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
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
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
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
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
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
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
8
Q
Phases of wound healing:
A
- Hemostasis
- Inflammation
- Epithelialization (proliferation)
- Fibroplasia (proliferation)
- Maturation (remodeling)
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
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
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
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
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
14
Q
Normal timeframe of healing depends on what
A
- geometric shape of wound
- linear > rectangle/square > circle - vascularity
- 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
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
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
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
18
Q
Wound measurements
A
- size
- length: head-toe
- width: left-right
- depth: deepest part
should capture longest length/width, perpendicular
- undermining
- wound edges separated from underlying base, parallel to skin surface
- use clock method to document - tunneling
- linear channel extending beyond open wound base
- may have entrance/exit in same wound or two adjacent wounds
- clock method to document
19
Q
Assessing wound bed
A
- color
- healthy: pink, “beefy” red
- necrotic: yellow, tan, black
- various colors can present in same wound bed
** remove necrotic tissue first to adequately assess
- assess visible structures
- exposed bone, tendon, joint
- protect these structures to maintain function and prevent infection - assess for necrosis
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
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
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
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
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
25
Assess wound edema
- 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
26
Assess wound sensation
- 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
27
Assess for s/s of infection and inflammation
```
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
28
Assess for s/s of dehiscence
- 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
29
Progression of drainage
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
30
What are the 3 types of wound closure
1. primary
2. delayed primary
3. secondary intention
31
Primary wound closure
- direct apposition of skin edges w/sutures or stables
| - 2 week healing time
32
Delayed primary closure
- skin edges re-approximated with sutures or stables AFTER interval of wound management
33
Secondary intention
- wound purposefully left open and fills w/granulation tissue and eventually epithelialization over prolonged period of time
- skin edges NOT brought together
34
Negative pressure wound therapy
Wound VAC
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
35
Additional wound coverage and types
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
36
Biologic graft
- 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
37
Skin graft
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
38
Skin flaps
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
39
Wound cleansers
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
Types of debridement
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
Mechanical debridement
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
Surgical debridement
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
Enzymatic debridement
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
Biologic debridement
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
Autolytic debridement
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
What should you avoid debriding?
Do NOT debride stable eschar
47
What do wound dressings do?
- eliminate dead space
- control exudate/drainage
- protect tissue
- prevent bacterial overgrowth
- barrier to bacteria
- ensure proper fluid balance
- decrease pain
48
Dressing basics
Debridement: hydrogels
Granulation stage: low-adherent, moisture-retentive dressings
Epithelialization stage: low-adherent dressings
Typically changed q day or qod
49
Dressing absorbency spectrum
Less to More
- gauze
- foam
- alginate
- hydrofiber
50
Components of dressing change order
- 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
Management of surgical incision
- 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
Management of pressure-induced soft tissue wound
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
Stages of Pressure Wounds
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
Management of diabetic foot wound
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
Management of wound dehiscence
- 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
Management of abrasions
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
When to refer wound care?
- 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
Conventional gauze
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
Impregnated gauze
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
Semi-permeable film
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
Semi-permeable foams
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
Hydrogels
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
Hydrogel sheets
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
Mechanical debridement
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
Surgical debridement
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
Enzymatic debridement
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
Biologic debridement
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
Autolytic debridement
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
What should you avoid debriding?
Do NOT debride stable eschar
70
What do wound dressings do?
- eliminate dead space
- control exudate/drainage
- protect tissue
- prevent bacterial overgrowth
- barrier to bacteria
- ensure proper fluid balance
- decrease pain
71
Dressing basics
Debridement: hydrogels
Granulation stage: low-adherent, moisture-retentive dressings
Epithelialization stage: low-adherent dressings
Typically changed q day or qod
72
Dressing absorbency spectrum
Less to More
- gauze
- foam
- alginate
- hydrofiber
73
Components of dressing change order
- 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
Management of surgical incision
- 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
Management of pressure-induced soft tissue wound
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
Stages of Pressure Wounds
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
Management of diabetic foot wound
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
Management of wound dehiscence
- 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
Management of abrasions
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
When to refer wound care?
- 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
Conventional gauze
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
Impregnated gauze
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
Semi-permeable film
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
Semi-permeable foams
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
Hydrogels
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
Hydrogel sheets
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
Hydrocolloids
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
Alginates
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
Hydrofibers
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
Barrier creams
- 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
Collagens
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
ORC-Collagen
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
Topical antimicrobial agents
Purpose is to offer topical bacteriostatic/cidal treatment to assist with wound healing
- may be used in conjunction w/systemic abx
94
Steri-strips
Strips of tape used for surgical incisions
Useful for protection of wound as well as incision strength
95
Compression bandage system
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
