2. General Assessment
The general assessment is to identify and eliminate
any underlying causes or contributing factors which
may impede the wound healing process
• Age (extreme of age)
• Diseases or co morbidities
• Medications
• Obesity
• Nutrition
• Impaired blood supply
• Lifestyle
3. Local Wound Assessment
• Review of wound history
• Assessment of physical wound characteristic
– Location,size,base,depth
– Presence of pain
– Condition of wound bed
4.
5.
6.
7.
8.
9. Points to remember…
• Wound assessment include local and systemic
assessment
• T.I.M.E principle
• Wound documentation according to wound
chart
10. Dressing
• The purpose of dressing is to protect wound
from trauma and infection
• Reduce pain
• Maintain moisture and temperature
• Absorb drainage and debride the wound
• Control and prevent haemorhage
• Provide psychological comfort
11. Ideal dresing
• Remove excess exudate
• Waterproof
• Maintain moist wound healing environment
• Trauma protection
• Allow gaseous exchange if appropriate
• Non adherant
• Provide barrier to pathogen
• Safe and easy to use
• Provide thermal insulation
13. Modern DressingDressing Purpose Advantage Disadvantage Practical Usage
1. Film -protect against
contamination
and friction
-maintain moist
surface
-prevent
evaporation
-facilitate
assessment
-Adherent
-Transparent
with
measurement
grid
-Bacterial
barrier
-Waterproof
-Breathable
-Fluid
collection
-Possibility of
stripping away
newly formed
-Apply the film
over the site
making sure
there is no air
under it
-To remove the
film, stretch
the film and
pulled slowly
from the edge
-Frequency of
dressing
change:
2-5 days
depending on
the wound
14.
15. 2. Hydrogel -Rehydrate,
debride and
deslough the
wound
-promote
moist healing
-cavity filling
-comfortable
-provide moist
environment
and reduce
pain
-rehydrate
eschar
-desloughing
agent
promotes
granulation
-need
secondary
dressing
-maceration of
skin around
the wound
-apply the
hydrogel on
the wound bed
as a primary
dressing
-frequency of
dressing
change-every
2-3 days
16.
17. 3. Hydrocolloid -Provide moist
environment
-abscorb
exudates
-bacterial
barrier
-cleans and
debrides by
autolysis
-easy to use
-cost effective
-promotes
grannulation
tissue
-effective for
low to
moderate
exudic wound
-waterproof
-unpleasant
odour
-forms a
yellow liquid
gel
-difficult to
use in cavities
-maceration of
skin around
wound
- Apply the
adhesive
side onto
the wound
without
touching
the wound
bed
- A yellow
liquid is
seen after
the
dressing is
left in situ
which need
to be
cleansed
- Frequency
of dressing
of change-
2-5 days
18.
19. 4.Calcium
alginate
-absorb wound
exudate and
maintain
moisture
-economical
and easy to
apply
-biodegradable
-hemostatic
properties
-not helpful for
dry wounds
-need
secondary
dressing
-available in
sheet or rope
form
-effective to
stop bleeding
-the residue of
the
biodegradable
product has to
be washed off
during the
cleansing
process
-frequency of
dressing
change-2-5
days
20.
21. 5. foams -absorbent
-cushioning
-conforms to
body contour
-design for
cavity wound
-highly
absorbent
-provides
protection
-bacterial and
waterproof
-can adhere to
wounds if
exudate dries
out
-foam dressing
is used as a
secondary
dressing or as
cavity fillers
-frequency of
dressing
change:2-3
days or longer
if for
offloading
22.
23. 6. hydrofibre -manage heavy
exudate
wound
-maintain
moist healing
environment
-longer wear
time
-comfortable
and non
traumatic upon
removal
-reduce risk of
maceration
-can be used
on infected
wound
-Not helpful on
dry wound
-needs
secondary
dressing
-the hydrofiber
will become
gel like layer
which can be
easily removed
-frequency of
dressing
changed-2-5
days
24.
25. 7.charcoal Odour
absorbent
Reduces odour Needs
secondary
dressing
Frequency of
dressing
change-2 days
8. Silver To reduce
bacterial
bioburden in
infected
wounds
-locally acting
-no known
resistance
-bactericidal
Some silver
dressings do
discolour the
wound
-Place the
dressing with
the side with
silver facing the
wound bed
-frequency of
dressing
change-2-3
days
26.
27.
28. 9. Multi-
function
dressing(polym
eric membrane
dressing)
To manage
moisture
imbalance(
from dry to
moderate)
-antiseptic
property
-has surfactant
which helps
cleanse the
wound when it
is applied
-offloading
property
-not for heavily
Exudative
wounds
-frequecy of
dressing
change:2-5
days
10. Composite
dressing
(combination
of 2 or more
dressing)
-according to
components of
the material
multifunction Same as
individual
components
listed above
Frequecy of
dressing
change: 2-5
days
29.
30. Other
advanced
dressing
-not widely used –some may be used in specialised centre-
eg: collagen, matrix and regenerative dressings, cultured epidermis,
growth factor,stem cells
31.
32.
33.
34.
35. Negative Pressure Wound Therapy-
Vacumm Dressing
• For slow healing wound
• Involved controlled application of sub-
atmospheric pressure to the local wound
environment, using a sealed wound dressing
connected to a vacumm pump
• The continued vacumm draws out fluid from
the wound and increases blood flow to the
area
36. Negative Pressure Wound Therapy
• The vacumm maybe applied continuosly or
intermittently, depending on the type of
wound being treated and the clinical objective
• Typically dressing changed 2-3times per weeks
40. Points to remember:
• -know your dressing material well and use it
judiciously
• -all wounds need to be cleaned thoroughly
before applying any type of dressing material
42. Reference
• Datuk Dr Noor Hisyam, Wound care manual
,ministry of health malaysia, edition 2014
• https://www.bbraun.com/content/dam/catalog/
bbraun/bbraunProductCatalog/S/AEM2015/en-
01/b8/time-concept.pdf.bb-.66460533/time-
concept.pdf
• https://woundeducators.
• https://www.slideshare.net/MookyMook/advanc
ed-dressing?from_m_app=androidcom
• https://www.slideshare.net/rohanparis1/wound-
dressing-45940763?from_m_app=android
Notas do Editor
The management of chronic wounds has progressed from merely assessing the status of the wound to understanding the underlying molecular and cellular abnormalities that prevent the wound from healing. The concept of wound bed preparation has simultaneously evolved to provide a systematic approach to removing the barriers to natural healing and enhancing the effects of advanced therapies. Wound bed preparation and the TIME framework are most likely to be successful when used alongside the wound bed preparation care cycle.
Calcium alginate is a highly absorbent, biodegradable alginate dressing derived from seaweed. Alginate dressings maintain a physiologically moist microenvironment that promotes healing and the formation of granulation tissue. Calcium alginate is readily removed with saline irrigation, making dressing changes virtually painless.1 Calcium alginate has been around for years. More recently, it has been added to wound gels, hydrocolloids, and cleansers. Silver, a known antimicrobial agent, also has been added to many wound products, including calcium alginate. Unadulterated calcium alginate comes in the form of a flat square or mat (in many sizes) or a rope. The ropes can be manipulated to fit easily in wound cavities. Although one of its stated uses is to provide homeostasis, calcium alginate is more commonly thought of as the dressing that can absorb 20 times its weight in exudate, soak up loose debris from the wound bed, provide an optimal environment for healing, and provide a painless dressing change. This study is a reminder that calcium alginate is a valuable tool in our wound care arsenal.
Made of semipermeable polyurethane, foam dressings contain foamed polymer solutions with small, open cells that can hold fluids. These cells may be layered with other materials. Their absorptiveness varies depending on the thickness of the dressing. The contact area of a foam dressing is nonadherent and nonlinting, so the dressing is easy to remove. The outer layer of the dressing is often hydrophobic or waterproof to keep out bacteria and other contaminants. Foam dressings come either with or without an adhesive border and in many sizes and shapes. Some foam dressings also include a bacterial barrier made from a transparent film. Additionally, some foam dressings are impregnated with an antimicrobial agent such as silver, Manuka honey, cadexomer iodine, antibiotics, or include surfactants as a vehicle for delivery of these substances to the wound bed.
A primary feature of foam dressings is that they help maintain a moist wound environment. Also important is that foam helps cushion the wound and periwound area from additional trauma, as well as providing thermal insulation for wounds. Easy to apply and remove, foam dressings don't cause wound trauma. Foam dressings can be used when there is an infection and during compression therapy. In addition, foam dressings are compatible with enzymatic debridment agents. Depending on the amount of exudate, foam dressings have a wear time of one to seven days.
Hydrofiber® Technology is a soft, absorbent material that transforms into a gel on contact with wound fluid
The gelling action creates an optimal environment for wound healing*1,
Alginate and hydrofiber dressings are popular absorptive dressings indicated for wounds with moderate to high levels of exudate. While they are similar, there are some important differences between them. Alginate dressings are biodegradable, absorb up to 20 times their weight in wound fluid, and serve as hemostatic agents. Hydrofiber dressings absorb up to 30 times their weight and provide less risk of maceration because of their vertical fluid absorption properties
Charcoal has been introduced into several classes of wound care . Although charcoal in itself does not enhance wound healing, it can help to control odors associated with wounds, such as fungating and/or infected wounds
Silver dressings are topical wound care products derived from ionic silver. These products release a steady amount of silver to the wound and provide antimicrobial or antibacterial action. The silver is activated from the dressing to the wound’s surface based on the amount of exudate and bacteria in the wound. Silver dressings are available as foam dressings, hydrocolloids, barrier layers, and charcoal cloth dressings
Polymeric membrane dressings (PMDs), cavity filler, extra-absorptive with or without silver, or rope were applied depending on depth, exudate or suspected infection. Collagenase was applied with standard PMDs for fibrinous wounds. Antibiotic ointment was applied with PMDs to help eliminate pseudomonas infections quickly
UNDERSTANDING COMPOSITE WOUND DRESSINGS
September 12, 2013
37
SHARES
Composite combine different types of dressings with several functions in one single dressing that can address different needs. They can be used as a primary and/or secondary dressing and feature an absorptive layer, and a strike-through barrier