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Chronic wound treatment vs. moist environment

Effective chronic wound treatment
 Features of a perfect dressing
 How to choose the dressing to the wound?


„(…) they affect up to half a million people in our country. If we add to this the number of family members caring for the people, that number will increase up to 1.5 million people directly related to the subject of chronic wound treatment (…)”

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The term „wounds” often evokes the notion of cut and stab wounds, which is a result of all sorts of crime fiction, novels and thrillers. These wounds of course require professional treatment and dressings but heal more quickly. It is much more difficult to treat so-called chronic wounds, which occur in up to half a million people in our country. If we add to this the number of family members caring for the people, that number will increase up to 1.5 million people directly related to the subject of chronic wound treatment, and thus – the principles of selection and dressing change.

Treatment of chronic wounds, or such as diabetic foot and pressure ulcers, and even burns, often lasts for months. It is very inconvenient for family members, as well as difficult for the person affected by this problem. This article is to encourage to become familiar with modern methods of chronic wound treatment in a moist environment, in accordance with principles developed by researchers. Let this article serve as an introduction to the topic and let it be some kind of hint, how in a modern way effectively and quickly treat chronic wounds.

Speaking of the modern chronic wound treatment, we do not recognise traditional dressings as bad. Traditional gauze dressings, bandages and plasters are good! No one questions their effectiveness, because they are perfect for the treatment of acute wounds (i.e. those resulting from mechanical reasons e.g. cuts, stab wounds, gunshot wounds and abrasions). In those cases sterile gauze dressings and plasters are most appropriate to be used.

EFFECTIVE CHRONIC WOUND TREATMENT

In case of chronic wounds (such as bedsores, burns, diabetic foot) as already as 40 years ago specialists discovered and clearly stated which conditions favour their rapid healing. This is the complete opposite to what traditional dressings provide. It turns out that a chronic wound will heal better if the following conditions are met:

  • moist wound healing environment – promotes natural wound cleansing processes, regeneration of damaged tissues and reduces pain. This allows the wound to heal on average 50% faster;
  • reduced pH value – lowering the pH value, the acidity of the wound environment increases, inhibiting bacterial growth;
  • tightly closed wound (occlusion) – protects the wound from being infected by bacteria present in the patient’s environment. The use of special dressings of polyurethane foams also protects the wound against mechanical damage;
  • stable temperature – stable temperature of about 37°C accelerates cell division, and thus regeneration of damaged tissues.

leczenie_ran_przewl_w_srod_wilgot_8FEATURES OF A PERFECT DRESSING

Continuing research conducted by Georg Winter since 1962, William Tuner collected and summarised their results and presented them in 1979, defining the qualities of a perfect dressing. According to W. Turner a dressing, which, according to the modern (wet) wound healing model, will facilitate the healing process should:

  • maintain optimum moisture in the wound,
  • remove excess exudate and toxic components,
  • isolate the wound thermally,
  • allow gas exchange between the wound and the environment,
  • be impermeable to bacteria and other microorganisms,
  • be free from toxic particles and substances,
  • provide protection for the newly formed tissues,
  • be easily removed from the wound surface, without causing injury.

Dressings meeting the above criteria form a moist environment that favours important processes which take place in the wound, so that the healing process is about 50% faster with reduced sensation of pain and reduced risk of infection.

Why, despite the presence of a whole range of advanced dressings, the choice of the right one is so difficult?

Good identification of processes appearing during the wound healing process resulted in creating many specialised dressings with a number of very different characteristic features. Paradoxically, a large variety of dressings raises dilemmas about accurate selection in a specific situation. Remember that the decision to use a given dressing determines its effectiveness or lack thereof.

HOW TO CHOOSE THE DRESSING TO THE WOUND?

It seems that the choice of dressing must meet two basic criteria – we must remember that according to the modern wound healing approach there is no universal dressing that would meet requirements of every wound, and that choice must be aware, based on the correct diagnosis of the processes taking place in the wound and suitable for that characteristic features of the dressing.

To facilitate the correct dressing choice, you can use the wound classification based on the phenomena that take place in different phases of wound healing and based on that wound colour assessment.

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Photo 1. Application helping to adjust the dressing to a wound available on the website www.na-rany.pl

The scale consists of four colours respectively assigned to the specific stages of the wound healing process.

Selection of the dressing to the given wound while using the wound colour classification system becomes easier, because the wounds of the same type (colour) set similar challenges, and therefore require a similar procedure.

„BLACK” WOUND – NECROTIC TISSUE

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OBJECTIVE OF THE TREATMENT:

  • removal of necrotic tissue

WOUND CHARACTERISTICS:

  • in form of dehydrated dead tissue
  • necrotic tissue covers the entire wound or is present locally in form of patches
  • exudate level – low (up to the point where necrosis turn into liquid discharge and separates from healthy tissue)
  • necrotic tissue inhibits the healing process – it is the source of infection for healthy tissues, constitutes a barrier to the building new tissue

PROCEDURE:

  • it is necessary to remove necrotic scab by a surgeon or in the autolysis process by the maintenance of a moist environment

RECOMMENDED DRESSINGS:

„YELLOW” WOUND – NECROLYSIS

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OBJECTIVE OF THE TREATMENT:

  • removal of necrotic tissue and preparing the wound bed for granulation

WOUND CHARACTERISTICS:

  • cream colour of the wound – yellow, fibrous
  • exudate level: high, medium, rarely low

PROCEDURE:

  • maintain a moist wound environment
  • control the level of exudate

RECOMMENDED DRESSINGS:

  • Medisorb SILVER and SILVER PAD – infected wounds with high level of exudate
  • Medisorb A – deep wounds with high or medium level of exudate
  • Medisorb P – shallower wounds with medium level of exudate
  • Medisorb P PLUS – shallower wounds with quite high level of exudate
  • Medisorb H – moderate and low exuding wounds
  • Medisorb G – infected wounds with low level of exudate (promotes wound cleansing by binding pre-hydrated dead tissue with microorganisms that colonise it)

„RED” WOUND – GRANULATING TISSUE

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OBJECTIVE OF THE TREATMENT:

  • maintain a moist wound environment conducive to granulation
  • control the level of exudate

WOUND CHARACTERISTICS:

  • wound in a bright red colour, moist
  • uneven wound surface
  • the tissue is delicate, sensitive to pain, susceptible to infection

RECOMMENDED DRESSINGS:

  • Medisorb A, Medisorb P or Medisorb P PLUS – heavy and moderate exuding wounds
  • Medisorb H – moderate and low exuding wounds
  • Medisorb G – infected wounds with low level of exudate (promotes wound cleansing by binding pre-hydrated dead tissue with microorganisms that colonise it)
  • Medisorb A – in case of infected wounds with high level of exudate

„PINK” WOUND – EPITHELISING TISSUE

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OBJECTIVE OF THE TREATMENT:

  • protection of new tissue
  • stimulation of skin formation

WOUND CHARACTERISTICS:

  • pink or white tissue appears on the wound surface
  • epithelial cells migrate from the wound edges to the centre

PROCEDURE:

  • encourage or support the process of skin formation
  • maintain a moist wound environment
  • protect against mechanical damage

RECOMMENDED DRESSINGS:

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Photo 2. Table of dressing adjustment