Galen (120-201A.D) Advanced Wound Dressing Wounds heal optimally in a moist environment นพ.เก งกาจ ว น ยโกศล Wound assessment Ideal wound dressing Type of wound Clinical appearance Wound location Measurement dimension Exudate Wound edge Surrounding skin Pain Infection High moisture vapour permeability Non adherent High capacity for absorption Provide barrier to external contaminants Prevent capillary loop penetration into dressing material Capable of being sterilized Good adhesion to surrounding skin Hypoallergenic Comfortable to wear Cost effective Scales JT, Br Med J. 1956 Classification Function Debridement, antibacterial, absorbent, adherence Type of material Hydrocolloid, alginate, collagen Physical form of the dressing Ointment, film, foam, gel 1
Grow throughout the tropics in approximately 107 countries Wide availability Safety Rapid epithelization Pain-free bandage renewal and removal Inexpensive or free acquisition Banana leaves Simple Less expensive No direct effect on the wound except protecting it Pain when removal Gauze Emmanuella G, Dermatol Surg 2013 Modern dressing Interactive dressings Provide optimum environment at the wound dressing interface Moisture vapour transmission rate (MVTR) is less than 840g/m 2 /24 hrs Low-adherence dressings Placed directly in contact with the wound Non-medicated e.g. paraffin gauze dressing Medicated e.g. containing povidone iodine or chlorhexidine Moist environment is beneficial for healing Winter GD. Nature. 1962 Field FK, Am J Surg. 1994 Low-adherence dressings Suitable for flat, shallow wounds Low exudates Films Permeable to water vapour and oxygen but not to water or microorganisms Indication Superficial wound Superficial pressure ulcer, superficial burn, blister, donor site skin graft, post-operative wound Protection Stromal site, friction Fixation Primary dressing, catheters 2
Hydrocolloid dressings Composed of gelatine, pectin and or carboxymethylcellulose Provide a moist environment Impermeable to water and bacteria But permeable to water vapour Hydrocolloid dressings Hydrogel dressings Advantages Absorb wound exudates Long wear time Decreases the cost Decreases inconvenience and local trauma associated with dressing changes Cross-linked insoluable polymers Carboxymethylcellulose or starch 96%water Indication Superficial wound Light to moderately exuding wound Dry wound Painful wound Skin tear and surgical wounds Advantages Absorb wound exudate Rehydrate a wound Hydrogel dressings Foam dressings Highly absorbent polyurethane dressings Pads, sheets and cavity dressings Advantages Create a moist environment Provide thermal insulation to the wound Nonadherent Easy to apply and remove Meant for highly exuding wounds Jennifer GP, Dermatologic Therapy, 2013 3
Foam dressings Reactic* film switches High rate of fluid transpiration Wound fluid Rapid rate of initial fluid uptake Alginate dressings Contain calcium and sodium salts of alginic acid Gelatinous mass Helps in maintaining moist environment Facilitates autolytic debridement Conform to the shape of the wound If larger they can cause periwound maceration Highly absorbent Absorbs 20 times its weight Indication Pressure ulcers Diabetic ulcers Infected wound Moderate to heavy exudates Alginate dressings Kannon GA, Dermatol Surg. 1995 Alginate dressings Negative pressure wound therapy Jennifer GP, Dermatologic Therapy, 2013 4
Negative pressure wound therapy Silver-impregnated dressings Antiseptic agent Most pathogenic organisms are killed invitro at concentration of 10-40 ppm Nanochemistry micro fine particles Increase silver's solubility and releases silver ions in concentration of 70-100 ppm Can be left in place for up to 5-7 days Silver-impregnated dressings Silver-impregnated dressings Pathogen type Gram-negative bacteria Gram-positive bacteria Antibiotic-resistant bacteria Fungal organisms Sample species P. aeruginosa, P. stutzeri, E. cloacae, E. aerogenes, E. coli, K. pneumoniae, B. cepacia S. aureus, S. epidermidis, E. faecium, E. faecalis Methicillin-resistant S. aureus (MRSA), Vancomycin-resistant E. faecium and E. faecalis (VRE), multi-drug resistant B. cepacia C. glabrata, C. albicans, C. tropicalis, S. cerevisiae Skin substitute Dermal collagen replacement Dermal matrix replacement Dermal living replacement Skin living replacement Lansdown AB. Curr Probl Dermatol. 2006 5
Future of wound care Stem cells Active biological dressing Regeneration of damaged tissue Stimulate proliferation and differentiation Secreting growth factors Remodelling matrix Increasing angiogenesis Inhibiting scar formation Improving tensile strength of the wound Summary No single dressing that is perfect for all wounds 6