Wound Care

Tissue wound types [1]

Wound stages and treatments

Stage 1

 

Turn

Skin barrier cream:

- (kalmozine) zinc oxide cream

- A&D (soothe and cool moisture barrier) Vaseline white petroleum jelly

A+D+aloe

- Z-guard paste – combo of above with zinc oxide and petroleum

 

 – makes it more slippy

Also helps with moisture incontinence

 

Tegaderm (cheap)

 

Optifoam (cheap) – edges curl – more for stage 2 or when drainage

This may be better for heals

 

Stage 2, skin tear

 

Duoderm (cheap) (hydrocolloidal) dressing (apple pectin) – may stick to bedding

 

vs adaptic (medium$ but can be left on longer) – non-adhering dressing – mesh+petroleum

 

 

Foam dressing (if wet) to absorb +/- silver (expensive, 2-3 weeks max due to resistence)

 

Little drain? – hydrogel (medium$) – for super dry stage 2 wounds

Medi-honey for bigger stage 2t

 

Hydroguard $? (silicone cream) – creates a ‘film’ apply to EDGES of wound to prevent maceration at edges. Also for around ostomies

 

ALWAYS wound cleanser – has surfactant – kills microbes – better than saline

 

Dressing change frequency

 

Stage 2 couple times a week

 

Barrier cream whenever wet diaper

Stage 3

 

Hydrogel with silver

Honey

calcium alginate

 

Foam dressing with silver

 

Silver no more than 3 weeks, microbes become resistant

Silvasorb gel

Therahoney gel

 

Calcium alginate (medium$) dressing or gel absorbs exudate so bed can heal – need to irrigate gel out after use – get wound bed to move ‘up’

 

+

Gauze or kerlix to soak extra fluid

 

Heavy discharge/infected wounds – MeSalt (cheap) – helps break necrotic tissue (rope dressing like calcium alginate) absorbs A LOT

Rope for packing, leave some sticking out always. Use if expecting healing.

 

Iodoform (medium$) – ribbon of gauze with iodine – when poor prognosis

 

‘xeroform’ (medium$) is a brand that comes with Vaseline imbedded compound

 

‘nu-guaze’ (cheap) also similar to above without iodine (if no sign of infection)

 

PuraCol (expensive) + 100% collagen, diabetic ulcers, burns, vascular ulcers. Natural wound environment.

 

Heal from bottom up – pack.

 

Pack with soaked dressing – ‘wet to dry’

 

Slough wound bed (non-viable, non-granulating)

Dressing change frequency

 

Stage 3 depends frequency

Stage 4

 

Try MeSalt and loads of gauze – absorbs exudate and creates moist environment NaCl helps break dead tissue and antimicrobial

 

Anything else?

 

Not going to heal

Dressing change frequency

 

Stage 4 packing – daily

Foley for wound protection

 

Unstageable

 

Santyl (expensive and inefficient) – brand name – break down necrotic tissue but so will medihoney if left long enough – very expensive

DTI

 

Not much to do until open. Barrier cream to help prevent opening.

Misc

 

Debridement kit – scalpel, scissors

 

Big thick eschar – ‘score’ it with little cuts

 

Non-arterial leg wounds (venous) – coloflex compression bandage

First layer is like calmoseptine and then compression wrap – both come in package

 

Medfix – adhesive tape – hypoallergenic tape

 

Barrier cream whenever wet diaper

 

'Afrin for bleeding wounds.

If dry wet it, if wet dry it.

 

Flagyl for wounds that smell.

 

Anti-fungal (clear moisture barrier with antifungal) – alternative to flagyl

 

See medline wound care pocket guide

 

Decision Tree for Lower Extremity Wound Care

 

1. **Assess the Wound**

- **Type of Wound**: Determine if it's a laceration, ulcer, abrasion, burn, etc.

- **Wound Depth**: Superficial, partial-thickness, full-thickness.

- **Wound Size**: Measure the length, width, and depth.

- **Exudate Level**: None, low, moderate, high.

- **Infection Signs**: Redness, warmth, swelling, pus, foul odor.

 

2. **Clean the Wound**

- **Remove Debris**: Use saline solution or sterile water.

- **Disinfect**: Apply antiseptic solution if necessary.

 

3. **Evaluate for Debridement**

- **Necrotic Tissue**: If present, consider debridement (mechanical, enzymatic, or surgical).

 

4. **Choose Initial Dressing**

- **Low Exudate**:

- Use non-adherent dressing (e.g., Telfa) with a secondary dressing.

- **Moderate Exudate**:

- Use hydrocolloid or foam dressing to manage moisture.

- **High Exudate**:

- Use alginate, super absorbent, or foam dressing to absorb excess fluid.

 

5. **Assess for Infection**

- **Signs of Infection Present**:

- Apply an antimicrobial dressing (e.g., silver, glycerin, manuka honey, iodine) and consult a

healthcare provider.

- **No Infection**:

- Continue with the selected dressing and monitor regularly.

 

6. **Monitor and Reassess**

- **Daily or Weekly Checks**: Depending on wound severity and healing progress.

- **Adjust Dressing Type**: Based on changes in exudate levels, wound size, and signs of

infection.

 

7. **Consider Advanced Dressings (If No Improvement) **

- **Evaluate Healing Progress**: If no significant improvement after 2-4 weeks. (see LCD)

- **Consult Wound Care Specialist**: For potential use of amniotic membrane dressings.

 

8. **Implement Advanced Dressing**

- **Preparation**: Ensure the wound bed is clean and free of infection.

- **Application**: Follow specific instructions for amniotic membrane dressing use.

- **Monitor**: Continue regular assessment and adjust as needed.

 

This decision tree provides a structured approach to wound care, emphasizing initial assessment

and basic wound management before considering advanced treatments like amniotic membrane

dressings.

 

 

Dressing categories:

Wound care dressings can be categorized based on their properties and the type of wound they are

designed to treat. Here are the primary categories:

 

1. **Gauze Dressings**

- **Properties**: Absorbent, available in sterile and non-sterile forms, can be impregnated with

various substances.

- **Use**: Basic wound coverage, primary or secondary dressing, packing for deep wounds.

 

2. **Non-Adherent Dressings**

- **Properties**: Do not stick to the wound bed, minimizes trauma during dressing changes.

- **Use**: Superficial wounds, minor burns, abrasions, and donor sites.

 

3. **Hydrocolloid Dressings**

- **Properties**: Occlusive, forms a gel in contact with wound exudate, maintains a moist

environment.

- **Use**: Partial and full-thickness wounds, pressure ulcers, minor burns, and venous ulcers.

 

4. **Hydrogel Dressings**

- **Properties**: High water content, provides moisture, can cool and soothe wounds.

- **Use**: Dry or minimally exuding wounds, burns, necrotic wounds, painful wounds.

 

5. **Foam Dressings**

- **Properties**: Highly absorbent, provides cushioning and protection, semi-permeable.

- **Use**: Moderate to heavily exuding wounds, pressure ulcers, leg ulcers, surgical wounds.

 

6. **Alginate Dressings**

- **Properties**: Derived from seaweed, highly absorbent, forms a gel when in contact with

exudate.

- **Use**: Moderate to heavily exuding wounds, cavity wounds, venous ulcers.

 

7. **Film Dressings**

- **Properties**: Transparent, adhesive, waterproof, allows oxygen exchange.

- **Use**: Superficial wounds, minor burns, as a secondary dressing, protection of IV sites.

 

8. **Composite Dressings**

- **Properties**: Combination of different dressing types often includes a non-adherent layer,

absorbent layer, and adhesive border.

- **Use**: Various wound types, moderate to heavy exudate, surgical wounds.

 

9. **Antimicrobial Dressings**

- **Properties**: Contain agents like silver, iodine, or honey, designed to reduce bacterial load.

- **Use**: Infected wounds, wounds at high risk of infection.

 

10. **Hydrofiber Dressings**

- **Properties**: Highly absorbent, converts to gel upon absorbing exudate, maintains moist

environment.

- **Use**: Moderate to heavily exuding wounds, cavity wounds, leg ulcers.

 

11. **Collagen Dressings**

- **Properties**: Promote wound healing by providing a scaffold for new tissue growth.

- **Use**: Chronic wounds, pressure ulcers, surgical wounds.

 

12. **Amniotic Membrane Dressings**

- **Properties**: Derived from human amniotic membrane, contains growth factors and

extracellular matrix components.

- **Use**: Chronic wounds, burns, surgical wounds, diabetic foot ulcers.

References:

1. Healthcare improve Scotland.

https://archive.healthcareimprovementscotland.scot/www.healthcareimprovementscotland.org/our_work/patient_safety/tissue_viability

 

Also see:

 

Scottish Wound Assessment and Action Guide:

https://drive.google.com/file/d/1-hC-93IYQp3jM4sE6JvTY6sJFYIv-SOH/view

 

Grey J. Wound Assessment:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1360405/

 

XWrap

https://www.appliedbiologics.com/product-showcase/xwrap-ecm/

 

Website for free wound care education and tools:

www.nmwoundcare.com