Wound Care Presentation 6r5zq

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@ ‡ 1960¶s Moist wound healing ‡ 1990¶s Advanced technological products ‡ 1999¶s Wound Bed Preparation »Tissue engineered products

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| ‡ Coagulation: 0-2 hours ‡ Inflammation: 0-3 days ‡ Cell migration and proliferation: 3-21 days ‡ Angiogenesis ‡ Remodeling: 21 days -1.5 years

Age

Body Build Stress Nutrition

Medications

Tissue Oxygenation Immunity Concomitant Disease

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Traditional Treatment Modalities ± Hydrogels: Normlgel, Hypergel, Clearsite, etc ± Hydrocolloids: Duoderm, Comfeel, Restore, Tegasorb, Replicare ± Transparent films: Opsite, Tegaderm, bioclusive, epiview ± Wet to dry dressing ± Foam dressings: Allevyn, Biatain, Hydrasorb, etc. ± Calcium alginates: Sorbsan, AlgiSite, Curasorb, Kaltostat ± Enzymatic: Santyl, Panafil, Accuzyme, Gladase, ± Biological: Maggot therapy ± Antibacterial: Acticoat, Iodosorb, Prisma

Normlgel, Hypergel, Clearsite, Curasol gel, Solosite, Intrasite, Hydrogel, Nu-Gel, Skintegrity, Clearsite, etc

‡ Hydrophillic / glycerin based gels ‡ High water content, viscosity varies by manufacturer ‡ Limited absorptive capacity ‡ Autolytic debridement of necrotic / slough tissues ‡ Partial or full thickness wounds ‡ Hydrogels help maintain a moist wound healing environment for granulation, epithelialization, and facilitation of autolytic debridement.

Flexderm, Vigilon, Flexigel, Curasol Gel, Restore, CarraGauze, etc

‡ Higher rate of absorption ‡ Cooling, soothing effect on superficial wounds



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Duoderm, Comfeel, Restore, Tegasorb, Replicare, NuDerm, Dermatell, Curaderm, Hydrocol

‡ Components of gelatin, pectin or cellulose ‡ More occlusive compare to other dressings ‡ Waterproof ‡ Partial thickness wounds with low - moderate exudate ‡ Contraindicated for clinical infected wounds ‡ Conformable ‡ Adhesive, may damage fragile periwound skin





‡ Advanced wound care device comprised of a sterile freeze dried composite of 45% oxidized regenerated cellulose (ORC) and 55% collagen. ± Maintains moist microenvironment at the wound surface ± Enhances granulation tissue formation, epithelization and rapid wound healing.

‡ PRISMA: Anti-Bacterial property

á Opsite, Tegaderm, Bioclusive, Epiview

á ‡ Polyurethane or co-polyester composition ‡ Waterproof and gas permeable ‡ Superficial wounds with no / minimal exudate ‡ Promote autolysis of necrotic / slough tissue ‡ Permit evaluation of wound progress ‡ Can tear healthy skin if improperly removed ‡ Occlusion may reduce pain

á Autolytic Debridement

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Sorbsan, AlgiSite, Curasorb, Kaltostat, Gentell, Restore, SeaSorb, Maxorb, Curasorb, AlgiDerm

‡ Non-woven fibers V V V ‡ Useful for filling moderate exudate wounds ‡ Interact with fluid to form a gel-like ‡ Safe to use with clinical infected wounds ‡ Will not debride hard eschar



Hydrofiber Dressing

á ‡ Nanocrystalline Silver ‡ Slow release cadexomer iodine

i ‡ Centuries of proven › imicrobi›l›civi ‡ Cytotoxicity concerns associated with carriers not silver - ex. Silver nitrate, Silver sulfadiazine15 ‡ Traditional delivery required repeated applications due to binding with chlorine and proteins ‡ Contemporary silver dressings allow for continued release up to 7 days ‡ Broad spectrum - inactivates almost all know bacteria including MRSA and VRE15 ‡ No documented cases of bacterial resistance15 ‡ Ex: Silver Cel, Acticaot G

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‡ Commonly used in variety of wounds ‡ Effective against broad range of resistant organisms ‡ Painless upon application ‡ Difficult to remove ‡ May form pseudoeschar

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Used in 1943 in treatment of burns Wide spectrum of activity No known bacterial resistance Staining of skin Frequent dressing changes Not effective with eschar

| Enzymatic Panafil, Accuzyme, Gladase, Kovia ointment, Ziox ointment, Ethezyme

i ‡ decreased size of silver particles leads to increased proportion of surface atoms compared with internal atoms1 Magnification of Normal Silver

‡ it is believed that the nanocrystalline structure is responsible for the rapid and long lasting action1 ‡ Broad spectrum - inactivates almost all know bacteria including MRSA and VRE Magnification of Nanocrystalline Silver (<1 micron) @

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| ‡ Growth Factor/Cytokine Preparations: ± Regranex ± Procurren Solutions ‡ Dermal Equivalent Skin Substitutes ± Alloderm: Decellularized cadaver dermis ± Biobrane: acellular, porcine collagen chemically bound to nylon mesh ± Dermagraft: Human fibroblasts on matrix mesh ± Integra: biovine collagen and chondroitin-6-sulfate ± Oasis ± Graft-Jacket, Mediskin, EZ derm, Primatrix ‡ Bilayered Skin Substitutes ± Apligraf: Human fibroblasts and keratoinocytes in a bovine collagen matrix.

á ! ‡ Tissue engineered xenografts ± Oasis, MediSkin, EZ Derm ‡ Tissue engineered allografts ± Apligraf, Dermagraft, GammaGraft, Alloderm ‡ Tissue engineered acellular dermal replacements: ± GraftJacket, GammaGraft, Integra, Primatrix

0 — : Freeze dried porcine xenograft, stored at room temperature, long shelf life.

0 2 : Porcine xenografts, long shelf live, stored at room temperature

0 R: frozen epidermal/dermal porcine modified xenograft; must be kept frozen at less than 32 degrees Fahrenheit, thawed at room temperature 1-2 hours prior to application.

— ‡ Small Intestine Submucosa ± Derived from porcine small intestine ± Complex matrix of collagen, growth factors and other proteins

0 ` : Bi-layered laminate of epidermis and dermis and grown from neonatal foreskin; shelf life up to 10 days when stored in its own shipping container.

0 : human fibroblast derived dermal skin substitutes

0 ˜ : Contains dermal elements and no epidermis, allow rapid revascularization and cell re-popularization, can use on tendons, capsule, exposed bone

‡ Bilayered living skin substitute ± Epidermal layer of human keratinocytes ± Dermal layer of human fibroblasts ± Bovine type I collagen lattice

‡ Mechanism of Action ± Provide a collagen scaffolding ± Provide cellular structures ± Release growth factors from cell

" ‡ Dermagraft, when implanted into an adequately prepared diabetic foot ulcer, assists in the restoration of the dermal bed allowing the patient¶s wound to reepithelialize. ‡ Derived from foreskin

! # " DERMAGRAFT is indicated for use in the treatment in fullthickness diabetic foot ulcers greater than six weeks duration which extend through the dermis, but without tendon, muscle, t capsule, or bone exposure. DERMAGRAFT should be used in conjunction with standard wound care regimens and in patients that have adequate blood supply to the involved foot.

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0 `: Freeze dried de-cellularized human product. Defined as human allogeneic skin; acellular tissue; allograft.

0 ˜ ˜ : Irradiated human skin allograft from human cadaveric donors. Stored in a foil pouch at room temperature for up to 2 years.

0 ! : Bilayer Matrix (Integra Bilayer Matrix Wound Dressing²Intergra BMWD and Single layer Wound Dressing)

0 a : acellular dermal matrix from fetal bovine skin, stored at room temperature up to 2 years.

| ‡ Fibrin Glue: Combination of fibrinogen, calcium and thrombin ‡ Fibrin Gel: Combination of calcium and thrombin and autologous plasma. ‡ Platelet Gel: Autologous blood is collected and centrifuged to isolate platelet rich plasma and then combined with thrombin.

@%&' ‡ PDGF-BB: Recombinant Human PlateletDerived Growth Factor 1997 ‡ Stimulates mesenchymal cells

# á á ( #á ‡ Increases mast cell degranulation ± ± ± ± ± ± ±

Vascular permeability Realease of mitogenic growth factors Migration of macrophages and fibroblasts Capillary density Calcium up take in fibroblasts Collagen synthesis Tensile strength and elasticity of collagen

‡ 40 KHz ‡ Effective in reducing bacterial load, stimulate debridement, induce granulation buds.

%)| ‡ Superoxidized Water (Dermacyn; Oculus Innovative Sciences, Petaluma, Calif) ± Flush wounds under 8 pounds per square inch of pressure (twice weekly) AND/OR ± Sock wounds with superoxidized water for 30 minutes AND/OR ± Use as wet dressing to the wound daily

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48 hour dressing changes Aggressive reduction in interstitial fluids Can be used for any size of wound Can be used on infected wound (12 hour change) ‡ Can treat more than one wound at a time.

*&+! + ,! ,á * -(' ‡ Contraindications: ± Fistulas to organs or body cavities ??? ± Necrotic tissue with eschar present: Need debridement ± Untreated Osteomyelitis ± Malignancy in the wound ± Application of dressing over exposed arteries or veins.