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Wound management & dressings

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

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Wound management & dressings

  1. 1. Omer hashm H.O
  2. 2. Sugical wound Traumatic wound Untidy Tidy (incisional) (penetrating, lacerating. Degloving)
  3. 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. 4. Size, dep th & location Lab tests: HISTORY examination WOUND ASSESMENT WOUND BED SURROUNDING skin
  5. 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. 6. 3. Infected wound •Aims: reduce exudate, odour and promote healing 4.Granulating wound  Aims: support granulation, protect new tissue, keep moist
  7. 7.  PRIORITIES -Correct Etiology -Provide Systemic Support -Use appropriate therapy • GOAL -Healing -Maintenance
  8. 8. 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!!!
  9. 9. Autolytic Fillers Hydrating Primary Non-adhesive Active Absorbing Secondary Enzymatic
  10. 10. 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:
  11. 11.  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
  12. 12.  Indications:  Minor injuries (abrasions)  Post-op dressing over sutures  IV sites  Contraindications:  High exudate wounds  Fragile skin  Examples: Tegaderm, Opsite
  13. 13.  Indications:  Highly exuding wounds  Infected wounds (change daily)  Contraindications:  Dry wounds or wound with eschar  Aquacel, Melgisorb, Seasorb, Kaltostat
  14. 14. 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.
  15. 15. Processed Tissue  Primatrix®  Oasis® Acellular collagen dermis (fetal bovine origin) Acellular bovine graft (Bovine Small Intestinal Submucosa)
  16. 16.  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
  17. 17.  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
  18. 18.  Enzymatic Viridine-strptokinase  biological maggots
  19. 19.  Bacteriocidal:  Silver  Honey  Cadexomer iodine  Bacteriostatic:  Methylene Blue and Gentian Violet  Xeroform
  20. 20.  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)
  21. 21.  Hydrogen peroxide  Acetic acid  Effective against Pseudomonas aeruginosa  Diguanides (Chlorhexidine)  Sodium hypochlorite (Dakin’s)  Not recommended unless suitable are unavailable  Povidone Iodine
  22. 22. 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
  23. 23. 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

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