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