Wound management
-
Upload
elaine-chin -
Category
Health & Medicine
-
view
86 -
download
7
description
Transcript of Wound management
WOUND MANAGEMENTDr Yap Gaik Chin
Wound Care TeamSurgical Department
Wound Management
Management of non healing wound is a complex process and requires a multidisciplinary approach
Starts from the first assessment upon inspection of patient by making a general assessment and further local assessment of the wound
Outline
Assessment ( General & local )
TIME – wound bed preparation
Wound cleansing
Types of debridement
Types of dressing
General assessment
Age Psychosocial health Complicating conditions
vascular problem, diabetic, smoking, immunosuppressive
Nutritional status Pain/Comfort Hygiene
Local /Wound Assessment
Wound etiology Pressure, trauma, shearing, friction
Size Wound edges Wound Bed
necrotic, granulation tissue, odour, exudate Surrounding skin ( colour, moisture)
Wound AppearanceThe Colour Model
In early 1980s, Lars Hellgrens, a Sweeden dermatologist was the first to claim that wounds could be categorised according to the colour of the wound surface
Red-Granulation Yellow-Slough Pink-Epithelialization Black-Necrotic
What is TIME?
Mnemonic for Principles of Wound Bed Preparation
What is wound bed preparation?
Management of wound to accelerate endogenous healing or facilitate the effectiveness of other therapeutic measures
TIME
T : Tissue Viability I : Inflammation, Infection M : Moisture Imbalance E : Epidermal Margin/ Edge of
Wound
Tissue Viability
Viable ( Granulation, Epithelialising) Non viable ( Necrotic, Sloughly, Eschar)
How does non viable tissue impede healing?
Prolongs inflammation Impedes epitheliazation Medium for bacteria growth
Goals of treating chronic wounds
Clear away dead or necrotic tissue Debridement
Always ensure adequate tissue oxygenation for angiogenesis and granulation process
Inflammation , Infection
The bacterial continuum What is infection? End spectrum of bacterial continuum ,
more infected than critically colonized wound
Assessing of wound infection1. Contamination2. Colonized 3. Critically colonized4. Infection ( Local, Systemic)
Clinical presentation
Classic Presentation of infection of local wound
1. Advancing erythema2. Fever3. Warmth4. Oedema/ Swelling5. Pain6. Purulence
Clinical Presentation
Secondary clinical presentation of local wound
1. Delayed healing2. Change in colour of wound bed3. Absent/abnormal granulation tissue4. ↑ or abnormal odour 5. ↑ drainage/exudate6. ↑ pain @ wound site
Moisture Balance
Too much moisture –impede wound healing
Cause Dessication / Maceration of skin Need to match exudate volume with
product absorbency for optimal moisture balance
Epidermal Margin/ Edge of wound
Non advancing wound edge
Also known as non healing wound
Undermining of edge is either critically colonised or infected
What if Epidermis Fails to advance?
Reconsider the principles of wound bed preparation and the acronym TIME,
1. Has necrotic tissue been debrided?2. Is there a well vascularised wound bed?3. Has infection been adequately
controlled?4. What is the status of inflammation or
infection in this patient?5. How well is moisture balance optimized?6. What dressings have been applied
before?
Wound Cleansing
Removing foreign debris & necrotic tissue
The process of removing inflammatory contaminants from the wound surface since necrotic tissue, excess exudate and foreign objects impede healing & ↑ the risk of infection
Routine cleansing ( Fluid irrigation, mild scrub)
Debridement
Reducing bioburden
Antibiotic should be used to reduce bacterial level within the wound
Selection of antibiotic is based upon proven efficiency against microorganisms obtained from culture.
Routine Wound Cleansing
Saline Octanisept Superoxide solution Water for irrigation PHMB with Betaine
Antiseptic Skin Cleansers
Antiseptics should not be used to clean wounds
Topical antiseptics:1. Betadine2. Povidone-Iodine3. Dakin’s Solution ( Eusol)4. Acetic Acid-> effective against
Pseudomonas A organisms5. Hydrogen Peroxide
What is scrubbing?
A method of high pressure irrigation which is a gentle mechanical action to loosen debris and necrotic tissue
Reasons for debridement
Wound healing is impaired due to prolong inflammation
Necrotic tissue –culture medium for bacteria
Amtibiotics do not reach the wound milieu
Dressings especially antimicrobial or silver do not reach wound bed
For staging of undetermined stage pressure ulcer
Methods of Debridement
Surgical Mechanical Autolytic Enzymatic Biological
Maggot Debridement Therapy( MDT)
Autolytic Debridement
Wound bed utilizes phagocytes and proteolytic enzymes to remove non viable tissueining a moist environment
This process can be promoted and enhanced by maintaining a moist environment
Surgical Debridement
Recommended for removal of thick, adherent eschar and devitalized tissue in large wounds
Not recommended in severely compromised patients
Analgesia / anaesthesia may be required
Enzymatic Debridement
The use of topically applied enzymatic agents to stimulate the breakdown of non viable tissue
Faster debridement process compared to autolytic
Eg: Honey, Prolase dressing
Mechanical Debridement
Used for decades where dressings are allowed to proceed from moist to dry
Manually removing the dressing causes a form of non selective debridement
Works best on wounds with moderate amounts of necrotic debris
Biological Debridement
Small maggots are introduced to a wound to consume necrotic tissue
Able to debride a wound within 1-2/7
The maggots derive nutrients through a process called ` extracorporeal digestion’
What is the purpose of dressings?
Protect wound from trauma or microbial contamination
Absorb drainage and debride wound Control & prevent haemorrhage
( pressure dressing) Reduce pain Maintain temperature and moisture of
wound Provide psychological comfort
Categories of dressings
Traditional Conventional
Leaves, herbs, Honey, Gauze
Advanced/ environmental dressingsI. more expensive II. Can be left in situ for several daysIII. Films, Alginates, Silver, Hydrogels,
Foams, Hydrocolloids, Charcoals
The Ideal Dressing
Safe and easy to use Remove excess exudate Provide thermal insulation Trauma protection Provide barrier to pathogens Allow gaseous exchange Water proof Non adherent Maintain moist wound healing
environment
Reference
The Compendium of Wound Care Dressings in Malaysia, Volume 2 , Harikrishna K.R Nair
THANK YOU