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Adjuvant therapies
WOCN program
| Question | Answer |
|---|---|
| explain the difference between cellular and acellular products | Cellular is from autologous or allogenic is living, acellular (ECM scaffold) is nonliving-can be aulogous, allogenic, xenographic or synthetic |
| Define and give an example of a bioengineered skin substitute | Derma graft (dermal) apligraf (bilayered) Consists of Keratinocytes and/or growth factors, and ECM. Meant to stimulate the host's repair process. |
| give and example of an acellular product | ECM scaffold: (OASIS) Alloderm , Graftjacket |
| what are the indications for Apligraf | diabetic LEND >4wks full thickness failed standard care; venous ulcer > 1 month duration |
| what is an indication for Graftjacket and what is it derived from | nonhealing diabetic wounds that failed standard therapy acellular dermal matrix: regenerative tissue matrix meshed cadaver skin |
| what issues must be considered before recommending skin substitutes or ECM scaffolds | Systemic and local wound impairments to healing, underlying pathology of wound, cost, reimbursement, evidence based support |
| identify contraindications for NPWT | untreated Osteomyelitis, exposed blood vessels or organs, necrotic tissue, uncontrolled infection, malignancy, unexplored fistula, precaution with anticoag therapy |
| identify the indications for HBO (hyperbaric oxygen therapy) related to wound care | hypoxic wounds (limb threatening) chronic osteomyelitis, crush injury, compromised grafts and flaps, delayed radiation injuries, unresponsive diabetic wagner grade III or higher |
| 90 minutes 5-7 times per week | what is the usual length of time for HBO treatments |
| What is the most common side effect of HBO? | claustrophobia |
| pressure ulcer, stage IV is an indication for HBO- True or False? | HBO not recommended for pressure ulcers |
| Topical oxygen is the same as hyperbaric oxygen for wound healing True or False? | topical and HBO are different |
| list effects that electrical stimulation has on a wound | galvanotaxic, stimulatory, antibacterial blood, flow, tissue oxygenation |
| electrical stimulation can be used on stage III and stage IV pressure ulcers - True of False? | true |
| What topical dressings cannot be used with electrical stimulation? | silver or iodine |
| Identify the effects of UV light therapy | may reduce bioburden, wound debridement and speed granulation and reepithelialization |
| identify two newer types of ultrasound used in wound management | Low frequency (noncontact) and low frequency debridement |
| what is macro-deformation | Wound contraction |
| what is micro-deformation | Micro deformation is the stretching of the cell shape under NPWT |
| explain mechanical stretch perfusion | Microdeformation and stretch of cells changes the cell shape, activates vascular growth/ angiogenesis, cell division and proliferation |
| xenographic | from one species to another |
| autologous | from the same individual |
| allogenic | same species, different individual |
| what are indications for NPWT | open abd wound, deep and/or heavily draining wounds, enteric fistulas, non-healing diabetic or pressure ulcers, can be used with infected wounds if being treated and closely monitored |
| possible side effects of NPWT | tissue trauma, bleeding |
| how does HBO work? | increases oxygen delivery to tissues, increases perfusion, reduces edema, increased nitric acid in wound, incrased GF expression, fibroblast proliferation |
| absolute contraindications for HBO | untreated pneumothorax, hx of bleomycin, adriamycin, disulfiram, cis-platinum, sulfamylon |
| relative contraindications for HBO | pregnancy, URI, emphysema, hyperthermia, seizure disorder, known malignancy, pneumonia |
| side effects of HBO | lowered blood sugar, elevated b/p, ear or sinus squeeze, visual acuity changes |
| three types of NPWT | VAC vacuum assisted closure, Renasys EZ-gauze wound filler, Egenex: biodome easy release wound filler |
| Ultrasonic mist | Selective consider for clean recalcitrant stage 2 and 4 PI's, stem's fibrinolysis, blood flow |
| Selective debridement method methods | Autolysis, enzyme, CSWD, maggot, ultrasonic mist |
| Nonselective debridement methods | Surgical, hydrotherapy, surgical sharp, wet to dry |
Created by:
Beth Perry
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