Chapter 6: Wound Management Products
4 Contact Hours
By Kiran Panesar, BPharm (Hons), MRPharmS, RPh, CPh. Kiran has over 15 years of experience as a pharmacist, pharmacy
consultant and pharmacy manager. In addition to authoring her own articles for publication, and presenting pharmacy topics as a
guest speaker, she edits and reviews articles for the US Pharmacist.
Author Disclosure: Kiran Panesar and Elite Professional Education,
LLC. do not have any actual or potential conflicts of interest in relation
to this lesson.
Universal Activity Number (UAN): 0761-9999-15-169-H01-T
Activity Type: Knowledge-based
Initial Release Date: June 1, 2015
Expiration Date: May 31, 2017
Target Audience: Pharmacy Technicians in a community-based
setting.
To Obtain Credit: A minimum test score of 70 percent is needed
to obtain a credit. Please submit your answers either by mail, fax, or
online at PharmacyTech.EliteCME.com.
Learning objectives
ŠŠ Summarize the anatomy and physiology of the skin.
ŠŠ Discuss the factors that affect skin integrity.
ŠŠ Discuss wounds and the wound healing process.
ŠŠ List the most commonly encountered wounds and the major
classifications of wound types.
ŠŠ Discuss factors that delay the wound healing process.
Introduction
Pharmacy technicians are key in helping health care professionals
make choices for wound care products. Furthermore, they are an
excellent point of call for patients wanting to learn more about the
selected product and how to use it correctly. In this course, we discuss
Anatomy and physiology of the skin
The skin is the largest organ of the body, making up to 16 percent of
the body weight. It weighs about 5-8 pounds in an adult and can spread
across 20 square feet.1
Five layers of the skin
The skin consists of five layers:
●● Epidermis: The external layer mainly composed of layers of
keratinocytes.
●● Dermis: A supportive connective tissue between the epidermis and
the underlying subcutis. This layer contains the sweat glands, hair
roots, nerve cells and fibers as well as blood vessels.
●● Subcutaneous tissue: Loose connective and fat tissue beneath the
dermis.
●● Fascial layer: Connects the subcutaneous layer and the above
layers to the muscle tissue.
●● Muscle tissue: Keeps the muscles moving by absorbing oxygen.1
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Questions regarding statements of credit and other customer service
issues should be directed to 1-888-666-9053. This lesson is $16.00.
Educational Review Systems is accredited by the
Accreditation Council of Pharmacy Education (ACPE)
as a provider of continuing pharmaceutical education.
This program is approved for hours (0.4 CEUs) of
continuing pharmacy education credit. Proof of
participation will be posted to your NABP CPE profile within 4 to 6
weeks to participants who have successfully completed the post-test.
Participants must participate in the entire presentation and complete
the course evaluation to receive continuing pharmacy education credit.
ŠŠ Identify the presentation, indications and methods of use for each
dressing type and other wound management products.
ŠŠ Discuss the most appropriate wound products for commonly
encountered wounds and how to select the products for pressure
ulcers, arterial ulcers, venous ulcers, diabetic ulcers, surgical
wounds and burns.
the basics of the skin and wounds and the natural wound healing
process. The second part of the course reviews the wound care
products available to augment this process, how to choose the correct
product, and what new products to expect in the near future.
One centimeter of skin contains:
●● 15 sebaceous glands.
●● 3 yards of blood vessels.
●● 100 sweat glands.
●● 3,000 sensory cells.
●● 4 yards of nerves.
●● 300,000 epidermal cells.
●● 10 hair follicles.1
The skin is dynamic layer in a constant state of change in which the
cells of the outer layers are continuously shed and replaced by cells
moving up from the lower layers.1
Epidermis
The epidermis is the thin, outermost layer of the skin that continually
regenerates every 21-28 days from the basal cell layer.1 It functions
as a barrier to water loss and protects against chemicals, pathogens
and mechanical damage. The thickness of the epidermal layer varies
between different parts of body from as thin as 0.05 mm on the eyelids
to 0.8-1.5 mm on the soles of the feet.1
The epidermis is stratified squamous epithelium that contains four
types of cells:
●● Keratinocytes: These are the most abundant cells in the epidermis.
They produce tough keratin that forms the outer protective layer
of the skin. The keratinocytes are linked by protein bridges called
desmosomes. The different stages of keratin maturation result in
four separate layers of the epidermis.
Dermis
The dermis is a strong structural matrix and is the thickest layer of the
skin. Three major protein fibers provide this layer with mechanical
strength: collagen, elastin and reticular. The dermis consists of blood
vessels, nerves, hair, nails and skin glands.1
The dermis has a number of roles to play:
●● Supplies the epidermis with nutrients.
●● Provides mechanical support to the epidermis.
●● Regulates heat, immune response and receptor for pain and cold
sensations.
Subcutaneous tissue
The subcutaneous tissue layer is made up of loose connective tissue
and fat. This layer can be up to 3 cm thick around the abdomen.
It is located directly beneath the dermis and houses major vessels,
lymphatics and nerves.1 The fatty layer provides insulation for heat
Fascial layer
The fascial layer is a tough, flexible skin layer that gives rise to fibers.
Fascia is the Latin term for band or bandage.
Muscle layer
This layer consists of muscles that have a high metabolic demand, and
is very sensitive to oxygen flow.
Functions of the skin1
The skin is a sensory organ that has a protective role in the body’s
defense mechanism. The functions of the skin include:
●● Protection: The skin acts as a physical barrier against trauma,
bacteria, loss of fluids and proteins. In doing so, it protects the
body from mechanical injury. Furthermore, the Langerhans cells,
tissue macrophages and mast cells found in the skin layers provide
immune protection. The melanin found in the melanocytes of the
skin protects against UV radiation.
●● Sensation: The skin has numerous nerve endings that relay
messages of pain, pressure and temperature to the brain. Damage
to these sensory pathways increases the chances of injury.
●● Thermoregulation: Skin regulates the body temperature through
an interaction between nerves, blood vessels and glands. Under
Skin integrity
Because of the number of vital functions the skin has in the body, it
is important that the integrity and normal processes of the skin are
maintained. However, there are certain factors that alter the integrity of
the skin. These include:
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●● Melanocytes: These produce the pigment that gives the skin its
color by producing the brown pigment melanin. The melanin
absorbs harmful ultraviolet rays.
●● Langerhans cells: These present an antigen to helper T cells,
thereby facilitating their responsiveness to skin-associated
antigens.
●● Granstein cells: These interact with suppressor T cells, possibly
regulating skin-activated immune responses.1
The four layers of the epidermis are the:
●● Stratum basale: the innermost basal or germinative layer.
●● Stratum spinosum: the spinous or prickle cell layer.
●● Stratum granulosum: granular cell layer.
●● Stratum corneum: the outermost horny layer.1
The dermis is comprised of two layers:
●● A thin papillary layer.
●● A thicker reticular layer.
Collagen and elastin provide tensile strength. Collagen contributes
to about 70 percent of the skin’s dry weight. Elastin fibers that
interconnect with collagen ensure that the skin remains pliable, while
proteoglycans provide viscosity and hydration. The breakdown of
collagen and elastin contributes to the formation of wrinkles. This
normal process of aging is enhanced by overexposure to sunlight.1
and cold, absorbs shock, and reserves calories that may be used during
illness and starvation. It is this layer that becomes considerably thinner
as an individual ages.1
conditions of raised body temperature, the arteries in the skin
dilate, and blood flow and sweat production increases, allowing
the body to cool.
●● Excretion: There are more than 2 million pores in the skin that
excrete water and toxins from the body. It is estimated that on
average, an adult loses about 500 ml of water through the skin in
a day.
●● Metabolism: Vitamin D is synthesized in melanocytes upon
exposure to the sun. From here it is absorbed into the body, where
it assists with the mineralization of bones and teeth.
●● Social interaction: The appearance of an individual’s skin is
linked to self-esteem and confidence. Damage to the skin can have
physiological as well as psychological effects.
●● Age: At birth, the skin and nails are thin and gradually thicken
with age. During adulthood, the process of skin thinning begins,
leading to the formation of lines and wrinkles. Elderly individuals
have thin, fragile skin with poor blood circulation. This means that
 wounds form more quickly and heal more slowly. The production
of vitamin D also decreases, as does the production of oil in the
glands, leading to dryness, scales and itch.
●● Sun: Overexposure to the sun can lead to dry skin with wrinkling
and irregular pigmentation. Furthermore, the epidermis thickens
and the dermal vessels dilate. Prolonged exposure to the sun
reduces the concentration of the Langerhans cells by 50 percent.
●● Cosmetics: Soaps remove the lipid coating of the skin and reduce
the skin’s water-holding ability. Alkaline soaps may increase
Wounds
A wound is any process that leads to the disruption of the normal
architecture and function of the tissue.2 Wounds can be described as
either:
●● Closed wounds, such as a bruises or sprains.
●● Open wounds, such as an abrasions, lacerations, avulsions,
ballistic, hemia, or surgical wounds.
Hemostasis phase
During hemostasis, epinephrine is released in an attempt to minimize
bleeding into the soft tissues. It happens from initial injury to
Inflammatory phase
The inflammatory phase follows the hemostasis phase from 0 to 3
days post-injury. Part of the body’s normal defense mechanism, the
inflammatory stage is essential to the healing process and occurs
within seconds of injury.3 It involves cleaning up the wound of cellular
debris by leukocytes and macrophages.
There is immediate vasoconstriction of the damaged blood vessels and
coagulation to limit blood loss.4 Platelets are attracted to the damaged
blood vessels, and the coagulation cascade is initiated, leading to a
platelet plug that is later stabilized by fibrin.4
Following this, histamine and other chemical mediators are released
from the damaged cells, resulting in vasodilation.3 Vasodilation
Proliferation
Also known as the fibroblastic or regenerative phase, proliferation
typically occurs 3 to 21 days post-injury, during which angiogenesis
and granulation tissue formation occur.6 Macrophages, fibroblasts,
immature collagen, blood vessels, and ground substance make up the
granulation tissue that fills the wound’s cavity. Granulation tissue,
comprised of macrophages, fibroblasts of immature collagen, blood
vessels and ground substance, is formed. Fibroblasts play two roles in
Maturation
The maturation phases can take anywhere from 21 days post-injury
and can last up to 1½ years later.4 Fibroblasts, MMPs and growth
factors are critical in this phase, during which collagen fibers cross-
link and reorganize, and the strength of the scar increases.7
The entire process of wound healing is dependent upon cytokines,8
chemicals that are released by cells to alter the activity of surrounding
cells.8 One cytokine can trigger different responses in different cells,
depending upon the target cell. Cytokines are becoming a target for
newer wound healing products.8
Some of the most important cytokines in wound healing are:
●● Transforming growth factor alpha (TGF-α), which is released by
macrophages and promotes migration and proliferation of a variety
of cells.
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the skin’s pH, which may change the ability of the skin to resist
bacteria.
●● Diet: A healthy, well-balanced diet is required for normal skin
integrity.
●● Drugs: Corticosteroids reduce the thickness of the skin and
interfere with the synthesis of collagen.
●● Disease processes: Various diseases alter nutritional status and
oxygenation.
The management of closed wounds is beyond the scope of this
course. The healing of a wound is a highly complex process
involving an interplay of cellular, physiological, biochemical and
molecular processes that can be divided into four phases: hemostasis,
inflammation, proliferation and maturation. These lead to the
restoration of cell structures and tissue layers after an injury.
approximately three hours post-injury. Platelet cells form a clot and
release cytokines.
releases growth factors and brings white blood cells to the area,
leading to the release of other chemical mediators that are essential for
wound healing.4
Some of these mediators increase capillary permeability, causing
exudate to be released into the wound area.3 Exudate is a broad term
used to describe the fluid that is produced by wounds following
hemostasis. It primarily consists of water and may include proteins,
electrolytes, nutrients, proteases, growth factors, white blood cells,
platelets and inflammatory mediators.5 Healthy exudate is a pale amber
color, odorless and watery and is a sign of healing.5 Neutrophils in the
exudate serve to remove foreign material and dead or dying cells and
attract macrophages to the area.4
wound healing process; they stimulate the production of collagen and
elastin that increase the strength of the wound, and they stimulate the
growth of new blood vessels.4
As granulation tissue fills the wound site, the edges of the wound pull
together, decreasing the surface of the wound. Epithelialization in the
final step in which the epithelial cells migrate from the wound edges
and the wound is finally covered, resulting in the formation of a scar.6
●● Fibroblast growth factor (FGF) is released by macrophages
and endothelial cells. It causes angiogenesis and fibroblast
proliferation.
●● Transforming growth factor beta1 and beta 2 are secreted by
platelets and macrophages. They lead to epidermal cell motility,
chemotaxis of macrophages and fibroblasts, synthesis and
remodeling of the extracellular matrix.
●● Platelet-derived growth factor (PDGF) are secreted by platelets,
macrophages and epidermal cells. These cause fibroblast and
macrophage chemotaxis and proliferation.8
Acute wounds
Acute wounds are usually caused by trauma or injury and heal easily
by themselves and require very little care, such as burns.9 The wound
undergoes three distinct phases:
●● Phase 1: The inflammatory, defensive or reaction phase that
normally lasts 4-6 days.
Burns
Burns are acute wounds that can be caused by several external factors,
such as exposure to chemicals, heat or flames.9 There are four types of
burns:
●● Thermal burns, caused by extreme heat or cold.
●● Chemical burns, caused by skin contact or inhalation with a caustic
agent.
●● Electrical burns, caused by a live electrical current.
●● Radiation burns, caused by overexposure to the sun or radioactive
materials.
The scale used to measure the level of tissue injury in burns describes
the burns by degrees: superficial, partial thickness or full thickness.9
The spread of the burn injury is measured in terms of the body that it
affects and is calculated using the rule of nines.9 The different parts of
the body are divided as shown in the table below.
Chronic wounds
Chronic wounds are those that take longer than 21 days and sometimes
even years to heal.9 This can be due to various factors, including:
●● Pressure.
●● Poor nutritional status.
●● Disease.
●● Poor circulation.
A chronic wound is usually in an inflammatory or proliferative
state and requires a comprehensive therapeutic approach.9 When
managing chronic wounds, several treatment modalities may have to
be incorporated into the treatment plan, including nutritional support,
improvement of circulation and management of incontinence.9
Pressure ulcers
Pressure ulcers are sometimes referred to as pressure sores, bedsores or
decubitus ulcers that occur when a soft tissue is compressed between
two hard surfaces.9 These are commonly found in the sacrum and
coccyx, the trochanter and the heels and ankles.9
The first step in the treatment of pressure ulcers is to remove the
source of pressure. The time it takes for the pressure ulcer to heal
varies among patients and is dependent upon a number of factors,
including the patient’s nutritional status.9
Pressure ulcers can be classified into four stages based upon the depth
of the ulcers. Classification helps in developing a treatment protocol,
selecting a reduction support surface, and obtaining reimbursement for
the wound care management products.9
Arterial ulcers
Arterial ulcers occur in the lower extremities of the body, usually
between the ankles, the toes and other areas that are prone to rubbing
from footwear. Arterial ulcers occurs when damaged arteries decrease
the blood flow to the tissue, leading to lack of blood flow and resulting
in consequential cell death.9 It is useful to note that arterial ulcers can
be perpetuated by smoking, vascular disease or diabetes.9
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●● Phase 2: Proliferation phase that lasts from 4-24 days.
●● Phase 3: The maturation or remodeling phase that lasts 21 days to
as much as 24 months.
Body part Percentage of body surface
area (BSA)
Head 9
Chest 18
Back 18
Right arm 9
Left arm 9
Right leg 18
Left leg 18
Genitals 1
Hence, a burn covering the arm and chest of a small child would total
27 percent of the total body surface area (9 percent for the arm and 18
percent for the chest).9
The exudate of chronic wounds contains higher levels of neutrophils,
pro-inflammatory cytokines, biofilm phenotype bacteria and
deleterious protein digesting enzymes (matrix metalloproteinases,
MMPs).8 In the right amounts, MMPs can aid wound healing by
promoting cell migration, remodeling and breaking down damaged
extracellular matrix.8 Excessive MMPs, however, can cause increased
degradation of cellular components.
Because chronic wound exudate is irritating to periwound skin and
leads to contact dermatitis and allergic reactions, the MMPs need to
be inhibited.8 Examples of exudate producing chronic wounds are leg
ulcers, diabetic foot ulcers, pressure ulcers, fungating carcinomas,
chronically infected wounds, fistulae, deep wounds, and wounds
associated with limb and sinus edema.8
●● Grade 1 pressure ulcers are non-blanchable erythema of intact
skin. Other indicators that are particularly useful in darker
skinned individuals are discoloration of the skin, warmth, edema,
induration or hardness.
●● Grade 2 pressure ulcers are associated with partial-thickness
skin loss involving the epidermis, dermis or both. The ulcer is
superficial and presents clinically as an abrasion or a blister.
●● Grade 3 pressure ulcers are those that have full-thickness skin
loss involving damage to or necrosis of subcutaneous tissue that
may extend down to but not through underlying fascia.
●● Grade 4 pressure ulcers have extensive destruction, tissue
necrosis, or damage to muscle, bone, or supporting structures with
or without full-thickness skin loss.9
Arterial ulcers are small in size, about 1-2 cm in diameter,
symmetrically round-shaped with a pale, deep wound bed. They have
demarcated borders that appear thickened and rolled but have minimal
drainage.9
Venous stasis ulcers
Venous stasis ulcers occur in the lower extremities of the body Unlike arterial ulcers, venous ulcers have irregular, poorly demarcated
anywhere between the ankle and the midcalf.9 They arise when the borders with moderate to heavy drainage.9 Because venous ulcers
veins of the legs become dilated and the valves cannot function sometimes go as deep as the subcutaneous tissue, they may be very
properly. This leads to the congestion of blood, and the fluid leaks painful.9
from the veins and congests the immediate tissue area.9 The poorly Assessing a patient for a venous ulcer involves obtaining a complete
perfused tissue eventually dies, leading to the formation of an ulcer. patient history.9 A physical examination should be conducted to reveal
A number of factors predispose individuals to venous insufficiency, any edema, hemosiderin deposits, dermatitis, positive pules, scarring
including: from previous ulcers and ankle flare.9
●● Prior pregnancy. Clinical signs of venous ulcers are:
●● Deep vein thrombosis. ●● Brown staining seem in the skin above the medial malleolus.
●● Leg trauma. ●● Edema.
●● Cardiac disease. ●● Varicose eczema.
●● Poor nutrition.
●● Poor calf muscle pumps.9 Venous ulcers are treated using compression therapy techniques.

Diabetic ulcers
Diabetic ulcers occur in the bony or pressure-bearing surfaces of The University of Texas Wound Classification System11
the foot (ball, heel and surfaces). Their classification depends upon Stage Grade 0 Grade 1 Grade 2 Grade 3
the depth of the ulcer, the presence of ischemia, and the degree of
infection.9 A Pre-ulcerative Superficial Ulcer Ulcer
or post- ulcer without penetrating penetrating
There are two classification systems currently used to categorize ulcerative tendon, to tendon or to bone
diabetic foot ulcers: foot at risk capsule, joint capsule
●● The Wagner Ulcer Grade System. for further or bone
●● The University of Texas Wound Classification System. ulceration involvement
The Wagner Ulcer Grade Classification System10 B Presence of Presence of Presence of Presence of
Grade Characteristics infection infection infection infection
0 ●● Pre-ulcer lesion C Presence of Presence of Presence of Presence of
●● Healed ulcer ischemia ischemia ischemia ischemia
●● Presence of bone deformity D Presence of Presence of Presence of Presence of
1 ●● Superficial ulcer without infection and infection and infection and infection and
subcutaneous tissue ischemia ischemia ischemia ischemia
involvement The underlying cause of diabetic foot ulcers is elevated glucose levels
2 ●● Penetration through the from diabetes. The pressure points on the planta r of the foot build up
subcutaneous tissue; may as a callous, creating further pressure. The skin eventually ruptures,
expose the bone, tendon, leading to an ulcer.9
ligament, or joint capsule Diabetic ulcers tend to be symmetrically round with a heavy peri-
3 ●● Osteitis, abscess or ulcer callous and have moderate to heavy drainage. The ulcer contains
osteomyelitis granular tissue, has a deep wound bed, and is at a high risk of infection.9
4 ●● Gangrene of the digit Assessing the diabetic ulcer involves a comprehensive patient history,
5 ●● Gangrene requiring foot physical examination, tests to evaluate neurologic function, and tests
amputation to evaluate pressure and perfusion of the lower leg and foot.9
Diabetic foot ulcers need to be properly cleaned and dressed as well
as off-loaded. Treatment modalities include topical antimicrobials,
debridement, biotherapies and even surgery.9

Surgical wounds
A surgical wound is an intentional wound created by a surgical
incision.9 It is considered acute for the first 14-21 days, but chronic if
it lasts longer. Most surgical wounds are closed with negligible tissue
loss.
The type and frequency of wound care depends upon the location of
the incision, the extent of tissue loss and the condition of the surgical
wound. Wound healing is monitored from a baseline. Chronic surgical
wounds can be closed through primary, secondary or tertiary healing
techniques.9

Wound thickness
In some situations, classifying the wound based upon the depth of Partial-thickness wounds are those that are involved with destruction
damage may be useful. throughout the epidermis into but not through the dermis. Such
wounds heal by re-epithelialization. Examples of partial-thickness
Superficial wounds are those in which only the epithelial layer of
wounds include stage I and II pressure ulcers, mild abrasions, second-
the skin is damaged. The skin has a reddened appearance, might
degree burns and donor sites.9
be swollen and feels very sore. Sunburns are a typical example of
superficial wounds.9
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Full-thickness wounds are those that have complete damage through
the skin.9 Tissue destruction extends through the epidermis and the
dermis. In some cases, the subcutaneous layer, underlying muscle
or connective tissue may be damaged.9 Full-thickness wounds heal
Factors that delay wound healing
When managing wounds, it is useful to know what factors might delay
wound healing and remove these factors, if possible, to accelerate the
wound healing process. These factors include:
●● Local factors that impede the healing process, including:9
○○ Pressure: Pressure impedes blood flow to the surrounding
tissue and delays healing.
○○ Desiccation: Cells in desiccated wounds dehydrate and dry,
resulting in slower wound healing.
○○ Trauma and edema: Trauma and edema can reduce localized
blood supply and hence slow down wound healing.
○○ Infections: The presence of an infection means that the wound
will remain in the inflammatory phase for longer and hence
delay the healing process.
○○ Necrosis: Necrotic tissue, both slough and eschar, must be
removed before healing can occur.
○○ Incontinence: Urinary and fecal incontinence can alter the
skin’s integrity.
●● Systemic factors that affect the overall body include:9
○○ Age: Elderly patients are at a higher risk for developing
problem wounds because of their compromised immune,
Therapies
Patients undergoing radiation therapy or taking steroids are at an
increased risk of delayed wound healing.9 Radiation impairs the
cells responsible for collagen production and may actually shrink the
numbers of collagen cells, disrupting the wound healing or resulting
in a weak wound. Furthermore, radiation can damage blood vessels,
reducing tissue perfusion.9
Wound management products
Topical preparations including dressings for wound care have been
used for centuries. These play a role in wound management and have
developed greatly over the last 50 years from passive to more active
types.12 The first dressings used in the 18th century were made from
natural materials, such as oakum. These dressings were absorbent but
could not retain the exudate, caused infections, and adhered to the
wound bed.5
This led to the development of Gamgee, an absorbent cotton-wool core
sandwiched between two layers of absorbent cotton gauze.5 In the 19th
and 20th centuries, synthetic ingredients were increasingly used in the
manufacture of dressings.6
In modern day medicine, when dispensing a prescription for wound
management products, you will come across a variety of items apart
from simple dressings. These include:
●● Biologics and biosynthetics, including growth factors.
Wound cleansers
Before a wound can be dressed, it needs to be thoroughly cleaned.
There are various cleaning solutions that can be used to remove any
contaminants, foreign debris and wound exudate from the wound
surface or to irrigate deep cavity wounds.
In rare cases, you may have to prepare a cleaning solution in the
pharmacy or advise patients on how to prepare the solution at home.
●● Sterile water: Sterile water is safe to use anywhere on the body.
Water can be sterilized by boiling for 60 seconds and allowing it
to cool. Sterile water prepared this way must be stored in a closed,
Page 61 PharmacyTech.EliteCME.com
by granulation, contraction and re-epithelialization. Examples of
full-thickness wounds include Stage III and IV pressure ulcers, deep
surgical incisions, and third-degree burns.9
circulatory and respiratory systems, poor hydration and
improper nutrition.
○○ Body mass index: Obesity reduces the supply of blood to
the adipose tissue and limits people’s mobility. Emaciation
compromises patients’ nutritional status and increases the bony
prominences.
○○ Stress: Hormones, such as steroids, become elevated during
periods of stress. To overcome the stress, the body’s defenses
are diverted to manage the stressful condition, away from the
healing process of the wound.
○○ Nutrition: The correct levels of total protein, serum albumin
and hematocrit are required to facilitate wound healing.
Nutritional assessment provides a better insight of patients’
nutritional status.
○○ Medications: Drugs may prevent or slow the healing process.
○○ Tissue oxygenation: Tissue hypoxia leads to tissue
deterioration and the formation of an ulcer.
○○ Concomitant disease: Medical conditions, such as diabetes,
can delay the wound healing process.
Corticosteroids suppress inflammation, including the inflammatory
phase of wound healing. Patients that cannot be taken off
corticosteroid therapy should be prescribed Vitamin A for topical
and systemic use to reverse the effects of corticosteroids on wound
healing9.
●● Biophysical agents, such as electrical stimulation therapy and
oxygenation.
●● Cellular and tissue-based products for wounds, including both
nonviable and viable human and tissue-based products.
●● Compression therapy.
●● Debridement agents.
●● Drainage collectors.
●● Mobility aids.
●● Negative pressure wound therapy.
●● Nutritional management products, including nutritional
supplements.
●● Off-loading devices.
●● Positioners and protectors.
●● Tapes and bandages.
●● Wound cleansers.
sterile container and refrigerated, if possible. The water is useable
for several days.13
●● Saline: Safe to use anywhere on the body. Can be made by adding
1 teaspoon of salt to 1 liter of water, boiling for at least 60 seconds
and then allowing it to cool. Saline solution prepared this way
needs to be stored in a closed, sterile container and refrigerated if
possible. The solution is useable for several days.13
●● Povidone-iodine: Povidone iodine should be used diluted in the
ratio of 1:4 in water because it is toxic to healthy tissues.13
●● Dakin’s solution: Dakin’s solution is a mixture of 5-100 ml of normal tissues. It also reduces odor in wounds. Dakin’s solution
liquid bleach in 1 liter of saline solution. This mixture is best should not be used around the eyes.13
used further diluted in saline in a ratio of 1:4. Dakin’s solution is Commercially available preparations include 3M Wound Cleanser,
a better antibacterial than saline and therefore, slightly harsher on Amerigel wound wash, and Dermagran wound cleanser.

Dressings
An ideal dressing should:4,14 15 Wound characteristics include:
●● Maintain a moist environment. ●● Location.
●● Provide thermal insulation. ●● Stage.
●● Be nonadherent. ●● Size and depth of involvement.
●● Require infrequent changing. ●● Extent of undermining.
●● Provide mechanical protection. ●● Absence or presence of sinus tracts.
●● Be free from particulate contaminants. ●● Appearance of the wound surface.
●● Be safe to use (i.e., non-toxic, non-allergenic). ●● Amount and characteristic of wound exudate.
●● Be conformable, moldable, and comfortable. ●● Status of the periwound tissues.
●● Have good absorption characteristics. ●● Presence of amount and type of bioburden.
●● Be impermeable to microorganisms. ●● Absence or presence of epithelialization and granulation tissue.
●● Be acceptable to the patient. ●● Host response to previous treatments.
●● Be cost effective.
The aim of the wound treatment should be to decrease the local
●● Be sterile.
bioburden and facilitate healing. This can be achieved through
●● Be available in a suitable range of forms and sizes.
adequate oxygenation, debridement of nonvitalized tissue, removal of
Presently, there are more than 20 different categories of wound debris and exudates, and provision of a moist, but not wet, wound bed.
treatment products, including cleansers, debriders, dressings and Therapy should be aimed at not only healing the wound by preventing
fillers. Others include: complications but also at minimizing scarring and disability.
●● Alginates.
Patient factors to be taken into consideration when selecting therapy
●● Collagens.
include patient comfort, odor control, costs, and individual preferences.
●● Composites.
Underlying conditions, such as malnutrition, anemia, diabetes, and
●● Contact layers.
obesity, and cardiopulmonary, gastrointestinal and immunologic disorders,
●● Foams.
need to be taken into account when selecting a treatment option.
●● Hydrocolloids.
●● Hydrogels. Wound dressings can be divided according to the effect they have on
●● Specialty. the moisture in the wound bed as follows:
●● Wound fillers. Absorb moisture Neutral Add moisture
●● Transparent films.
Alginates Composites Sheet hydrogels
The product selection is based upon both the patient and wound Specialty absorptives Mini-VAC devices Amorphous hydrogels
characteristics.
VAC devices Transparent films Debriding agents
Patient characteristics include:
●● Endocrine disease, e.g., diabetes, hypothyroidism. Gauze Biological dressings
●● Hematologic conditions, e.g., anemia, polycythemia, Foam Collagen dressings
myeloproliferative disorders. Hydrocolloids Contact layers
●● Cardiopulmonary problems, e.g., chronic obstructive pulmonary
Compression Warm-up therapy
disease.
dressings systems
●● Gastrointestinal problems that may cause malnutrition and vitamin
deficiencies. Wound fillers
●● Obesity.
●● Peripheral vascular pathology, e.g., atherosclerotic disease, chronic Primary dressings cover the wound directly, whereas secondary
venous insufficiency, lymphedema. dressings are used to hold a primary dressing in place.
●● Autoimmune disorders.

Alginates
Alginates are made of soft, nonwoven fibers derived from brown
seaweed extract. They are usually supplied in the forms of pads, ropes
or ribbons.6, 14 The calcium salts of alginic, mannuronic, or gularonic
acids are processed to form the fibers. When these fibers come into
contact with fluid rich in sodium such as that in wound exudates,
the calcium ions undergo a transaction that results in the formation
of a soluble sodium gel. Depending upon the type of seaweed used,
some alginate dressings may swell in the wound rather than gelling.7
Alginates do not physically inhibit wound contraction.6
Alginates are highly absorbent and useful for wounds that have
copious amounts of exudates because they can absorb up to 20 times
their own weight in fluid. They are not recommended for wounds
with light exudates or dry eschar. Alginate rope is particularly useful
to pack exudative wound cavities or sinus tracts. They should not be
used in burns. In some cases, alginates can also be used to provide
hemostasis as the alginate stops bleeding after ion exchange with the
wound bed, the wound fluid and the dressing.
Most alginates absorb many times their own weight. The dry dressing
is extremely lightweight and easy to apply. These dressings require a
secondary dressing to secure them in place and may leave fibers in the
wound if irrigation is not adequately performed. Caution should be
used because the pooling exudate from alginate dressings may cause
maceration of the surrounding tissues. Care should be taken to leave
room for expansion when packing cavities.16 They should not be used
with hydrogels that will add fluid to the alginate and reduce its fluid
handling capacity.4

PharmacyTech.EliteCME.com Page 62
Most alginates last three days, although some can last as long as seven
days. When removing an alginate dressing, ensure that all of the used
dressing is removed because it can form a crust around the wound.
Case study
Mrs. Y. is a regular customer at your pharmacy. Her daughter brings
in a prescription for a Sorbsan dressing and 500 ml of normal saline.
Unfortunately, you have run out of normal saline but are expecting the
next delivery within two days. Mrs. Y.’s daughter starts to panic. When
you ask her whether the wound has been cleaned, she explains that the
nurse came with one bottle of normal saline, which she used to clean
the wound. She is not sure why she requires more normal saline.
Charcoal dressings
Some wounds, such as leg ulcers and fungating (cancerous) lesions,
may become malodorous from the metabolic processes of bacteria
within the wound. Charcoal dressings absorb the molecules released
from the wound that may be responsible for the odor. Organisms
Collagens
Collagen is a natural biomaterial that plays an integral part in each
phase of wound healing. Collagen dressings are derived from porcine,
avian, and bovine tendon. Placing collagen on the wound activates
inflammatory cells, including fibroblastic growth, and promotes
increased vascularization of the healing tissue.
Collagen dressings are suitable for moderate to heavily draining
wounds to enhance healing and tissue repair. They are indicated for
Composite treatments
Composite treatments combine more than one component into a
single dressing, for example, an antimicrobial and an absorbent pad.9
They are useful for a broad range of wound types, including those
with minimal or heavy exudates, partial- and full-thickness wounds,
and those with granulation and necrotic tissue.9 These dressing are
particularly useful in outpatient settings and for home use. They are
most widely seen in the delivery of topical antimicrobials, such as
silver and iodine.9
Composite dressings are easy to use, maintain hydration, treat
bioburden and have the potential of reducing the frequency of dressing
Contact layers
Contact layers are thin, nonadherent sheets placed directly on an open
wound bed to protect the wound tissue from direct contact with other
agents or dressings applied to the wound. They are porous, allowing
the fluid to pass through for absorption by an overlaid dressing.9
Contact layer dressings are best for partial- to full-thickness wounds,
infected wounds, donor sites and split-thickness skin grafts. They may
be used with topical medicated preparations.9
Foams
Foam dressings are highly absorbent dressings usually made from
a hydrophobic polyurethane foam or silicone foam, and generally
have a waterproof backing.17 They have various absorption rates,
and some foam products also come with adhesive tapes surrounding
an island of foam. They are useful for heavily exudating wounds,
particularly during the inflammatory phase following debridement and
desloughing, when drainage is at its peak.17 They are also effective
for packing deep cavity wounds to prevent premature closure while
absorbing exudate and maintaining a moist environment, and in
Page 63 PharmacyTech.EliteCME.com
Some brands can be removed as one sheet after moistening with
normal saline, while others may need irrigation with normal saline to
flush out the old dressing.
From this information, you gather that the normal saline is not required
for wound cleaning, but rather for removing the dressing three days
later. You therefore have time to order and dispense the normal saline.
Upon calling the nurse, you discover that this is in fact the case, and
that Mrs. Y.’s daughter can come for the normal saline in a couple of
days.
frequently isolated from malodorous wounds include anaerobes such
as Bacteroides and Clostridium species, and aerobic bacteria including
Proteus, Klebsiella and Pseudomonas spp.
partial- and full-thickness pressure ulcers, venous ulcers, donor sites,
surgical wounds, vascular ulcers, diabetic foot ulcers, second-degree
burns, abrasions, traumatic wounds and cuts. Collagen is an excellent
hemostatic agent that can absorb 40-60 times its weight in fluid.
Because a secondary dressing is required to keep collagen dressings in
place, they are not recommended for use in wounds with eschar. When
combined with other dressings, they may have an advantageous effect
on growth-stalling matrix metalloproteinases.
changes.9 They are, however, costly and may promote prolonged
moisture contact with the surrounding intact skin.9
Dressings impregnated with antibacterials, such as silver or iodine,
are targeted at preventing infections.9 Additionally, topical bacitracin,
polymyxin B, neomycin and their compound forms may be formulated
into an ointment.9 These are soothing, comfortable to wear, lubricating,
occlusive and deliver the antibiotic directly to the wound. They are
effective in limiting scab formation.
Because contact layer dressings provide physical separation between
the wound and the external environments, they aid in the creation
of a moist wound environment and prevent bacterial contamination.
Contact layers require the use of a secondary dressing and are
therefore not recommended for shallow or dehydrated wounds or
wounds covered with eschar.9
weeping ulcers, such as venous stasis.19 The correct size of a foam
dressing is one that overlaps the wound edges from 2-5 cm.
Foam dressings rarely adhere to the wound bed and are very
comfortable to wear. They can be worn during bathing and can
frequently be left undisturbed for three to four days.17 Foams that
absorb exudate will decrease maceration to the surrounding tissue but
can cause a drying effect on the wound if there is too little drainage.
Gauze products
Gauze and nonwoven wound dressings are dry woven or nonwoven
sponges and wraps. These products vary in the degree of absorbency,
and are available as sterile or nonsterile and with or without adhesive
borders.9
Honey-based dressing
Honey has been used for the treatment of acute and chronic wounds
for centuries for its antimicrobial properties. Furthermore, honey
reduces edema, lowers wound pH, and debrides slough and eschar. The
honey used today in wound preparations has to be carefully selected
because not all types of honey are suitable.19 Manuka honey from
New Zealand is considered to be most appropriate for wound care. It
absorbs exudate and has antibiotic properties.19
To achieve medical grade honey, it has to be filtered, gamma-
irradiated, and produced under controlled standards of hygiene to
ensure standardization. It can be used on its own or added to other
dressings, including alginates and synthetic mesh.19 Honey is indicated
Hydrocolloids or hydrofibers
These occlusive and adhesive wafer dressing, also referred to as
hydrofibers, are made of a microgranular suspension of natural or
synthetic polymers, such as gelatin, carboxymethyl cellulose, or
pectin, in an adhesive matrix. Most hydrocolloids react with the wound
exudate to form a gel-like covering that protects the wound bed and
maintains a moist wound environment. In this way, they promote
debridement of necrotic tissue.17 Hydrocolloids are available in sheets,
pastes and powders.
Hydrocolloid wound dressings are best for granulating and
epithelializing wounds with low-to-moderate amounts of exudate.17,20
They should not be used for dry wounds or exposed bone or muscle.
Because they are occlusive, patients can shower while wearing a
hydrocolloid dressing, however their occlusive properties may cause
them to promote overgrowth of anaerobic bacteria, and therefore, they
are contraindicated for infected wounds.21
Hydrogels
Hydrogels consist of a matrix of insoluble hydrophilic polymers that
swell in water but do not themselves dissolve. They contain about
60 percent to 90 percent water and are available as gels, sheets, and
impregnated nonwoven dressings. Hydrogel wound dressings are
effective, comfortable, easy to use, and cost effective. Some hydrogel
sheets have an adhesive border, but most require a secondary dressing.
Hydrogels keep the wound surface moist as long as it is not allowed to
dehydrate.
Hydrogels are useful for wounds with minimal or no exudate, painful
wounds, burns, and skin tears because they hydrate the wound surface
and in some cases, absorb excess exudate.17, 22 They are primarily
rehydrating, although some can absorb excess exudate. This ability
Iodine-based dressings
Iodine is a traditionally used antiseptic that is found in several different
formats. Dressings that are impregnated with cadexomer-iodine are
absorbent and promote debridement as well as having an antimicrobial
effect. These dressings are suitable for infected necrotic wounds.9
Dressings with povidone-iodine are low adherents, nonabsorbent and
mainly used on minor traumatic injuries, including cuts and grazes.9
Since the absorption of large amounts of iodine by the thyroid gland
PharmacyTech.EliteCME.com Page 64
Gauze swabs are widely used in wound care both as primary and
secondary dressings. Gauze swabs stick to wounds and can be painful
to remove at the same time, damaging any newly regenerated tissue.
They are not very absorbent, and exudate can easily soak through
them, allowing the movement of bacteria through the wound.9
for pressure ulcers, leg ulcers, burns, donor sites of skin grafts and
surgical wounds.19
Honey is very sticky and requires careful application – it is either
poured onto the wound bed or applied via a honey-saturated
substrate.19 These techniques are cumbersome, wasteful and messy.
Furthermore, the viscosity of the honey increases with an increase
in temperatures and liquefies at body temperatures. Honey dressings
should not be used in diabetic patients because honey may result in
hyperglycemia.19 The drawing sensation produced by honey may be
discomforting.
The sheets are conformable, with easy application, and help reduce
pain at the wound site; shaped sheets are available for awkward areas,
such as the heels and elbow.17 Pastes and powders tend to have a
greater absorptive capacity than the sheets and are usually used to fill
cavity wounds to the surface.4
These dressings break down to produce residue of various colors
and a foul odor that may sometimes be mistaken for an infection.
Hydrocolloids containing gelatin from pigs may not be acceptable in
patients of some religious backgrounds and vegetarians. The frequency
of changing the sheets depends upon the level of exudate, and is
usually between five to seven days. Because of this long wear time and
the opaque nature of the dressing, patients often become concerned
about infected wounds.
allows desloughing and debriding capacities to necrotic and fibrotic
tissue. They are soothing, cooling, and may even reduce pain, and
therefore are particularly useful when applied to radiation burns.4
On the downside, the high water content of hydrogels may lead to
maceration around the wound area. It is therefore important that no
more than the required amount of dressings be applied to the wound.4
Hydrogels contain propylene glycol, a chemical that is contraindicated
before larvae therapy. Wounds that are to be treated using larval
therapy should therefore be free of hydrogels and thoroughly irrigated
24 hours before therapy. Hydrogel dressings are changed between one
to three times a week.17
can be harmful, the long-term use of iodine dressings is not advisable.
Furthermore, the systemic absorption of iodine can cause an allergic
response.9
Silicone dressings
Silicone dressings are made of soft polymers with a slightly tacky
wound contact layer. As such, they can be removed without causing
any trauma to the wound or surrounding skin.9 Silicon dressings
Silver dressings
Silver has antimicrobial properties that can be added to dressings.
Silver sulphadiazine is useful as a cream for the management of burns.
Silver has also been shown to be effective in treating wounds that are
infected with methicillin-resistant Staphylococcus aureus (MRSA).
Silver may be added to alginate, hydrofiber, hydrocolloid, foam, and
activated charcoal dressings.23
Silver exerts its antibacterial effects in a number of ways:14
●● Interferes with bacterial electron transport.
●● Binds to DNA of bacteria and their spores, increasing the stability
of the double helix and impairing replication.
●● Interacts with the bacterial cell membrane and damages the
structure.
●● Forms insoluble, metabolically ineffective compounds.
Specialty absorptives
This is a broad range of composite products that have a capillary
action that wicks away mild, moderate, or heavy drainage from
wounds. These type of dressings help prevent the periwound area from
becoming macerated.15 They include pads containing nonadherent
contact layers with highly absorbent layers of fibers (cellulose, cotton,
or rayon) that gel upon contact with the drainage.
Transparent films
Transparent adhesive film dressings are made of polyurethane and
are semi-permeable membrane dressings that are waterproof yet
permeable to oxygen and water vapor.15 They maintain a moist wound
environment and help prevent bacterial contamination.15,17 These films
facilitate cellular migration and promote autolysis of necrotic tissue by
trapping moisture at the wound surface.15
Film dressings are best for superficial wounds; wounds with light
exudate; wounds on the elbows, heels, or flat surfaces; covering
blisters; and for the retention of primary dressing, especially
hydrocolloid and alginates, because they provide waterproof cover.16
Wound fillers
Wound fillers including pastes, powders, beads, gels, foams,
pillows, strands and other formulation of substances, are designed
to fill cavities and manage wound drainage.9 They maintain a moist
environment and may contain antibacterials impregnated in them.9
Wound fillers are the perfect choice of dressing for partial- or full-
thickness wounds when used alongside foams, hydrocolloids and
composites to increase the absorption of wound drainage.9 The use
of wound fillers in dry wounds or sinus tracts is not recommended.
Wound fillers obliterate dead space, absorb exudate, retain moisture,
and promote autolytic debridement. However, the application of
wound fillers needs some experience, and some dressings may even
require reconstitution with saline or sterile water for application.9
An example of wound fillers is polysaccharide bead dressings, which
are made of hydrophilic, biodegradable, sterile dextranomer beads
Methods of dressing retention
Once a dressing is applied, it needs to be held in place using either
surgical tapes or bandages, which are the main methods of retaining
dressings.9
Page 65 PharmacyTech.EliteCME.com
may be combined to form silicone layer dressings with a variety of
backings, which impact the level of absorbency.9
It is important that the minimum effective amount of silver is applied
to reduce systemic absorption, because silver may be toxic.14 Some
patients may find the gray discoloration, formed when the silver
reacts with pollutants in the environment to form silver sulphide,
unpleasant.14 Silver dressings are used for two weeks and then the
wound is reassessed. They should not be used in patients receiving
radiotherapy, x-rays, ultrasound, and diathermy.23 Because silver is
inactivated by protein binding, dressings that release silver slowly
need to be changed less frequently than those that immediately release
silver.12
Specialty absorptives are best on wounds that have a heavy discharge.
They may be used as primary or secondary dressings. Those without
an adhesive border are usually changed once daily, whereas those with
an adhesive border may be changed every other day.15
An appropriate film dressing is one that allows for a 4-5 cm overlap
onto the surrounding skin.
Film dressings cannot be used for wounds with moderate-to-heavy
exudate and must be selected carefully, because some newer films are
intended for IV sites and may dry up the wound.17 They are usually
changed up to three times per week.17
Transparent films permit evaluation of the wound progress without
having to remove the product. They are usually waterproof,
gas permeable, economical, and help maintain a moist wound
environment. As an adhesive, transparent films have the potential of
causing skin tears if not correctly removed.
mixed with glycol and water to form a paste.9 They are also available
in a pad form, and may contain antiseptics such as iodine.9 Bead
dressings can absorb up to seven times their weight in fluid through
capillary action, which helps to remove slough and hold bacteria
from the wound bed. Beads containing iodine slowly release this
antimicrobial as they swell.9
Dressings should be changed frequently when the iodine loses color.
This indicates saturation with exudate.9
The beads can cause discomfort when applied to clean, granulating
wounds, and they must be used in conjunction with a secondary
dressing. Beads containing iodine may cause allergic reactions to
iodine and may affect the thyroid if too much iodine is absorbed.9
Surgical tapes
Surgical tapes or strapping are adhesive-backed paper, cloth, latex,
foam, mesh or other nonwoven materials. Most modern tapes are
hypoallergenic, although they may cause skin irritation in a few
patients.9 Therefore, such irritation should not be ruled out in patients
presenting to the pharmacy with a minor skin irritation around the site
of an application of the surgical tape.
Surgical tapes come in a variety of shapes and stretches.9 Stretchable
tapes are better applied over joints to allow room for movement
Bandages
Bandages are available for a number of purposes, such as support
bandages for sprained ankles and gauze bandages to hold cotton or
gauze swabs in place.9 Retention used to hold dressings in place are
made from cotton or nonwoven fabric and have very little elasticity, if
Wound healing promoters
These products are designed to control odor, cleanse wounds and
inhibit microbial contamination. Other types of wound healing
promoters include therapies aimed at closing the wound by inhibiting
bacterial growth or other mechanisms, such as electrical stimulation,
ultrasound stimulation, topical hyperbaric oxygen and laser therapy. 19
Wound healing promoters are useful in a range of wounds, although
all wound healing promoters cannot be used on all wounds. The
therapies provide a favorable environment for granulation formation
and other healing processes.19 They may increase patient comfort and
decrease the duration of wound healing, thereby reducing the risk
of complications. It is useful to inform patients that the use of these
products may cause temporary stinging or burning sensations.
An example of wound healing promoters is protease inhibitors,19
which contain chemicals to reduce elastase, plasmin and MMP activity
in chronic wounds.19 By blocking these proteases, the dressings reduce
degradation of cellular components in chronic wounds, allowing them
to transition from chronic to acute wounds that effectively decrease
exudate production.19 However, the efficacy of these dressings is still
a matter of debate as it is argued that alginates may provide similar
results.19
Biological and biosynthetic methods of wound healing promotion
include growth factors, chemokines, cytokines, and various gels,
solutions or semi-permeable sheets derived from natural sources,
including animals and human cadavers. Biological skin substitutes
Negative pressure wound therapy
Vacuum-assisted wound closure (VAC) is a type of topical negative
pressure therapy based on the theory that the application of negative
pressure either continuously or intermittently can speed up the healing
process.23 A vacuum is applied across the wound together with a
specially designed foam dressing or moistened gauze connected
to a vacuum machine by tubing. VAC is useful in enhancing blood
flow, diminishing chronic edema, limiting bacterial proliferation and
accelerating granulation and the formation of tissue in the wound.23
Enzymatic debriders
Proteases (e.g., matrix metalloproteinases) are associated with
angiogenesis and the natural debridement and cleansing of wounds.
Enzymatic debriders are proteolytic enzymes that provide a base for
optimal wound healing by digesting collagen fibers, fibrin, elastin
and other proteins that anchor necrotic debris to the wound base.
PharmacyTech.EliteCME.com Page 66
without displacing the dressings.9 Micropore is an example of a
commonly used surgical paper tape. Transpore is a transparent,
perforated surgical tape that is made out of plastic. It is slightly
stronger than Micropore and should be avoided on very thin skin.
Zinc oxide added to surgical tape is often used to prevent infections.
Furthermore, zinc oxide tape is used as grip for sports equipment, such
as tennis racquets, because of its rough texture.9
any. They come in various widths and either are a bandage or a tubular
bandage.9 When applying the bandage, ensure that it is not too tight,
and use only enough bandage to secure the dressing.9
include dermal (allogenic), epidermal (autograft) and composite
grafts.9
These treatments have a variety of uses, depending upon the therapy in
question.
Biological and biosynthetics offer a broad range of applications for
use in a variety of settings.9 As a wound starts to heal, the amount
of exudate decreases and the wound surface area reduces. They can
improve healing and decrease the need for surgical intervention.9
These therapies require a clean wound bed and evidence of good
tissue oxygenation before they can be used.9 They can be expensive
and inconvenient to store and access, and may cause hypersensitivity
reactions in some patients.9
Growth factors, such as epidermal growth factors, are believed
to stimulate the growth of keratinocytes and are therefore helpful
in healing wounds that depend upon mitosis and the migration of
keratinocytes.
Growth factor is used for the treatment of diabetic foot ulcers.
Regranex™ is the brand of platelet-derived growth factor isoform BB
that is currently available in the U.S. It is thought to act by promoting
the chemotactic recruitment and proliferation of cells involved in
wound repair.
The application of growth factors to wounds that have raised levels of
proteolytic activity may mean that they are degraded by proteolytic
enzymes rendering them inactive. The growth factors available in the
market have a low bioavailability and very high manufacturing costs.
VAC is most frequently recommended for use with chronic wounds,
acute and traumatic wounds, flaps, grafts and other nonsutured
wounds, such as dehisced incisions.23
This therapy is helpful in removing excess exudate, increasing
granulation in some wounds that were poorly granulating, increasing
wound bed perfusion and protecting the wound from trauma and
contamination. VAC should not be used in ischemic wounds.23
Furthermore, they assist in tissue remodeling by allowing cells to
move through the wound bed.24,25
Debriders are indicated for the debridement of necrotic tissue and
liquefication of slough in acute and chronic lesions, such as pressure
ulcers, diabetic ulcers, burns, post-operative wounds, trauma
wounds, and infected wounds. Debriding agents should be used
when individuals cannot tolerate surgery or when patients require
maintenance debridement while being managed in long-term care
facilities or at home.9 They have also found a use in facilitating
Compression therapy
Compression therapy includes dynamic compression or static
compression. Dynamic compression makes use of pumps and sleeves.
Static compression products include:
●● Multilayer wraps, which provide controlled, graduated
compression.
●● Unna boots.
●● Compression stockings.9
Multilayer wraps are layered primary dressings that are used to apply
compression in the treatment of venous ulceration.14 They vary in
the amount of stretch they provide intrinsically and extrinsically, and
correct application is essential for maximum effectiveness. They may
consist of two or more of the following layers:14
●● First layer: Natural wool layer, which is subcompression wadding
bandage, used to absorb exudate and redistribute the pressure
around the ankle; applied in a loose spiral.
Larvae therapy (biosurgery)
Larvae therapy uses sterile fly larvae (maggots) to debride necrotic and
sloughy wounds effectively and quickly, and in many cases, removes
the need for surgical debridement.23, 26 The maggots break down dead
tissue by releasing proteolytic enzymes to digest it and promote the
formation of granulation tissue.23 The maggots die very quickly, and
should be applied the same day they are delivered.
A nonocclusive dressing should be applied over the maggots, because
they require oxygen to survive. The periwound area should be
protected, because healthy skin can be damaged by the maggots.23
Larvae therapy can be used for purulent, sloughy wounds on the
skin.27 The process takes about three to five days and requires close
monitoring. The outer dressing should be changed as required to keep
Newer therapies
Chitosan
Chitosan is currently under investigation for its antimicrobial
properties.19 This is a natural, positively charged polysaccharide that
is the partially N-deacylated derivative of chitin. Chitin is found in the
exoskeleton of crustaceans such as lobsters, crabs, shrimps and other
shellfish.19
Chitosan inhibits the growth of both Gram-positive and Gram-negative
bacteria with minimal toxicity to mammalian cells.19 Of particular
interest is the ability of chitosan to inhibit the growth of MRSA.
Furthermore, chitosan has demonstrated other properties, including
Page 67 PharmacyTech.EliteCME.com
debridement between episodic debridements, such as sharp
debridement and in tunneling wounds, where they remove debris that
may be difficult to visualize and reach.9
●● Second layer: A crepe bandage that increases absorbency and
smoothes the orthopedic wool layer.
●● Third layer: A light compression bandage.
●● Fourth layer: Elastic cohesive bandage that keeps the four layers
in place.
There are specific systems designed for ankle circumferences less than
18 cm, 18 cm to 25 cm, 25 to 30 cm, and greater than 30 cm. These
can be left in place for up to a week.
Unna boots are made of a gauze bandage that is evenly impregnated
with a non-hardening paste of zinc oxide to provide venous ulcer
compression therapy. They should not be used in patients with a
known hypersensitivity to zinc oxide.
the maggots from suffocating, and patients should be careful not to
squash the maggots, especially at pressure sites.23
Larval therapy is quick, efficient and effective. Furthermore, it
breaks down bacteria, thereby reducing malodor. This therapy can,
however, be painful as a result of the changing pH, and patients may
be prescribed a simple analgesic such as acetaminophen to overcome
this.21,23 Some patients and even health care prescribers may be hesitant
to use it for fear of handling maggots. 21,23
It is useful to note that patients cannot be prescribed larval therapy
if they have used hydrogels. Hydrogels contain propylene glycol, a
chemical that is too toxic to larvae.
●● Hemostasis.
●● Analgesia.
●● Antitumor activity.
●● Activation of immune system and inflammatory cells, such
as macrophages, fibroblasts and angio-endothelial cells to aid
healing.19
Examples of wound management products
Dressing type Indication Brand names
Absorbent As primary or secondary dressing to manage surgical CombiDERM, Multipad, Sofsorb, Iodoflex, Drawtex,
incisions, lacerations, abrasions, burns, donor or skin graft Multipad, Primapore
sites, or any exudating wound.
Alginates Wounds with moderate to heavy exudate, such as pressure Algicell, CarraSorb, Kaltostat, Silvercell, Algisite M,
ulcers, infected wounds, diabetic ulcers and venous stasis Seasorb Soft, Tegaderm Alginate, Sorbsan
ulcers
Antimicrobial ointments Infected wounds Neosporin, Polysporin, Bacitracin
Compression Venous leg ulcers 3M Coban 2 Layer, DYNA-FLEX, Profore Lite, Gelocast
Unna Boot, Comprilan, Tricofix, DuoDERM SCB,
Setopress, UNNA-FLEX, Unna-Pak, TENDERWRAP,
Profore, Profore LF
Collagen dressings Primary dressings for artial and full-thickness pressure Biostep, Biostep Ag, Collasorb
ulcers, venous ulcers, donor sites, surgical wounds,
vascular ulcers, diabetic ulcers, second-degree burns,
abrasions and traumatic wounds.
Contact layer dressings Partial- and full-thickness wounds, infected wounds, ProFore WCL (wound contact layer)
donor sites and split-thickness skin grafts
Debriders Debridement of necrotic tissue and liquefaction of slough Iodosord Gel absorbent, Collagenase SANTYL ointment
in acute and chronic lesions, such as pressure ulcers,
diabetic ulcers, burns, post-operative wounds, trauma
wounds, and infected wounds
Film Partial-thickness wounds with little or no exudate, CarraFilm, OpSite, Uniflex, Cutifilm, Tegaderm Film
wounds with necrosis, and as both a primary or secondary Dressing
dressing.
Foam Partial- and full-thickness wounds, Allevyn, Tegaderm Foam Dressing, Tielle
Foam (combination) Partial- and full-thickness wounds Urgocell, Versiva
Honey dressings Partial- and full-thickness wounds including pressure Activon Tulle, Algivon, Medihoney, Mesitran.
ulcers, leg ulcers (arterial, venous, and diabetic ulcers),
burns, donor sites, and surgical wounds
Hydrogels Partial- and full-thickness wounds, wounds with necrosis, IntraSite, Curacel, Actiform Cool, Nu-Gel, Purilon
minor burns and radiation tissue damage.
Hydrocolloids Partial- and full-thickness wounds with or without Tegasorb, Hydrocol, Comfeel Plus, Duoderm, Granuflex,
necrotic tissue. Tegaderm Hydrocolloid Dressing
Nonadherent Packing and covering a variety of wounds. Adaptic, Melolin, NA Dressings, Telfa
Protease modulating Chronic wounds Cadesorb, Tegqaderm Matrix
Silicone dressings Prevent or improve the appearance of old and new Biobrane, Cica-Care, Mepiform. Mepilex, Mepitel
hypertrophic and keloid scars
Silver dressings Infected wounds Acticoat,. Actisorb Silver 220, Aquacel Ag, Contreet,
UrgoCell Silver, Flamazine
Tapes and bandages Hold dressings into place Micropore, Durapore, Medipore, Transpore, Blenderm
Wound fillers Partial- and full-thickness wounds, infected wounds, Altrazeal, Dermagram, Hydrophilic-B, Flexigel, Gold
draining wounds and deep wounds that require packing Dust, Silverlon Wound Packing Strips

PharmacyTech.EliteCME.com Page 68
Selecting wound management products
As discussed earlier, the choice of the wound management product
is affected by a number of factors. Equipped with all the basic
knowledge discussed above, health care professionals can select the
most appropriate dressing for each wound.
The aim of the treatment and what is expected from the treatment
modality should be clear before the choice of therapy can be made.
Cuts
Because there is not loss of tissue in cuts, the treatment is aimed at
controlling bleeding and holding the skin edges together to allow
healing.9 Depending on the depth of the cut, sutures, adhesive strips or
tissue adhesives may be required.9
Sutures need skill and experience to ensure minimal scarring.9
Adhesive strips such as Steri-strips are useful if the patient has fragile
skin that may tear with sutures. Adhesive strips are not recommended
for use over joints because they may tear away from the skin if
stretched.9
Tissue adhesives or glues are useful for quick and painless
management of cuts. They contain cyanoacrylate compounds,
Abrasions
Abrasions are superficial injuries in which the skin has rubbed against
a hard surface and there is little or no bleeding.9 Abrasions need to be
cleaned thoroughly because they may have foreign bodies embedded
Pre-tibial lacerations
A laceration is a tear in the skin caused by a blunt instrument or a
force that has a jagged edge. Simple lacerations, even with a small
hematoma or skin-edge necrosis, can be managed conservatively.9
Necrotic wounds
In healthy individuals and under ideal conditions, the dead tissue in
a wound will autolytically debride from healthy tissue underneath.
Exposing this tissue to a drying environment can dehydrate the
tissue to the point where a hard black or olive eschar is formed. The
formation of an eschar delays the healing process, and shrinking
causes pain.9 The goal of treatment for such wounds is rehydrating the
wound and removing hard, dead tissue.9
Hydrogel dressings rehydrate the wound and make it easier to remove
the eschar. Amorphous gel preparations are the preferred type of
hydrogel for such wounds.9 Barrier preparations, such as white soft
paraffin, can be used to protect the surrounding skin from maceration.
The primary dressing will have to be held in place with a secondary
dressing. Secondary dressings include perforated plastic film adsorbent
dressings or vapor permeable films.9
Necrotic wounds can also be managed with larval therapy.9 However
this form of biosurgery is not useful if a hydrogel has been used
Necrotic digits
Necrotic digits are treated slightly differently from necrotic wounds
found in other parts of the body. These tissues should not be
rehydrated because of the potential for infections.9 Such wounds
should be left exposed to the air to allow the natural separation of the
nonviable and the viable tissue.9
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These may include:
●● Facilitate cosmetically acceptable healing in the shortest possible
time.
●● Remove extensive areas of necrosis.
●● Relieve pain.
●● Eliminate odors.
●● Control infections.21
including bucrylate, enbucrilate and mecrylate, which polymerise in an
exothermic reaction on contact with a fluid or basic substance, forming
a strong, flexible, waterproof bond.
In rare cases, the heat from the reaction may burn and cause
discomfort to the patient. Special care is required during application
to ensure that the adhesive does not pass between the wound edges.
The wound edges need to be held together for at least 30 seconds after
application. If the adhesive accidentally spills onto the skin or lips,
the bonded surfaces should be immersed in warm soapy water and the
surfaces peeled or rolled apart with the aid of a spatula.
in them that can cause long-term scarring. Abrasions usually heal on
their own, but the application of a film dressing or a thin hydrocolloids
or adhesive foam dressing may help to alleviate the soreness.9
Any hematoma should be evacuated and necrosis trimmed, after which
adhesive tape can be used to bring the skin together.9
previously. Hydrogels contain propylene glycol that is toxic to the
larvae.9 Hydrocolloids are a suitable alternative for managing necrotic
wounds in patients who may eventually require larval therapy.
However, because hydrocolloids are occlusive, they may promote
infections and therefore should not be used in necrotic wounds that
may already be infected or may become infected.9
While infected necrotic wounds are rare, health care professionals may
have to treat such wounds.9 Alginates that can absorb large amounts of
exudate are suitable for infected necrotic wounds. They should not be
used once the wound becomes dry.9
Once the necrotic portion of the tissue is treated appropriately,
the eschar separates from the healthy tissue, and a sloughy wound
remains.9 Because a sloughy wound is treated differently, it is
important to monitor the wound so that the change from a necrotic to a
sloughy wound can be detected.9
If the edges of a necrotic digit wound are moist, an iodine dressing
together with a dry secondary dressing may be used to fight the
infection and reduce the pain.9
Sloughy wounds
Slough is the term used to refer to a mixture of fibrin proteins, serous
exudates, leucocytes and bacteria.9 Slough can build up rapidly on the
surface of previously clean wounds and be too thick to be removed
by swabbing or irrigation.9 Because slough is an excellent media
for the growth of bacteria, the wound should be properly treated to
enable wound healing. Furthermore, care should be taken to avoid
maceration, which can lead to further tissue breakdown.9
Infected wounds
Wounds that are already infected usually require antibiotics and an
antimicrobial dressing. A wound swab should be tested for culture and
sensitivity.9 Topical antibiotics, such a mupirocin and metronidazole
preparations, are available, but their use is limited because of concerns
about microbial resistance.9 Topical antifungal preparations containing
Granulating wounds
Granulation tissue contains a mixture of proteins and polysaccharides
linked together with collagens to form a highly vascular, gel-like
matrix with a characteristic red appearance.9 Granulating wounds
must be kept warm and moist, and the exudate should be appropriately
managed.9
Low-depth granulating wounds can be protected with a low- or
nonadherent dressing or a hydrocolloid.9 The hypoxic environment
Epithelializing wounds
Such wounds are in the final stages of wound healing, when a sheet
of epithelial cells begins to grow from the wound margins to the
middle of the wound.9 These wounds required minimal intervention
and basically need to be kept moist until they close.9 Hydrocolloid or
semipermeable dressings are sufficient in most cases. Because the new
Burns
Burns can be caused by heat, chemicals, electricity, sunlight or
radiation. Scalds may be caused by contact with hot fluids, steam, or
flammable liquids or gases.9 Management of burns is based upon the
first aid, the initial assessment, the management of superficial and
partial thickness burns and aftercare.9
A burn that covers more than 15 percent of an adult’s body or 10
percent of a child’s body requires management in a specialist burns
First aid for burns
The basic first aid for all burns is the same as proposed by St. John’s
Ambulance.28
Cool the affected area straight away to prevent the burn from
spreading. This can be achieved easily by placing the burn under
cold water for a minimum of 10 minutes.28 All jewelry, watches,
and clothing that are not stuck to the skin should be removed while
Superficial burns
Superficial burns can generally be managed using a moisturizing
cream applied liberally to the affected area. Creams are both cooling
and soothing to the overheated skin. Generally this is sufficient for
PharmacyTech.EliteCME.com Page 70
Alginates are useful for sloughy wounds because they maintain a moist
healing environment and draw away excess exudate.9
Hydrofiber dressings combined with an absorbent secondary
dressing can be used in moderately or heavily exudating wounds.9
These dressings absorb large amounts of fluid even under pressure,
preventing maceration. Furthermore, they can be removed with little or
no damage to the newly formed tissue.9
Larval therapy is also useful in the management of sloughy wounds.9
metronidazole, however, are useful for fungating wounds that are
colonized with anaerobes.9
Charcoal dressings reduce the odor of infected wounds, but in some
cases should only be used as a secondary dressing.9 Furthermore, they
may stick to wounds if they are allowed to dry out, leading to trauma
upon removal.
created by occlusive hydrocolloids promotes granulation. Alginates are
suitable for heavily exudating wounds.9
Deep cavity granulating wounds are best managed by a polyurethane
foam dressing to pack the wound.9
The granulation process in the effectively healing wound continues
until the base of the wound cavity is almost level with the surrounding
skin. From this point onwards, the wound begins to epithelialize.9
layer of tissue is very delicate, care needs to be taken when changing
the dressings to avoid trauma.9 Soft silicone dressings, knitted viscose
preparations and nylon sheet dressings are also useful for such
wounds.9
unit.9 Other cases of burns that should be referred to a specialist burns
unit include:
●● Initial burn: Burns to the face, neck, axilla, hands, genitalia,
popliteal region, and feet; circumferential burns; electrical or
chemical burns; non-accidental burns; and burns associated with
inhalation injury, trauma or disease.
●● Late: Burns not healed in 10-14 days; late onset of fever, pain,
malaise, redness, odor and increasing exudate.
●● Very late: Hypertrophic scarring or contractures.9
wearing disposable gloves. Do not apply any cream or ointments to the
burn until the wound is assessed. Blisters should not be broken. The
burn may be wrapped with cling film or a plastic bag.28
Analgesia should be provided as necessary.28 Any burn that is larger
than the size of a postage stamp should be assessed by a suitably
qualified health care provider.28
superficial burns because they heal within a few days, and in some
cases, the epidermis may peel off after 1-2 days.9
Partial-thickness burns
If the burn is not already clean, it should be cleaned by placing under
cold running water.9 There are contradictory proposals on how blisters
should best be managed. Some authors recommend that blisters should
not be touched.9 Others argue that small wounds should be punctured
and drained while large ones should be removed.9
Aftercare
Aftercare of burns is necessary to ensure healing without scarring.
Patients should be advised to:
●● Moisturize the healed burn regularly with a lotion or cream.
Chronic wounds
Chronic wounds that are usually manifestations of an underlying
condition need to be managed using two approaches. The underlying
pathophysiological cause needs to be removed, and healing of the
Pressure ulcers
Pressure ulcers are commonly found over bony prominences,
especially the sacrum, buttocks and heels.9 Early signs of pressure
damage should be identified and managed appropriately to reduce
extensive damage.9 Pressure over the ulcer should be reduced to nil
or minimal to promote healing. This can be achieved by “two-hourly
turning” – a routine in which all patients with pressure ulcers change
their position or are repositioned frequently. Furthermore, the use of
pressure redistributing devices is encouraged.9
The use of various devices for pressure ulcer prevention is advisable.9
These include mattress, overlays, specialized beds and cushions made
from a range of materials that work by either reducing or relieving
pressure. The patient “sinks” into a device and the weight is spread,
reducing the pressure on bony prominences.
Below are listed some pressure redistribution devices that come as
mattresses or overlays:
●● High specification foam.
Case study 1
A 25-year-old paraplegic male, Mr. X., uses a specially designed
wheelchair that allows him to continue his daily activities
independently. A few years ago, he was provided a cushion for his
wheelchair to allow the pressure to redistribute and prevent pressure
damage. However, the cushion has not been checked because he has
not been for a checkup for the last four years. A few days ago, Mr. X.
called his nurse about a stain on his underwear, which turned out to be
a pressure ulcer.
Case study 2
Mrs. Z., an 82-year-old lady, slipped and fell in the shower. Her
daughter called the ambulance because she could not move, and Mrs.
Z. was rushed to the hospital. Upon examination, it was revealed that
she had broken her hipbone and required surgery. Her history revealed
that she suffered from incontinence. Following the surgery, Mrs. Z.
Leg ulcers
Venous or arterial leg ulcers need to be assessed thoroughly, and the
etiology of the presenting ulcer needs to be determined.9 Co-existing
medical conditions need to be identified.9 Patients who experience pain
Page 71 PharmacyTech.EliteCME.com
The burn should be covered with a dressing that will keep the wound
moist and absorb any exudate.9 Dressings that are suitable for burns
include alginates, foams, hydrocolloids and silicone dressing.9
Selecting the most appropriate one of these depends upon the location
of the burn, the cost-effectiveness of the dressings, and type of burn.9
Furthermore, the dressing that requires the least possible changing is
recommended because dressing changes can be painful for patients.9
●● Seek medical advice if the site becomes very itchy.
●● Protect the burn site from sun or use a sunscreen with a minimum
of SPF 25 lotion.9
wound needs to be promoted. Chronic wounds include nonhealing
surgical wounds, burns, malignant wounds, fistulae, leg ulcers,
pressure ulcers and diabetic foot ulcers.
●● Cut foam.
●● Gel-filled.
●● Fluid-filled.
●● Air-filled.
●● Alternating pressure.
Pressure redistributing beds are also available. These include:
●● Low fluid loss.
●● Air fluidized.
●● Turning beds.
The patient’s nutritional status should be assessed, including regular
weighing of the patient, skin assessment, and documentation of food
and fluid intake. Nutritional supplements should be considered if the
patient’s diet is not providing adequate nutrition.9
Deep pressure ulcers are often associated with necrotic tissue that must
be debrided before the wound can heal. This requires management as
for necrotic tissue discussed above.9
The causes of the pressure ulcer are:
●● Poor redistribution of pressure because the cushion is wearing out.
●● Immobility.
●● Loss of sensation from paraplegia.
The pressure ulcer wound needs to be treated. Additionally, the
pressure redistribution device needs to be changed. The patient should
be strongly advised to go for regular check-ups to prevent a pressure
ulcer from forming again.
developed a pressure ulcer on her sacrum. This ulcer was caused by
her immobility, fragile skin because of her age, and incontinence.
The pressure ulcer in this case needs to be treated appropriately. Mrs.
Z.’s position needs to be changed every two hours to prevent the
formation of other pressure ulcers. She should also be given a device
to help her in the shower and prevent slipping in future.
alongside the ulcer require a pain management modality incorporated
into the therapeutic plan.9
A suitably qualified professional should conduct a hand-held Doppler
ultrasound to establish whether there is an adequate blood supply
to the limb. The results of this test are known as the ankle/brachial
pressure index (ABPI), and the readings indicate the following:
Arterial leg ulcers
Smokers should be strongly advised to stop smoking because this
aggravates the condition.9 Patients who have arterial disease will
have to undergo a surgery or angioplasty to improve blood supply.
A compression bandage should not be used in patients with impaired
Venous stasis leg ulceration
Conservative therapy with compression therapy, elevation and exercise
should be initiated upon diagnosis of the venous ulcer. A primary
dressing should be used to dress the wound. The periwound skin
Diabetic foot ulcers
Diabetics should be encouraged to inspect their feet daily for any
changes in their normal skin, such as reddening, blisters, and areas of
dry hardened skin.9 These are all early signs of a diabetic foot ulcer.9
Pharmacy staff dispensing prescriptions for diabetics are in an ideal
Case study
Mr. W., a 69-year-old diabetic male, presents with an ulcer on his left
toe. He admits that the ulcer has been there for several weeks. He
enjoys walking in the evenings, and his daughter bought him some new
walking shoes for Christmas. His children had taken him away with
them on vacation, and he was wearing his new shoes most of the time.
He noticed the wound a couple of weeks ago but didn’t want to spoil
their holiday by complaining about his heel. At the hotel, he managed
to get some Elastoplast that he used to cover the heel until he could get
back.
Conclusion
In essence, we have come a long way from the traditional dressings
made from oakum. The initial focus was on dressings to cover the
wounds and promote healing. Current research is focusing on newer
References
1. Sherwood Lauralee. Human Physiology: From Cells to Systems. Minneapolis: West Publishing
Company, 1993.
2. Cockbill S. “Wounds, the healing process.” Hospital Pharmacy. 9 (2002):255-260.
3. Dealey C. The Care of Wounds: A Guide for Nurses. West Sussex, UK: Wiley-Blackwell, 2012.
4. Flynn J. “Understanding chronic wound management: Part 1”. Pharmaceutical Journal. 282
(2009):777-780.
5. Ovington LG. Advances in wound dressings. Clinical Dermatology. 25 (2007):33-8.
6. Hess CT. Wound Care. New York, NY: Lippincott Williams & Wilkins, 2005.
7. Baranoski S, Ayello EA. Wound Care Essentials: Practice Principles. 3rd ed. New York, NY:
Lippincott Williams & Wilkins, 2011.
8. Casey G. “Wound repair: advanced dressing materials”. Nursing Standard. 17 (2002):49-53.
9. Dealey ,Carol and Cameron, Janice. Wound Management. New Jersey :Wiley-Blackwell,2009.
10. Glugla M and, Mulder GD. “The Diabetic Foot: Medical Management of Foot Ulcers” in Chronic
Wound Care. Edited by Krasne D. King of Prussia Pa.: Health Management Publications, Inc, 1990.
11. lnlow Orstead H and, Sibbald RG. “Best Practices for the Prevention, Diagnosis, and Treatment of
Diabetic Foot Ulcers”. Ostomy Wound Management, 11(2000):55-68
12. Leaper DJ. “Silver dressings: their role in wound management”. International Wound Journal.
3(2006):282-294
13. Semer, N. “The HELP Guide to the basics of wound care”. Accessed July 10, 2013. http://www.
global-help.org/publications/books/help_basicwoundcare.pdf
14. Morgan D. “Wounds: what dressings should a formulary include?” Hospital Pharmacist.
9(2002):261-266.
PharmacyTech.EliteCME.com Page 72
●● ABPI > 1: Normal arterial blood supply.
●● ABPI 0.8-0.9: Some arterial impairment.
●● ABPI <0.8: Significant arterial impairment.
arterial blood supply. The dressings can be held in place with a light
retention bandage.9
The ulcer should be kept moist, and all necrotic tissue and slough
removed by the use of hydrogels, hydrocolloids or larvae therapy.9
should be protected from wound exudate. Skin should be kept moist
with a simple emollient, such as 50 percent white soft paraffin and 50
percent liquid paraffin, which can be mixed up in the pharmacy.
position to reiterate this point. If a patient comes in with any of the
above symptoms, he should be referred to his diabetes care health care
specialist immediately because a poorly managed diabetic ulcer can
quickly lead to gangrene and amputation.
Looking from the patient records, you will have established that the
patient is diabetic. Upon assessing the wound, you discover that it is
possibly a diabetic ulcer. At this point, you need to refer the patient to
his or her physician immediately so that he can be further treated.
Mr. W. should be assessed urgently for his diabetic status because
he may be suffering from diabetic neuropathy. Appropriate footwear
needs to be recommended to Mr. W. An alginate dressing may be
required for the wound, and the surrounding skin may be protected
with a zinc paste. A light pad and tubular stockinette may be used to
secure the dressings in place.
therapies that enhance the body’s own defense system through
cytokines and other biologics.
15. Lionelli GT and Lawrence WT. “Wound dressings”. Surgical Clinics of North America. 83
(2003):617-638.
16. Young T. “When to use film dressings”. Community Nurse.4 (1998) :36-37.\Kifer ZA. Fast Facts
for Wound Care Nursing: Practical Wound Management in a Nutshell. New York, NY: Springer
Publishing Company, 2011.
17. Fletcher J. “Understanding wound dressings: foam dressings”. Nursing Times. 101(2005):50-51.
18. Sweeney IR, Miraftab M, Collyer G. “A critical review of modern and emerging absorbent dressings
used to treat exuding wounds”. International Wound Journal,9(2012):601–612.
19. Jones V, Grey JE, Harding KG. “Wound dressings”. British Medical Journal. 332 (2006) :777-780.
20. Bennett-Marsden M. “How to select a wound dressing”. Clinical Pharmacy. 2 (2010):363-365.
21. Eisenbud D, Hunter H, Kessler L and, Zulkowski K. “Hydrogel wound dressings: where do we stand
in 2003?” Ostomy Wound Management. 49(2003):52-57.
22. Flynn J. “Understanding chronic wound management: Part II”. Pharmaceutical Journal.
283(2009):41-44.
23. Rushton I. “Understanding the role of proteases and pH in wound healing” . Nursing Standard. 21
(2007):68,70, 72 passim.
24. Casey G. “Wound repair: advanced dressing materials”. Nursing Standard. 17(2002):49-53.
25. Bonn D. “Maggot therapy: An alternative for wound infection”. Lancet. 356(2000):1174.
26. Mumcuoglu KY. Clinical applications for maggots in wound care. American Journal of Clinical
Dermatology. 2(2001);2:219-227.
27. St Johns Ambulance. “Burns and Scalds”. Accessed on Jul 11, 2013. http://www.sja.org.uk/sja/first-
aid-advice/effects-of-heat-and-cold/burns-and-scalds.aspx
 WOUND MANAGEMENT PRODCUTS
Final Examination Questions
Choose the best answer for questions 1 through 5 and mark your answers
online at PharmacyTech.EliteCME.com

1. What is the final stage in wound healing? 4. Which of the following dressings is best for superficial wounds?
a. Granulation. a. Gauze.
b. Coagulation. b. Collagen.
c. Maturation. c. Foams.
d. Late inflammation. d. Transparent film dressing.
2. According to the Wagner Ulcer Grade Classification System, a 5. You are presented with a prescription for a hydrogel. Which of the
diabetic ulcer that has progressed to gangrene of the digit only is following products would you dispense for this prescription?
classified as a: a. Intrasite.
a. Grade 1. b. Melolin.
b. Grade 2. c. Tegasorb.
c. Grade 3. d. Cadesorb.
d. Grade 4.
3. Which of the following dressings rarely adheres to the wound bed
and is comfortable to wear?
a. Foam.
b. A specialty absorptive.
c. Gauze.
d. Honey.

RPTAZ04WME16

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