Wounds 4

Question 1

Necrotic wounds

Answer 1

• Must remove dead tissue to expose health tissue
• Reduce risks of: 
– Infection
– General sepsis
– Failure to heal
– Failure to reduce in size
• Necrotic wounds require debridement

Question 2

Necrotic wound debridement: Autolytic debridement

Answer 2

Autolytic debridement
• Utilises bodies own enzymes to break down dead tissue
• Will not break down healthy tissue
• Need occlusive dressing to retain moisture
• Dressings:
– Hydrogels (ideal)
– Hydrocolloids (use thin)
– Alginates (only in very wet sloughy wounds)

• Slow process

Question 3

Necrotic wound debridement: Sharp debridement

Answer 3

Sharp debridement
• Selective removal of dead tissue
• Conservative
– Bedside using scissors or scalpel
– Should be painless but LA may be used
• Surgical
– Requires general anaesthetic
– Removes both dead and healthy tissue
– Painful
– Often more than one visit to theatre required

Question 4

Necrotic wound debridement: Biosurgical debridement

Answer 4

Biosurgical debridement
• Sterilelarvae
• Lucilia sericata (green bottle larvae)
• “Free range” maggots (contained in a net!) 
– Secrete proteolytic enzymes
– Break down dead tissue for ingestion
– pH of wound changed promoting healing
– Destroy bacteria
• Only destroy necrotic tissue

Question 5

Granulating wounds

Answer 5

• Dressing choice depends on depth of wound and exudate level
• Exudate produced by body to maintain moist healing environment
• Exudate =
– Serum (without blood cells)
– High in protein
– Nutrients
– Inflammatory components
• Exuding wounds classified as light, medium or high exudate

Question 6

Granulating wounds classifications

Answer 6

• None–light exudate
– Foams
– Hydrogels

• Medium–heavy
– Alginates
– Hydrocolloids
– Foams

• Light–medium exudate 
– Foams
– Alginate
– Thin hydrocolloids
 – Hydrogels

• Heavy
– Alginate
– Hydrocolloids
– Foams

Question 7

Epithelialising wounds

Answer 7

• Choice depends upon level of exudate 
– Hydrocolloid (not dry wound)
– Alginate (not dry wound) 
– Hydrogel
– Foam (not dry wound)
– Vapour permeable films 
– Low adherent dressing

Question 8

Points to remember

Answer 8

• Dressings should be left in place as long as possible
– Minimise trauma to healing wound
– Minimise pain of dressing changes
• Appropriate dressings should be considered at each dressing change
– Do not simply continue with what went before
• Wounds are often at different stages of healing in the same area
– Where possible one dressing to promote each stage should be used
– Need to avoid maceration
– Need to avoid over‐granulation (results in raised scars)
– Need to avoid tearing delicate, newly healed skin
• Difficult to assess cost‐effectiveness of dressings
• Not all dressings from each dressing type are interchangeable
• When packing cavity wounds, count any dressings in and then out!