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PHYSIOLOGICAL

PROCESS OF WOUND
HEALING
FOUR PHASES OF WOUND HEALING

1.Hemostasis
2.Inflammation
3.Repair
4.Remodelling
SQUENCE OF MOLECULAR
AND CELLULAR EVENTS IN
SKIN WOUND HEALING
PATIENTS PERCEPTION
NORMAL WOUND HEALING
Inflammatory phase
Induration
Heat
Discomfort
Redness
Swelling

Are part of normal wound healing


processes not likely to be due to wound
infection!
The first 3 weeks after surgery, the
patient is at high risk for wound
dehiscence and evisceration
CLASSIFICATION OF EXUDATE

I . TYPE = Colour and consistency


Serious or clear fluid
Sanguineous for blood
Purulent PUS

II. AMOUNT : When the dressing is removed


None
Small-Less than 33% of dressing surface
Moderate less than 67%
Large covering more than 67%
THE MNEMONIC:
WOUND PICTURE

Wound or Pain?
ulcer? Induration
Odor? Color
Ulcer category? Tunneling?
Necrotic Undermining?
tissue? Redness?
Dimension? Edge of Skin?

WOUND INFECTION
CLINICAL SIGNS AND SYMPTOMPS
Superficial wound infection (NERDS)
Non healing wound
Exudate wound
Red and bleeding wound surface granulation tissue
Debris on the wound surface
Smell on unpleasant odor
WOUND INFECTION
CLINICAL SIGNS AND SYMPTOMS
Deep Infection (STONES)
Size bigger
Temperature increase
Os = prone to or exposed bone
New on satellite areas of breakdown
Exudate, evythemia, edema
Smell
MANAGING WOUND
BIOBURDEN
Wound cleaning
Cleaning agents?
Skin cleaners ? no!
Antiseptic ? no!
Cleaning devices?
Wound irrigation?
Optimum pressure for wound cleaning? (5-15 psi)
MANAGING WOUND BIOBURDEN

Antimicrobial therapy
After removal of necrotic tissue
Topical elemental antimicrobial therapy with silver based creams
be limited to 2 weeks
The effectiveness of systemic antibiotics is dependent on an
adequate blood supply to the wound
WOUND TREATMENT OPTIONS

Moist wound therapy


Dressings based on assessment of wound
characteristics
Indications for use of dressings by categories
The advantages and disadvantages for each
dressing category
The principles of care in dressing selection
Use of advanced therapies
THE CASE AGAINST GAUZE
DRESSINGS

A gauze dressing can impair wound healing because


it lowers the wound temperature and impedes fluid
evaporation
Wet-to-dry gauze dressings are non-selective
mechanical debridement method removal of
healthy tissue causes injury to the wound and pain
Higher infection rates than transparent films or
hydrocolloids
Bacteria are released into the air when gauze
dressings are removed
Semi occlusive dressings are more financially
feasibleOvington
form a total
LG: Advanced cost
in Skin perspective
& Wound Care 15 (2), 79-84,2002
WHY ARE GAUZE DRESSINGS STILL USED
?
Gauze dressings have a long tradition in wound care-
gauze and saline are familiar and readily available
Gauze is perceived is being inexpensive how
about total cost?
Most advanced dressings are discrete dimensions
and cant always be adjusted for wounds of different
sizes
Many practitioners are unaware of the broad array
of alternative dressing may be perceived as more
expensive than gauze
Ovington LG: Advanced in Skin & Wound Care 15 (2), 79-84,2002
PRACTICE POINTS

Partial thickness wounds in pigs covered with a


plastic material had two times faster
epithelialization than identical wounds left open to
air
Nature 193: 293-94.1962
Dressing choice = wound assessment + principles of
wound care
If the wound is dry, add moisture, if the wound has
drainage, absorb it, if the wound has necrotic tissue,
debride it
Wound dressings should be changed to meet the
characteristics of the wound bed
THE IDEAL DRESSING

Maintain a moist environtment


Facilitate autolytic debridement
Be comfortable for the range of use needed
Come in numerous shape and sizes
Be absorbent
Provide thermal insulation
Act as a bacterial barrier
Reduce or eliminate pain at the wound site
and not cause pain on dressing removal
Seaman S, J Am Podiatric med Ass, 92 (1) 24-33, 2002
HOW TO EVALUATE THE DRESSING

Number of days the dressing can remain in


place
Reason for change and removal
Appearance of dressing (soiled or intact)
Ease of dressing application
Ease of dressing removal
Ease of dressing maintenance
Ease of teaching about dressing to caregiver
Seaman S, J Am Podiatric med Ass, 92 (1) 24-33, 2002
MOIST WOUND THERAPY AND DRESSING
OPTIONS
1. Transparant film dressings
2. Hydrocolloid dressings
3. Hydrogel dressings
4. Foam dressings
5. Calcium alginate dressings
6. Hydrofiber dressings
7. Composite dressings
8. Collagen dressings
9. Contac layer dressings
10. Gauze dressings
11. Antimicrobial dressings
ADVANCED THERAPIES

Tissue engineered skin substitutes


Negative pressure wound therapy (NPWT)
Electrical stimulation
Low-level laser therapy in wound healing
Ultraviolet light
Compression therapy
Growth factors
Hyperbaric oxygen therapy
Ultrasound energy for wound healing
KONSEP MANAJEMEN LUKA
Dasar - Dasar Perawatan Luka

1. Ekstraksi 2. Irigasi 3. Pengkondisian dengan 4. Penge - 5. Pengangkatan


zat-zat asing bahan dressing spesial luaran jaringan mati

1. Larutan Pember - 1. Jahitan pada


makanan luka
sihan
2. Faktor-faktor
2. Staples
pertumbuhan
Stimulasi Penutupan
3. Kompres LUK 3. Plester peng -
salep
A ganti jahitan

4. Arus Coverage / 4. Perekat


listrik Perlindungan jaringan

2. Dressing 3. Tubular Dressing 4. Film 5. Special


1. Dressing
siap pakai Dressing Dressing
KONSEP MANAJEMEN LUKA
II. PERAWATAN LUKA

Pencegahan infeksi dengan


Obat-obat ter - pengangkatan
tentu yang zat-zat asing dan kuman
dapat Pember- Mengurangi
menggantikan celah luka,
sihan
kekurangan sehingga
dari zat-zat memungkinkan
esensial yang Stimulasi Penutupan kerusakan jari -
dapat menunda
LUK ngan diperbaiki
penyembuhan, A dengan lebih
dengan demiki Coverage / cepat
-an akan mem
Perlindungan
-bantu proses
penyembuhan
Dressing memelihara luka dari faktor
- faktor yang mengganggu
CHARACTERISTICS OF AN
IDEAL WOUND DRESSING

Maintains a moist wound environment


Absorbs excess exudate
Eliminates dead space
Does not harm the wound
Provides thermal insulation
Provides a bacterial barrier

(Seaman. S, Dressing selection in chronic wound management,


Journal of the American Podiatric Medical Association,