Week 3 Flashcards
1
Q
What is negative pressure wound therapy?
A
Closed wound dressing system with suction
2
Q
What does negative pressure wound therapy do?
A
Applies controlled, sub-atmospheric pressure across open wounds
• 0-125 mmHg
3
Q
What are the mechanisms of action and benefits of negative pressure wound therapy?
A
• Removal of exudate • Moist wound environment • Decrease bacterial burden • Reduce edema and excess interstitial fluid - Increases blood flow • Increase in microvascular blood flow • Stimulation of granulation tissue - Mechanical deformation • Promotes wound contraction • Reduces dressing change frequency
4
Q
What are the general equipments used in negative pressure wound therapy?
A
• Pump provides suction
- Electric, battery
- Reusable, disposable; large, portable, tiny
• Wound filler or cover transfer pressure across wound bed &
allow fluid to move through & into canister
• Tubing – delivers suction, transports fluids
• Canister – holds evacuated fluids
• Occlusive sheeting provides air-tight seal
- Maintain sub-atmospheric pressure
• Application – simple to complicated
5
Q
What are the indications for negative pressure wound therapy with acute and chronic wounds?
A
• VI, pressure injuries, traumatic, surgical, burns,
• Mass casualty & high energy injuries - military
• Bone or tendon exposure – w/protection
• Over grafts – with protection
- removes fluid, compresses, stabilizes/splints
- Intermittent mode contraindicated
6
Q
What are the indications for negative pressure wound therapy with acute and chronic wounds over sutures?
A
With protection, intermittent mode contraindicated
• For at-risk pts: removes fluid, approximation
• Disposable units, up to ~7 days
7
Q
What are the indications for negative pressure wound therapy with pediatrics?
A
- Special guidelines, lower pressure (50-125)
- Based on age, wt, etiology, location
- Dehydration (also in elderly)
8
Q
What are the characteristics of negative pressure wound therapy and tissue protection?
A
• Can apply over any body tissue – with protection
- Adaptic
- Sometimes 3-4 layers
• White foam
- Less aggressive compared to black/green
9
Q
What are the precautions to take for negative pressure wound therapy?
A
- Anticoagulants, low platelet count
- Non-enteric & unexplored fistulas
- Over named structures (bone, tendon, organs, vessels, etc.)
- Requires several layers of barrier dressing or use of white foam
- Monitor for bleeding
- Avoid circumferential occlusive sheeting application due to increased risk of ischemia
- Monitor skin condition when placed over bony prominences or prominent hardware due to compression
- Sharp edges of exposed bone should be debrided prior to application to protect soft tissue during compression
- MD notified if drainage in canister is sanguineous, fills w/n 1 hour, or if >2 canisters filled w/n 24 hrs
10
Q
What are the precautions to take for negative pressure wound therapy in regards to arterial insuffuciency?
A
AI (not for moderate/severe AI)
• Compression at wound edge causes 1-2.5 cm area of hypoperfusion
- Not a good idea for AI wounds where surrounding tissue is already
compromised
- Use lower pressures
- Intermittent mode - if appropriate
11
Q
What are the contraindications of negative pressure wound therapy?
A
• >30% slough/necrotic tissue or over dry wounds
• Untreated osteomyelitis
• Gross inf w/or w/o frank pus or sepsis
• Malignancy except in palliative care
• Lack of hemostasis
• Blood dyscrasia as w/leukemia/hemophilia
• Directly over exposed vessels/by-pass grafts/organs/named structures
• Ischemic wounds w/significant proximal occlusion
• No intermittent over grafts due to high potential for disruption
• No suction devices/pumps in MRI, HBOT, or close to flammable anesthetics
(See specific vendor specifications)
• Any wound showing negative response to initial tx
12
Q
What are the pre-requisites to do when using negative pressure wound therapy with an infection?
A
• Pt free of most systemic s/s of gross infection
• Necrotic tissue debrided
• Abscesses drained
• Adequate perfusion
• Can be combined w/Ag
- Silver dressings
• Instillation (V.A.C.)
- Wound wash w/o removal of dressing
- Antibiotics, saline, etc.
13
Q
What are the signs of wound deterioration?
A
- Increased peri-wound erythema
- Repeated need for sharp or surgical debridement
- Increased drainage, bleeding
- Newly observed infection/necrosis
- Increased pain
- Increased wound size
- Newly observed undermining or tracts
14
Q
How do we know when to discontinue negative pressure wound therapy?
A
- Goals have been met
- Good granular bed achieved, even w/ skin surface
- No appreciable benefit evident post 48 hrs
- S/s of deterioration
- Development of new infection post NPWT initiated
- Pt discomfort/intolerance
- When other dressings better suit current phase of healing
- Progression too little/no drainage
- Anticoagulants
- Sanguineous drainage (indicating hemostasis has not been achieved), fills canister in 1 hour or > 2 in 24 hours (may require temporary hold on therapy)
15
Q
What are the different parameter choices for negative pressure wound therapy?
A
- Filler & protective barriers
- Mode of delivery
- Frequency of change
- Pressure
16
Q
What are the different wound fillers used for negative pressure wound therapy?
A
- Black, white, green foam
- Gauze & JP “type” drain
- Flat, simple, disposable “stick on” dressings
17
Q
What are the modes of delivery of negative pressure wound therapy?
A
• Continuous - always on • Intermittent - on & off cycles • Variable - up & down but not off • Combination - continuous at first, then intermittent
18
Q
What are the recommendations for the use of continuous negative pressure wound therapy?
A
- 80-125 mmHg for most acute wounds & pressure injuries
- 100-125 mmHg over grafts for first 3-5 days
- 80 mmHg shown to give max effects on blood flow
- 50-75 mmHg if pain issue
- 50-75 mmHg for most chronic wounds
- 40-50 mmHg for wounds w/decreased circulation
- 75 mmHg for abdominal wounds due to presence of pressure receptors in abdomen
19
Q
What are the recommendations for the use of intermittent negative pressure wound therapy?
A
- 125 mmHg, 5 minutes on/2 minutes off
* 40-75 mmHg for mild arterial wounds (& lower pressures)
20
Q
What are the recommendations for the use of variable negative pressure wound therapy?
A
10-125 mmHg depending on etiology & pt comfort
21
Q
What are the recommendations for the use of combination negative pressure wound therapy?
A
125 mmHg x first 24 hours, 80 mmHg intermittent
22
Q
What are the methods to help reduce pain at the dressing change of negative pressure wound therapy?
A
• Soak wound filler 3-5 minutes w/saline - infuse via tubing
• Protective layer – prevents adherence to fragile tissues
• Xeroform strips around wound edges (allows for more re-ep too)
• Pull occlusive sheeting parallel to the skin
• Skin protectant
• Frequent dressing change (24 verses 48 hours)
• Granulation ingrowth less likely w/gauze
- Greater compression/contraction w/foam compared, less pain
• Pain/discomfort at initial pressure application may last 20 minutes
• White foam may be less painful upon removal vs black foam
• Calcium alginate under foam may reduce removal pain
• At dressing change, cover tissue w/soak to prevent dehydration
• Pain meds prior to dressing change
23
Q
What are the patient education tips to provide a patient that uses negative pressure wound therapy?
A
- Basic operation, alarms, how to patch
- Benefit wound healing
- Device “on” 24 hours a day
- Keep tubing open, no kinks
- 24 hour troubleshooting assistance line (if vendor supplies)
- Keep battery charged
- What to do: bleeding, increased pain, etc
24
Q
What are the different depths recognized when it comes to burns?
A
- Superficial (1st degree)
- Partial thickness (2nd degree)
- Superficial partial thickness
- Deep partial thickness - Full thickness (3rd degree)
25
What are the usual presentations of a superficial burn?
- Typically pink or red with erythema, and blanching present. Sensation is usually intact and painful
- Little to no risk of scarring or contracture
26
How does a superficial burn take to heal?
3-4 days
27
What are the usual presentations of a superficial partial thickness burn?
- They go into the papillary dermis
- Can vary in shade, but are usually pink, may be moist and may have blistering present
- Blanching may be present,
- Intact with sensation, and very painful
- Low risk of scarring or contracture
28
How does a superficial partial thickness burn take to heal?
1- 3 weeks
29
What are the usual presentations of a deep partial thickness burn?
- They go into the reticular dermis
- Usually a mild white appearance
- Blanching is absent
- Sensation is diminished to insensate
- May need surgical intervention
- Moderate to high risk of scarring or contracture
30
How does a deep partial thickness burn take to heal?
3- 9 weeks
31
What are the usual presentations of a full thickness burn?
- Vary in appearance, can be red and leathery looking
- Blanching and sensation are completely absent
- Require surgical intervention for healing
- Scarring is typical and skin grafting is likely
32
What are the different types of causes of burns?
- Scald
- Flame
- Electrical
- Chemical
- Radiation
- Contact
33
What types of burns does a PT treat?
- Superficial partial thickness
- Deep partial thickness
- Full thickness (3rd degree)
34
What are the typical treatment methods for a partial thickness burn?
- Irrigation
- Debridement (blisters or dead skin)
- Anti microbial ointment or cream
- Impregnated gauze
- Dry gauze
- Elastic netting
35
What does a PT do for the treatment of a full thickness burn?
Prepare for grafting and dress the wound to prevent infections
36
What are PTs responsible for in the treatment of burns?
Early ROM and splinting for contracture and functional limitations prevention.
- Apply dressing to allow movement (do in a figure 8 style)
37
How are skin grafts typically dressed?
Dressed with soaked gauze and irrigated frequently, splinting incorporated for protection and often finished with compression. Elevation if possible and changed every 1-2 days
38
How is a graft treated after adherence of the graft (vascularized)?
Ointment with impregnated gauze, gauze wrap and netting
39
How is wound care for the donor site done?
Moist wound healing principles
40
What are the most common treatments for scar management and prevention?
- Compression
- Massage
- Silicone
- Exercise
- Splinting
- Positioning
41
What are the compression recommendation for scar management after a wound?
23 hours a day during maturation, 5-40 mmHg
42
What are the massage recommendation for scar management after a wound?
Evidence lack for impact on scar, but is useful for mobilizing superficial tissues
43
What are the things to consider when prescribing exercise for a burn patient?
- Consider the phase of healing
- Stretching to blanching, slow sustained elongation
- Note over aggressive stretching is linked to heterotopic ossification
44
What is the most recommended position for most burn patients?
Fully extended, elongating along the burn areas to avoid contractures
45
What is the most recommended position for burn patients that sustained a burn to the posterior neck?
Flexed to prevent a contracture
46
What is the primary intention of surgical wound healing?
Edges approximated during surgery
| • Sutures, staples, dermal glues
47
What is the secondary intention of surgical wound healing?
Left open after surgery, healing with scar tissue
48
What is the tertiary or delayed primary closure of surgical wound healing?
Initially wound left open then after a short time edges are
| approximated
49
What are the parameters of surgical site assessment?
• Screening
- Onset, fever, pain, last dressing change
- Complicating factors
• Observations
- Epithelialization/wound closure, exudate
- Wound tissue, periwound, surrounding skin
- S/s of infection (clinical & critical colonization)
• Measurement of incision
• Palpation
- Incision & surrounding area
50
What are the positive signs of surgical healing within days 1-4?
```
• Edges approximated
• Normal inflammation
• Minimum to moderate
drainage (Bloody progressing to
serosanguineous)
```
51
What are the negative signs of surgical healing within days 1-4?
* No signs of inflammation
| * Tension along the incision line
52
What is the primary dressing used during days 1-4 of surgical healing?
Dry or non-adherent gauze
53
What are the positive signs of surgical healing within days 5-9?
```
• No inflammation
• No drainage
• New epithelium along entire
incision line
• Healing ridge present
- Firmness along incision line
from collagen deposition
- Feels like a pencil under the
incision line
```
54
What are the negative signs of surgical healing within days 5-9?
* Drainage
* Little or no new pink epithelium
* Absent or partial healing ridge
* S/s of infection
* Dehiscence
55
What are the positive signs of surgical healing within days 10-14?
* Sutures/staples removed
* Pink incision site
* Tiny openings post removal
56
What are the negative signs of surgical healing within days 10-14?
```
• Signs of inflammation or
infection
• Drainage
• Dehiscence
• Absent or partial healing ridge
```
57
What are the positive signs of surgical healing within days 15 up to 1-2 years?
```
• Pale pink scar
progressing to
white/silver
- Will be darker in darkly
pigmented skin
- Note: Scar will always be
weaker. Only up to 80% of
full strength
```
58
What are the negative signs of surgical healing within days 15 up to 1-2 years?
Keloid or hypertrophic scarring
59
What are the typical suture removal timeframe (in days) following a surgical wound?
* Face: 3-5
* Scalp: 7
* Chest: 7-10
* Abdomen: 7-10
* Extremities: 7-10
* Ear: 10-14
* Back: 12-14
* Foot: 12-14
*7-10 days is typical
60
What are the most common forms of dressing surgical wounds?
* Dry or non-adherent gauze
* Bordered foam
* May see beta-dine dabs along incision line as well
61
When is a moist dressing of a surgical wound appropriate?
When viable tissue is exposed
• Impregnated gauze cut to fit over opening
• Dry gauze over the rest
62
What are the characteristics of steri-strips after surgical wound?
```
• PT placement
- Post suture/staple removal
- Sometimes placed over/w/sutures & staples
• Removal post closure
- When they fall off
- Ok to shower
• For ~2 wks after suture or
staple removal
```
63
Why aren't surgical wounds closed via primary intention?
```
• Risk of infection
• Too much tissue removed
- Deep cavity
• Closure would result in too much tension
- Edema
```
64
What are the complications that can come with taking an incision from simple to complex?
* Dehiscence
* Surgical site infection
* Obesity
* DM
65
What are the causes of a wound dehiscence?
* Tension, edema
* Smoking
* Infection/osteomyelitis
* Trauma (pressure)
* HTN
* Stress
* Malnutrition
* Decreased healing potential (DM, etc.)
66
What are the risk factors for an abdominal dehiscence?
```
• Advanced age
• Anemia
• Chronic pulmonary disease
• Infection
• Increased intra-abdominal pressure
- Obesity, ascites, coughing, etc.
• Drains
- Continuous draining of fluids to reduce edema/tension
- Can be located anywhere
- Different types – negative pressure bulb, tubing
```
67
What is the most common type of surgical site infection?
Nosocomial infection
68
Majority of SSI related to ___
Majority of SSI related to incision
• IV abx 1 hr prior to first cut (Sussman, 2012)
- Good infusion into tissue
- Continued throughout surgical procedure
69
What are the parameters of preoperative hair removal in order to avoid surgical site infection (SSI)?
Clip when you can instead of shave
70
What are the basic incision care guidelines to follow?
```
• Keep dry
- Dry gauze, telfa
- Abx ointment (slight amt) &
impregnated gauze (Xeroform, Adaptic) if tissue exposure
• Protection
- Reduce tension (edema), steristrips
• Cleansing & debridement
- Clean water, wipe toward incision line
- Remove loose debris/scab
• Monitor
- (+) & - signs of healing, s/s of infection
```
71
When should the PT contact the MD in regards to a surgical wound?
* Early increased bloody drainage
* Change to purulent drainage
* Drainage after days 5 - 6
* Absence of healing ridge by day 9
* Infection: local s/s post day 4, systemic s/s anytime
* Dehiscence
* Increased pain
* Consider contributions of increased mobility
Always use clinical judgment
72
How do we go about scar management in an incision line?
```
• Minimize inflammation
• Encourage quick closure
• Functional mobility during healing
- Upright posture, ROM, etc.
- Moisturize lightly
- STM
```
73
What are the guidelines of pt education for self care of a surgical wound?
* Infection: signs and symptoms & action to take
* Showering/bathing
* Nutrition/social habits
* Wound cleansing, dressing changes, protection
* Antibiotics
* Pain meds
74
What are the treatment options for bites?
```
• Short term use of antiseptics
- If at risk for infection
• Thorough irrigation:
- PLWS, syringe & catheter, etc.
• Aggressive debridement
• Test sensation, monitor for s/s of infection – educate!
- 24 hr follow-up
• Medical Management
- Systemic complications
- Antibiotics, steroids, anti-inflammatories, anti-histamines
```
75
What are the characteristics of a cat bite?
• Tiny, sharp teeth
- Deep puncture wounds difficult to irrigate – higher rate of infection w/puncture wounds
• Consider opening w/scalpel for easier cleaning
- Surgical consult
76
What are the characteristics of a dog bite?
* Lacerations, punctures, crush injuries
* Rabies status, behavior, known dog, etc.
* Very low infection rate with tx 6-13%
* Need to involve local health authorities
77
What are the characteristics of a human bite?
• 3rd most common bite (Tabbara, 2012)
- Dog, cat are 1 and 2
- Can be worse than animal bites
• Antibiotics & tetanus is typical
- High risk of infection: 10-20%
- s/p 72 hrs & no s/s: hold antibiotics
• Determine health status of other person
- Hepatitis
- Higher transmission rate than HIV (still low)
- 75% have detectable antigen in saliva
• HIV
- 1 in 250 people in US; 1 in 5 unaware of status
- Not saliva alone, bld/saliva mix
78
What are the characteristics of bite wounds?
• Can lead to serious infection (can develop rapidly)
- Inoculation of oral (& skin) flora into the body
- Local infection, abscess, pain, loss of function
- Osteomyelitis, meningitis, sepsis, endocarditis, brain abscess, disease transmission, etc.
• Use antiseptics & antimicrobial topicals
• Check lymph nodes adjacent to injury
• Follow-up 24-48 hrs post injury
79
What are the general treatment guidelines of traumatic wounds?
```
• History, review of systems
• Wound exam
• Functional exam
- As PTs we address the whole person
- Mobility plays a role in wound healing
• Irrigation?
• Debridement?
• Moisture balance?
• Dressing?
• Others: edema, positioning, ROM, strength, function
```
80
What is the purpose of a wound dressing?
Provide optimal environment
• Moisture, neutral warmth, protection/barrier, odor, delivery of topicals, reduce pain,
• Not Static - applied in response to changing wound status/needs
• Changes w/drainage amount/type, healing phase,
activity, temp, tissue, bioburden, etc.
81
When should the re-eval of dressings be done?
Every visit
82
What are the considerations of deciding upon a dressing?
* Exudate: type & amount
* Bioburden
* Tissues: granular, tendon, nonviable, etc.
* Location, size, depth
* Peri-wound & surrounding skin
* Etiology & tx hx
* Allergies
* Pt comfort, age, pt/caregiver ability
* Supplies, cost & coverage, schedule, goals
* Secondary dressing, retention, compression
* Common sense
83
When do we change a dressing?
```
• When saturated – “strike through”
• Maintain moist environment
• Timeline for topicals or combo dressings
• Becomes soiled, contaminated, wet
• Disrupted – loose/falls off, MD visit
• Bathing
• Odor
• When concerned
- New tx, trying longer change schedule, etc.
```
84
What are the general categories of a dressing?
* Gauze
* Impregnated gauze
* Film
* Hydrogel
* Foam
* Hydrocolloid
* Alginate
* Hydrofiber
* Antimicrobial
85
What are the characteristics of a "regular" gauze?
* Readily available, various sizes, inexpensive
* Non-occlusive & absorptive (drying)
* Mechanical debridement
* Padding, primary (with hydrogel) or secondary dressing (wet-todry)
* Cut to size
* Telfa: non-adherent, little absorption
* Changed daily as primary dressing
86
What are the cautions to take when using a regular gauze?
Drying, can absorb topicals quickly, fibers, roll gauze
| applied at an angle
87
What are the characteristics of an impregnated gauze?
• Atraumatic removal – “contact layer”
• Multiple sizes, cut to fit
• Mild occlusiveness, promotes moist wound healing
• Less permeable then “regular” gauze (fluid held underneath)
• Can be combined with topicals
• Can be primary or secondary (requires coverage)
• Some can be left in place several days
• Typically used on wounds w/o a lot of depth
- Some used to protect deeper named structures
• Ex: Adaptic, Xeroform
88
What are the cautions to take when using an impregnated gauze?
Maceration, adherent if allowed to dry
89
What are the characteristics of a semipermeable film dressing?
• Thin, flexible, multiple sizes, cut to size
• Transparent, occlusive (promotes autolytic debridement)
• Barrier to outside world, can stay in place up to 7 days
• Little absorption if used alone, can be combined w/other dressings
• Primary or secondary dressing
• Usually for more superficial wounds
- Requires primary dressing for cavity/deep wounds
• Highly conformable, adherent to peri-wound/surrounding skin
90
What are the cautions to take when using a semipermeable film dressing?
Limit wrinkles, applied w/o tension, difficult to apply, not
| water proof, specific removal technique, damage skin w/removal
91
What are the characteristics of a hydrogel dressing?
```
• Donate moisture
- Can absorb small amounts of drainage
- Decrease pain
- Promote autolytic debridement
• Gel & sheet forms
• Can be combined w/other dressings
- Silver powder + hydrogel = silver gel
- Regular gauze + saline + hydrogel = moist dressing
- Mush into nu-gauze for easy wound filling – but adds moisture
• Requires secondary dressing
```
92
What are the cautions to take when using a hydrogel dressing?
Maceration, sheets not used on infected wounds
93
What are the characteristics of a foam dressing?
• Absorptive
- Can be used with most thicker topicals (ointments)
• Flexible, variety of sizes, cut to size
• Non-adherent, thick & thin
• Primary or secondary dressing
- Padding, additional absorption
- Can be combined w/other dressings (layered over primary dressing)
• Insulating
- Promote autolytic debridement
• Can be left in place up to 7 days
94
What are the cautions to take when using a foam dressing?
Maceration, can roll w/friction
95
What are the characteristics of a hydrocolloids dressing?
• Highly occlusive
- Promote autolytic debridement
• Highly adhesive
• Sheets: various sizes, cut to fit, thick & thin
• Paste: can be used for deeper wounds
• Primary or secondary dressing (usually as primary)
96
What are the cautions to take when using a hydrocolloids dressing?
Maceration (not as absorbent as some say), skin damage
w/removal, sheet forms not for deep wnds, paste/particles
expand in deeper wnds, edges can roll w/friction, linked
w/hypergranulation
97
What are the characteristics of an alginate dressing?
• Highly absorptive
- Hold drainage in dressing, absorb vertically/laterally
- Gel w/absorption for atraumatic removal, may trap bacteria w/n dressing,
• Some assist w/clotting
• Sheet & rope, various sizes, cut/tear to fit
• Frequently combined in or w/other dressings
• Can be left in place up to 7 days
• Non-occlusive
• Contour easily to wound surfaces, can be layered into deeper wounds
98
What are the cautions to take when using an alginate dressing?
Maceration if placed outside of wound margins, for highly draining wounds, wound desiccation, look “bad” when wet
99
What are the contraindications of an alginate dressing?
Not to be used over bone, tendon, etc. or on neonates (<38wks gestation
100
What are the characteristics of a hydrofiber dressing?
• Highly absorptive (more than alginate)
• Absorb vertically (less risk of maceration vs alginate)
• Different sizes, cut to size
- Sheets
• Aquacel (ConvaTec)
- New wound ribbon dressing
- “stitchbonding” to increase strength
101
When should an antimicrobial dressing be used?
* Critical colonization (trial ~ 2 wks)
* Active infection
* High risk of infection
102
When should an antimicrobial dressing be discontinued?
* Clean wound, epithelializing/granulating
* Risk is removed
* Short term dressings – clear reason to use them, know when to stop
103
What are some examples of an antimicrobial dressing?
* Cadexomer Iodine
* Silver
* Honey
104
What are the characteristics of a cadexomer iodine dressing?
• Broad spectrum antimicrobial
- Slow release of iodine, non-cytotoxic
• Absorptive
- Turns white w/absorption
• Various forms
• Can be cheaper than others depending on dressing frequency
• Can stain skin, cannot combo w/collagenase
105
What are the cautions to take when using a cadexomer iodine dressing?
Allergy to iodine/shellfish, pregnancy/breast feeding, < 6
| months old, widespread prolonged use (hyperthyroidism/cytotoxicity)
106
What are the contraindications of a cadexomer iodine dressing?
Thyroid disease, deep cavity wounds
107
What are the characteristics of a silver dressing?
• Broad spectrum
• Various forms (combined w/other dressings)
- Powder, gel, alginate, hydrocolloid, foam, sheets, creams, etc.
• Various wear times: daily – 7 days (Depending on method of release)
• SSD (Silvadene, Silversulfadiazine)
- Cream must be thoroughly removed daily
- Adds moisture
• Some require pre-moistening
• Cannot combine w/collagenase
108
What are the cautions to take when using a silver dressing?
Toxicity risk w/prolonged use, allergy, irrigate w/sterile
| water, use on newborns/infants/young children
109
What are the characteristics of a honey dressing?
• Broad-spectrum antimicrobial
• Various forms/combinations
- Some can absorb exudate
• Can reduce odor, pain
• Anti-inflammatory, nontoxic, decreases odor
• Promotes autolytic debridement
- Assists w/break down of nonviable tissue
110
What are the cautions to take when using a honey dressing?
Initial stinging
111
What are the contraindications of a honeydressing?
Allergy to bees or honey
