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Adjuvant therapies

WOCN program

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