WOUND MANAGEMENT

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WOUND MANAGEMENT ١

WOUND MANAGEMENT

DR.MAHMOUD GH. FAKIHA

By:

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WOUND MANAGEMENT ٢

• Wound healing

• Types of wound

• Management of different types of wounds.

• Dressing .

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WOUND MANAGEMENT ٣

Wound healing :

I. Inflammatory phase (1-2 d) II. Prolifrative phase (3-5 d)

III.Maturation phase (5 d – months)

021

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3 ﺔﺤﻳﺮﺸﻟا 021 neutrophil---24

macro---48 fibroplast---5 Mfakieh, 2/9/2004

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WOUND MANAGEMENT ٤

Factors affecting wound healing ;

Systemic Local

Nutritional deff.

Steroid therapy Cytotoxic drugs Ionizing radiation Malignancy

D.M

Ageing Infection

Ischemia - tension - shock - anemia

-vascular dis.

Foreign body malignancy

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WOUND MANAGEMENT ٥

Types of wound

• Acute wound

Surgical incions open wounds

Chronic wound

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WOUND MANAGEMENT ٦

Management of surgical incisions :

 Pre-operative assessment of pt. general condition{ nutrition, medication, co-

morbid dis. }

 general concepts & techniques of antisepsis and asepsis:

- hand scrub

- preparation of operative field

 consider prophylactic antibiotics

 Type of incision .

 Sutures

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WOUND MANAGEMENT ٧

Management of open wounds :

1) Adequate cleansing & debridement . 2) Edema control .

3) Avoidance & treatment of ischemia .

4) Achievement of moist wound healing environment .

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WOUND MANAGEMENT ٨

Management of open wounds :



Adequate cleansing & debridement

Fact : open wounds contain devitalized tissue

& exudate  higher bacterial counts ,edema ,more infl. Mediators  poor healing .

Fact : if necrotic dermis is left in place , the

underlying subcutaneous tissue (fat) – which is less vascular – becomes infected.

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WOUND MANAGEMENT ٩

Management of open wounds :

• Clinically :

Adequate & sufficient debridement

Surgical enzymatic

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WOUND MANAGEMENT ١٠



Edema control :

Fact : in normal tissue each cell in only a few cell diameters away from the nearest

capillary,and received nutrient & oxygen by diffusion .

Fact : with inflammation  extra cellular &

extra vascular fluid increases  increase the distance  low tissue Po2.

Fact : chronic protein leak  “ cuffing “

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WOUND MANAGEMENT ١١

Management of open wounds :

• Clinically :

• Even if the extremity in not noticeably

swollen, edema control is very important .

• Edema control :

leg elevation elastic wraps

compression stocking

sequential compression machines

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WOUND MANAGEMENT ١٢



Avoidance & treatment of ischemia :

 Fact : oxygen is necessary for

1. normal metabolic function(esp. proliferating cells)

2. bacterial killing (superoxide radicals) 3. Collagen synthesis .

 Fact : normal local tissue Po2 level is 40 mmHg

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WOUND MANAGEMENT ١٣

Management of open wounds :

 Factors that contribute to wound ischemia :

i. Poor arterial inflow– atherosclerosis ii. poor venous flow – venous stasis iii. Smoking

iv. Radiation v. Edema vi. D.M

vii. Vasculitis

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WOUND MANAGEMENT ١٤

• Clinically :

• Supplemental oxygen

• Optimal fluid administration

• Pain control

• edema control

• Arterial reconstruction .

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WOUND MANAGEMENT ١٥

Management of open wounds :



Moist wound healing :

Fact : epithelialzation is more rapid under moist conditions than dry conditions.

Clinically :

Moist healing can be achieved by :

 Occlusive dressing.

 Occlusive ointments or cream.

 Continually moistened dressing.

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WOUND MANAGEMENT ١٦

Management of chronic wounds

• Examples:preeure sores, leg ulcers, diabetic foot ulcer.

• It differ from open wounds in:

• Significant increase of tissue proteases

& collagenases  -degrading matrix .

-Decrease level of growth factors .

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WOUND MANAGEMENT ١٧

Management of chronic wounds

• Apply the same principles of open wound management .

• Consider :

 Skin is more resistant to pressure than underlying subcutaneous fat or muscle.

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WOUND MANAGEMENT ١٨

Dressing

 Properties of the "Ideal" Dressing

• A moist wound environment

• Promotion of wound healing

• Provision of mechanical protection

• Non adherent to the wound

• Allowance for removal without pain or trauma

• Capability of absorbing excess exudates

• Allowance of gaseous exchange

• Impermeance to microorganisms

• Acceptability to the patient

• Ease to use

• Cost effectiveness.

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WOUND MANAGEMENT ١٩

Dressing

 Types of Dressings :

passive dressings: simply serve a protective function .

active dressings create a moist environment at the wound/dressing interface .

interactive dressings are believed to also be capable of modifying the physiology of the wound environment by modulating and

stimulating cellular activity and growth factor release

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WOUND MANAGEMENT ٢٠

Films :

• semiocclusive.,semipermeable

• Provides moist environment.

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WOUND MANAGEMENT ٢١

Hydrocolloid Dressings

occlusive dressings designed to create and maintain a moist wound

environment.[23] They are capable of

absorbing a moderate amount of wound

exudate

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WOUND MANAGEMENT ٢٢

Alginate dressings

Alginates can absorb between 15 to 20

times their own weight in fluid.[25] The

absorptive capacity of alginates makes

them eminently suited for the treatment

of heavily draining wounds

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WOUND MANAGEMENT ٢٣

Hydrogel dressings

absorb and retain significant volumes of wound exudate.[26] Hydrogels facilitate autolysis and rehydrate the wound.

Hydrogels may be appropriate in

diabetic ulcers that require debridement when surgical debridement is not an

option.

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WOUND MANAGEMENT ٢٤

Iodine dressings

in a diluted form, the antimicrobial

effects are still present, but the toxicity

to human cells is diminished.

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WOUND MANAGEMENT ٢٥

Promogran

Promogran is a combination collagen and oxidized regenerated cellulose (ORC) topical wound dressing.

• inhibit the proteolytic activity while

allowing continued growth factor

activity.

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WOUND MANAGEMENT ٢٦

• Arguments Against Antiseptics

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WOUND MANAGEMENT ٢٧

Developments in Biological Skin Substitutes

• Biological skin substitutes, also known as living skin equivalents (LSEs), are produced from neonatal fibroblasts and keratinocytes using tissue-engineering technology. Available for epidermal, dermal, and composite

(epidermal and dermal) wounds

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WOUND MANAGEMENT ٢٨

Epidermal Grafts

• sheets of viable keratinocytes

• can provide coverage of large skin defects with acceptable cosmetic results and are

currently indicated for burns and leg ulcers.

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WOUND MANAGEMENT ٢٩

Dermal Grafts

• It is believed that the elements in the dermal layer exert positive effects on epithelial

migration, differentiation, attachment, and growth in the wound healing process

• Recently approved by the FDA for use in diabetic foot ulcers, Dermagraft

• consists of neonatal dermal fibroblasts

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WOUND MANAGEMENT ٣٠

Composite Grafts

• bilayered skin equivalents consisting of both epidermal and dermal components

• contains an outer layer of allogeneic human keratinocytes on an inner dermal layer

consisting of human fibroblasts on type 1 collagen dispersed in a protein matrix . acts like human skin, producing all the cytokines and growth factors produced by normal skin during the wound healing process

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WOUND MANAGEMENT ٣١ 023

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31 ﺔﺤﻳﺮﺸﻟا .y. old male.NIDDM with neuropathy & charcot deformity55 - 023

.(SE)A--day 0 : deb. & application of Skin E.

B--day 7 : same SE on day 14.21.28 c--week 6 : healed D--week 12 Mfakieh, 2/9/2004

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WOUND MANAGEMENT ٣٢

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WOUND MANAGEMENT ٣٣

WOUND MANAGEMENT