Principles of Wound Management define aetiology control factors influencing healing select appropriate dressing or device plan for maintenance.

Wounds seen in General Practice trauma: abrasions and cuts superficial partial thickness burns venous leg ulcers arterial leg ulcers foot wounds often associated with neuropathy and neuro-ischaemia skin cancers. Generally do not see: pressure injuries or dehisced surgical wounds

Factors Influencing Healing poor nutrition Infection/inflammation ongoing trauma incorrect cleansing and dressing underlying disease processes.

Other Factors Related to Delayed Wound Healing age debris and foreign bodies in the wound smoking wound tissue too dry or too wet pain psychological issues.

Decision Making Tools Select the most appropriate dressing according to: Tissue colour Wound depth Exudate level Periwound skin condition Predicted weartime Skill of carer Availability/cost of product

Same thing mostly yellow: discuss percentages for documentinh and what does it need? 6

What does this wound need? Debridement or cleaning? 7

Discuss infected wounds and www.ewma.com what do infected wounds need? Systemic antibiotics according to biopsy and safe topical agents World of Wounds 8

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What does this wound need? Protection and possibly some hydration. World of Wounds 11 11

Ideal Dressing provide mechanical protection protect against secondary infection non adherent and easily removed without trauma leave no foreign particles in the wound remove excess exudates cost effective offer effective pain relief.

Generic Names calcium alginates hydrofibre hypertonic salt cadexomer iodine silver medicated honey zinc bandages

Case Studies skin tear burn venous ulcer arterial ulcer foot wound.

Skin Tear: 3

Burns: First Contact Assessment site depth surface area involved age of patient other influencing factors

What is reasonable to care for in general practice? small superficial partial burns not involving face, feet, hands, perineum, genitalia on the very young or the elderly further guidelines and very good advice may be found on the NSW DoH Website for Severe Burn Injury or ringing Concord Burns Unit

Superficial Burn Characteristics epidermis only erythema (vasodilatation) tenderness (nerve irritability) oedema.

Superficial Partial Burn Characteristics epidermis and outer dermis blisters (fluid shift) shedding of skin painful exposed (nerve endings to kinins) bleeds when pricked with needle hair present (hard to pull out) full sensation blanches on pressure.

Burn Surface Area Wallace’s rule of nines Lund and Browder chart closed palmar hand of victim = 1% of body surface area.

Anatomical Site Considerations hands feet face perineum genitalia joints circumferential burns All these areas require special consideration to prevent cosmetic and functional problems secondary to hypertrophic scaring. 25

Other Considerations extremes of age: very young or very old will need special care co-morbidities medications.

Lower Leg Ulceration Statistics venous 70% arterial 10% mixed 10% skin cancers 2% others 8%

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Arterial Ulcer Characteristics usually located between ankles and toes or high up on leg or posterior leg deep, punched out regular shape, often dry thin, shiny, non hair bearing skin thickened toenails diminished or absent foot pulses elevation pallor, dependant rubor necrotic tissue, infection pain, especially at night or when elevated.

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