choices of wound dressing

Mr Zairuddin

HRPZ II

Kota Bharu Kelantan

HISTORY OF WOUND CARE

A long and eventful history that traces its origins to ancient Egypt and Greece

The Ebers Papyrus, circa 1500BC, details the use of lint, animal grease, and honey as topical treatments for wounds - lint provided a fibrous base that promoted wound site closure - animal grease provided a barrier to environmental pathogens - honey as an antibiotic agent.

THE EGYPTIANS :

Ulcerating lesions were bound with figs containing papainWine, vinegar, and hot water were used to clean woundsAfter cleansing, dry powder consisting of a mixture of copper, mercury, zinc and silver were used to prevent inflammationSilver was used as an ingredient in plasters to cover open wounds, as well as to purify waterSeaweed, which contains iodine, was used for sunburns

THE ROMANS De Medicina written by Celcus ( 25 BC – 50 AC ) -- described the 4 fundamental signs of infection ( rubor, color, dolor, tumor ) & addressed the importance of wound cleansing“Clean the wound of old blood because this can

change into pus, which inhibits healing”

THE GREEKS

The first to differentiate between acute and chronic wounds, calling them "fresh" and “nonhealing” respectively

Claudius Galen of Pergamun (120-201 AD) , a Greek surgeon in the Roman empire discovered the importance of maintaining wound moisture to ensure healing of the wound

17th CENTURY :Invention of microscope by Anton von Leeuwenhook (1632-1723) of Netherland

19th CENTURY :Development of MICROBIOLOGY & PATHOLOGY

Ignaz Philipp Semmelweis ( 1818-1865), a Hungarian obstetrician developed sterile surgical procedures using chlorinated lime solutions Louis Pasteur ( 1822-1895), a French scientist known as the “father of microbiology” --- “Germ Theory Of Disease”

Rudolf Virchow ( 1821-1902 ) of Germany discussed his ideas on formation, proliferation and regeneration of cells

PROGRESS BEYOND ANCIENT WOUND CARE PRACTICES IS A RECENT PHENOMENON

EARLY 20th CENTURY

20th CENTURY & THE WARS :

Surgeons used full-strength phenol in war patients developing gangrene due to infections

French surgeon Alexis Carrel ( 1873-1944) from New York & who was awarded the Noble Prize for Physiology & Medicine in 1912, bathed wounds in Dakin’s Solution

[ Sodium Hypochloride + Boric Acid ]

1 month before introduction of Dakin’s Solution, Professor J Lorraine Smith introduced Edinburgh University Solution Of Lime ( EUSOL), ), [[chlorinated lime + boric acid ] for use in wounds of war soldiers

Davies, a physician in Hertford, used iodine solution to disinfect wound in 1839 which was used extensively during American Civil War ( 1863) and WW1 to treat wounds and to scrub hands before surgery

Nevertheless, iodine disinfection failed to gain general acceptance till 1870s when French bacteriologist Casimir Davaine ( 1812-1882) confirmed that iodine solution could kill a wide variety of micro-organisms

In 1878, iodoform was introduced as a hospital disinfectant by Apollinaire Bouchardat, a pharmacist in Paris

William Stewart Halsted (1852-1922) : silver foil dressing for infected wounds which were used extensively during

WWII

Chlorhexidine was discovered in 1946 & introduced into clinical practice in 1954 for washing hands and as surgical scrub

Other antiseptic used included alcohol, hydrogen peroxide, hexachlorophene, thimerosal, gentian violet and permanganet

After the war, in vitro research indicated that these substances were cytotoxic to human cells and have adverse effects on wound healing

The discussion on the toxicity of these agents, started by Alexander Fleming in 1914, still continues today, almost 100 years later

1968, Dr Charles L Fox Jr, a bacteriologist in Columbia University combined silver nitrate and sulfadiazine to create a synergistic compound that is extremely effective against infection

Silver sulfadiazine (SSD) quickly became the drug of choice due to its effectiveness at controlling bacterial infection and pain-free application.

It was used extensively during the Vietnam War Since then, various silver-coated dressings which use

metallic silver, ionic silver etc combined with various carriers ( polyurethane, alginates, carboxymethyl cellulose, knitted fabrics ) were gradually introduced

Joseph Gamgee

Gamgee TissueAbsorbent cotton woolGauze outer wrappingReduced adherenceReduced fibre shedPartial barrierCushioning

Traditional

Conventional

Advanced

CONVENTIONAL DRESSINGS

Soaked

Gauze/Gamgee

Povidone

Iodine

Chlorhexidine

Normal Saline

Tullegras

Hydrogen

Peroxide

CONVENTIONAL DRESSING

Problems :

Adherence to wound

Dehydration of wound

Fibre Shed

'Strikethrough’

WOUND CARE NOT A PART OF MEDICAL SCHOOL CURRICULUM ---- not before and not even now !

DOCTORS ARE EXPECTED TO LEARN ON THEIR OWN

Most have no idea HOW TO DO IT, WHAT TO USE, WHEN TO DO WHAT

Majority just “DO IT THE WAY IT HAS BEEN DONE OVER THE YEARS” or just “LEAVE IT TO THE NURSE”

MODERN WOUND CARE

EVIDENCE-BASED

Convert dirty to clean woundHealing without infectionHealing without painRapid healing Cost-effective wound management

Combining your experience, patient’s situation and the best scientific evidence

CRITERIA:

Moist healing

Bacterial barrier Permeable Waterproof Insulate Manage exudates Trauma protection Non-adherent Safe & easy to use

HYDROGEL ENZYMATIC SILVER DRESSING CADEXOMER IODINE FOAM DRESSING CALCIUM ALGINATES HYDROFIBER HYDROCOLLOID FILM DRESSING

HydrogelEnzymatic

T

Autolysis is a natural process, uses the body own enzymes. Autolysis as a selective type of debridement.Gently rehydrates dry and softens necrotic tissue and sloughProvides moist wound healing environment

The use of topically applied enzymatic agent to stimulate the break down of non-viable tissue.

Faster debridement compared autolytic

Painless and less bleeding.

Does not effect intact epithelium, granulation tissue, fatty tissue or muscle.

Cadexomer IodineSilver

I

ACTICOAT™

ACTICOAT™ Absorbent

DesloughDeslough

Remove odorRemove odor

Remove biofilmRemove biofilm

Slow release Slow release iodine: kills iodine: kills bacteria / prevent bacteria / prevent infection (broad infection (broad spectrumspectrum))

Used for centuries to prevent and treat infection

Reduces the risk of colonization and acts to kill micro – organisms which can cause infection and prevent or retard healing

Broad spectrum – inactivates almost all known bacteria including MRSA and VRE

Silver is first choice antimicrobial dressing.

FilmFoamHydrocolloidAlginateHydrofibreNegative Pressure

Therapy

M

Waterproof film

Bacterial barrier

Low adherent

Can be used in combination with others dressing

Absorb light to moderate exudate so they can be worn for 3 to 7 days.

Maintain moisture

Does not adhere to the wound bed

Highly absorbentHighly absorbent

Maintains optimal Maintains optimal healing temperature, healing temperature, reducing the risk of reducing the risk of infectioninfection

Keeps wound bed Keeps wound bed moist while moist while minimizing the risk of minimizing the risk of maceration and maceration and leakage for optimal leakage for optimal wound healingwound healing

Soft and cushioningSoft and cushioning

Soft non woven fibers from seaweed.

Maintain moisture

Useful for packing exudate.

Highly absorbent.

Haemostatic properties.

Soft non-woven, made from sodium carboxymethylcellulose

Absorption and retention of fluid.

Reduces maceration.

Creates a moist wound healing environment.

Assists in autolytic debridement.

Thank You