Wound Care and Dressings

Wound Healing - Healing's ABCs

📌 Mnemonic for phases: "Heavy Inflammation Produces Remodeling"

• Phases & Key Players:
  • Hemostasis (mins-hrs): Platelets; PDGF, TGF-β. Platelet plug, clot.
  • Inflammation (Day 1-6): Neutrophils, Macrophages; TNF-α, IL-1. Neutrophil & macrophage influx.
  • Proliferation (Day 4 - Wk 3): Fibroblasts, Keratinocytes; VEGF, FGF, EGF. Granulation, re-epithelialization, new Collagen III.
  • Remodeling (Wk 3 - 2 yrs): Myofibroblasts; MMPs. Collagen III → I, ↑ strength (~80% max).
• Factors Affecting Healing:
  • Local: ↓O₂, infection, foreign body, poor perfusion.
  • Systemic: Age, poor nutrition (Vit C, Zn, protein), DM, steroids, smoking.
• Acute vs. Chronic:
  • Acute: Timely healing.
  • Chronic: Stalled > 4-6 weeks.

  ⭐ Chronic wounds are often stalled in the inflammatory phase due to persistent stimuli or impaired cellular responses.

Wound Assessment & Prep - Clean Sweep

• Assessment Parameters:
  • Site, Size (LxWxD cm), Depth (cm), Exudate (type, amount, odour)
  • Wound Bed: % Necrotic (black), Sloughy (yellow), Granulating (red), Epithelializing (pink)
  • Surrounding Skin: Colour, oedema, maceration, induration, cellulitis
  • Infection Signs: Classic (rubor, calor, tumor, dolor), ↑exudate, delayed healing, odour.
• Cleansing:
  • Solutions: Normal saline ($0.9%$ NaCl), potable water. Antiseptics (povidone-iodine) for infected wounds.
  • Technique: Gentle irrigation.
• Debridement Types:
  • Autolytic: Slow, selective (hydrocolloids, hydrogels).
  • Enzymatic: Selective (collagenase).
  • Mechanical: Non-selective (wet-to-dry, hydrotherapy); often painful.
  • Sharp/Surgical: Fast; for extensive necrosis/infection.
  • Biological: Selective (medical maggots). 📌 TIME Framework (wound bed prep): Tissue, Infection/Inflammation, Moisture, Edge.

⭐ The TIME framework (Tissue, Infection/Inflammation, Moisture, Edge) provides a systematic approach to wound bed preparation, guiding treatment choices.

Dressing Decisions - Material Matters

• Ideal Properties: Maintains moist environment, infection protection, non-adherent, gas exchange.
• Classification:
  • Passive: Protective cover (e.g., gauze).
  • Active: Promote healing.
  • Interactive: Modulate wound bed (e.g., hydrocolloids).
• Common Dressing Types:

• Dressing Selection Principles: Match dressing to wound characteristics:
  • Exudate level (low, moderate, heavy)
  • Wound depth (superficial, partial, full-thickness)
  • Presence of infection or necrosis
  • Condition of surrounding skin

⭐ Alginate dressings are highly absorbent and suitable for wounds with moderate to heavy exudate, forming a gel that maintains a moist environment.

Specific Wound Scenarios - Tricky Spots

• Diabetic Foot Ulcers (DFU):

  • Key: Offloading, glycemic control, debridement, infection check.
  • Dressings: Moisture-retentive (hydrogels, foams); antimicrobials if infected. Wagner grades 0-5.

  ⭐ Effective offloading is the cornerstone of diabetic foot ulcer management and prevention, significantly impacting healing outcomes.

• Pressure Ulcers:

  • Prevention vital. Staging (I-IV, Unstageable, DTPI).
  • Dressings: Stage I: Film. Stage II: Hydrocolloid/foam. Stage III/IV: Alginate/hydrofiber for exudate, consider antimicrobials.

• Burns:

  • Assess depth & %TBSA (Rule of Nines).
  • Superficial (1st/2nd degree): Non-adherent, moisture-retentive.
  • Deep (2nd/3rd degree): Antimicrobials (e.g., silver-based), pain control.

• Venous Leg Ulcers (VLU):

  • Key: Compression therapy.
  • Dressings: Absorbent (foams, alginates) for exudate, under compression.

High‑Yield Points - ⚡ Biggest Takeaways

• Wound cleansing is crucial; normal saline is preferred for most acute wounds.
• Debridement removes necrotic tissue; autolytic debridement is slowest, surgical is fastest.
• Moist wound healing is superior to dry for epithelialization and reduced scarring.
• Occlusive dressings (e.g., hydrocolloids) promote moist healing and autolytic debridement.
• Silver-impregnated dressings are used for infected wounds or those at high risk of infection.
• Negative Pressure Wound Therapy (NPWT) promotes granulation tissue formation in complex wounds.
• Honey-based dressings offer antimicrobial and anti-inflammatory properties for certain wounds.