1. THEME: MANAGEMENT OF NEGLECTED ORTHOPAEDIC CONDITIONS
TOPIC
CURRENT CONCEPTS IN WOUND MANAGEMENT
MILDRED ODHIAMBO RN, BN, MSc HSM
10th Scientific conference Kenya Orthopaedic Association 22nd -24th June 2016

2. INTRODUCTION Wounds are a challenge to the health system
Annual cost of wound care in UK in 2014 was estimated at £2,165 million
Surgical site infection, dehiscence and poor cosmesis increase morbidity among orthopaedic patients
Orthopaedic patients who develop wound infections are hospitalized for two extra weeks

3. BIOFILM Complex microbial communities containing bacteria and fungus.
Attaches firmly on living & non living objects
Leads to delayed wound healing

4. THE TIME - FRAMEWORK Developed in 2002. Used in wound bed preparation
Accelerates wound healing
1.T`-Tissue non-viable or deficient-
2. I- Infection or inflammation
3. M- Moisture Imbalance
4. E- Edge of wound non- advancing/undermining

5. IDENTIFY AIM OF TREATMENT
Rapid and cosmetically acceptable healing
Remove or contain odour
Reduce pain
Prevent or combat infection
Contain exudate
Cause minimum distress to the patient
Hide or cover a wound for cosmetic reasons

6. SELECTION PROCESS OF DRESSING MATERIALS
1. Wound related factors include :
nature, location of wound; presence or risk of infection & amount of exudate
2.Wound type- four basic types

7. TYPES OF WOUNDS

8. WOUND BED PREPARATION FOR NECROTIC & SLOUGHY WOUNDS
1. Surgical/ sharp debridement
2. Mechanical debridement- saline dressing or LaserJet
3. Chemical debridement- enzymes such as collagenase used to dissolve necrotic tissue
.4. Autolytic debridement-Used wet-dry dressings or hydrogels -intrasite gel or nugel
5. Biological method- Maggot therapy

9. 3.TYPES OF DRESSING MATERIALS
Wide range
Identify category
Use well researched materials
1. Hypertonic salt sol –Curasalt
2. Foam dressings
3. Chemical-impregnated dressings -silver, petroleum, collagen and antibiotics

10. Cont....TYPES OF DRESSINGS
4. Alginate dressings e.g. alginate release, silvercel alginate
5. Hydro fiber dressing e.g. aquacel
6. Hydrogel dressings- intrasite & nugel
7. Hydrocolloids –gel forming occlusive dressing e.g. duoderm, 3m tegaderm

11. 4. OTHER WOUND MANAGEMENT CONCEPTS
Negative pressure wound therapy- acute & chronic wounds
Compression therapy- improves venous return

12. CURRENT WOUND MANAGEMENT
Dynamic & Patient focused
Aggressive management of wounds
Provides structured approach to wound Mx.
Encourages multidisciplinary approach
“Let the wound speak to you”

13. CURRENT WOUND MANAGEMENT
Avoid antiseptics- betadine and hydrogen peroxide
Avoid dry gauze as primary dressing
Reduce frequency of dressings
Look at overall value of the dressing method

14. CONCLUSION
Current concepts would reduce overall economic burden on the patient , health worker and entire Health system

15. THANK YOU!