The document discusses wound dressings and wound healing. It defines a wound as a break in the epithelial integrity of the skin that disrupts normal tissue structure and function. Wound healing involves complex, overlapping phases of hemostasis, inflammation, proliferation, and remodeling. Proper wound dressing is crucial to maintain moisture balance and prevent infection while the wound heals. A variety of dressing types are described, including hydrocolloids, hydrogels, calcium alginates, foams, and enzymatic debriding agents. Selecting the appropriate dressing depends on factors like a wound's drainage and healing stage.

1. Wound dressingWound dressing
Dr. Rohan ParisDr. Rohan Paris

2. woundwound
 Break in the epithelial integrity ofBreak in the epithelial integrity of
the skin and may be accompaniedthe skin and may be accompanied
by disruption of the structure andby disruption of the structure and
function of underlying normalfunction of underlying normal
tissuetissue
 May result from precise disruptionMay result from precise disruption
of tissue by surgeon’s knife toof tissue by surgeon’s knife to
wide spread tissue damage.wide spread tissue damage.

3.  Continuity of the skin must beContinuity of the skin must be
restored expeditiouslyrestored expeditiously
 Crucial role in maintainingCrucial role in maintaining
homeostasishomeostasis

4.  Healing of acute wound involvesHealing of acute wound involves
complex, dynamic, wellcomplex, dynamic, well
orchestrated series of eventsorchestrated series of events
 Healed woundHealed wound
 Connective tissue have been repairedConnective tissue have been repaired
 Completely reepithelialisedCompletely reepithelialised
 Returned to normal structure & functionReturned to normal structure & function
 No need of continued drainage & dressingNo need of continued drainage & dressing
 Some Wounds fail to heal timely &Some Wounds fail to heal timely &
orderly manner resulting inorderly manner resulting in
chronic non healing woundchronic non healing wound

5. Out line of wound healingOut line of wound healing
 Primary healing( healing by 1Primary healing( healing by 1stst
intention)intention)
 Wound is closed within 12-24 hours of it’s creationWound is closed within 12-24 hours of it’s creation
 Edges approximated using suture, glue, tapes or mechanicalEdges approximated using suture, glue, tapes or mechanical
devicedevice
 Epithelial regeneration predominant over fibrosis.Epithelial regeneration predominant over fibrosis.
 Delayed Primary healingDelayed Primary healing
 Contaminated or poorly delineated woundsContaminated or poorly delineated wounds
 Left open for few daysLeft open for few days
 Closure performed after host defenses have helped to debrideClosure performed after host defenses have helped to debride
the wound.the wound.
 Secondary healing(2Secondary healing(2ndnd
intention)intention)
 In extensive loss of soft tissueIn extensive loss of soft tissue

6. Phases of wound healingPhases of wound healing
 4 overlapping but well defined phases4 overlapping but well defined phases
 HaemostasisHaemostasis
 InflamoteryInflamotery
 Early Within 24-48 hours, PMN PredominateEarly Within 24-48 hours, PMN Predominate
 Late 2-3 days, Macrophages predominateLate 2-3 days, Macrophages predominate
both involved cytokines and other chemical mediators, &both involved cytokines and other chemical mediators, &
inflammatory cellsinflammatory cells
 ProliferationProliferation
2-21 days, formation of ECM2-21 days, formation of ECM
 Remodling & Scar MaturationRemodling & Scar Maturation
Wk 1 to several wksWk 1 to several wks

8. 1 2 3 4 5 6
7 .
Vascular Scar Epithelial Scar
Clotting Response Inflammation Formation Healing Contraction Remodeling
Sequence of Molecular and Cellular Events in Skin Wound HealingSequence of Molecular and Cellular Events in Skin Wound Healing
Four Phases
of
Healing
Hemostasis
Inflammatio
n
Repair
Remodeling

9. Factors involved in wound healingFactors involved in wound healing
 Cellular factorsCellular factors
 Plt, RBCPlt, RBC
 PMNPMN
 LCLC
 MQMQ
 Fibroblast, MyofibroblastFibroblast, Myofibroblast
 Chemical FactorsChemical Factors
 CK, TGF, PDGF, MetaloprotinesCK, TGF, PDGF, Metaloprotines

10. Local Factors impeding woundLocal Factors impeding wound
healinghealing
 Blood SupplyBlood Supply
 Increased skin tensionIncreased skin tension
 Poor venus drainagePoor venus drainage
 Presence of FB, Slough, Non viable tissue.Presence of FB, Slough, Non viable tissue.
 InfectionInfection
 Excess Local mobilityExcess Local mobility
 Malignant transformationMalignant transformation
 Underlying osteomyelitisUnderlying osteomyelitis

11.  Reduced Local O2 TensionReduced Local O2 Tension
normal tissue 45 mmhg to 0 near the centernormal tissue 45 mmhg to 0 near the center
of the woundof the wound
 suboptimal environment temperaturesuboptimal environment temperature

12. Importance of moisture balance inImportance of moisture balance in
wound carewound care
• Insufficient moisture in exposed wound tissues causesInsufficient moisture in exposed wound tissues causes
desiccation and cell death,desiccation and cell death, and prevents epithelial migrationand prevents epithelial migration
and matrix depositionand matrix deposition
• Excessive moisture due to exudate inhibits cellExcessive moisture due to exudate inhibits cell
proliferation and breaks down matrix componentsproliferation and breaks down matrix components
• Moisture balance in the wound bed is maintained byMoisture balance in the wound bed is maintained by
appropriate choice of dressingsappropriate choice of dressings

13.  Although normal saline is isotonic, as itAlthough normal saline is isotonic, as it
evaporates from the dressing, it becomesevaporates from the dressing, it becomes
hypertonic and tissue fluid is drawn into thehypertonic and tissue fluid is drawn into the
dressingdressing
 Blood and proteins eventually accumulate onBlood and proteins eventually accumulate on
dressing surface and dressing dries out completelydressing surface and dressing dries out completely
 Has to be applied at least three times a dayHas to be applied at least three times a day

14. Wound dressingWound dressing
 Appreciate why you apply dressingAppreciate why you apply dressing
 What you expect from themWhat you expect from them
 How often they should be changedHow often they should be changed
DRESSINGS - material applied to
wound with or without medication,
to give protection and assist in
healing.

15. Keys to selecting dressingsKeys to selecting dressings
 Must use clinical judgmentMust use clinical judgment
 Keep wound bed continuously moistKeep wound bed continuously moist
 Keeps surrounding skin dryKeeps surrounding skin dry
 Control exudate without desiccatingControl exudate without desiccating
(drying out) wound bed(drying out) wound bed
 Caregiver timeCaregiver time

16. Ideal surgical dressingIdeal surgical dressing
 They shouldThey should
1/ be absorbent , remove excess exudate1/ be absorbent , remove excess exudate
2/ maintain moist environment2/ maintain moist environment
3/ aid tissues to remove necrotic material3/ aid tissues to remove necrotic material
4/ promote healing4/ promote healing
5/ prevent trauma to underlying healing5/ prevent trauma to underlying healing
grnulation tissuegrnulation tissue
6/ leak-proof, prevent passage of organism6/ leak-proof, prevent passage of organism
to woundto wound

17. Cont…Cont…
7/ maintain temperature & gaseous exchange7/ maintain temperature & gaseous exchange
8/ allow easy pain free dressing change8/ allow easy pain free dressing change
9/ odourless9/ odourless
10/ cosmetically acceptable & comfortable10/ cosmetically acceptable & comfortable
11/ inexpensive11/ inexpensive

18. Wound Dressings-Current StateWound Dressings-Current State
Of AffairsOf Affairs
 1 of the greatest and most confusing challenges1 of the greatest and most confusing challenges
in wound carein wound care
 Over 3000 wound dressing productsOver 3000 wound dressing products
 Over 30 different dressing categoriesOver 30 different dressing categories
 Inappropriate dressings can lead to a delay inInappropriate dressings can lead to a delay in
wound healingwound healing
 Many dressing choice strategies exist and haveMany dressing choice strategies exist and have
merit; the clinician must choose which to use.merit; the clinician must choose which to use.
Broussard CL. Dressing decisions. In Krasner DL, Rodeheaver GT, Sibbald RG,eds.
Chronic Wound Care: A Clinical Source Book for Healthcare Professionals. 4 th
Malvern, PA: HMP Communications, 2007: 249-262.

19. Which One Is Best?Which One Is Best?

21. ““In the old days we only had toIn the old days we only had to
know saline and gauze”know saline and gauze”
 HydrocolloidHydrocolloid
 HydrogelHydrogel
 Calcium alginateCalcium alginate
 FoamFoam
 CollagenaseCollagenase
 AntimicrobialsAntimicrobials
 Growth factorsGrowth factors
 Matrix enhancing agentsMatrix enhancing agents

22. HYDROCOLLOIDHYDROCOLLOID
 Absorbency and film dressingAbsorbency and film dressing
 Highly absorbent gel (polyurethane)Highly absorbent gel (polyurethane)
 Oxygen and water vapor permeableOxygen and water vapor permeable
 Adhesion and elasticityAdhesion and elasticity
 Bacterial barrierBacterial barrier
 Allows for autolytic debridementAllows for autolytic debridement
 Can stay in place for 72 hoursCan stay in place for 72 hours
 Indications: Venous ulcers, pressure ulcers, diabeticIndications: Venous ulcers, pressure ulcers, diabetic
ulcers, 1ulcers, 1stst
and 2and 2ndnd
degree burnsdegree burns

23. HydrocolloidsHydrocolloids
 Smith & NephewSmith & Nephew
 Replicare, Cutinova hydroReplicare, Cutinova hydro
 ColoplastColoplast
 ComfeelComfeel
 3M3M
 TegasorbTegasorb
 ConvaTec/CVLConvaTec/CVL
 DuoDERMDuoDERM
 J&JJ&J
 NU-DERMNU-DERM

24. HYDROGELHYDROGEL
 Absorbs 5 times own weightAbsorbs 5 times own weight
 Hydrophilic polysaccharide particlesHydrophilic polysaccharide particles
 Cooling soothing effectCooling soothing effect
 Facilitates autolytic debridementFacilitates autolytic debridement
 Delivered in many formsDelivered in many forms
 Amorphous gel, Sheets, StrandsAmorphous gel, Sheets, Strands
 Can stay in place for 24 hoursCan stay in place for 24 hours
 Indications: Mildly exuding wounds, clean wounds,Indications: Mildly exuding wounds, clean wounds,
partial thickness woundspartial thickness wounds

25. HydrogelsHydrogels
 Smith & Nephew (Impregnated gauze)Smith & Nephew (Impregnated gauze)

Sheets (Flexigel),Sheets (Flexigel), Amorphous (Amorphous (SoloSiteSoloSite))
 CarringtonCarrington
 CarraGauze, Carrasyn GelCarraGauze, Carrasyn Gel
 ConvaTec/CVLConvaTec/CVL
 DuoDERM GelDuoDERM Gel
 HealthpointHealthpoint
 Curasol,Curasol, Curasol GelCurasol Gel
 J & JJ & J
 Nu-GELNu-GEL
 KendallKendall
 Curafil, Curafil GelCurafil, Curafil Gel
 3M3M
 TegagelTegagel

26. CALCIUM ALGINATECALCIUM ALGINATE
 Absorbs up to 30 times weightAbsorbs up to 30 times weight
 Comes in many formsComes in many forms
 Sheets, tubes, loose fibers packsSheets, tubes, loose fibers packs
 Maintains a moist wound environmentMaintains a moist wound environment
 Can stay in place 24 to 72 hoursCan stay in place 24 to 72 hours
 Indications: Wounds with large amount of drainageIndications: Wounds with large amount of drainage

27. Calcium AlginatesCalcium Alginates Smith & NephewSmith & Nephew
 AlgiSiteAlgiSite
 CarringtonCarrington
 CarraSorbCarraSorb
 ConvaTec/CVLConvaTec/CVL
 KALTOSTATKALTOSTAT
 Dow HickamDow Hickam
 SORBSANSORBSAN
 J & JJ & J
 FIBRACOLFIBRACOL
 KendallKendall
 CURASORBCURASORB
 3M3M
 TegagenTegagen

28. FOAMFOAM
 Highly absorbent (20 times weight)Highly absorbent (20 times weight)
 Non-adherent wound contact layer, hydrocellular foam,Non-adherent wound contact layer, hydrocellular foam,
waterproof outer layerwaterproof outer layer
 Allows for autolytic debridement and gaseous exchangeAllows for autolytic debridement and gaseous exchange
 Can be left in place for 72 to 96 hoursCan be left in place for 72 to 96 hours
 Indications: Highly exudative wound requiring a non-Indications: Highly exudative wound requiring a non-
stick surface (e.g. venous stasis)stick surface (e.g. venous stasis)

29. FoamsFoams
 Smith & NephewSmith & Nephew
 AllevynAllevyn,, Allevyn adhesiveAllevyn adhesive
 BeiersdorfBeiersdorf
 Cutinova foamCutinova foam
 CarringtonCarrington
 CarrasmartCarrasmart
 ConvaTec/CVLConvaTec/CVL
 HydrasorbHydrasorb
 J & JJ & J
 Nu-Derm, TielleNu-Derm, Tielle
 KedndallKedndall
 CuraformCuraform

30. Enzymatic DebridementEnzymatic Debridement
 Indications: A wound requiring debridement ofIndications: A wound requiring debridement of
fibrinous exudate, other necrotic material orfibrinous exudate, other necrotic material or
sloughslough
 Removes:Removes:
 Senescent fibroblasts - can’t produce cytokines orSenescent fibroblasts - can’t produce cytokines or
collagencollagen
 Necrotic tissue harboring bacteriaNecrotic tissue harboring bacteria

31. Enzymatic DebridementEnzymatic Debridement
 HealthpointHealthpoint
 ACCUZYMEACCUZYME
 Papain (Papaya) – digestant of nonviable proteinPapain (Papaya) – digestant of nonviable protein
 Active over pH 3 to 12Active over pH 3 to 12
 Require stimulators: ureaRequire stimulators: urea
 Solvent action on activators of papain, denatures non-viable proteinSolvent action on activators of papain, denatures non-viable protein
 May burn when appliedMay burn when applied
 APPLY DIRECTLY TO THE WOUNDAPPLY DIRECTLY TO THE WOUND
 Irrigate out – BID or QDIrrigate out – BID or QD
 May need to crosshatch escharMay need to crosshatch eschar

32. Combination AgentsCombination Agents
 HealthpointHealthpoint
 XENADERMXENADERM
 Balsam Peru – increases blood flow to wound siteBalsam Peru – increases blood flow to wound site
 Castor oil – creates moist wound environmentCastor oil – creates moist wound environment
 Trypsin – maintains clean wound bedTrypsin – maintains clean wound bed
 Aluminum magnesium hydroxide stearate – repels fluidsAluminum magnesium hydroxide stearate – repels fluids
 BID for stage I and II woundsBID for stage I and II wounds

33. AntimicrobialsAntimicrobials
 Indications: Infected wounds, wounds withIndications: Infected wounds, wounds with
bacterial counts greater than 10bacterial counts greater than 1055
 Bacterial count greater than this decrease woundBacterial count greater than this decrease wound
healing rateshealing rates
 Bacterial proteases degrade growth factorsBacterial proteases degrade growth factors
 Therapeutic concentration at the site of theTherapeutic concentration at the site of the
woundwound

34. AntimicrobialsAntimicrobials
 Water-based topical antibioticsWater-based topical antibiotics
 Penetrate granulation tissuePenetrate granulation tissue
 Inhibit fibroblast growthInhibit fibroblast growth

35. AntimicrobialsAntimicrobials
 SilvedeneSilvedene
 SulfamylonSulfamylon
 ActicoatActicoat
 IodoflexIodoflex
 Polysporin/BacitracinPolysporin/Bacitracin
 Dakin’sDakin’s

36. SulfamylonSulfamylon
 5 % Sulfamylon cream5 % Sulfamylon cream
 (Mafenide Acetate, Bertek Pharm)(Mafenide Acetate, Bertek Pharm)
 Bacteriostatic vs. Gram neg, Gram pos. (includingBacteriostatic vs. Gram neg, Gram pos. (including
pseudomonas), and some anaerobespseudomonas), and some anaerobes
 Metabolyte cleared through kidneysMetabolyte cleared through kidneys
 Inhibits carbonic anhydraseInhibits carbonic anhydrase
 DOES NOT INHIBIT FIBROBLASTSDOES NOT INHIBIT FIBROBLASTS

37. ActicoatActicoat
 Nanocrystalline silver coatingNanocrystalline silver coating
 Silver coated on polyethylene meshSilver coated on polyethylene mesh
 Rayon polyester coreRayon polyester core
 BacteriostaticBacteriostatic
 Can stay in place for one weekCan stay in place for one week
 Non-stickNon-stick
 Indications: Venous ulcers, diabeticIndications: Venous ulcers, diabetic
ulcersulcers

38. Iodoflex/IodosorbIodoflex/Iodosorb
 Iodine gel or impregnated padIodine gel or impregnated pad
 Wound exudate absorbed by cadexomer polymer –Wound exudate absorbed by cadexomer polymer –
gelgel
 As polymer expands 9% elemental iodine releasedAs polymer expands 9% elemental iodine released
 72 hours: color change from brown to gray72 hours: color change from brown to gray
 Lowers pHLowers pH
 Toxic to fibroblasts?Toxic to fibroblasts?

39. Appearance of WoundAppearance of Wound
 Wound with clean granular baseWound with clean granular base
 Wound with craterWound with crater
 Wound with necrotic/non-viable tissueWound with necrotic/non-viable tissue
 Wound with exudateWound with exudate
 Wound with sinus, tunnel, underminingWound with sinus, tunnel, undermining
 Wound with infectionWound with infection

40. Wound with clean granular baseWound with clean granular base
 Objectives: Protect & keep moistObjectives: Protect & keep moist
 Treatments:Treatments:
 HydrocolloidHydrocolloid
 HydrogelHydrogel
 Vacuum assisted closure (VAC) deviceVacuum assisted closure (VAC) device

41. Wound with craterWound with crater
 Objective: Fill the space with uniform contactObjective: Fill the space with uniform contact
 Treatments:Treatments:
 HydrogelHydrogel
 AlginateAlginate
 FoamFoam
 HydrocolloidHydrocolloid
 Vacuum assisted closure (VAC) deviceVacuum assisted closure (VAC) device

42. Wound with necrotic/non-viableWound with necrotic/non-viable
tissuetissue
 Objective: Debride and cleanseObjective: Debride and cleanse
 Treatments:Treatments:
 Enzymatic dressingEnzymatic dressing
 Hydrogel dressingsHydrogel dressings
 Calcium alginatesCalcium alginates
 Pulse irrigationPulse irrigation
 Vacuum assisted closure (VAC) deviceVacuum assisted closure (VAC) device
 Hypertonic saltsHypertonic salts

43. Wound with exudateWound with exudate
 Objectives: Absorb and containObjectives: Absorb and contain
 Treatments:Treatments:
 AlginateAlginate
 FoamFoam
 Vacuum assisted closure (VAC) deviceVacuum assisted closure (VAC) device

44. Wound with sinus, tunnel,Wound with sinus, tunnel,
underminingundermining
 Objectives: Prevent pre-mature closure, absorbObjectives: Prevent pre-mature closure, absorb
exudateexudate
 Treatments: Loose packingTreatments: Loose packing
 Impregnate gauze with hydrogelImpregnate gauze with hydrogel
 Calcium alginate if high drainageCalcium alginate if high drainage
 Vacuum assisted closure (VAC) deviceVacuum assisted closure (VAC) device

45. Wound with infectionWound with infection
 Objectives: Decrease local bacterial countObjectives: Decrease local bacterial count
 Treatments:Treatments:
 Pulse irrigationPulse irrigation
 Long-acting time-release antibioticLong-acting time-release antibiotic
 Short-acting antibiotic or antimicrobialShort-acting antibiotic or antimicrobial
 Vacuum assisted closure (VAC) deviceVacuum assisted closure (VAC) device

46. Slow healing woundsSlow healing wounds
 Topical negative pressureTopical negative pressure
This therapy involves the controlled application ofThis therapy involves the controlled application of
sub-atmospheric pressure to the local woundsub-atmospheric pressure to the local wound
environment, using a sealed wound dressingenvironment, using a sealed wound dressing
connected to a vacuum pump.connected to a vacuum pump.

47.  The continued vacuum draws outThe continued vacuum draws out fluidfluid from thefrom the
wound and increases blood flow to the area.wound and increases blood flow to the area.
 The vacuum may be applied continuously orThe vacuum may be applied continuously or
intermittently, depending on the type of woundintermittently, depending on the type of wound
being treated and the clinical objectives.being treated and the clinical objectives.
 Typically, the dressing is changed two to threeTypically, the dressing is changed two to three
times per week.times per week.

48. Application of a vacuum pump
using a foam dressing to a wound
Pump used to create negative
pressure

49. General rulesGeneral rules
 No tight dressings– compromise blood supplyNo tight dressings– compromise blood supply
 Tight dressing only to control bleedingTight dressing only to control bleeding
temporarytemporary
 Pressure should be equally distributedPressure should be equally distributed
 Newer allow tight banding around limbs orNewer allow tight banding around limbs or
fingersfingers
 When changing shouldn’t damage tissues ofWhen changing shouldn’t damage tissues of
healing wound.healing wound.

50. Thank youThank you