THEME: MANAGEMENT OF NEGLECTED ORTHOPAEDIC CONDITIONS TOPIC CURRENT CONCEPTS IN WOUND MANAGEMENT MILDRED ODHIAMBO RN, BN, MSc HSM 10th Scientific conference Kenya Orthopaedic Association 22nd -24th June 2016

INTRODUCTION Wounds are a challenge to the health system Annual cost of wound care in UK in 2014 was estimated at £2,165 million Surgical site infection, dehiscence and poor cosmesis increase morbidity among orthopaedic patients Orthopaedic patients who develop wound infections are hospitalized for two extra weeks

BIOFILM Complex microbial communities containing bacteria and fungus. Attaches firmly on living & non living objects Leads to delayed wound healing

THE TIME - FRAMEWORK Developed in 2002. Used in wound bed preparation Accelerates wound healing 1.T`-Tissue non-viable or deficient- 2. I- Infection or inflammation 3. M- Moisture Imbalance 4. E- Edge of wound non- advancing/undermining

IDENTIFY AIM OF TREATMENT Rapid and cosmetically acceptable healing Remove or contain odour Reduce pain Prevent or combat infection Contain exudate Cause minimum distress to the patient Hide or cover a wound for cosmetic reasons

SELECTION PROCESS OF DRESSING MATERIALS 1. Wound related factors include : nature, location of wound; presence or risk of infection & amount of exudate 2.Wound type- four basic types

TYPES OF WOUNDS

WOUND BED PREPARATION FOR NECROTIC & SLOUGHY WOUNDS 1. Surgical/ sharp debridement 2. Mechanical debridement- saline dressing or LaserJet 3. Chemical debridement- enzymes such as collagenase used to dissolve necrotic tissue .4. Autolytic debridement-Used wet-dry dressings or hydrogels -intrasite gel or nugel 5. Biological method- Maggot therapy

3.TYPES OF DRESSING MATERIALS Wide range Identify category Use well researched materials 1. Hypertonic salt sol –Curasalt 2. Foam dressings 3. Chemical-impregnated dressings -silver, petroleum, collagen and antibiotics

Cont....TYPES OF DRESSINGS 4. Alginate dressings e.g. alginate release, silvercel alginate 5. Hydro fiber dressing e.g. aquacel 6. Hydrogel dressings- intrasite & nugel 7. Hydrocolloids –gel forming occlusive dressing e.g. duoderm, 3m tegaderm

4. OTHER WOUND MANAGEMENT CONCEPTS Negative pressure wound therapy- acute & chronic wounds Compression therapy- improves venous return

CURRENT WOUND MANAGEMENT Dynamic & Patient focused Aggressive management of wounds Provides structured approach to wound Mx. Encourages multidisciplinary approach “Let the wound speak to you”

CURRENT WOUND MANAGEMENT Avoid antiseptics- betadine and hydrogen peroxide Avoid dry gauze as primary dressing Reduce frequency of dressings Look at overall value of the dressing method

CONCLUSION Current concepts would reduce overall economic burden on the patient , health worker and entire Health system

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