Wounds 4 Flashcards

1
Q

Necrotic wounds

A
• Must remove dead tissue to expose health tissue
• Reduce risks of: 
– Infection
– General sepsis
– Failure to heal
– Failure to reduce in size
• Necrotic wounds require debridement
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2
Q

Necrotic wound debridement: Autolytic debridement

A

Autolytic debridement
• Utilises bodies own enzymes to break down dead tissue
• Will not break down healthy tissue
• Need occlusive dressing to retain moisture
• Dressings:
– Hydrogels (ideal)
– Hydrocolloids (use thin)
– Alginates (only in very wet sloughy wounds)

  • Slow process
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3
Q

Necrotic wound debridement: Sharp debridement

A
Sharp debridement
• Selective removal of dead tissue
• Conservative
– Bedside using scissors or scalpel
– Should be painless but LA may be used
• Surgical
– Requires general anaesthetic
– Removes both dead and healthy tissue
– Painful
– Often more than one visit to theatre required
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4
Q

Necrotic wound debridement: Biosurgical debridement

A
Biosurgical debridement
• Sterilelarvae
• Lucilia sericata (green bottle larvae)
• “Free range” maggots (contained in a net!) 
– Secrete proteolytic enzymes
– Break down dead tissue for ingestion
– pH of wound changed promoting healing
– Destroy bacteria
• Only destroy necrotic tissue
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5
Q

Granulating wounds

A

• Dressing choice depends on depth of wound and exudate level
• Exudate produced by body to maintain moist healing environment
• Exudate =
– Serum (without blood cells)
– High in protein
– Nutrients
– Inflammatory components
• Exuding wounds classified as light, medium or high exudate

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6
Q

Granulating wounds classifications

A

• None–light exudate
– Foams
– Hydrogels

• Medium–heavy
– Alginates
– Hydrocolloids
– Foams

• Light–medium exudate 
– Foams
– Alginate
– Thin hydrocolloids
 – Hydrogels

• Heavy
– Alginate
– Hydrocolloids
– Foams

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7
Q

Epithelialising wounds

A
• Choice depends upon level of exudate 
– Hydrocolloid (not dry wound)
– Alginate (not dry wound) 
– Hydrogel
– Foam (not dry wound)
– Vapour permeable films 
– Low adherent dressing
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8
Q

Points to remember

A

• Dressings should be left in place as long as possible
– Minimise trauma to healing wound
– Minimise pain of dressing changes
• Appropriate dressings should be considered at each dressing change
– Do not simply continue with what went before
• Wounds are often at different stages of healing in the same area
– Where possible one dressing to promote each stage should be used
– Need to avoid maceration
– Need to avoid over‐granulation (results in raised scars)
– Need to avoid tearing delicate, newly healed skin
• Difficult to assess cost‐effectiveness of dressings
• Not all dressings from each dressing type are interchangeable
• When packing cavity wounds, count any dressings in and then out!

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