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• The condition of the wound edges can indicate the progress of healing or identify potential complications. Undermined edges (where the skin under the edge of the wound is eroded) or rolled edges (where the edge turns downward) may require special attention to ensure they are managed properly to promote healing.

• Dressings should secure well to the skin and possibly help in approximating the wound edges for better healing.

Epithelialization:

• Epithelialization is the process where new skin cells form at the wound edges and migrate across the wound bed, a critical phase of wound closure. Treatments that protect the new epithelium and do not disrupt this delicate new layer are essential.

• Transparent films and hydrocolloid dressings are often used as they allow oxygen exchange and maintain a moist environment that can support the growth of new skin cells.

Granulation:

• Granulation tissue is new connective tissue and microscopic blood vessels that form on the surfaces of a wound during the healing process. Healthy granulation tissue is typically red or pink and indicates progression towards healing.

• To promote granulation, a moist environment is beneficial, and dressings like hydrogels, hydrocolloids, or alginate can be used, particularly if the wound is deep or has a cavity.

Incontinence:

• Incontinence can complicate wound healing, especially for wounds located near the perineal area, due to the risk of contamination and increased moisture. Managing incontinence is crucial in wound care.

• Barrier creams, frequent cleaning and drying of the skin, and using absorbent pads that wick moisture away from the skin can help manage the effects of incontinence on wound healing.

Infection:

• Infection can severely disrupt wound healing and may require antimicrobial treatments. Signs of infection include increased redness, swelling, heat, pain, or pus.

• Antimicrobial dressings containing silver or iodine can be used to help control infection. Systemic antibiotics may also be necessary depending on the severity and depth of the infection.

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• The location of the wound affects its exposure to bacteria, ease of dressing changes, and the type of dressing that can be used. For instance, wounds on joints or areas that experience frequent movement may require a more flexible dressing that can tolerate movement.

Wound Stage:

• Understanding the stage of the wound is crucial for appropriate treatment. Wound stages typically range from I (least severe, superficial) to IV (most severe, involving muscle and bone).

• Stage I and II wounds may be managed with cleansing and use of semi-occlusive or occlusive dressings.

• Stage III and IV wounds might require more complex treatments like debridement, advanced dressings, or even surgery.

Cavities:

• Wounds with cavities, meaning there is a significant depth or a pocket, require dressings that can fill the space without damaging new tissue. Alginate or foam dressings can be used as they conform to the shape of the wound and help in absorbing excess fluid.

Necrosis:

• The presence of necrotic (dead) tissue in a wound can impede healing and increase the risk of infection. Such wounds often require debridement (removal of dead tissue) before applying any dressing.

• Dressings that maintain a moist environment and promote autolytic debridement (the body's process of breaking down dead tissue) can be beneficial.

Drainage:

• The amount and type of drainage from a wound influence the choice of dressing. Highly exudative (draining) wounds need dressings that can absorb and contain the drainage, such as foam or superabsorbent dressings.

• It’s important to change these dressings frequently enough to manage the drainage effectively without causing maceration of the surrounding skin.

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Wound dressings serve to protect wounds from further harm and contamination while promoting an optimal environment for healing.

Purpose:

Provides the proper environment

Help remove any excess exudate without causing the wound

It allows for gaseous exchange

Thermally insulating

Impermeable to microorganisms

Nontraumatic, non-adherent to wound

Easily accessible and cost-efficient

Easy to apply and remove

It's a basic treatment

It minimizes the need for any secondary dressings

It remains in place

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Primary dressing:

Is the first dressing that covers a wound

Secondary dressings:

Consist of all dressings applied over the primary dressing.

Inert Dressings:

Passive

Exudate absorption

Wound coverage

Interactive Dressings:

Work with wound properties to promote healing

6 different types of interactive dressings

Film Dressings:

Thin membranes coated with acrylic adhesive

Permeable to oxygen and water vapor, but impermeable to microorganisms

Flexible, elastic, extensible, and transparent

May have antimicrobial properties

Foam Dressing:

Polyurethane, soft, open cell sheets

May have one layer or multiple layers

Similar in appearance to hydroactive polymer products

May have a waterproof backing or be impregnated with charcoal

Hydrogel:

Complex organic polymers with high water content

3-dimensional, water-swollen, cross-linked structures Two types:

Amorphous: free-flowing, easily fills a cavity space

Sheet: thin, flexible sheets that swell as they absorb fluid

Hydrocolloids:

Dressings that are a combination of gel-forming polymers with adhesives with a backing of a polyurethane film or a foam

Wound exudate combines with the polymers to create a soft gel in the wound

Dressing only adheres to surrounding tissues

Alginates:

Made of calcium or calcium/sodium salts of alginic acids from seaweed

Available as textile fiber sheets or a loose packing ribbon

Produce a hydrophilic gel in the wound

Provide calcium ions to the wound to promote hemostasis

Hydroactive:

Multiple layers of highly absorbent polymer gel with adhesive backing

Similar to hydrocolloids, but do not form gel in wound

Semipermeable

Adhere to surrounding skin

Available in various forms, including cavity fillers, foam, and thin types

Others:

Collagen Matrix Dressings:

Promogran and Oasis

Act as extracellular matrix (ECM)

Contain collagen that stimulates fibroblast activity Hydrofibers:

Aquacel and Aquacel Ag

Look like alginates

Activated by moisture, polymers absorb and trap moisture in their structure

Silicone:

Mepilex, Mepilex Transfer, Allevyn Gentle Border

Used on the surface layer to help maintain adhesion of the dressing to the skin without actually sticking to the wound or skin to reduce trauma during removal

Found on foams and other types of dressings

Gauze:

Gauze:

dressings are one of the most common and versatile types of wound dressings. They come in woven and non-woven varieties:

Woven Gauze:

More traditional and loosely woven, allowing for absorption of exudate and aeration of the wound. They are useful for packing wounds, securing other dressings, and general wound care. However, they can adhere to the wound bed, which might disrupt new tissue growth when removed.

Non-Woven Gauze:

Made from fibers that are pressed together to resemble a weave, which helps in creating a smoother surface. This type is less likely to adhere to the wound and is softer and more absorbent than woven gauze. Non-woven gauze is often used for more delicate tasks such as padding, protection, and absorption.

Wet-to-dry:

Traditionally, wet-to-dry gauze has been used to treat wounds. Wound dressings that create and maintain a moist environment, however, are now considered to provide the optimal conditions for wound healing.

Impregnated gauze:

dressings are saturated with a therapeutic compound, such as petroleum jelly, antiseptics, antibiotics, or other medications that promote healing or reduce the risk of infection.

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In general,

1. Allergic Reactions: Some patients may have allergies to materials used in certain wound dressings, such as adhesives, latex, or certain medicated components. It is important to check for any known allergies before applying a wound dressing.

2. Infection: Certain types of dressings are not suitable for infected wounds, unless they are specifically designed to manage infection. Infected wounds may require dressings that can handle higher levels of exudate and promote drainage, along with appropriate antimicrobial treatment.

3. Necrotic Tissue: Wounds with significant amounts of necrotic (dead) tissue may require debridement (removal of dead tissue) before certain types of dressings can be applied. Some dressings are designed to help with autolytic debridement, but others might be contraindicated until the necrotic tissue is managed.

4. Dry Wounds: Hydrocolloid dressings and other moisture-retentive dressings are generally contraindicated for very dry wounds or wounds with minimal exudate. These dressings are designed to maintain a moist wound environment, which isn't suitable for wounds that are naturally dry.

5. Excessive Exudate: Conversely, wounds that produce excessive amounts of fluid may be contraindicated for certain types of dressings that cannot manage large amounts of exudate, as these can become easily saturated and ineffective.

6. Sensitive Skin Areas: In individuals with fragile or sensitive skin, such as the elderly or those with certain dermatological conditions, some dressings may cause skin damage or irritation due to the adhesives or materials used

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Film Dressings:

Minor burns

Simple injuries such as abrasions and skin tears

Post-op dressing

Foam Dressings:

Exudating wounds

Superficial and cavity types of wounds

LE ulcers, such as venous ulcers

Pressure injuries

Hydrogels:

Dry and minimally draining wounds

LE wounds, such as arterial ulcers

Pressure injuries, Stages 2-4

Full or partial-thickness wounds

Over tendons and other tissues to prevent tissue dehydration

Infected and necrotic wounds

Hydrocolloids:

Superficial and small cavity wounds

LE wounds, burns, pressure injuries

Alginates:

Heavily exudating wounds, including sanguinous exudate

Infected wounds

Cavity wounds

LE wounds

Pressure injuries

Donor sites

Hydroactive:

Moderate to heavily exudating wounds

LE ulcers, such as venous ulcers

Pressure injuries

Wounds around joints