WOUNDS AND DRESSINGS Definition Skin Anatomy Wound healing Primary intention,Secondary intention,Tertiary intention Non healing ulcers / chronic ulcers Causes for non-healing ulcers Treatment for chronic ulcers Wound dressings When to change dressings Things to Avoid in chronic wounds

1. WOUNDS AND DRESSINGS
Dr Joel Arudchelvam
MBBS (COL), MD (SUR). MRCS (ENG)
ConsultantVascular andTransplant Surgeon

2. Wound /Ulcer / abrasion
 A full thickness breach in the continuity of the
skin
 Partial thickness - Abrasion

3. Skin Anatomy

4. Wound healing
 4 stages
 Haematoma formation
 Inflammation/ debridment
 Proliferation /granulation formation
 Remodelling / maturation

5. Phases overlap

6. Wound healing
 Primary intention
 Secondary intention
 Tertiary intention
 Delayed closure

7. Primary IntentionPrimary intention
Healing of a clean wound approximated by sutures
Small scar

8. Healing by second intention
Healing of extensive wound with granulation tissue
formation andscarring.

9. Wounds / ulcers not showing signs of healing
after 6 weeks.
Non healing ulcers / chronic
ulcers
 Ulcers not showing signs of healing by 6
weeks are called chronic ulcers.

10. Causes for non-healing ulcers
1. Local causes
2. Regional causes
3. Systemic causes

11. Causes for non-healing ulcers
1. Local causes
-Repeated trauma
-Presence of foreign body / slough
-ongoing infection / osteomyelitis
l

12. Causes for non-healing ulcers
2. Regional causes
-Venous
-Arterial
-Neuropathic

13. Causes for non-healing ulcers
3. Systemic causes
- Diseases- diabetes mellitus, CKD,
etc.
- Drugs- immunosuppressive,
cytotoxic
- Nutritional deficiencies- hypo-
albuminaemia, anaemia, vitamin
and mineral deficiencies

14. Differentiating Arterial, Venous and Neuropathic
Ulcers

15. Differentiating Arterial, Venous and Neuropathic Ulcers

16. Treatment for chronic ulcers
 Local
 Regional
 Systemic

17. Treatment for chronic ulcers
 Local
 Wound toilet
o Process of removal of slough, dead tissue,
foreign bodies and draining pus.
o Following a wound toilet the wound base is
made suitable for future granulation and
epithelialisation.

18. Treatment for chronic ulcers
 Regional causes
 Arterial- revascularization

19. Treatment for chronic ulcers
 Regional causes
 Venous - Strapping
 i.e. multilayer compression

20. Treatment for chronic ulcers
 Regional causes
 Neuropathic- off loading

21. Treatment for chronic ulcers
 Systemic causes
 Correct anaemia, vitamin deficiency and other
nutritional deficiencies.
 Optimization of underlying comorbidities.
 Role of antibiotics in wound - indicated only in
patients with evidence of local or systemic
infection.

22. Wound dressings
 The material which is applied to the surface
of the wound to cover it is called a dressing.
 1ry – dressing which touches the wound
 2ry – dressing used to cover the primary dressing

23. Ideal wound dressing
Dressings are applied to wounds for the following
reasons;
 To provide a protective cover
 To maintain moisture
 To reduce pain
 To absorb exudates
In addition an ideal dressing have the following features;
 does not induce pain or itching
 easy to change
 Allows gaseous exchange
 Cheap
 Freely available

24. Types of Wound Dressings
 Gauze dressings
 Tulle
 Hydrocolloid dressings
 Hydrogel dressings
 Alginate dressings
 Foam dressings
 Transparent film dressings
 Etc.

25. Gauze
 Cheap
 Freely available
 Dry
 Painful on removing
 Damages epithelium

26. Tulle
 Cheap
 Freely available
 Easy removal
 E.g :Vaseline

27. Hydrocolloid Dressings

28. Hydrocolloid Dressings
 Made up of pectin based material
 Absorb exudate
 Occlusive – should not be used on infected
wounds
 Come in various shapes and sizes

29. Hydrogel Dressings

30. Hydrogel Dressings
 Made up of primarily water in a polymer to
maintain moist wound base
 used in dry wounds
 Should not be used in exudating wounds

31. Foam Dressings

32. Foam Dressings
 Made up of polyurethane foam
 Absorbs moderate to large amounts of fluid
 Available in various sizes and shapes
 Some types my macerate peri wound skin if it
allows drainage laterally

33. Silver Dressings
 Antimicrobial to reduce bio burden of wound
through slow release of silver ion into the
wound
 e.g.Acticoat, Biatin Ag, Atruman Ag

34. Vacuum assisted closure VAC

35. Vacuum assisted closure VAC

36. Vacuum assisted closure VAC
 Macrostrain - visible stretch that occurs when negative
pressure contracts the foam.
 Draws wound edges together
 Removes exudate and infectious materials
 Microstrain - micro deformation at the cellular level
 Reduces edema
 Promotes granulation - facilitates cell migration and
proliferation

37. Vacuum assisted closure VAC
 Indications for use
 Large wounds
 Cavities
 Large amount of exudate

38. Summary
Wound type Dressing
Dry Hydrocolloid, Hydrogel
Exudating wound Hydrocolloid, foam
Slough Hydrocolloid, hydrogels
Dead space / cavity Foam,VAC

39. When to change dressings
 When there is an indication to change
 Soaking
 Pain
 Need to inspect
 Discuss with doctor before changing

40. Avoid in chronic wounds
 Iodine (Betadine)
 Hydrogen peroxide
 Other toxic agents

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

42. ThankYou