Definition Wound healing Chronic Ulcers Causes for Non-healing Ulcers Management of Chronic Ulcers Role of Antibiotics /Antiseptics Wound dressings Ideal wound dressing Types of Wound Dressings When to change dressings Things to avoid in chronic wounds

1. WOUNDS AND
CHOICE OF WOUND DRESSINGS
Dr Joel Arudchelvam
MBBS (COL), MD (SUR). MRCS (ENG)
ConsultantVascular andTransplant Surgeon

2. Ulcer / Abrasion
 A full thickness breach in the continuity of the
skin
 Partial thickness - Abrasion

3. Wound healing
 4 stages
 Haematoma formation
 Inflammation/ debridment
 Proliferation / granulation
 Remodelling / maturation

4. Wound healing
 4 stages
 Haematoma formation
 Inflammation/ debridment
 Proliferation
 Remodelling / maturation

5. Phases overlap

6. Wounds / ulcers not showing signs of healing
after 6 weeks.
Non Healing Ulcers
(Chronic Ulcers )
 Ulcers not showing signs of healing by 6
weeks

7. Causes for Non-healing Ulcers
1. Local causes
2. Regional causes
3. Systemic causes

8. Causes for Non-healing Ulcers
1. Local causes
-Repeated trauma
-Presence of foreign body / slough
-lnfection / osteomyelitis

9. Causes for Non-healing Ulcers
2. Regional causes
-Venous
-Arterial
-Neuropathic

10. Causes for Non-healing Ulcers3. Systemic causes
- Diseases
- DM, CKD, etc.
- Drugs
- Immunosuppressive, cytotoxic
- Nutritional deficiencies
- Hypo-albuminaemia, anaemia, vitamin and mineral deficiencies

11. Arterial,Venous,Neuropathic Ulcers

12. Management of Chronic Ulcers
 Local
 Regional
 Systemic

13. Management of Chronic Ulcers
 Local
 Wound toilet
oRemoval of slough, dead tissue, foreign bodies
oWound base is made suitable for granulation and
epithelialisation.
o Treat infection

14. Management of Chronic Ulcers
 Regional causes
 Arterial- revascularization
 Regional causes
 Venous - Strapping
 i.e. multilayer compression
 Regional causes
 Neuropathic- off loading

15. Management of chronic ulcers
 Systemic causes
 Correct anaemia and other nutritional deficiencies.
 Optimization of underlying comorbidities.

16. Role of Antibiotics /Antiseptics
 Indicated only in local infection / critical
colonisation (Unhealthy granulation , oozing)
 Systemic infection
 Not for ;
 Contamination
 Colonisation

17. Wound dressings
 The material which is applied to the surface
of the wound to cover it
 1ry – dressing which touches the wound
 2ry – dressing used to cover the primary dressing

18. Ideal wound dressing
 Provide a protective cover
 Maintain moisture
 Not painful
 Absorb exudates
 Easy to change
 Allow gaseous exchange
 Cheap
 Freely available

19. Types of Wound Dressings
 Gauze dressings
 Tulle
 Hydrocolloid dressings
 Hydrogel dressings
 Alginate dressings
 Foam dressings
 Film dressings

20. Gauze
 Cheap
 Freely available
 Dry
 Painful on removing
 Damages epithelium

21. Tulle
 Cheap
 Freely available
 Easy removal
 E.g :Vaseline tulle

22. Hydrocolloid Dressings

23. Hydrocolloid Dressings
 Made up of pectin based material
 Absorb exudate
 Available in various shapes and sizes

24. Hydrogel Dressings

25. Hydrogel Dressings
 Made up of water in a polymer to maintain
moisture
 used in dry wounds
 Should not be used in exudating wounds

26. Foam Dressings

27. Foam Dressings
 Made up of polyurethane foam
 Absorbs moderate to large amounts of fluid
 Available in various sizes and shapes

28. Silver Dressings
 Antimicrobial to
reduce bio burden
 Through slow
release of silver ion
 e.g. Acticoat, Biatin
Ag, AtrumanAg

29. Vacuum Assisted Closure VAC

30. Vacuum assisted closure VAC

31. Vacuum Assisted Closure VAC
 Macrostrain - occurs when negative pressure contracts
the foam.
 Draws wound edges together
 Removes exudate and infectious materials
 Microstrain - at the cellular level
 Reduces edema
 Promotes granulation - facilitates cell migration and
proliferation

32. Vacuum Assisted Closure VAC
 Indications for use
 Large wounds
 Cavities
 Large amount of exudate

33. Summary
Wound type Dressing
Dry Hydrocolloid, Hydrogel
Exudating wound Hydrocolloid, foam
Dead space / cavity Foam,VAC

34. When to change dressings
 When there is an indication to change
 Soaking
 Pain
 Need to inspect

35. Avoid in chronic wounds
 Iodine (Betadine)
 Hydrogen peroxide
 Other toxic agents

36. Avoid
• Do not apply gauze bandage tightly
around limbs, digits – causes
ischaemia
• Use – plaster , crepe instead

37. ThankYou