View
229
Download
0
Category
Preview:
Citation preview
8/8/2019 Wound and Advanced Wound Material
http://slidepdf.com/reader/full/wound-and-advanced-wound-material 1/63
TX 9159 MEDICAL TEXTILES
UNIT IV
Wound ± types, healing process; requirement of
wound dressing; an overview of wound care
materials - study of various kinds of wound caredressing and advanced wound dressings;
8/8/2019 Wound and Advanced Wound Material
http://slidepdf.com/reader/full/wound-and-advanced-wound-material 2/63
Wounds
Definition:
An injury to any part of the body
External injury in which the skin is torn, cut, or
pierced
8/8/2019 Wound and Advanced Wound Material
http://slidepdf.com/reader/full/wound-and-advanced-wound-material 3/63
Classification of wounds
1. Intentional Vs. Unintentional.
2. Open Vs.C
losed.3. Degree of contamination.
4. Depth of the wound.
8/8/2019 Wound and Advanced Wound Material
http://slidepdf.com/reader/full/wound-and-advanced-wound-material 4/63
8/8/2019 Wound and Advanced Wound Material
http://slidepdf.com/reader/full/wound-and-advanced-wound-material 5/63
Open Vs. Closed wounds
Open wound: the mucous membrane or skin surface is
broken.
Closed wound: the tissue are traumatized without a
break in the skin.
8/8/2019 Wound and Advanced Wound Material
http://slidepdf.com/reader/full/wound-and-advanced-wound-material 6/63
Degree of contamination
Clean wounds: are uninfected wounds in which minimal
inflammation exist, are primarily closed wounds.
Clean ²contaminated wound: are surgical wounds in
which the respiratory, alimentary, genital, or urinary
tract has been entered. There is no evidence ofinfection.
8/8/2019 Wound and Advanced Wound Material
http://slidepdf.com/reader/full/wound-and-advanced-wound-material 7/63
Degree of contamination
Contaminated wounds: include open, fresh,
accidental wounds. There is evidence of
inflammation.
Dirty or infected wounds: includes old, accidental
wounds containing dead tissue and evidence ofinfection such as pus drainage.
8/8/2019 Wound and Advanced Wound Material
http://slidepdf.com/reader/full/wound-and-advanced-wound-material 8/63
Depth of the wound
Partial thickness: the wound involves dermis and
epidermis.
Full thickness: involving the dermis, epidermis,
subcutaneous tissue, and possibly muscle and bone.
8/8/2019 Wound and Advanced Wound Material
http://slidepdf.com/reader/full/wound-and-advanced-wound-material 9/63
8/8/2019 Wound and Advanced Wound Material
http://slidepdf.com/reader/full/wound-and-advanced-wound-material 10/63
Anatomy of Skin
Dermis:
composed of a thick layer of skin that containscollagen and elastic fibers, nerve fibers, blood
vessels, sweat and sebaceous glands, and hairfollicles.
Subcutaneous Tissue:
composed of a fatty layer of skin that containsblood vessels, nerves, lymph, and looseconnective tissue filled with fat cells.
8/8/2019 Wound and Advanced Wound Material
http://slidepdf.com/reader/full/wound-and-advanced-wound-material 11/63
8/8/2019 Wound and Advanced Wound Material
http://slidepdf.com/reader/full/wound-and-advanced-wound-material 12/63
Stage I
8/8/2019 Wound and Advanced Wound Material
http://slidepdf.com/reader/full/wound-and-advanced-wound-material 13/63
Stage II
8/8/2019 Wound and Advanced Wound Material
http://slidepdf.com/reader/full/wound-and-advanced-wound-material 14/63
Stage III
8/8/2019 Wound and Advanced Wound Material
http://slidepdf.com/reader/full/wound-and-advanced-wound-material 15/63
Stage IV
8/8/2019 Wound and Advanced Wound Material
http://slidepdf.com/reader/full/wound-and-advanced-wound-material 16/63
Wound Healing Process
8/8/2019 Wound and Advanced Wound Material
http://slidepdf.com/reader/full/wound-and-advanced-wound-material 17/63
Exact biologic process that takes place in orderly
sequence
An exudate containing blood, lymph, and fibrin beginsclotting and loosely binds the cut edges together
Blood supply to the area is increased, and the basic
process of inflammation is set in motion Leukocytes increase in number to fight bacteria in the
wound area and by phagocytosis help to removedamaged tissues
The served tissue is quickly glued together by strandsof fibrin and a thin layer of clotted blood, forming ascab
8/8/2019 Wound and Advanced Wound Material
http://slidepdf.com/reader/full/wound-and-advanced-wound-material 18/63
Wound Healing
Plasma seals to the surface to form a dry protectivecrust
This seal helps to prevent fluid loss and bacterial
invasion During the first few days of wound healing, the seal
has little tensile (The resistance of a material to aforce tending to tear it apart) strength
After 3-4 days , connective tissue cells(fibroblasts)rapidly proliferate and give strength tothe wound by producing collagen, a tough fibrousprotein responsible for the structural integrity of theskin
8/8/2019 Wound and Advanced Wound Material
http://slidepdf.com/reader/full/wound-and-advanced-wound-material 19/63
Wound Healing
At the same time small blood vessels regenerate andbuild new blood channels, granulation tissue (fibrousconnective tissue)includes blood vessels and
lymphatics that proliferate from the base of thewoind
Rapidly growing and multiple epithelial cells begin torestore the epithelial continuity of the skin
At this stage the wound appears healed, healing isnot complete until the granulation tissue organizes intoscar tissue
8/8/2019 Wound and Advanced Wound Material
http://slidepdf.com/reader/full/wound-and-advanced-wound-material 20/63
Wound Healing
By the ninth or tenth day, the wound is moderately
well healed and then becomes progressively stronger
The whole process of repair takes 2 weeks or more
depending on factors such as physical condition of thepatient, size and location of the wound, and stresses
put on the incisional area
During this time the scar (cicatrix)strengthens as the
connective tissue shrinks
8/8/2019 Wound and Advanced Wound Material
http://slidepdf.com/reader/full/wound-and-advanced-wound-material 21/63
Wound healing phases
Inflammatory phase
Proliferative phase
Maturational phase
8/8/2019 Wound and Advanced Wound Material
http://slidepdf.com/reader/full/wound-and-advanced-wound-material 22/63
Inflammatory phase
The body·s defenses are aimed at limiting the
amount of damage and preventing further injury
8/8/2019 Wound and Advanced Wound Material
http://slidepdf.com/reader/full/wound-and-advanced-wound-material 23/63
At the initial time of tissue
disruption, platelets
release coagulation factors
and cytokines to initiate
the healing process
Inflammatory phase
8/8/2019 Wound and Advanced Wound Material
http://slidepdf.com/reader/full/wound-and-advanced-wound-material 24/63
Within the first day
following tissue injury,
neutrophils attatch to
surrounding vessel walls
and then move through the
vessel walls to migrate to
the wound site
Inflammatory phase
8/8/2019 Wound and Advanced Wound Material
http://slidepdf.com/reader/full/wound-and-advanced-wound-material 25/63
8/8/2019 Wound and Advanced Wound Material
http://slidepdf.com/reader/full/wound-and-advanced-wound-material 26/63
Angiogenesis
The process of new blood vessel formation to
support a healing wound environment
Stimulants ;
tissue hypoxia ² major stimulus
TNF-, heparin, VEGF, FGF-1, FGF-2
8/8/2019 Wound and Advanced Wound Material
http://slidepdf.com/reader/full/wound-and-advanced-wound-material 27/63
The fibroplasia phase is
characterized by
movement of wound
macrophages into the site
of injury, which in turn
attract fibroblasts. The
fibroblasts then repair the
site by producing new
connective tissue matrix.
8/8/2019 Wound and Advanced Wound Material
http://slidepdf.com/reader/full/wound-and-advanced-wound-material 28/63
Maturational phase ( = remodeling )
The period of scar contracture with collagen
cross-linking, shrinking, and a loss of edema
8/8/2019 Wound and Advanced Wound Material
http://slidepdf.com/reader/full/wound-and-advanced-wound-material 29/63
The remodeling phase is
characterized by an
equilibrium between
collagen synthesis and
collagen degradation in an
effort to reestablish the
connective tissue matrix.
8/8/2019 Wound and Advanced Wound Material
http://slidepdf.com/reader/full/wound-and-advanced-wound-material 30/63
8/8/2019 Wound and Advanced Wound Material
http://slidepdf.com/reader/full/wound-and-advanced-wound-material 31/63
8/8/2019 Wound and Advanced Wound Material
http://slidepdf.com/reader/full/wound-and-advanced-wound-material 32/63
8/8/2019 Wound and Advanced Wound Material
http://slidepdf.com/reader/full/wound-and-advanced-wound-material 33/63
8/8/2019 Wound and Advanced Wound Material
http://slidepdf.com/reader/full/wound-and-advanced-wound-material 34/63
8/8/2019 Wound and Advanced Wound Material
http://slidepdf.com/reader/full/wound-and-advanced-wound-material 35/63
8/8/2019 Wound and Advanced Wound Material
http://slidepdf.com/reader/full/wound-and-advanced-wound-material 36/63
Factors influencing wound healing
Other factors pat age, stress level, presxisting
condition as diabete, anemia, malnutriion, cancer ,
obesity, advanced age, cardiovascular, respiratory
impairments. Overall physiacal and psychologicalcondition
8/8/2019 Wound and Advanced Wound Material
http://slidepdf.com/reader/full/wound-and-advanced-wound-material 37/63
8/8/2019 Wound and Advanced Wound Material
http://slidepdf.com/reader/full/wound-and-advanced-wound-material 38/63
Study of Various Kinds of WoundCare Dressing and Advanced
Wound Dressings
8/8/2019 Wound and Advanced Wound Material
http://slidepdf.com/reader/full/wound-and-advanced-wound-material 39/63
8/8/2019 Wound and Advanced Wound Material
http://slidepdf.com/reader/full/wound-and-advanced-wound-material 40/63
8/8/2019 Wound and Advanced Wound Material
http://slidepdf.com/reader/full/wound-and-advanced-wound-material 41/63
Dressing Choice
Wound Type Goal Superficial
Wound
Cavity
Black/ lowexudate
Rehydrate/debride HydrogelHydrocolloid
HydrogelHydrocolloid
Yellow/ high
Exudate
Remove slough
Control exudate
Hydrocolloid
Exudate
Absorbers
Hydrocolloid
Exudate Absorbers
Foam dressing
Yellow / low
exudate
Remove slough
Control exudate
Hydrogel
Hydrocolloid
Film
Hydrocolloid
Exudate Absorbers
Foam dressing
8/8/2019 Wound and Advanced Wound Material
http://slidepdf.com/reader/full/wound-and-advanced-wound-material 42/63
Dressing Choice
Wound type Goal Superficial Cavity
Red/ high
exudate
Absorb exudate
Maintain moist
environment
Promote
granulation
Foams
Hydrocolloid
Exudate
absorbers
Hydrocolloids
Exudate
Absorbers
Foam cavity
dressing
Red/ low exudate Maintain moist
environmentPromote
granulation
Hydrogel
Hydrocolloid(thin)
Film
Hydrogel
HydrocolloidFoam dressing
8/8/2019 Wound and Advanced Wound Material
http://slidepdf.com/reader/full/wound-and-advanced-wound-material 43/63
Wound Dressings-Hydrogels
Used to keep woundsmoist
Clear viscous gelsprotect wound fromdesiccating
Not used if wound isproducing heavyexudate.
If wound is infected,hydrogel serves no purpose.
Used as primary dressing
with wounds substantially orfully granulated
If there is black eschar oryellow slough, the necrotic
tissue should be removed.
8/8/2019 Wound and Advanced Wound Material
http://slidepdf.com/reader/full/wound-and-advanced-wound-material 44/63
Wound Dressing-Hydrogel Sheets
Non-adhesive and will not stick wound base
Keeps wound moist
Protects against contamination
Capable of absorbing exudate
Promotes healing
Secured to wound: gauze or tubular bandage
8/8/2019 Wound and Advanced Wound Material
http://slidepdf.com/reader/full/wound-and-advanced-wound-material 45/63
Wound Dressing-Hydrogel gauze
Combination of gauze
and hydrogel in same
package
Should be used on
wounds free of necrotic
tissue and /or infection
8/8/2019 Wound and Advanced Wound Material
http://slidepdf.com/reader/full/wound-and-advanced-wound-material 46/63
Wound Dressings-Hydrogel
Applications
Used daily for 30 days
3 ounces of gel per wound depending
on how large the wound is.
8/8/2019 Wound and Advanced Wound Material
http://slidepdf.com/reader/full/wound-and-advanced-wound-material 47/63
Wound Dressing - Alginates
Made from seaweed
Formed into flat squares or sheets ofunwoven fibers into twisted robes or pads.
Fibers are soft in texture and easily pulledapart.
Primary dressing for wounds that havemoderate to heavy exudate.
Applied to wound beds to absorb exudateand transudate ² keeping the wound moist.
8/8/2019 Wound and Advanced Wound Material
http://slidepdf.com/reader/full/wound-and-advanced-wound-material 48/63
WoundDressings-Alginates
Form a gel like plug which absorbs 20
times its weight
Held in place by secondary
dressing(MVPF, hydrogel sheet, gauze)
Doesn·t cause infection or inflammation
8/8/2019 Wound and Advanced Wound Material
http://slidepdf.com/reader/full/wound-and-advanced-wound-material 49/63
Wound Dressings-MVPF
Moisture Vapor Permeable Film
Adhesive film dressing, waterproof but allow
passage of O2 and H2O vapor from site
Prevent desiccation and bacterial contamination
Moist healing environment, retain growth factors
Promotes autolysins of necrotic tissue in bed
Translucent, help clinician visualize wound
8/8/2019 Wound and Advanced Wound Material
http://slidepdf.com/reader/full/wound-and-advanced-wound-material 50/63
Wound Dressings-MVPF
Uses:
Secondary dressing over wounds with
high shear
Adhere better to protect light to medium
exudate
May be left in place for days withuninfected wounds
Hold primary dressing in place
8/8/2019 Wound and Advanced Wound Material
http://slidepdf.com/reader/full/wound-and-advanced-wound-material 51/63
Wound Dressings-Cleansers
Solutions contain water, surfactants, salt
Wash and irrigate wounds with mild pressure
Wet wound to wash out exudate
Makes debridement easier
8/8/2019 Wound and Advanced Wound Material
http://slidepdf.com/reader/full/wound-and-advanced-wound-material 52/63
Wound Dressings-Hydrofiber
Exudate Absorber
Held in place by secondary dressing
Keeps wound moist yet absorbs excessive
exudate
8/8/2019 Wound and Advanced Wound Material
http://slidepdf.com/reader/full/wound-and-advanced-wound-material 53/63
Wound Dressings-Foams
Highly absorbent primary
dressings composed ofhydrophilic polyurethane
foam
8/8/2019 Wound and Advanced Wound Material
http://slidepdf.com/reader/full/wound-and-advanced-wound-material 54/63
Wound Dressings-Foams
Keeps wound environment
moist, absorbs exudate
Can be placed in wound tofill bed while absorbing
continuous exudate
Remains in wound for 3-4days
8/8/2019 Wound and Advanced Wound Material
http://slidepdf.com/reader/full/wound-and-advanced-wound-material 55/63
8/8/2019 Wound and Advanced Wound Material
http://slidepdf.com/reader/full/wound-and-advanced-wound-material 56/63
Wound Dressings-Hydrocolloid
Placed on wet wounds and wet
surrounding skin, remains intact
because it can adhere to WET
TRACK
Do not use on infected wounds
May have foul odor after
2-4 days
8/8/2019 Wound and Advanced Wound Material
http://slidepdf.com/reader/full/wound-and-advanced-wound-material 57/63
Advanced wound dressings
8/8/2019 Wound and Advanced Wound Material
http://slidepdf.com/reader/full/wound-and-advanced-wound-material 58/63
Wound Dressings-Tissue Engineering
Science of creating functional tissues or organs
Potentially has a dramatic effect on medicine
by providing physiologic implants for tissueregeneration
Products
Dermagraft
TransCyte
Apligraft
8/8/2019 Wound and Advanced Wound Material
http://slidepdf.com/reader/full/wound-and-advanced-wound-material 59/63
Wound Dressings-Dermagraft
Human living dermal replacement
Designed for the treatment of skin ulcers
Provides a living metabolically activehuman dermal tissue that interacts with
the wound bed
Produced by seeding dermal fibroblasts onto scaffold of bioabsorbable
material
Advantages:
Accelerates healing bye introducing collagens, matrix proteins,growthfactor.
8/8/2019 Wound and Advanced Wound Material
http://slidepdf.com/reader/full/wound-and-advanced-wound-material 60/63
Wound Dressings TransCyte
Human based temporary skin substitute
Treatment for second and third degree burns
Advantages:
Easy application and removal
Faster healing time with lessinflammation
One time applications
Decreased hospital periods
8/8/2019 Wound and Advanced Wound Material
http://slidepdf.com/reader/full/wound-and-advanced-wound-material 61/63
Wound Dressings: TransCyte
Consists of dermal tissue and synthetic epidermal layer
Provides a temporary covering to protect wound from fluidloss and infection
Remains in place until sufficent skin grafting is available or
until healed
http://www.advancedtissue.com/transcyte.html
Players dealing in innovative/ advance
8/8/2019 Wound and Advanced Wound Material
http://slidepdf.com/reader/full/wound-and-advanced-wound-material 62/63
Players dealing in innovative/ advance
Wound Dressings
Quick- Med Technologies,
US
Comvita, NewZeland.
Imedex Biomateriaux,
France.
3M
Kimberly clark
Smith & Nephew
Area Labs, US
Johnson & Johnson
Nycomed Pharma,
Norway
8/8/2019 Wound and Advanced Wound Material
http://slidepdf.com/reader/full/wound-and-advanced-wound-material 63/63
Recommended