COUNTESS OF CHESTER HOSPITAL WOUND CARE FORMULARY

Transcription

1 COUNTESS OF CHESTER HOSPITAL WOUND CARE FORMULARY 1

2 CONTENTS OBJECTIVE 3 Absorbent Primary Dressings 4 Alginates 5 5 Antimicrobial Dressings 6 Iodine Dressings 7 Barrier film and creams 8 Charcoal Dressings 9 Fibrous Dressings (Aquafiber) 10 Film 12 Hydrocolloid 13 Hydrogel 14 Low / Non Adherent Dressings 15 Polyurethane Foams 18 Retention of dressings / Bandages 16 Specialist Dressings 22 Hydrocolloid 23 Absorbent dressings 24 Larval Therapy 25 PHMB 26 Topical Negative Pressure 27 Glossary 28 References 32 2

3 OBJECTIVE To provide a formulary of wound management dressings to facilitate the selection of the most appropriate wound management product. The following is a complete list of all dressings included on the Trust Formulary, including sizes available. Unless otherwise stated all wards/ departments will be stocked with the recommended dressings on top up. The specialist dressings will not be held on wards as stock (to prevent wastage), these will be available on request to Stores following consultation with the Tissue Viability Nurse 3

4 Absorbent Primary Dressings Dressing with adhesive border and absorbent central pad. Mode of Action For use on wounds closed by primary intention. To absorb slight oozing from wounds. Ideal as a protective covering. Do not provide a moist wound healing environment. Low to moderate exuding wounds. Post-Operative Wounds Lacerations Cuts Abrasions Minor Burns Contraindications For use on arterial bleeds Heavily exuding wounds Chronic wounds. Tissue Types For use on superficial wounds and epithelialising wounds or as secondary dressings. Formulary Product Cosmopore E Hydrofilm Plus 5x7.2cm 8x10cm 8x15cm 10x20cm 10x25cm 10x35cm 5 x 7.2cm 9 x 10cm 9 x 15cm 10 x 20cm 10 x 25cm 10 x 30cm 4

5 Alginates Alginates are highly absorbent dressings derived from seaweed. Mode of Action The Alginate dressing gels when it absorbs exudate: To facilitate moist wound healing. To maintain a moist wound environment. To aid autolysis. To effectively absorb exudate. Debride slough and encourage granulation of the wound. Reduces the risk of maceration of the surrounding skin. Needs a secondary dressing to contain moisture and aid autolysis and maintain optimum wound environment. Pressure Ulcers Leg Ulcers Cavity Wounds Skin Donor Sites Abrasions and Lacerations Post Surgical Wounds Contraindications Surgical Implantation Full Thickness Burns Dry Wounds Tissue Types Suitable for wounds with moderate and high levels of exudate, with varying tissues types of sloughy, granulating, infected and cavity wounds. Formulary Product ActivHeal Alginate 5x5cm 10x10cm 10x20cm 30cm rope Note - Alginates are not suitable for use on wounds that are too dry. Do not wet. Aquafiber comprises of natural fibres thus allowing the dressing to be used as a haemostat and can therefore be used to control minor bleeding. 5

6 Antimicrobial Dressings Antimicrobial dressings inhibit or kill bacteria and provide a moist environment for healing. They are chemicals which are used to either kill or control the growth of micro-organisms in wounds (White, 2002). Mode of Action Killing the common open wound aerobic and anaerobic pathogens. Control bacteria. Work against a variety of different micro organisms. Help control odour and exudate. (Vuolo,2009) For use on infected wounds. There are two main generic groups of wound management products that have the potential to reduce the bacterial burden in the wound. Silver Iodine They all have the capability of killing the common open wound aerobic and anaerobic pathogens. Iodine has antiseptic properties, which control the bacteria on the surface of the wound (Flores et al, 2007). Silver is effective against a broad range of micro- organisms, including Pseudomonas aeruginosa and Staphlococcus aureus. ( Flores et al, 2007) Silver dressing release continuously small amounts of antimicrobial silver into the wound to inhibit the growth of bacteria. Silver dressings are classed as a specialist dressing. 6

7 Iodine Dressings For the management of infected, chronic wounds and ulcers. Precautions Caution should be taken when being used on new born babies and infants under 6 months. It can be used on patients with Thyroid problems. Should not be used on pregnant women or lactating women or any patients with a sensitivity to iodine. Iodine can interact with other medications such as lithium, sulphonylureus so co administration is not recommended. Not suitable for dry wounds. Tissue Types Infected wounds with moderate to high levels of exudate. Formulary Product Inadine 5x5cm 9.5x9.5cm 7

8 Barrier film and creams Barrier films and creams are to provide a long lasting protection from bodily fluids, friction or shear whilst moisturising the skin. Mode of Action To prevent maceration Protect skin from damage associated with incontinence dermatitis and adhesive trauma. Prevent skin breakdown. Protect at risk skin. Encourage the maintenance of healthy, intact skin. For use on intact skin to prevent damage associated with bodily fluids, incontinence and friction and shear. To prevent further breakdown of excoriated skin. Barrier cream can be used as a moisturiser. Contraindications/Precautions Barrier Cream may increase the adherence of some adhesive products, thus patient s with fragile skin avoid using the cream under all adhesive products. Not to be used on infected areas of the skin eg fungal infections. Barrier film can under electrodes affect the reading. Barrier film s use with other creams may reduce it s effectiveness. Tissue Types Can be used on both intact and excoriated skin. Formulary Products Cavilon No Sting Barrier Film Cavilon Durable Barrier Cream 1ml Foam applicator 3ml Foam applicator 2g sachet 28g tube Please note: Cavilon Barrier film last for hours and wears off naturally. Cavilon Durable Barrier cream please apply every 3rd or 4th incontinent episode or wash. 8

9 Charcoal Dressings Malodour is a result of bacterial metabolism and the production of noxious agents. Activated charcoal dressings absorb toxins. Mode of Action Effectively absorbs toxins and controls malodour. Chronic wounds Fungating wounds Discharging, purulent wounds Gangrenous lesions. Contraindications Not indicated for dry wounds. Tissue Types Any wound type that has a malodour and is exuding. Formulary Products Clinisorb 10x10cm 10x20cm Actisorb x x x 19 Note Clinisorb consists of a charcoal sandwich between layers of viscose rayon. An advantage is that it can be cut to size. 9

10 Fibrous Dressings (Aquafiber) Absorbent dressing that converts from a fibrous dressing to a soft gel on contact with exudate and retains exudate within the fibres. Mode of Action To maintain a moist wound environment To support the healing process To aid autolytic debridement. To absorb exudate effectively To help encourage granulation To reduce maceration of the surrounding skin To assist with intact removal without damaging the healing tissue. Chronic Wounds Pressure ulcers. Leg ulcers. Venous ulcers. Arterial ulcers. Diabetic ulcers. Cavity wounds. Acute Wounds Lacerations and abrasions. Graft wounds. Donor sites. Post operative wounds. Trauma wounds. Superficial and partial thickness burns. Contraindications Surgical implantation. To control heavy bleeding. Low exuding wounds. Tissue Types Should be used on wounds that are either medium to heavy exudate. Can be used on sloughy, granulating and cavity wounds. 10

11 Formulary Product ActivHeal Aquafiber 5x5cm 10x10cm 15x15cm 2x42cm NB: Aquafiber comprises of natural fibres thus allowing the dressing to be used as a haemostat and can therefore be used to control minor bleeding. 11

12 Film Films are non absorbent, with moisture levels governed by the moisture vapour transmission rate. Films control the loss of moisture into the environment. Films have an MVTR. MVTR this means they are permeable to moisture vapour and oxygen but impermeable to bacteria. Mode of Action Ensure waterproofing of the wound. Acts as a shield in preventing bacterial and other micro-organisms in the wound tissues. To protect the skin from friction and external contamination. Provide a moist wound environment. Can be used as a primary or secondary dressing Generally suitable for low exuding, shallow non infected wounds. Can be used as a secondary dressing. Contraindications Films should not be used with moderate to heavy levels of exudate as can cause maceration. Films should not be used to retain dressings that already have a MVTR eg Foam dressings. Tissue Types Can be used in the management of both granulating and epithelialising wounds with light exudate. Formulary Product Hydrofilm 6x7cm 10x12.5cm 10x15cm 15x20cm 12x25cm 20x30cm 12

13 Hydrocolloid Hydrocolloids absorb exudate and forms a cohesive gel that facilitates moist wound healing. Mode of Action Maintain a moist wound environment. Aid autolysis. Promote angiogenesis. Ensure ease of removal. Provide a bacterial barrier. Provide a waterproof barrier. Chronic Wounds Pressure Ulcers Leg Ulcers Cavity Wounds Skin Donor Sites Superficial and Partial Thickness Burns Post Operative Surgical Wounds Abrasions Contraindications Full Thickness Burns Highly Exuding Wounds Tissue Types Hydrocolloids are interactive dressings, in the presence of wound exudate, absorb exudate and form a cohesive gel. For use on low to moderate exuding wounds. They encourage autolytic debridement. Can be used for the management of necrotic, sloughy, granulating and epithelialising wounds. 13

14 Formulary Products ActivHeal Hydrocolloid Foam Backed Duoderm Extra Thin Tegaderm Hydrocolloid 5x7.5cm 10x10cm 15x15cm 15x18cm scacral 7.5x7.5cm 10x10cm 15x15cm 5x10cm 9x15cm 9x25cm 9x35cm 10x12cm oval 10x10cm 13x15cm oval 15x15cm 16.1x17.1cm sacral 14

15 Hydrogel Hydrogels are a class of dressing composed mainly of water and a stabiliser/preservative to keep the gel intact. hydrogels works by donating water to the wound surface. This debrides the wound by rehydration, promotion of autolysis, and de-sloughing of the necrotic or sloughy wound bed. Mode of Action Donating moisture. Providing a moist wound environment for healing. Encouraging and facilitating autolysis. Removing devitalised tissue. Encouraging growth and migration of epithelial cells. Needs a secondary dressing to contain moisture and aid autolysis and maintain optimum wound environment. Pressure Ulcers Cavity Wounds Leg Ulcers Skin Donor Sites Diabetic Foot Ulcers Contraindications Surgical Implantation Full Thickness Burns Note: Please ensure the wound is thoroughly cleaned of hydrogel prior to the application of Larvae. Tissue Types Hydrogels are indicated for use in dry wounds where rehydration is required. Hydrogels should not be used on heavily exuding wounds as this can encourage maceration to the surrounding skin. Hydrogels can be used for the management of necrotic and sloughy wounds. Formulary Product ActivHeal Hydrogel 15g Tube 15

16 Polyurethane Foams Foam dressings are designed to absorb large amounts of exudate and provide a moist wound environment. Mode of Action Maintain a moist wound environment. Facilitate moist wound healing. Absorb and retain exudate. Provide an effective barrier function. Pressure Ulcers. Arterial Leg Ulcers. Venous Leg Ulcers. Superficial Burns. Graft Wounds and Skin Donor Sites. Lacerations and Abrasions. Non Infected Diabetic Foot ulcers. Contraindications Foams should not be used on dry wounds as they may adhere. Surgical Implantation Full Thickness Burns Post Operative Wounds. Tissue Types Dressings can be used as a primary dressing to protect granulation and epithelial tissue in a wound or to absorb exudate or as a secondary dressing. ActivHeal Foam Adhesive 7.5x7.5cm 10x10cm 15x15cm 20x20cm ActivHeal Foam Non Adhesive 5x5cm 10x10cm 17.8x10cm 20x20cm 16

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18 Low / Non Adherent Dressings Guidelines to Generi Recommended as a primary dressing where adherence is a potential problem. Mode Wound of Type Action Necrotic Sloughy Granulating Aids less traumatic removal Prevents damage to the wound bed Allows the passage of exudate through to secondary dressing. Provides a moist wound environment. Leg Ulcers Pressure Ulcers Post Operative Wounds Donor Sites Necrotic wounds Skin Abrasions are typified by black Mixture of dead white cells, dead Granulating tissue usually deep pink Superficial Partial dead tissue. Thickness Burnsbacteria, rehydrated in colour at the Superficial Wounds necrotic tissue and fibrous tissue. base with red lumps over the Tissue Types surface. Can be used on all tissue types to prevent dressing adherence the wound and aid atraumatic removal. Treatment To soften and remove To soften and To maintain ideal Aim necrotic tissue by remove slough by environment for Atrauman rehydration and rehydration 5x5cm and granulation. debridement to allow debridement. 7.5x10cm granulation. 10x20cm Nil/Low Exudate Medium/ High Exudate Hydrogel & Foam or Hydrocolloid Hydrocolloid or Alginate & Foam Hydrogel or Hydrocolloid Hydrocolloid or Foam Alginate & Foam Hydrocolloid Hydrocolloid or Foam unlikely to be high exudate May by s oed incr pun infla pain To c man Con syst if cli indi topi dres Silv Foa Algi 18

19 c Woundcare Range Infected Epithelialising Fungating/ Malodorous Cavity be identified igns including ema, swelling, eased exudate, gent odour, mmation and. Typified by pink /pale mauve coloured tissue. Has an offensive odour indicating infection or colonisation of bacteria. Palliative. Wound extends to tissues deep into the epidermis and dermis. ontrol and age infection. sider use of emic antibiotics nical signs cate and lso cl antimicrobial sings. e.g. er. m nate & Foam To protect epithelialising tissue until established. To promote an ideal environment for epithelialisation and contraction. Film Hydrocolloid Foam (unlikely to be high exudate) To manage odour, bleeding and exudate. Odour Systemic antibiotics Charcoal Dressing Bleeding Alginate Exudate Alginate & Foam To promote granulation from the base of the wound. Alginate & Film or Alginate & Foam Alginate & Foam 19

20 Retention of dressings / Bandages For general bandage requirements and fixation of dressings. Formulary Products Formflex (Base Layer) Hospiform Hospilite Economy Bandage Tubular bandage Comfi fast* 5cmx2.7m 7.5cmx2.7m 10cmx2.7m 15cmx2.7m 20cmx2.7m 6cmx4m 8cmx4m 10cmx4m 12cmx4m 5cmx4.5m 7.5cmx4.5m 10xcmx4.5m 15cmc4.5m 3.5cmx10m Red Line* 5cmx10m Green Line* 7.5cmx10m Blue Line* 10.75cmx10m Yellow Line* 17.5cmx1m Beige Line* * ward stock Correct Application Base layer (wool) Formflex Minimum of 2 rolls per limb this gives padding shape and protection. Application of bandages Start at the base of the toes, encircle the ball of the foot and anchor the bandage in place. The next turn takes the bandage to the point of the heel and back to the front of the foot, ready to cover the arch of the foot in turn 3. The third turn encircles the rest of the foot and returns to the Achilles tendon from where the straight part of the leg can be approached. Please do not overstretch the bandage during this part of the application. The bandage is then applied by unrolling the bandage to a length suitable for wrapping around the leg in a simple spiral, extending it to the required 20

21 extension and then placing it on the leg so that 50% of the previous turn is covered. Bandage is passed from one hand to the other to achieve an even extension and overlap up the leg as far as the tibial plateau, the bandage application is completed when it is just below the knee and the is not impeded. In obese patients the knee joint may be difficult to locate and it may help to ask the patient to bend the knee in order to determine its position. Adhesive tape should be used to secure the bandage effectively Please Note-No figure of 8 bandaging to be applied on any patient. Any excess bandage should be cut off, extra layers can cause a tourniquet effect. 21

22 Specialist Dressings These dressings are only available following consultantation with the Tissue Viability Nurse. Atraumatic Polyurethane Foam (Silicone) Foam dressings are designed to absorb large amounts of exudate and provide a moist wound environment. The atraumatic adhesive ensures the dressing can be changed without damaging the wound or surrounding skin or exposing the patient to pain. Mode of Action Maintain a moist wound environment. Facilitate moist wound healing. Absorb and retain exudate. Pressure Ulcers. Arterial Leg Ulcers. Venous Leg Ulcers. Foot Ulcers Wounds with compromised / surrounding skin. Contraindications Foams should not be used on dry wounds as they may adhere Surgical Implantation Full Thickness Burns Tissue Types Dressings can be used as a primary dressing to protect granulation and epithelial tissue in a wound or to absorb exudate or as a secondary dressing. Formulary Products Mepilex Border 22 7x7.5cm 10x12.5cm 10x20cm 10x30cm 15x17.5cm 17x20cm Sacral 18x18cm 23x23cm

23 Hydrocolloid Hydrocolloids are interactive dressings, in the presence of wound exudate, absorb exudate and form a cohesive gel. For use on low to moderate exuding wounds. They encourage autolytic debridement. Can be used for the management of necrotic, sloughy, granulating and epithelialising wounds. Granuflex Bordered 20 x 20 23

24 Absorbent dressings Are highly absorbent dressings used for the management of wound that are high exuding. For use on wounds with high levels of exudate. Suitable for leg ulcers, abdominal, pressure ulcers, cellulitis and surgical wounds Contra indicated On dry wounds. Tissue Types For use on all tissue types as long as the wounds are high exuding. Formulary Products Zetuvit Pad Zevuit Plus 10x10cm 10x20cm 20x20cm 20x40cm 10x10 10x20 15x20 20x25 20x40 Zetuvit dressing should be worn with the blue backing upper most, facing away from the wound. 24

25 Larval Therapy The use of sterile larvae to debride wounds. Mode of action Larvae move over the surface of the wound secreting enzymes. These enzymes break down dead devitalized tissue. Osteomyelitis Burns Abscesses Leg Ulcers Pressure Ulcers Infected surgical wounds Necrotising fasciitis Malignant wounds Contra-indicated Should not be applied to fistulae or on wounds that connect with vital organs, or used with exposed blood vessels. Survival of larvae is reduced in the presence of excess exudate. Tissue Types Used to debride soft necrotic tissue including infected wounds Note: Please ensure all traces of hydrogel are removed prior to the application of larvae. 25

26 PHMB PHMB is polyhexamethylene biguanide. It is a mixture of polymers and is a synthetic compound structurally similar to naturally occurring antimicrobial peptides AMP s. AMP s have a broad spectrum of activity against bacteria, viruses and fungi. Mode of action PHMB is thought to adhere to and disrupt target cell membranes, causing them to leak potassium ions and other cytosolic components. Advantages of PHMB excellent skin tolerance non toxic, non irritant hypoallergenic no known resistance suitable for long term use, not absorbed can be used up to 8 weeks no inhibition of granulation tissue unlike antiseptics For use on varying levels of exudate of critically colonised and infected wounds. Contra indications Known sensitivity to PHMB During pregnancy and Lactation Should be used selectively on both Newborns and infants. Tissue Types All tissues types with critically colonised and infected wounds. Formulary Products Prontosan Wound Irrigation Solution Prontosan wound gel 350ml 40ml 30ml 26

27 Topical Negative Pressure Topical negative pressure therapy is a device, which applies a universal negative pressure to a wound, to encourage blood flow and faster granulation. It also removes exudate, reduces bacteria colonisation and reduces odour. Mode of action The vacuum assisted device assists in wound closure by applying localised negative pressure to the wound bed. The system creates a hypoxic environment in which anaerobic bacteria cannot survive and pulls blood that is rich in growth factors and macrophages into the area. It is shown to accelerate debridement, promote angiogenesis, and remove slough and loose necrotic tissue in many wound types. Acute Wounds Chronic Wounds Traumatic Wounds Pressure Ulcers Diabetic Wounds Dehisced Surgical Wounds Skin Flaps and Grafts Infected Wounds Contra indications Necrotic tissue with eschar Malignant wounds Untreated ostemyelitis Fistulas to organs or body cavities Over exposed arteries or veins. If haemostasis has been difficult or if patient has active bleeding or is on anticoagulant therapy. Topical negative pressure therapy should be used with caution. Telf Clear 7.5 x 7.5cm 10 x 12.5cm 30 x 30cm 30 x 60cm 27

28 Glossary A Abrasion. Wearing away of the skin through mechanical process such as shear or trauma. Abcess. A collection of pus that forms in tissue as a result of localised infection and associated with tissue destruction. Acute wound. A recently inflicted wound that will usually heal without problems. Aerobic Bacteria. Bacteria that thrive in an oxygen rich environment. Aetiology. The cause and process of disease. Alginate. Dressing derived from seaweed. Anaerobic Bacteria. Bacteria that thrive in an oxygen free environment. Angiogenesis. The formation and regeneration of blood vessels. Ankle flare. Tiny dilation of superficial blood vessels on the medial aspect of the foot. Antimicrobial. An agent that kills microbes or inhibits growth. Apposition. Bringing together two structures. Approximation. A wound that has the edges brought together and heal through primary intention. Aseptic. Without pathogens, infections or toxins. Aseptic technique. To prevent bacteria from reaching vulnerable sites through use of sterile techniques. Atherosclerosis. Fatty deposits on the walls of arteries and that harden. Autolysis. The body s natural capacity for breaking down necrotic tissue. In wound care autolysis is encouraged through the use of moist wound dressings. B Bacteria. One celled microorganisims that break down dead tissue, have no true nucleus and reproduce by cell division. Bacteraemia. Bacteria that enters the blood stream. Biofilm. A membrane of glycocalyx that is secreted by highly organised bacterial communities. Blanchable erythema. Reddened area of the skin that temporarily turns white or pale when pressure is applied with a fingertip. Bony prominence. Projections of bones e.g. greater trochanter. Burn. An acute wound that s caused by exposure to thermal extremes, chemicals, electricity or radiation. C Cachexia. Poor state of health. Callus. Hard skin. Capillary. A capillary is small blood vessel that is a link between arterial and venous system. Cellulitis. Inflammation and infection of the cells, associated with heat, redness, swelling and pain. Chemical debridement. Topical application of biological enzymes to break down devitalised tissue. Chronic wound. Wound that has remained unhealed for more than six weeks. Collagen. Most abundant protein in the body and is responsible for holding the body together. Collagen is laid down and modified during the proliferation and maturation phase of wound healing. Colonised. Contaminated with bacteria. Contamination. The presence of bacteria, microorganisms or other foreign material in or on tissues. D 28

29 Dead space. An area of tissue destruction or loss that extends out from the main body of the wound, leaving a cavity or tract. Debridement. Removal of devitalised tissue through surgery, larvel therapy, autolysis or occlusive dressings. Debris. The remains of broken down or damaged cells or tissue. Deglove. The epidermis is torn away exposing the dermis or lower structures. Dehiscence. Separation of the opposed edges of a surgical wound. Dermis. Thick, inner layer of skin. Desiccated. Dried out. Devitalised Tissue. Tissue that is no longer viable. E Epidermis. The outermost layer of the skin. Epithelialisation. Wound bed level with the surface, epithelial cells will migrate over the wound bed to complete healing. Erythema. An inflammatory redness of the skin caused by engorged capillaries. Eschar. Hard necrotic tissue. Excoriation. Skin has been traumatised, worn away or eroded as a result of incontinence or inappropriate dressing. Exudate. Serous fluid that has passed through the walls of a damaged or overextended vein. Characteristically high in protein and white blood cells. Factitious. Wounds caused by self wounding. Fascia. A band of fibrous tissue that lies deep in relation to the skin and forms a supportive sheath for muscles and various body organs. Fibrin. An insoluble protein formed by fibrinogen by the proteolytic action of thrombin, essential in blood clotting. Fibroblast. In wound healing, fibroblasts stimulate cell migration, angiogenesis, embryonic development and healing. Film Dressing. Transparent film that can be used as a primary or secondary dressing. Fissure. Split in the skin, may be moist or dry, small or extensive. Foam. A polyurethane foam dressing that has absorbative properties that may be adherent or non-adherent. Friable. Easily damaged. A wound easily bleeds when touched. Friction. The act of rubbing one surface against another. Full thickness wound. A wound that penetrates completely through the skin into underlying tissues, adipose tissue, muscle, tendon or bone may be exposed. Fungating wound. A skin lesion, generally malodorous and heavily exuding. Arises from underlying tumours. G Gangrene. Devitalised, dead tissue caused by failure of the blood supply. Granulation. Combination of newly formed vascular tissue and fibroblasts which lay down a matrix of cellular tissues during wound healing. Guluronic acid. Present in alginates, maintains the structure making removal in one piece. H Haematoma. A bruise or collection of blood in the tissues. Haemostasis. Control of bleeding. Haemorrhage. Bleeding (internal or external). Homeostasis. The body s natural mechanism for maintaining health constancy and ensuring 29

30 survival. Includes blood pressure and thermoregulation. Hydrocolloid. An adhesive dressing made of carboxymethylcellulose, that has some absorptive properties. Hydrogel. Water based product for rehydrating necrotic tissue. Hydrophilic. Water loving - absorbent dressing. Hydrophobic. Water Hating - Non-absorbent dressing. Hypovolaemia. A decrease in circulating blood volume. Hypoxia. The reduction of oxygen in body tissues to below normal levels. Hypergranulation. (Overgranulation) - Excessive production of granulation tissue. I Infection. Caused by micro organisms which evade the immunological defences, enter and establish themselves within the tissues. Inflammation. Natural defence against bacterial invasion, stimulates wound healing. Irrigation. Cleaning tissue and removing cell debris from an open wound. Ischaemia. Localised deficiency of arterial blood. K Keloid Scar. Over grown scar tissue. Scar is prominent and misshapen and extends beyond wound boundaries. Keratinised. The process whereby epidermal cells differentiate to form the stratum corneum. Laceration. A tearing or splitting of the skin caused by blunt trauma. Leg Ulcer. Wound of the lower limb that is frequently chronic in nature. Lymphoedema. Chronic swelling of a body part from accumulation of interstitial fluid secondary to obstruction of lymphatic vessels or lymph nodes. M Maceration. Softening of tissue that has remained moist or wet for a long period. The skin becomes white and soggy and less resilient. Can pre-dispose to tissue breakdown. Malnutrition. Poor nutritional status from impaired absorption, poor diet. Mannuronic acid. Present in alginates, form a soft flexible gel, breaks down in the presence of sodium and rinses away. Maturation. Final stage of wound healing which involves wound contraction, full epithelialisation and reorganisation. Mechanical debridement. The removal of foreign material and devitalised tissue from a wound by physical force, e.g. wet to dry dressings. Moisture Vapour transfer rate (MVTR). The rate at which moisture (mainly from wound exudate) passes through a dressing and evaporates into the atmosphere. N Necrosis. Death of tissue or organ in response to injury, disease or occlusion of blood flow. Necrotising fasciitis. A serious bacterial infection usually due to Streptococcus pyogenes. Neuropathy. Interruption of nerve function. May result in lack of sensation, motor function. Non blanching erythema. A redness of the skin that persist when gentle pressure is applied to it and released. O Oedema. An unnatural accumulation of fluid in the interstitial spaces. Osteomyelitis. Clinical infection sited in the bone. Overgranulation. Granulation continues to fill the wound until it is proud of the wound, preventing epithelial tissue from migrating over the surface. P Partial thickness wounds. Any wound that involves only the epidermal layer of skin or extends through the epidermis and into but not through the dermis. Peripheral Vascular disease. A disorder that affect blood vessels outside of the heart. Pressure. A force that s applied vertically or perpendicular to a surface. 30

31 Pressure Ulcer. An area of localised damage to skin and underlying tissue caused by pressure, shear and friction. Primary dressing. A dressing that is applied directly to the wound bed. Pilonidal Sinus. Caused by a hair that folds back on itself and grows into the tissue and becomes infected. Proliferation Phase. Third phase of wound healing, intense proliferation of fibroblasts and endothelial cells. Pus. A production of inflammation usually caused by infection containing used cells, debris and tissue elements. Pyoderma gangrenosum. Is a rapidly evolving skin disease. S Sacrum. Lowest portion of the spinal column. Secondary dressing. A dressing used over the top of one that is already in contact with the wound bed. Sharp debridement. Method of debridement using scalpel or scissors to remove necrotic tissue. Shearing force. A mechanical force that runs parallel, rather than perpendicular to an area of skin. Sinus. An epithelial cell lined tube from the outside of the body to the inside. Slough. A mixture of dead white cells, dead bacteria, rehydrated necrotic tissue and fibrous tissue. Subcutaneous layer. A layer of loose connective tissue below the epidermis and dermis that contains major blood vessels, lymph vessels and nerves. Surgical wound. A healthy and uncomplicated break in the skin from surgery. T Tissue Viability. The ability of tissue to perform it s function optimally. Traumatic Wound. A sudden, unplanned injury to the skin that can range from minor to severe. U Undermining. A tunnelling effect or pocket under the edges of a wound that s caused by the pressure gradient transmitted from the body surface to the bone. V Vapour permeable. Gases and water vapour pass through e.g. dressing surface. Varicose veins. Swollen veins, usually on the legs, that look lumpy and bluish. Vasoconstriction. The arteries and arterioles constrict under the influence of drugs, hormones or cold. Vascularity. Blood supply in an area of tissue. Vascular Response. May be dilation or contraction in a response to a variety of stimuli e.g. temperature, inflammatory state and blood volume. Vascular wound. Any chronic wound that stems from peripheral vascular disease in the venous, arterial or lymphatic system. Vasodilation. The lumen of blood vessels opens and becomes wider. Blood slow slows and oxygen reaches the tissues. W Wound. A breakdown in the epidermis that can be related to trauma orpathological changes within the skin or body. Definitions are taken from Collins, et al. (2002), Benbow (2005) and Vuolo, (2009) 31

32 References Flores, A & Kinglsey, A (2007) Topical Antimicrobial Dressings: An Overview. Wound Essentials 2, pg Thomas, S (2000) Alginate Dressings in Surgery and Wound Management: Part 3 Journal of Wound Care Vol 9 No.4. Vuolo, J (2009) Wound Care Made Incredibly Easy, London, United Kingdom, Lippincott Williams & Wilkins. White, R (2002) Trends in Wound Care, Wiltshire, United Kingdom: Quay Books 32