Wound Management Flashcards
What are 4 characteristics of the primary/contact layer of a bandage?
- sterile
- conforms to the body and contours
- nontoxic and nonirritating
- minimizes pain
In what ways can primary layers of bandages maintain the optimal environment for wound healing?
- protection
- debridement
- absorbs exudate
- delivers topical medications
- promotes moist wound healing
What are the 2 types of primary layers?
- ADHERENT - dry, wet to dry, moist
- NON-ADHERENT - semiocclusive, occlusive
What are the most moisture retentive primary dressings?
occlusive dressings (non-adherent) —> low moisture vapor transmission rate (MTVR)
What are 5 examples of highly absorptive primary layers?
- hypertonic saline - 20% dry sodium chloride combined with absorbent dressing
- saline impregnated dressings
- gauze sponges
- calcium alginate
- copolymer starch
What are adherent brandages?
bandages with wide mesh openings and no cotton filler, which provides micro-debridement —> painful and not recommended for prolonged use
- dry
- wet to dry
- moist
What is a dry bandage? When are they most commonly used?
an adherent bandage applied dry and covered with an absorbant layer and takes necrotic debris attached to it upon removal
wounds with low viscosity exudate (thin, runny)
What is the major indication for wet to dry gause dressings? Why?
wounds producing primarily serous or serosanguinous exudate
applying sponges dry allows them to soak up more fluid
What is calcium alginate dressing? What 3 functions does it have?
nonwoven felt-like material derived from seaweed
- extremely hydrophilic - fluid absorption converts it into a gel
- enhances granulation tissue formation
- aids in hemostasis
What is the major indication for applying calcium alginate dressing? What is a major benefit to this type of dressing?
moderate to heavy exudative wounds in the early stages of healing
less painful to change than gauze
What is maltodextrin? What 4 functions does it have?
D-glucose polysaccharide
- chemotactic of PMNs, lymphocytes, macrophages
- provides energy for cells
- stimulates rapid granulation tissue formation and epithelialization
- antibacterial
What are the 3 indications for the use of maltodextrin in bandages?
- cleanse and promotes healing of contaminated and infected wounds
- enhances granulation tissue formation
- induce healing in chronic wounds and ulcers
Why are gunshot wounds especially dangerous?
- high energy
- foreign material (tiny, scatters)
- collateral damage = small entry point, but a lot of contamination underneath
In what kinds of wounds are wet to dry bandages used? What happens when they are removed?
wounds with high viscosity exudate
bandage is removes dry with necrotic debris attached
What are 2 indications for the use of wet to dry gauze bandages? What type of gauze is used?
- necrotic tissue and/or FB
- high viscosity exudate
wide mesh gauze to liquefy viscous exudate and entrapment within the dressing
- can be used as a vehicle to deliver antiseptic to the wound
What is Kerlix AMD? What additional effect does it have?
polyhexamethylene biguanide used as an adherent topical dressing to aid wound debridement
broad-spectrum antibacterial
What are 3 indications for the use of Kerlix AMD for wounds?
highly exudative wounds
- degloving injuries
- bite wounds
- deep cavity wounds
What are wet to dry bandages? When are they used?
bandage applied moist, typically with saline or 1:40 chlorhexidine, and covered in an absorbent layer
wounds in the inflammatory and debridement phases of wound healing —> more tissue-friendly dressings should be used whenever possible
What are the 4 major disadvantages to using adherent absorptive dressings?
- tissue trauma
- removes substances in wound fluid that promote healing
- maceration of surrounding skin
- if bandage is able to soak through, bacteria can move in or out
When are moist bandages used?
when the bandage is used to remove moisture, typically in wounds without exudate at the repair stage
How do moisture retentive dressings compare to adherent dressings?
better for wounds in late debridement/proliferative phases because they optimize the body’s inherent wound healing abilities - maintains proteases, protease inhibitors, growth factors, and cytokines
(occlusive)
What are 3 examples of moisture retentive dressings?
- polyurethane foam/film
- hydrogel
- hydrocolloids
What are 4 advantages to using moisture retentive dressings?
- selective autolytic debridement - WBCs remain active
- lower oxygen tension in wound lowers wound pH, deterring bacterial growth and favors angiogenesis and fibroblast function
- less risk of infection with exogenous bacteria
- less painful to remove
What are 2 examples of biological dressings?
- equine amnion - early stages of wound healing, limited storage time (6 months)
- matrix derived xenograft and allografts - collagen, porcine small intestinal/urinary bladder submucosa
What collagen is used as a biological dressing? What 3 actions does it have?
bovine - powder, matrix sponge, semiliquid gel
- scaffold or fibroblast ingrowth
- collagen deposition
- enhances epithelial cell migration
What is the main indication for collagen biological dressings? What is an important precaution? How can this be avoided?
wounds in late inflammatory and early repair stages of wound healing
can cause inflammatory reactions - avoid overlapping sponges onto surrounding skin
What are 3 functions of type I collagen as a biological dressing?
- acts as a wound graft by providing a lattice for fibroblast and capillary bed migration
- assists in hemostasis
- some absorption
What forms does type I collagen come in?
- particles
- suspension
- dressing
What is the function of porcine small intestinal submucosa?
reinforces wound tissue and is absorbed by the body as it is replaces by host tissue
- single/multi layer sheets
- sponge
- powder
- discs for corneal ulcers
How is porcine small intestinal submucosa extracted for biological dressings? What does it contain?
in a manner that removes all cells, but leaves the complex matric intact
- collagen I, III, V
- fibronectin
- decorin
- hyaluronic acid
- chondroitin sulphate A
- heparin sulfate
- growth factors
What are the 3 main indications for porcine small intestinal submucosa?
- degloving injuries and other large skin defects containing healthy tissue
- use until definitive reconstruction
- dermal substitute to guide wound repair in reparative stage of wound healing
How does porcise small intestinal submucosa dressings guide wound repair?
inhibits wound contraction, allowing epithelialization to predominate
- can take longer than second intention healing
How are porcine submucosa dressings applied?
- rough side in contact with the wound
- suture into wound bed and under wound edge to enhance epithelial cell migration
What are 2 uses of porous non/low adherent dressings?
- protects sutured wounds
- wounds in reparative stages with healthy granulation tissue
What are the 3 types of non-adherent bandages?
- NONOCCLUSIVE - Adaptic
- SEMI-OCCLUSIVE - Telfa, DuoDerm
- OCCLUSIVE - Biodres, Ulcer Dressing
What are 2 functions of non-occlusive bandages? When is it indicated?
- permits gas exchange without retention of moisture
- acts as a microbial barrier
partial thickness wounds in the repair stage
What are 2 functions of semi-occlusive bandages? When is it indicated?
- retains moisture to prevent wound dehydration
- permits excess fluid to be absorbed
acute wounds in repair stage
What are 2 functions of occlusive bandages? When are they indicated?
- retains complete moisture to prevent wound dehydration and variable gas exchange
- microbial barrier
wounds in the repair stage
What is the secondary layer? What material is commonly used?
the layer overlying the contact layer that absorbs exudate and acts as a splint to provide some support
cast padding, rolled cotton
What are 3 functions to the tertiary layer? What materials are used?
- secures bandage layers in place
- porous material allows for evaporation of moisture
- pressure applied can help control hemorrhage
rolled gauze and porous/elastic tape
What is primary closure? In what 2 situations is this done?
closure of a wound soon after injury
- minimal contamination
- minimal trauma
What is delayed primary closure?
closure after local infection or heavy contamination is controlled or debrided, usually within 2-3 days
What is secondary closure?
closure after a granulation bed has formed with heavy infection management, usually >5 days after injury
What is second intention healing? What are 2 indications? What precaution should be noted?
healing by contraction and epithelialization
- large defects with heavy tissue damage
- serious infection present
may result in abnormalities requiring additional surgery
When is topical wound medication recommended? How do most of them work?
slow healing or nonhealing wounds
modulating macrophage functions
What antimicrobials are commonly used for topical wound therapy?
- Bacitracin/Neomycin/Polymyxin (triple antibiotic) ointment
- povidone-iodine ointment
- chlorhexidine ointment
- Nitrofurazone
- silver Sulfadiazine
Why is the use of triple antibiotic ointment controversial? What is its indication?
- may slow down epithelialization
- benefits may be due to the vehicle
- must be handled aseptically and in limited amounts
superficial wounds or skin graft dressings
What is the indication for povidone-iodine and chlorhexidine ointment use?
control of superficial wound infections
(can slow down epithelialization!)
What effect do nitrofurazone and silver sulfadiazine have? What added effect does silver sulfadiazine have?
both broad spectrum and very effective in decreasing bacterial counts, especially in burn patients
enhances epithelialization
What are 2 common healing enhancers used for topical therapy?
- zinc oxide ointment
- type I collagen
What are 4 functions of zinc oxide ointment?
- soothing
- promotes healing of abraded skin
- enhances epithelialization
- protects against dehydration
What 3 functions does honey have for wounds?
- hygroscopic - osmotically draws out moisture
- promotes granulation tissue formation
- antibacterial/antifungal - decreases pH
What are 4 functions of sugar used for wound management?
- primary antibacterial effect due to osmolality
- cleans and reduced edema
- promotes granulation tissue formation
- attracts macrophages
What 3 properties make aloe vera good for wound management? In what wounds are they used? What can it be combined with?
- antibacterial
- antiprostaglandin
- antithromboxane
partial thickness wound, manages eschar
silver sulfadiazine for burn management
What is Acemannan? What are 3 functions?
complex mannose-containing polymer derived from aloe vera
- stimulates macrophages, resulting in IL-2 and TNF-a secretion
- IL-1 = enhances fibroblast proliferation, collagen deposition, neovascularization, and epidermal growth and motility
- TNF-a = induces angiogenesis
Wound dressings:
What is critical to wound healing?
continuous and efficient evaculation of exudate
What is passive drainage? When is it used? What are 2 pros?
drainage by overflow or gravity, using Penrose, cigarette, and sump drains
wounds with dead space, heavy contamination, and infection
cost-effective and easy to apply
What is correct with these drain placements?
- places perpendicular to primary incision (parallel = dehiscence
- hole larger than drain to allow fluid to drain around it
- tacked above and below to avoid loss under the skin
What is wrong with these drain placements?
- drain coming out of primary incision, long and untacked, touching hair
- drain coming out of primary incision, exit not gravity-dependent, touching hair, not tacked down
What is active drainage? What are 3 advantages? Disadvantage?
discharge is removed by negative pressure applied through a closed suction drain
minimizes dressing moisture, bacterial contamination, and drainage time
expensive!
