Wound Dressings. Choosing the Ideal Dressing. Local Wound Care THE IDEAL DRESSING... Hydrogels 10/12/12

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1 10/12/12 Wound Dressings Choosing the Ideal Dressing Protect from 2nd infection Provide a moist wound healing environment. Protect granulation tissue and absorb exudate. Todd Sommer, D.O., D.P.M., CWS Diplomate, American Board of Podiatric Surgery Diplomate, American Board of Family Practice Certified UHMS American Board of Preventive Medicine Director, St. Vincent Hospital Wound Center Local Wound Care THE IDEAL DRESSING... THE RULE IS TO KEEP THE WOUND BED MOIST AND SURROUNDING TISSUE DRY Dressing Class D N Hydrocolloids Hydrogels Gauzes Alginates Foams Trans Films Collagen Dressings Exudate absorbers W VW Hydrogels Curasol, DuoDERM g\gel, Hypergel, TegaDerm Gel, Intrasite Gel CONDITION Dry or Desiccated Wound GOALHydrate Wound If perfusion adequate Clear, viscous gel made up of combination of water and glycerin Viscosity will depend on greater % of glycerin Help maintain a moist healing environment OPTIONS Hydrogel/Sheets Hydrogel Gauze 1

2 10/12/12 Hydrogel Sheet Aquasorb, Flexgel, Skintegrity CONDITION - Minimally Draining Wound n Used on dry wounds or when moisture is required for comfort or cushion. n Can provide moisture over longer periods. n Little absorptive qualities. n Change every 1-2 days. GOAL - Maintain Adequate Hydration/Moisture OPTIONS - Hydrogel Hydrogel Gauze Saline Gauze Film Dressing Hydrocolloid Films Opsite, Suresite, Tegaderm n Possess high adherence properties. n Nonabsorbant. n Avoid use on fragile tissue. Hydrocolloids Comfeel, DuoDerm, Exuderm, Restore, Tegasorb n Hydrocolloid dressings contain a dressing matrix which absorbs exudate and creates a gel like dressing. n For low to moderate exudating wounds. n Avoid on skin tears, diabetic foot ulcers, intact blisters, or areas that requires frequent dressing changes. Change every 3-7 days. Does have an odor when it breaks down. Moderate to Heavy Drainage CONDITION - Moderate to Heavy Draining Wound GOAL- Absorb Drainage Moisture Necrotic Tissue Exposed Muscle Moderate Drainage Peri-Wound - Macerated OPTIONS - Alginates/ Hydrofiber Foams Absorptive Dressings NPWT Vac Iodoflex/ Medihoney 2

3 10/12/12 Alginate/Hydrofiber Algisite, Maxorb, SeaSorb Aquacel Alginate/Hydrofiber dressings are considered to be primary dressings for wounds that have moderate to heavy exudate and transudate. Alginate/Hydrofiber once wet with exudate, forms a gel-like plug in the wound. Alginates/Hydrofiber can absorb up to 20 times its weight in exudate. It facilitates autolytic debridement of the wound Moderate Alginate/Hydrofiber to highly exudating wounds. Requires secondary dressing. such as a biocclusive thin film, a hydrogel sheet, or gauze Change when exudate visible on secondary dressing. If dressing particle remain in wound bed, may irrigate them out with normal saline. Do not use on dry wound bed. Foam Advantages CONDITIONS No evidence of Increased Bioburden Absorb under compression Insulator for wound Easy to apply Adhesive foams leave no residue Gentle on friable skin Does not adhere to wound bed GOAL Based on Risk of Contamination Consider Prophylaxis OPTIONS Silver Based Dressings Silver Products Acticoat, Actisorb, Aquacel Ag, Arglaes, Silvasorb, SilverCel Antimicrobial Action of Topical Silver Active against a wide range of bacteria & fungi Staphylococcus aureus coli Pseudomonas aeruginosa Candida albicans Escherichia 3

4 10/12/12 Increased Bio-burden Necrotic Tissue Exposed Bone, Muscle, Tendon CONDITION Increased Burden GOAL - Decrease Bioburden OPTIONS Topical antiseptics/antibiotics Cadexemer iodine / Medihoney Silver dressings / Santyl Debridement Systemic Antibiotics Cadexomer Iodine Iodoflex, Iodosorb n Cadexomer iodine based products absorb fluids, removing exudate, pus and debris. As they swell, iodine is slowly released killing micro-organisms and forming a protective gel over the wound surface. n avoid in patients with thyroid disorders & pregnancy CONDITION abnormal odor GOAL Control Odor Eliminate Cause OPTIONS Activated Charcoal Iodosorb Multidex Metronidazole Multidextran Polysaccharide Gel or Powder Controlling Odor in Wounds n Multidex (DeRoyal) n Monosaccharides and polysaccharides derived from plant starches n 1% ascorbic acid n Molecular weight prevents systemic absorption of starches n Heals by adding topical nutrients and creating osmotic effect of glucose to PMN (polymorphonuclear cells) n Indicated on both infected and non-infected wounds including Activated Charcoal n Activated Charcoal Dressings contain a layer of activated charcoal that traps volatile, odor containing molecules, thereby containing the smell. n Example: CarboFlex- Convetec Metronidazole (Flagyl) n Metronidazole is an antibiotic effective against anaerobic bacteria and certain parasites. 4

5 10/12/12 Hydrofera Blue MediHoney Promogran Prisma Vac Skin Substitutes Hydrofera Blue (Hollister)- MediHoney Methylene Blue and Gentian Violet Provides broad spectrum bacteriostatic protection, Effective against MRSA & VRE, Provide some odor control properties Polysaccharides derived from Manuka Honey Molecular weight prevents systemic absorption of starches Mode of action, works by adding topical nutrients and creating osmotic effect of glucose. Indicated on both infected and non-infected wounds including Moisten with sterile H2O or saline PROMOGRAN PRISMA (Systagenex) Cellulose/Collagen Promogran (Systagenix) 45% oxidized regenerated cellulose, 55% collagen biopolymer Binds matrix metalloproteases with tissue growth factors in chronic wound exudate Heals by providing an environment which attracts cells and limits the proteases (MMP) that inactivate growth factors. Collagen, oxidized regenerated cellulose (ORC) and silver-orc Kills clinically relevant bacteria in the dressing to help maintain bacterial balance and reduces bacterial growth 5

6 10/12/12 Negative Wound Pressure Therapy Skin Substitutes The End 6