Integumentary PT presentation.pptx

Wound Treatment options
Chapter no 09

Challenge for clinicians
we can no longer care only for the wound itself; we must step
back and look at the entire human being who happens to have a
wound that needs healing
Providing quality care for your wound patients starts with an
analysis of the patient’s individualized wound assessment
and continues with developing a plan of care, selecting the
proper product, and reevaluating the plan of care as
appropriate

Moist wound Healing
In a dry wound bed, epithelial cells burrow
underneath the wound bed,
Dr Winter(1960)
Hinman & maibach
In a moist environment, epithelial cells can migrate on the
wound bed surface to close the wound( leap frogging)

The concept of moist wound healing based on wound
physiology and characteristics required hat new dressing
materials be developed to replace the passive coverings
that had been used in the past, which evolved from such
“natural” coverings as feathers, lint, grease, milk, wine,
mud, leaves, and other concoctions

Moisture balanced or Moisture retentive
dressings
Moisture-balanced or moisture retentive dressings also act as a
barrier against bacteria and absorb excess wound fluid, creating
opportune conditions for healing. Greatest advantage of
contemporary dressings is the maintenance of moist wound
conditions, which is in contrast to the “classical gauze techniques
wet-to-dry gauzeis still popular with many
physicians, especially surgeons who have not been influenced
by the development of modern wound dressings.
Salinegauzedressing acts as an osmotic dressing. As
water evaporates from the saline dressing, it becomes
hypertonic.
World Union of Wound Healing
Societies recommends that clinicians
use dressings that minimize pain and
trauma during application and
removal The right balance of
moisture is critical to wound
healing.A balanced moist wound
environment facilitates cellular
growth and collagen proliferation
within a healthy no cellular matrix
Film and hydrocolloid were among
the first dressing materials that could
maintain a moist wound-healing
environment moisture-balanced
dressings are occlusive, semi-
occlusive, absorptive, hydrating,
autolytic, debriding, or hemostatic
characteristics

Treatment decisions
With so many wound care products available, it can be confusing to choose the right
one. It's important to base our decisions on wound assessment and expected outcomes.
The MEASURESacronym is a helpful tool for wound assessment.
Principles of care:
The MEASURES acronym
Minimize trauma to wound bed
Eliminate dead space (tunnels, tracts, undermining)
Assess and manage the amount of exudates
Support the body’s tissue defense system
Use nontoxic wound cleansers
Remove infection, debris, and necerotic tissue
Environment maintenance, include- ing thermal insulation and a moist wound bed
Surrounding tissue, protect from injury and bacterial invasion

Treatment goalsin wound care can vary, such as achieving a clean wound,
promoting healing, maintaining a clean wound bed, or transitioning the patient to another care
setting. It's important for clinicians to match the characteristics of the wound assessment with
the appropriate dressing or treatment function. The ultimate goal is to use the right
product on the right wound at the right time. For example, a granular, moist or wet wound
would require a dressing that maintains a moisture balance without causing maceration or
desiccation. On the other hand, a necrotic draining wound would benefit from a dressing that
helps loosen or soften the eschar, absorbs excess exudate, and prevents trauma to surrounding
tissue.
Types of dressing
1)Dressings that come in contact with the wound bed are considered primary dressings.
Primary dressings fall within three categories: those that maintain adequate moisture, those that absorb
excess moisture, and those that add moisture.
2)Secondary dressings are those that cover a primary dressing or secure a dressing in place. Reviewing the
NICE model for dressing selection can help streamline your decision process

Dressings should be matched carefully to the wound, patient, and
setting. For deep wounds with a lot of drainage, highly absorbent
dressings like alginate or foam are used. As the depth and drainage
decrease, dressings like hydrogel, hydrocolloid, or film may be used. It's
important to consider wound assessment and expected outcomes when
selecting the appropriate dressing.

Using wound healing biology to select treatment
New technology is helping wounds heal better. One way is by using special proteins called
growth factors that make cells divide and help with healing. These growth factors can come
from a patient's own platelets or be given as a medicine. Another way is by using artificial skin
to heal stubborn wounds. Scientists are also looking into using gene therapy to help wounds
heal even more effectively.
(moist wound therapy and dressing options
Research has shown that keeping wounds moist helps them heal faster with less scarring. George Winter's
work comparing air drying to occlusive dressings was a significant milestone in moist wound healing. However,
concerns about infection slowed down the development of these dressings. Eventually, the first moist wound
therapy dressing, OpSite, was created.

Transparent film dressings
Transparent film dressings are thin, see-through membranes that adhere to the wound margins
without sticking to the actual wound. They create a moist environment for healing, similar to a blister.
These dressings allow epithelial cells to migrate over the wound surface and help create a cleaner
wound. They provide protection against contaminants and aid in pain control. Transparent films can
be used on various wound types and can be left on for up to 7 days. Some newer films even contain
ionic silver.
Practice Essentials
• Apply transparent film dressings to healthy skin; use with caution on aging and fragile skin
.• These dressings aren’t recommended for use on infants or small children
.• These dressings may be used on dry to mini- mally moist wounds.
• Don’t use transparent film dressings on exudating wounds.
• Transparent film dressings make excellent secondary dressings
.• Not all film dressings can be used on infected wounds.
• Change the dressing when fluid reaches the edge of the dressing, when the seal is broken, or when the adhesive bond
is compromised.
• When removing the dressing, lift the corner and pull the film toward the outside of the wound to break the adhesive
barrier.
• Avoid roughness when removing the film; gently stretch the corner of the dressing and support the skin as you remove
the dressing.
• Skin protective wipes and sprays can be used on the periwound area before applying the dressing. Skin wipes also
provide an additional seal to prevent the dressing edges from rolling.• Always read the package insert before applying
the dressing because product usage may vary.• Numerous sizes and shapes are available.

Hydrocolloid dressings
, introduced in the 1980s, are opaque wafer-shaped dressings made of adhesive,
absorbent polymers, and gelling agents. They react with wound fluid to form a gel
over the wound bed. They provide a moist environment, act as a barrier, and can
absorb exudate. They come in various forms and sizes and are used for wounds with
moderate exudate. They promote autolytic debridement but should be changed
appropriately to prevent issues like hyper-granulation and maceration. They're also
used for prevention and protection in high-risk areas.
Practice Essentials
• Change the dressing every 3 to 7 days, or before it reaches its maximal absorption or when fluid reaches
within 1 ̋ of the edge
.• Not all hydrocolloid dressings can be used on infected wounds. Check product insert.
• These dressings aren’t recommended for undermining, tunnels, or sinus tracts.
• Hydrocolloid dressings may be cut to fit the wound area, such as on an elbow or heel
.• These dressings may be used as primary or secondary dressings or over other wound Transparent film and
hydrocolloid dressings are known for their ability to maintain existing moisture levels in the wound.
• Remove the dressing by starting at a corner and gently rolling it off the wound; don’t pull to remove
.• Flush out any residue with saline or wound cleanser.
• Skin protective wipes or sprays may be used on the periwound area to enhance adherence.• Picture-framing
with paper tape may pre-vent the dressing edges from rolling.

Hydrogel dressings
a type of wound dressing that provide moisture to dry wound beds. They come in different
forms, like gels or sheets, and contain water in polymer matrices. The moist environment
created by hydrogel dressings helps with wound healing and the removal of dead tissue. They
are commonly used for hydrating dry wounds, softening slough and necrotic debris, and can be
used for various types of wounds. Hydrogels have limited absorptive capacity and may require
protective barriers to prevent excess hydration. They can also be used with topical medications
and antibacterial agents. Some newer versions even contain silver for added benefits.
Practice Essentials
• Don’t use hydrogels with heavily draining wounds or on intact skin.
• Daily dressing changes may be necessary due to evaporation of the hydrogel. Some sheet hydrogels may last
for several days. Check daily to maintain a moist environment.
• Protect the surrounding skin with a skin barrier ointment, wipe, or spray.
• Watch for areas of maceration on surrounding skin.

Foam dressing
Foam dressings are highly absorbent and are usually made from a polyurethane base with a heat- and
pressure-modified wound contact layer. Foam dressings are permeable to both gases and water vapor.
They are indicated for wounds with moderate to heavy exudate, prophylactic protection over bony
prominences or friction areas, partial- and full thickness wounds, granular or necrotic wound beds.
Foams shouldn’t be used on dry eschar wound bed. Foams may be used in combination with topical
treatments .
Practice essential:
Not all foams have FDA approval for use on infected wounds—be sure to check the package insert Foam dressings
can be left in place for up to 3 to 7 days, depending on the amount of exudate absorption.
• Removal of these dressings is usually trauma-free
.• Foam dressings can be cut to fit the size of the wound
.• Skin wipes or sprays can be used to protect the per wound area from maceration
.• Non-adhesive border dressings will require taping or wraps to secure.
• Make sure you put the correct side of the foam dressing in contact with the wound bed.

Calcium alginate dressing
Alginate dressing's are absorbent, non-adherent, biodegradable, nonwoven fibers derived from
brown seaweed, composed of calcium salts of alginic acid and mannuronic and galuronic
acids.They are extremely beneficial in managing large draining cavity wounds, pressure ulcers,
vascular ulcers, surgical incisions, wound dehiscence, tunnels, sinus tracts, skin graft donor sites,
exposed tendons, and infected wounds. Alginates are contraindicated for dry wounds, eschar-
covered wounds, surgical implantation, or third-degree burns.
Practice Essentials
• Calcium alginate dressings provide easy applications and trauma-free removal.
• These dressings are a good choice for undermined or tunneled draining wounds.
• Calcium alginate dressings require a secondary dressing.
• These dressings may leave fiber residue, which can be removed by flushing with saline.
• Calcium alginate dressings facilitate autolytic debridement
.• These dressings can be used on infected wounds, with or without ionic silver.
• These dressings are cost-effective if used appropriately.

COMPOSITE DRESSINGS
combination of materials makes up a single layered composite dressing. These dressings have multiple
functions, such as a bacterial barrier, absorptive layer, foam, hydrocolloid, or hydrogel.Not all composite
dressings provide a moist environment; many are used or created by using a secondary dressing. They are
also referred to as island dressings
Practice Essentials
• Use composit dressings with caution when treating a patient with fragile skin
.• Composite dressings are easy to apply.
• These dressings may be used on infected wounds and with topical products
.• They may facilitate autolytic or mechanical debridement.
• Frequency of dressing change depends on the wound type and the manufacturers’ recommendation's
.• These dressings may adhere to wound bed; use caution when removing them.

Collagen dressing:
Collagen is a major protein of the body and is necessary for wound healing and repair. Collagen
dressings are derived from bovine hide (cowhide). Collagen dressings are either 100% collagen or
may be combined with alginates or other products. They are a highly absorptive, hydrophilic,
moist wound dressing. Collagen dressings can be used on granulating or necrotic wounds and on
partial- or full-thickness wounds.
Practice Essentials
• Use collagen dressings with caution when treating patients with fragile skin if adhesive secondary dressings
are also being used.
• These dressings are contraindicated for patients' who are sensitive to bovine products
.• Don’t use these dressings on dry wounds or third-degree burns.
• Collagen dressings are easy to remove
.• Their gel properties prevent these dressings from adhering to the wound bed
.• Collagen dressings facilitate a moist wound environment and may be used with other topical products
.• Change collagen dressings daily if used on infected wounds.

Contact dressing:
Contact layer dressings are a single layer of a woven net that acts as a low adherence material
when applied to wound surfaces. A contact layer dressing is applied directly to the wound and
acts as a protective interface between the wound and the secondary dressings. Their main
purpose is to allow exudate to pass through the contact layer and into the secondary dressing.
They are often used with ointments, creams, or other topical products.
Practice Essentials
• Contact layer dressings aren’t recommended. Practice Essentials
• Contact layer dressings aren’t recommended. Contact layer dressings are easy to apply and are secured
with a secondary dressing .They protect wound bed during dressing changes.

Antimicrobial dressings
Antimicrobial dressings have added a new dimension to the wound dressing arena. These new dressings
are different than topical antibiotic therapy. They provide the benefits of an antimicrobial effect against
bacteria and a moist environment for healing. The active ingredient may be silver ions, cadexomer
iodine, or polyhexamethylene biguanide.Antimicrobial dressings are available in a
variety of forms: transparent dressings, gauze,
island dressings, foams, and absorptive fillers
to name a few. Some of these dressings can
remain in place for 7 days.
Practice Essentials
• Antimicrobial dressings are an adjunct in treating wound infections.
• Frequency of dressing change varies among antimicrobials.
• Antimicrobial dressings are used in wounds with high bacterial bio burden or in wounds that are critically colonized
to prevent wound infection.
• Antimicrobial dressings may be used under compression wraps to prevent infection in

Advanced therapies: TISSUE-ENGINEERED SKIN SUBSTITUTES
Skin substitutes were originally were designed to replace auto grafts, which are the harvesting of a patient’s own skin to
apply to a burn or wound. Tissue engineering is the development of materials that combine novel substances with living
cells to yield functional tissue equivalents, such as skin substitutes.19Current skin substitutes may be comprised of
epidermal cells, dermal cells, or both supported by a biodegradable matrix. Two tissue-engineered products containing
living cells are approved for use in the United States. Apligraf and Dermagraf both contain living cells derived from
neonatal foreskin. Apligraf is a bilayered skin product consisting of a dermal equivalent composed of type I bovine
collagen that contains living human dermal fi broblasts as an overlying cornifi ed epidermal layer of living human
keratinocytes. Apligraf doesn’t contain Langerhans’ cells, melanocytes, or endothelial cells. Dermagraft is a
cryopreserved human fi broblast-derived dermal skin substitute indicated for use in the treatment of full-thickness
diabetic foot ulcers.Dermagraft is not recommended for use on infected wounds or wounds with sinus tracts. The wound
may be cultured prior to the procedure and appropriate oral antibiotic therapy used, as well as an antimicrobial wound
dressing, to prevent “losing” the graft.
Practice Essentials
• Skin substitutes will only adhere to a clean wound bed.• Watch for signs and symptoms of infection.• Don’t
debride the yellow caramelized crust at the edges or in the wound; this is the growth factor and you may be
removing the tissue-engineered skin substitute. This is important to teach physicians and staff who are
changing the wound dressings.• Don’t allow the graft site to adhere to a secondary dressing.

Biophysical technologies
Biophysical technologies include physical modalities that create tissue changes at the
tissue/cellular level. These agents include electrical, light, sound, and mechanical energies, all of
which have been used to promote soft tissue regeneration in both acute and chronic wounds.31
Biophysical agents are divided into three primary categories': mechanical or kinetic,
electrical/electromagnetic, and acoustic.

NEGATIVE-PRESSURE WOUND THERAPY
Negative-pressure wound therapy (NPWT) was developed in the early 1990s in Europe and launched in the
United States in 1997.NPWT applies sub atmospheric pressure, or suction, to the wound bed by way of a
mechanical unit that is attached to a dressing through a plastic tube . Several types of dressings are used with
these devices, including foam, moistened cotton gauze, and nonwoven polyester layers joined by a silicone
elastomer. The application and type of dressing vary by the specific manufacturer and the goals for use of the
device. NPWT reportedly facilitates wound closure and healing through several mechanisms of action,
including31: • removing third space edema, which improves nutrient and oxygen delivery. • removing wound
exudate, which is a medium for bacterial colonization. • decreasing harmful levels of pro- inflammatory agents,
such as matrix metalloprotease's (MMPs), found in chronic wounds• facilitating wound retraction or
contraction • promoting angiogenesis.
Practice Essentials
• Dressing changes should be performed according to the specific manufacturer’s
directions.• Be sure to apply skin sealant to the entire periwound area under the drape to
assist in preventing blistering and excoriation when removing the adhesive drape.• Check the
manufacturer’s directions to see how long the suction unit can be off until the dressing must
be changed

Electrical stimulation and light
therapy in wound treatment

Discovery:
• In 18th and 19th century both Galvanic and Matteucci made
preparation for Cut sciatic nerve and muscle tissue from an excised
frog leg, they observed that small electric currents were generated at
cut points.The electric potential associated with these cut points are
now referred as Injury potential

Uses of electrical stimulation:
• Electric stimulation has been used for decades foSevere compromised
blood pressure accelerate rate of chronic wound healing.
• Electric stimulation has been used as adjunctive therapy for
treatment of stage III and IV pressure.
• Electric stimulation is used in lower limbs with Severe compromised
blood flow.
• Electric stimulation is used over inflamed area to accelerate healing
process.

Effects of electrical stimulation:
• Stimulation of fibroblast to enhance collagen and DNA synthesis.
• Increase number of receptor sites for growth factors.
• Activation of cells in wound site and Increase tissue perfusion and
decrease edema
• Increase wound tensile strength and Increase angiogenesis.

Congratulations of electrical stimulation:
• Don’t place ES electrode over carotid sinus .
• Do not apply over heart.
• Do not apply over laryngeal musculature.
• Do not apply over eyes.
• Do not apply over active wounds.

Light therapies:
• Inlorsuction; Light is a form of electromagnetic radiation. Light comes in
different wavelength and Colors.Sunlight is known for centuries to have
beneficial effect on humans.In light therapy a specific wavelength of
light is used for treatment of certain illness.

Phototherapy devices:
• Low level or cold laser devices are used as phototherapy devices.
• Low level laser therapy in wound healing:
• Laser therapy is also known as monochromatic therapy.Laser light lies
in infrared area of light spectrum.
• LLLT has positive effects on three overlapping areas of wound healing
including inflammation, proliferation and remolding.
• LLLT is used in treatment of soft tissue injuries and shingles.

INTERMITTENT COMPRESSION THERAPY
External pneumatic compression therapy
or intermittent compression therapy (ICT)
contributes to the healing of venous insuf-
fi ciency ulcers by collapsing the superfi cial
venous system and forcing blood into the
deep system, thus increasing subcutaneous
pressure. ICT prevents the leakage of blood,
fi brin, and protein from the skin capillaries.

• ICT RESULTS IN IMPROVED CIRCULATION WITH AN
• INCREASE IN OXYGENATED BLOOD FL OW AND THE
• REMOVAL OF POTENTIALLY HARMFUL TOXIC WASTE
• FROM THE WOUND AND PERIWOUND AREA.90

• Application of ICT to the lower extremity is best accomplished with
the patient positioned supine and the extremity elevated above
• the heart. Treatment time varies but usually
• lasts from 45 to 60 minutes

• ICT is contraindicated for patients with
• acute deep vein thrombosis or severe peripheral vascular disease.
Although not an absolute contraindication, vigilant observation and
• communication with the patient who has a
• history of congestive heart failure must be
• practiced when using any type of compression system.

• • Compression therapy should be applied cautiously and at lower
levels of
• compression (20 mm Hg) when there
• is evidence of mild to moderate peripheral arterial disease.
• • If a patient presents with mixed etiology
• of venous and arterial insuffi ciency, he
• or she should be monitored diligently to
• ensure that arterial compromise is not
• occurring.

• Growth factors are proteins (polypeptides)
• that occur naturally in the body. They are
• found primarily in platelets and macrophages.
• Various types of growth factors are being
• researched: epidermal growth factors, plateletderived growth factor (PDGF), transforming
• growth factors, and fi broblast growth factors,
• to list a few. The types of growth factors used
• in research can be categorized into two major
• groups: single growth factors manufactured
• through recombinant DNA technology and
• multiple growth factors secured from human
• platelet releasate.24
• PDGF is the most widely recognized growth
• factor today. It has been found to be effi cacious
• in the management of diabetic ulcers and in
• granulating wounds.

• Hyperbaric oxygen therapy
• Most chronic wounds are hypoxic, which means
• they require an increase in oxygen for adequate
• wound healing to take place. Hyperbaric oxygen therapy (HBOT) is the
delivery of oxygen
• at pressures greater than normal atmospheric
• (sea level) pressure or more pressure than one
• atmosphere absolute (ata). This requires that
• the entire body be placed in a pressure chamber
• while 100% oxygen is circulated for the patient
• to breathe.

• The following is a partial list of the
• principal methods by which HBOT is capable
• of affecting wound healing

• Vasoconstrictive effects of oxygen: Vasoconstriction takes place in both arterial and
venous
• vessels, which reduces edema and congestion while the amount of oxygen supplied
• by the plasma is increased.96
• • Hyperoxygenation of ischemic tissue: Chronic
• wounds are frequently hypoxic. HBOT
• increases tissue partial pressure of oxygen
• (pO2), correcting wound hypoxia intermittently95. It then allows for acceleration of
• the wound healing process through a series of actions that continue long after the
• HBOT session has ended and tissue oxygen
• levels have returned to pretreatment
• values

• Improved wound metabolism: The elevation
in pO2 promotes wound healing by directly
enhancing fi broblast replication, collagen
synthesis, and the processes of neovascularization and epithelialization.95,99
• Up-regulation of growth factors: HBOT
causes the up-regulation of cytokines, including PDGF, which may be one of the
mechanisms by which HBOT enhances angiogenesis.100,101
• Antibacterial effects: The increase in available oxygen enhances the leukocyte bactericidal effect, including the killing
gram-positive (S. aureus) and gram-negative
organisms in addition to being cytotoxic to
anaerobes. Neutrophils or polymorphonuclear cells (PMNs) require oxygen for phagocytosis and killing of bacteria to t

Ultrasound energy in Wound Care and Healing
Therapeutic ultrasounds deliver energy through mechanical vibration in form
of sound waves at frequencies above detection by human ear (>20kHz).
High frequency ultrasound is currently used in the range of 1 to 10 MHz for
fetal imaging and duplex scanning and has been used in the 1 to 3 MHz rang
for our six decade to promote soft-tissue injury healing.In addition high
frequency ultrasound has been implemented to facilitate wound healing.
Ultrasound affect tissue through thermal and nonthermal mechanism.The
thermal effect with greater tissue absorpition increase with higher
frequencies a,whereas nonthermal effect are predominate with lower
frequencies and when ultrasound is pulsed.

Low Frequency
Ultrasound
 Delivery of LFU wound has been shown affectively debride necrotic tissue eradicate
some strain of bacteria from the wound , and facilitate the wound healing process .
 There are currently two delivery mechanisms contact and noncontact for LFU
energy to wounds.
 The SonicOne machines delivers ultrasound energy as contact devices in which the
ultrasound probe is direct contact with the wound surface The SonicOne operate
at frequency at 225 kHz in continuous or pulsed and cause cell destruction with in
the wound bed through combined vibrational and cavitational effect.
 The Sonoca-180 operate at frequency of 25kHz in the continuous mode This allow
the energy to gently loosen necrotic tissue and fibrine layers. An irrigation solution
(0.9 % NaCl or Ringers solution) is used to transmit the ultrasound energy as well as
for wound irrigation.

 The MIST therapy System operate at frequency of 40 kHz in the continuous
mode and is a non-contact LFU device that promotes healing by actively
simulating cell,reducing the bioburden ,increasing blood flow to the immediate
treatment area ,and providing cleansing and gentle debridment .
 The Qoustic Wound Therapy System is a contact/noncontact system operating
at a frequency of 35 kHz in either continuous or plused model provide
selective,precise,and gentle fragmentation of soft and hard tissue with preservation
of healthy tissue through ultrasonic sepration of damaged tissue .
 Various clinical studies have evaluated the safely and efficacy of LFU therapy in
patients with a variety of wounds,including recalcitrant pressure ulcers,chronic
lower-extremity leg and foot ulcer,and diabetic foot ulcer.

SCAR MANAGEMENT
 Patients ,clinicians ,and researchers are all concerned about scar appearance .
 The scientific principal for scar management and minization-support,
controlled inflammation,adequate hydration, and remodeling/maturation of
collagen- from the basic of product selection for scar control strategies.
 Controlling scar formation is an important part of wound management
practice.Widgerow and colleagues have described a patented process of
appling a cream/gel that contains anti-scar active agents to the surface of
microporous tape .This process has been used successfully for scar
management .Within 2 minutes , the active agent in the gel are absorbed
through the tape and on to the scar tissue.

 In a comprehensive trails, 170 scar were assessed based on the SCAR
acronym .
 Hypertrophy was prevented in more than 80% of cases .Hypertrophy and
scar exaggeration are seen in 60% to 80% of cases when there is no scar
management.

WOUND TREATMENT OPTIONS
SCAR Acronym for the practicle
application of principle for scar
management (continued)

PRINCIPLE: Adequate hydration
PATHOPHYSIOLOGY:
• Hydration of the scar surface is the
basis of action of 90% of scar
management system on the
market.
• Most oils (tissue oils), lotions, and
creams have beneficial effects on
scars purely on the basis of their
hydrative capacities. Although this
is obviously beneficial, it is limited
in terms of the outcome it can
produce and affects only area of
scar control.
• Normal skin has mature stratum
corneum characterized by minimal
transepidermal water loss(TEWL).
PROVEN AGENTS
(EXAMPLES)
• The most effective barrier to
TEWL and stratum corneum
breach is silicone, in the form
of either sheeting or gels
(dimethicone).
• In addition , gel derived from
the plant Bulbine frutescens
has been found to be effective
as a hydrating agents; the
glycoprotiens of this plant
extract are large and remain
on the surface of the skin long
enough to produce effective
hydration of the skin.

Continued:
Continue:
• Dehydration of the stratum
corneum initiates signaling
to keratinocytes. These
keratinocytes are stimulated
to produce cytokines, which
activate dermal fibroblasts
to synthesize and release
collagen .excessive collagen
production leads to
abnormal scarring.
..
• .

PRINCIPLE: Remodling/maturation of collagen.
• PATHOPHYSIOLOGY:
• The quicker the scar matures , the
less chance there is of hypertrophy.
• Collagen maturation goes through
phases, with collagen type lll being
present in greater levels in the
early scaring phase.
• As the scar matures , the ratio of
type lll to type l collagen returns to
normal level . Thus any agent that
encourages a return to stable ratio
is advantageous to scar outcome.
PROVEN AGENTS
(EXAMPLES):
• Extracts of Centella asiatica plant
increase level of mature collagen
and encourage normalization of
collagen ratios.
• Purified extracts (triterpenic
fractions, including asiatica -
side ) isolated from C. asiatica
have been shown to induce type l
collegen synthesis in human
dermal fibroblast cells.

Continued:
• Transforming growth factor
(TFG)-B is the prototype of a
protein super family that has
been recognized as the major
fibro proliferative and
collagen- stimulating agent
involved in excess scarring (
particularly TGF –B ). Many is
forms of the protein exist,
most of which share the same
fibroproliferative properties.
One isoforms ( TFG-B3).
However, appears to have a
protective effect against
excess collagen formation
contracting the TGF-B1 effect
• Laboratory evidence of
asiaticoside efficacy was
demonstrated in the rabbit ear
model , one of the only
consistent animal models
producing hypertrophic
scarring.

Ultraviolet Light
▶Used to treat myriad of health problems
▶In old times
▶Recent era
sunlight
artificial UV generated source
Amina Mumtaz
1

Types of UV
UVA
Amina Mumtaz
UVB
2
UVC
Responsible for
pigmentation and
erthyema
Responsible for pigmentation
and erthyema
Treatment of chronic wound
because of its bactericidal
effect specifical chronic ulcer
infected with methicillin
resistant Staphylococcus aureus
Assist in wound healing
• Inducing inflammatory rxn
• Stimulatory growth of
granulation tissue
• Promoting breakdown
• Elimination of dead tissue
for wound

Protocol for application of UVC
at a distance 1 and
▶Remove dressing
▶Debride the wound
▶Protect open wound with pelnleum jelly
▶Hold light perpendicular to wound bed
apply UV light
It is equipped with distance guards which ensures correct
distance and reproducibility of UV treatment
Amina Mumtaz
3

Compression Therapy
▶It is used to manage fluid accumulation and promote
sufficient return of venous blood back to central system and
lymph back into the blood stream
▶It is used in patients with edematous wounds
Amina Mumtaz
4

Types of Compression Therapy
▶ Compression wraps can be applied in spiral fashion, figure
of eight configuration or a combination of two wrapping
techniques
▶Bandages classified by their elasticity
 Short stretch bandages have smaller degree of stretch
 Long stretch bandages have longer degree of stretch
Amina Mumtaz
5

Short Stretch Bandages
▶Also known as rigid compression system
▶Suitable for managing
a) Fluid accumulation of lymphedema
b) Combination of renous insufficiency
c) Lymphedema in same leg
Amina Mumtaz
6

Example of Short Stretch Bandages
Unna Boot
1. Function to facilitate fluid return to central system and
decrease edema
2. It is a Mold lymph impregnated with several substance
including zinc oxide, calamine and gelatin which when
dried create a high working pressure during ambulation
3. When applied, wound is secured first with non-adherent
dressing to avoid damage to healing tissue
Amina Mumtaz
7

Long Stretch Bandages
▶Has long extensibility and can recoil back to configuration
▶It is suitable for individuals who are not active or non-
ambulatory
Amina Mumtaz
8

Other Compression Systems
Garments
▶These are use usually short-stretch system consisting of
material that do not give away during ambulation
For Example
▶Velcro strap to help conform the garment to extremity
contour
▶Application treatment vary according to product
Amina Mumtaz
9

WOUND TREATMENT OPTIONS
Summary

SCAR MANAGEMENT
4 Principles of Scar Management
Acronym to Remember Principles: SCAR
1. Support
Pathophysiology:
• Vector forces increase the production of collagen
• All Scars need support in areas where vector forces continually pull on the scar.

SCAR MANAGEMENT (CONT’D)
2. Controlled Inflammation
Pathophysiology:
• Because excessive inflammation results in exaggerated scars, controlled inflammation is a
sought-after principle in scar management.
Proven Agent:
• Topical application of olive oil compounds have anti-inflammatory effects.

3. Adequate Hydration
Pathophysiology:
• Basis of action of 90% of SM systems on the market.
• Most oils, lotions & creams have beneficial effects on scars purely on basis of their
hydrative capacities.
• Normal skin has a mature stratum corneum (SC) characterized by min.
transepidermal water loss.
• Dehydration of SC ➡ signals keratinocytes ➡ stimulate cytokines ➡activate dermal
fibroblasts to synthesize & release collagen (Excessive collagen production) ➡
Abnormal Scarring.

4. Remodelling / Maturation of Collagen
Pathophysiology:
• The quicker the scar matures , the less chance there is of hypertrophy.
• Collagen maturation goes through phases, with collagen III being present in greater
levels in early scarring phase.
• As the scar matures, the ratio of Type III to Type I collagen returns to normal levels.
Thus, any agent that encourages a return to stable ratios is advantageous to scar
outcome.

Integumentary physiotherapy
Group no 3
Presentation page no 222-223

Wound dressing categories
Page no 222
Generic
category
Trade
names
Indications Advantages
and benefits
Disadvantages
Transparent
film
• BlisterFil
m
• CarraSma
rt Film
• ClearSite
• Comfeel
Film
• Partial thickness wounds
• Pressure ulcers, Stages I
• and II
• Superficial burns
• Secondary dressing
• Abrasions
• Impermeable to external
fluids
and bacteria
• Numerous sizes available
• Waterproof
• Nonabsorptive
• May adhere to fragile skin
• Not for draining wounds
Transparent
film
with silver
• Arglaes • Post op incisions
• Infected wounds
• Highly colonized wounds
• Antimicrobial
• Same advantages as
transparent films
Same disadvantages as
transparent fi lms

Continued page no 223
Generic category Trade names Indications Advantages
and benefits
Disadvantages
Hydrocolloid Sorbex
Exuderm
Cutinova Hydro
3M Tegasorb
• Pressure ulcers,
Stages II & III
• Partial and full
thickness wounds
• First- and second-
degree
• burns
Self-adherent
Reduces wound pain
Thermal insulation
Impermeable to fl
uids/bacteria
• Contraindicated
with
muscle, bone, or
tendon
• Not recommended
for heavily draining
wounds or
fragile skin
Hydrocolloid
with silve
Contreet • Infected wounds
• Highly colonized
wounds
Antimicrobial
Same advantages as
hydrocolloid dressings
Same disadvantages
as
hydrocolloid dressings

◦Name:Fakhara zeb.
◦Roll.Number: 16

Topic:Wound
Dressing Categories…

1) Hydrogel:
◦ Trade Names*
◦ Hypergel.
◦ Elta.
◦ Hydrogel.
◦ Aquasite.
◦ Curafilgel.

Composition OF
Hydrogel:-
◦Water or glycerin based,Contains 80 to 99 percent
OF water.
◦Numerous sizes and forms ( Gels, Strips, sheets and
gauze available.

Indications:-
◦Painful wounds.
◦Partial and full thickness wound.
◦First and second degree burns.
◦Radiation Tissue damage.
◦Dermal ulcers.

Advantages and Benefits:-
◦Reduces wound pain.
◦Non adherent.
◦Soothing to patient.
◦Rehydrates the wound bed.
◦Soften and loosen necrosis.
◦Can be used wit topical medications.

Disadvantages:-
◦Some require secondary Dressing to
Secure.
◦Containdicated for third Degree burns.
◦Not recommended for Heavily draining
wounds.

Composition:-
◦Controlled-release Ionic silver.

Indications:-
◦Infected wounds.
◦Highly colonized wounds.

Advantages:-
◦Antimicrobial.
◦Can be left On upto three days.
◦Non adherent.
◦Rehydrates the wound bed

Disadvantages:-
◦Sensitivity to silver.
◦No used in conjunction with Topical
medications.
◦Same disadvantages as hydrogelDressings.

Trade names:-
◦Polywic.
◦Polyderm.
◦Dermafoam.
◦Dermalevin.
◦Biatain.

Composition:-
◦Hydrophilic polyurethane Or gel film_Coated
Foam,Non adherent layer absorptive wound
dressing.

Indications:-
◦Partical and full thickness wounds.
◦Pressure ulcers Stage 2 to 4
◦Surgical wounds.
◦Dermal ulcers.

Advantages and
Benefits:-
◦Non-adherent.
◦Easy to apply and remove.
◦Frequency of dressing depends upon amount of
drainage.
◦3 to5 day dressing change.

Disadvantages:-
◦May require secondary dressings.
◦Contraindicated for third degree burns.
◦Not recommended for no-draining wounds.

◦ That’s All..
◦Thankyou For
Listening.😍

WOUND DRESSING
CATEGORIES
FAIZA KHURSHID
ROLL NO 21

Generic
category
Description/
composition
Indications Advantages
and benefits
Disadvantages
Negative
pressure
wound
therapy
Noninvasive
active therapy
using localized
negative
pressure to
promote
healing
• Moderate to
heavy exuding
wounds
thickness wounds
• Venous, arterial,
diabetic ulcers
Stages III and IV
• Surgical wounds
Flaps and grafts
• Acute traumatic
wounds
• Decreases edema
• Decreases bacterial
colonization
• Increases blood
supply and granular
tissue formation
• Generally, dressing
changed every 48 to
72 hours (specifics
for dressing and
equipment vary by
manufacturer)
• Healthcare worker needs
training to apply and
operate equipment.
• Not reimbursed in acute and
long term care facilities
• May adhere to some
wounds
• Not recommended for
nondraining wounds or
wounds with eschar
• Contraindicated for
wounds with malignancy
and untreated osteomyelitis

Generic
category
Description/
composition
Trade names Indications Advantages
and benefits
Disadvantages
• Skin
substitute
Skin substitutes
developed in
the laboratory
from tissue
of human origin
or bioengineered
tissue
Apligraf
DermaGraft
GammaGraft
thickness
wounds
• Venous and
diabetic ulcers
• Granular
wounds
• Burns
• Chronic wounds
• Growth factors
present in skin
equivalent.
• Decreases wound
healing time.
• No donor site
• Decreases pain
for many
patients
• Wound has to be
granular.
• Check
manufacturer’s
directions for
storage and
shelf life
Extracellular
matrix
Extracellular
matrix material
derived from the
submucosal layer
of porcine
small intestines
Oasis Wound
Matrix
thickness
wounds
• Diabetic ulcers
• Second-degree
burns
• Graft sites
Biological dressing
Strength and
flexibility
• Sensitivity to
porcine- or
bovine-derived
products
ADVANCED WOUND CARE
THERAPIES

INTEGUMENTRY PHYSIOTHERAPY
Maryum Fiaz
Roll No. 20
Class : 9th Semester
Submitted to: mam Amina Alvi
Subject: Integumentary system
Department of physiotherapy
University of azad & jammu Kashmir

Generic
category
Trade names Indications Advantages
and benefits
Disadvantages
Transparent
film
• BlisterFilm
• CarraSmart
Film
• ClearSite
• Comfeel Film
• Partial thickness
wounds
Stages I
• and II
• Superficial burns
• Secondary dressing
• Abrasions
• Impermeable to
external fluids
and bacteria
• Numerous sizes
available
• Waterproof
• Nonabsorptive
• May adhere to
fragile skin
• Not for draining
wounds
Transparent
film
with silver
• Arglaes • Post op incisions
• Infected wounds
wounds
• Antimicrobial
• Same advantages as
transparent films
Same disadvantages
as
transparent films

Generic category Trade names Indications Advantages
and benefits
Disadvantages
Hydrocolloid Sorbex
Exuderm
Cutinova Hydro
3M Tegasorb
Stages II & III
thickness wounds
• First- and
second-degree
• burns
Self-adherent
Reduces wound pain
Thermal insulation
Impermeable to
fluids/bacteria
• Contraindicated
with
muscle, bone, or
tendon
• Not
recommended
for heavily draining
wounds or
fragile skin
Hydrocolloid
with silver
Contreet • Infected wounds
wounds
Antimicrobial
Same advantages as
hydrocolloid
dressings
Same disadvantages
as
hydrocolloid
dressings

Integumentary PT presentation.pptx

Recommended

Recommended

More Related Content

Similar to Integumentary PT presentation.pptx

Similar to Integumentary PT presentation.pptx (20)

Recently uploaded

Recently uploaded (20)

Integumentary PT presentation.pptx

Editor's Notes