integ3 wounds dress
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| Selective debridement | involves removing only nonviable tissues from a wound. Selective debridement is most often performed by sharp debridement, enzymatic debridement, and autolytic debridement.
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| Sharp debridement | requires the use of scalpel, scissors, and/or forceps to selectively remove devitalized tissues, foreign materials or debris from a wound.
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| 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.
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| Sharp debridement | is the most expedient form of removing necrotic tissue. Physical therapists are permitted to perform sharp debridement in the majority of states.
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| Enzymatic debridement | refers to the topical application of enzymes to the surface of necrotic tissue.
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| 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.
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| 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.
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| 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.
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| 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.
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| 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.
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| Non-selective debridement | involves removing both viable and nonviable tissues from a wound.
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| Non-selective debridement). | is often termed “mechanical” and is most commonly performed by wet-to-dry dressings, wound irrigation, and hydrotherapy (whirlpool
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| 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.
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| 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
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| Removal of dry dressings from granulation tissue | may cause bleeding and be extremely painful.
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| 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
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| Wound irrigation | Most devices permit varying pressure settings and provide suction for removal of the exudate and debris.
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| 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.
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| 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.
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| 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.
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| 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.
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| Indications: | Hydrocolloids are useful for partial and full-thickness wounds. The dressings can be used effectively with granular or necrotic wounds.
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| Advantages hydrocolloids | Provides a moist environment for wound healing
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| Advantages hydrocolloids | Enables autolytic debridement
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| Advantages hydrocolloids | Offers protection from microbial contamination
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| Advantages hydrocolloids | Provides moderate absorption
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| Advantages hydrocolloids | Does not require a secondary dressing
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| Advantages hydrocolloids | Provides a waterproof surface
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| Disadvantages hydrocolloids | May traumatize surrounding intact skin upon removal
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| Disadvantages hydrocolloids | May tend to roll in areas of excessive friction
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| Disadvantages hydrocolloids | Cannot be used on infected wounds
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| 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.
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| 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.
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| Advantages Hydrogels | Provides a moist environment for wound healing
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| Advantages Hydrogels | Enables autolytic debridement
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| Advantages Hydrogels | May reduce pressure and diminish pain
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| Advantages Hydrogels | Can be used as a coupling agent for ultrasound
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| Advantages Hydrogels | Minimally adheres to wound
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| Disadvantages Hydrogels | Potential for dressings to dehydrate
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| Disadvantages Hydrogels | Cannot be used on wounds with significant drainage
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| Disadvantages Hydrogels | Typically requires a secondary dressing
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| 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.
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| Foam Dressings | The dressings allow exudates to be absorbed into the foam through the hydrophilic layer.
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| 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.
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| 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.
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| Advantages Foam Dressings | Provides a moist environment for wound healing
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| Advantages Foam Dressings | Available in adhesive and non-adhesive forms
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| Advantages Foam Dressings | Provides prophylactic protection and cushioning
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| Advantages Foam Dressings | Encourages autolytic debridement
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| Advantages Foam Dressings | Provides moderate absorption
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| Disadvantages Foam Dressings | May tend to roll in areas of excessive friction
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| Disadvantages Foam Dressings | Adhesive form may traumatize periwound area upon removal
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| Disadvantages Foam Dressings | Lack of transparency makes inspection of wound difficult
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| 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.
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| 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.
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| Transparent Film Indications: | Film dressings are useful for superficial wounds (scalds, abrasions, lacerations) or partial-thickness wounds with minimal drainage.
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| Advantages Transparent Film | Provides a moist environment for wound healing
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| Advantages Transparent Film | Enables autolytic debridement
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| Advantages Transparent Film | Allows visualization of the wound
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| Advantages Transparent Film | Resistant to shearing and frictional forces
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| Advantages Transparent Film | Cost-effective over time
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| Disadvantages Transparent Film | Excessive accumulation of exudates can result in periwound maceration
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| Disadvantages Transparent Film | Adhesive may traumatize periwound area upon removal
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| Disadvantages Transparent Film | Cannot be used on infected wounds
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| Gauze dressings are manufactured | from yarn or thread and are the most readily available dressing used in an inpatient environment.
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| 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.
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| 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.
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| Advantages Gauze | Readily available, cost-effective dressings
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| Advantages Gauze | Can be used alone or in combination with other dressings or topical agents
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| Advantages Gauze | Can modify number of layers to accommodate for changing wound status
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| Advantages Gauze | Can be used on infected or uninfected wounds
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| Disadvantages Gauze | Has a tendency to adhere to wound bed
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| Disadvantages Gauze | Highly permeable and therefore requires frequent dressing changes (prolonged use decreases cost effectiveness)
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| Disadvantages Gauze | Increased infection rate compared to occlusive dressings
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| Alginate dressings consist of | calcium salt of alginic acid that is extracted from seaweed.
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| Alginates are | highly permeable and non-occlusive. As a result, they require a secondary dressing.
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| Alginate dressings . | are based on the interaction of calcium ions in the dressing and the sodium ions in the wound exudate
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| 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.
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| Advantages Alginates | High absorptive capacity
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| Advantages Alginates | Enables autolytic debridement
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| Advantages Alginates | Offers protection from microbial contamination
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| Advantages Alginates | Can be used on infected or uninfected wounds
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| Advantages Alginates | Non-adhering to wound
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| Disadvantages Alginates | May require frequent dressing changes based on level of exudate
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| Disadvantages Alginates | Requires a secondary dressing
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| Disadvantages Alginates | Cannot be used on wounds with an exposed tendon, joint capsule or bone
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