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UNDERSTANDING WOUND CARE DRESSING
33rd annual confernce of North Chapter of ASI
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Greetings from DrRPGMC Kangra at Tanda
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Why dressing is required
To produce rapid and cosmetically acceptable healing,
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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.
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AVAILABLE DRESSINGS CONVENTIONAL DRESSINGS GAUGES BIOLOGICAL
TOPICAL ANTIBACTERIAL/ANTIBIOTICS ADVANCED DRESSINGS POLYMERIC GROWTH FACTORS NEGATIVE PRESSURE THERAPY ODOUR ABSORBENT COMPOSITE
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GAUGE DRESSINGS DRY GAUGE PADS BANDAGE VASELINE GAUGE ADHESIVE TAPES
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Classification of fibres used in surgical dressings
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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)
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Hydropolymers
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POLYMERIC DRESSINGS HYDROGELS HYDROCOLLOIDS FOAMS MEMRANES HYDROFIBRES
SPRAYS SKELETONS
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NANOPARTICLES ZnO ZrO2 TiO2 GRAPHENE GRAPHENE OXIDE CLAY
SILVER NITRATE SILVER
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ACTION OF HYDROGELS
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BIOLOGICAL DRESSINGS SKIN GRAFTS AUTOGRAFT HOMOGRAFT XENOGRAFT AMNION
ACELLULAR DERMIS
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TOPICAL ANTIBACTERIALS
IODINE CHLORHEXIDINE SILVER ANTIBIOTICS HONEY POLYMERS
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ODOUR ABSORBENT ACTIVATED CHARCOAL
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GROWTH FACTORS PDGF and EGF are approved by FDA for human application.
insulin-like growth factor, transforming growth factor (TGF)-β
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Negative pressure therapy
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COMPOSITE Mix & match
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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.
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HOW VARIOUS DRESSINGS ACT
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GAUGE DRESSINGS PASSIVE
WET TO DRY----DEBRIDE,DAMGE KERATINOCYTES,FIBROBLASTS Pads--ABSORVE EXUDATE PARFFIN GAUGE---HYDROPHOBIC
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POLYMERIC DRESSINGS BIOCOMPATIBLE BIODEGRADEABLE/NONBIODEGRADEABLE
MOIST HEALING ABSORVE/DONATE WATER VAPOUR PERMEABLE AUTOLYTIC DEBRIDEMENT AMORPHOUS ANTIBACTERIAL
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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
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ANTIBACTERIALS CONTAMINATED COLONISED CRITICALLY COLONISED INFECTED
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ANTIBACTERIALS Clinical (celsian) localized signs of acute infection
Pain (dolor) Swelling (tumor) Warmth (calor) Redness (rubor) Loss of function (functio laesa recognized much later)
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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
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ANTIBACTERIALS TOPICAL ANTIBIOTICS SHOULD BE AVOIDED
USE OF ANTISEPTICS SHOULD BE REVIEWED AT WEEKLY INTERVAL
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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
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ISSUES WITH WOUNDS
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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
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INFECTION TREAT OVERT & COVERT INFECTION BY ANTIBACTERIALS
AVOID ANTIBIOTIC CREAMS ANTIBACTERIALS INHIBIT WOUND HEALING
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NECROTIC TISSUE ISCHEMIA—DRY, AMPUTATION NON ISCHEMIC--DEBRIDEMENT
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SLOUGH GAUGE DRESSING AUTOLYTIC DEBRIDEMENT SURGICAL DEBRIDEMENT
ENZYMATIC DEBRIDEMENT(Collagenase and papain/urea formulations ) JET HYDROSURGERY SYSTEM BIOLOGICAL DEBRIDEMENT
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PROTECTION OF GRANULATION TISSUE & KERATINOCYTES
USE MOIST DRESSING PARAFFIN TULLAE SILICONE NETS POLYMERIC DRESSINGS
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EXUDATING WOUNDS COTTON PADS HYDROGELLS HYDROCOLLOID HYDROFIBRES
POLYMER SPONGES POLYMER FILMS
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EPITHELISATION MOIST DRESSING VASELLINE OINTMENTS VASELLINE TULLAE
SILICONE NETS POLYMER FILMS
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STRENGTH POLYMER FILMS ADHESIVES BANDAGE
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UNDERLYING PATHOLOGY NEUROPATHY—PROTECTION &OFFLOAD
ISCHEMIA---REVASCULARISATION VENOUS HYPERTENSION-- COMPRESSION DEFORMITY---CORRECTION DIABETES MELLITES-CONTROL PRESSURE----CHANGE OF POSTURE MALIGNANCY---EXCISION
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ASSOCIATED MORBIDITY FACTORS IMPAIRING WOUND HEALING
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COST MAJOR ISSUE
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EVIDENCE
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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.
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THANKS
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