WOUND TREATMENT

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By: nisy1972 (115 month(s) ago)

very useful presentation.please mail me wound treatment ppt.i shall be highly obliged.my mail address ([email protected])

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Treatment of Wounds:

Treatment of Wounds BINIAM EWNTE C-II JIMMA UNIVERSTY

principles:

principles

Principles ….:

TAT Anesthesize: lidocaine/ bupivacaine with epinephrine Epinephrine not used for ear, nose, finger, toe, penis, Irrigation Visualize wound area Remove foreign material With normal saline H 2 O 2 ,I 2 .povidone I 2 not applied directly on wound bed Principles ….

Principles ….:

Evacuate hematomas Control bleeding with ligature or cautery Resect/ revascularize marginally viable tissue or skin Principles ….

Antibiotics:

Should be used only when there is an obvious wound infection. S n Local General rubor (erythema) fever tumor (swelling) rigor calor (warmth) leucocytosis dolor (pain) LAP Indiscriminate use multidrug resistant bacteria. based on organisms suspected to be found within the infected wound and the patient's overall immune status topically as part of irrigations or dressings??? Antibiotics

Slide 6:

The main purpose of wound dressings is to provide the ideal environment for wound healing. The dressing should facilitate the major changes taking place during healing to produce an optimally healed wound. Desired Characteristics of Wound Dressings to - Promote wound healing (maintain moist environment) -Conformability -Pain control -Odor control -Nonallergenic and nonirritating -Permeability to gas Safety -Nontraumatic removal -Cost-effectiveness -Convenience Dressings

Slide 7:

Dressings…. Covering a wound with a dressing mimics the barrier role of epithelium and prevents further damage. Application of compression provides hemostasis and limits edema. Occlusion of a wound with dressing material helps healing by controlling the level of hydration and oxygen tension within the wound. It also allows transfer of gases and water vapor from the wound surface to the atmosphere. Occlusion affects both the dermis and epidermis, and it has been shown that exposed wounds are more inflamed and develop more necrosis than covered wounds.

Dressings…. :

Occlusion also helps in dermal collagen synthesis and epithelial cell migration and limits tissue desiccation. As it may enhance bacterial growth, occlusion is contraindicated in infected and highly exudative wounds. Dressings can be classified as primary or secondary. A primary dressing is placed directly on the wound and may provide absorption of fluids and prevent desiccation, infection, and adhesion of a secondary dressing. A secondary dressing is one that is placed on the primary dressing for further protection, absorption, compression and occlusion Dressings….

Slide 9:

Dressings… For Incisional wounds, dressings optimally include several layers with different functions. 1. The layer immediately adjacent to the wound must be sterile and non adhering and should not be occlusive. A fine meshed gauze impregnated with a hydrophilic substance meets these demands. 2. The layer over the contact layer should be absorptive and should wick exudates or transudate away from the wound surface. Wide meshed gauze facilitates this capillary action and drainage. Such absorptive layers must not become saturated which will then collect on the wound surface and cause maceration. 3. The outermost layer of the dressing is the binding layer that fixes the dressing in place. Tape is commonly used, though wraps are used in extremities.

Slide 10:

Dressings… The type of dressing to be used depends on the amount of wound drainage. A non draining wound can be covered with a semi occlusive dressing. -Drainage of less than 1 to 2 mL/d may require a semiocclusive or absorbent non adherent dressing. -Moderately draining wounds (3 to 5 mL/d) can be dressed with a nonadherent primary layer plus an absorbent secondary layer plus an occlusive dressing to protect normal tissue. -Heavily draining wounds (>5 mL/d) require a similar dressing to moderately draining wounds, but with the addition of a highly absorbent secondary layer

Slide 11:

Absorbent Dressings Accumulation of wound fluid can lead to maceration and bacterial overgrowth. The Dressing should absorb without getting soaked through, as this would permit bacteria from the outside to enter the wound. The dressing must be designed to match the exudative properties of the wound and may include cotton, wool, and sponge.

Slide 12:

Non adherent Dressings Non adherent dressings are impregnated with paraffin, petroleum jelly, or water-soluble jelly for use as non adherent coverage. A secondary dressing must be placed on top to seal the edges and prevent desiccation and infection. Occlusive and Semiocclusive Dressings Occlusive and semiocclusive dressings provide a good environment for clean, minimally exudative wounds. These film dressings are waterproof and impervious to microbes, but permeable to water vapor and oxygen.

Slide 13:

Hydrophilic and Hydrophobic Dressings Hydrophilic and hydrophobic dressings are components of a composite dressing. Hydrophilic dressing aids in absorption, whereas a hydrophobic dressing is waterproof and prevents absorption. Hydrocolloid and Hydrogel Dressings Attempt to combine the benefits of occlusion and absorbency. Form complex structures with water, and fluid absorption occurs with particle swelling, which aids in atraumatic removal of the dressing. Absorption of exudates by the hydrocolloid dressing leaves a yellowish-brown gelatinous mass after dressing removal that can be washed off. Hydrogel is a cross-linked polymer that has high water content. Hydrogels allow a high rate of evaporation without compromising wound hydration, which makes them useful in burn treatment .

Slide 18:

Absorbable Materials Are mainly used within wounds as hemostats and include collagen, gelatin, oxidized cellulose, and oxidized regenerated cellulose Medicated Dressings Used as a drug-delivery system. Agents include benzoyl peroxide, zinc oxide, neomycin, and bacitracin -zinc. These agents have been shown to increase epithelialization by 28%.

Slide 19:

Mechanical Devices Augments and improves on certain functions of dressings, in particular the absorption of exudates and control of odor. The vacuum-assisted closure system assists in wound closure by applying localized negative pressure to the surface and margins of the wound. The negative pressure therapy is applied to a special foam dressing cut to the dimensions of the wound and positioned in the wound cavity or over a flap or graft. This form of therapy has been found to be effective for chronic open wounds (diabetic ulcers and stages 3 and 4 pressure ulcers), acute and traumatic wounds, flaps and grafts.

Closure :

Timing of closure: primary if the closure occurs soon (hours) after it has occurred Delayed primary closure occurs within a week of the wound occurring. Secondary closure is repair at any time after that Closure

Closure of Tidy Wounds::

Tidy wounds should be closed primarily All damaged structures should be repaired Sutures are to oppose NOT necrose Use monofilament materials Closure of Tidy Wounds:

Closure of Untidy Wounds:

Only close primarily if can be converted to a tidy wound Copious Levage “Dilution is the solution to pollution ” If in doubt, don’t close Closure of Untidy Wounds

Types of wound closure:

Primary closure Approximation of acutely disrupted tissue with sutures, staples or tape Types of wound closure Delayed primary closure Approximation of wound margin delayed for several days Prevents wound infection in cases of contamination/foreign bodies/tissue trauma Less bacterial colonization in open wound Normal healing progress occurs Secondary wound closure Open wound margins approximate by biologic contraction

Closure…:

Use the smallest suture required minimize suture related inflammation Suture/staple removal Face 3-5 days Non-tension areas 7-10 days Tension areas 10-14 days Non absorbable/slowly absorbable  for deep facial layers Sub cutaneuos braided absorbable: care not to put in fat Closure…

Skin Replacements :

Conventional Skin Grafts : Skin grafts have long been used to treat both acute and chronic wounds. Split- or partial-thickness grafts consist of the epidermis plus part of the dermis, whereas full-thickness grafts retain the entire epidermis and dermis. Split-thickness grafts require less blood supply to restore skin function. The dermal component of full-thickness grafts lends mechanical strength and resists wound contraction better, resulting in improved cosmesis Skin Replacements

Skin Replacements… :

Skin Substitutes Manufactured by tissue engineering, they combine novel materials with living cells to provide functional skin substitutes, providing a bridge between dressings and skin grafts. Have advantages of being readily available, not requiring painful harvest, and they may be applied freely or with surgical suturing. They promote healing, either by stimulating host cytokine generation or by providing cells that may also produce growth factors locally. Disadvantages include limited survival, high cost, and the need for multiple applications . Allografting , albeit with a very thin graft, may at times be required to accomplish complete coverage. Skin Replacements…

Skin Replacements…:

Skin Substitutes The acellular (e.g., native collagen or synthetic material) component acts as a scaffold, promotes cell migration and growth, and activates tissue regeneration and remodeling. The cellular elements re-establish lost tissue and associated function, synthesize extracellular matrix components, produce essential mediators such as cytokines and growth factors, and promote proliferation and migration. Bioengineered skin substitutes have evolved from keratinocyte monolayers to dermal equivalents to split-thickness products with a pseudoepidermis and, most recently, to products containing both epidermal and dermal components that resemble the three-dimensional structure and function of normal skin . Skin Replacements…

Skin Replacements:

Growth Factor Therapy Growth factors for clinical use may be either recombinant or homologous/ autologous . Autologous growth factors are harvested from the patient's own platelets, yielding an unpredictable combination and concentration of factors, which are then applied to the wound. Recombinant molecular biologic means permit the purification of high concentrations of individual growth factors. At present, only platelet-derived growth factor BB (PDGF-BB) is currently approved by the Food and Drug Administration for treatment of diabetic foot ulcers. A great deal more needs to be discovered about the concentration, temporal release, and receptor cell population before growth factor therapy is to make a consistent impact on wound healing. Skin Replacements

Complications of wound healing::

Infection seromas Pigmentation Deficient scar formation Incisional hernia Hypertrophied scars and keloid formation Extensive contraction Neoplasia Hematomas Wound dehiscence Soft tissue necrosis Complications of wound healing:

Complications…:

Seroma :collection of serous exudates in hollow space within wounds due to irritation in the wound region: Smaller aspirated with syringe Wound opened &explored for larger ones Could get infected treated as abscess Complications…

Complications…:

Wound dehiscence : parts of the wound surfaces don’t adhere & become bound by connective tissue despite apposing sutures After laparatomy : complete  all layers affected incomplete intact peritoneum occult  skin suture closed Sx serosaginous secretion increase in wound pain paralytic ileus evaceration Complications…

Complications…:

Hypertrophic scars and kelloids Excessive healing processes- increase in net collagen synthesis raised thickened scar Keloid- Extension beyond wound margin, familial, may develop up to 1 year, rarely subside , black race Hypertrophic scar- Confined to wound margin, light skinned, early after injury, may subside, cause contractures Tx - excision, steroid injection, pressure garments, radiation tx Complications…

Slide 35:

“C.L.E.A.N.S.E.D” Contaminants out Levage Evacuate hematoma and obtain hemostasis Abc & anti tetanus cover Necrotic tissue removed Skin cover Easy closure without tension Drains and dead space obliteration

Slide 36:

Remember Treat the WHOLE patient and not just the HOLE in the patient

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THANK YOU

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