2. Wound management is an important aspect of healthcare in which surgeons play a vital role. Mx requires multi- professional approach. Involvement of surgeon in wound care is to optimize the environment for which a wound can heal. Debridement of infected, necrotic tissue ensuring adequate blood supply to wound edges.

3. Systemic factors such as nutritional status and sepsis should also be addressed with medical co- morbidities such renal failure liver failure and DM optimized. In practice all of this is managed concurrently with the use of modern dressings to facilitate optimal healing.

4. PATHOPHYSIOLOGICAL PROCESSES UNDERLYING DEVELOPMENT OF DRESSINGS ….. Traditional wound dressings worked on the basis of forming a dry protective barrier which could prevent bacterial contamination and absorb exudates. But researches carried out in 1960s established that moist wound healing with inhibition of dry scab formation greatly increases reepithelialization rates.

5. Shedding of scab in the process of healing, stratum corneum which act as a body’s barrier to water vapour loss is lost. Inhibition of this process retain moisture – aid different stages of wound healing. Wound dressing market has grown considerably over the last 10 years, but few dressings only have the required characteristics for wound healing.

6. PHYSIOLOGICAL WOUND ENVIRONMENT THAT IS EXPECTED TO BE ATTAINED BY IDEAL DRESSINGS…….. Wound kept moist Excess exudate absorbed without leakage Thermal insulation provided Dead space elimination Avoidance of trauma/ pain on dressing change Scar tissue formation minimized

7. PHYSIOLOGICAL WOUND ENVIRONMENT THAT IS EXPECTED TO BE ATTAINED BY IDEAL DRESSINGS…….. Minimal toxicity to surrounding skin and base Non- viable tissue debridement Maintenance of gas exchange

8. WOUND ASSESSMENT BY TYPE Assessment requires an accurate clinical history ◦ Duration ◦ previous wounds ◦ Hx of trauma ◦ Wound characteristics ◦ Underlying medical conditions ◦ Smoking ◦ Medications ◦ Allergy

9. WOUND ASSESSMENT BY TYPE Prior to selecting a wound dressing, the characteristics of wound bed need to be assessed. Wounds 1. NECROTIC 2. SLOUGHY 3. GRANULATING 4. EPITHELIALIZING

10. WOUND ASSESSMENT BY TYPE Dressing selection depends on : Wound base Wound site Surrounding skin Exudate level Mode of action of dressing

11. WOUND DRESSING CHARACTERISTICS AND TREATMENT AIMS WOUND DRESSING CHARACTERISTICS AND TREATMENT AIMS TYPEDESCRIPTIONAIM OF TREATMENT NECROTIC Black in colour dehydrated covered with devitalized tissue facilitate removal of necrotic tissue ( except ischamic wounds usually they kept dry) SLOUGHY covered in thick/ thin layer of yellow/ grey tissue slough is made of fibrin, leucocyte, serous exudate and protein. To reduce infection risk and prepare the wound bed for healing by surgical debridement or the use of topical agents GRANULAT ING dark pink or red cobblestone appearance wound requires warm, moist, environment with minimal disturbance to healing EPITHELIAL IZING End stage maintain moist environment and protection of wound wound edges should not dry out- to facilitate cell migration.

12. NECROTIC WOUNDNECROTIC WOUND……. NECROTIC WOUND

13. SLOUGHY WOUND….. SLOUGHY WOUND…..

14. GRANULATING WOUND…… GRANULATING WOUND……

16. WOUND DRESSING TYPES AND INDICATION FOR USE PRODUCT TYPE INDICATION FOR USEPRODUCT SAMPLE Semi permeable films Dry superficial wounds, but cannot cope with exudates Tegaderm, Opsite, Hydrofilms Semi permeable films and pad Postoperative wounds Opsite post op Tegaderm film and pad Hydrofilm plus Non- adherent contact If there is a risk of adherence, Can be used as a transport layer for gels and ointments Mepitel Atrauman Melolin Hydrocolloid Low to moderate exudating wounds. It promote debridement of slough and necrosis. Reduce pain through hydration of nerve endings Comfeel Granuflex

17. PRODUCT TYPEINDICATION FOR USE PRODUCT SAMPLE Alginate Moderate to heavy exudating wounds Bleeding wounds Ribbon and packing variations enables insertion into wound cavity Sorbsan Kaltostat HydrogelDry, necrotic, thick sloughy wounds Intrasite Activheal Actiform cool Antimicrobial Infected and critically colonized wounds. Wet and dry wounds Acticoat Iodoflex DeodorizingTo reduce/ eliminate Odour. Most contain charcoal. Actisorb silver Carboflex

18. PRODUCT TYPEINDICATION FOR USE PRODUCT SAMPLE Larval therapy Treatment of sloughy infected wounds to debride devitalized tissue. Larv E Topical Negative pressure therapy Highly exudating wounds, Complex wounds and those where healing is compromised. VAC pumps

19. DRESSINGS…….. Semi permeable film dressings 1. Semi permeable- tranmitting moisture vapour but do not absorb exudate 2. Provide protective environment – impermeable to bacteria and liquids 3. Can keep in place for 7 days 4. Caution when removing film dressings as the adhesive can damage the epidermal skin layer.

20. Semipermeable film dressings Semipermeable film dressings

21. Semipermeable film with pad Semipermeable film with pad

22. Hydrocolloid…. 1. They use wound fluid to form moist gel at the wound interface. 2. Contains Carboxymethyl cellulose, gerlatin and pectin. 3. Low moisture transmission rates 4. Promote wound debridement and angiogenesis 5. absorb excess exudates 6.Depends on the level of exudate dressing can stay upto 6 days

23. Hydrocolloid….

24. Alginate dressings……. 1.Contain calcium or sodium alginate derived from sea algi. 2. When in contact with wound exudate, a hydrophilic gel is formed which makes for easier dressing removal. 3. Calcium component in this act as a haemostat- useful for bleeding wounds. 4. Ribbon and ropes are available – useful to pack cavity wounds

25. Alginate dressings……. Alginate dressings…….

26. Hydrogel…… 1. Insoluble polymers with high water content – make them ideal to facilitate autolytic debridement of necrosis and slough. 2. In tubes or flat sheet dressings and selection depends on position and depth of the wound

27. Hydrogel…Hydrogel…… Hydrogel…

28. Antimicrobial….. 1.Increase in use following concerns over the development and spread of antibiotic resistance 2. Acute and chronic wounds 3. two main types which use silver or iodine. 4. Effective against Psedumonas, Staph aureus

29. Antimicrobial…..

30. Deodorizing……. 1. Made up of activated charcoal- able to absorb gas molecules 2. Used in infected or malignant wounds to control odour.

31. Deodorizing…….

32. Foam dressings: 1. Made up of polyureathene/ silicone- enable them to handle large volume of exudates 2. Available range of thickness 3.Adhesive and non adhesive formula 4. Useful in reducing over granulation when applied with slight pressure 5. Easy dressing removal

33. Foam dressings:

35. COST FACTOR Evaluation of the cost necessitates an appraisal of other factors apart from the cost of the dressing alone These include: 1. Number of dressing change 2. Healing time 3. Nursing cost 4. Expenses from in patient stay

36. COST…… One study from UK showed ( Cost effectiveness of wound Mx protocol Br j Nur 2009) healing of venous ulcer over 12 weeks period, the average dressing changes from gauze were 171, compared to 26 with hydrocolloid dressing. Audit from Hull in 2005 showed inpatient care required to only 16% with modern dressing.

37. To increase the overall cost- effectiveness emphasis on early treatment of wounds with avoidance of complications and a reduced demand of nursing time. Nursing time demand is reduced by minimizing dressing change with complication of wounds reduced by improving overall wound management practice.

38. CONCLUSION…… All wounds heal differently Individual approach to dressing selection is essential Need understanding the basic principals of wound healing and a systematic assessment of each individual wound will permit clinician to provide optimal treatment.