Flashcards in Wound treatments Deck (33):
Methods of debridement
Not appropriate if insufficient vascular supply or poor nutrition.
Sharp debridement termination
Decline in status/tolerance
New fascial plane
No more necrotic tissue
Natural degredation of devitalization
Not appropriate with infection or arterial insufficiency
Use of enzymatic ointments to loosen and remove devitalized tissue and protein
May be painful
Enzymatic Debridement procedure and termination
Termination: failure to decrease necrosis or necrosis resolve.
Procedure: prescription needed.
Larva: sterile, lab-raised maggots.
Requires 2* dressing.
Can reduce bacteria
Seldom used in US
External force to non-selectively remove necrotic tissue
Can cause bleeding
Gauze, pulse lavage, whirlpool, wet to dry
Physician: extensive exploration of wound bed and deep debridement
For: ascending cellulitis, osteomyelitis, undermining
Necrotic tissue near vital organs
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.
Must have script
Selective vs non
Conservative sharps only.
Type/amount of necrosis
Intact eschar s drainage, erythema or flatuance or poor circulation
Unidentified structures in wound bed
Benefits: cleanses wound, promotes circulation, promotes debridement
Precautions: malignancy, promotes edema, can cause trauma to healthy tissue, avoid in diabetic wounds
Infections: contaminated water, cross contamination
Changing of skin pH
water temp: 80-92, 92-96, 96-104
Promotes local circulation
Reduces bacterial load
Healthy debridement if using high pressure jet
Wear protective clothing
Reliable alternative to whirlpool
Minimal risk of cross contamination
Eliminates dependant edema issues
Syringe vs gauze: 35 ml syringe
Irrigate with dressing changes
Increases tensile strength
Migration of inflammatory and repair cells
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
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.
severe arterial insufficiency
untreated acute wound
consider poor ability to penetrate eschar
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
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
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
Photo energy that produces NO in hemoglobin to reoxygenate wound bed.
Full body or multiplace
100% o2 at high pressures
Daily or BID
Promotes angiogenesis and o2 perfusion
Grade 3/4 diabetic ulcer, compromised skin graft, radionecrosis, arterial insufficiency, crush injury, necrotizing fasciitis, gas gangrene, chronic osteomyelitis
Base of toes to knees
Distal to proximal
ABI greater than .6-.8.
1: 14-18=edema prevention, DVT prophylaxis
2: 18-24: dependent edema
3: 25-35: venous insufficiency
4: 40-50: lymphedema
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
from pig small intestine submucosa
collagenous ECM c cytokines
temporary dressing for partial and full thickness wounds
hydrated on application