Management of wounds

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Management of wounds

• V.Southard PT MS GCS

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Purpose of Wound Treatments

• 1. Cleanse
• 2. Treat infection
• 3. Debride
• 4. Provide optimal environment for healing
• 5. Relieve pain/discomfort
• 6. Prevent complications

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Infection

• Results in local cellular injury because of a
  competitive metabolism, toxins, intracellular
  replication or antigen-antibody response.
• SS

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Cleansing the Wound

• Wound debris is removed prior to dressing
  application. This will facilitate both repair
  and assessment
• Sterile saline is sufficient to remove debris
• Max pressure to cleanse wound is 8-14/in2.
• 19 gauge needle and 35 ml syringe.

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Debriding the Wound

• Necrotic tissue
• Delays healing.
• Also Associated with the presence of
  pseudomonas and Proteus in pressure ulcers.
• Acts as a splint to keep wound open.

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Four Basic Methods of Wound Debridement

• 1. Mechanical- wet to dry
• 2. Sharp- scalpel. Esp. good with thick eschar.
  Requires pain control.
• 3. Enzymatic- Lysing agent. Breaks down fibrin,
  collagen, elastin. D/c as soon as wound is
  clear.
• 4. Autolytic- Natures way of cleansing the wound
  using the bodys own enzymes.

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Optimal Healing Environment

• Moisture retention dressings have been found to
  facilitate reepithialization and influence
  inflammation, granulation tissue, and collagen
  formation.

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Dressings Pain and Discomfort

• Adherent dressings are painful to remove.
• Location walking on an ankle dressing over an
  ankle wound is painful. Also 2nd degree burns do
  better with moisture retention dressings than
  just ointments

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Prevention of Complications

• 1. Prevent dehydration and infection.
• By treating the wound infections are prevented,
• Less necrotic tissue
• Moisture retentive dressings maintain an acidic
  pH 5.8-6.6 correlation with decreased bacterial
  proliferation

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Prevention of skin breakdown

• Watch the surrounding skin
• Underlying pathology shear, friction or pressure
  in pressure ulcers. Or as with venous lesions,
  inadequate compression.
• Look at the support surface the client is on.
• Assure that topical debridement agents are only
  on the wound. Remove saturated occlusive
  dressings. Watch tape placement

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Air mattress
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Alternating Pressure
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Foam
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Different needs of different wounds

• Acute wounds
• 1. May epithelialize in as little as 24 hours.
• 2. Dressings for sutured wounds should be safe
  and protect the wound from physical damage,
  chemical damage and microbial contamination.
• 3. Comfortable, flexible, easy to use, allow
  hygiene

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Surgical and Traumatic Non Sutured Wounds

• Heal by 2ary intention, heavily contaminated,
  dehised, 2nd degree burns, skin graft donar
  sites, dermabrasions as well as some biopsy and
  surgical excision wounds

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Clean Surgical and Traumatic Partial Thickness
Wounds

• Skin graft donor sites need 7-20 days to heal,
  depends on wound depth and dressing type.
• Generally occulsive dressings heal faster as
  compared to conventional gauze with or without
  antimicrobial ointments

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Contaminated or Dehisced Surgical Wounds

• Either delayed surgical closure or secondary
  intention.
• For granulation and epithelialization to occur
  often require wound fillers, 2ary to wound depth.
• Fluff dont stuff

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Prevention of Allergic Reactions

• Chronic wounds become sensitized to topical
  agents and adhesives
• As a result, use hypoallergenic and non
  sensitizing products. Use caution when using
  rubber based products

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What is a Chronic Wound?

• Wounds that dont heal because of repeated trauma
  that destroys tissue formation, or when 1 or more
  chemical or cellular elements of the healing
  process are deficient.
• When the balance is restored the wound will heal.

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Pressure Ulcers

• Apply general wound healing principles. (Remove
  necrotic tissue and keep clean.)
• Factors related to healing depth, nutritional
  status, pressure relieving devices, incontinence,
  mobility, and age.

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Leg Ulcers

• 80-90 LE ulcerations have venous origin
• 5-10 LE ulcerations are 2ary to arterial
  disease.
• Remainder neuropathy or combinations of A or V
  disease.
• Compression is a must in venous ulcers.