2. TOPICAL WOUND CARE
WHAT TO PICK?

4. PHASES OF WOUND HEALING
1) Inflammatory (0 – 4 days). Vasoconstriction, clot
formation and hemostasis.
2) Proliferative (2-3 days to 30 days). Fibroblasts lay
framework for ECM and new granulation.
Angiogenesis connects new granulation and
epithelialization progresses across wound base.
3) Remodeling (3 weeks to 2 years). Completion of
wound contraction with crosslinking of collagen and
reduction in scar size. Tensile strength ultimately
becomes appro. 80% of original.

5. WOUND CARE FUNDAMENTALS
 Maintain moist wound environment
 Remove eschar, debris and necrotic tissue from
wound bed
 Control exudate
 Prevent trauma and further wounding
 Identify and treat infection
 Manage edema
 “Back to basics”

6. MOIST WOUND CARE
 Moist wound environment facilitates healing
 Wounds that are too wet or too dry cannot
progress through normal phases of healing
 Products to absorb and dry if too wet
 Products to maintain and add moisture if too dry
 Should be a part of essentially every wound care
regimen
 No air drying or soaking!

7. HYDROCOLLOIDS

8. HYDROCOLLOIDS
 Impermeable to bacteria
 Facilitates autolytic debridement
 Self adhesive
 As exudate is absorbed, forms a colloidal gel
 Not for use in heavily exudating wounds
 Common uses are pressure ulcers, burns
 Ex: Duoderm, Tegaderm, Replicare, Restore

10. CALCIUM ALGINATES

11. CALCIUM ALGINATES
 Use in exudating wounds
 Absorbs drainage and turns it into gel
 Fills dead space
 Prevents wound base from being too wet but yet
prevents drying
 Commonly used in exudating cavity and tunnel
wounds as well as venous insufficiency ulcers
 Secure with secondary dressing

13. HYDROGELS

14. HYDROGELS
 Soothing and pain reducing
 Rehydrates wound and maintains moist
environment
 Prevents dressing adherence
 Can fill small voids or dead spaces
 Comes in gels and sheets
 Requires secondary dressing
 Can cause peri-wound maceration

16. FOAMS

17. FOAMS
 Highly Absorptive
 Non-adherent
 Conformable
 Protects wound and peri-wound from trauma
 Thermal insulation
 Common uses are pressure (decubitus) ulcers
 Can use under compression for venous ulcers

19. SILVER PRODUCTS

20. SILVER PRODUCTS
 Documented antimicrobial activity thru history
 Effective against MRSA and VRE
 Available in a wide variety of dressing substrates
 Products containing silver that also absorb
drainage, ie, silver alginates, tend to perform the
best
 Common uses are CVI and diabetic ulcers

22. COMBINATIONS
22

23. COLLAGEN DRESSINGS
 Stimulate and recruit cells for healing
 Provide gridwork or matrix for new tissue
 Available as synthetic or bioengineered
 Common uses are in well granulated wounds.
Not of value over eschar or slough

25. COLLAGEN DRESSINGS

26. FILM DRESSINGS
 Semi-permeable
 Waterproof (also retain moisture)
 Transparent for visualization
 Can tear fragile skin
 Not for infected or exudating wounds
 Common uses are lacerations, skin tears and IV
sites.

28. BIOENGINEERED SKIN
SUBSTITUTES
 Useful for relatively shallow, well granulated
wounds
 Surface area; small to large wounds
 Speeds up wound closure remarkably
 Grafts must be offloaded and carefully protected

29. 29

31. GAUZE
 Wet to dry leads to non-selective mechanical
debridement
 Stimulates F.B. reaction frequently
 Good bacterial growth medium. 7.1% infection
rate vs 1.3% for hydrocolloid dressing
 Readily permeable to gas and bacteria
 Lots of good evidence that we should not use
anymore as a primary dressing
 Effective and economical as secondary or cover
dressing

33. Betadine
Peroxide
Dakins
Neosporin
N.S Gauze
Air

34. Soaking
Air Drying

35. PRODUCT SELECTION
 1) What does the wound need?
 2) Does the product accomplish that
 3) Does it need more than one product?
 4) What is available (Insurance?)
 5) What is practical
 6) What can the patient/caregivers apply
 7) What can the patient afford?
 8) Is it cytotoxic

36. THANK YOU !
QUESTIONS ???