Surgery Book

http://www.fpnotebook.com/

Wound DressingAka: Decubitus Ulcer Dressing, Pressure Sore Dressing, Venous Ulcer Dressing, Arterial Ulcer Dressing, Neuropathic Ulcer Dressing

Advertisement

  1. See also
    1. Odor Reducing Dressing
  2. General Dressing Guidelines
    1. Reassess wound at a minimum of weekly intervals
      1. Change management if no improvement in 3-6 weeks
    2. Sheet dressings should extend 1-2 cm beyond margin
    3. Gently irrigate wounds with each dressing change
      1. See Wound Cleansing
    4. Write date and time of dressing change on dressing
    5. Treating Candidiasis at wound edges
      1. Apply zinc oxide with Nystatin mixture (1:1)
    6. Decreasing wound maceration
      1. Apply stomal adhesive wafer around wound
      2. Apply vaseline around wound edges
      3. Apply zinc oxide around wound edges
    7. Dry surrounding skin
      1. Keeps the peri-ulcer skin dry, but ulcer bed moist
    8. Exudate control
      1. Dressing controls exudate without dessicating ulcer
    9. Optimize caregiver time
      1. May avoid Saline Gauze Dressing (time intensive)
      2. Consider Hydrocolloid wound dressing
    10. Prevent abcess formation
      1. Loosely fill all cavities with dressing material
      2. Do not overpack
    11. Consider applied Growth factors at Night
      1. Animal studies suggest benefit
  3. Dressings based on exudate amounts
    1. Minimal to mild exudates
      1. Hydrocolloid Dressing (e.g. Comfeel)
      2. Polyurethane Dressing (e.g. Tegaderm)
      3. Saline Gauze Dressing
    2. Moderate to heavy exudates
      1. Alginate Dressing (Sorbsan)
      2. Consider stomal or collection bags
      3. Consider Hypertonic Saline Gauze (Mesalt)
        1. May cause tissue destruction
  4. Dressings based on wound tissue color
    1. Red (granulation) or pink tissue (epithelialization)
      1. Keep wound clean and slightly moist
      2. Cover with Transparent Film Dressing (e.g Tegaderm)
      3. Consider topical antimicrobial (e.g. Bacitracin)
    2. Yellow wound (soft, yellow, creamy slough)
      1. Debride non-viable tissue and absorb excess exudate
      2. Absorption Dressing (e.g. Sorbsan) changed bid to tid
        1. Rinse wound with saline between dressings
      3. Hydrocolloid Dressing changed every 7 days
    3. Black wound (hard, dehydrated, necrotic eschar)
      1. Wound Debridement
      2. Follow management of yellow wound above
  5. Dressings for infected wounds
    1. Preferred Strategy
      1. Topical antiseptic
      2. Saline Gauze Dressing (Wet-to-Dry Dressing)
      3. Avoid prolonged use longer than 5 days
    2. Amorphous Hydrogel Dressing
      1. Duoderm Gel
      2. Intrasite
    3. Polurethane Foam Dressings
      1. Allevyn
      2. Lyofoam
    4. Alignate Dressing (if excessive exudate present)
      1. Kaltostat
      2. Sorbsan
  6. Dressings for wound cavities
    1. Alginate packing fiber (for excessive exudates)
    2. Hydrocolloid Dressing pastes
    3. Polyurethane Foam Dressing fillers
    4. Expanding dressings (only fill cavity by 50%)
      1. Dermasorb Spiral Wound Dressing
      2. Cutinova cavity
    5. Iodine Impregnated Gauze (Iodoform Gauze)
      1. May cause tissue destruction
  7. Dressings for wound protection
    1. Nonadherant Dressing (e.g. Telfa)
    2. Foam Dressing
    3. Transparent Film Dressing
  8. Dressings for Pressure Sores (Decubitus Ulcer)
    1. Example: Sequential protocol for non-infected wounds
      1. Clean ulcer with saline during dressing change
      2. Calcium Alginate Dressing for first 4 weeks
        1. Change dressing when saturated or every 2 days
      3. Hydrocolloid Dressing for next 4 weeks
        1. Change dressing every 3 days or more
      4. Efficacy
        1. Results in faster healing than hydrocolloid alone
      5. References
        1. Belmin (2002) J Am Geriatr Soc 50:269
    2. Grade I Pressure Ulcer
      1. Polyurethane Dressing
      2. Hydrocolloid Dressing
    3. Grade II or II Pressure Ulcer
      1. Clean ulcer
        1. Saline Gauze Dressing (Wet-to-Moist Dressing)
        2. Polyurethane Dressing
        3. Hydrocolloid Dressing
        4. Hydrogel Dressing
      2. Infected ulcer (until infection resolved)
        1. Topical antiseptic
        2. Saline Gauze Dressing (Wet-to-Dry Dressing)
        3. Avoid prolonged use longer than 5 days
    4. Grade IV Pressure Ulcer
      1. Clean ulcer
        1. Saline Gauze Dressing (Wet-to-Moist Dressing)
        2. Hydrocolloid Dressing
        3. Hydrogel Dressing
      2. Infected ulcer (until infection resolved)
        1. Topical antiseptic
        2. Saline Gauze Dressing (Wet-to-Dry Dressing)
        3. Avoid prolonged use longer than 5 days
    5. Example of a protocol used at Mayo
      1. Solutions
        1. Saline
        2. Dakin's Solution (1/2 strength)
          1. Has antibacterial activity
          2. Can prepare with 0.5 tsp bleach in 1 gallon water
        3. Acetic acid 0.25%
          1. For pseudomonas infection (green discharge)
          2. Can prepare with 1/4 cup vinegar in 1 quart water
      2. Dressings
        1. Weaping, moist lesion: Wet-to-Dry Dressing
          1. Dakin's Solution soaked gauze for most lesions
          2. Acetic acid for pseudomonas infected lesions
        2. Dark, leathery eschar: Sulfamylon penetrates eschar
        3. Other dressings
          1. Xeroform/vaseline
          2. Silver nanotech (e.g. Aquacel Ag)
            1. Effective, and use is common in Europe
          3. Avoid Duoderm for Pressure Sores
      3. Other measures
        1. Vacuum Assisted Closures (VAC)
          1. Highly effective in Pressure Sore healing
      4. References
        1. RP Clay (Fall 2005) Mayo Geriatric Reviews
  9. References
    1. Bello (2000) JAMA 283(6):716
    2. Degreef (1998) Dermatol Clin 16(2):365
    3. Findlay (1996) Am Fam Physician 54(5):1519
    4. Habif (1996) Clinical Derm, Mosby, p. 810-13
    5. Knapp (1999) Pediatr Clin North Am 46(6):1201
    6. Krasner (1995) Prevention Management Pressure Ulcers
    7. Lewis (1996) Med-Surg Nursing, Mosby, p. 199-200
    8. Lueckenotte (1996) Gerontologic Nurs., Mosby, p. 800-7
    9. PUGP (1995) Am Fam Physician 51(5):1207
    10. PUGP (1994) Pressure Ulcer Treatment, AHCPR 95-0653
    11. Way (1991) Current Surgical, Lange, p.95-108

Navigation Tree