wound management, dressings type, dirty and clean wounds, presents plan to manage different types of wounds and options of available dressings.

1. Omer hashm
H.O

2. Sugical
wound
Traumatic
wound
Untidy
Tidy
(incisional)
(penetrating,
lacerating.
Degloving)

3. Untidy wound
Tidy wound
which heal themselves by
primary intensin
Othervise they undergo
 Scars
 Contractures
 Severe infections
Tidy wound <6hrs..
Primarily closed or
delayed primary closure
after 3-5 days
…untidy wound dealt
with secondary
closure, culture
sensitivty
done, antibitics and
dressing

4. Size, dep
th &
location
Lab tests:
HISTORY
examination
WOUND
ASSESMENT
WOUND
BED
SURROUNDING
skin

5. 1.Sloughy wound
• Dead cells accumulated in exudate
Aim:
to liquefy slough and aid its removal
2.Necrotic wound
•Aims:
• to debride and remove eschar

6. 3. Infected wound
•Aims: reduce exudate,
odour and promote
healing
4.Granulating
wound
 Aims: support granulation,
protect new tissue, keep moist

7.  PRIORITIES
-Correct Etiology
-Provide Systemic Support
-Use appropriate therapy
• GOAL
-Healing
-Maintenance

9. Traditional dressings:
Modern Moist Wound Dressings:
• Gauze, lint and fiber
products
• Hydrocolloids
•
•
•
•
•
•
•
Foams
Films
Alginates/Hydrofibers
Collagen
Hydrogels
Topical Antimicrobials
Silicone
Look how far we’ve come!!!

10. Autolytic
Fillers
Hydrating
Primary
Non-adhesive
Active
Absorbing
Secondary
Enzymatic

11. Need to be compatible with the wound:
 May be hydrating or absorptive
 Promote/maintain moist, healing environment
 Provide insulation
 Impermeable to microrganisms
 Atraumatic to the wound/periwound area
 Cost effective
 In conventional terms: dry, or wet
 In technical terms we have:

14.  Indications:
 Superficial and full thickness wounds
 Skin grafts, donor sites, burns, skin tears
 Under compression for ulcers
 Contraindications:
 Dry wounds
 Examples: Mepilex (Border), Allevyn (Plus
Adhesive), Polymem, Biatain

15.  Indications:
 Minor injuries (abrasions)
 Post-op dressing over sutures
 IV sites
 Contraindications:
 High exudate wounds
 Fragile skin
 Examples: Tegaderm, Opsite

16.  Indications:
 Highly exuding wounds
 Infected wounds (change daily)
 Contraindications:
 Dry wounds or wound with eschar
 Aquacel, Melgisorb, Seasorb, Kaltostat

17. Regranex®
Growth Factor Preparations

PDGF preparation in a
hydrogel
Dermagraft®
Single-Layered Tissue

Human fibroblasts on
matrix meshBilayered Tissue

Apligraf®
Human fibroblasts and
keratinocytes in a
bovine collagen matrix.

18. Processed Tissue
 Primatrix®
 Oasis®
Acellular collagen dermis (fetal
bovine origin)
Acellular bovine graft
(Bovine Small Intestinal
Submucosa)

20.  Indications:
 Dry wounds
 Wounds with slough wounds
 Wounds with eschar
 Over tissues and tendons to prevent drying
 Contraindications:
 High exudate wounds
 Examples: Solosite, Woun’ Dress, SkinTegrity

21.  Chemically inert, adverse effects rare
 Designed to be removed without trauma or pain
 Protect friable or newly healed tissue from injury
 Less trauma to periwound
 Examples: Mepilex, Allevyn Gentle

22.  Enzymatic
Viridine-strptokinase
 biological
maggots

23.  Bacteriocidal:
 Silver
 Honey
 Cadexomer iodine
 Bacteriostatic:
 Methylene Blue and Gentian Violet
 Xeroform

24.  Antimicrobial action through (+) silver ion
 Effective when in contact with wound fluid
 Consider:
 Kill rate AND sustained release rate
 Testing Methods: Simulated wound fluid, saline
 Delivery methods:
foams, gels, alginates, hydrofibers, creams
 (SSD - approved for burns, only)

25.  Hydrogen peroxide
 Acetic acid
 Effective against Pseudomonas aeruginosa
 Diguanides (Chlorhexidine)
 Sodium hypochlorite (Dakin’s)
 Not recommended unless suitable are unavailable
 Povidone Iodine

26. Usually Type I bovine or avian or type III
porcine collagen
Indications:


Partial & full thickness wounds
Minimal to moderate drainage
 Contraindications:



Eschar covered
Full thickness burns
Sensitivity to contents

27. Based on amount of drainage and presence of
infection
 Infected wounds need to be monitored daily
 Heavily draining wounds may need to be changed 2-3
times a day
 As drainage decreases, increase time between dressing
changes