Wound management Flashcards
In wound healing, when does the inflammatory phase occur?
Days 0-5
Outline the inflammatory phase of wound healing
- Initiates inflammation of tissue
- Haemorrhage followed by haemostasis
- Produces heat, redness, swelling, pain
- Localised vasodilation, oedema and serous-type ooze
When does the debridement phase of wound healing occur?
From day 0
Outline the debridement phase of wound healing
- Migration of leukocytes
- Phagocytosis removing and destroying bacteria
- Cellular debris removed
When does the proliferative phase of wound healing occur?
Day 3 up to 4 weeks
Outline the proliferative phase of wound healing
- Repair of damaged tissues
- formation of a repair framework and granulation tissue
- Wound contraction and epithelialisation
When does the remodelling phase occur in wound healing?
Day 20 to years
Outline the remodelling phase of wound healing
- Repaired tissue is replaced by collagen
- Wound continues to contract
- Tissue regains some elasticity and protective barrier function
Discuss the rate of epithelialisation of a superficial wound in relation to the presence of a scab
Much slower to epithelialise when covered normally by a dry scab is present
What are the ideal properties of a dressing to promote granulation tissue formation?
- Non-restrictive
- Non-adherent
- Sterile
- Provides moist environment
Outline the desirable properties of a dressing in the case of chronic granulation tissue
Something that actively debrides the tissue and helps re-stimulate growth of healthy granulation tissue
List the broad types of wound dressing
- Adherent
- Non-adherent
- Absorbent
- Active
- Antimicrobial
What is the primary function of adherent/debridement wound dressings?
Control wound infection and debride infected/neccrotic wounds
Give examples of adherent/debridement dressings
- Wet-to-dry, dry-to-dry
- Saline soaked or dry sterile gauze applied directly on wound’s surface
Outline the management of adherent/debridement dressings
- Change at least every 24hours
- Should peel away necrotic tissue/debris
- Fresh granulation tissue handled carefully to avoid compromising the progression of the wound
- May need analgesia/sedation as removal can be painful
Give examples of non-adherent wound dressings
- Perforated polyurethane membranes
- Paraffin gauzes
- Vapour permeable films
Give examples of perforated polyurethane membrane dressings
- Melolin
- Primapore
What are the indications for use of a perforated polyurethane membrane dressing?
Post operative wound where the incision site and sutures require protection throughout the immediate post-op period
Explain the contraindications for use of a perforated polyurethane membrane dressing
Should not be used in granulating wounds as they lack the ability to provide the ideal healing environment for the granulation process, may disrupt healing on removal
What are paraffin gauze dressings?
Dressings comprising a thin, cotton netting impregnated with soft paraffin
Briefly describe the use of paraffin gauze dressings
- Applied as primary layer over open wound
- Should have secondary layer over gauze to act as absorbent layer and draw exudate away from wound
Explain the function of paraffin gauze dressings
Prevent dressing stickig to the wound and to support healing under moist and aseptic conditions
What wounds is the use of paraffin gauze dressings most suited to?
Skin wounds, burns, skin graft sites, traumatic injuries where skin loss is evident
Give example of vapour permeable film dressings
Opsite Flexigrid
What is the main function of vapour permeable film dressings?
Promote moist wound healing and provide protective barrier, allows for vapour exchange at wound surface while maintaining moist environment
Briefly describe the use of a vapour permeable film dressing
The thin membrane of the dressing should be stretched over the wound, with the edges sticking to the skin surface (can be tricky to apply)
What wounds are vapour permeable films suited to?
Small or shallow wounds producing little exudate only, as this becomes trapped underneath the dressing
What is the primary function of absorbent dressings?
Provide absorbent layer for wounds producing high volumes of exudate, such as large, extensive wounds undergoing the granulation process
Give examples of absorbent dressings
- Foams e.g. Allevyn, Tielle
- Super-absorbent dressings e.g. Eclypse
Explain the use and properties of foam dressings
- Absorb wound exudates while maintaining a moist environment suitable for granulation and epithelialisation to take place
- Outer layer of dressing prevents strike through
- Can absorb up to 10x their own weight
- Protective barrier over wound
- No debriding properties
Explain the use and properties of super-absorbent wound dressings
- Used for wounds experiencing large volumes of exudates and moisture management may be proving tricky
- Contain polyacrylate polymers which have hydroactive properties so can hold and retain large volumes of fluid
What is the function of active dressings?
Gently debride the wound’s surface, provide moist wound environment, encourage wound granulation
Give examples of active dressings
- Hydrocolloids e.g. Granuflex, Tegasorb
- Hydrogels e.g. Intrasite Gel and Nugel
Outline the properties of hydrocolloid wound dressings
- Microgranular layer of natural or synthetic polymers within adhesive polymer matrix
- Usually semipermeable outer membrane and have antioxidant property by releasing small quantities of hydrogen peroxide
- Absorb and hold wound exudates, pressure exerted on wound bed
Give examples of the polymers found in hydrocolloid dressings
- Gelatin
- Pectin
- Carboxymethylcellulose
What is the benefit of the hydrogen peroxide released by hydrocolloid dressings?
Assists in minimising cellular metabolism and proliferation
Which types of wounds are suited to use of a hydrocolloid dressing?
Chronic granulation tissue or necrotic tissue
Which types of wounds are hydrocolloid dressings unsuitable for?
Care in presence of infection, therefore unsuitable for early stages of wound debridement
Outline the care required when using a hydrocolloid dressing
- Need to monitor closely for healthy granulation tissue to establish how it is reacting to these dressings
- Wound may become enlarged slightly due to debridement properties
Describe the use of hydrogel dressings
When applied to the wound, should be covered with a semi-permeable adhesive layer to maintain a moist environment
Outline the advantages of hydrogel dressings
- Debriding action of hydrogels is atraumatic compared to wet-to-dry or surgical debridement (less pain on application and removal)
- Encourages formation of granulation tissue
- Application provides analgesia
- Debriding action means they can be used in infected wounds and actively assist in removal of bacteria and debris
Give examples of antimicrobial wound dressings
- Silver dressings
- Manuka honey
- Polyhexamethylene biguanide PHMB)
What types of wounds are well suited to the application of silver dressings?
- Chronic infeciton
- Delayed healing
- Large open wounds at risk of colonisation
How should silver dressings be used?
Use with suitable secondary layer to absorb wound’s exudates
Briefly characterise the antimicrobial activity of silver dressings
Powerful broad-spec antimicrobial with goof activity against Staphlococcus and Pseudomonas spp.
Briefly characterise antimicrobial the activity of manuka honey as a wound dressing
Topical, broad spec antimicrobial effects including against resistant strains of bacteria
Outline the properties of manuka honey dressings
- Antimicrobial
- Wound debridement
- Anti-inflammatory
- Optimal moist environment
Which wounds are best suited to use of manuka honey?
- Dirty, sloughing, necrotic wounds that require debridement and infection management
- Abscesses, bite/puncture wounds and other grossly contaminated wounds
Briefly describe the use of manuka honey dressings
- Appropriate preparation and lavage of wound first
- Secondary sterile dressing placed on top to allow absorption of exudates
When is the use of manuka honey contraindicated and why?
- Arterial or actively bleeding wounds, as it may encourage further haemorrhage
- Or if patient has a known anaphylactic response to bee venom
Characterise and explain the antimicrobial properties of polyhexamethyl biguanide (PHMB) dressings
- Antiseptic mode of action and effective against broad spectrum of bacteria
- PHMB molecules insert into bacterial membrane, destroy bacterial integrity, rupture cell membrane
What are the advantages of PHMB wound dressings?
- Reduces wound associated pain
- Increases formation of granulation tissue
- Assists in removal of non-viable tissue
