chapter 19 wound management, stoma and incontinence products

Chapter 19Wound Management, Stoma and Incontinence Products

Reporters: Dune Vienis Karen Rafael & Melodel TorculasBS-Pharmacy 4A

University of the Immaculate Conception

WOUNDS- any damage to the skin caused by mechanical injuries, burns and underlying medical conditions giving rise to ulcers.

WOUND HEALING- a process which involves the growth of fibrous and vascular tissue within the wound and the migration of epithelial cells from the edges of the wound.

TYPES OF WOUNDS

1. Necrotic Wounds2. Sloughy Wounds3. Granulating Wounds4. Epithelializing Wounds5. Exuding Wounds6. Infected and Malodorous Wounds

Types of Wounds

Necrotic Wounds• Covered with a hard, dry,

black layer of dead tissue known as eschar.

• Often occurs in pressure sores.

Types of WoundsSloughy Wounds

• Sloughs are formed as white, yellow or brown soft material formed from dead cells on the surface of the wound.

Types of Wounds

Granulating Wounds• Red, granular and moist due

to the granulation tissue which consists of blood vessels, collagen and other connective tissue, being laid down in the base of the wound.

Types of Wounds

Epithelializing Wounds• Pink in color as a new

epidermis is being formed.• Occurs within 24 hours w/

shallow superficial wounds

Types of Wounds

Exuding Wounds• Wounds where exudates

are produced from granulating and epithelial wounds.

• Decreases the wound healing process.

Types of Wounds

Infected and Malodorous Wounds

• Often surrounded by red, hot inflamed tissue, and pus as an indication of infection which delays wound healing.

Traditional DressingsDressings are used to cover and hide the wound but have a little impact on the healing process.

AbsorbentsUses and Application Guidelines

Purpose:• Clean and swab wounds• Absorb excess wound exudate• Apply medicaments to the skin• Protect the wound from future knocks

Absorbent dressings should not be left directly on moist wound for several reasons:• Dehydration of the wound surface• Adhesion• Formation of capillary loops as new blood vessels grow• Shedding of fibers into the wound• Absorption of antibacterial exudate• Strike through of exudate to the outer surface of the skin

BandagesThe British National Formulary 1996 classifies bandages as retention, support and compression and medicated.

Retention Bandages• They may be extensible or non-extensible or tubular.

Retention Bandages are used to:• Protect absorbent dressings and keep them in place• Provide light support for minor sprains• Secure splints


Support and Compression Bandages• The support and compression they give increase with the

weight of the dressing and its elasticity.• Non-adhesive products of this type provides light support for

strains and sprains.• Elastic web and net bandage provides superior support.

Support and Compression Bandages• Useful in the treatment of fractured ribs and collar bones, leg

ulcers, and varicose veins especially in patients who are mobile.

Support and Compression Bandage Disadvantages• Application and removal can be painful and may damage

fragile skin.• Possible sensitivity to ingredients of the adhesive (e.g. rubber).

Bandages may be:• Self – adhesive• Diachylon – the bandage is warmed prior to application in order to

produce adhesion• Cohesive – the bandage adheres to itself but not to the patient’s skin.


Medicated Bandages• Consist of a cotton bandage impregnated with a medicament

formulated in a moist paste (zinc).• Used in the treatment of dermatological conditions (e.g.

eczema and inflamed leg ulcers).• Usually covered by a support and compression bandage.

Elastic HosieryElastic hosiery performs a similar function to support and compression bandages, but in a more controlled manner.

Graduated Compression Hosiery• Designed so that the compression is

greatest at the ankle and decreases up the leg.

• Classified according to the pressure exerted at the ankle.

Compression Hosiery• Indicated for the treatment of varicose

veins, varicose ulcers and venous insufficiency

Measurements required for elastic hosiery are:• Mid-thigh circumference• Widest part of the calf• Around the ankle• Length of foot.

Classification of Graduated Compression Hosiery

Class Pressure at ankle (mmHg) Degree of support

I 14-17 Light

II 18-24 Medium

III 25-35 Strong

Class I hosiery is also used prophylactically during pregnancy. Class II and II are used for support of soft tissue injuries.

Adhesive Tapes and DressingsConsist of a backing material coated on one side with an adhesive mass.

Different Permeabilities:• Permeable to air, water and bacteria• Vapor-permeable

o Permeable to air and water vaporo Impermeable to liquid water and bacteria

• Occlusive or impermeable.

They are used:• For securing dressings and appliances• As skin closures for small incisions• For covering infected wounds to prevent

contamination

Non-adherent DressingsNon-adherent, or more accurately low-adherent dressings are either a single layer over which another dressing is placed, or multi-layered with the non-adherent layer in direct contact with the wound.

Paraffin Gauze Dressing/Tulle Gras Dressing

• Made of cotton and/or viscose gauze impregnated with white or yellow soft paraffin.

• Antimicrobial medicaments, e.g. chlorhexidine, may also be included.

• Used mainly to treat partial thickness wounds, where soft paraffin reduces dehydration of thewound surface.

Non-adherent DressingsNon-adherent, or more accurately low-adherent dressings are either a single layer over which another dressing is placed, or multi-layered with the non-adherent layer in direct contact with the wound.

Knitted Viscose Dressing

• A dressing having an open structure which allows liquid exudate from the wound to pass through to a superimposed absorbent pad.

• Can also be impregnated with povidone-iodine

• Used for infected superficial burns and other injuries.

Perforated Film Absorbents• Consists of three layers with the layer in contact with the wound

being a perforated plastic film.• The film minimizes adherence to the wound while the

perforations allow excess exudate to pass through to the middle absorbent fibrous layer.

• Has four types

Melolin: Type 1 Perforated Film Absorbent

DescriptionMelolin consists of a film of poly(ethylene terephthalate), onto which is bonded an absorbent layer consisting of a mixture of cotton and polyacrylonitrile fibres, backed with a layer of an apertured non-woven cellulose fabric. The plastic film is present to prevent the dressing adhering to the surface of the wound, and is perforated to allow the passage of exudate from the wound into the body of the pad.

IndicationsMelolin may be used on its own to dress dry sutured wounds, superficial cuts and abrasions, and other lightly exuding lesions. It may also be used as the primary wound contact layer for more heavily exuding wounds, if backed by a second absorbent dressing.

Telfa: Type 2 Perforated Film Absorbent

DescriptionTelfa consists of a thin layer of absorbent cotton fibres, enclosed in a sleeve of poly(ethylene terephthalate) that is perforated in a regular pattern and sealed along two edges. The plastic film is present to prevent the dressing adhering to the surface of the wound, and is perforated to allow the passage of exudate from the wound into the body of the pad.

IndicationsTelfa may be used on its own to dress dry sutured wounds, superficial cuts and abrasions, and other lightly exuding wounds. It may also be used as the primary wound contact layer for more heavily exuding wounds, if backed by a second absorbent dressing.

Release: Type 3 Perforated Film Absorbent

DescriptionRelease consists of a textured sleeve of EMA (ethylene-methyl acrylate) open at two ends, surrounding an absorbent core consisting of viscose fibres enclosed between two spreader layers of non-woven tissue. The sleeve, which provides a wound contact layer of low-adherence, is perforated to allow the passage of exudate into the body of the pad.

IndicationsRelease is indicated for the management of clean, light-moderately exuding superficial wounds including lacerations, abrasions and sutured wounds

Skintact: Type 4 Perforated Film Absorbent

Skintact is a dual-sided, low-adherent perforated film dressings. Protective dressing for low to medium exudating wounds. Double sided for ease of use. Highly conformable. Sterile.

Charcoal DressingsActivated charcoal is used in several dressings to absorb noxious materials and so eliminate offensive odor from infected malodorous wounds.

Modern Wound Management ProductsMany of the wound management products which have been introduced in the last 20 years affect the wound healing process. Most are vapor permeable, enabling gaseous exchange but preventing dehydration of the wound surface.

Vapor-Permeable Adhesive Films

The vapor-permeable properties of these films enable water vapor, but not liquid water, to pass through.

Vapor-permeable films are indicated for:• Lightly exuding shallow wounds, such as minor burns• Prevention and treatment of superficial pressure sores• Securing cannulae and catheters• Use as sterile drapes during surgery.

FoamsMade of polyurethane or silicone to absorb liquid exudates from the wound.

Lyofoam®• Consists of a hydrophobic polyurethane

foam sheet, one side of which has been heated under pressure to produce a smooth low-adherent hydrophilic surface.

• Used for lightly to moderately exuding wounds when it needs to be secured by adhesive tape.

• The liquid exudate is absorbed into its 0.5 mm thick hydrophilic layer.

• Two types: Lyofoam A and Lyofoam C

FoamsMade of polyurethane or silicone to absorb liquid exudates from the wound.

Kelo-cote®• Made in situ by stirring the silicone base

with a catalyst for 15 seconds, then pouring into the wound. The foam sets in 3-4 minutes, expanding to about four times its original volume.

• The hydrophilic foam absorbs the exudates from the wound surface.

Foam Film Dressings

Foam Film Dressings are multilayered products consisting of:• an outer vapor-permeable polyurethane film• a central absorbent hydrophilic polyurethane foam or membrane• a low-adherent or adhesive layer.

They are recommended for light to moderately exuding wounds such as leg ulcers and pressure sores (Type 1), variety of exuding wounds of limited depth, including leg ulcers, minor burns, and donor sites (Type 2 & 4) and, pressure sores and traumatic injuries (Type 3).

Polysaccharide BeadsThey are tiny spherical beads of glucose polymers (cardexomer or dextranomer). They are indicated for infected, medium to heavily exuding wounds especially leg ulcers.

Iodosorb® ointment is a sterile formulation of cadexomer iodine. When applied to the wound, Iodosorb cleans it by absorbing fluids, removing exudate, pus and debris and forming a gel over the wound surface. As the ointment swells, iodine is released, killing bacteria in the wound.


Iodoflex® consists of individual applications of a cadexomer iodine paste consisting of a macrogol ointment base incorporating sterile, yellow-brown microspheres or beads 0.1- 0.3 mm in diameter.

• The beads, which are formed from a three-dimensional network of cadexomer - a chemically modified starch, contain elemental iodine within their structure. The paste is presented between two layers of gauze fabric which act as carriers and facilitate application.

The iodine content of the beads used to produce the paste is higher than that of standard Iodosorb, in order to produce a final concentration of iodine in the paste of 0.9% w/w. In the presence of aqueous solutions or wound fluid, the beads in the ointment take up liquid and swell, slowly releasing the iodine, which imparts antibacterial properties to the dressing.


Beads should not be used on dry or lightly exudating wounds, as they may dry out and be difficult to remove.

Other available as alternative formulations:• Paste• Ointment• Paste enclosed in a nylon bag or gauze

chapter 19 wound management, stoma and incontinence products

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