Wound Healing Interventions

Question 1

What is the red-yellow-black system?

Answer 1

System used to determine what type of goals are expected depending on the appearance of the wound.

Question 2

Yellow Wound

Answer 2

Wound that is moist with a yellow slough. Goals are to remove exudate and debris, absorb damage.

Question 2

Red Wound

Answer 2

Wound that has pink granulation tissue. Goals are to protect the wound and maintain a moist environment.

Question 3

Black Wound

Answer 3

Wound that is black with thick eschar firmed adhered. Goals are to debride necrotic tissue.

Question 4

What is selective debridement? What are the 3 types?

Answer 4

The removal of only nonviable tissues from a wound. The types are sharp, enzymatic, and autolytic.

Question 5

Sharp Debridement

Answer 5

Use of a scalpel, scissors, and/or forceps to remove devitalized tissue and debris from a wound. Typically used for wounds with thick, adherent, necrotic issue (eschar), and sometimes with cellulitis or sepsis.

Question 6

Enzymatic Debridement

Answer 6

Use of topical application of an enzymatic preparation to necrotic tissue. Can be used on infected and non-infected wounds.

Question 7

Autolytic Debridement

Answer 7

Refers to use of the body’s own mechanisms to remove nonviable tissue. Common methods include use of transparent films, hydrocolloids, hydrogels, and alginates. Non-invasive and pain free alternative.

Question 8

What is Non-selective Debridement? What are the 3 types?

Answer 8

The removal of both viable and nonviable tissues from a wound. Often termed mechanical debridement. Types are wet-to-dry dressings, wound irrigation, and hydrotherapy.

Question 9

Wet-to-dry dressing

Answer 9

Refers to the application of a moist gauze dressing over an area of necrotic tissue. Dressing is then allowed to dry then removed along with any necrotic tissue that has adhered to the gauze. Most often used on wounds with moderate exudate and necrotic tissue.

Question 10

Wound irrigation

Answer 10

Removal of necrotic tissue from the wound bed using pressurized fluid. Commonly used on wounds that are infected or have loose debris. Ex: pulsatile lavage

Question 11

Hydrotherapy

Answer 11

The removal of necrotic tissue by using a whirlpool tank with agitation directed towards the wound.

Question 12

Negative Pressure Wound Therapy (NPWT)

Answer 12

AKA a V.A.C. A non-invasive wound care modality that is used to facilitate healing and manage drainage. Sterile foam is placed on wound and sealed airtight with a secondary dressing and vacuum pump.

Question 13

When is NPWT indicated?

Answer 13

From chronic or acute wounds that cannot be closed by primary intention. Examples are dehisced surgical incisions, full thickness wounds, partial-thickness burns, heavy draining granular wounds, grafts, and ulcer.

Question 14

What are contraindications of NPWT?

Answer 14

Malignancy with the wound, insufficient vascularity, large amounts of necrotic tissue, osteomyelitis, exposed blood vessels.

Question 15

What are some advantages of NPWT?

Answer 15

Management of wound drainage
Maintains moist wound environment
Decreased interstitial edema
Decreased bacteria
Increases capillary blood flow
Increases granular tissue formation
Enhances epithelial cell migration

Question 16

What are some disadvantages of NPWT?

Answer 16

Requires special supplies and training
Treatment can be painful
No reimbursement in acute or long term care settings

Question 17

Hyperbaric Oxygen

Answer 17

Refers to inhalation of 100% O2 delivered at pressures greater than 1atm. Delivered in closed chamber at pressures 2-3 times greater than the atmosphere which can help reduce edema and hyperoxygenation tissues.

Question 18

When is hyperbaric oxygen indicated?

Answer 18

Osteomyelitis, diabetic wounds, crush injuries, compartment syndrome, infection, thermal burns, radiation necrosis

Question 19

What are contraindications for Hyperbaric Oxygen

Answer 19

Terminal illness, pneumothorax, active cancer, pregnancy, seizures, emphysema

Question 20

What are some advantages of Hyperbaric Oxygen?

Answer 20

Antibiotic effects
Stimulation of fibroblast production
Stimulation of growth factor release

Question 21

Growth Factors

Answer 21

Naturally occurring protein factors that assist with healing

Question 22

When are growth factors indicated?

Answer 22

Neuropathic ulcers

Question 23

What are contraindications for growth factors?

Answer 23

primary intention wounds

Question 24

What are some advantages of growth factors?

Answer 24

adjunct to promote wound healing environment
increase growth rate of tissue
promote cell division

Question 25

What are some disadvantages of growth factors?

Answer 25

costly
additional research needed
no FDA approval

Question 26

Types of wound dressings

Answer 26

Primary and secondary dressings. Primary is one that comes in direct contact with wound. Secondary are ones that are placed over a primary dressing to provide addition protection, absorption, occlusion, and/or to secure primary.

Question 27

Alginates

Answer 27

Derived from seaweed extraction. Highly absorptive, but highly permeable and non-occlusive. Require secondary dressing. Used on partial or full thickness draining wounds like venous or pressure ulcers. Can be used on infected wounds.

Question 28

Advantages and disadvantages of alginates

Answer 28

A: High absorptive, autolytic debridement, protection from contamination, useful in both infected and non-infected, non-adhering
D: Requires frequent dressing changes, requires secondary dressing, cant be used on subcutaneous wounds

Question 29

Foam dressing

Answer 29

Hydrophilic base that contacts wound and hydrophobic outer layer. Dressing absorbs exudate into the foam. Both adhesive and non-adhesive forms. Used on partial and full thickness wounds with exudate.

Question 30

Advantages and disadvantages of foam dressings

Answer 30

A: provides moist environment, two forms, provides protection and cushioning, autolytic debridement, moderate absorption.
D: Can roll in areas with increased friction, removal can cause damage to periwound, can’t inspect wound with it on.

Question 31

Gauze

Answer 31

yarn or thread and most readily available. Many shapes and sizes. Impregnated gauze is a variation that contains petrolatum, zinc, or antimicrobials. Used on infected or non-infected wounds. Can be used wet-to-wet, wet-to-moist, or wet-to-dry debridement.

Question 32

Advantages and disadvantages of gauze

Answer 32

A: readily available and cheap short-term dressing, can be used alone or in combination, can modify amount of layers, infected and non-infected.
D: can adhere to wound bed which can damage tissue on removal, highly permeable, requires frequent changing, increased infection rate compared to occlusive dressings

Question 33

Hydrocolloids

Answer 33

gel forming polymers backed by strong film or foam adhesive. Does not attach to wound, but surrounding skin. Absorbs exudate by swelling. Used on partial and full thickness wounds, effective on granular or necrotic wounds.

Question 34

Advantages and disadvantages of hydrocolloids

Answer 34

A: provides moist environment to promote healing, autolytic debridement, protection from contamination, moderate absorption, no secondary dressings needed, waterproof
D: Damage surrounding skin on removal, can’t be used on infected wounds.

Question 35

Hydrogels

Answer 35

contain varying amounts of water and gel-forming materials. Very moisture retentive and are used on superficial and partial-thickness wounds that have minimal drainage.

Question 36

Advantages and disadvantages of Hydrogels

Answer 36

A: provides moist environment to promote healing, autolytic debridement, can reduce pressure and pain, can be used with ultrasound, minimally adheres to wound
D: dressing can dehydrate, not useful for wounds with significant drainage, requires secondary dressing

Question 37

Transparent Film

Answer 37

water resistant adhesives that are permeable to vapor and oxygen, but impermeable to bacteria and water. Highly elastic and allow for easy inspection of wound. Used on superficial or partial thickness wounds with minimal drainage.

Question 38

Advantages and disadvantages of transparent films

Answer 38

A: Provides moist environment to promote healing, autolytic debridement, can see the wound, resistant to shearing and friction, cost effective
D: Not good with wounds with excessive exudate, can’t be used on infected wounds