Advanced wound healing Centers

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Advanced wound healing Centers

  1. 1. TOPICAL WOUND CARE WHAT TO PICK?
  2. 2. 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.
  3. 3. 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”
  4. 4. 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!
  5. 5. HYDROCOLLOIDS
  6. 6. 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
  7. 7. CALCIUM ALGINATES
  8. 8. 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
  9. 9. HYDROGELS
  10. 10. 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
  11. 11. FOAMS
  12. 12. 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
  13. 13. SILVER PRODUCTS
  14. 14. 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
  15. 15. COMBINATIONS22
  16. 16. 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
  17. 17. COLLAGEN DRESSINGS
  18. 18. 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.
  19. 19. 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
  20. 20. 29
  21. 21. 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
  22. 22. Betadine Peroxide DakinsNeosporinN.S Gauze Air
  23. 23. SoakingAir Drying
  24. 24. 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
  25. 25. THANK YOU !QUESTIONS ???

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