wound dressings (1)

8/8/2019 Wound Dressings (1)

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Click to edit Master subtitle style7/20/2010

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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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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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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7/20/2010Necrosis caused by incorrectly applied bandage

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!

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