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Surgery (bpa) > Surgical Wounds > Flashcards

Surgical Wounds Flashcards

1
Q

Functions of the skin

A
  • thermoregulation: blood vessels, sweating
  • sensation: pain, touch, temperature, pressure
  • protection
  • water balance
  • metabolism: synthesis of vitamin D
  • communication
  • cosmetic
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2
Q

Effects of aging

A
  • decreased epidermal and dermal thickness
  • flattening of dermo-epidermal junction: increased risk of skin tear
  • loss of insulating subq fat: bony prominences less protected, thermoregulation affected
  • decreased sweat glands
  • decreased epidermal regeneration, collagen synthesis = poor healing
  • reduction of mast cells: decreased inflammatory response
  • decreased collagen and elastin: less recoil
  • decreased sensation and metabolism
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3
Q

Wound

A

Disruption of normal structure and function of skin and underlying soft tissue

Causes:

  • acute trauma: abrasion, puncture, crush, burn, cut, gunshot, animal bite, surgery
  • chronic decreased blood flow for prolonged period: PAD, vascular compression (hematoma, immobility), microvascular occlusion/thrombosis
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4
Q

Acute Wounds

A
  • easily identifiable mechanism of injury w/disruption of skin integrity
  • blunt vs. penetrating
  • surgical wounds fall into this category and further classified by bacterial load/contamination

Healing:

  • transition through phases of wound healing in linear fasion w/clear start and endpoints
  • complete w/in 2-4wk
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5
Q

Types of surgical wounds

A

Clean
- uninfected operative wounds w/out inflammation, respiratory, alimentary, genital or uninfected urinary tracts are not entered

Clean/contaminated
- operative wounds in respiratory, alimentary, genital or uninfected urinary; without unusual contamination

Contaminated
- open, fresh, accidental wounds, operations with major breaks in sterile technique or gross spillage from GI tract, and incisions in which acute, non-purulent inflammation is encountered

Dirty
- old traumatic wounds w/retained devitalized tissue or those that involve existing clinical infection or perforated viscera

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6
Q

Chronic wounds

A
  • develop from acute trauma or surgical skin trauma OR from breakdown of previously intact skin
  • often a/w conditions wherein patient has decreased sensation

Healing:

  • arrested healing in one of the wound healing stages (typically inflammation stage)
  • failure to progress results in ongoing issues w/out clear endpoint
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7
Q

General wound healing

A
  • cellular response to skin injury/trauma
  • organized cell activation, migration, and recruitment of endothelial cells for angiogenesis - necessary for normal wound healing to occur
  • wound heal in staged manner w/multiple overlapping phases
  • appropriate healing requires: vascularization, free of necrotic tissue, clear of infection, moisture
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8
Q

Phases of wound healing:

A
  1. Hemostasis
  2. Inflammation
  3. Epithelialization (proliferation)
  4. Fibroplasia (proliferation)
  5. Maturation (remodeling)
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9
Q

Stage 1 of healing

A

Hemostasis

  • immediately after injury
  • small vessels constrict to provide hemostasis for 5-10min
  • platelet aggregation = clotting cascade, growth factors and cytokines released
  • larger vessels often require compression, ligation, etc. in order to achieve hemostasis
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10
Q

Stage 2 of healing

A
  • typically completed w/in 3d of injury: chronic wounds usually cease in this stage
  • increased vascular permeability and cellular recruitment
  • presence of necrotic tissue, foreign material, and bacterial will slow this stage
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11
Q

Stage 3 of healing

A

Epithelialization

  • epithelial cell migration: across approximated skin edges
  • normally completed in 48hr, ceases when epithelial layer is completed
  • very difficult in wounds not closed primarily or need to heal by secondary intention
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12
Q

Stage 4 of healing

A

Fibroplasia

  • fibroblast proliferation, accumulation of ground substance and collagen production**
  • begins POD #4 and lasts 2-3wk
  • collagen matrix stimulates angiogenesis resulting in granulation tissue

“Healing ridge” 1st palpated POD #5-9

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13
Q

Stage 5 of healing

A

Maturation

  • collagen cross-linking, remodeling, wound contraction, repigmentation
  • tensile strength of wound directly proportional to amount of collagen and connection of subunits (cross-linking)
  • 80% of original strength by 6wk post-op; never achieve 100% previous strength
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14
Q

Normal timeframe of healing depends on what

A
  1. geometric shape of wound
    - linear > rectangle/square > circle
  2. vascularity
  3. wound depth
    Partial thickness (0.04-0.4cm)
    - skin loss of epidermis and upper dermal layer
    - heals through re-epitheliazation from wound margin and epidermal stem cell population of hair follicle and sweat glands
    - tissue re-generated to original function

Full thickness (>0.4cm)

  • skin loss extending through epidermis and dermis
  • may include tissue loss to subq tissue, tendon, muscle, and bone
  • heals by granulation tissue formation, contraction, and eventual epithelialization resulting in scar formation
  • tissue does not regenerate, loss of tensile strength
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15
Q

Impaired wound healing causes

A

Often multiple small issues disrupting healing process

Intrinsic:

  • chronic disease
  • age
  • malnutrition
  • tissue hypoxia/ischemia
  • neuropathy
  • edema
  • obesity

Extrinsic:

  • meds
  • bioburden present
  • stress
  • immobilization
  • smoking

Iatrogenic: inappropriate care

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16
Q

Prevention for impaired wound healing

A

Preop:

  • eliminate tobacco use for at least 30d prior to surgery
  • eliminate meds w/an anticoagulant effect
  • optimize nutrition status w/focus on protein

Early postop:

  • maintain blood volume w/fluid replacement
  • maintain warmth (prevent vc)
  • aggressively manage pain
  • maintain normal O2 levels
  • blood glucose <200
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17
Q

Components of wound assessment exam

A
  • wound measurement
  • wound bed assessment
  • wound edges
  • drainage
  • periwound skin
  • vascular assessment
  • edema
  • sensation
  • s/s of infection
  • s/s of dehiscence
  • wound re-evaluation
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18
Q

Wound measurements

A
  1. size
    - length: head-toe
    - width: left-right
    - depth: deepest part

should capture longest length/width, perpendicular

  1. undermining
    - wound edges separated from underlying base, parallel to skin surface
    - use clock method to document
  2. tunneling
    - linear channel extending beyond open wound base
    - may have entrance/exit in same wound or two adjacent wounds
    - clock method to document
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19
Q

Assessing wound bed

A
  1. color
    - healthy: pink, “beefy” red
    - necrotic: yellow, tan, black
    - various colors can present in same wound bed

** remove necrotic tissue first to adequately assess

  1. assess visible structures
    - exposed bone, tendon, joint
    - protect these structures to maintain function and prevent infection
  2. assess for necrosis
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20
Q

Necrotic tissue types

A

Fibrin/slough

  • moist
  • loose to firm adherence
  • stringy appearance
  • soft, thick texture
  • yellow, tan, gray

Eschar

  • most to dry fibrin
  • firmly
  • concave
  • soft to hard, smooth and leathery
  • yellow, brown, black

Scab

  • dehydrated body fluid
  • loosely to firmly
  • convex
  • rough
  • yellow, brown, black
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21
Q

Assess wound edges

A
  • allows for timely intervention to address barriers to healing
  • check for: maceration, epibole (rolled edge), callous, fibrosis, hypergranulation
  • attached or detached edges
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22
Q

Assess wound drainage

A

Type:

  • serous
  • serosanguinous
  • sanguineous
  • purulent

Amount:

  • none, scant, small (<25%), moderate (25-50%), large (>50%)
  • % of dressing saturated

Odor:

  • sweet, ammonia-like, foul, etc.
  • pseudomonas = sweet
  • often indicator of infection
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23
Q

Assess peri-wound skin

A

Presence/absence of:
- hair, callous, edema, scarring, new epithelial growth

Skin hydration: maceration vs. dry skin

Skin color: erythema, ecchymosis, hemosiderin staining

Palpate: skin turgor, mobility

Induration: “hard edema”, monitor

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24
Q

Assess vascular status

A
  • skin temperature
  • pulses: palpate
  • vascular test/ABI
  • toe pressures needed for pt w/DM, ESRD

May apply modified compression for pt w/ABI >0.5-0.8

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25
Q

Assess wound edema

A
  • pitting edema
  • obtain objective measurement to track progress
  • girth measurements: use bony landmarks for consistency, measure circumference at various locations, may use opposite limp for comparison
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26
Q

Assess wound sensation

A
  • especially important in pt w/neuropathy, CVA, SCI - will affect wound healing and potential for future wounds
  • sharp/dull
  • light touch
  • vibration
  • proprioception
  • protective sensation
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27
Q

Assess for s/s of infection and inflammation

A 
Pain* (deep, throbbing) 
Erythema* (darker w/infection vs. inflammation) 
Edema* (localized to wound site) 
Heat* (4 deg difference) 
Purulent exudate*

Other:

  • delayed healing
  • discoloration of granulation tissue
  • friability of granulation tissue
  • pocketing of wound base
  • foul odor
  • wound breakdown
  • culture positive

TX if 3 or more

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28
Q

Assess for s/s of dehiscence

A
  • inspect for epithelialization vs. incisional separation
  • palpate incision for “healing ridge”
  • absence of healing ridge by POD 5-9 = delayed healing and inc risk of dehiscence
  • most cases, dehiscence occurs between POD 5-8
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29
Q

Progression of drainage

A

Sanguineous to serosanguineous by days 3-4

Drainage amount decrease from moderate to scant by day 4, none 5-9

Healing ridge days 5-9

Incision appear red color, pink, then white/silver or darker than surrounding tissue by remodeling phase

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30
Q

What are the 3 types of wound closure

A
  1. primary
  2. delayed primary
  3. secondary intention
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31
Q

Primary wound closure

A
  • direct apposition of skin edges w/sutures or stables

- 2 week healing time

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32
Q

Delayed primary closure

A
  • skin edges re-approximated with sutures or stables AFTER interval of wound management
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33
Q

Secondary intention

A
  • wound purposefully left open and fills w/granulation tissue and eventually epithelialization over prolonged period of time
  • skin edges NOT brought together
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34
Q

Negative pressure wound therapy

Wound VAC

A

Use:

  • reduces edema, stimulating circulation and increasing rate of granulation tissue formation
  • helps maintain moist environment
  • useful for large wounds
  • useful for stimulating healing by secondary intention

Indications:

  • acute wounds
  • traumatic wounds
  • sub-acute wounds
  • dehisced surgical incisions
  • chronic wounds
  • diabetic ulcers
  • flaps/grafts
  • stage III/IV pressure ulcer
  • enteric fistula

CI:

  • malignancy
  • necrotic tissue/eschar
  • untreated osteomyelitis
  • do NOT place over exposed artery/vein

Expected outcome:

  • beefy red appearance of wound
  • increased granulation tissue
  • decreased wound size
  • gradual decrease in wound drainage

Abnormal outcome:

  • wound bruised, darker or grayish
  • increased slough or odor
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35
Q

Additional wound coverage and types

A

Advantages:

  • cover large wounds
  • provide covering which maintains healing environment
  • decreases risk of infection

Disadvantage:

  • potential long operation
  • painful
  • risk for failure
  1. biologic graft
  2. skin graft
  3. skin flap
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36
Q

Biologic graft

A
  • temporary wound coverage
  • promote healing and bridge to definitive coverage: protect from dessication and promote re-epithelialization

Types:

  • allograft: skin harvested from cadaver or live human donor and transferred to patient
  • xenograft: skin graft from different species
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37
Q

Skin graft

A
  1. split thickness: variable thickness of dermis
  2. full thickness:
    - epidermis and entire dermis
    - good for small areas, uncontaminated, well-vascularized
    - does NOT have own blood supply: relies on circulation from wound bed for survival until adequate vascular ingrowth from surrounding tissue has occurred
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38
Q

Skin flaps

A

Intrinsic blood supply

Need to determine how much of that tissue can be supported by that blood supply

4-6wk of immobilization

Large operation facilitated by plastic surgery

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39
Q

Wound cleansers

A

When:

  • prior to assessing wound
  • each time dressing change is performed (decrease bioburden and remove dressing remnants)
  • any time visible soiling of wound has occurred
  • before any wound cultures are taken

Agents:

  1. normal saline**
    - physiologic
    - not harmful to tissue
    - surfactant free
    - adequate cleansing in most situations
  2. commercial agents
    - assess for cytotoxicity
    - antiseptics: Dakin’s, acetic acid, hydrogen peroxide, hypochlorus acid
40
Q

Types of debridement

A

Required for devitalized/necrotic tissue or contamination
- will impede healing if not managed appropriately

  1. Mechanical
  2. Surgical
  3. Enzymatic
  4. Biologic
  5. Autolytic
41
Q

Mechanical debridement

A

Necrotic tissue removed w/mechanical force

Types:

  1. Irrigation
    - decrease bacterial load, remove loose tissue
    - psi: 10-15 (>15 may traumatize)
    - 1994 AHCPR guidelines: 4-15 psi
  2. Wet-to-dry dressing
42
Q

Surgical debridement

A

Sharp excisional debridement w/scalpel or other sharp instrument to remove devitalized tissue and accumulated debris

Decrease bacterial load, stimulate wound contraction and epithelialization

Good for large area of necrosis and w/associated infection

May occur in OR or at bedside

43
Q

Enzymatic debridement

A

Dec necrotic tissue through topical application of an enzyme

Break down necrotic tissue, harmful to good tissue

More is NOT better - only apply to necrotic tissue

Good option for pt who is not surgical candidate

44
Q

Biologic debridement

A

Larvae use necrotic tissue as food

Proteolytic enzymes released by larvae liquefy necrotic tissue

Useful bridge between debridement procedures or when surgical debridement not an option

45
Q

Autolytic debridement

A

Use body own process to break down necrotic tissue

Keep wound fluids in constant contact w/wound
- semi-occlusive or occlusive dressings useful

Slowest process

Do NOT use w/infected wounds

46
Q

What should you avoid debriding?

A

Do NOT debride stable eschar

47
Q

What do wound dressings do?

A
  • eliminate dead space
  • control exudate/drainage
  • protect tissue
  • prevent bacterial overgrowth
  • barrier to bacteria
  • ensure proper fluid balance
  • decrease pain
48
Q

Dressing basics

A

Debridement: hydrogels

Granulation stage: low-adherent, moisture-retentive dressings

Epithelialization stage: low-adherent dressings

Typically changed q day or qod

49
Q

Dressing absorbency spectrum

A

Less to More

  • gauze
  • foam
  • alginate
  • hydrofiber
50
Q

Components of dressing change order

A
  • anatomical location
  • cleanser to be used (NS)
  • preparation of peri-wound skin (skin prep)
  • primary dressing
  • secondary dressing
  • adhesive
  • frequency of dressing change
  • special instructions if needed
51
Q

Management of surgical incision

A
  • dressing typically on 24-48hr
  • optional after complete epithelialization
  • no evidence that providing dressing postop will decrease SSIs but prudent to protect incision from harm
  • majority of primary dressings steri-strips w/gauze
  • no difference in pain and wound healing despite general rec to use moisture retentive dressing
52
Q

Management of pressure-induced soft tissue wound

A

More than just sacrum!

Usually over bony prominence
- increased likelihood for development when pt are in same position for extended period of time

Mgmt

  • depends on wound
  • consider wound VAC for enhancing wound healing

Prevention is key
- re-position q 2hr for existing pressure wound and prevent new pressure wounds

53
Q

Stages of Pressure Wounds

A

1: skin intact, non-blanchable erythema
- preventive measures, wound protection

2: partial loss of dermis, shallow open ulcers
- dressing to maintain moisture

3: full thickness skin loss, fat exposed
- treat infection, debride necrotic tissue, appropriate dressing

4: full thickness skin loss, exposed bone, muscle or tendon
- treat infection, debride necrotic tissue, appropriate dressing

Unstageable: covered w/slough or eschar, depth undermined

Deep tissue pressure injury
- purplish skin discoloration, potential for deeper tissue damage

54
Q

Management of diabetic foot wound

A

Debridement often necessary to remove extensive necrosis

Do NOT debride stable eschar overlying heel - reduced perfusion and proximity to bone

Dressing choice:

  • excess fluid - maceration
  • desiccation - slows epithelial cell migration and inhibits healing

Wet wound = absorptive dressing

  • foam
  • alginate
  • hydrofiber

Dry wound = wet dressing

  • saline-moistened gauze
  • transparent film
  • hydrocolloids
  • hydrogels
55
Q

Management of wound dehiscence

A
  • once dehiscence occurs, manage as you would any other open wound
  • focus on nutrition and circulatory support, controlling co-morbidities, utilizing appropriate topical therapy
  • reduce cause: mechanical trauma, infection

topical therapy:

  • eliminate necrotic tissue
  • control bioburden
  • maintain moist wound environment
56
Q

Management of abrasions

A

Best: high-volume, low-pressure
- mild soap or saline is best

2-3 layer dressing based on superficial vs. deep abrasions

  • impregnated gauze ideal for deep abrasion
  • telfa for superficial abrasion
  • dry dressing applied on-top of first layer to keep everything intact
57
Q

When to refer wound care?

A
  • edema mgmt may be required to promote improved healing
  • any evidence that a wound is stalling or worsening in any of the phases of healing or failure to respond to conservative wound mgmt for 30d
  • PT may need to be incorporated for off-loading techniques, positioning, use of biophysical technologies and lifestyle adaptations
  • complications w/pt w/high risk co-morbidity
58
Q

Conventional gauze

A

Cotton or synthetic fibers woven together into varying shapes and thickness
- 4x4s, 2x2s, Nu-gauze, super sponges, Kerlix, ABDs

Indications:

  • for cleaning of wounds (synthetic best bc does not leave fibers behind)
  • secondary dressing
  • loose filling of cavity/tunneling wounds (Kerlix, Nu-gauze)

Precaution:

  • tendency to desiccate wounds bc it is extremely permeable to air
  • “packing” wound w/gauze may occlude small capillaries and cause wound bed to become ischemic, thus delaying healing process
59
Q

Impregnated gauze

A

Woven gauze w/compound or solution (NS, hypertonic saline, petrolatum, iodoform, hydrogel, zinc) has been added

E.g.
- adaptic, xeroform, unna boot

Indications:

  • provide small amount of moisture
  • may protect tendon/bone under VAC dressing
  • decrease pain a/w dressing changes
  • may use w/small burns, donor sites, skin graft, skin tear
60
Q

Semi-permeable film

A

Transparent film coated on one side w/water-resistant, hypoallergenic adhesive

E.g.

  • tegaderm
  • op-site
  • bioclusive

Indications:

  • small amount of drainage
  • superficial wounds
  • when autolytic debridement is needed
  • when visual monitoring is necessary

Do NOT use w/infected wounds

61
Q

Semi-permeable foams

A

Varying layers of foam w/ability to absorb some exudate

E.g.
- lyofoam, allevyn

Indications:

  • moderate-heavy drainage
  • help decrease pain w/dressing change
  • maintain body temp in wound
  • need good peri-wound tissue bc some require additional tape
62
Q

Hydrogels

A

Contain high amounts of water and varying amounts of gel-forming materials

E.g.
- saf-gel, solosite, intrasite

Indications:

  • conform to shape of the wound
  • add moisture to wound
  • can assist autolytic debridement
  • act as thermal insulator
  • watch for peri-wound maceration*
63
Q

Hydrogel sheets

A

Water and glycerin in a fixed structure w/polymer film backing

E.g.
- acryderm, curagel, MPM

Indications:

  • maintain moist wound environment while absorbing small amounts of drainage
  • promote autolytic debridement
  • conforms well
  • decrease pain w/dressing changes
64
Q

Mechanical debridement

A

Necrotic tissue removed w/mechanical force

Types:

  1. Irrigation
    - decrease bacterial load, remove loose tissue
    - psi: 10-15 (>15 may traumatize)
    - 1994 AHCPR guidelines: 4-15 psi
  2. Wet-to-dry dressing
65
Q

Surgical debridement

A

Sharp excisional debridement w/scalpel or other sharp instrument to remove devitalized tissue and accumulated debris

Decrease bacterial load, stimulate wound contraction and epithelialization

Good for large area of necrosis and w/associated infection

May occur in OR or at bedside

66
Q

Enzymatic debridement

A

Dec necrotic tissue through topical application of an enzyme

Break down necrotic tissue, harmful to good tissue

More is NOT better - only apply to necrotic tissue

Good option for pt who is not surgical candidate

67
Q

Biologic debridement

A

Larvae use necrotic tissue as food

Proteolytic enzymes released by larvae liquefy necrotic tissue

Useful bridge between debridement procedures or when surgical debridement not an option

68
Q

Autolytic debridement

A

Use body own process to break down necrotic tissue

Keep wound fluids in constant contact w/wound
- semi-occlusive or occlusive dressings useful

Slowest process

Do NOT use w/infected wounds

69
Q

What should you avoid debriding?

A

Do NOT debride stable eschar

70
Q

What do wound dressings do?

A
  • eliminate dead space
  • control exudate/drainage
  • protect tissue
  • prevent bacterial overgrowth
  • barrier to bacteria
  • ensure proper fluid balance
  • decrease pain
71
Q

Dressing basics

A

Debridement: hydrogels

Granulation stage: low-adherent, moisture-retentive dressings

Epithelialization stage: low-adherent dressings

Typically changed q day or qod

72
Q

Dressing absorbency spectrum

A

Less to More

  • gauze
  • foam
  • alginate
  • hydrofiber
73
Q

Components of dressing change order

A
  • anatomical location
  • cleanser to be used (NS)
  • preparation of peri-wound skin (skin prep)
  • primary dressing
  • secondary dressing
  • adhesive
  • frequency of dressing change
  • special instructions if needed
74
Q

Management of surgical incision

A
  • dressing typically on 24-48hr
  • optional after complete epithelialization
  • no evidence that providing dressing postop will decrease SSIs but prudent to protect incision from harm
  • majority of primary dressings steri-strips w/gauze
  • no difference in pain and wound healing despite general rec to use moisture retentive dressing
75
Q

Management of pressure-induced soft tissue wound

A

More than just sacrum!

Usually over bony prominence
- increased likelihood for development when pt are in same position for extended period of time

Mgmt

  • depends on wound
  • consider wound VAC for enhancing wound healing

Prevention is key
- re-position q 2hr for existing pressure wound and prevent new pressure wounds

76
Q

Stages of Pressure Wounds

A

1: skin intact, non-blanchable erythema
- preventive measures, wound protection

2: partial loss of dermis, shallow open ulcers
- dressing to maintain moisture

3: full thickness skin loss, fat exposed
- treat infection, debride necrotic tissue, appropriate dressing

4: full thickness skin loss, exposed bone, muscle or tendon
- treat infection, debride necrotic tissue, appropriate dressing

Unstageable: covered w/slough or eschar, depth undermined

Deep tissue pressure injury
- purplish skin discoloration, potential for deeper tissue damage

77
Q

Management of diabetic foot wound

A

Debridement often necessary to remove extensive necrosis

Do NOT debride stable eschar overlying heel - reduced perfusion and proximity to bone

Dressing choice:

  • excess fluid - maceration
  • desiccation - slows epithelial cell migration and inhibits healing

Wet wound = absorptive dressing

  • foam
  • alginate
  • hydrofiber

Dry wound = wet dressing

  • saline-moistened gauze
  • transparent film
  • hydrocolloids
  • hydrogels
78
Q

Management of wound dehiscence

A
  • once dehiscence occurs, manage as you would any other open wound
  • focus on nutrition and circulatory support, controlling co-morbidities, utilizing appropriate topical therapy
  • reduce cause: mechanical trauma, infection

topical therapy:

  • eliminate necrotic tissue
  • control bioburden
  • maintain moist wound environment
79
Q

Management of abrasions

A

Best: high-volume, low-pressure
- mild soap or saline is best

2-3 layer dressing based on superficial vs. deep abrasions

  • impregnated gauze ideal for deep abrasion
  • telfa for superficial abrasion
  • dry dressing applied on-top of first layer to keep everything intact
80
Q

When to refer wound care?

A
  • edema mgmt may be required to promote improved healing
  • any evidence that a wound is stalling or worsening in any of the phases of healing or failure to respond to conservative wound mgmt for 30d
  • PT may need to be incorporated for off-loading techniques, positioning, use of biophysical technologies and lifestyle adaptations
  • complications w/pt w/high risk co-morbidity
81
Q

Conventional gauze

A

Cotton or synthetic fibers woven together into varying shapes and thickness
- 4x4s, 2x2s, Nu-gauze, super sponges, Kerlix, ABDs

Indications:

  • for cleaning of wounds (synthetic best bc does not leave fibers behind)
  • secondary dressing
  • loose filling of cavity/tunneling wounds (Kerlix, Nu-gauze)

Precaution:

  • tendency to desiccate wounds bc it is extremely permeable to air
  • “packing” wound w/gauze may occlude small capillaries and cause wound bed to become ischemic, thus delaying healing process
82
Q

Impregnated gauze

A

Woven gauze w/compound or solution (NS, hypertonic saline, petrolatum, iodoform, hydrogel, zinc) has been added

E.g.
- adaptic, xeroform, unna boot

Indications:

  • provide small amount of moisture
  • may protect tendon/bone under VAC dressing
  • decrease pain a/w dressing changes
  • may use w/small burns, donor sites, skin graft, skin tear
83
Q

Semi-permeable film

A

Transparent film coated on one side w/water-resistant, hypoallergenic adhesive

E.g.

  • tegaderm
  • op-site
  • bioclusive

Indications:

  • small amount of drainage
  • superficial wounds
  • when autolytic debridement is needed
  • when visual monitoring is necessary

Do NOT use w/infected wounds

84
Q

Semi-permeable foams

A

Varying layers of foam w/ability to absorb some exudate

E.g.
- lyofoam, allevyn

Indications:

  • moderate-heavy drainage
  • help decrease pain w/dressing change
  • maintain body temp in wound
  • need good peri-wound tissue bc some require additional tape
85
Q

Hydrogels

A

Contain high amounts of water and varying amounts of gel-forming materials

E.g.
- saf-gel, solosite, intrasite

Indications:

  • conform to shape of the wound
  • add moisture to wound
  • can assist autolytic debridement
  • act as thermal insulator
  • watch for peri-wound maceration*
86
Q

Hydrogel sheets

A

Water and glycerin in a fixed structure w/polymer film backing

E.g.
- acryderm, curagel, MPM

Indications:

  • maintain moist wound environment while absorbing small amounts of drainage
  • promote autolytic debridement
  • conforms well
  • decrease pain w/dressing changes
87
Q

Hydrocolloids

A

Occlusive dressing w/carboxymethyl cellulose contact layer

E.g.
- duoderm, replicare

Do NOT use w/infected wounds*

Indications:

  • occlusive to stool and urine
  • increased wear time to limit wound perturbation
  • absorb minimal to moderate amounts of drainage
  • assist in autolytic debridement
88
Q

Alginates

A

Absorptive dressings composed of seaweed elements

E.g.
- kaltostat, curasorb, sorbsan

Indications:

  • moderate to heavy amounts of drainage
  • decreased pain w/dressing changes
  • must use secondary dressing
  • turns into a “gel block” as it absorbs drainage
  • may pre-moisten to donate moisture
89
Q

Hydrofibers

A

Carboxymethylcellulose fibers capable of handling large amounts of exudate

E.g.
- aquacel

Indications:

  • holds its shape as it absorbs drainage and turns into a gel
  • decreased pain with dressing changes
  • may be pre-moistened for use with low drainage wounds
  • will NOT macerate peri-wound
90
Q

Barrier creams

A
  • provide protection against incontinence and drainage
  • are NOT a replacement for good, frequent skin care and cleansing
  • should be applied sparingly - more is NOT better

E.g.

  • aloe vesta, baza, remedy
  • xenaderm: healing properties as well as protective ones; effectively treats partial thickness wounds, applied BID/prn, requires prescription
91
Q

Collagens

A

Dressing sheets, granules or gels containing collagen derived from bovine, porcine or chicken sources

E.g.
- fibracol, kollagen-medifil

Indications:

  • hemostatic agent
  • provide 3D matrix for tissue and blood vessel growth
  • chemotactic for fibroblasts and macrophages
  • highly absorbent (don’t use on dry wounds)
92
Q

ORC-Collagen

A

Dressing that dissolves into the wound and binds excess matrix metalloproteases while releasing growth factors

E.g.
- promogran

Indications

  • promote granulation tissue in an already clean wound
  • requires secondary dressing
  • may assist healing process in chronic wounds that have “stalled out”
93
Q

Topical antimicrobial agents

A

Purpose is to offer topical bacteriostatic/cidal treatment to assist with wound healing
- may be used in conjunction w/systemic abx

94
Q

Steri-strips

A

Strips of tape used for surgical incisions

Useful for protection of wound as well as incision strength

95
Q

Compression bandage system

A

Used to manage edema and promote venous return

Typically have multiple layers applied in specific pattern

Indications:

  • tx of choice for venous ulcers
  • typically changed weekly
  • apply appropriate dressing over wound first
  • assess ABIs and PMH for CHF prior to use

Surgery (bpa) (19 decks)

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