1. Wounds and wound Care Pressure Ulcer Staging
Negative Pressure Wound Therapy
Supplementation for wound healing
Treatment Principles

2. Pressure Ulcer Staging
National Pressure Ulcer Advisory Panel (NPUAP)Guidelines - Based on depth of tissue injury, not size
Typically over bony prominences, but can occur over any area excessive pressure is applied

3. Stage 1
Non-blanchable erythema

4. Stage 2
Skin only – excoriation, blister, shallow ulcer

5. Stage 3
Involves subcutaneous tissue

6. Stage 4
Involves structures below the subcutaneous tissue – muscle, tendon, fascia, bone

7. Unstagable
Necrotic tissue present which does not allow accurate staging

8. Unstagable - Kennedy

9. DTI
Purple or maroon discoloration of the skin

10. Negative Pressure Wound Therapy “WOUND Vac”

11. Benefits Removes exudates, infectious material Reduces edema
Promotes perfusion and angiogenesis
Promotes granulation tissue formation

12. NPWT / NWPTi

13. SmaLL pORTABLE NPWT PICO – Smith & Nephew SNaP - Spiracur
NPD 1000 – Kalypto Medical

14. Nutritional supplementation for wound healing
The Dietician is my friend!

15. Wounds = hypermetabolic state
Calories
30-35 Kcal/Kg
35-40 Kcal/Kg – underweight or loosing weight
Protein
g/Kg – Adults
g/Kg – Elderly
g/Kg – At risk for pressure ulcers
g/Kg – Promote wound healing
Adequate hydration
30-40 ml/Kg/day
ml/Kcal
Increased requirements with wound drainage, fever

16. Vitamin C
Works with the amino acids proline and lysine during collagen synthesis
Angiogenesis
Fibroblast and leucocyte function
500 mg twice daily
Renal failure – 250mg/day – avoid oxalate deposits

17. ZINC Cofactor in collagen synthesis
Cellular proliferation and synthesis – enzyme and immune function
Can adversely affect copper status
ZnS mg (50 mg elemental) once daily for weeks

18. iRON Hemoglobin Synthesis and collagen formation
Iron (FESO4) - 325mg 1 to 3 times/day for iron deficiency
Vitamin C aids absorption
Can have adverse affects if excess leads to tissue deposition

19. VITAMIN a Collagen synthesis and cross linking Stage I-II:
Replete only if deficient
10, 000 – 25,000 IU x 10 days
Stage III-IV:
5000 IU per 1000 kcal
Concomitant glucocorticoid use:
10,000-15,000 IU x 7 days

20. B vITAMINS Collagen linkage. Healthy immune system
Protein and DNA synthesis.
Formation of red blood cells
Multivitamin unless specific deficiency

21. Other considerations Glycemic control - proper cell function Copper
- cofactor in connective tissue formation - collagen polymerization and cross link formation
Arginine
- conditionally essential amino acid
- increase collagen deposition and blood flow
Glutamine
- facilitates nitrogen metabolism
- supports protein synthesis
- critical substrate for the cellular immune
HMB (hydroxymethybutarate)
– metabolite of leucine
– promotes tissue building, increase in muscle mass
EFAs

22. Wound healing Dressing choice and frequency depends on many factors
Maintain optimal moisture for wound healing – exceptions stable dry heel eschar and severe arterial disease
Control bacterial colonization and infection
Control inflammation
Promote tissue proliferation
Outpatient
- Patient convenience and ability
- Requirement for nursing assistance
Wound team follow up typically weekly unless longstanding or stable non-healing