Wound care for general practitioners and nurses
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Wound care for general practitioners and nurses
- 1. WOUND CARE FOR GENERAL PRACTITIONERS AND NURSES FACEBOOK: HAPPY FRIDAY KNIGHT THAILAND
- 2. OUTLINES • definitions • Normal wound healing process • Wound types and classification • Wound assessment • Wound care: • Basic fundamentals • Adjuncts to wound care
- 3. WOUND DEFINITIONS • Wound: • injury to the integument or underlying structure • result of individual cell death or damage • that may or may not result in a loss of skin integrity whereby physiological function of the tissue is impaired • Ulcer: • An interruption of continuity of an epithelial surface with an inflamed base • usually a result of an underlying or internal etiology
- 4. NORMAL WOUND HEALING PHASE • Coagulation • Immediate after injury • Activation of clot cascade to prevent further hemorrhage • Inflammation (0 – 7 days) • Inflammatory cells infiltration • Proliferation (4 – 21 days) • Granulation • Fibroblast migration • Remodeling (21 - 365 days) • Wound contraction and remodeling
- 5. NORMAL WOUND HEALING PROCESS
- 6. ABNORMAL WOUND HEALING • Excessive scar formation • Hypertrophic scar • keloid • Excessive regeneration • Psoriasis • granuloma • Inadequate regeneration • Bone nonunion • Corneal ulcer • Inadequate scar formation • DFU • Sacral decubitus • Venous stasis ulcer
- 7. WOUND CLASSIFICATION • Acute • sudden disruption of skin integrity; usually due to trauma or surgery • Chronic • wound that failed to proceed through an orderly and timely process to produce anatomic and functional integrity
- 8. ACUTE WOUND surgical traumatic True traumatic: Abrasion Laceration Cut Animal bite Puncture Gun shot stab burn
- 9. CHRONIC WOUND • VASCULAR ULCER: ISCHEMIC AND VENOUS STATIC • DIABETIC ULCER • PRESSURE ULCER • MALIGNANT ULCER • RADIATION ULCER • MIXED
- 11. WOUND ASSESSMENT • General assessment • Local wound assessment
- 12. WOUND ASSESSMENT: GENERAL • Identify underlying factors that affect healing process • Age • Comorbid • Medication • Obesity • Nutrition • Blood supply • lifestyle
- 13. WOUND ASSESSMENT: FACTORS AFFECTED HEALING • infection and foreign bodies • Ischemia and hypoxia • Arterial occlusive disease • Venous stasis • Metabolic condition • DM • Malnutrition • Macronutrients • Micronutrients • Trace element • Immunosuppression • CKD • Collagen vascular disease • radiation
- 14. LOCAL WOUND ASSESSMENT • Wound history (what, where, when, who, how) • Physical wound characteristics • Location, size, base • Pain • Wound bed
- 16. WOUND CARE
- 17. NUTRITION • Malnutrition hypoprotein delayed healing process • Add ไข่ 1 ฟอง/วัน หรือคำนวนตำมควำมต้องกำร
- 18. GLUCOSE CONTROL • Blood sugar > 200 : WBC dysfunction • Management: keep sugar < 200 SMOKING CESSATION • Smoking: risk factor for atherosclerosis
- 19. DEBRIDEMENT • Surgical: direct removal • Mechanical: force to remove debris • Fluid irrigation: high or low pressure • Autolytic: occlusive or hydrogel, hydrocolloid dressing • Enzymatic: collagenase, papain • Biologic: maggot
- 20. SCRUBBING • No evidence support except severe contamination • Wound cleansing with betadine is effective
- 21. WOUND IRRIGATION • High pressure: only severe contamination • High pressure = irrigation with needle no.18 • Optimal is pressur 8 – 12 psi (bulge irrigation) • 50 – 100 ml of NSS or sterile water/cm • Laceration length • Cm2 of a wound • If severe contaminate, more volume • Useful antiseptics: betadine, hypocloride • No proved: soap, dettle
- 22. ANTIBIOTICS • All traumatic wound are at least contaminated • Assessment risk of infection: low risk needs no ABO • Type: Straight stab wound • Location: Well vascularized area • Head • Neck • scalp • Host: • Child • Young • adult
- 23. ANTIBIOTICS • Non-bite wound: 3 – 5 days • Bite wound: 5 -7 days
- 25. ASSESSMENT OF TETANUS IMMUNIZATION STATUS
- 26. WOUND DRESSING • Primary dressing: • directly contact to the wound • Secondary dressing: • cover primary dressing to protect the wound from contact environment • Occlusive dressing • Protect wound and exudate not to contact environment • Semi-occlusive dressing • Oxygen and vapour can across the dressing
- 27. WOUND DRESSING • Frequency is important • Dressing wound OD appropriate for the wound that may change or progress each day • Wound may be dressed with • Sterile wet gauze with NSS • Sterile silver sulfadiazine and Gamgee • If the wound don’t get worse we may dress the wound every other day
- 28. WOUND DRESSING • What kind of dressing we choose depends on amount of exudate • Low light, maintain moisture • Hydrogel • hydrocolloids • High highly absorb • hydrofiber, foam, alginate dressing, NPWT • Infected antibiotics or silver components
- 29. WOUND DRESSING:HYDROGEL • Complex organic polymers • Rehydration • Good for well-granulated tissue
- 30. WOUND DRESSING: HYDROCOLLOIDS • Components of polysaccharides, sodium carboxymethylcellulose, pectin, galatin, adhesive • Good to keep moisture • Good for both light and heavy exudate • Not adhere to the wound no tissue damage • Urgotul, SI herb
- 31. WOUND DRESSING: ALGINATES • Seaweed • Absorb exdate becomes gel • Good for heavy exudate • Can cause skin maceration if excessive exudate • fragile
- 32. WOUND DRESSING: HYDROFIBER • From wood • Coated with silver • Very good for absorbing heavy exudate become gel and easily remove • Expensive • Do not use with minimal exudate wound due to bleeding after removing
- 33. WOUND DRESSING: TULLE • Fiber coated with oil or paraffin • Bactigras, Sofra-tulle • Not expensive • Easy to bleed due to adhesiveness • Good for STSG recipient wound
- 34. WOUND DRESSING: FOAM • Good for heavy exudate
- 35. WOUND DRESSING: NANOCRYSTALLINE SILVER DRESSING • Acticoat • High silver = bacteriocide • Change dressing every 2 – 7 days • Expensive • Good for infected wound • Use with caution
- 36. NORMAL WOUND HEALING PROCESS • ;ljl;jljk
- 37. CASES
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- 67. REFERENCES Thorne CH et al. Grabb and Smith’s Plastic Surgery. 7th ed. Phildelphia: Lipppincott Williams and Wilkins, 2014. กุสุมำ ชินอรุณชัย. How to improve in traumatic wound care. Handout อภิรักษ์ ช่วงสุวนิช. Essential in wound management. ขอนแก่น: โรงพิมพ์คลังนำนำวิทยำ, 2561. Ministry of health Malaysia. Wound care manual 1st ed. 2014 Prevaldi et al. Management of traumatic wounds in the Emergency Department: Position paper from the Academy of Emergency Medicine and Care (AcEMC) and the World Society of Emergency Surgery (WSES). World journal of emergency surgery. 2016: 11(30);1-6. ศัลยศำสตร์ทั่วไป เล่ม 27, 28