leaves healthy vasc. Bed
Disadvantages:
• Painful
• Can remove too much

14. Enzymatic Debridement:
Collagenase selectively
digests collagen types
1 & 3 in necrotic
tissue
Advantages: Easy,Not
painful
Disadvantage: Slow

15. Decrease Bacterial Load:
• All Chronic wounds sit somewhere along a
bacterial continuum.
Contaminated Colonized
Increased
bacterial burden
Infected

16. Infection:
Risk = Bacterial x Virulence
Infection Burden Microorganism
Host Resistance

17. Infection Concepts:
• Host Resistance : Immunocompromised,
Malnutrition
• Bacterial Burden: >10 5th microbes/g
• Biofilm: Microcolonies of Bacteria secrete
protective glycocalyx

18. Manage Wound Exudate:
Chronic Wound Exudate :
Inhibits: Proliferation
Fibroblasts,Keratinocytes,Endothelial cells
Contains MMP’s,Serine Proteases
Fibrinogen &Fibrin bind and inactivate
growth factors

19. Hospital Wounds:

20. Pressure Ulcers: