Project C.H.O.I.C.E.

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Wounds

• Definition
• An injury to any part of the body
• External injury in which the skin is torn, cut,
  or pierced
• The following types of wounds are more likely to
  become infected bites, punctures, crushing
  injuries, dirty wounds, wounds on the feet, and
  wounds that do not receive prompt medical
  attention.

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Wound Types

• Avulsion
• In an avulsion, a portion of skin is torn. This
  can be partial, with a portion of skin remaining
  as a "flap." In a total avulsion, a body part is
  completely torn off.
• Bruise
• Bleeding that occurs under the skin causes
  discoloration, swelling. The area begins as red
  but may turn into a "black and blue mark."
• Cut
• A cut is a split in the skin caused by a sharp
  object, such as a knife, or even a dull object. A
  cut can have either a jagged or smooth edge.
• Puncture
• A puncture wound is caused when the skin is
  pierced by a sharp object. Included in this
  category are gunshot wounds, impaled objects, and
  an object that passes totally through a part of
  the body.
• Scrape
• A scrape is very common, and occurs when skin is
  rubbed or scraped away.

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Wound Types

• What is an Ulcer?
• An ulcer is an open sore on a mucous membrane
  (most commonly in the stomach, esophagus,
  duodenum, or in the small or large intestine) or
  on the skin (commonly occurring on the
  leg).Ulcers can also develop on the cornea of the
  eye.
• Ulcers can be a sign that there is an imbalance
  in your system.
• Decubitus Ulcer is a problem for those confined
  to a bed

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Wound Dressings Requirements

• Light Weight
• Flexible
• Odor Free
• Impermeable to microorganisms
• Permeable to water vapor, oxygen, exudate

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Wound Dressings Goals

• Goals
• Understand the pathophysiology of wound healing.
• Learn effective wound evaluation and management
  skills.
• Learn wound closure techniques appropriate for
  outpatient, traumatic wounds.
• Learn appropriate methods for control of pain in
  patients with traumatic wounds.
• Understand quality assurance/risk management
  issues relating to wound care.
• Learn effective documentation skills in patients
  with traumatic wounds.
• Learn appropriate disposition and referral
  skills.
• Learn appropriate follow-up techniques and
  management of the complications of traumatic
  wounds.

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Dressing Choice
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Dressing Choice
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Wound Dressings Hydrogels
CARASOL GEL

• Used to keep wounds moist
• Clear viscous gels protect wound from
  desiccating
• Not used if wound is producing heavy exudate.

• If wound is infected, hydrogel serves no purpose.
  
• Used as primary dressing with wounds
  substantially or fully granulated
• If there is black eschar or yellow slough, the
  necrotic tissue should be removed.

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Wound Dressing Hydrogel Sheets

• Non-adhesive and will not stick wound base
• Keeps wound moist
• Protects against contamination
• Capable of absorbing exudate
• Promotes healing
• Secured to wound gauze or tubular bandage

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Wound Dressing Hydrogel Gauze

• Combination of gauze and hydrogel in same
  package
• Should be used on wounds free of necrotic tissue
  and /or infection

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Wound Dressings Hydrogel

• Applications
• Used daily for 30 days
• 3 ounces of gel per
• wound depending on how
• large the wound is.

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Wound Dressing - Alginates

• Made from seaweed
• Formed into flat squares or sheets of unwoven
  fibers into twisted robes or pads.
• Fibers are soft in texture and easily pulled
  apart.
• Primary dressing for wounds that have moderate to
  heavy exudate.
• Applied to wound beds to absorb exudate and
  transudate keeping the wound moist.

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Wound Dressings Alginates

• Form a gel like plug which absorbs 20 times its
  weight
• Held in place by secondary dressing(MVPF,
  hydrogel sheet, gauze.
• Doesnt cause infection or inflammation

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Wound Dressings MVPF

• Moisture Vapor Permeable Film
• Adhesive film dressing, waterproof but allow
  passage of O2 and H2O vapor from site
• Prevent desiccation and bacterial contamination
• Moist healing environment, retain growth factors
• Promotes autolysins of necrotic tissue in bed
• Translucent, help clinician visualize wound

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Wound Dressings MVPF

• Uses
• Secondary dressing over wounds with high shear
• Adhere better to protect light to medium
  exudate
• May be left in place for days with uninfected
  wounds
• Hold primary dressing in place

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Wound Dressings Cleansers

• Solutions contain water, surfactants, salt
• Wash and irrigate wounds with mild pressure
• Wet wound to wash out exudate
• Makes debridement easier

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Wound Dressings Hydrofiber

• Exudate Absorber
• Held in place by secondary dressing
• Keeps wound moist yet absorbs excessive exudate

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Wound Dressings Foams

• Highly absorbent primary dressings composed of
  
• hydrophilic polyurethane foam

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Wound Dressings Foams

• Keeps wound environment moist, absorbs exudate
• Can be placed in wound to fill bed while
  absorbing
• continuous exudate
• Remains in wound for 3-4 days

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Wound Dressing Hydrocolloid

• Contains an active matrix
• Creates a gel like dressing
• Gel may be formed with in wound bed or on
  dressing
• Allows wound to autolytially bebride itself
• Impermeable to water vapor, O2, and bacteria
• Not adherent to wound bed, removed w/o tearing
  granulated tissue
• Best with light to medium exudate

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Wound Dressings Hydrocolloid

• Placed on wet wounds and wet surrounding skin,
  remains intact because it can adhere to
• WET TRACK
• Do not use on infected wounds
• May have foul odor after
• 2-4 days

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Wound Dressings Infections

• Caused by bacteria, virus, fungi
• Breaks in skin integrity, especially areas
  inoculated with pathogens
• Skin is largest surface area of all body organs,
  most exposed organ
• Bacterial infection caused by corynebateria
• Erythrasma
• Trichmysosis axillaris
• Pitted Keraatolysis

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Wound Dressings Procedures

• Hydrocolloid Dressing Procedure
• Used in 4 Stages of skin breakdown
• Stage I- redness only no open area
• Stage II- superficial abrasion small amt of
  sevious drainage
• Stage III- through second layer of skin ulcer not
  deeper than thickness of dressing
• Stage IV- deep ulcer may involve connective
  tissue
• Apply hydrocolloid dressing over area/ press
  warm cloth over
• dressing
• Should be changed when area over ulcer becomes
  raised and white
• If exudate increases or becomes purulent switch
  to normal saline

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Wound Dressings Surgical Wounds

• Management Goals
• Achieve healing w/o complications of wound
  infection
• Complications can be minimized with pre-op
  preparation and patient education
• Methods of Closure
• Primary, Secondary, Territory intention depending
  on type, size, amt of tissue loss, risk of
  infection, swelling
• Purpose
• Approximation of wound edges to produce a strong
  scar with minimal disturbance of function and a
  good cosmetic look

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Wound Dressings Surgical Wounds

• Types of Suture Material
• Staples, Clips, Adhesive tape, Sutures
• Depends on type of tissue, wound position,
  preference
• Staples preferred due to improved cosmetic
  appearance, easy application and removal
• VAC or vacuum assisted closures (non invasive)
• Absorbable or Non Absorbable
• Absorbable more frequently used

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Wound Dressings Tissue Engineering

• Science of creating functional tissues or organs
• Potentially has a dramatic effect on medicine by
  providing physiologic implants for tissue
  regeneration
• Products
• Dermagraft
• TransCyte
• Apligraft

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Wound Dressings New Products

• Polyurethane Products
• Beiersdorf
• Cutinova Foam
• Cutinova Cavity
• Cutinova Thin
• Cutinova Hydro

• Engineered Tissue
• Advanced Tissue Sciences
• TransCyte
• Dermagraft
• Apligraft
• Lifecell Corp.
• Alloderm
• Ortec Inc.
• CCS

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Wound Dressings Dermagraft

• Human living dermal replacement
• Designed for the treatment of skin ulcers
• Provides a living metabolically active human
  dermal tissue that interacts with the wound bed
• Produced by seeding dermal fibroblasts onto
  scaffold of bioabsorbable material
• Advantages
• Accelerates healing bye introducing collagens,
  matrix proteins, growth factors
• http//www.advancedtissue.com/dermagraft.html

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Wound Dressings TransCyte

• Human based temporary skin substitute
• Treatment for second and third degree burns
• Advantages
• Undergoes viral and bacterial testing
• Easy application and removal
• Faster healing time with less inflammation
• One time applications
• Decreased hospital periods

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Wound Dressings TransCyte

• How it works
• Consists of dermal tissue and synthetic epidermal
  layer
• Alternative to cadaver skin
• Provides a temporary covering to protect wound
  from fluid loss and infection
• Remains in place until sufficent skin grafting is
  available or until healed
• http//www.advancedtissue.com/transcyte.html

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Wound Dressing Bioactive

• Composed of cellulose dressings covalently
  coupled w/ proteolytic enzymes, collogenase,
  hyaluronidase
• In vivo trials with burn wounded guinea pigs
  demonstrate high efficiency by dissolving
  necrotic tissue rapidly

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Wound Dressings Smith Nephew

• Founded in Britain 1856
• Global healthcare company who deliver cost
  effective solutions
• Leader in BIOTECH in advanced wound care
• Products
• Unisolve, CovRSite, CicaCare, Solo Site Gel,
  Intra Site Gel, Opsite, Allevyn Adhesive