Dressings for Chronic wounds
Dr. Joel ArudchelvamConsultant Vascular and Transplant Surgeon
Dressings for Chronic wounds
• Definition of chronic wound / dressing
• Types of dressings
• Summary of use of various dressings
• When to change
• What not to do
Chronic ( non healing ) ulcer / wound
• Wounds / ulcers not showing signs of healing after 6 weeks.
Wound dressings • The material which is applied to the surface of
the wound to cover • – 1ry – dressing which touches the wound– 2ry – dressing used to cover the primary dressing
Ideal wound dressing
Dressings are applied to wounds for • To provide a protective cover • To maintain moisture • To absorb exudates
In addition an ideal dressing
• Does not induce pain or itching • Easy to change • Allows gaseous exchange
• Cheap • Freely available
Types of Wound Dressings• Gauze • Tulle • Hydrocolloid • Hydrogel • Alginate • Foam • Transparent film • Etc.
Gauze
• Cheap • Freely available
• Dry• Painful on removing• Damages epithelium
Tulle
• Cheap • Freely available• Easy removal– E.g : Vaseline
Hydrocolloid Dressings
• Made up of pectin based material• Absorb exudate• Come in various shapes and sizes
Hydrogel Dressings
• Made up of water in a polymer • Used in dry wounds
Alginate Dressings
• Made from seaweed • Absorb moderate amounts of drainage• becomes a gel when it comes into contact with
wound fluid
Foam Dressings
• Made up of polyurethane foam• Absorbs large amounts of fluid• Available in various sizes and shapes
Silver Dressings
• Reduce bio burden - through slow release of silver ion into the wound
• e.g. Acticoat, Biatin Ag, Atruman Ag
Vacuum Assisted Closure VAC
Vacuum Assisted Closure VAC
• Mechanisms of action–Macro strain–Micro strain
• Macrostrain - visible contraction which occurs when negative pressure is applied.
– Draws wound edges together– Provides direct and complete wound bed
contact– Removes exudate
Vacuum Assisted Closure VAC
• Microstrain - micro deformation at the cellular level
– Reduces edema– Promotes granulation tissue
formation by facilitating cell migration and proliferation
• Indications for use– Large wounds– Cavities – Large amount of exudate
Vacuum Assisted Closure VAC
Summary
Wound with slough , dead tissue – needs wound toilet.
Wound type Dressing
Dry Hydrocolloid, Hydrogel
Exudating wound Hydrocolloid, foam
Dead space / cavity Alginate, foam, VAC
Gauze, tulle and gel Most wounds
When to change dressings
• When there is an indication to change
– Soaking / smelling – Need to inspect – pain , swelling , fever, ect.
• Discuss with doctor before changing
Avoid in chronic wounds
• Iodine (Betadine)• Hydrogen peroxide• Other toxic agents
Avoid
• Do not tie gauze bandage tightly around limbs, digits – causes ischaemia
• Use – plaster , crepe instead
Thank You