4/2/2018

1

How to facilitate faster healingChristine Herb, MS, FNP-C, CWON-AP

Syracuse VA Medical Center“The price of freedom can be seen here.”

its a symphony !

4/2/2018

2

Platelet Activation and Cytokine Release

Depending on the cytokine and its role, it may be appropriate to either enhance or inhibitthe cytokine to achieve the desired outcome

https://www.rndsystems.com/resources/articales/cytokines-wound-healing

Influencing factors:

diabetes comorbidities perfusion necrosis Chronic wounds

get “stuck”, lacking the components of a progressing healing cascade.

4/2/2018

3

NS evaporates quickly, leaving woundbed dry.

This environment does NOT support cellular growth.

(Winter GD. Formation of the scab and the rate of epithelialization of superficial wounds in the skin of the young domestic pig. Nature 1962;193-293.)

NS wet to dry gauze Hydrogel & gauze

We’ve know this for 56 years & it’s still not practiced!

Etiology is essential to determine treatment: Surgical Venous Arterial Neuropathic Pressure trauma Dermatology

4/2/2018

4

Tissue managementInflammation & Infection controlMoisture balanceEpithelial (edge) advancement

Falanaga V. Classifications for wound bed preparation and stimulation of chronic wounds. Wound Repair Regen. 2000;8:347-52.

Woundbed character:◦ Necrotic tissue Eschar Slough vs “fibrous exudate”◦ Fibrin biofilm◦ Moist or dry tissue◦ Granular vs HYPERgranular◦ Adipose tissue

Infection vs critical bioburden: purulence, erythema, induration, odor, rash. Topical + systemic antimicrobials

Edema: huge impediment to healing!

exudate : a fluid with a high content of protein and cellular debris which has escaped from blood vessels and has been deposited in tissues or on tissue surfaces, usually as a result of inflammation.

4/2/2018

5

Biofilm: bacterial impeded in a thick, slimy barrier of sugars & proteins.

Not tissue. Removable film, usually granular tissue beneath. Not always visible.

Stage 1: reversible surface attachmentStage 2: permanent surface attachmentStage 3: slimy protective matrix/biofilm

Removal by combination of:Debridement (sharp)Vigorous cleansing Topical anti-microbial: Silver Iodine Honey

Saye DE, Recurring and antimicrobial-resistant infections:considering the potential role of biofilms in clinical practice Ostomy Wound Manage. 2007 Apr;53(4):46-8, 50, 52

Fibrin covered, inflamed Sharp debridement, note scar tissue -very chronic venous ulcer

4/2/2018

6

Vibrant, Red, glistening Raised ABOVE skin level

Poorly vascularized

desperatelyneeds MOISTURE !!!

4/2/2018

1

Woundbed character:◦ Necrotic tissue Eschar Slough vs “fibrous exudate”◦ Fibrin biofilm◦ Moist or dry tissue◦ Granular vs HYPERgranular◦ Adipose tissue

Infection vs critical bioburden: purulence, erythema, induration, odor, rash. Topical + systemic antimicrobials

Edema: huge impediment to healing!

Which leg heals faster?Reduce edema HEAL !w/ compression

4/2/2018

2

Macrostrain: the visible stretch that occurs when negative pressure contracts the foam. Draws wound edges together Provides direct and complete wound bed contact Evenly distributes negative pressure Removes exudate and infectious materials

Microstrain: is the microdeformation at the cellular level, which leads to cell stretch.Reduces edema Promotes perfusion Promotes granulation tissue formation by facilitating cell migration and

proliferation

Over the past 2 decades, advancements in the clinical understanding of wounds and their pathophysiology have commanded significant biomedical innovations in the treatment of acute, chronic and other types of wounds. Including:

Biologicals Skin substitutes Scaffolds

4/2/2018

3

Human fibroblast-derived skin substitute.

Indications: DFU

SINGLE:

Bilayered, living cellular construct composed of living human cells (fibroblasts & keratinocytes) and a collagen matrix.

Indications: VLU & DFU

BILAYERED

BILAYERED

BILAYERED

BILAYERED

4/2/2018

4

51 x 35mmX

41 x 27mm

Amniotic membrane is a unique material and its composition containscollagen types I, III, IV, V, and VII. Amniotic membrane is composed of structural extracellular matrix (ECM), that also contains specialized proteinsfibronectin, laminins, proteoglycans and glycosaminoglycans. In addition, amniotic membrane contains essential, active, healing growth factors such as epidermal growth factor (EGF), transforming growth factor beta (TGF-b), fibroblast growth factor (FGF), and platelet derived growth factor (PDGF) & cytokines.

A-------- is processed from human tissue according to the American Association of Tissue Banks (AATB) standards, and is regulated as a human cell, tissue, or cellular or tissue-based product (HCT/P) under Section 361 of the Public Health Service Act

4/2/2018

5

Advanced , Effective Wound Healing requires that we move forward and embrace MOIST wound healing, edemamanagement+ new technology & alternate strategiesto healing.

Everyone benefits.

…Questions

Corrin Morris, BSN, CWOCN

Christine Herb, FNP, CWON-AP