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integ3 wounds dress

Selective debridement involves removing only nonviable tissues from a wound. Selective debridement is most often performed by sharp debridement, enzymatic debridement, and autolytic debridement.
Sharp debridement requires the use of scalpel, scissors, and/or forceps to selectively remove devitalized tissues, foreign materials or debris from a wound.
Sharp debridement is most often used for wounds with large amounts of thick, adherent, necrotic tissue; however, it is also used in the presence of cellulitis or sepsis.
Sharp debridement is the most expedient form of removing necrotic tissue. Physical therapists are permitted to perform sharp debridement in the majority of states.
Enzymatic debridement refers to the topical application of enzymes to the surface of necrotic tissue.
Enzymatic debridement can be used on infected and non-infected wounds with necrotic tissue. This type of debridement may be used in wounds that have not responded to autolytic debridement or in conjunction with other debridement techniques.
Enzymatic debridement can be slow to establish a clean wound bed and should be discontinued after removal of devitalized tissues in order to avoid damage.
Autolytic debridement refers to using the body’s own mechanisms to remove nonviable tissue. Common methods of autolytic debridement include transparent films, hydrocolloids, hydrogels, and alginates.
Autolytic debridement results in a moist wound environment that permits rehydration of the necrotic tissue and eschar and allows enzymes to digest the nonviable tissue. Autolytic debridement can be used with any amount of necrotic tissue and is non-invasive and pain free.
Patients and caregivers can be instructed to perform autolytic debridement with relative ease; however, this type of debridement requires a longer period of time for overall wound healing to occur. Autolytic debridement should not be performed on infected wounds.
Non-selective debridement involves removing both viable and nonviable tissues from a wound.
Non-selective debridement). is often termed “mechanical” and is most commonly performed by wet-to-dry dressings, wound irrigation, and hydrotherapy (whirlpool
Wet-to-dry dressings refer to the application of a moistened gauze dressing placed in an area of necrotic tissue. The dressing is then allowed to dry completely and is later removed along with the necrotic tissue that has adhered to the gauze.
Wet-to-dry dressings are most often used to debride wounds with moderate amounts of exudate and necrotic tissue. This type of debridement should be used sparingly on wounds with both necrotic tissue and viable tissue since granulation tissue will be traumatized in the process
Removal of dry dressings from granulation tissue may cause bleeding and be extremely painful.
Wound irrigation removes necrotic tissue from the wound bed using pressurized fluid. Pulsatile lavage is an example of wound irrigation that uses a pressured stream of irrigation solution. This type of debridement is most desirable for wounds that are infected or have loo
Wound irrigation Most devices permit varying pressure settings and provide suction for removal of the exudate and debris.
Hydrotherapy is most commonly employed using a whirlpool tank with agitation directed toward a wound that requires debridement. This process results in the softening and loosening of adherent necrotic tissue.
Physical therapists must be aware of the side effects of hydrotherapy such as dependent positioning of the lower extremities, systemic effects such as a drop in blood pressure, and maceration of surrounding skin.
Hydrocolloid dressings consist of gel-forming polymers such as gelatin, pectin, and carboxymethylcellulose with a strong film or foam adhesive backing. The dressings vary in permeability, thickness, and transparency.
Hydrocolloids absorb exudate by swelling into a gel-like mass and vary from being occlusive to semipermeable. The dressing does not attach to the actual wound itself and is instead anchored to intact skin surrounding the wound.
Indications: Hydrocolloids are useful for partial and full-thickness wounds. The dressings can be used effectively with granular or necrotic wounds.
Advantages hydrocolloids Provides a moist environment for wound healing
Advantages hydrocolloids Enables autolytic debridement
Advantages hydrocolloids Offers protection from microbial contamination
Advantages hydrocolloids Provides moderate absorption
Advantages hydrocolloids Does not require a secondary dressing
Advantages hydrocolloids Provides a waterproof surface
Disadvantages hydrocolloids May traumatize surrounding intact skin upon removal
Disadvantages hydrocolloids May tend to roll in areas of excessive friction
Disadvantages hydrocolloids Cannot be used on infected wounds
Hydrogels consist of varying amounts of water and varying amounts of gel-forming materials such as glycerin. The dressings are available in sheet form or amorphous form.
Indications: Hydrogels are commonly used on superficial and partial-thickness wounds (e.g., abrasions, blisters, pressure ulcers) that have minimal drainage. Rather than absorb drainage, hydrogels are moisture retentive.
Advantages Hydrogels Provides a moist environment for wound healing
Advantages Hydrogels Enables autolytic debridement
Advantages Hydrogels May reduce pressure and diminish pain
Advantages Hydrogels Can be used as a coupling agent for ultrasound
Advantages Hydrogels Minimally adheres to wound
Disadvantages Hydrogels Potential for dressings to dehydrate
Disadvantages Hydrogels Cannot be used on wounds with significant drainage
Disadvantages Hydrogels Typically requires a secondary dressing
Foam dressings are composed from a hydrophilic polyurethane base. The dressings are hydrophilic at the wound contact surface and are hydrophobic on the outer surface.
Foam Dressings The dressings allow exudates to be absorbed into the foam through the hydrophilic layer.
Foam Dressings The dressings are most commonly available in sheets or pads with varying degrees of thickness. Semipermeable foam dressings are produced in adhesive and non-adhesive forms. Non-adhesive forms require a secondary dressing.
Indications: Foam dressings are used to provide protection over partial and full-thickness wounds with varying levels of exudate. They can also be used as secondary dressings over amorphous hydrogels.
Advantages Foam Dressings Provides a moist environment for wound healing
Advantages Foam Dressings Available in adhesive and non-adhesive forms
Advantages Foam Dressings Provides prophylactic protection and cushioning
Advantages Foam Dressings Encourages autolytic debridement
Advantages Foam Dressings Provides moderate absorption
Disadvantages Foam Dressings May tend to roll in areas of excessive friction
Disadvantages Foam Dressings Adhesive form may traumatize periwound area upon removal
Disadvantages Foam Dressings Lack of transparency makes inspection of wound difficult
Film dressings are thin membranes made from transparent polyurethane with water-resistant adhesives. The dressings are permeable to vapor and oxygen, but are mostly impermeable to bacteria and water.
Transparent Film They are highly elastic, conform to a variety of body contours, and allow easy visual inspection of the wound since they are transparent.
Transparent Film Indications: Film dressings are useful for superficial wounds (scalds, abrasions, lacerations) or partial-thickness wounds with minimal drainage.
Advantages Transparent Film Provides a moist environment for wound healing
Advantages Transparent Film Enables autolytic debridement
Advantages Transparent Film Allows visualization of the wound
Advantages Transparent Film Resistant to shearing and frictional forces
Advantages Transparent Film Cost-effective over time
Disadvantages Transparent Film Excessive accumulation of exudates can result in periwound maceration
Disadvantages Transparent Film Adhesive may traumatize periwound area upon removal
Disadvantages Transparent Film Cannot be used on infected wounds
Gauze dressings are manufactured from yarn or thread and are the most readily available dressing used in an inpatient environment.
Gauze dressings come in many shapes and sizes (e.g., sheets, squares, rolls, packing strips). Impregnated gauze is a variation of woven gauze in which various materials such as petrolatum, zinc or antimicrobials have been added.
Gauze Indications: are commonly used on infected or non-infected wounds of any size. The dressings can be used for wet-to-wet, wet-to-moist or wet-to-dry debridement.
Advantages Gauze Readily available, cost-effective dressings
Advantages Gauze Can be used alone or in combination with other dressings or topical agents
Advantages Gauze Can modify number of layers to accommodate for changing wound status
Advantages Gauze Can be used on infected or uninfected wounds
Disadvantages Gauze Has a tendency to adhere to wound bed
Disadvantages Gauze Highly permeable and therefore requires frequent dressing changes (prolonged use decreases cost effectiveness)
Disadvantages Gauze Increased infection rate compared to occlusive dressings
Alginate dressings consist of calcium salt of alginic acid that is extracted from seaweed.
Alginates are highly permeable and non-occlusive. As a result, they require a secondary dressing.
Alginate dressings . are based on the interaction of calcium ions in the dressing and the sodium ions in the wound exudate
Alginates Indications: are typically used on partial and full-thickness draining wounds such as pressure wounds or venous insufficiency ulcers. Alginates are often used on infected wounds due to the likelihood of excessive drainage.
Advantages Alginates High absorptive capacity
Advantages Alginates Enables autolytic debridement
Advantages Alginates Offers protection from microbial contamination
Advantages Alginates Can be used on infected or uninfected wounds
Advantages Alginates Non-adhering to wound
Disadvantages Alginates May require frequent dressing changes based on level of exudate
Disadvantages Alginates Requires a secondary dressing
Disadvantages Alginates Cannot be used on wounds with an exposed tendon, joint capsule or bone
Created by: micah10



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