Wound management and dressing
selection
Edwin T. Chamanga (Tissue Viability Service Lead)
12/02/2014
Our Passion, Your Care.
Aims
• To discuss wound care related clinical
challenges.
• To discuss different wound beds.
• To explore the concept of wound bed
preparation.
• To discuss wound dressing selection
based on the Trust’s formulary.
Our Passion, Your Care.
Clinical challenges
•
•
•
•
•
•
•
•
Lacerations / Skin tears
Leg ulcers
Pressure ulcers
Cancerous wounds
Surgical wounds
Diabetic foot ulcers
Traumatic wounds
Any other?
Our Passion, Your Care.
Wound bed types
Includes:
–
–
–
–
Necrotic wound
Sloughy wound
Granulation wound
Epithelialising wound
Our Passion, Your Care.
Wound bed preperation
• A framework that can provide a structured
approach to the management of wounds
using the TIME principle.
T
Tissue
I
Infection and/or inflammation
M
Moisture inbalance
E
Epidermal margin and extra’s!
Flanagan and Moffat 2004 EWMA position document Wound bed preparation in
practice.
Our Passion, Your Care.
Wound bed preparation
Our Passion, Your Care.
Wound management products
• Identify objectives on the wound bed.
• Understand what can be reasonable be
expected from a dressing.
• Have information about availability, cost, cost
effectiveness, evidence based practice.
• Is it within the Trust’s wound care formulary?
• Clinical evidence to date.
Our Passion, Your Care.
Providing an ideal environment
• Ability to maintain a moist environment.
• Allows gaseous exchange.
• Antibacterial properties and permeable to
bacteria.
• Free from trauma.
• Fluid handling, removal of exudate.
Our Passion, Your Care.
Dressing categories
• Passive
• Interactive
• Occlusive
Our Passion, Your Care.
Passive dressings
•
•
•
•
•
•
•
•
Protect by simply covering the wound.
Offer protection against dehydration.
For low exudation, epithelising wounds.
Types
Low adherent dressing.
Low adherent secondary dressing.
Silicone technology.
Disadvantages: rapid exudates saturation, dry out
quickly, adheres to wound surface.
Our Passion, Your Care.
Interactive dressings
• Actively interacts with wound surface.
• Promotes optimal environment for wound
healing.
• Does not allow the wound surface to dehydrate.
• For clean granulating wounds.
• Types: Alginates, Hydrocolloids, Hydrofibres,
Hydrogels, Semi-permeable films.
Our Passion, Your Care.
Occlusive dressings
• Totally seal off the wound from the
external environment.
• Semi/impermeable to moisture.
• Many interactive dressings are occlusive
but not all are both.
• Types: Hydrocolloids, Foam and Films.
Our Passion, Your Care.
Rationale for dressing choice
• To hydrate
• To aid granulation
• To debribe
• To aid epithelisation
• To absorb
• To protect
Our Passion, Your Care.
Alginates
• Basic elements extracted from seaweed.
• Absorb exudate, debribe slough and
encourage granulation.
• Forms soft gel in presence of exudate.
• Provides moist environment.
• Easily irrigated with normal saline/water
for removal.
Our Passion, Your Care.
Alginates cont:
•
•
•
•
•
•
•
•
Daily dressing- reduce as wound healing proceeds.
Daily dressing if wound is infected.
Comfortable.
Kaltostat used for haemostatic properties.
Not suitable for dry necrotic wounds.
Suitable for flat or cavity wounds.
Requires secondary dressing.
May prevent free drainage of pus or exudate.
Our Passion, Your Care.
Vapour permeable films
• General principle: Allows passage of excess exudate
away from the wound surface into the atmosphere in
form of water vapor.
• Permeable to water vapor and oxygen.
• Impermeable to water and micro-organisms.
• Provides moist healing environment.
• Comfortable and convenient.
• Permits wound observation.
• Resistant to shear and tear.
Our Passion, Your Care.
Foams dressings
•
•
•
•
•
•
•
Provides thermal insulation.
Do not shed properties.
Gas permeable.
Easily cut or shaped to fit.
Low adherent contact layer.
Easily removable.
Used as primary or secondary dressing.
Our Passion, Your Care.
Hydrocolloids
•
•
•
•
•
•
•
•
Are occlusive dressings that contain gel-forming
properties.
Protects the wound and provides pain relief.
Provides moist wound healing environment.
Slow absorption of fluid physically changes into gel.
Promotes autolytic debridement.
Can be left in place up to 7 days depending on level of
exudate.
Debriding increases wound volume.
May cause trauma to surrounding skin if fragile and
removed before 5-7 days.
Our Passion, Your Care.
Hydrogels
•
•
•
•
•
•
•
High water content.
Rehydrate wounds.
Debribe and clean.
Maintains moist wound healing.
Gas permeable.
Requires secondary dressing.
May cause maceration.
Our Passion, Your Care.
Hydrofibres
• Soft absorbent gelling fibre.
• Draws and retains exudate and debris within
fibres.
• Provides moist wound healing.
• Converts from dry dressing to soft gel on contact
with moisture.
• Removable in one piece.
• Comfortable and easy to use.
• Aids autolytic debribement.
Our Passion, Your Care.
Topical antimicrobials
• Silver
• Iodine
• Honey
Our Passion, Your Care.
Case study
Mr X is a 66 year old male with a history of hypertension
and type 2 diabetes with stable glycemic control and
peripheral vascular disease. He presented with a diabetic
foot ulcer on the right heel that is less than six weeks old.
The wound measures 3.5cm in length, 2.4cm in width and
less than 0.5cm in depth. The wound bed is 75% covered
in slough and 25% pale granulation tissue. The peri-wound
skin is macerated and wet. Moderate amount of malodour
and thick tenacious exudate is present indicating that the
wound is critically colonised. How would you prepare the
wound bed?
Our Passion, Your Care.
Case study
Bob is a 47-year-old office worker, who presents
with a small ulcer on the dorsum of his left foot. It
is becoming increasingly painful, particularly at
night. He is feeling generally unwell and has
pyrexia. The ulcer has moderate, yellow, sloughy
exudate. He also has peripheral vascular disease
and is a smoker. How would you prepare the
wound bed?
Our Passion, Your Care.
Case study
A 29 year old mother presents to the surgery
with a dehisced C-section. The wound bed
is exudating moderate amount of exudate
with slough on the wound bed. Patient has
been commenced on oral antibiotics. How
would you prepare the wound bed?
Our Passion, Your Care.
WOUND DRESSING SELECTION GUIDE
TYPE OF
WOUND
AIM
EXUDATE LEVEL
TYPE OF DRESSING
SHALLOW WOUND
NECROTIC
TO REHYDRATE WOUND SURFACE AND
REMOVE NECROTIC TISSUE
NONE
HIGH
SLOUGHY
TO AID DEBRIDEMENT OF SLOUGHY
TISSUE
Actiform Cool (Activa) / Intrasite Gel (Smith & Nephew)
Granuflex Modified (Convatec) / Tegaderm Oval (3M) / Duoderm Extra Thin (Convatec)
Sorbsan Plus (Unomedical) / Aquacel sheet
(convatec) +/- Tegaderm Foam (3M) / Allevyn
Adhesive Foam (Smith & Nephew)
Sorbsan Plus (Unomedical) / Aquacel Ribbon (convatec) +/Tegaderm Foam (3M) / Allevyn Adhesive Foam (Smith &
Nephew)
Granuflex Modified (Convatec) / Tegaderm Oval
(3M) / Duoderm Extra Thin (Convatec)
Sorbsan Plus (Unomedical) / Aquacel Ribbon (convertec)
+/- Tegaderm Foam (3M) / Allevyn Adhesive Foam (Smith &
Nephew)
MODERATE
LOW
CLINICALLY INFECTED
TO TREAT INFECTION, CONTROL ODOUR
AND
PREVENT CROSS CONTAMINATION
HIGH
OR
MODERATE
HIGH
MODERATE
GRANULATING
TO PROMOTE GRANULATION AND
PROTECT FRAGILE TISSUE
CAVITY/SINUS
LOW
SYSTEMIC ANTIBIOTICS
Inadine (Systagenix) / Iodoflex paste (smith & Nephew) / Activon Tube, Algivon anc Activon Tulle (Advancies
medical) / Flaminal Hydro/ Flaminal Forte (Crawford Health Care) / Carboflex (Convatec) / CliniSorb (Clinimed)
/Acticoat Flex 7 (Smith & Nephew) / Atrauman Ag (Hartmann) / Urgotul Silver (Urgo) / Aquacel Ag ribbon
(Convatec)
Sorbsan Plus (Unomedical) / Aquacel sheet
(convatec) / Sorbion Sachet Extra (H&R Healthcare)
/ Eclypse (Advancis) / Mesorb (Molnlycke) / Zetuvit
E (Hartmann) / Kerramax Care (Crawford)
N-A Ultra (Systagenix) + Dressing Pad / Tegaderm
Foam (3M) / Allevyn (Smith & Nephew)
Kaltostat (Convatec) / Aquacel Ribbon (Convatec) / Sorbsan
Plus (Unomedical)
Sorbsan Plus (Unomedical) / Aquacel sheet (convatec) /
Sorbion Sachet Extra (H&R Healthcare) / Eclypse (Advancis)
/ Mesorb (Molnlycke) / Zetuvit E (Hartmann) / Kerramax
Care (Crawford)
Mepore Ultra (Molnlycke) / Cosmopore E
(Hartmann)
HIGH
EPITHELIALISING
TO PROMOTE EPITHELIALISATION AND
PROTECT FRAGILE TISSUE
N-A Ultra (Systagenix) / Atrauman (Hartmann) / Urgotul (Urgo) / Allevyn Gentle (Smith & Nephew) / Mepitel One
(Molnlycke)
MODERATE
LOW
Duoderm Extra Thin (Convatec) / Mepore Ultra (Molnlycke)
Our Passion, Your Care.