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PRINCIPLES OF Wound Care

PRINCIPLES OF Wound Care. Dr. S.A. Ademola FWACS Department of Plastic Surgery University College Hospital Ibadan. Disclosures. NONE. What is a wound?. A wound is a breach in the integrity of tissues. It can affect all tissues of the body

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PRINCIPLES OF Wound Care

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  1. PRINCIPLES OF Wound Care Dr. S.A. Ademola FWACS Department of Plastic Surgery University College Hospital Ibadan

  2. Disclosures • NONE

  3. What is a wound? • A wound is a breach in the integrity of tissues. • It can affect all tissues of the body • Usually, wounds should progress towards healing by natural mechanisms

  4. Acute wound management • Flap • Graft • Direct closure • Do nothing • Usually follows the reconstructive ladder principle

  5. Do nothing • Rest +/- Elevation • Analgesics • Proper cleansing • Dressing • Antibiotics if necessary • Tetanus prophylaxis

  6. Direct Closure (The fundamentals) • Incisions should follow skin tension lines • Gentle handling of tissues with adequate • debridement/irrigation (? Jet lavage) •  Haemostasis is ensured • Eliminate tension at edges •  Use fine sutures. •  Evert wound edges during closure

  7. Other steps of the ladder should be employed when wound edges cannot be apposed without tension

  8. What is a chronic wound? • A wound that has failed to proceed through an orderly and timely process to produce anatomic & functional integrity • Wound that has failed to progress towards healing within 6 weeks.

  9. What is wound-care? • It is a set of processes undertaken to provide optimal wound environment for healing to take place • It can be encapsulated in wound bed preparation paradigm

  10. Wound healing trajectory • A wound size should be reduced by 30% at four weeks to be able to heal in 12 weeks • If WBP is ensured and wound is stalled, review the diagnosis

  11. Principle of medical practice is to treat the whole patient • WBP paradigm is to treat the whole patient before treating the hole in the patient

  12. Identify and treat the cause • Determine if there is adequate blood supply to heal • Identify the cause(s) as specifically as possible or make appropriate referrals • Review cofactors/comorbidities (systemic disease, nutrition, medications) that may delay or inhibit healing • Evaluate the person’s ability to heal: healable, maintenance, non-healable

  13. Address patient centered concerns • Pain • Activities of daily living • Psychological well-being • Smoking • Access to care • Financial limitations

  14. Local wound treatment • D (T) – Debridement/ Tissue viability • I – Infection / Persistent inflammation • M – Moisture Balance • E - Edge

  15. Debride the wound • Sharp/versajet • Wet to dry dressing • Iruxol • Hydrogels (Intrasite gel) • Medical maggot • Surgical • Mechanical • Enzymatic • Chemical • Autolytic • Biological

  16. Cleansing the wound • Normal saline • Water • Dilute acetic acid (0.5 – 1%) • Others

  17. Identify & Treat infection

  18. Example of agents • Silver • Povidone iodine • Honey • Cutimedsorbact • Chlorhexidine

  19. Provide moisture balance • Acrylics • Foams • Films • Hydrogels • Hydrocolloids

  20. Re-evaluate • Always re-evaluate if stuck • Proceed to edge effect if succeeding but wound is large

  21. The Edge Effect • Skin grafts • Flaps • NPWT • Other adjunctive therapies

  22. Conclusion • Contemporary woundcare is dynamic and interactive • The wound does have a language

  23. If you cannot read the wound, it is not the fault of the wound but the fault of the clinician who has failed to learn the language of the wound – Hiske Smart

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