Lecture 11 - Basic Wound Care and Skin Grafting Flashcards
What does DIMES stand for?
debride, infection, moisture, edge protection, and support
What are the types of debridement?
surgical, autolytic, enzymatic, mechanical, and biosurgical
What is surgical debridement?
when devitalized tissues are removed with sharp dissection
What is removed during surgical debridement?
fat, fascia, skin, and muscle
In surgical debridement you want a ______ edge.
bleeding
What is surgical debridement often combined with?
autolytic debridement
What is osteostixis/forage?
the use of small pins to penetrate bone that is exposed
What does osteostixis/forage promote?
vascular medullary canal communication with the wound bed
Osteostixis/forage enhances _____.
healing
When is autolytic debridement preferred?
with tissue viability
What type of dressings do you use with autolytic debridement?
hydrophilic, occlusive dressings
What is enzymatic debridement?
enzyme agents are applied topically to dissolve collagenous tissue and cause superficial sloughing of debris
What is enzymatic debridement an adjunct to?
lavage and surgical debridement
What enzymes are used for enzymatic debridement?
trypsin, collagenase, papain, and urea
What is enzymatic debridement used for?
chronic, nonhealing, indolent wounds
If wet-to-dry dressings are done, how long are they usually done for?
1-2 days
Wet-to-dry dressings and enzymatic debridement are both ________ debridement.
nonselective
What are the risks that accompany wet-to-dry dressings?
they can leave lint/fiber in the wound and they inhibit epithelialization
What are some forms of biosurgical debridement?
maggots and leeches
If you use a maggot for biosurgical debridement, how many do you put per cm squared of wound surface area?
5-10 larva
What do you cover the maggots with in biosurgical debridement?
dacron chiffon dressing
What do maggots do in biosurgical debridement?
they secrete enzymes that dissolve necrotic tissue
What can be the negatives to using maggots for biosurgical debridement?
they can destroy healthy epithelium if not careful or be irritating to the patient
What do leeches do in biosurgical debridement?
they can improve skin perfusion
What are leeches used for in biosurgical debridement?
venous insufficiency and to salvage skin flaps and grafts
What is the goal of moist wound healing?
to keep the wound exudate on the wound bed
What type of debridement does moist wound healing allow for?
autolytic debridement
What does moist wound healing promote?
granulation tissue formation and epithelialization
What does moist wound healing prevent?
desiccation and tissue devitalization
What does moist wound healing limit?
infection
What are some things used for inflammation/debridement?
hypertonic saline and TenderWet
What are some things used for inflammation/early repair?
sugar, honey, alginate, hydrogel, hydrocolloid, and foam
What does hypertonic saline do?
its osmotic gradient lyses and destroys bacteria
What does hypertonic saline reduce?
edema
What does hypertonic saline remove?
exudate and debris
When is hypertonic saline used?
in heavily exudative, necrotic, and infected wounds
What can happen if hypertonic saline is left on for too long?
it can dehydrate viable tissue
What is TenderWet?
hypertonic Ringer’s solution
Is sugar hypertonic or hypotonic?
hypertonic
What does sugar do in wounds?
dehydrates bacteria to inhibit growth
What does sugar enhance?
granulation formation and epithelialization
How do you apply sugar on wounds?
1cm thick on the wound surface with an absorbent bandage
What can sugar be combined with for an antimicrobial effect?
betadine solution
When is sugar used and in what type of wounds is it used in?
in the inflammatory phase in exudative wounds
What does honey do in wounds?
its hyperosmolarity decreases edema and inflammation, and enhances debridement
What does honey promote?
granulation and epithelialization
What does honey have that makes it antimicrobial?
it releases a small amount of hydrogen peroxide and methylglyoxal
What is honey used for?
inflammatory and early repair
What are some types of honey that is used in wound healing?
manuka honey and medihoney
What is alginate?
polysaccharide fibers that are in sheets or rope
What type of agent is alginate?
a hemostatic agent
What does alginate form?
hydrophilic gel-like substance on the wound
What does alginate maintain?
moisture - it absorbes 20-30x its weight
What can alginate supply?
calcium, zinc, manganese, and silver
When is alginate used?
for early inflammation, heavy exudate wounds, deep wounds, and after surgical debridement
When can alginate dehydrate a wound?
if there is not enough exudate
What is polyurethane foam?
an absorbaent, nonirritating synthetic polymer
What does polyurethane foam maintain?
moisture with wound surface
What can polyurethane foam slow?
granulation tissue formation
What does polyurethane foam promote?
epithelialization
What does polyurethane foam provide?
thermal insulation
What is a negative of using polyurethane foam?
it can dessicate tissues if they are non-exudative
What is polyurethane foam used for?
repair phase mostly, moderate exudative wounds depending on the product
What is hydrocolloid?
sheet, paste, or powder that turns into gel with absorption
What does hydrocolloid promote?
autolytic debridement, granulation tissue formation, and epithelialization
What can hydrocolloid inhibit?
wound contraction and promote excess granulation tissue
When do you want to avoid using hydrocolloid?
in infected wounds
What is hydrocolloid used for?
inflammatory or repair phase with low-to-moderate exudate
What is hydrogel?
gel, impregnated guaze or sheets up to 95% water