PHASES OF WOUND HEALING1) Inflammatory (0 – 4 days). Vasoconstriction, clot formation and hemostasis.2) Proliferative (2-3 days to 30 days). Fibroblasts lay framework for ECM and new granulation. Angiogenesis connects new granulation and epithelialization progresses across wound base.3) Remodeling (3 weeks to 2 years). Completion of wound contraction with crosslinking of collagen and reduction in scar size. Tensile strength ultimately becomes appro. 80% of original.
WOUND CARE FUNDAMENTALS Maintain moist wound environment Remove eschar, debris and necrotic tissue from wound bed Control exudate Prevent trauma and further wounding Identify and treat infection Manage edema “Back to basics”
MOIST WOUND CARE Moist wound environment facilitates healing Wounds that are too wet or too dry cannot progress through normal phases of healing Products to absorb and dry if too wet Products to maintain and add moisture if too dry Should be a part of essentially every wound care regimen No air drying or soaking!
HYDROCOLLOIDS Impermeable to bacteria Facilitates autolytic debridement Self adhesive As exudate is absorbed, forms a colloidal gel Not for use in heavily exudating wounds Common uses are pressure ulcers, burns Ex: Duoderm, Tegaderm, Replicare, Restore
CALCIUM ALGINATES Use in exudating wounds Absorbs drainage and turns it into gel Fills dead space Prevents wound base from being too wet but yet prevents drying Commonly used in exudating cavity and tunnel wounds as well as venous insufficiency ulcers Secure with secondary dressing
HYDROGELS Soothing and pain reducing Rehydrates wound and maintains moist environment Prevents dressing adherence Can fill small voids or dead spaces Comes in gels and sheets Requires secondary dressing Can cause peri-wound maceration
FOAMS Highly Absorptive Non-adherent Conformable Protects wound and peri-wound from trauma Thermal insulation Common uses are pressure (decubitus) ulcers Can use under compression for venous ulcers
SILVER PRODUCTS Documented antimicrobial activity thru history Effective against MRSA and VRE Available in a wide variety of dressing substrates Products containing silver that also absorb drainage, ie, silver alginates, tend to perform the best Common uses are CVI and diabetic ulcers
COLLAGEN DRESSINGS Stimulate and recruit cells for healing Provide gridwork or matrix for new tissue Available as synthetic or bioengineered Common uses are in well granulated wounds. Not of value over eschar or slough
FILM DRESSINGS Semi-permeable Waterproof (also retain moisture) Transparent for visualization Can tear fragile skin Not for infected or exudating wounds Common uses are lacerations, skin tears and IV sites.
BIOENGINEERED SKIN SUBSTITUTES Useful for relatively shallow, well granulated wounds Surface area; small to large wounds Speeds up wound closure remarkably Grafts must be offloaded and carefully protected
GAUZE Wet to dry leads to non-selective mechanical debridement Stimulates F.B. reaction frequently Good bacterial growth medium. 7.1% infection rate vs 1.3% for hydrocolloid dressing Readily permeable to gas and bacteria Lots of good evidence that we should not use anymore as a primary dressing Effective and economical as secondary or cover dressing
Betadine Peroxide DakinsNeosporinN.S Gauze Air
PRODUCT SELECTION 1) What does the wound need? 2) Does the product accomplish that 3) Does it need more than one product? 4) What is available (Insurance?) 5) What is practical 6) What can the patient/caregivers apply 7) What can the patient afford? 8) Is it cytotoxic