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BASIC PRINCIPLE OF WOUND CARE

PPP MOHD FIRDAUS BIN MOHD NOR

PENOLONG PEGAWAI PERUBATAN U5

KLINIK KESIHATAN HILIRAN, PKD KUALA TERENGGANU,

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Outline

  1. Introduction – definition of wound , types of wound
  2. Wound assessment ( wound colour model , TIME )
  3. Pelan perawatan luka
  4. Type of dressing
  5. Case study

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Definition Of Wound And Ulcer

  • A wound is a break in the integrity of the skin or tissues often associated with disruption of structure and function.

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DEFINITION OF WOUND

DEFINITION OF ULCER

  • An interruption of continuity of an epithelial surface with an inflamed base.
  • It is usually a result of an underlying or internal etiology.

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Definition Of Wound And Ulcer

TYPES OF WOUND

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Classification Of Wound : Aetiology

Traumatic Wound

Pressure Injury

Vasculitic Ulcer

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Classification Of Wound : Aetiology

Burn Wound

Surgical Wound

Diabetic Foot Ulcer

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Classification Of Wound : Aetiology

Venous Ulcer

Neuropathic Ulcer

Malignant Wound

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Wound assessment�the colour model

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Identify & remove barriers to wound healing

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Promote wound healing

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Factors Affecting Wound Healing

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Size

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T.I.M.E

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Clinical Signs & Symptoms of Infection

i. Covert (subtle) signs and symptoms of wound infection include:

  • Hypergranulation.
  • Bleeding, friable granulation.
  • Epithelial bridging and pocketing in granulation tissue.
  • Increasing exudate.
  • Delayed wound healing beyond expectations.

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Clinical Signs & Symptoms of Infection

ii. Overt (classic) signs and symptoms of wound infection may include:

  • Erythema (which may present differently depending on the individual’s skin tone)
  • Local warmth
  • Swelling
  • Purulent discharge
  • Wound breakdown and enlargement
  • New or increasing pain
  • Increasing malodour.

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Clinical Signs & Symptoms of Infection

iv. Systemic signs and symptoms of infection may include:

  • Malaise
  • Lethargy or nonspecific general deterioration
  • Loss of appetite
  • Fever/pyrexia
  • Severe sepsis
  • Septic shock
  • Organ failure
  • Death.

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  • Desiccation / maceration
  • Composition of chronic wound fluid
  • Matching exudate volume with product absorbency for optimal moisture balance

Moisture Imbalance

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  • Non advancing wound edge = non healing wound
  • Undermining (critically colonized or infected )

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Edges of Wound

Advancing

Non advancing

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Skin within 4cm of the wound edge, or any skin under the dressing

  • Maceration
  • Dry skin
  • Excoriation
  • Eczema
  • Hyperkeratosis
  • Callus

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Surrounding Skin / Periwound skin

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Cleansing solution

remove inflammatory contaminants from the wound surface. These contaminants can impede healing and increase risk of infection.

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  • Superoxidise solution
  • Polyhexamethylene biguanide (phmB)
  • Octenidine dihydrochloride
  • Water for irrigation
  • Diluted povidone

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Primary dressing

  • Hydrogel
  • Antimicrobial gel
  • Alginate gel
  • Collagen
  • Polymeric membrane dressing
  • foam

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Secondary dressing

  • Tulle dressing
  • Film dressing
  • Alginate
  • Polymeric membrane dressing
  • Foam
  • Gauze/Gamgee

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Skin protection / barrier

  • Aquoes cream
  • Zinc oxide
  • Collagen lotion
  • Barrier cream

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  • Tnya Dr, Nak dressing pakai ape ni????
  • Tp Dr dok respon

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Types of Dressing

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Film Dressing

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Film Dressing

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Hydrogels

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Hydrogels

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Hydrocolloid

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Hydrocolloid

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Calcium Alginate

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Calcium Alginate

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Foam

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Foam

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Gelling Fiber & Charcoal

DRESSINGS

PURPOSE

ADVANTAGES

DISADVANTAGES

PRACTICAL USAGE

  1. Gelling Fiber

Manage heavy exudating wounds

Maintain moist healing environment

Longer wear time

Comfortable and non traumatic upon removal

Reduce risk of maceration

Can be use on infected wounds

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Not helpful for dry wounds

Needs secondary dressings

The gelling fiber will become gel- like layer which can be easily removed

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Frequency of dressing change:

2 to 5 days

  1. Charcoal

Odour absorbent

Reduces odour

Needs secondary dressing

Frequency of dressing change:

2 days

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Gelling Fiber

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Silver

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Silver

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Iodine based product

 

 10. Iodine based product

 

 To reduce bacterial bio burden in infected wounds

 

Locally acting

 

 

No known resistance

 

 

Bactericidal

 

Cadexomer iodine will change its color from yellowish to white when the PVPI is used up.

 

Some solution may decolorize the wound

 

Frequency of dressing change:

2 to 5 days

 

11. Composite dressing (combination of 2 or more dressing materials)

 

According to components of the materials

 

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multifunction

 Same as individual components listed above

 Frequency of dressing change:

2 to 5 days

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Iodine based product

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Other advanced dressings

 

12. Other advanced dressings

 Not widely used – some may be used in specialized center

e.g Collagen, matrix and regenerative dressings, cultured epidermis, growth factors , stem cells

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Other advanced dressings

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Point to remember

• Know your dressing material well and use it judiciously

• All wounds need to be cleansed thoroughly before applying any types of dressing

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Maggot Debridement Therapy

STORAGE OF CAPTURED FLY COLONIES OF L. CUPRINA

STERILISED MAGGOTS ARE FED WITH STERILISED BEEF

PARCEL PACKED WITH DRY ICE WAS SENT TO CLINIC

TOTAL 5 PATIENTS DONE MDT AT KK HILIRAN SINCE 2017

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MAGGOT DEBRIDEMENT PROCESS

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Terima Kasih