WOUND CARE

The basics of care for most wounds can be summarized as follows:

 Optimize systemic parameters
 Debride nonviable tissue
 Reduce the wound bioburden
 Optimize blood flow
- Warmth
- Hydration
- Surgical revascularization
 Reduce edema
- Elevation
- Compression
 Use dressings appropriately, and selectively use biologic
dressings, with attention to cost-effectiveness of overall
treatment. Aims include:
- Moist wound healing
- Exudate removal
- Avoid trauma to wound or pain to patient with dressing
changes
 Use pharmacologic therapy when necessary
 Close wounds surgically with grafts or flaps as indicated

CONDITIONS THAT CONTRIBUTE TO IMPAIRMENTS IN WOUND

HEALING
 Age
 Ischemia
 Reperfusion injury
 Infection or bacterial burden
 Malnutrition
 Global
 Nutrient-specific
 Foreign bodies
 Diabetes
 Steroids
  Uremia
 Jaundice
 Cancer
 Genetic causes (e.g., Ehlers-Danlos, Werner syndromes)
 Irradiation
 Chemotherapy
 Tobacco use
 Alcohol use
 Edema
 Pressure

ADVANCES IN WOUND CARE

Old paradigm New paradigm

Acute wounds versus chronic Appreciation that not all problem

wounds wounds are chronic. Some acute
wounds deserve to be treated as
intensively as chronic wounds from
the onset, if systemic or local factors
are expected to impact
on healing.

Problem wounds are A unifying hypothesis that most

segregated by underlying problem wounds share the burdens
disease process of age, episode of ischemia
with reperfusion, and infection.

Wet to dry dressings Moist wound healing.

Reliance on H2O2 , Dakin Products with cadexomer iodine and

solution (bleach), Povidine- silver, strategically developed to
iodine solutions decrease the bioburden in the
wound, are key elements in the
wound-care arsenal.

Underappreciation of pain Importance of pain relief for healing

relief and compliance with therapy.
Unna boot as “one-size-fits
all” therapy for venous stasis
ulcers.
Air mattresses
Gauze as the universal surgical
dressing
Dressings or surgery as sole
options for wound care
Lack of pharmacologic agents
to accelerate healing of
problem wounds
Limited options for treatment
of scars
Skin grafts
Multilayered, sustained, graduated
compression therapy products,
customized to fit each patient, to
better assist in edema control and
wound healing.
Pressure reducing and pressure-
relieving products.
Dressings are now tailored to
wounds to manage various levels of
exudate and bacterial burdens.
Negative-pressure wound therapy
has introduced a new option for
wound care, allowing both
temporizing of wounds and
definitive treatment
Growth factors as biotech-derived
products indicated in the
therapeutic treatment of problem
wounds.
Scar modulation and prevention of
hypertrophic scars with
compression garments, compression
dressings, and silicone sheets.
Bioengineered skin products
available to stimulate the wound-
healing process in hard-to-heal or
stalled wounds. Some are available
as dermal replacements, others are
available as combined epidermal–
dermal replacements. They will on
occasion permit coverage of
exposed bone or tendons.