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  1. 1. Dr. MUHIBULLAH BANGASH PG-1 Resident Surgical-E Unit KTH, Peshawar
  2. 2.  Definitions  History of Surgical Dressings  Properties of Ideal wound Dressings  Types of Surgical Dressings  Commonly used Surgical Dressings  Miscellaneous Dressings  Conclusion  Videos
  3. 3. SURGICAL DRESSING: A dressing is a sterile pad or compress applied to a wound to promote healing and prevent further harm. BANDAGE: A bandage is a piece of material used either to support a medical device such as a dressing or splint, or on its own to provide support to the body.
  4. 4.  Historically, a dressing was usually a piece of material, sometimes cloth, but the use of cobwebs, dung, leaves and honey have also been described.  Previously, the accepted wisdom was that to prevent infection of a wound, the wound should be kept as dry as possible.
  5. 5.  1860, English surgeon, Joseph Lister, began treating his surgical gauze with carbolic acid, known today as phenol, and subsequently dropped his surgical team's mortality rate by 45%.
  6. 6.  1870, Robert Wood Johnson, co-founder of “Johnson & Johnson”, began producing gauze and wound dressings treated with iodine.  1960, George Winter published his controversial research on moist healing. He demonstrated that wounds kept moist healed faster.
  7. 7.  1990, the surgical dressings expanded into the well-recognized groups of products, such as vapor-permeable adhesive films, hydrogels, hydrocolloids, alginates, and synthetic foam dressings. Additionally, new groups of products, such as antiadhesive, mostly silicone meshes; tissue adhesives; barrier films; and silver- or collagen-containing dressings, were introduced. Finally, combination products and engineered skin substitutes were developed.
  8. 8.  Primary Dressing: A dressing that touches the wound  Secondary Dressing (Bandage): Keeps the primary dressing in site  Some dressings function as primary dressing only. However some could function both as primary as well as secondary dressing
  9. 9.  Provide mechanical and bacterial protection  Maintain a moist environment at the wound/dressing interface  Allow gaseous and fluid exchange  Remain nonadherent to the wound  Nontoxic, nonsensitizing, and nonallergic  Well acceptable to the patient (e.g., providing PAIN RELIEF and not influencing movement)  Cost effective
  10. 10.  Highly absorbable (for exuding wounds)  Absorb wound odor  Sterile  Easy to use (can be applied by medical personnel or the patient)  Require infrequent changing  Available in a suitable range of forms and sizes
  11. 11. CLASSIFICATION:  Dry dressings  Moisture-keeping dressings  Bioactive Dressings  Skin Substitutes
  12. 12.  Most commonly available dressings  Tend to absorb wound moisture.  Tightly Adherent to granulation Tissue – will break upon removal EXAMPLES:  Gauze and bandages  Membranes and foils  Foams  Tissue adhesives
  13. 13.  Nonadherent to the wound  Heals faster  Do not break granulation tissue on removal  Comparatively less painful
  14. 14. EXAMPLES:  Pastes, creams and ointments  Nonpermeable, semipermeable membranes or foils,  Hydrocolloids  Hydrogels  Combination products.
  15. 15. They play a significant active role in wound healing because  enhance granulation tissue formation  Reduce slough formation  Inhibits bacteria  Some provide growth factors
  16. 16. EXAMPLES:  Antimicrobial dressings  Interactive dressings  Single-component biologic dressings  Combination products
  17. 17.  Skin substitutes are heterogeneous group of wound coverage materials that aid in would closure and replace the functions of the skin, either temporarily or permanently, depending on the product characteristics.
  18. 18. EXAMPLES:  Epidermal substitutes (autologous or allogenic)  Acellular skin (dermis) substitutes (allogenic or xenogenic)  Autologous and Allogenic skin  Skin substitutes containing living cells.
  19. 19.  Gauzes  Foams  Polymeric films (Opsite)  Tissue adhesives  Tulles  Hydrocolloids  Hydrogels  Debriding agents  Enzymatic dressings  Bead dressings  Silicone dressings  Human Amniotic Membrane  Porcine skin
  20. 20.  Most readily available simple wound dressings  Non-adherent coating  Absorbs exudate  Promote desiccation in wounds  Can be used as a primary or secondary dressing  Inexpensive  Highly permeable  Relatively non-occlusive  FORMS: squares, sheets, rolls, and packing strips.
  21. 21.  polyurethane porous sponges or polyurethane foam films  Light-to-medium exuding wounds (Absorbent)  Left on the wound surface for up to 7 days, depending on exudate volume.  Not recommended for any kind of dry wounds!!  Can be shaped to fit deep cavities and granulating wounds.
  22. 22.  Semipermeable film dressings  Primary adhesive  transparent  Waterproof  Impermeable to bacteria  Breathable  Ultra thin & high elasticity Examples:  Opsite  Bioclusive  Tegaderm
  23. 23. Uses:  General wound care  Skin biopsies  Donor sites  Superficial partial thickness burns  Surgical incisions  Securing of peripheral IV lines  central venous catheters Contraindicted in highly exudative wounds
  24. 24.  contain CYANOACRYLATE which polymerize in an exothermic reaction on contact with either a fluid or a basic substance  Used for SIMPLE LACERATIONS, which otherwise might require the use of fine sutures, staples, or skin strips  cosmetic results similar/better than traditional suturing
  25. 25.  Needleless & Painless method of wound repair  Does not require follow-up visits for suture removal  Strength of healed tissue seen at 7 days  Ensure that wound edges are appropriately adapted and that no adhesive passes between wound borders
  26. 26.  Tulle: A light, thin type of cloth that is like a net  They comprise a gauze cloth impregnated with paraffin for non-traumatic removal  Antiseptics/Antibiotics are added for prevention or treatment of infection.  Does not stick to wound surface  Suitable for flat, shallow wound  Useful in patient with sensitive skin  Require a secondary dressing
  27. 27.  Soft paraffin dressing  Contains chlorhexidine which is an ANTISEPTIC  Allows the wound to drain freely into an absorbent secondary dressing  Used for covering wounds such as superficial burns, lacerations, abrasions, graft sites and leg ulcers.
  28. 28.  It consists of a cotton fabric, impregnated with a base composed of white soft paraffin, anhydrous lanolin, and 1.0% Framycetin Sulphate  Framycetin is an antibiotic of the aminoglycoside group  It is used for Infected wounds, combining low adherence with antimicrobial activity.
  29. 29.  Hydrocolloids slowly absorb fluids, leading to a change in the physical state of the dressing & the formation of gel covering the wound. Thus, they are called interactive dressings  Provide moist wound environment  Promote the formation of granulation tissue  Provide PAIN RELIEF by covering nerve endings with both gel and exudate.  Constituents are methylcellulose, pectin, gelatin, and polyisobutylene.
  30. 30.  USES:  Both acute wounds and chronic wounds  Desloughing purpose  For different stages of light-to-heavily exuding wounds  Initially, dressings need to be changed daily, but once the exudate has diminished, dressings may be left for up to 7 days  Do not use on infected wounds!!
  31. 31.  Brand: DueDERM®
  32. 32.  Contain WATER i.e., > 70-90% They have some important characteristics of an IDEAL DRESSING  Cool the surface of the wound, resulting in MARKED PAIN REDUCTION  Maintain the moist wound environment  For use on dry or necrotic wounds or on lightly exuding wounds  Can be used at all stages of wound healing except for infected or heavily exuding wounds
  33. 33.  May MACERATE the healthy skin (mostly wound border areas), decreasing the keratinocyte reepithelialization ratio or leading to over wetting of split-skin donor sites.  Available as sheet dressings or gels.  Brands: Tegagel®, Intrasite®
  34. 34. GEL FORM SHEET FORM
  35. 35.  Provide acidic environment  Enhance healing via debriding action  Only used in Necrotic sloughing skin ulcers EXAMPLE:  Benoxyl-benzoic acid
  36. 36.  Activate fibrinolysis and liquefy pus on CHRONIC SKIN ULCERS Example:  Varidase-streptokinase/streptodornase
  37. 37.  Remove bacteria and excess moisture by CAPILLARY ACTION  Useful in Deep Granulating Wounds EXAMPLES:  Debrisan®  Iodosorb®  Available as Sheeths & Pastes
  38. 38.  May reduce Hypertrophic scarring and Keloid formation  Work as Antiadhesives  useful in covering split-skin donor sites or fresh meshgrafts
  39. 39. MAKING THE SCARS MORE COSMETICALLY ACCEPTABLE via:  flattening of scarring tissue  increasing elasticity  reducing discoloration
  40. 40.  An ALGINATE dressing is a natural wound dressing derived from different types of algae and seaweeds.  Best used on wounds that have a LARGE AMOUNT OF EXUDATE  Can absorb Exudate upto 20 times their own weight  Available as Sheaths and Ropes
  41. 41. BRANDS:  Kaltostat®  Sorbsan®
  42. 42.  Obtained from the placenta after delivery  To cover burn wounds.  Can be prepared relatively inexpensively CHARACTERISTICS OF AN IDEAL SKIN SUBSTITUTE:  Excellent adherence to the wound  Very low immunogenicity  Decrease of pain  Bacterial control  Stimulation of healing
  43. 43.  It is translucent, allowing inspection of the wound.  Can be applied on superficial second-degree burns, deep second-degree burns after early debridement and donor sites  To cover 1:3 meshed autografts  Extremely effective in sterilizing contaminated wounds and cleaning burns of bacteria within 3-5 days.
  44. 44.  Have to be changed DAILY  Need to be covered with gauze to prevent desiccation  Can be kept refrigerated for 6 weeks  They can be frozen for longer storage
  45. 45.  Porcine skin is the most common source of xenograft because of its high similarity to human skin.  Well-suited temporary dressing for the coverage of second-degree burns, especially after early excision.  It usually promotes scar-free healing  Average healing period of about 10 days.  suitable overlay to cover widely meshed (1:8 to 1:12) autografts
  46. 46.  Promote the deposit of newly formed collagen in the wound bed  These dressings chemically bind to Matrix Metalloproteinases (MMPS) found in the extracellular fluid of wounds. MMPs normally attack and break down collagen, so dressings containing collagen give MMPs an alternative collagen source, leaving the body’s natural collagen available for normal wound healing.  Mainly used for Chronic NonhealingWounds
  47. 47.  Bilayer Skin Substitute  Constructed of a Silicon Film with a Nylon fabric partially imbedded into the film to which Collagen has been chemically bound and cross-linked  Used in Severe burns and Donor sites  significantly reduce local wound pain  speed up the healing process
  48. 48.  Tissue engineering is the use of a combination of cells, engineering and materials methods to improve or replace biological functions  Engineered skin substitutes have been developed to address the need for wound coverage and tissue repair as conventional wound dressings have significant limitations for skin regeneration
  49. 49.  EXAMPLES:  TransCyte® was the first human-based, bioengineered, temporary skin substitute for the treatment of Full and Partial thickness burns  Integra® serves to prepare the wound bed in preparation for transplantation with autologous split-thickness skin three weeks later  Currently, NO engineered skin substitute can replace all of the functions of intact human skin
  50. 50.  Determine and address cause of wound  Establish plan of care that includes dressings that will address principles of moist wound healing  Keep dressings as simple as possible  Assure Pain is addressed
  1. 1. Dr. MUHIBULLAH BANGASH PG-1 Resident Surgical-E Unit KTH, Peshawar
  2. 2.  Definitions  History of Surgical Dressings  Properties of Ideal wound Dressings  Types of Surgical Dressings  Commonly used Surgical Dressings  Miscellaneous Dressings  Conclusion  Videos
  3. 3. SURGICAL DRESSING: A dressing is a sterile pad or compress applied to a wound to promote healing and prevent further harm. BANDAGE: A bandage is a piece of material used either to support a medical device such as a dressing or splint, or on its own to provide support to the body.
  4. 4.  Historically, a dressing was usually a piece of material, sometimes cloth, but the use of cobwebs, dung, leaves and honey have also been described.  Previously, the accepted wisdom was that to prevent infection of a wound, the wound should be kept as dry as possible.
  5. 5.  1860, English surgeon, Joseph Lister, began treating his surgical gauze with carbolic acid, known today as phenol, and subsequently dropped his surgical team's mortality rate by 45%.
  6. 6.  1870, Robert Wood Johnson, co-founder of “Johnson & Johnson”, began producing gauze and wound dressings treated with iodine.  1960, George Winter published his controversial research on moist healing. He demonstrated that wounds kept moist healed faster.
  7. 7.  1990, the surgical dressings expanded into the well-recognized groups of products, such as vapor-permeable adhesive films, hydrogels, hydrocolloids, alginates, and synthetic foam dressings. Additionally, new groups of products, such as antiadhesive, mostly silicone meshes; tissue adhesives; barrier films; and silver- or collagen-containing dressings, were introduced. Finally, combination products and engineered skin substitutes were developed.
  8. 8.  Primary Dressing: A dressing that touches the wound  Secondary Dressing (Bandage): Keeps the primary dressing in site  Some dressings function as primary dressing only. However some could function both as primary as well as secondary dressing
  9. 9.  Provide mechanical and bacterial protection  Maintain a moist environment at the wound/dressing interface  Allow gaseous and fluid exchange  Remain nonadherent to the wound  Nontoxic, nonsensitizing, and nonallergic  Well acceptable to the patient (e.g., providing PAIN RELIEF and not influencing movement)  Cost effective
  10. 10.  Highly absorbable (for exuding wounds)  Absorb wound odor  Sterile  Easy to use (can be applied by medical personnel or the patient)  Require infrequent changing  Available in a suitable range of forms and sizes
  11. 11. CLASSIFICATION:  Dry dressings  Moisture-keeping dressings  Bioactive Dressings  Skin Substitutes
  12. 12.  Most commonly available dressings  Tend to absorb wound moisture.  Tightly Adherent to granulation Tissue – will break upon removal EXAMPLES:  Gauze and bandages  Membranes and foils  Foams  Tissue adhesives
  13. 13.  Nonadherent to the wound  Heals faster  Do not break granulation tissue on removal  Comparatively less painful
  14. 14. EXAMPLES:  Pastes, creams and ointments  Nonpermeable, semipermeable membranes or foils,  Hydrocolloids  Hydrogels  Combination products.
  15. 15. They play a significant active role in wound healing because  enhance granulation tissue formation  Reduce slough formation  Inhibits bacteria  Some provide growth factors
  16. 16. EXAMPLES:  Antimicrobial dressings  Interactive dressings  Single-component biologic dressings  Combination products
  17. 17.  Skin substitutes are heterogeneous group of wound coverage materials that aid in would closure and replace the functions of the skin, either temporarily or permanently, depending on the product characteristics.
  18. 18. EXAMPLES:  Epidermal substitutes (autologous or allogenic)  Acellular skin (dermis) substitutes (allogenic or xenogenic)  Autologous and Allogenic skin  Skin substitutes containing living cells.
  19. 19.  Gauzes  Foams  Polymeric films (Opsite)  Tissue adhesives  Tulles  Hydrocolloids  Hydrogels  Debriding agents  Enzymatic dressings  Bead dressings  Silicone dressings  Human Amniotic Membrane  Porcine skin
  20. 20.  Most readily available simple wound dressings  Non-adherent coating  Absorbs exudate  Promote desiccation in wounds  Can be used as a primary or secondary dressing  Inexpensive  Highly permeable  Relatively non-occlusive  FORMS: squares, sheets, rolls, and packing strips.
  21. 21.  polyurethane porous sponges or polyurethane foam films  Light-to-medium exuding wounds (Absorbent)  Left on the wound surface for up to 7 days, depending on exudate volume.  Not recommended for any kind of dry wounds!!  Can be shaped to fit deep cavities and granulating wounds.
  22. 22.  Semipermeable film dressings  Primary adhesive  transparent  Waterproof  Impermeable to bacteria  Breathable  Ultra thin & high elasticity Examples:  Opsite  Bioclusive  Tegaderm
  23. 23. Uses:  General wound care  Skin biopsies  Donor sites  Superficial partial thickness burns  Surgical incisions  Securing of peripheral IV lines  central venous catheters Contraindicted in highly exudative wounds
  24. 24.  contain CYANOACRYLATE which polymerize in an exothermic reaction on contact with either a fluid or a basic substance  Used for SIMPLE LACERATIONS, which otherwise might require the use of fine sutures, staples, or skin strips  cosmetic results similar/better than traditional suturing
  25. 25.  Needleless & Painless method of wound repair  Does not require follow-up visits for suture removal  Strength of healed tissue seen at 7 days  Ensure that wound edges are appropriately adapted and that no adhesive passes between wound borders
  26. 26.  Tulle: A light, thin type of cloth that is like a net  They comprise a gauze cloth impregnated with paraffin for non-traumatic removal  Antiseptics/Antibiotics are added for prevention or treatment of infection.  Does not stick to wound surface  Suitable for flat, shallow wound  Useful in patient with sensitive skin  Require a secondary dressing
  27. 27.  Soft paraffin dressing  Contains chlorhexidine which is an ANTISEPTIC  Allows the wound to drain freely into an absorbent secondary dressing  Used for covering wounds such as superficial burns, lacerations, abrasions, graft sites and leg ulcers.
  28. 28.  It consists of a cotton fabric, impregnated with a base composed of white soft paraffin, anhydrous lanolin, and 1.0% Framycetin Sulphate  Framycetin is an antibiotic of the aminoglycoside group  It is used for Infected wounds, combining low adherence with antimicrobial activity.
  29. 29.  Hydrocolloids slowly absorb fluids, leading to a change in the physical state of the dressing & the formation of gel covering the wound. Thus, they are called interactive dressings  Provide moist wound environment  Promote the formation of granulation tissue  Provide PAIN RELIEF by covering nerve endings with both gel and exudate.  Constituents are methylcellulose, pectin, gelatin, and polyisobutylene.
  30. 30.  USES:  Both acute wounds and chronic wounds  Desloughing purpose  For different stages of light-to-heavily exuding wounds  Initially, dressings need to be changed daily, but once the exudate has diminished, dressings may be left for up to 7 days  Do not use on infected wounds!!
  31. 31.  Brand: DueDERM®
  32. 32.  Contain WATER i.e., > 70-90% They have some important characteristics of an IDEAL DRESSING  Cool the surface of the wound, resulting in MARKED PAIN REDUCTION  Maintain the moist wound environment  For use on dry or necrotic wounds or on lightly exuding wounds  Can be used at all stages of wound healing except for infected or heavily exuding wounds
  33. 33.  May MACERATE the healthy skin (mostly wound border areas), decreasing the keratinocyte reepithelialization ratio or leading to over wetting of split-skin donor sites.  Available as sheet dressings or gels.  Brands: Tegagel®, Intrasite®
  34. 34. GEL FORM SHEET FORM
  35. 35.  Provide acidic environment  Enhance healing via debriding action  Only used in Necrotic sloughing skin ulcers EXAMPLE:  Benoxyl-benzoic acid
  36. 36.  Activate fibrinolysis and liquefy pus on CHRONIC SKIN ULCERS Example:  Varidase-streptokinase/streptodornase
  37. 37.  Remove bacteria and excess moisture by CAPILLARY ACTION  Useful in Deep Granulating Wounds EXAMPLES:  Debrisan®  Iodosorb®  Available as Sheeths & Pastes
  38. 38.  May reduce Hypertrophic scarring and Keloid formation  Work as Antiadhesives  useful in covering split-skin donor sites or fresh meshgrafts
  39. 39. MAKING THE SCARS MORE COSMETICALLY ACCEPTABLE via:  flattening of scarring tissue  increasing elasticity  reducing discoloration
  40. 40.  An ALGINATE dressing is a natural wound dressing derived from different types of algae and seaweeds.  Best used on wounds that have a LARGE AMOUNT OF EXUDATE  Can absorb Exudate upto 20 times their own weight  Available as Sheaths and Ropes
  41. 41. BRANDS:  Kaltostat®  Sorbsan®
  42. 42.  Obtained from the placenta after delivery  To cover burn wounds.  Can be prepared relatively inexpensively CHARACTERISTICS OF AN IDEAL SKIN SUBSTITUTE:  Excellent adherence to the wound  Very low immunogenicity  Decrease of pain  Bacterial control  Stimulation of healing
  43. 43.  It is translucent, allowing inspection of the wound.  Can be applied on superficial second-degree burns, deep second-degree burns after early debridement and donor sites  To cover 1:3 meshed autografts  Extremely effective in sterilizing contaminated wounds and cleaning burns of bacteria within 3-5 days.
  44. 44.  Have to be changed DAILY  Need to be covered with gauze to prevent desiccation  Can be kept refrigerated for 6 weeks  They can be frozen for longer storage
  45. 45.  Porcine skin is the most common source of xenograft because of its high similarity to human skin.  Well-suited temporary dressing for the coverage of second-degree burns, especially after early excision.  It usually promotes scar-free healing  Average healing period of about 10 days.  suitable overlay to cover widely meshed (1:8 to 1:12) autografts
  46. 46.  Promote the deposit of newly formed collagen in the wound bed  These dressings chemically bind to Matrix Metalloproteinases (MMPS) found in the extracellular fluid of wounds. MMPs normally attack and break down collagen, so dressings containing collagen give MMPs an alternative collagen source, leaving the body’s natural collagen available for normal wound healing.  Mainly used for Chronic NonhealingWounds
  47. 47.  Bilayer Skin Substitute  Constructed of a Silicon Film with a Nylon fabric partially imbedded into the film to which Collagen has been chemically bound and cross-linked  Used in Severe burns and Donor sites  significantly reduce local wound pain  speed up the healing process
  48. 48.  Tissue engineering is the use of a combination of cells, engineering and materials methods to improve or replace biological functions  Engineered skin substitutes have been developed to address the need for wound coverage and tissue repair as conventional wound dressings have significant limitations for skin regeneration
  49. 49.  EXAMPLES:  TransCyte® was the first human-based, bioengineered, temporary skin substitute for the treatment of Full and Partial thickness burns  Integra® serves to prepare the wound bed in preparation for transplantation with autologous split-thickness skin three weeks later  Currently, NO engineered skin substitute can replace all of the functions of intact human skin
  50. 50.  Determine and address cause of wound  Establish plan of care that includes dressings that will address principles of moist wound healing  Keep dressings as simple as possible  Assure Pain is addressed

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