Dressing Materials

8/6/2019 Dressing Materials

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Everything starts with the name of Allah (God), whoknows everything, who is supreme, the lord of theuniverse.

He who is almighty and always there with all his

powers.

He takes care of the whole world, He is alone, Hefeeds and is very kind to every living being.

So one should praise His blessings with prayers.

Because He is the merciful one who has created thiswhole world


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DR.NAVEED SARWAR MAHAR

FCPS-II TRAINEE

WARD 26,JPMC


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Wound dressings is the topicWound dressings is the topicof discussion infact..of discussion infact..


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INTRODUCTIONINTRODUCTION

yWound:y Any break in the continuity of skin or other organ.

y An injury to the feelings.

yWound Dressing:

y A therapeutic or protective material applied to a wound

y Sterile/aseptic:

y free of living microorganisms

y Antiseptic:y a substance that tends to inhibit the growth and

reproduction of microorganisms when applied to livingtissue.


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WOUND DRESSINGS


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HISTORY OF WOUND DRESSINGSHISTORY OF WOUND DRESSINGS

y 1600 BC: Linen strips soaked in oil or grease and covered with plasterused to occlude wounds

y 1891: Woven absorbent cotton gauze

y Until the mid of 20th , it was firmly believed that wounds healed more

quickly if kept dry and uncovered

y 1948: Oscar Gilje described moist chamber effect for healing ulcers

y 1962: Mr.Winterconducted landmark study demonstrating the efficacyof moist wound healing by occlusive dressings:

y 30% greater benefit of occlusive dressings versus air drying of wounds


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INTERACTION OF DRESSING IN WOUND HEALINGINTERACTION OF DRESSING IN WOUND HEALINGINTERACTION OF DRESSING IN WOUND HEALINGINTERACTION OF DRESSING IN WOUND HEALING

y Debridement

y

Optimal environmenty Promotes granulation and epithelialization

y Protection from infections

yAbsorption of fluids

y Hemostasis

y

Soothing effect


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PRINCIPAL REASONS TO APPLY DRESSINGSPRINCIPAL REASONS TO APPLY DRESSINGS

y Rapid and cosmetically acceptable healing,

y Remove / contain odour,

y Prevent / combat infection

y Contain exudate

y Minimize distress


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IDEAL DRESSING COMPOSITIONIDEAL DRESSING COMPOSITION

y Inertness:y Material should not shed fibers or compounds, which may

evoke a foreign-body, irritant, or allergic reaction

y Maintain moisture :y To suppresses tissue dessication/eschar formation for

effective keratinocyte migration and re-epithelialization

y It decreases the amount of lost dermis thus improving thecosmetic outcome of the injury

y Maintain O2 balance:y Cells need O2 for migration and mitosis,

y Hypoxia promotes angiogenesis,


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EFFECT OF AIR DRYING AND DRESSINGS ON

THE SURFACE OF WOUND

2.52.5 cmcm22woundswoundsAfter 3 daysAfter 3 days

99 %99 %

41 %41 %

18 %18 %

OcclusiveOcclusive dressingdressing

Air dryer (hot)Air dryer (hot)

Withoutany dressing (air exposed)Withoutany dressing (air exposed)

Dehydrated dermisDehydrated dermis

epidermisepidermis

exsudateexsudate

Wound HealingRef: British Journal for Dermatology


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Moist wound healingMoist wound healingMoist wound healingMoist wound healing

Dry exudate


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CHOICE OF DRESSINGCHOICE OF DRESSING

The choice of dressing is inf luenced by many factors:

1. Type of wound

2. Reliability of product

3. Economic factors


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TYPE OF WOUND

y The presence or risk of infection and the

y Amount of exudate produced.

y Nature and location of the wound,

y Necrotic wounds - covered with devitalized epidermis,

frequently black in colour,

y Sloughy wounds contains a layer of viscous adherent

slough, generally yellow in colour,

y Granulating wounds contains highly vascularisedgranulation tissue, generally red or deep pink in colour,

y Epithelialising wounds - show evidence of a pink margin to

the wound or isolated pink islands on the surface


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COMONLY USED DRESSINGS

1. OCCLLUSIVE:y Simple traditional dressings (Gauzes/ Tulles)

y Polymeric(Foams/Films)

y Hydrocolloids

y Hydrogels

y Fibrous polymers(alginates)

2. DEBRIDING AGENTS

y

ENZYMAT

IC AGENT

Sy Chemical agents

3.3. GENETICALLY ENGINEEREDBIOLOGICAL MEMBRANESGENETICALLY ENGINEEREDBIOLOGICAL MEMBRANES

4.4. COMPOSITES DRESSINGSCOMPOSITES DRESSINGS


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TRADITIONAL WOUND DRESSINGS

Layered Dressing

y> Three layers1. Contact/Interface layer:

y non-adherent, fluid-permeable, in direct contact withwound

2. Absorbent layer:

y absorbs exudate and molds dressing to wound shape

3. Wrap Layer:

y retains underlying layers

y Ex. Gauze or tulles/Cotton gauze/Cover-roll


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TRADITIONAL WOUND DRESSINGS

Layered DressingyAdvantages

y Hemostasis

y wound stability

y decreased edema

y low cost

y Disadvantages

y adherence to wound

y ischemia/necrosis

y Bulk

y frequent changes


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POLYMERIC FILMS

y Thin, elastic, self-adhesive transparent sheetsy Polyurethane or other synthetic materialy Semi-permeable:

y Gas-permeable: O2, CO2, H2O vapor

y Impermeable to proteins, fluids, bacteria

y Indicationsy Uncontaminated, superficial wounds

y IV sitesy Skin tearsy Skin graft donor sites


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POLYMERIC FILMS

y Advantages:y Translucent

y Reducespost-oppain

y Bacterial barrier

yDisadvantages:

yD

ifficulttohandleyAdherencetowound

yNon-absorbent, allowingexudate accumulation


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POLYMERFOAMPOLYMERFOAM

y

Bilaminate Structure:y Inner layer: absorbent, gas-permeable polyurethane

foam mesh

y Outer layer: semi-permeable, non-absorbent

membrane (polyurethane, polyester, silicon).Indications:

y Chronic wounds

y Diabetic, venous, sacral ulcers

y Deep cavity wounds with high exudate

y Granulating wounds with minimal exudate


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Advantages:

yVery absorbent

y maintains moistenvironment

y Molds and contours towound shape

y Less cost

y Skilled nursing not required

Disadvantages:

y

Opaquey Undesirable drying effect on

inadequately exudativewounds(hence no use in dry

wounds)


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HYDROCOLLOIDSHYDROCOLLOIDSy

Made ofmicrogranularsuspension ofnatural/syntheticpolymers, (gelatin orpectin)

y The granules changefrom a semihydratedstate to a gel as thewound exudate isabsorbed


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HYDROCOLLOIDSHYDROCOLLOIDS

y Indications:

y low to moderate exuding wounds

y Clean, granulating, superficial wounds

yAdvantages:y Require changing only every 3 - 7 days

y Provide effective occlusion and barriery Cost effective

y More effective than traditional dressings


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HYDROGELSHYDROGELS

y

Hydrophilic contain 96% watery Semi-permeable outer membrane

y Semi-transparent/ Semi or non-adherent

y Highly absorptive: 100-200% of their volume

y Cornstarch-derived polymerized compound formsa gel upon hydration at the time of use

yAvailable in a powdered or pre-mixed form

y

Applied wet to the wound defect and requires asecondary outer dressing

yWater application is required for removal


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HYDROGELSHYDROGELS

INDICATIONS:INDICATIONS:

y Highly exudating wounds

y Chronic Ulcers

y Thermal burns

y Chemical peels

y Graft donor sites


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HYDROGELS:HYDROGELS:

yAdvantages:

y Reduction in post-op pain/inflammation

yAccelerate wound healing as compared to

traditional dressings

yDisadvantages:

yBacterial growth

y Frequent dressing changes because ofabsorption capacity


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FIBROUS POLYMERS(ALGINATE)FIBROUS POLYMERS(ALGINATE)

y Natural complex polysaccharide derived from algae or kelp(seaweed)

y When applied, an ion exchange between the Ca++within

the alginate fibers and the Na+

from the blood or woundexudate occurs forming a soluble sodium alginate gel thatprovides a moist wound healing environment

y The release of free Ca during ion exchange augments theclotting cascade in the wound bed (haemostasis)

y Highly absorbent, non-adherent

y May remain in place for several days

y If allowed to desiccate, it adheres to and irritates wound


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ALGINATE GELS:ALGINATE GELS:

yy Indications :Indications :y Wounds with copious exudate.

y Exudative wound cavities or sinus tracts(alginate rope).

y Full-thickness burns

y Infected surgical wounds

y Chronic ulcers


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ALGINATESALGINATES

Advantages:y Soluble, removal by saline

irrigation with less painy Skilled nursing not

required

Disadvantagesy Unpleasant odory Requires 2nddressingy Yellow-brown color

confused with pus

y Sorbsany Algidermy AlgiSitey Kaltostaty Fibracol Plus

(Collagen +Alginate)


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DEBRIDING AGENTSDEBRIDING AGENTSy

Activate fibrinolysis and liquify pusy Used in dry necrotic wounds

y An adjunct to surgical debridement

y Chemical agents (Hypochlorites i-e Eusol, Milton, ChloramineT)

y Enzymatic agents

y

Collagenase (Santyl)y removes devitalized tissue without damage to healthy tissue;

promotes granulation and re-epithelialization

y Papain (Panafil)

y digests devitalized tissue, harmless to viable tissue

y Require urea as an activator

y Trypsin (Granulex)Processed in combination with:

y Balsam of Peru: stimulates capillaries; bactericidal

y Castor oil: reduces dessication, cornification, pain


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BIOLOGICAL MEMBRANES(PORCIN)BIOLOGICAL MEMBRANES(PORCIN)

y New group of wound dressings derivedfrom cultured keratinocytes andfibroblasts

y Indicated for chronic, refractory wounds

y

Advantage is the avoidance of skingrafting, which creates another painful,slowly healing wound

y Expensive

y

Higher infection rates vs. other dressingsy Apligraf

y Derived from human neonatal foreskin

y Biobrane

y synthetic


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Skin Grafts

Full thickness or partialthickness skin grafts can beused as dressing in a chronic

non healing wound


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COMPOSITESCOMPOSITES

y Combination of two or more types of semi-occlusive

dressings into one product

y Engineered to maximize efficiency and comfort of

dressings by expanding absorbency while decreasing

the chance of maceration

y

No retention dressing requiredy Improved waterproof coverings improves quality of life


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SUMMARYSUMMARYy Dressings should provide the optimum environment for rapid

healing

y Moist environment and prevention of eschar formation allow

wounds to re-epithelialize and heal faster than if left uncovered

y Semi-permeable or occlusive dressings provide a moist environment,

retain wound fluid that contains growth factors conducive to healing,and promote a low tissue oxygen tension that stimulates

angiogenesis and collagen deposition

y Newer, advanced technology dressings include: Hydrogels, alginates,

foams, films, hydrocolloids

y Tissue-engineered skin equivalents have been developed combining

living keratinocytes and fibroblasts from human foreskins with

bovine collagen


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Documents

Dressing Materials