Download Wound Healing Wound Care - TOT e

Wound Healing
Wound Care
Saran Worasakwutiphong MD.
WOUND CARE
• Most wounds  heal with minimal intervention.
• Systemic diseases, hospitalized
•
 Nonhealing
• 3 types :
–(a) acute wound
–(b) wound-healing difficulties
–(c) chronic wound
• Basics of wound care  treat the broad
spectrum of wounds
• Understanding the biochemical and cellular
aspects of tissue repair
• Maximizing rates of limb salvage
• Choosing a wound-care modality
• Tetanus prophylaxis
• History and physical examination
•  cause of the wound
•  identifying any comorbid conditions
• Systemic & local factors
• interfere healing
• Bioburden
1. Contaminated (without proliferation)
2. Colonized (multiplying without reaction)
3. Critically colonized (host resistance is
beginning)
4. Infected (expanding bacterial host reaction)
• Wound cleansers
– colonized and contaminated wounds
• Surface irrigation with saline
– contaminated wounds
• Surgical debridement
– infected wounds
 Most wounds: Antibiotics = unnecessary
 Antibiotic therapy
•
•
•
•
Cellulitis
Contaminated wounds (oral flora, animal bites)
Mechanical implants
Infected wounds
• Healing decreases
• Increased pain
• straw-colored “oozing” from the skin
Wound Bed Preparation
T
I
M
E
•issue debridement
•nfection control
•oisture wound
13
 Healing by reducing the bioburden
 Remove eschar - matrix formed from
exudated serum
 Prolong inflammatory stage of wound healing
 Persistent bacterial colonization
 Meal for bacteria
•
•
•
•
•
•
•
Surgical
Enzymatic
Mechanical
Autolytic
Water jet
Syringe with a 20-gauge 15 psi
Maggot
Sharp Debridement
Moisture
ADJUNCTS TO WOUND TREATMENT
Debridement
Dressings
Negative-Pressure Wound Therapy
Hyperbaric Oxygen
Growth Factors
Skin Substitutes
Wound dressing
 Wound characteristics & treatment goals
 Films for incisions
 Hydrogels or hydrocolloids for open wounds
Light exudates - Hydrogels, films
Moderate exudates - Hydrocolloids
Heavier exudate - Alginates, foams, NPWT
Necrotic tissue - Surgical debridement
Antiseptic
GAUZE
•
•
•
•
Traditional first choice
Moist to dry dressings
 Traumatic and proinflammatory
Expenses, painful, nonselective debriders,
damage to healthy tissue, leave behind fine
microfibers
• Small, noncomplicated wounds
• Impregnated with petrolatum, iodinated
compounds,  keeping moist
Impregnated Gauze
Bactrigas
Urgotul
• Impermeable to fluids, passage of small gas
• Combination with gauze to maintain the
moisture
• Cover and protect freshly closed incisions and
skin graft donor sites  enhance
epithelialization
• Should not be used in contaminated / fragile skin
prone to tearing
Film Transparent Dressing
• Maintaining a moist wound
• Rehydrating wounds
• Autolytic debridement
• Absorb moderate amounts of fluid
• Can be used in infected wounds
• Nonadhesive, minimal pain
• Pastes, powders, or sheets
• Form an occlusive barrier & absorbs mild
exudates
• Left on the wound for 3 to 5 days
• Not to be used in heavily colonized with
bacteria,esp. anaerobes
• Nonadhering polyurethane
• Occlusive cover
• Useful in highly exudative wounds
•
•
•
•
•
•
Brown seaweed
Useful in wounds with heavier exudate
Frees from the multiple dressing changes
Not to be used in nonexudative wounds
Absorb ~20 times in fluid
Should be covered with a semiocclusive dressing
36
 Most beneficial = Silver
 Broad spectrum of microbicidal with low
toxicity to human cells
 cell membrane permeabilizer
 inhibitor of cellular respiration
 nucleic acid denaturer
 Also against
 vancomycin-resistant Enterococcus(VRE)
 Methicillin-resistant Staphylococcus aureus(MRSA)
Silver Sulfadizine
38
Silversulfadizine Cream
39
• Cadexomer iodine : slow-release form of
iodine formulated bactericidal levels
• Silver sulfadiazine
• Mupirocin
• Topical antibiotics
•
•
•
•
Neomycin
Gentamicin
Metronidazole
Bacitracin ointments and creams.
Topical Antibiotic
41
1. Porous sponge within the wound
2. Covered by an airtight occlusive film
3. Vacuum system
•
•
•
•
Relief of edema diffusion O2 to cells
Removes deleterious enzymes
Remove excess exudate
Wound contraction
 Sponge should not be placed on normal skin,
sensitive to pressure and ischemia
 Optimally pressure ~ 125 mm Hg
 Lymphatic leaks, venous ulcers, DM, fistulae, sternal
wounds, orthopedic wounds, and abdominal
wounds
 Contraindications
 Malignancy
 Ischemia
 Inadequately debrided / badly infected wounds
VAC dressing
• 100% O2 saturation at 2 to 3 ATA
•  O2 saturation plasma 0.3% to 7%
• Periwound area/extremity rise in tcPO2 when
supplemental O2
• Not benefit:
– normal environmental perfusion
– ischemic limbs who need a bypass
• Still a paucity of RCT to support its use
Hyperbaric Oxygen
• Platelet-derived growth factor (PDGF)
– Becaplermin (Regranex)
• Vascular endothelial growth factor (VEGF) clinical trials
• Diabetic foot, irradiated wounds and in aged.
• Only in a well-prepared wound bed
 Digest necrotic, devitalized tissue and prevent
slough and eschar
 Sometimes associated with pain
 Less traumatic < surgical debridement
 Papain with urea
 Proteases
 Collagenase
•
•
•
•
•
•
Tissue-engineered products
Contain living cells that are cellular factories
Applied to meticulously clean wounds
Adequate vascularity
Immobilized
useful for sites prone to contracture
(neck, axillae)
53
54
•
•
•
•
•
•
•
Silicone sheets
 increased moisture &
collagenolysis
Steroids
Pressure garments
Calcium channel blockers
Topical salicylic acid
• Silicone sheets improves the appearance of
scars
•  increased moisture &
• collagenolysis
• Steroids
• Pressure garments.
• Calcium channel blockers
• Topical salicylic acid
Nutrition
Nutrition
DIRTY OPEN WOUND
CLEAN OPEN WOUND
CLOSE WOUND
Secondary Intention
Primary Closure
Skin Graft