Wessex Health Partners Wessex Integrated Care, Population Health, Research & ...
Wound management
1. Dr Yap Gaik Chin
Wound Care Team
Surgical Department
2. Management of non healing wound is a
complex process and requires a
multidisciplinary approach
Starts from the first assessment upon
inspection of patient by making a general
assessment and further local assessment of the
wound
3. Assessment ( General & local )
TIME – wound bed preparation
Wound cleansing
Types of debridement
Types of dressing
4. Age
Psychosocial health
Complicating conditions
vascular problem, diabetic, smoking,
immunosuppressive
Nutritional status
Pain/Comfort
Hygiene
6. In early 1980s, Lars Hellgrens, a Sweeden
dermatologist was the first to claim that
wounds could be categorised according to the
colour of the wound surface
Red-Granulation
Yellow-Slough
Pink-Epithelialization
Black-Necrotic
7. Mnemonic for Principles of Wound Bed
Preparation
What is wound bed preparation?
Management of wound to accelerate
endogenous healing or facilitate the
effectiveness of other therapeutic measures
8. T : Tissue Viability
I : Inflammation, Infection
M : Moisture Imbalance
E : Epidermal Margin/ Edge of Wound
9. Viable ( Granulation, Epithelialising)
Non viable ( Necrotic, Sloughly, Eschar)
How does non viable tissue impede healing?
Prolongs inflammation
Impedes epitheliazation
Medium for bacteria growth
10. Clear away dead or necrotic tissue
Debridement
Always ensure adequate tissue oxygenation
for angiogenesis and granulation process
11. The bacterial continuum
What is infection?
End spectrum of bacterial continuum , more
infected than critically colonized wound
Assessing of wound infection
1. Contamination
2. Colonized
3. Critically colonized
4. Infection ( Local, Systemic)
12. Classic Presentation of infection of local wound
1. Advancing erythema
2. Fever
3. Warmth
4. Oedema/ Swelling
5. Pain
6. Purulence
13. Secondary clinical presentation of local wound
1. Delayed healing
2. Change in colour of wound bed
3. Absent/abnormal granulation tissue
4. ↑ or abnormal odour
5. ↑ drainage/exudate
6. ↑ pain @ wound site
14. Too much moisture –impede wound healing
Cause Dessication / Maceration of skin
Need to match exudate volume with product
absorbency for optimal moisture balance
15. Non advancing wound edge
Also known as non healing wound
Undermining of edge is either critically
colonised or infected
16. Reconsider the principles of wound bed
preparation and the acronym TIME,
1. Has necrotic tissue been debrided?
2. Is there a well vascularised wound bed?
3. Has infection been adequately controlled?
4. What is the status of inflammation or
infection in this patient?
5. How well is moisture balance optimized?
6. What dressings have been applied before?
17. Removing foreign debris & necrotic tissue
The process of removing inflammatory
contaminants from the wound surface since
necrotic tissue, excess exudate and foreign
objects impede healing & ↑ the risk of infection
Routine cleansing ( Fluid irrigation, mild scrub)
Debridement
18. Antibiotic should be used to reduce bacterial
level within the wound
Selection of antibiotic is based upon proven
efficiency against microorganisms obtained
from culture.
19. Saline
Octanisept
Superoxide solution
Water for irrigation
PHMB with Betaine
20. Antiseptics should not be used to clean
wounds
Topical antiseptics:
1. Betadine
2. Povidone-Iodine
3. Dakin’s Solution ( Eusol)
4. Acetic Acid-> effective against Pseudomonas
A organisms
5. Hydrogen Peroxide
21. A method of high pressure irrigation which is a
gentle mechanical action to loosen debris and
necrotic tissue
22. Wound healing is impaired due to prolong
inflammation
Necrotic tissue –culture medium for bacteria
Amtibiotics do not reach the wound milieu
Dressings especially antimicrobial or silver do
not reach wound bed
For staging of undetermined stage pressure
ulcer
24. Wound bed utilizes phagocytes and proteolytic
enzymes to remove non viable tissueining a
moist environment
This process can be promoted and enhanced by
maintaining a moist environment
25. Recommended for removal of thick, adherent
eschar and devitalized tissue in large wounds
Not recommended in severely compromised
patients
Analgesia / anaesthesia may be required
26. The use of topically applied enzymatic agents
to stimulate the breakdown of non viable tissue
Faster debridement process compared to
autolytic
Eg: Honey, Prolase dressing
27. Used for decades where dressings are allowed
to proceed from moist to dry
Manually removing the dressing causes a form
of non selective debridement
Works best on wounds with moderate
amounts of necrotic debris
28. Small maggots are introduced to a wound to
consume necrotic tissue
Able to debride a wound within 1-2/7
The maggots derive nutrients through a
process called ` extracorporeal digestion’
29. Protect wound from trauma or microbial
contamination
Absorb drainage and debride wound
Control & prevent haemorrhage ( pressure
dressing)
Reduce pain
Maintain temperature and moisture of wound
Provide psychological comfort
30. Traditional
Conventional
Leaves, herbs, Honey, Gauze
Advanced/ environmental dressings
I. more expensive
II. Can be left in situ for several days
III. Films, Alginates, Silver, Hydrogels, Foams,
Hydrocolloids, Charcoals
31. Safe and easy to use
Remove excess exudate
Provide thermal insulation
Trauma protection
Provide barrier to pathogens
Allow gaseous exchange
Water proof
Non adherent
Maintain moist wound healing environment
32. The Compendium of Wound Care Dressings in
Malaysia, Volume 2 , Harikrishna K.R Nair