Wound dressing

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Sutures & Wound Dressings

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Wound Care and Management
 More than a million Americans suffer from non-healing
wounds annually, at a cost of $750 million;
 Etiology: trauma, inactivity, disease and surgery;
 3,852 wound care products on the market;
 Some classified as drugs or biologics, while others are
classified as devices;

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Wound Care Products
Goals:
 Bind surface epithelium and underlying connective
tissues when possible;
 Protect wound from infection;
 Maintain moist wound environment;
 Permit gas exchange; and,
 Promote rapid epithelialization.

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Principles of Wound Healing
 Hemostasis
 Inflammation
 Granulation Tissue
 Tissue remodeling or maturation

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Keys to Wound Care
 Identify the causative factors
 Improve the local environment

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Common Underlying Causes of
Wounds
 Trauma-accident or intentional (surgery)
 Scalds and burns (chemical and physical)
 Animal bites or insect stings
 Pressure (spinal injured)
 Vasculature related, arterial, venous, mixed
 Immunodeficiency
 Malignancy
 Connective tissue disorders
 Metablolic or endocrine disorders (diabetes)
 Nutritional deficiencies
 Psycho social
 Adverse effects of medications

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Timetable of Wound Healing
 Hemostasis immediate
 Inflammation 1-4 days
 Granulation Tissue 4-21 days
 Tissue remodeling 21 days-2 years
or maturation

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Treat
cause
Local
Wound
Care
Debride
Cleanse and
absorb-Bacterial
Management
Non-healing
Wounds
Biological agents
Chronic Wound diagnosis
Patient Centered
Concerns
Protect-Moist
Interactive
Healing

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Wound Color
Black. Necrotic tissue is non-viable, and it must be removed
before healing can take place.
Yellow. Yellow wounds may contain moist necrotic tissue
(slough) and/or contain purulent drainage. The primary objective
is to remove unhealthy tissue, any contaminants, debris and
excess exudate which deter the healing process. Once a clean,
moist and viable wound bed is achieved, healing can begin.
Red. Is good-the actively healing phase of a wound, cells
proliferate, fibroblasts form collagen and eventually small, red,
fleshy masses called granulation tissue (angiogenesis) begin to
form.

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History of Biomaterials in
Medicine
 Ancient cultures used primitive materials from their
natural surroundings to heal their wounds and to cure
diseases.
 The oldest known use of bandages -Sumeria (2100 BC).
 a medical manuscript written on stone tablets describes
detailed procedures of washing wounds, making plaster,
and bandaging.

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“Early Wound Dressing”
 Natural adhesive bandages
were used 4,000 years ago by
the Egyptians.
 In the Edwin Smith papyrus,
Egyptians wrote of using
woven bandages soaked in a
quick setting plasters used as
adhesive tapes were
discussed in the manuscript.
 The oldest bandages that
have been found were in the
tombs of the Pharaohs.

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Sutures
 Used as the means of
repairing damaged
tissues, cut vessels, and
surgical incisions-
 Initially a variety of
natural materials were
used: flax, hair, linen
strips, pig bristles,
grasses, mandibles of
pincher ants, cotton, silk,
and the gut of an animal

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Sutures
 The largest group of devices implanted in humans;
 By definition, a suture is a filament that either
approximates or maintains tissues in juxtaposition until
the natural healing process has provided a sufficient
level of wound strength or compresses blood vessels in
order to stop bleeding;
 Classified into one of two groups, absorbable and
nonabsorbable;

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Commercially Available
Sutures
 cellulose based (cotton)
 protein-cellulose (silk)
 processed collagen
(catgut)
 nylon
 Polypropylene
 Aramid
 Alha-hydroxy acids
 polyglycologic acid
 polyglycolide-lactide
polymer
 polytetraflourethylene
 Stainless steel
 aluminum alloys

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Test Specifcation for Sutures
 breaking strength
 elongation-to-break
 Young's modulus
 knot security
 viscoelastic properties
 tissue reaction
 cellular response
 cellular enzyme activity
 suture metabolism
 chronic toxicity
 teratologics
 mutagenicity
 carcinogenicity
 allergenicity
 Immunigenicity

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Suture Size

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Staples
 Thin metal used to
approximate the edges of the
skin (area must be
anesthetized);
 Staple appliers push the two
prongs of the staple down
through the epidermis and
dermis into the subdermal
layer and then bend these
prongs inward;
 Once these prongs have
been bent inwards, the
positions of the skin edges
are fixed;
 The major advantages are
speed of closure and less
scarring.
 Indicated on scalp and
abdomen (tendons, nerves
deep)

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Stapling a Craniotomy Skin
Incision

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Staples

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Staple Considerations
 If the edges are not lined
up flush, misalignment
will be maintained during
the healing process and
may impede the
formation a skin layer
across the skin surface or
result in excessive scar
tissue formation.

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Removal
• removed by
your health care
provider 3 to 14
days after they
are put in.

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Materials Used for Hemostais
 Surgical cellulose is a
material that is comes in
thin sheets of interwoven
specially treated cellulose
that provides a matrix to
which platelets and
clotting factors can
adhere leading to
formation on the cellulose
of a dense clot which can
act as a patch over an
area of bleeding.

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Tissue Adhesive
 Indicated for the closure of topical skin incisions
including laparoscopic incisions, and trauma-induced
lacerations in areas of low skin tension that are simple,
thoroughly-cleansed, and have easily approximated skin
edges.
 INDERMILTM Tissue Adhesive Receives FDA Approval
for Closure of Topical Skin Incisions and Lacerations
 Indermil may be used in conjunction with, but not in
place of, deep dermal stitches.

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Device Description
 Tissue adhesives are sterile, liquid topical
composed of n-Butyl or octyl-2-Cyanoacrylate
monomer supplied in a 0.5g single patient use,
plastic ampule.
 Each ampule is sealed within a foil packet so the
exterior of the ampule is also sterile.
 Remains liquid until exposed to water or water-
containing substances / tissue, after which it cures
(polymerizes) and forms a film that bonds to the
underlying surface.

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Traditional Wound Care
Products
Protective and gas permeable
 Transparent Films
 Foams
 Hydrocolloids or Hydrogels
 Alginates
 Specialty Absorptive Dressings

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Transparent Films
 Acu-derm
 Bioclusive
 Blisterfilm
 Polyskin II
 Pro-Clude
 Op-Site
 Opraflex
 Tegaderm
 Transeal
 Transite
 Uniflex
 Ventex

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Infection Control Products
-Dressings to Secure Catheters
 a thin, semi-occlusive,
transparent polyurethane
film dressing that
provides a bacterial/viral
barrier and helps secure
catheters, reducing
mechanical irritation.

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Transparent Films
 Advantages:
 Waterproof and Bacteria-proof
 Allows visualization of the wound.
 Won’t traumatize wound when removed.
 Disadvantages
 Not rec. for wound with moderate/heavy
exudate.
 Not rec. for wound with fragile surrounding
skin.
 Provides no cushioning to wound.

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Foams
 Examples
 Allevyn
 Cutinova Foam
 Epilock
 Flexzam
 Hydrasorb
 Lyofoam
 Mitraflex
 Nu-derm
 Polymem
 Tielle

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Foams-polyurethane pads
-Indications: Noninfected, draining granular
wound
 Advantages
 Non-adherent
 Won’t injure surrounding skin
 Can repel contaminants
 May be used under compression
 Cushions wound surface
 Maintains moist wound evironment
 Highly conforming
 Gas permeable

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Hydrocolloids
in pad,sheet or filler form for occlusive use.
Forms a “gel” as it absorbs water from the
wound bed that sits on wound
Indications: Small, solitary non-draining ulcers
or light-to-moderate exudate wounds
 Advantages
 Impermeable to bacteria and other
contaminants
 Promotes autolysis, angiogenesis, and
granulation
 Self-adhesive and molds well
 Limited-to-moderate absorption
 Creates moist environment
 May be left in place for up to 5 days
 May be worn in the shower

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Hydrocolloids
 AquaCel
 Comfeel
 Cutinova Hydra
 Duoderm
 Hydrapad
 Intrasite
 J&J Ulcer
Dressing
 Procol
 Replicare
 Restore
 Triad
 Ultec

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Hydrogels
-cross-linked hydrophilic matrix impregnated into gauze-
type pads which allows transmission of water, vapor and
CO2 but discourages dehydration.
Indications: full thickness wounds with moderate drainage
 Soothing and conforms to wound
 Fills in dead spaces
 Highly absorptive
 Can be used on infected wounds
 Disadvantages
 Difficult to keep in place
 Encourages gram negative organisms

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Hydrogels
 AquaSorb
 Carrington Gel
 Carrasyn-V
 Clear-Site
 Curasol Gel
 Flexderm
 Hydron
 Intrasite Gel
 Solosite
 SAF-Gel
 Transorb
 WounDres

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Adhesive Gel Sheets for Scar
Treatment
 Flexible, adhesive, semi-
occlusive silicone gel sheet.
 Reduces raised scars and
redness of the scar so it
fades and becomes less
noticeable.
 Self-adhesiveness and
durability mean that
application is simple and
the gel sheet can be
washed and used several
times.

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Resorbing Matrices
 Matrix is a primary dressing
which transforms into a soft,
conformable gel, allowing
contact with the entire wound
bed;
 Consists of 45% regenerating
cellulose and 55% type I
collagen

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Resorbing Matrices
 The persisting inflammatory
phase in chronic wounds
contributes to exudate with
high concentrations of matrix
metalloproteases (MMPs);
 Excess MMPs result in
degradation of extracellular
matrix proteins;
 Excess MMPs inactivate
growth factors;
 cellulose/collagen combination
binds more MMPs than ORC
or collagen alone

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Apligraf®
human skin-like products comprised of living human skin cells
Organogenesis

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Living Skin Equivalents
 Living bi-layered skin substitutes
 Apligraf (formerly Graftskin)
 Type I bovine collagen, extracted and purified from bovine
tendons, and viable allogenic human fibroblast and
keratinocyte cells.
 Dermagraft
 Human neonatal fibroblasts derived from fetal foreskin,
extracellular matrix and a bioabsorbable suture like
scaffold.

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Indications: diabetic foot ulcer care of full-thickness ulcers of
neuropathic etiology of at lease three weeks duration and
burns
Contraindications:
-infections
-exposed bone, capsule, muscle or
tendon
Living Skin Equivalents