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wound dressing selection.pdf
- 1. Wound dressing selection -basedon healing phase General surgery IC: Lao Chi Tong Tutor: Dr Pang Heong Keong Date: 2022/06/17 Department: general surgery
- 2. Ancient dressing Accordingto one of the oldest medical papers dated 2200 BC, the science of wound healing is reported as “three healing gestures.” The three healing gestures are cleaning the wound, sticking plaster, and bandaging the wound Mesopotamian used clay tablet to treat wounds in 2500 BC. They washed wounds with milk or water before dressing with the resin and honey. Hippocrates of ancient Greece used wine or vinegar to clean wounds in 460–370 BC.21
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- 5. The requirement inwound healing
- 6. The target ofdressing Healing Moist Clean Warm
- 8. Principle of dressingchoice Every wound is unique Should be assessed and treated individually, principally correcting the underlying causes and systematically ~ by Halim, Khoo & Saad, 2012 Accurate, ongoing assessment of the needs of the wound No single product is suitable for all wounds or all stage of healing process Adequate knowledge of the functions and performance of the dressing Journal wound care Vol 15, Feb 2006. Jones AM, San Miguel L
- 10. Pathophysiology of WoundHealing Hemostasis Inflammation Proliferation (Migration) Maturation (Remodeling)
- 11. Hemostasis phase Followingwound creating immediately Hemostasis phase is an attempt to limit damage by stopping bleeding Local arteriolar and capillary vasoconstriction Erythrocytes and platelet adhere to the damaged endothelium Thromboxane A2, prostaglandin F2 -> platelet aggregation and vasoconstriction Secondary hemostasis by clotting cascade Active platelet cause vasodilation and increase vascular permeability Plasma leakage from intravascular space to extracellular compartment due to permeability
- 12. Hemostasis phase Forhemostasis: Collagen patch (Hemopatch) Fibrinogen and thrombin sponge patch (Tachosil) Oxidized regenerated cellulose (Surgicel) Provide frame for platelet aggregation
- 13. Hemostasis phase Dressingtarget in hemostasis phase: Cover and protection Provide moist wound healing environment Loss of skin barrier function Absorb exudate/blood
- 14. Hemostasis phase Dressingselection: Semi-permeable films + Pad/ absorption gauze: Composed of a transparent polyurethane coating with a layer of adhesive Allow inspection of the wound Permeable to gases and vapor, waterproof, impermeable to liquid and bacteria Hydrocolloid contain gel-forming agents such as sodium carboxymethylcellulose and gelatin, applied to a carrier such as foam or film to form an absorbent, self-adhesive, waterproof wafer.
- 15. Pathophysiology of WoundHealing Hemostasis Inflammation Proliferation (Migration) Maturation (Remodeling)
- 16. Inflammation phase Activatedinnate immune: Macrophage, polymorphonuclear cells Chemokines: Interleukin, Interferon, TNF… Complement system Bacteria, dead immune cells, & damaged tissue accumulation Impaired micro-circulation Appearance: red, hot, swollen, slough, much exudate
- 17. Inflammation phase Controlinfection Minimal inflammation Maintain moist
- 18. Inflammation phase Necrotictissue is a proinflammatory stimulus and a culture medium for bacterial growth Debridement is defined as the removal of necrotic tissue, exudate, bacteria, and metabolic waste from a wound in order to improve or facilitate the healing process Mechanical, sharp/surgical, enzymatic, and autolytic are the common methods of debridement Autolytic debridement can be facilitated with appropriate dressings under moist wound environment
- 19. Inflammation phase Controlinfection Debridement Cation dressing: Mesalt(Na+), Sorbalgon(Ca2+), Melgisorb (Ca2+), Aquacel Ag (Ag+) electrostatic attraction, bacteriostatic Minimal inflammation Maintain moist
- 20. Inflammation phase Controlinfection Minimal inflammation Non-adhesion dressing Polyester mesh: UrgoTui Biodegradable material Collagen, Gelatin(Hydrocoll), polysaccharide, polyethylene glycol (Intrasite) Nature material (Sorbalgon) Maintain moist
- 21. Inflammation phase Controlinfection Minimal inflammation Maintain moist Exudate absorption Foam (Allevyn), Hydrofiber technology: Alginate dressing(Sorbalgon), Hydrofiber(Aquacel) 1. Breathable Top Film 2. Highly Absorbent Foam 3. Non-Adherent Wound Contact Layer
- 22. Pathophysiology of WoundHealing Hemostasis Inflammation Proliferation (Migration) Maturation (Remodeling)
- 23. Proliferative phase Scaffoldingfor repair of the wound Angiogenesis Fibroplasia Collagen, elastic fiber, extracellular matrix The aim is the formation of granulation tissue consists of a capillary bed; fibroblasts; macrophages; and a loose arrangement of collagen, fibronectin, and hyaluronic acid Appearance: pink, granular tissue, little or no slough, little exudate
- 24. Proliferative phase Inflammation phase Proliferative phase Character: Less exudate Fragile granulation tissue Dressing target Protection Moist wound healing Non-adhesion before epithelial tissue Absorption Occlusion
- 25. Pathophysiology of WoundHealing Hemostasis Inflammation Proliferation (Migration) Maturation (Remodeling)
- 26. Maturation phase Crosslinking of collagen>increase strength Wound contraction Reduce cellular activity and blood vessels Paler and flatten scar Skin function deficiency Lotion Sunscreen Non-adherent pad
- 28. Summary Every woundis unique Should be assessed and treated individually, principally correcting the underlying causes and systematically ~ by Halim, Khoo & Saad, 2012 Accurate, ongoing assessment of the needs of the wound No single product is suitable for all wounds or all stage of healing process Adequate knowledge of the functions and performance of the dressing Journal wound care Vol 15, Feb 2006. Jones AM, San Miguel L
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- 30. Thank you forlistening