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Flashcards in Wound treatments Deck (33):
1

Methods of debridement

Selective: Sharp
Autolytic
Enzymatic
Biologic

Non-Selective:
Mechanical
Surgical

2

Sharps Debridement

Selective
Aggressive
Possible pain

Not appropriate if insufficient vascular supply or poor nutrition.

3

Sharp debridement termination

Clinician fatigue
Excessive pain
Decline in status/tolerance
Extensive bleeding
New fascial plane
No more necrotic tissue

4

Autolytic Debridement

Natural degredation of devitalization
Conservative
Little pain
Slow

Not appropriate with infection or arterial insufficiency

5

Enzymatic debridement

Use of enzymatic ointments to loosen and remove devitalized tissue and protein

Papain-Urea
Collagenase
Sometimes slow
Non-selective
May be painful

6

Enzymatic Debridement procedure and termination

Termination: failure to decrease necrosis or necrosis resolve.

Procedure: prescription needed.
cross-hatch first.
moist environment

7

Biologic debridement

Larva: sterile, lab-raised maggots.
Requires 2* dressing.
Selective
Can reduce bacteria

Seldom used in US

8

Mechanical Debridement

External force to non-selectively remove necrotic tissue

Painful
Can cause bleeding

Gauze, pulse lavage, whirlpool, wet to dry

9

Surgical Debridement

Physician: extensive exploration of wound bed and deep debridement

For: ascending cellulitis, osteomyelitis, undermining

Necrotic tissue near vital organs

10

Goals of debridement

Promote wound cleansing to remove debris and necrosis.
Reduce bacterial bioburden/risk of infection.
Promote optimal enviroment for wound healing.
Promote inflammation to facilitate angiogensis.

11

PT documentation

Must have script
Selective vs non
Conservative sharps only.
Type/amount of necrosis
Insturments

12

Contraindications

Dry gangrene
Intact eschar s drainage, erythema or flatuance or poor circulation
Unidentified structures in wound bed

13

Whirlpool

Benefits: cleanses wound, promotes circulation, promotes debridement

Precautions: malignancy, promotes edema, can cause trauma to healthy tissue, avoid in diabetic wounds

14

Whilpool Risks

Infections: contaminated water, cross contamination
Superhydration/maceration
Changing of skin pH

15

Hydrotherapy considerations

water temp: 80-92, 92-96, 96-104
Dependent position
Duration
Addatives

16

Pulsatile lavage

Promotes local circulation
Reduces bacterial load
Healthy debridement if using high pressure jet
5-15 psi.
Wear protective clothing

17

Pulsatile Lavage

Reliable alternative to whirlpool
Minimal risk of cross contamination
Eliminates dependant edema issues

18

Wound Irrigation

Syringe vs gauze: 35 ml syringe
Irrigate with dressing changes
Saline
Wound cleanser
Betadine
Hydrogen Peroxide
Dakin's
Acetic Acid

4-15 psi

19

Electrotherapy

Increased perfusion
Stimulates fibroblasts
Increases tensile strength
Antibacterial
Debridement effects
Migration of inflammatory and repair cells

20

Current of injury

Electrical potential across skin
Current disappears with regeneration of tissue.

Positive polarity: coagulation of protein, hardening of tissue, coagulation of blood, enhancing scar formation

Negative polarity: liquefying protein, softening tissue, bactericidal, debridement

21

US

Stimulates release of chemoattractants by fibroblasts, mast cells, and macrophages.
May stimulate fibroblast proliferation for collagen deposition, angiogensis, and wound contraction.
Increases wound tensile strength.

22

US contraindications

osteomyelitis
active bleeding
severe arterial insufficiency
acute DVT
untreated acute wound

consider poor ability to penetrate eschar

23

Wound Vac (negative pressure therapy)

Increases perfusion to wound: increases o2 and nutrients
Helps drainage control
Change dressing every 48 hrs

Decreased edema, increased blood flow, decreased bacteria, more granulation tissue, promotes epithelialization

24

npwt indications

Arterial, venous, pressure, mixed vascualr ulcers, dehisced surgical wounds, wounds with tunneling/undermining, assist flap survival

Not indicated for wounds with 20%+ non viable tissue

25

NPWT contraindication and precaution

Contra: malignancy in wound, untreated osteomyelitis, unexplored fistula, eschar, exposed vessels/organs

Precaution: bleeding, anticoagulants, proximity to vessels, organs, bone, and enteric fistula

26

MIRE (anodyne)

Photo energy that produces NO in hemoglobin to reoxygenate wound bed.
Vasodilates

27

Hyperbaric o2

Full body or multiplace
100% o2 at high pressures
Daily or BID
Promotes angiogenesis and o2 perfusion
Restores pH

28

HBOT indications

Grade 3/4 diabetic ulcer, compromised skin graft, radionecrosis, arterial insufficiency, crush injury, necrotizing fasciitis, gas gangrene, chronic osteomyelitis

29

Compression

Reduce/control edema
Base of toes to knees
Distal to proximal
ABI greater than .6-.8.
Precaution: CHF

30

Compression classifications

1: 14-18=edema prevention, DVT prophylaxis
2: 18-24: dependent edema
3: 25-35: venous insufficiency
4: 40-50: lymphedema

31

Bioengineered skin substitutes

Apligraf: cultured from newborn foreskin, replaces dermis and epidermis
Indicated for non-infected venous ulcers
Dont use with bovine alergies

Dermagraft: derived from human fibroblast, replaces dermis only

32

OASIS

from pig small intestine submucosa

collagenous ECM c cytokines

temporary dressing for partial and full thickness wounds

hydrated on application

33

Topical growth factors

from recombinant human platelet derived growth factor

expensive