wound healing and wound care - khon kaen university .pdf · v.a.c. is a non-invasive, active wound...
TRANSCRIPT
11/10/2014
1
Palakorn Surakunprapha
Division of Plastic Surgery
Department of Surgery
Srinagarind Hospital
11/10/2014
2
Collagen synthesis
Wound contraction
Epithelization
11/10/2014
3
WOUND BED PREPARATION
TIME. Tissue management Inflammation and infection control Moisture balance Epithelial (edge) advancement
11/10/2014
4
11/10/2014
5
Wound cleansing
Wound dressing
11/10/2014
6
Technique
Sterile or clean
Clean surrounding skin
การท าความสะอาดแผล
Normal Saline or Tap water Cheap
Available
No report : Delay wound healing
NSS : Not practical in homecare
Angeras and Brandbard : No corresponded between bacteria culture and wound infection
Wood ( 1976 ) Cotton wool or gauze are know to shed fine, fibrous particles, which can be responsible for foreign body reaction
Thomlinson ( 1987 )
Swabbing from clean to dirty, top to bottom, or inside to outside merely resulted in redistribution of bacteria across the wound
Bathing and showering
Psychological benefit
Thorough cleansing
Should be not bathing in non – running water
11/10/2014
7
11/10/2014
8
11/10/2014
9
Moist Wound Healing
No-residual left Transparent
สามารถท าให้แผลชุ่มชื้น
สามารถปิดกันน้ าได้
สามารถปิดได้ 3 -5 วัน
เสียสภาพได้ง่าย
ห้ามใช้ในแผลติดเชื้อ
11/10/2014
10
11/10/2014
11
สามารถรับแรงกระแทกได้ดี
ไม่สูญเสียสภาพได้ง่าย
สามารถท าให้แผลชุ่มชื้น
เหมาะกับแผลท่ีมีน้ าเหลืองมาก เช่น DM Foot, VLU, PU etc.
11/10/2014
12
ใช้ในแผล cavity และ แผลท่ีมีน ้ำเหลืองค่อนข้ำงมำก
Stop surface bleeding
ต้องใช้ secondary dressings
ห้ำมใช้ในแผลท่ีมีน ้ำเหลืองน้อยเพรำะแผลจะแห้งมำก
Remove all hyperkeratotic tissue and callous
Hyperkeratotic Tissue
Wound Preparation Debridement
11/10/2014
13
Week 0
Week 6
Week 4
11/10/2014
14
Week 0
Week 9
Week 5
Week 0
Week 8
Week 4
11/10/2014
15
Epidermal Growth Factor
Action • The rhEGF has stimulating
effect on Angiogenesis,
Fibroblast proliferation and
collagen synthesis.
• This enhances
Cell proliferation
Cell differentiation and
Cell migration
• Contributes to the scar less
repair
Diabetic foot ulcer
First & second degree burns
Donor site skin grafts
Twice daily
Low Moderate High
Exudates
Absorbency
Film*
Hydro-Gel
Hydrocolloid
Ca-Alginate
Hydro cellular/Foam
11/10/2014
16
APPLICATION & REMOVAL
SILVER
WHY?
11/10/2014
17
Antimicrobial property Kill microbes by blocking respiratory enzyme
Broad spectrum Silver is effective against a broad range of aerobic, anaerobic, Gram-negative and Gram-positive bacteria, yeast, filamentous fungi and viruses
BIOLOGIC PROPERTIES OF SILVER
Silver nitrate and silver sulfadiazine release silver at concentrations up to 3,200ppm but most of this is rapidly inactivated through the formation of chemical complexes
Silver sulfadiazine is commonly applied twice a day and silver nitrate up to 12 times a day.
MOISTENING BY SPRAYING
11/10/2014
18
COVER ACTICOAT WITH GAUZES AND A MULTI-PERFORATED CATHETER
DIPPING FROM STERILE WATER BOTTLE
11/10/2014
19
11/10/2014
20
11/10/2014
21
ALOE VERA
VITAMINS
MINERAL : ZINC HONEY
11/10/2014
22
RADIANT HEAT
11/10/2014
23
V.A.C.®
Vacuum Assisted Closure
V.A.C. is a non-invasive, active wound closure
system that uses controlled, localised
negative pressure to promote healing in acute
and chronic wounds
in the early 1990s Argenta and Morykwas developed a system that uses suction to help draw wound edges together; commercialised in 1995, negative pressure wound therapy (NPWT; V.A.C. Therapy) creates a closed, moist wound environment while applying subatmospheric pressure that removes exudate
Acute traumatic wounds
Abdominal wounds
Sternal wounds
Pressure ulcers (full thickness)
Lower extremity ulcers
Diabetic foot ulcers
Cut the V.A.C.® Foam to fit the size and shape of the wound,
including tunnels and undermined areas.
11/10/2014
24
Trim the drape to cover the foam, plus
3-5 cm border of intact skin.
Make a small hole (approx 1 cm) in the drape and
apply the T.R.A.C.™ Pad.
Final dressing in place with Therapy ON.
Continuous therapy
Always for first 48 hours
Maintain for length of treatment when:
Significant discomfort in intermittent mode
High amounts of exudate
Difficulty maintaining seal
Using VersaFoam™
Wound requires constant contraction (sternal
wounds, tunnels)
Meshed Skin Grafts
Intermittent therapy
Use to stimulate
granulation tissue faster
After 48 hours in
Acute/Traumatic Wounds,
Pressure Ulcers, Chronic
Wounds, Diabetic Foot Ulcers
An intermittent suction of 125 mm of Hg for 20 min/hr
Due to the child’s poor cardiopulmonary state, pressure was set at 10 mmHg it was then increased to 25 mmHg over the course of 48 h to finally reach 50 mmHg.
it was not clear whether a high pressure level of 150 mmHg caused any problems when used in complex wounds after replantation.
In the guideline of the VAC,2 it is recommended that VAC therapy should not be used in ischemic wounds or wounds with deteriorated circulation, or used with a low pressure level under 80 mmHg.
11/10/2014
25
Boy 4 years
Dog bite at head
After 2 days
Male 84 years
Sternal wound
After 3 weeks
11/10/2014
26
With active bleeding
With difficult wound haemostasis
Who are taking anticoagulant
medication
11/10/2014
27
11/10/2014
28
11/10/2014
29
11/10/2014
30
11/10/2014
31