Types of Wounds. Diabetic Ulcer. Vascular/Gangrene. Trauma (Accident)

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1 Conflict of Interest Disclosure Wound Care for Assistants Benjamin W. Weaver, DPM, CWS DABPOPPM, FACFAOM, FCCWS, FAPWCA, FAAPPM Dr. Weaver has a financial relationship with the following companies and/or products. These relationships may or may not apply to this lecture: My wife Brooke Weaver is a consultant for Traknet The content of this presentation reflects the opinions of the speaker alone and any products or services mentioned are not endorsed by the AAPPM. Types of Wounds Mechanical blisters, corns, calluses Diabetic ulcer Vascular/Gangrene Trauma (accident) Diabetic Ulcer Diabetic ulcer An open sore or wound that most commonly occurs on the foot Causes: Elevated blood glucose Neuropathy Uncontrolled blood pressure Poor nutrition Prolonged pressure Vascular/Gangrene Gangrene occurs when tissue dies (necrosis) because its blood supply is interrupted. Gangrene may be caused by an infection or injury, or be a complication of a long-term condition that restricts blood circulation. Trauma (Accident) High-velocity blunt trauma Low-velocity blunt trauma High-velocity penetrating trauma Low-velocity penetrating trauma Thermal/Chemical injuries 1

2 Wound Treatment Approaches - mechanical, enzymatic, manual Off-Loading Various dressings and wound products Infection and bioburden control Management of vascular problems Medical and Nutritional management Negative Pressure Wound Therapy Hyperbaric Oxygen Treatment/Prevention Orthotic supports Skin grafts (autografts and allografts) Flowable soft tissue scaffold Topical wound-healing agents Goals of debridement: Remove potential pathogens Remove necrotic and fibrous infiltrates Forms of : Cold steel scalpel, curette, rongeur, tissue nippers Mechanical wet to dry dressings, pulse lavage Enzymatic debridement---santyl 2

3 TOO MANY DRESSING CHOICES!!!! Factors Influencing Dressing Choice Anatomical site Amount of exudate Dead space Surrounding skin Caregiver ability Wound status Cost Calcium Alginates Brown seaweed Extremely absorbent Patient must have moderate to heavy drainage (Available in ropes for filling and flat pads for open wounds Interacts with wound exudate to form a moist gel May use in infected wounds Example: Algisite, Silvercel, Aquacel Ag Alginate Dressings Foams Very absorbant Moderate to heavy drainage Have film, adhesive or no backing on outer surface Does not adhere to wound bed Not useful for dry eschar Example: PolyMem, Allevyn Foams 3

4 Collagens Absorbent, conformable and nonadherent Mild, moderate, or heavy drainage Available in pads, particles, powders, paste and ribbons/strips Can use in Infected wounds and Tunneling wounds Provides matrix for tissue and vessel growth Not recommended for 3 rd degree burns, dry eschar or necrotic wounds Collagen Dressings Example: Promogran, Prisma, Puracol, Fibracol None to light drainage Available in amorphous gels, sheets, or impregnated in gauze Helps maintain a moist healing environment Can use when infection is present w/ topical antibiotics May cause maceration if exudate increases Example: Solosite, Amerigel Hydrocolloids Light to moderate drainage Flexible, mold around bony prominences Long wear time Impermeable to bacteria and other contaminants Facilitate autolytic debridement Problems with occlusion, opacity and odor May damage fragile periwound skin Examples : Duoderm, Replicare, Tegasorb (Use thin versions) 4

5 Hydrocolloid Dressings SUMMARY Maintain moisture - films, hydrocolloids, hydrogel sheets Add moisture - amorphous hydrogels Absorb moisture - foams, collagen, alginates, superabsorbents Protect wound surface - contact layers, impregnated gauzes SUMMARY Control bacteria - silver ions, slow-release iodine Control odor - activated charcoal Stimulate cells - collagen Progress Note Documentation Type of wound, necrotic tissue presence Wound location, Size, and Depth Amount of Drainage Has the wound been Debrided: Method of debridement (scalpel, nippers) Anesthesia used, how much. If not, why? Depth of debridement Partial, Full thickness, SQ, Muscle, Bone Pre and post debridement measurements Dressings applied in office (do not bill for these) Treatment Plan PROTOCOLS Completely assess Wound at each visit Know products well and change as needed Social and financial considerations of patient Facility protocol and formulary Cost vs. benefit Vascular Testing: ABI, Toe pressures, Venous Electromagnetic Neurovascular Therapy Diagnostic Ultrasound for depth assessment Advanced wound care: skin substitutes, grafts Tissue expanders Advanced wound care: biopsies, NPWT Photographic assessments, graphs Questions?? 5

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