Wound Care: Wound Management

Debridement

• Definition: Removal of Damaged Tissue or Foreign Objects from a Wound
• Devitalized Tissue, Contamination or Foreign Objects Inhibit Wound Healing
  • Stimulates Metalloproteases & Consumes Local Resources Necessary for Healing
• Approaches:
  • Surgical – Sharp Excision
    • Preferred for Large Areas or Evidence of Infection
  • Irrigation – Generally Use Warm Isotonic Saline in Pulsed-Fashion with Low-Pressure
    • Added Dilute Antiseptics (Iodine, Chlorhexidine, etc) are Unnecessary – Minimal Antibacterial Action & May Inhibit Wound Healing
  • Enzymatic – Application of Exogenous Enzymatic Agents (Collagenase, Papain, etc)
    • Use is Controversial
  • Biologic – Maggots Applied to the Wound Bed
    • Secrete Proteolytic Enzymes to Liquify Necrotic Tissue & Ingest, Leaving Healthy Tissue Alone
    • Can Bridge Between Surgical Debridements or Use When Surgery Not an Option
    • Primary Disadvantage is the Negative Perception

Wound Packing

• Using Saline-Soaked Gauze to Pack Dead Space
• Adheres to Surrounding Structures as it Dries – Debrides Necrotic Tissue
  • Also Removes Granulation Tissue
• Should Be Changed 1-3 Times Daily (Before it Becomes Completely Dried)
• Should Stop Once All Necrotic Tissue is Removed & Granulation Begins

Topical Antiseptics

• Can Be Used to Decrease Bacterial Load
• Consider for Select Patient Populations
• Types:
  • Iodine-Based (Povidone Iodine, Cadexomer Iodine/Iodosorb)
  • Silver-Based (Foam, Silvercel, Silver Sulfadiazine)
  • Honey (Medihoney/Therahoney)
    • High Osmolarity – High Sugar & Low Moisture Content
    • Acidic with Gluconic Acid
    • High Concentration of Hydrogen Peroxide
  • Acetic Acid
  • Sodium Hypochlorite 0.5% (Dakin’s Solution)
    • Should Be Diluted to 0.025% (1:20) – Unnecessarily Cytotoxic at Higher Doses
    • Generally Used Only for Necrotizing Soft Tissue Infections
    • Bleach is Sodium Hypochlorite 3-6%

Antibiotic Therapy

• Indicated for Signs of Local or Systemic Infection
• Prophylactic Antibiotics Not Indicated – Wound Colonization is Normal but Not Necessarily Infected