Wound Management

Question 1

What are 4 characteristics of the primary/contact layer of a bandage?

Answer 1

1. sterile
2. conforms to the body and contours
3. nontoxic and nonirritating
4. minimizes pain

Question 2

In what ways can primary layers of bandages maintain the optimal environment for wound healing?

Answer 2

• protection
• debridement
• absorbs exudate
• delivers topical medications
• promotes moist wound healing

Question 3

What are the 2 types of primary layers?

Answer 3

1. ADHERENT - dry, wet to dry, moist
2. NON-ADHERENT - semiocclusive, occlusive

Question 4

What are the most moisture retentive primary dressings?

Answer 4

occlusive dressings (non-adherent) —> low moisture vapor transmission rate (MTVR)

Question 5

What are 5 examples of highly absorptive primary layers?

Answer 5

1. hypertonic saline - 20% dry sodium chloride combined with absorbent dressing
2. saline impregnated dressings
3. gauze sponges
4. calcium alginate
5. copolymer starch

Question 6

What are adherent brandages?

Answer 6

bandages with wide mesh openings and no cotton filler, which provides micro-debridement —> painful and not recommended for prolonged use

• dry
• wet to dry
• moist

Question 7

What is a dry bandage? When are they most commonly used?

Answer 7

an adherent bandage applied dry and covered with an absorbant layer and takes necrotic debris attached to it upon removal

wounds with low viscosity exudate (thin, runny)

Question 8

What is the major indication for wet to dry gause dressings? Why?

Answer 8

wounds producing primarily serous or serosanguinous exudate

applying sponges dry allows them to soak up more fluid

Question 9

What is calcium alginate dressing? What 3 functions does it have?

Answer 9

nonwoven felt-like material derived from seaweed

1. extremely hydrophilic - fluid absorption converts it into a gel
2. enhances granulation tissue formation
3. aids in hemostasis

Question 10

What is the major indication for applying calcium alginate dressing? What is a major benefit to this type of dressing?

Answer 10

moderate to heavy exudative wounds in the early stages of healing

less painful to change than gauze

Question 11

What is maltodextrin? What 4 functions does it have?

Answer 11

D-glucose polysaccharide

1. chemotactic of PMNs, lymphocytes, macrophages
2. provides energy for cells
3. stimulates rapid granulation tissue formation and epithelialization
4. antibacterial

Question 12

What are the 3 indications for the use of maltodextrin in bandages?

Answer 12

1. cleanse and promotes healing of contaminated and infected wounds
2. enhances granulation tissue formation
3. induce healing in chronic wounds and ulcers

Question 13

Why are gunshot wounds especially dangerous?

Answer 13

• high energy
• foreign material (tiny, scatters)
• collateral damage = small entry point, but a lot of contamination underneath

Question 14

In what kinds of wounds are wet to dry bandages used? What happens when they are removed?

Answer 14

wounds with high viscosity exudate

bandage is removes dry with necrotic debris attached

Question 15

What are 2 indications for the use of wet to dry gauze bandages? What type of gauze is used?

Answer 15

1. necrotic tissue and/or FB
2. high viscosity exudate

wide mesh gauze to liquefy viscous exudate and entrapment within the dressing

• can be used as a vehicle to deliver antiseptic to the wound

Question 16

What is Kerlix AMD? What additional effect does it have?

Answer 16

polyhexamethylene biguanide used as an adherent topical dressing to aid wound debridement

broad-spectrum antibacterial

Question 17

What are 3 indications for the use of Kerlix AMD for wounds?

Answer 17

highly exudative wounds

1. degloving injuries
2. bite wounds
3. deep cavity wounds

Question 18

What are wet to dry bandages? When are they used?

Answer 18

bandage applied moist, typically with saline or 1:40 chlorhexidine, and covered in an absorbent layer

wounds in the inflammatory and debridement phases of wound healing —> more tissue-friendly dressings should be used whenever possible

Question 19

What are the 4 major disadvantages to using adherent absorptive dressings?

Answer 19

1. tissue trauma
2. removes substances in wound fluid that promote healing
3. maceration of surrounding skin
4. if bandage is able to soak through, bacteria can move in or out

Question 20

When are moist bandages used?

Answer 20

when the bandage is used to remove moisture, typically in wounds without exudate at the repair stage

Question 21

How do moisture retentive dressings compare to adherent dressings?

Answer 21

better for wounds in late debridement/proliferative phases because they optimize the body’s inherent wound healing abilities - maintains proteases, protease inhibitors, growth factors, and cytokines

(occlusive)

Question 22

What are 3 examples of moisture retentive dressings?

Answer 22

1. polyurethane foam/film
2. hydrogel
3. hydrocolloids

Question 23

What are 4 advantages to using moisture retentive dressings?

Answer 23

1. selective autolytic debridement - WBCs remain active
2. lower oxygen tension in wound lowers wound pH, deterring bacterial growth and favors angiogenesis and fibroblast function
3. less risk of infection with exogenous bacteria
4. less painful to remove

Question 24

What are 2 examples of biological dressings?

Answer 24

1. equine amnion - early stages of wound healing, limited storage time (6 months)
2. matrix derived xenograft and allografts - collagen, porcine small intestinal/urinary bladder submucosa

Question 25

What collagen is used as a biological dressing? What 3 actions does it have?

Answer 25

bovine - powder, matrix sponge, semiliquid gel 1. scaffold or fibroblast ingrowth 2. collagen deposition 3. enhances epithelial cell migration

Question 26

What is the main indication for collagen biological dressings? What is an important precaution? How can this be avoided?

Answer 26

wounds in late inflammatory and early repair stages of wound healing can cause inflammatory reactions - avoid overlapping sponges onto surrounding skin

Question 27

What are 3 functions of type I collagen as a biological dressing?

Answer 27

1. acts as a wound graft by providing a lattice for fibroblast and capillary bed migration 2. assists in hemostasis 3. some absorption

Question 28

What forms does type I collagen come in?

Answer 28

- particles - suspension - dressing

Question 29

What is the function of porcine small intestinal submucosa?

Answer 29

reinforces wound tissue and is absorbed by the body as it is replaces by host tissue - single/multi layer sheets - sponge - powder - discs for corneal ulcers

Question 30

How is porcine small intestinal submucosa extracted for biological dressings? What does it contain?

Answer 30

in a manner that removes all cells, but leaves the complex matric intact - collagen I, III, V - fibronectin - decorin - hyaluronic acid - chondroitin sulphate A - heparin sulfate - growth factors

Question 31

What are the 3 main indications for porcine small intestinal submucosa?

Answer 31

1. degloving injuries and other large skin defects containing healthy tissue 2. use until definitive reconstruction 3. dermal substitute to guide wound repair in reparative stage of wound healing

Question 32

How does porcise small intestinal submucosa dressings guide wound repair?

Answer 32

inhibits wound contraction, allowing epithelialization to predominate - can take longer than second intention healing

Question 33

How are porcine submucosa dressings applied?

Answer 33

- rough side in contact with the wound - suture into wound bed and under wound edge to enhance epithelial cell migration

Question 34

What are 2 uses of porous non/low adherent dressings?

Answer 34

1. protects sutured wounds 2. wounds in reparative stages with healthy granulation tissue

Question 35

What are the 3 types of non-adherent bandages?

Answer 35

1. NONOCCLUSIVE - Adaptic 2. SEMI-OCCLUSIVE - Telfa, DuoDerm 3. OCCLUSIVE - Biodres, Ulcer Dressing

Question 36

What are 2 functions of non-occlusive bandages? When is it indicated?

Answer 36

1. permits gas exchange without retention of moisture 2. acts as a microbial barrier partial thickness wounds in the repair stage

Question 37

What are 2 functions of semi-occlusive bandages? When is it indicated?

Answer 37

1. retains moisture to prevent wound dehydration 2. permits excess fluid to be absorbed acute wounds in repair stage

Question 38

What are 2 functions of occlusive bandages? When are they indicated?

Answer 38

1. retains complete moisture to prevent wound dehydration and variable gas exchange 2. microbial barrier wounds in the repair stage

Question 39

What is the secondary layer? What material is commonly used?

Answer 39

the layer overlying the contact layer that *absorbs exudate* and acts as a splint to provide some support cast padding, rolled cotton

Question 40

What are 3 functions to the tertiary layer? What materials are used?

Answer 40

1. secures bandage layers in place 2. porous material allows for evaporation of moisture 3. pressure applied can help control hemorrhage rolled gauze and porous/elastic tape

Question 41

What is primary closure? In what 2 situations is this done?

Answer 41

closure of a wound soon after injury 1. minimal contamination 2. minimal trauma

Question 42

What is delayed primary closure?

Answer 42

closure after local infection or heavy contamination is controlled or debrided, usually within 2-3 days

Question 43

What is secondary closure?

Answer 43

closure after a granulation bed has formed with heavy infection management, usually >5 days after injury

Question 44

What is second intention healing? What are 2 indications? What precaution should be noted?

Answer 44

healing by contraction and epithelialization 1. large defects with heavy tissue damage 2. serious infection present may result in abnormalities requiring additional surgery

Question 45

When is topical wound medication recommended? How do most of them work?

Answer 45

slow healing or nonhealing wounds modulating macrophage functions

Question 46

What antimicrobials are commonly used for topical wound therapy?

Answer 46

- Bacitracin/Neomycin/Polymyxin (triple antibiotic) ointment - povidone-iodine ointment - chlorhexidine ointment - Nitrofurazone - silver Sulfadiazine

Question 47

Why is the use of triple antibiotic ointment controversial? What is its indication?

Answer 47

- may slow down epithelialization - benefits may be due to the vehicle - must be handled aseptically and in limited amounts superficial wounds or skin graft dressings

Question 48

What is the indication for povidone-iodine and chlorhexidine ointment use?

Answer 48

control of superficial wound infections (can slow down epithelialization!)

Question 49

What effect do nitrofurazone and silver sulfadiazine have? What added effect does silver sulfadiazine have?

Answer 49

both broad spectrum and very effective in decreasing bacterial counts, especially in burn patients enhances epithelialization

Question 50

What are 2 common healing enhancers used for topical therapy?

Answer 50

1. zinc oxide ointment 2. type I collagen

Question 51

What are 4 functions of zinc oxide ointment?

Answer 51

1. soothing 2. promotes healing of abraded skin 3. enhances epithelialization 4. protects against dehydration

Question 52

What 3 functions does honey have for wounds?

Answer 52

1. hygroscopic - osmotically draws out moisture 2. promotes granulation tissue formation 3. antibacterial/antifungal - decreases pH

Question 53

What are 4 functions of sugar used for wound management?

Answer 53

1. primary antibacterial effect due to osmolality 2. cleans and reduced edema 3. promotes granulation tissue formation 4. attracts macrophages

Question 54

What 3 properties make aloe vera good for wound management? In what wounds are they used? What can it be combined with?

Answer 54

1. antibacterial 2. antiprostaglandin 3. antithromboxane partial thickness wound, manages eschar silver sulfadiazine for burn management

Question 55

What is Acemannan? What are 3 functions?

Answer 55

complex mannose-containing polymer derived from aloe vera 1. stimulates macrophages, resulting in IL-2 and TNF-a secretion 2. IL-1 = enhances fibroblast proliferation, collagen deposition, neovascularization, and epidermal growth and motility 3. TNF-a = induces angiogenesis

Question 56

Wound dressings:

Answer 56

Question 57

What is critical to wound healing?

Answer 57

continuous and efficient evaculation of exudate

Question 58

What is passive drainage? When is it used? What are 2 pros?

Answer 58

drainage by overflow or gravity, using Penrose, cigarette, and sump drains wounds with dead space, heavy contamination, and infection cost-effective and easy to apply

Question 59

What is correct with these drain placements?

Answer 59

- places perpendicular to primary incision (parallel = dehiscence - hole larger than drain to allow fluid to drain around it - tacked above and below to avoid loss under the skin

Question 60

What is wrong with these drain placements?

Answer 60

- drain coming out of primary incision, long and untacked, touching hair - drain coming out of primary incision, exit not gravity-dependent, touching hair, not tacked down

Question 61

What is active drainage? What are 3 advantages? Disadvantage?

Answer 61

discharge is removed by negative pressure applied through a closed suction drain minimizes dressing moisture, bacterial contamination, and drainage time expensive!