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NEW DRESSINGS FOR WOUND MANAGEMENT MAX BUSH, VMD DEPARTMENT OF SURGERY UPSTATE VETERINARY SPECIALTIES

New Dressings for Wound Management

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Page 1: New Dressings for Wound Management

NEW DRESSINGS FOR WOUND

MANAGEMENTMAX BUSH, VMD

DEPARTMENT OF SURGERY

UPSTATE VETERINARY SPECIALTIES

Page 2: New Dressings for Wound Management

OUTLINE• Introduction

• Pathophysiology of wound healing

• New management paradigms

• Primary dressing materials

• Honey

• Calcium Alginate

• Vacuum Assisted Closure (Negative Pressure Wound Therapy)

• Summary

Page 3: New Dressings for Wound Management

WOUND HEALING• Complex biologic process by which tissue attempts to restore

function and structural integrity after injury

• Organized into phases, which overlap

Page 4: New Dressings for Wound Management

PHASES OF WOUND HEALING• Inflammatory

• Removal of contaminants and dead/damaged tissue

• Proliferative

• Restoration of blood flow, ECM, and epithelium

• Maturation (Remodeling)

• Recovery of pre-wound strength

Page 5: New Dressings for Wound Management

INFLAMMATORY PHASE• Begins at time of

wounding

• Tissue disruption

• Coagulation cascade

• Platelets adherence, aggregation, degranulation

Page 6: New Dressings for Wound Management

• Neutrophils (24-48 hours)

• Bactericidal: ROS

• ECM breakdown

• Phagocytosis of bacteria and debris

• Cytokine release, prolonging inflammation

Inflammatory Phase

Page 7: New Dressings for Wound Management

PROLIFERATION PHASE• Days 4-12 (Duration variable)

• Wound size, location, age, health

• Predominant Cell Types

• Fibroblasts, endothelial and epithelial cells

• Capillary ingrowth, collagen production, wound contraction and coverage

Page 8: New Dressings for Wound Management

PROLIFERATION PHASE

Page 9: New Dressings for Wound Management

REMODELING PHASE

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REMODELING PHASE• Strengthening of collagen

• Conversion of matrix from thin, weak tissue to more organized rigid framework.

• Collagen synthesis complete by 4-5 weeks post injury –

maturation can continue for 12-18 months.

• Matrix strength improves as collagen is reabsorbed and redeposited along stress lines of the tissue.

• week 1: 3%

• week 3: 30%

• week 12: 80%

Page 11: New Dressings for Wound Management

IMPEDIMENTS TO HEALING• Local:

• Mechanical factors

• Wound perfusion

• Tissue viability

• Infection

Page 12: New Dressings for Wound Management

WOUND ASSESSMENT

• Location

• Exudate

• Infection

Culture and Sensitivity

• Stage

Does the wound require

additional debridement?

• What is the goal of the bandage?

Page 13: New Dressings for Wound Management

MOIST WOUND HEALING PARADIGM SHIFT

• Wet to dry bandages

• Non-selective mechanical debridement

• Destroy epithelial cells

• Can leave foreign material in the wound

• Painful

• Inefficient

• Increase risk of nosocomial infections

• Remove wound fluid

• Reduce temperature

Page 14: New Dressings for Wound Management

MOIST WOUND HEALING BENEFITS

• Improves resistance to infection

• Facilitates autolytic debridement

• Selective

• Preserves wound fluid

• Autolytic enzymes

• Growth factors

• Systemic antibiotics

Page 15: New Dressings for Wound Management

MOIST WOUND HEALING BENEFITS• Increases collagen synthesis and

fibroblast proliferation

• Hastens angiogenesis and wound

contraction

• Reduces pain

• Reduces scarring

• Faster healing

Page 16: New Dressings for Wound Management

SELECTION OF A DRESSING• Dressing should match the characteristics of the wound:

• Stage

• Exudate level

• Location

• Patient temperament

• Client compliance

Page 17: New Dressings for Wound Management

PETROLATUM IMPREGNATED GAUZE

Page 18: New Dressings for Wound Management

HYDROGELS

Page 19: New Dressings for Wound Management

HYDROCOLLOIDS

• Biocompatible hydrophilic polymersCarboxymethycellulose

• Powders, pastes, sheets• Absorbs exudate, conforms to wound

• Can cause maceration if gel overlaps skin edges

Page 20: New Dressings for Wound Management

CALCIUM ALGINATE

• Derived from Algae

• Non-occlusive, non-adhesive, highly absorptive

• Forms viscous hydrogel

• Can be inserted into deep cavitated wounds

Page 21: New Dressings for Wound Management

CALCIUM ALGINATE• Moderate to heavy exudate

• Many have silver ions to increase anti-microbial activity

• Hemostatic capability; can be applied post operatively

Page 22: New Dressings for Wound Management

HYDROFIBER

Page 24: New Dressings for Wound Management

HONEY DRESSINGS

Page 25: New Dressings for Wound Management

PHYSICAL/CHEMICAL CHARACTERISTICS

• Sugar concentration

• Osmotic effects

• Acidification

Page 26: New Dressings for Wound Management

DEBRIDEMENT

• Osmotic effect pulls fluid into the wound

from the interstitium

• Facilitates conversion of plasminogen to plasmin

Page 27: New Dressings for Wound Management

IMMUNOSTIMULATORY

• Upregulation of

• TNFa

• IL-1B

• IL-6

• TGF-a

Page 28: New Dressings for Wound Management

ANTI-INFLAMMATORY

• Phenolic compounds inhibit TNFa

• Apalbumin inhibits phagocytosis by macrophages

• Decrease inflammatory cells at the wound cells

• Reductions in pain, edema, exudate, scarring

Page 29: New Dressings for Wound Management

ANTIBIOSIS

• Effective against MDR Staph, Enterococci, Pseudomonas

• MOA

• Osmotic desiccation

• Acidity

• Enzymatic activity

• Plant factors

Page 30: New Dressings for Wound Management

BIOACTIVITY• Methylglyoxal – cytotoxic chemical, water soluble

• Maintains antibiotic efficacy above MIC even when diluted by wound fluids

• Effective against MDR bacteria

• MRSA

• Coagulase-negative Staphylococci

• VRE

• ESBL-E coli

• No resistance acquired

Page 31: New Dressings for Wound Management

NEGATIVE PRESSURE WOUND THERAPY

• Uses suction to modify the wound environment

• Macrostrain

• Microstrain

Page 32: New Dressings for Wound Management

NWPT THERAPY

• Open cell foam sealed with adhesive,

occlusive dressing

• Helpful to use stoma-paste

• Suction tubing is connected to canister,

creating closed system

Page 33: New Dressings for Wound Management

NWPT THERAPY

• Application of subatmospheric pressure

• Continuous or intermittent

• Dressing is changed q3-4d

• Standard pressure is -125mmHg

Page 34: New Dressings for Wound Management

NEGATIVE PRESSURE WOUND THERAPY

• Fluid removal

• Physical tension

• Microdeformation

Page 35: New Dressings for Wound Management

VAC USES

• Degloving

• Chronic wounds

• Severe abscess

• Incisions with risk of dehiscence or infection

• Traumatic wounds

• Ulcers

• Infected lacerations

• Flaps and grafts

Page 36: New Dressings for Wound Management

SUMMARY• Wide variety of wound dressings

• Assess the wound

• Match its needs

• Moist Wound Healing

• Speed wound healing

• Reduce client cost

• Improve patient outcomes

Page 37: New Dressings for Wound Management

FURTHER INFORMATION

• Moist Wound Healing: The New Standard of Care

• Bonnie Grambow Campbell,

Today’s Veterinary Practice July/August 2015

• Good article discussing MWH

• Guidelines for dressing selection and timing of changes

Page 38: New Dressings for Wound Management

QUESTIONS?