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WOUND DRESSINGS
GOOD MORNING
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OBJECTIVE
To know the importance ofwound dressings in
wound healing.
To learn the factors to consider in choosing primarywound dressing
Discuss some effective primary and secondary
wound dressings.To be able to identify most commonlyused wound
dressings, when and how touse them
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Early Wound Dressing
Natural adhesive bandageswere used 4,000 years ago by theEgyptians.
In the Edwin Smith papyrus,Egyptians wrote of using wovenbandages soaked in a quicksetting plasters used as adhesivetapes were discussed in themanuscript.
The oldest bandages that havebeen found were in the tombs ofthe Pharaohs.
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The Historyof Dressings
1600 BC: Linen strips soaked in oil or grease
and covered with plaster used to occlude wounds
Closed wounds heal more quickly than openwounds
- Edwin Smith Surgical Papyrus, 1615BC
1891: Woven absorbent cotton gauze
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The Historyof Dressings
1800s: Lister links pus with infection
The incorrect notion that pus always means infection
interfered with the acceptance of occlusive dressings
Until the mid-1900s, it was firmly believed that
wounds healed more quickly if kept dry anduncovered
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The Historyof Dressings
1948: Oscar Gilje describes moist chamber
effect for healing ulcers
1962: Winter conducts landmark studydemonstrating the efficacyof moist wound
healing byocclusive dressings:
- 30% greater benefit ofocclusive dressings versusair drying ofwounds
Numerous studies to date support this concept
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The History of Dressings
1800s: Lister links pus with infection
The incorrect notion that pus alwaysmeans infection interfered with theacceptance of occlusive dressingsUntil the mid-1900s, it was firmlybelieved that wounds healed morequickly if kept dry and uncovered (justlike mom told you)
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History of Biomaterials in Medicine
Ancient cultures used primitive materials fromtheir natural surroundings to heal theirwounds andto cure diseases.
The oldest known use of bandages -Sumeria(2100 BC).
a medical manuscript written on stone tablets
describes detailed procedures ofwashing wounds,making plaster, and bandaging.
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The Functions of a Wound Dressing
Substitute for the lost native epithelium
Provide the optimum environment for healing by
protecting the wound from trauma, bacteria
Conform to wound shape
Absorb wound fluids
Provide pressure for hemostasis
Eliminate or decrease pain
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The Functions of a Wound
Dressing
Promote re-epithelialization during the
reparative phase of wound healing
Easy application/removal with minimalwound injury
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Wound Care Products
Goals:
Bind surface epithelium and underlying connective tissues when
possible;
Protect wound from infection;
Maintain moist wound environment;
Permit gas exchange; and,
Promote rapid epithelialization.
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CHARACTERSTICS OF IDEALWOUND DRESSING
Maintain humidity
Remove excess exudates
Allow gaseous exchange
Provide thermal insulation
Impermeable to bacteria
Allow removal without causing trauma
Nontoxic andnonallergenic
Cost effective
Availability
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Ideal Dressing Composition
Inert material that does not shed fibers or
compounds into the wound which may evoke aforeign-body, irritant, or allergic reaction
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Traditional Wound Care Products
Protective and gas permeable
Transparent Films
Foams
Hydrocolloids or Hydrogels
Alginates
Specialty Absorptive Dressings
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Transparent Films
Acu-derm
Bioclusive
BlisterfilmPolyskin II
Pro-Clude
Op-Site
Opraflex
Tegaderm
Transeal
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Infection Control Products
-Dressings to Secure Catheters
a thin, semi-occlusive,
transparent polyurethane film
dressing that provides a
bacterial/viral barrier and
helps secure catheters, reducing
mechanical irritation.
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Transparent Films
Advantages:
Waterproof and Bacteria-proof
Allows visualization of the wound.
Wont traumatize wound when removed.
Disadvantages
Not rec. for wound with moderate/heavy exudate.
Not rec. for wound with fragile surrounding skin.
Provides no cushioning to wound.
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Foams
Examples
Allevyn
Cutinova Foam
Epilock
Flexzam
Hydrasorb
Lyofoam
Mitraflex
Nu-derm
Polymem
Tielle
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Foams-polyurethane pads
-Indications: Noninfected, draining granular wound
Advantages
Non-adherent
Wont injure surrounding skin
Can repel contaminants
May be used under compression
Cushions wound surface
Maintains moist wound evironment
Highly conforming
Gas permeable
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Hydrocolloidsin pad,sheet or filler form for occlusive use.
Forms a gel as it absorbs water from the wound bed that sits on wound
Indications: Small, solitary non-draining ulcersor light-to-moderate exudate wounds
Advantages
Impermeable to bacteria and other contaminants
Promotes autolysis, angiogenesis, and granulation
Self-adhesive and molds well
Limited-to-moderate absorption
Creates moist environment
May be left in place for up to 5 days
May be worn in the shower
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Hydrocolloids
AquaCel
Comfeel
Cutinova Hydra
Duoderm
Hydrapad
Intrasite
J&J Ulcer Dressing
Procol
Replicare
Restore
Triad
Ultec
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Hydrogels
-cross-linked hydrophilic matrix impregnated into gauze-type pads whichallows transmission of water, vapor and CO2 but discourages dehydration.
Indications: full thickness wounds with moderate drainage
Soothing and conforms to wound
Fills in dead spaces
Highly absorptive
Can be used on infected wounds
Disadvantages
Difficult to keep in place
Encourages gram negative organisms
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Hydrogels
AquaSorb
Carrington Gel
Carrasyn-V
Clear-Site
Curasol Gel
Flexderm
Hydron
Intrasite Gel
Solosite
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Adhesive Gel Sheets for Scar
TreatmentFlexible, adhesive, semi-occlusivesilicone gel sheet.
Reduces raised scars and redness
of the scar so it fades andbecomes less noticeable.
Self-adhesiveness and durability
mean that application is simple
and the gel sheet can be washedand used several times.
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Resorbing Matrices
Matrix is a primary dressing which
transforms into a soft, conformable
gel, allowing contact with the entire
wound bed;
Consists of 45% regenerating
cellulose and 55% type I collagen
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Resorbing Matrices
The persisting inflammatory phase in
chronic wounds contributes to exudate
with high concentrations of matrix
metalloproteases (MMPs);
Excess MMPs result in degradation of
extracellular matrix proteins;
Excess MMPs inactivate growth
factors;
cellulose/collagen combination binds
more MMPs than ORC or collagen
alone
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1. BANDAGES
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TYPES OF BANDAGES
CONFORMING BANDAGES: Flexiblesecondary dressing to secure primary dressings
ELASTIC BANDAGES: First quality bandage that
acts as a flexible secondary dressing to secure primarydressings, or to ensure a good compression over sprains.
RETENTION BANDAGES: As their namesuggests, these bandages are used to retain dressings in
placeSUPPORTIVE / FIXATION BANDAGES:
Support may be defined as the retention and control oftissue without the application of compression.
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INDICATIONS Vs
CONTRAINDICATIONS
Retention Holds dressing
in place i.e. Gauze.
Supportive/Fixation Used
for immobilization
Compression To assist in
venous/lymphatic disorders
rotection - Protects
specified area
Allergy to material
The simple elastic bandagecan cause trouble when it is
applied too tightly.
Problems arise when circulationin the limb beyond thebandage is impaired.
The limb shouldn't swell, hurt,or be cooler beyond thebandage.
The skin shouldn't have anyblue or purple colour.
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METHOD OF USE
Elastic: When wrapping thebandage, start distally and workproximally.
The bandage should be tighterat the distal point of applicationtowhere it ends proximally.
Many people think that becausea bandage is elastic it must be
stretched. That's wrong!!!
The stretchability is to allow theperson to move. Simplywrap thebandage as youwould a roll ofgauze.
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2.COMPRESSIVE
DEVICES
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Rigid
non-elastic compression
multi-layered compression
short-stretch and single-layercompression.
Multi-layered and short-stretch appear to be the
most commonly used.
Bandages are graduated (i.e. Are tighter at the footand ankle and become looser with more proximal
application)
TYPES OF COMPRESSIVE
DEVICES
HOW DOES COMPRESSION
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HOW DOES COMPRESSION
BANDAGING WORK?
Blockage or damage to the venous system will cause
disruption to normal blood flow, manifesting itself in
different ways such as edema and varicosities.
For patients with venous disease, the application of
graduated external compression (distal to proximal) can
help to minimize or reverse the skin and vascularchanges by forcing fluid from the interstitial spaces back
into the vascular and lymphatic compartments.
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INDICATIONS Vs
CONTRAINDICATIONS
Venous leg ulcer
management. E.g.
Chronic venous
insufficiency, lymphaticoedema.
Arterial disorders
Infection
Adverse Reactions:
Too tight or loose
Wrinkles because increase inthe numberof layers increases the
localised compression.
Swollen toes
Contact dermatitis &
allergies to the materials
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1.Apply bandage before weight bearing
2.Make sure that the leg is clean and thoroughly dry. Apply suitablemoisturizer and check leg and pedal pulses, to ensure that vascularity issuitable
3.A padding bandage is required for skin protection undercompression bandages. Zinc paste bandage or dressing is applied priorto the application of the padding bandage.
4.Apply the compression bandage in a spiral from toe to knee, includingthe heel, with a 50% overlap of the width.
5.Repeat the process using second compression bandage if low stretchcompression bandages are used. Additional layers may be applieddepending on the wound and degree of compression required.
6.Pressure should be increased around the ankle and lower leg andgradually reduce pressure when proceeding proximally.
7.Ensure bandage is not applied to tightly or loosely
METHOD OF USE
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Incorrectly applied bandage showing effects of slippage
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Frequencyof dressingchanges: Dependant on thepatients needs, but should be aminimum of once a week.Dressing should be changed
more than once a week ifpatient is mobile
Advice to patient/caregivers:
Generally application is bycaregiver due to improperapplication with selfadministration or administrationby unqualified individual.
ADVICETO PATIENT
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DIFFERENT COMPRESSIVE BANDAGES
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THE GREAT VANILLA SLICE CHALLENGE 2005
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3. FIXATIVE DEVICES
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May or may not be adhesive
May or may not contain elastic
May be comprised of various materials
Holds wound dressings and tubes in place.
GENERAL FEATURES
TYPES OF FIXATIVE
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Adhesive surgical tapes-smaller wounds to hold textilecompresses in place
Plasters with no adhesionfixation border- hydrogeldressings
Tapes may also be applied in
a parallel fashion on minorincisional wounds healing byfirst intention.
Steri-strips
Examples: Handipore, mefix,leucoplast tape.
TYPES OF FIXATIVE
DEVICES
INDICATIONS V
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INDICATIONS Vs
CONTRAINDICATIONS
When bandage is required to remain in place
Protection of wound from environment
Bridging edges of wounds
Aesthetically pleasing
Allergy to material or Zinc Oxide. Fragile skin
Non-allergenic contact dermatitis can result when tackifiersare trapped between the skin and the adhesive.
For patients with sensitive skin, use surgical tapes with skin-compatible polyacrylate adhesives.
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1)Cut material to shape,remove backing strip orunroll bandage andapply to the desired area.
2) The application ofrectangularstrapping (all fouredges fixed with stripsof tape) to be mosteffective, as thistechnique reduceswound irritationcaused by movement of
the dressing
METHOD OF USE
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ADVICE TO PATIENT
Frequencyof dressing
changes: As requested by
practitioner, or as often as
wound dressing requires.
Advice to
patients/caregivers:
Do not wet.
Remove bandage if irritation
occurs or foot is turning
blue/white.
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THANK YOU!