wound dressing, chronic wound, types, examples, what to avoid when dressing, wound care workshop, teaching hospital jaffna

1. Dressings for Chronic wounds
Dr. Joel Arudchelvam
Consultant Vascular and Transplant Surgeon

2. Dressings for Chronic wounds
• Definition of chronic wound / dressing
• Types of dressings
• Summary of use of various dressings
• When to change
• What not to do

3. Chronic ( non healing ) ulcer /
wound
• Wounds / ulcers not showing signs of healing
after 6 weeks.

4. Wound dressings
• The material which is applied to the surface of
the wound to cover
•
– 1ry – dressing which touches the wound
– 2ry – dressing used to cover the primary dressing

5. Ideal wound dressing
Dressings are applied to wounds for
• To provide a protective cover
• To maintain moisture
• To absorb exudates
In addition an ideal dressing
• Does not induce pain or itching
• Easy to change
• Allows gaseous exchange
• Cheap
• Freely available

6. Types of Wound Dressings
• Gauze
• Tulle
• Hydrocolloid
• Hydrogel
• Alginate
• Foam
• Transparent film
• Etc.

7. Gauze
• Cheap
• Freely available
• Dry
• Painful on removing
• Damages epithelium

8. Tulle
• Cheap
• Freely available
• Easy removal
– E.g : Vaseline

9. Hydrocolloid Dressings
• Made up of pectin based material
• Absorb exudate
• Come in various shapes and sizes

10. Hydrogel Dressings
• Made up of water in a polymer
• Used in dry wounds

11. Alginate Dressings
• Made from seaweed
• Absorb moderate amounts of drainage
• becomes a gel when it comes into contact with
wound fluid

12. Foam Dressings
• Made up of polyurethane foam
• Absorbs large amounts of fluid
• Available in various sizes and shapes

13. Silver Dressings
• Reduce bio burden - through slow release of
silver ion into the wound
• e.g. Acticoat, Biatin Ag, Atruman Ag

14. Vacuum Assisted Closure VAC

15. Vacuum Assisted Closure VAC
• Mechanisms of action
– Macro strain
– Micro strain
• Macrostrain - visible contraction which
occurs when negative pressure is
applied.
– Draws wound edges together
– Provides direct and complete wound
bed contact
– Removes exudate

16. Vacuum Assisted Closure VAC
• Microstrain - micro deformation
at the cellular level
– Reduces edema
– Promotes granulation tissue
formation by facilitating cell
migration and proliferation

17. • Indications for use
– Large wounds
– Cavities
– Large amount of exudate
Vacuum Assisted Closure VAC

18. Summary
Wound with slough , dead tissue –
needs wound toilet.
Wound type Dressing
Dry Hydrocolloid, Hydrogel
Exudating wound Hydrocolloid, foam
Dead space / cavity Alginate, foam, VAC
Gauze, tulle and gel Most wounds

19. When to change dressings
• When there is an indication to change
– Soaking / smelling
– Need to inspect – pain , swelling , fever, ect.
• Discuss with doctor before changing

20. Avoid in chronic wounds
• Iodine (Betadine)
• Hydrogen peroxide
• Other toxic agents

21. Avoid
• Do not tie gauze bandage tightly around
limbs, digits – causes ischaemia
• Use – plaster , crepe instead

22. Thank You