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1. WOUND MANAGEMENT
AND DESSING TECHNIQUE
MODERATOR:DR M F INAMDAR
ASSOSIATE PROFESSOR
D UNIT CHIEF
PRESENTER:DR ROOPA
PG

2. PRINCIPALS OF WOUND MANAGEMENT

3. ANTIBIOTICS
• Rare in acute wounds
• Suspect infection with bacteria
• Broad spectrum antibiotics –Amoxiclave

4. TETANUS PRONE WOUNDS

5. ANALGESIA AND ANESTHESIA
ANALGESIA
• NSAIDS
• OPOIDS
LOCAL ANAESTHETICS
• Duration of action: 20-90
minutes
• Use of Adrenaline: reduces
bleeding, increases duration of
action and reduces dose

6. TYPES OF WOUND DEBRIDEMENT
SURGICAL
Excision of non-viable tissue using surgical instruments such as a
scalpel, curette, scissors or rongeur until healthy bleeding occurs at the
wound edges
MECHANICAL
Non-selective debridement such as using irrigation, wet-to-dry
dressings and hydrotherapy. Both nonviable and viable tissue may be
removed

7. EUSOL SOLUTION
• EUSOL(Edinburgh University
Solution) which contains sodium
hypochlorite releases nascent
chlorine which forms a water
soluble complex with slough to
dissolve it.

8. AUTOLYTIC
Hydrocolloids
Transparent films
ENZYMATIC
Collagenase
Papain urea

9. BIOLOGICAL
Medically graded larvae of lucilia
sericata

10. RECONTRUCTION OPTIONS FOR WOUND CLOSURE
• Primary closure
Steri strips
Skin staples
• Secondary closure
• Tertiary (delayed primary)
closure
• Other reconstructive methods –
split skin graft , flaps…

11. MANAGEMENT ACUTE WOUNDS

12. BITES
• Mouth flora implanted into tissues
• Rabies
• tetanus
• Cat bite –Pasteurella multocida
• Dog bite-lacerated wounds
• Human bites following a punch to the mouth

13. DEGLOVING
• Degloving is the avulsion of skin and
subcutaneous fat from the underlying
fascia, muscle or bone
• Physiological degloving
• Morel-Lavallée lesion
• Delineate non viable tissues
(indocyanine green fluorescence)
• Affected area insensitive to pin prick
and pale Can be cut till the bleeding
edge.
• Referral to plastic surgeon.

14. CONTUSION
• Following Blow injury
• Small blood vessels
• Bruise/ecchymosis
• Red –blue-black-greenish yellow-
yellow by 7 days
• No treatment

15. HAEMATOMA
• Large volume of blood escaping
• Intra compartmental –
fasciotomy
• Subcutaneous – abscess
• Wire bore needle aspiration
• Incision & drainage
• Myositis ossification
• Fibrous tissue organization

16. ABRASION
• Scrubbing with the sterile brush
along the line of injury
• Dry dressing for 2-3 days
• analgesia

17. LACERATIONS
• Inspection for foreign body.
• Irregular edges trimmed till
bleeding edge.

18. PUNCTURE WOUNDS
• Probing to know the depth is
avoided.
• Usually referral to
superspecialist at higher centre.

19. CHRONIC WOUNDS
LEG ULCERS
● Vascular (venous, arterial, mixed)
● Trauma (bites, burns)
● Infection (bacterial, fungal, mycobacterial, syphilis)
● Metabolic disorders (diabetes mellitus, gout, calciphylaxis)
● Autoimmune disorders (vasculitis, systemic sclerosis, rheumatoid
arthritis)
● Neoplastic (squamous cell carcinoma, basal cell carcinoma)

20. DRESSING TECNIQUES
Dressings are applied over wounds
To provide rapid and cosmetically better healing
To Provide protective cover
To remove or contain odor
To prevent infection to maintain moisture
To absorb exudates
To reduce wound related pain

21. CLASSIFICATION OF DRESSINGS
DRY TO DRY
• Clean cut wounds
• Primary intention
• Layer -wide mesh cotton gauze
on wound surface
• second layer -dry absorbent
cotton
WET TO DRY
• Untidy infected wounds
• Secondary intension
• Layer of wide mesh cotton gauze
saturated with saline next to
wound surface
• Second layer of moist absorbent

22. WET TO WET
• Used in clean open wounds
• Layer of wide mesh gauze
saturated with antibacterial
solution next to the wound
surface
• second layer of absorbent
material saturated with same
solution to dilute viscous exudate.
WET TO DAMP
• Variation of wet to dry dressing

23. Gauze is a thin, translucent fabric
with a loose open weave
• Cheap ,Freely available
• Dry ,Painful on removal
• Damages epithelium
GAUZE

24. TULLE
• The Tulle Dressing is the fabric
based non allergic dressing
• Cheap , Freely available
• Easy removal
Eg . Vaseline

25. FOAM
• Available either as polyurethane or
silicone
• Adhesive and non adhesive variables,
adhesives may cause skin reaction
• Useful in Low to heavily exuding
wounds, Granulating and epithelializing
wounds
• Wounds such as: -Pressure injuries Leg
ulcers, Burns, Donor sites -Skin tears
• Avoided in dry wounds

26. SEMIPERMIABLE FILMS
•polyurethane coated with a layer of
adhesive
•They are generally clear, adherent,
and nonabsorbent
• They allow moisture, vapour and
gases to escape but are also
impermeable to liquids
• Scalds, Minor lacerations, Suture
lines, Intravenous catheter sites

27. HYDROCOLLOIDS
•Gel-forming agents, such as sodium
carboxymethylcellulose (NaCMC) and
gelatine
•Self adhesive and water repellent
•In the presence of wound exudate,
hydrocolloids absorb liquid and form a gel
Pressure injuries, Leg ulcers ,Surgical
incisions
•Not recommended for infected wounds.

28. HYDROGELS
• High water content and contain insoluble
polymers like carboxy methyl cellulose.
• They are designed to hydrate the
wound and promote autolytic
debridement.
• Useful in reducing pain.
• Avoided in Highly exudating wounds
and in Sinuses or cavities where you
cannot visualise the entire base of the
wound bed.

29. ALGINATE DRESSING
• Seaweed
• Fluid it absorbs the fluid and turns into
a gel like substance.
• The dressing is highly absorbent - it can
absorb up to 20 times its weight.
• Some of the alginate dressings have
hemostatic properties and are ideal
for bleeding wounds
• Two to four days or even once weekly.

30. SILVER DRESSINGS
• Broad spectrum antimicrobial agent
• Foams, alginates and gelling
cellulose fibres.
• Anti-inflammatory
• Should only be used for short
periods of time, 2-3 weeks to reduce
the risk of resistance
• Avoided in healthy granulating
wounds

31. VACUUM ASSISTED DRESSINGS
• Generally used for slow healing wounds.
• Involves application of sub atmospheric
pressure to the local wound environment,
using a sealed wound dressing connected
to a vacuum pump.
• Optimum pressure -125mmHg.
• It can be applied continuously or
intermittently.
• Main advantage is that a large complicated
wound can be converted into simple wound
and can be managed.

32. MACROSTRAIN
• Visible contraction which occurs
when negative pressure is applied.
• Helps in drawing wound edges
together.
• Provides direct and complete wound
bed contact.
• Removes exudates.
• Improves blood supply
MICROSTRAIN
• Micro deformation at cellular
level.
• It helps in reducing oedema.
• Promotes granulation tissue
formation by facilitating cell
migration and proliferation.

33. CONTRAINDICATIONS
• Malignant ulcers
• Exposed vessels ,tendons
INDICATIONS
• Slow healing large
wounds(diabetic ulcers,open
abdominal wounds etc).
• Cavities.
• Large amount of Exudate.

34. ANTIMICROBIAL FOAM DRESSINGS
• Effective against a broad range of bacteria and fungi.
• Used in infected wounds in combination with systemic oral
antibiotics.
• Ensure dressing is at least 1.5cm to 2cm larger than the wound
margins.
• Avoided if there is sensitivity to the antimicrobial.
• Reduces odor, maintains a moist wound environment and it can
reduce hyper granulation.

35. MEDICAL- GRADE HONEY
• Comprised of 82% carbohydrate,
enzymes & amino acids.
• Acidic pH between 3.2-4.5, which is
low enough to be inhibitory to many
pathogens.
• Medical-grade honey has been sterilised.
• used on infected or highly contaminated
wounds and malodorous wounds.
• Avoided if there is allergy or
hypersensitivity.
• If not sterile clostridium botulinum
infection can occur.

36. ODOR ABSORBING DRESSINGS
• Contain activated charcoal which absorbs
odor, bacteria and exudate.
• Available as Foams, High/super absorbent
pads, In combination with alginates.
Used in;
• Infected or highly colonized wounds.
• Malignant / fungating cancerous
wounds.
• Wounds with offensive odor

37. HYDROPHOBIC DRESSING
• Attract bacteria and fungi to the dressing
removing them from the wound surfacee.
• The hydrophobic coating on the dressing is
made from dialkylcarbamoylchloride
(DACC), a synthetically produced derivative of
a naturally occurring hydrophobic fatty acid.
• Available as Gel impregnated sheets,
Absorbent pad, Gauze, Ribbon gauze.
• Avoids using antiseptics or disinfectants to
cleanse the wound prior to application.
• Do not use in combination with ointments and
creams containing lipids

38. Wound type Dressing
Dry Hydrocolloid, Hydrogel
Exudating wound Hydrocolloid,
Foam
Dead space/Cavity Alginate, Foam,
VAC
Most wounds Gauze, Tulle, Gel

39. BANDAGING
PURPOSE
• To immobilize the injured part and relieve pain.
• To support wound and dressing.
• To immobilize fracture or dislocation.
• To control haemorrhage.
• To improve venous blood flow from lower extremities by applying
pressure.
• To reduce or prevent swelling.

40. DIMENTIONS
Body part Length Width
Toe or finger 90-270cm 1.8-2.5cm
Head 540cm 5-10cm
Arm 540cm 5-6.25cm
Leg 540-810cm 6.25-7.5cm
Trunk 540-810cm 10-15cm

41. BASIC BANDAGING FORMS
1.Circular bandaging
2.Spiral bandaging
3.Figure-of-eight bandaging
4.Recurrent bandaging
5.Reverse spiral bandage

42. CIRCULAR BANDAGING
• Used to hold dressings on body
parts such as
arm,leg,abdomen,Chest etc..
• Layers of bandaging are applied
on top of each other.
• Use circular wrap to end other
bandaging types such as pressure
bandages and also used in small
area bandaging.

43. SPIRAL BANDAGING
• Usually used for cylindrical body parts.
• Elastic bandages can be spirally
wrapped for tapering body parts for
close fit.
• Each turn of spiral bandage must
cover nearly 1/3rd
of the preceding
turn by width.
• It is used to cover a large area which
circular bandage can’t cover.

44. FIGURE OF EIGHT BANDAGE
• Used to support or limit joint
movement at the articular joint
eg: elbow,knee,wrist...
• Following a circular turn around
the middle of the joint the
bandage should fan out upwards
and downwards. The turn should
cross at the site where limb
flexes.

45. RECCURENT BANDAGING
• Used for blunt body parts consists
partly of reccurrent turns.
• It is used for anchoring a dressing
on finger tip, Head, or on a stump.
• Bandage is applied repeatedly from
one side across the top to the other
side of the blunt body part.
• Reccurrent bandages are fixed using
circular or spiral bandages.

46. REVERSE SPIRAL BANDAGING
• A type is spiral bandage where
the bandage is folded back on
itself by 180degree each turn.
• This V shaped fold allowed the
bandage to fit into the tapered
body part.
• Less commonly used because of
the development of elastic
bandages.

47. APLICATION OF ANCOR WRAP
• Lay the bandage end at an angle across
the area to be bandaged. (See Figure A.)
• Bring the bandage under the area, back
to the starting point, and make a
second turn.
• Fold the uncovered triangle of the
bandage end back over the second turn.
(See Figure C.)
• Cover the triangle with a third turn,
completing the anchor. (See Figure D.)

48. POINTS TO BE REMEMBERED
• Patient should be in comfortable position , parts in neutral position
• Only 5-7.5 cm of bandage should be unrolled at a time
• Start just below the part to be covered
• Roll in upward direction
• Prominences should be well padded
• Applied with equal pressure
• 1/3 rd of each turn should be left uncovered
• Check the circulation after application of the bandage
• Elevation to reduce oedema and bleeding

49. HEAD BANDAGE APPLICATION
• A 5-10cm cotton or crepe bandage is
required.
• Commence with a horizontal turn
around the head begins from the right
ear ------ to the low occiput------ and
forward over left ear then towards the
starting point----- then reverse the
bandage towards centre of head----
finally completes with horizontal turns.
• Used mainly in neurosurgery.

50. BREAST BANDAGE APPLICATION
• For right breast right arm is flexed and
supported.
• 10-15cm bandage is used.
• Elset S type of bandaging procedure is
done with adequate length and width.

51. ABDOMEN BANDAGE TECHNIQUE
• Mostly 4inch width bandages are
used.
• Overlapping turns which are
horizontally or obliquely applied.
• For patients with cough or weak
abdominal muscles following
dressings are used.
1.Tongue and slot method
2.Interlocking cutouts
3.Abdominal corset.
4.Many tailed abdominal binder..

52. MANAGEMENT OF SCARS
• HYPERTROPIC SCARS

53. KELOIDS

54. MANAGEMENT OF CONTRACTURES
• Surgical contracture release and reconstruction
• LOCAL FLAPS
• Z plasty
• Y-V plasty
• V-Y plasty
• W plasty

55. PHYSIOTHERAPAUTIC WOUND
MANAGEMENT
• ULTRASOUND THERAPY
• ELECTRICAL STIMULATION
• RADIANT HEAT
• NPWT
• SHORT WAVE DIATHERMY
• ULTRAVIOLET RADIATION
• HYPERBARIC OXYGEN THERAPY
• TOPICAL HYPERBARIC OXYGEN THERAPY
• COMPRESSTION THERAPY
• ELEVATION
• FOUR LAYER BANDAGE SYSTEM
• COMPRESSION GARMENTS

56. • Improve o2 supply
HPERBARIC OXYGEN THERAPHY

57. • COMPRESSTION THERAPY
• ELEVATION
• FOUR LAYER BANDAGE SYSTEM
• COMPRESSION GARMENTS

58. TOPICAL AGENTS

59. BIOLOGICAL DRESSING

60. THANK YOU