1. UNDERSTANDING WOUND CARE DRESSING
33rd annual confernce of North Chapter of ASI 

2. Greetings from DrRPGMC Kangra at Tanda

3. Why dressing is required
To produce rapid and cosmetically acceptable healing,

4. Why dressing is required
To produce rapid and cosmetically acceptable healing,
To remove or contain odour,
To reduce pain
To cause minimum distress or disturbance to the patient,
To hide or cover a wound for cosmetic reasons.

5. AVAILABLE DRESSINGS CONVENTIONAL DRESSINGS GAUGES BIOLOGICAL
TOPICAL ANTIBACTERIAL/ANTIBIOTICS
ADVANCED DRESSINGS
POLYMERIC
GROWTH FACTORS
NEGATIVE PRESSURE THERAPY
ODOUR ABSORBENT
COMPOSITE

6. GAUGE DRESSINGS
DRY GAUGE
PADS
BANDAGE
VASELINE GAUGE
ADHESIVE TAPES

7. Classification of fibres used in surgical dressings

8. POLYMERIC DRESSINGS NATURAL SYNTHETIC
COLLAGEN (LYCINE,PROLENE,HYDROXY-PROLENE)
CHITIN/CHITOSAN(N-acetyl-D-GLUCOSAMIN & N- glucosamine)
ALGINIC ACID ( GLUCURONIC ACID+ MANNURONIC ACID)
STARCH(AMYLOSE+GLUCAL+AMYLOPECTIN)
HYDROXYETHYL STARCH(HES)
DEXTRAN
GLUCAN
GELATIN (DENATURED COLLAGEN)
N-ACETYLGLUCOSAMINE
HYALURONIC ACID
BACTERIAL CELLULOSE
KERATIN/SILK
HYDROXY ETHYL METHA ACRYLATE(HEMA)
POLYURETHANE
PROPLAST
POLYETHYLENE
TEFLON
PTFE
POLY VINYL PYROLIDENE(PVP)
POLYEHYLENE GLYCOL(PEG)
POLY-N- ISOPRPYLEACRYLAMIDE(PNIPAm)

9. Hydropolymers

10. POLYMERIC DRESSINGS HYDROGELS HYDROCOLLOIDS FOAMS MEMRANES HYDROFIBRES
SPRAYS
SKELETONS

11. NANOPARTICLES ZnO ZrO2 TiO2 GRAPHENE GRAPHENE OXIDE CLAY
SILVER NITRATE
SILVER

12. ACTION OF HYDROGELS

13. BIOLOGICAL DRESSINGS SKIN GRAFTS AUTOGRAFT HOMOGRAFT XENOGRAFT AMNION
ACELLULAR DERMIS

14. TOPICAL ANTIBACTERIALS
IODINE
CHLORHEXIDINE
SILVER
ANTIBIOTICS
HONEY
POLYMERS

15. ODOUR ABSORBENT
ACTIVATED CHARCOAL

16. GROWTH FACTORS PDGF and EGF are approved by FDA for human application.
insulin-like growth factor, transforming growth factor (TGF)-β

17. Negative pressure therapy

18. COMPOSITE
Mix & match

19. COMPOSITE DRESSINGS
Most of the composite dressings possess three layers.
Composite dressings may also include an adhesive border of non-woven fabric tape or transparent film.
Outer most layer protect the wound from infection,
middle layer usually composed of absorptive material which maintains moisture environment and assist autolytic debridement,
bottom layer composed of non adherent material which prevents from sticking to young granulating tissues.

20. HOW VARIOUS DRESSINGS ACT

21. GAUGE DRESSINGS PASSIVE
WET TO DRY----DEBRIDE,DAMGE KERATINOCYTES,FIBROBLASTS
Pads--ABSORVE EXUDATE
PARFFIN GAUGE---HYDROPHOBIC

22. POLYMERIC DRESSINGS BIOCOMPATIBLE BIODEGRADEABLE/NONBIODEGRADEABLE
MOIST HEALING
ABSORVE/DONATE WATER
VAPOUR PERMEABLE
AUTOLYTIC DEBRIDEMENT
AMORPHOUS
ANTIBACTERIAL

23. Polymeric dressings Foams absorve exudate like sponge
Films are semipermeable to warer vapours & gases, don’t allow water & bacteria
Hydrocolloides & hydrofibers need exudating wound to turn to hydrogels
Silicone adhesive to normal skin but not to wound
Used as composite dressings

24. ANTIBACTERIALS
CONTAMINATED
COLONISED
CRITICALLY COLONISED
INFECTED

25. ANTIBACTERIALS Clinical (celsian) localized signs of acute infection
Pain (dolor)
Swelling (tumor)
Warmth (calor)
Redness (rubor)
Loss of function (functio laesa recognized much later)

26. ANTIBACTERIALS Clinical signs of infection in chronic wounds
Abnormal or excessive granulation tissue
Bleeding from fragile surface at dressing change
Increasing pain
Persistent odor
Bridging and pocketing of purulent material
Delayed healing

27. ANTIBACTERIALS TOPICAL ANTIBIOTICS SHOULD BE AVOIDED
USE OF ANTISEPTICS SHOULD BE REVIEWED AT WEEKLY INTERVAL

28. NEGATIVE PRESSURE THERAPY
reduces edema,
creates a positive wound environment by removing healing inhibitors,
increases blood flow,
stimulates angiogenesis and granulation tissue
and causes mechanical stress in the bed of the wound promoting cell proliferation.
promotes a moist environment

29. ISSUES WITH WOUNDS

30. ISSUES WITH WOUNDS INFECTION NECROTIC TISSUE & SLOUGH EXUDATE
PROTECTION OF KERATINOCYTES & GRANULATION TISSUE
EPITHELISATION
SHEAR FORCES
ODOUR
STRENGTH
SURFACE AREA
UNDERLYING PATHOLOGY
ASSOCIATED MORBIDITY OF PATIENT

31. INFECTION TREAT OVERT & COVERT INFECTION BY ANTIBACTERIALS
AVOID ANTIBIOTIC CREAMS
ANTIBACTERIALS INHIBIT WOUND HEALING

32. NECROTIC TISSUE
ISCHEMIA—DRY, AMPUTATION
NON ISCHEMIC--DEBRIDEMENT

33. SLOUGH GAUGE DRESSING AUTOLYTIC DEBRIDEMENT SURGICAL DEBRIDEMENT
ENZYMATIC DEBRIDEMENT(Collagenase and papain/urea formulations )
JET HYDROSURGERY SYSTEM
BIOLOGICAL DEBRIDEMENT

34. PROTECTION OF GRANULATION TISSUE & KERATINOCYTES
USE MOIST DRESSING PARAFFIN TULLAE SILICONE NETS POLYMERIC DRESSINGS

35. EXUDATING WOUNDS COTTON PADS HYDROGELLS HYDROCOLLOID HYDROFIBRES
POLYMER SPONGES
POLYMER FILMS

36. EPITHELISATION MOIST DRESSING VASELLINE OINTMENTS VASELLINE TULLAE
SILICONE NETS
POLYMER FILMS

37. STRENGTH
POLYMER FILMS
ADHESIVES
BANDAGE

38. UNDERLYING PATHOLOGY NEUROPATHY—PROTECTION &OFFLOAD
ISCHEMIA---REVASCULARISATION
VENOUS HYPERTENSION-- COMPRESSION
DEFORMITY---CORRECTION
DIABETES MELLITES-CONTROL
PRESSURE----CHANGE OF POSTURE
MALIGNANCY---EXCISION

39. ASSOCIATED MORBIDITY
FACTORS IMPAIRING WOUND HEALING

40. COST
MAJOR ISSUE

41. EVIDENCE

42. EVIDENCE
Systematic reviews and meta-analyses have identified little good quality evidence from randomised controlled trials (RCTs) to support the use of advanced or antimicrobial dressings (such as iodine,honey or silver dressings) for chronic wounds.

43. THANKS