Evolution of the Wound Management

1
Evolution of the Wound Management
Active Tissue Engineering Growth
Factors Antimicrobials Enzymatics
Advanced Moist Wound Healing Chronic Acute
2
How Dressings Interact in Wound Healing ?

• Help to debride
• Providing optimal moist environment
• Promoting granulation
• Promoting epithelialization
• Protecting from infection

3
The Principal Reasons for Applying a Dressing

• To produce rapid and cosmetically acceptable
  healing,
• To remove or contain odour,
• To reduce pain,
• To prevent or combat infection,
• To contain exudate,
• To cause minimum distress or disturbance to the
  patient,
• To hide or cover a wound for cosmetic reasons.
• A combination of two or more of the above.

4
The selection process

• Once the treatment aims have been
  clearly established, the selection process can
  begin.
• The choice of dressing or treatment
  regimen may be influenced by many different
  factors, these can be divided into different
  principal inter-related groups
• wound,
• Product,
• or patient related,
• Economic factors

5
Wound related factors

• These include the nature and location of
  the wound, the presence or risk of infection and
  the amount of exudate produced.
• Wound Type
• A simple wound classification system
  such as that shown below forms a useful starting
  point in the selection process. Within this
  classification wounds are divided into four basic
  types according to their appearance but it will
  be immediately obvious that these groups could be
  further sub-divided to take account of wound
  aetiology or depth for example.
• Necrotic wounds - covered with devitalised
  epidermis, frequently black in colour,
• Sloughy wounds - which contain a layer of viscous
  adherent slough, generally yellow in colour,
• Granulating wounds which contain significant
  amounts of highly vascularised granulation
  tissue, generally red or deep pink in colour,
• Epithelialising wounds - which show evidence of a
  pink margin to the wound or isolated pink islands
  on the surface

6
Factors Influencing Dressing Selection
Wound type Superficial Full thickness Cavity
Wound description Necrotic Sloughy Granulating Epithelialising
Wound characteristics Dry Moist Heavily exuding Malodorous Excessively painful Difficult to dress Liable to bleed easily
Bacterial profile Sterile Colonised Infected and potential source of serious cross infection
7
Dressing Choice by Wound Appearance
Wound Type (Color/Exudate) Goal Wound Depth Wound Depth
Superficial Cavity
Black/low exudate Rehydrate/debride Hydrogel Hydrocolloid Gauze Enzyme Hydrogel Hydrocolloid Gauze Enzyme
Yellow/high exudate Remove slough Control exudate Hydrocolloid Exudate Absorbers Enzymes Gauze Hydrocolloids (paste, granules, powder) Exudate Absorbers Enzymes Foam cavity dressings
Yellow/low exudate Remove slough Control exudate Hydrogel Hydrocolloid Enzymes Film Gauze Hydrocolloids (paste, granules, powder) Hydrogel Gauze Enzyme Foam cavity dress
Red/high exudate Absorb exudate, maintain moist environment, promote granualtion and epithelialization Foams Hydrocolloid Exudate Absorbers Hydrocolloids (paste, granules, powder) Exudate Absorbers Foam cavity dressings
Red/low exudate maintain moist environment, promote granualtion and epithelialization Hydrogel Hydrocolloid (thin) Enzymes Film Non-adherent Hydrocolloids (paste, granules, powder) Hydrogel Foam cavity dressing
8
(No Transcript)
9
Characteristics and Uses of Wound-Dressing
Materials
Applications Description Examples Category
Debriding agents are useful for necrotic wounds as an adjunct to surgical debridement. Various products provide some chemical or enzymatic debridement. Hypergel (hypertonic saline gel) Santyl (collagenase) Accuzyme (papain urea) Debriding Agents
These dressings are useful for cleaning granulating wounds with minimal exudate. Polyurethane foam has absorptive capacity. LYOfoam Spyrosorb Allevyn Foam
Hydrocolloid dressings are useful for dry necrotic wounds, wounds with minimal exudate and for clean granulating wounds. Hydrocolloid dressings are made of microgranular suspension of natural or synthetic polymers, such as gelatin or pectin, in an adhesive matrix. The granules change from a semihydrated state to a gel as the wound exudate is absorbed. Duoderm CGF Extra Thin Granuflex Tegasorb Hydrocolloid
10
Applications Description Examples Category
These dressings are highly absorbent and useful for wounds have copious exudate. Alginate rope is particularly useful to pack exudative wound cavities or sinus tracts. Alginate dressings are made of seaweed extract contains guluronic and mannuronic acids that provide tensile strength and calcium and sodium alginates, which confer an absorptive capacity. Some can leave fibers in the wound if they are not thoroughly irrigated. These dressings are secured with secondary coverage. Kaltostat Sorbsan Tegagel Alginate
Hydrofiber absorbent dressings used for exudative wounds. An absorptive textile fiber pad, hydrofiber is also available as a ribbon for packing of deep wounds. This material is covered with a secondary dressing. The hydrofiber combines with wound exudate to produce a hydrophilic gel. Aquacel-Ag contains 1.2 ionic silver that has strong antimicrobial properties against many organisms, including methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci. Aquacel Aquacel-Ag Versiva Hydrofiber
11
Selecting the correct dressing as the wound
changes
Wound condition
Product selected
why
Hydrate,separate Eschar
Hard dry black
Amorphous Hydrogel
Exuding yellow
Absorb exudate,autolytic Debridement
Alginate xerogel
Moist red
Provide barrier control humidity
Hydrocolloid
Transparent Film
Pink/red
Allow Epithelialization, Reduce shear
12
Major dressings properties

• Moist environment
• Debriding potential
• Comfort and analgesia
• Exsudation management
• Ease of application

13
Effect of air drying and dressings on the surface
of wound
Occlusiv dressing
Porcin model 2.5 cm2 wounds After 3 days
99
exsudate
Without any dressing (air exposed)
41
Air dryer (hot)
epidermis
Wound healing
18
Dehydrated dermis
14
Moist wound healing
Occlusive dressing
Stratum corneum
Exposed wound
Moist wound bed
epidermis
Dry exudate
No crust or scab
Crust Or scrab
Dry dermis
dermis
Fast epithelial migration On moist wound bed
Slow epithelial migration Below crust
15
None Small Moderate Large
Moisture Imbalance and Chronic wound
Exduate Amount

• Films
• Hydrogel
• Hydrocolloid
• Alginate
• Foam

16
Different Types of Dressing

• Dressing Based Essentially on Occlusion
  Principle
• Absorption Based Dressing
• Dressing Based on Occlusion and Absorption
  principle
• Dressing Based on Selected Absorption Principle
• Dressing in-between
• Dressing For Superfical Wounds
• Dressing For Dry Wound Autolytic Debridement
• Dressing Based on Adsorption-Delivery Principle

17
Impregnated Gauze

•  Traditional dressing 
• Contact dermatitis are frequent

18
Impregnated Gauze

• Adherent
• Pain and bleeding at removal

19
- For low exuding superficial
wounds. - Decrease pain at dressing removal.
SILICONE DRESSING
Mepilex
URGOTUL
Mepitel
20
Occlusive dressing
Extra-thin hydrocolloid
21
Hydrocolloid Indication

• For low to moderate exuding wounds
• For clean, granulating, superficial wounds
• With safe surrounding skin

22
Hydrocolloids Advantage

• Require changing only every 3 - 7 days
• Provide effective occlusion and barrier (prevent
  the spread of Infection
• Cost effective
• More effective than traditional dressings

1 week
23
Hydrocolloid
Hydrocolloid
loids
Diabetic ulcer for 5 month
21 days
24
Moist wound healing
Absorption base dressing
Alginate Hydrofibre
25
Alginate Indication

• For moderate to heavily exudating wounds
• Help to debride (in addition with mechanical
  debridement)

26
Alginate Indication

• For moderate to heavily exudating wounds
• Help to debride (in addition with mechanical
• debridement

27
(No Transcript)
28
Hydrofibre Aquacel

• CMC fiber gel formation
• Same indications than alginate
• Non haemostatic

29
Foam dressing Indication

• For light to medium exuding wounds
• Granulating and epithelializating wounds

30
For Cavity Wounds
31
Cavity Wounds(Healthy Granulation )
32

• Silver Dressing
• Silvercel (Alginatesliver)
• Aquacel(Ag(hydrofibresilver)
• Acticoat (Nanocrystalline
• silver-based dressing)

33
Promogran
Post traumatic chronic ulcer

• Growth factors protection
• Binding and inactivating proteases in excess

Growth Factors
Protease
inactive
Promogran