Download - Dressing Materials
-
8/6/2019 Dressing Materials
1/38
Everything starts with the name of Allah (God), whoknows everything, who is supreme, the lord of theuniverse.
He who is almighty and always there with all his
powers.
He takes care of the whole world, He is alone, Hefeeds and is very kind to every living being.
So one should praise His blessings with prayers.
Because He is the merciful one who has created thiswhole world
-
8/6/2019 Dressing Materials
2/38
DR.NAVEED SARWAR MAHAR
FCPS-II TRAINEE
WARD 26,JPMC
-
8/6/2019 Dressing Materials
3/38
-
8/6/2019 Dressing Materials
4/38
Wound dressings is the topicWound dressings is the topicof discussion infact..of discussion infact..
-
8/6/2019 Dressing Materials
5/38
INTRODUCTIONINTRODUCTION
yWound:y Any break in the continuity of skin or other organ.
y An injury to the feelings.
yWound Dressing:
y A therapeutic or protective material applied to a wound
y Sterile/aseptic:
y free of living microorganisms
y Antiseptic:y a substance that tends to inhibit the growth and
reproduction of microorganisms when applied to livingtissue.
-
8/6/2019 Dressing Materials
6/38
WOUND DRESSINGS
-
8/6/2019 Dressing Materials
7/38
HISTORY OF WOUND DRESSINGSHISTORY OF WOUND DRESSINGS
y 1600 BC: Linen strips soaked in oil or grease and covered with plasterused to occlude wounds
y 1891: Woven absorbent cotton gauze
y Until the mid of 20th , it was firmly believed that wounds healed more
quickly if kept dry and uncovered
y 1948: Oscar Gilje described moist chamber effect for healing ulcers
y 1962: Mr.Winterconducted landmark study demonstrating the efficacyof moist wound healing by occlusive dressings:
y 30% greater benefit of occlusive dressings versus air drying of wounds
-
8/6/2019 Dressing Materials
8/38
INTERACTION OF DRESSING IN WOUND HEALINGINTERACTION OF DRESSING IN WOUND HEALINGINTERACTION OF DRESSING IN WOUND HEALINGINTERACTION OF DRESSING IN WOUND HEALING
y Debridement
y
Optimal environmenty Promotes granulation and epithelialization
y Protection from infections
yAbsorption of fluids
y Hemostasis
y
Soothing effect
-
8/6/2019 Dressing Materials
9/38
PRINCIPAL REASONS TO APPLY DRESSINGSPRINCIPAL REASONS TO APPLY DRESSINGS
y Rapid and cosmetically acceptable healing,
y Remove / contain odour,
y Prevent / combat infection
y Contain exudate
y Minimize distress
-
8/6/2019 Dressing Materials
10/38
IDEAL DRESSING COMPOSITIONIDEAL DRESSING COMPOSITION
y Inertness:y Material should not shed fibers or compounds, which may
evoke a foreign-body, irritant, or allergic reaction
y Maintain moisture :y To suppresses tissue dessication/eschar formation for
effective keratinocyte migration and re-epithelialization
y It decreases the amount of lost dermis thus improving thecosmetic outcome of the injury
y Maintain O2 balance:y Cells need O2 for migration and mitosis,
y Hypoxia promotes angiogenesis,
-
8/6/2019 Dressing Materials
11/38
-
8/6/2019 Dressing Materials
12/38
EFFECT OF AIR DRYING AND DRESSINGS ON
THE SURFACE OF WOUND
2.52.5 cmcm22woundswoundsAfter 3 daysAfter 3 days
99 %99 %
41 %41 %
18 %18 %
OcclusiveOcclusive dressingdressing
Air dryer (hot)Air dryer (hot)
Withoutany dressing (air exposed)Withoutany dressing (air exposed)
Dehydrated dermisDehydrated dermis
epidermisepidermis
exsudateexsudate
Wound HealingRef: British Journal for Dermatology
-
8/6/2019 Dressing Materials
13/38
Moist wound healingMoist wound healingMoist wound healingMoist wound healing
Dry exudate
-
8/6/2019 Dressing Materials
14/38
CHOICE OF DRESSINGCHOICE OF DRESSING
The choice of dressing is inf luenced by many factors:
1. Type of wound
2. Reliability of product
3. Economic factors
-
8/6/2019 Dressing Materials
15/38
TYPE OF WOUND
y The presence or risk of infection and the
y Amount of exudate produced.
y Nature and location of the wound,
y Necrotic wounds - covered with devitalized epidermis,
frequently black in colour,
y Sloughy wounds contains a layer of viscous adherent
slough, generally yellow in colour,
y Granulating wounds contains highly vascularisedgranulation tissue, generally red or deep pink in colour,
y Epithelialising wounds - show evidence of a pink margin to
the wound or isolated pink islands on the surface
-
8/6/2019 Dressing Materials
16/38
COMONLY USED DRESSINGS
1. OCCLLUSIVE:y Simple traditional dressings (Gauzes/ Tulles)
y Polymeric(Foams/Films)
y Hydrocolloids
y Hydrogels
y Fibrous polymers(alginates)
2. DEBRIDING AGENTS
y
ENZYMAT
IC AGENT
Sy Chemical agents
3.3. GENETICALLY ENGINEEREDBIOLOGICAL MEMBRANESGENETICALLY ENGINEEREDBIOLOGICAL MEMBRANES
4.4. COMPOSITES DRESSINGSCOMPOSITES DRESSINGS
-
8/6/2019 Dressing Materials
17/38
TRADITIONAL WOUND DRESSINGS
Layered Dressing
y> Three layers1. Contact/Interface layer:
y non-adherent, fluid-permeable, in direct contact withwound
2. Absorbent layer:
y absorbs exudate and molds dressing to wound shape
3. Wrap Layer:
y retains underlying layers
y Ex. Gauze or tulles/Cotton gauze/Cover-roll
-
8/6/2019 Dressing Materials
18/38
TRADITIONAL WOUND DRESSINGS
Layered DressingyAdvantages
y Hemostasis
y wound stability
y decreased edema
y low cost
y Disadvantages
y adherence to wound
y ischemia/necrosis
y Bulk
y frequent changes
-
8/6/2019 Dressing Materials
19/38
POLYMERIC FILMS
y Thin, elastic, self-adhesive transparent sheetsy Polyurethane or other synthetic materialy Semi-permeable:
y Gas-permeable: O2, CO2, H2O vapor
y Impermeable to proteins, fluids, bacteria
y Indicationsy Uncontaminated, superficial wounds
y IV sitesy Skin tearsy Skin graft donor sites
-
8/6/2019 Dressing Materials
20/38
POLYMERIC FILMS
y Advantages:y Translucent
y Reducespost-oppain
y Bacterial barrier
yDisadvantages:
yD
ifficulttohandleyAdherencetowound
yNon-absorbent, allowingexudate accumulation
-
8/6/2019 Dressing Materials
21/38
POLYMERFOAMPOLYMERFOAM
y
Bilaminate Structure:y Inner layer: absorbent, gas-permeable polyurethane
foam mesh
y Outer layer: semi-permeable, non-absorbent
membrane (polyurethane, polyester, silicon).Indications:
y Chronic wounds
y Diabetic, venous, sacral ulcers
y Deep cavity wounds with high exudate
y Granulating wounds with minimal exudate
-
8/6/2019 Dressing Materials
22/38
Advantages:
yVery absorbent
y maintains moistenvironment
y Molds and contours towound shape
y Less cost
y Skilled nursing not required
Disadvantages:
y
Opaquey Undesirable drying effect on
inadequately exudativewounds(hence no use in dry
wounds)
-
8/6/2019 Dressing Materials
23/38
HYDROCOLLOIDSHYDROCOLLOIDSy
Made ofmicrogranularsuspension ofnatural/syntheticpolymers, (gelatin orpectin)
y The granules changefrom a semihydratedstate to a gel as thewound exudate isabsorbed
-
8/6/2019 Dressing Materials
24/38
HYDROCOLLOIDSHYDROCOLLOIDS
y Indications:
y low to moderate exuding wounds
y Clean, granulating, superficial wounds
yAdvantages:y Require changing only every 3 - 7 days
y Provide effective occlusion and barriery Cost effective
y More effective than traditional dressings
-
8/6/2019 Dressing Materials
25/38
HYDROGELSHYDROGELS
y
Hydrophilic contain 96% watery Semi-permeable outer membrane
y Semi-transparent/ Semi or non-adherent
y Highly absorptive: 100-200% of their volume
y Cornstarch-derived polymerized compound formsa gel upon hydration at the time of use
yAvailable in a powdered or pre-mixed form
y
Applied wet to the wound defect and requires asecondary outer dressing
yWater application is required for removal
-
8/6/2019 Dressing Materials
26/38
HYDROGELSHYDROGELS
INDICATIONS:INDICATIONS:
y Highly exudating wounds
y Chronic Ulcers
y Thermal burns
y Chemical peels
y Graft donor sites
-
8/6/2019 Dressing Materials
27/38
HYDROGELS:HYDROGELS:
yAdvantages:
y Reduction in post-op pain/inflammation
yAccelerate wound healing as compared to
traditional dressings
yDisadvantages:
yBacterial growth
y Frequent dressing changes because ofabsorption capacity
-
8/6/2019 Dressing Materials
28/38
FIBROUS POLYMERS(ALGINATE)FIBROUS POLYMERS(ALGINATE)
y Natural complex polysaccharide derived from algae or kelp(seaweed)
y When applied, an ion exchange between the Ca++within
the alginate fibers and the Na+
from the blood or woundexudate occurs forming a soluble sodium alginate gel thatprovides a moist wound healing environment
y The release of free Ca during ion exchange augments theclotting cascade in the wound bed (haemostasis)
y Highly absorbent, non-adherent
y May remain in place for several days
y If allowed to desiccate, it adheres to and irritates wound
-
8/6/2019 Dressing Materials
29/38
ALGINATE GELS:ALGINATE GELS:
yy Indications :Indications :y Wounds with copious exudate.
y Exudative wound cavities or sinus tracts(alginate rope).
y Full-thickness burns
y Infected surgical wounds
y Chronic ulcers
-
8/6/2019 Dressing Materials
30/38
ALGINATESALGINATES
Advantages:y Soluble, removal by saline
irrigation with less painy Skilled nursing not
required
Disadvantagesy Unpleasant odory Requires 2nddressingy Yellow-brown color
confused with pus
y Sorbsany Algidermy AlgiSitey Kaltostaty Fibracol Plus
(Collagen +Alginate)
-
8/6/2019 Dressing Materials
31/38
DEBRIDING AGENTSDEBRIDING AGENTSy
Activate fibrinolysis and liquify pusy Used in dry necrotic wounds
y An adjunct to surgical debridement
y Chemical agents (Hypochlorites i-e Eusol, Milton, ChloramineT)
y Enzymatic agents
y
Collagenase (Santyl)y removes devitalized tissue without damage to healthy tissue;
promotes granulation and re-epithelialization
y Papain (Panafil)
y digests devitalized tissue, harmless to viable tissue
y Require urea as an activator
y Trypsin (Granulex)Processed in combination with:
y Balsam of Peru: stimulates capillaries; bactericidal
y Castor oil: reduces dessication, cornification, pain
-
8/6/2019 Dressing Materials
32/38
BIOLOGICAL MEMBRANES(PORCIN)BIOLOGICAL MEMBRANES(PORCIN)
y New group of wound dressings derivedfrom cultured keratinocytes andfibroblasts
y Indicated for chronic, refractory wounds
y
Advantage is the avoidance of skingrafting, which creates another painful,slowly healing wound
y Expensive
y
Higher infection rates vs. other dressingsy Apligraf
y Derived from human neonatal foreskin
y Biobrane
y synthetic
-
8/6/2019 Dressing Materials
33/38
Skin Grafts
Full thickness or partialthickness skin grafts can beused as dressing in a chronic
non healing wound
-
8/6/2019 Dressing Materials
34/38
COMPOSITESCOMPOSITES
y Combination of two or more types of semi-occlusive
dressings into one product
y Engineered to maximize efficiency and comfort of
dressings by expanding absorbency while decreasing
the chance of maceration
y
No retention dressing requiredy Improved waterproof coverings improves quality of life
-
8/6/2019 Dressing Materials
35/38
-
8/6/2019 Dressing Materials
36/38
SUMMARYSUMMARYy Dressings should provide the optimum environment for rapid
healing
y Moist environment and prevention of eschar formation allow
wounds to re-epithelialize and heal faster than if left uncovered
y Semi-permeable or occlusive dressings provide a moist environment,
retain wound fluid that contains growth factors conducive to healing,and promote a low tissue oxygen tension that stimulates
angiogenesis and collagen deposition
y Newer, advanced technology dressings include: Hydrogels, alginates,
foams, films, hydrocolloids
y Tissue-engineered skin equivalents have been developed combining
living keratinocytes and fibroblasts from human foreskins with
bovine collagen
-
8/6/2019 Dressing Materials
37/38
-
8/6/2019 Dressing Materials
38/38