Wound Care
The wound is the deterioration of the normal structure and function of the tissue. Wound healing is a highly controlled sequence of cellular, humoral and molecular events that begin with trauma, resulting in time-dependent and predictable new tissue formation. This new tissue does not necessarily be the subject of injury. For example; traumas leading to major skin loss can heal with granulation tissue. Any deviation from this wound healing process results in chronic wound formation that does not heal.
Wounds can be divided into traumatic (surgical) and chronic. Traumatic wounds include surgical incisions, lacerations, abrasions, wounds left open for secondary healing, necrotizing fasciitis and burns.
Laseration is the rupture of the skin and underlying tissues after blunt trauma. If such wounds are clean, the edges of the wound may be approached primarily. Abrasions, on the other hand, are the abrasion of the epidermis as a result of rubbing on a hard surface and they need dressing just like the wounds left for secondary healing.
Chronic wounds include pressure sores, arterial and venous ulcers, diabetic foot, ulcers due to vasculitis, and malignant skin wounds. Determining the etiology and initiating appropriate treatment is critical in the management of chronic wounds. For example; One of the treatments for a venous ulcer is elastic bandages or intermittent compression, whereas this approach is contraindicated in arterial ulcers with poor circulation. Therefore, it is necessary to know the basic physical properties of chronic wounds.
Pressure sores are round or oval shaped, usually full-thickness wounds on bone protrusions with little tunneling. Although it is most commonly seen in the sacral region, all bone contacting the bed may be over the protrusions. Frequent change of position and pressure reducing surfaces should be used to prevent these injuries.
Venous ulcers are ulcers in the lower extremities adjacent to the malleolus due to venous return failure. These ulcers are dark colored and exudate abundantly. In addition to local wound care, compression or elevation is helpful in the treatment. Arterial ulcers are usually accompanied by peripheral cyanosis and weak pulses. The wound bed is necrotic. These wounds often benefit from additional treatments such as smoking cessation, heating hydration.
The second important point in the care of patients with wounds is to provide appropriate systemic support to patients. Nutritional support is critical in this regard. Patients should receive 30-35 kcal / kg / day energy, 1.2-1.5 g / kg / day protein and daily vitamin supplements.
In the topical treatment of wounds, the priority is to evaluate the wound in terms of tissue viability, infection, moisture balance and wound environment. One of the neglected points in wound care is the pain of the patients. Pain is inevitable as nerve endings will be exposed in open wounds. For this reason, it is appropriate to give analgesics to the patients half an hour before the dressings, to interrupt the dressing when the patient has pain and to avoid unnecessary stimuli. In addition, cleaning the wound with soap will cause pain.
Debridement is the removal of dead tissue from the wound. The dead tissue in the wound contains a high amount of bacteria, thus delaying wound healing. In addition, platelets released during debridement may initiate a new healing cascade. Most debridement methods should be chosen for the patient.
It is very important to recognize the infection in the early period and to start appropriate treatment. Infection symptoms in chronic wounds are not healing, granulation tissue is bright red and easy to bleed, increase in exudate amount, bad smell, new necrosis areas in the wound and cellulite around the wound.
The presence of reproduction in the swabs taken from the wound surface is insignificant in showing the presence of infection. The gold standard for demonstrating the presence of infection in the wound is tissue culture.
Excessive exudate delays wound healing. The concentration of matrix metalloproteinase in the exudate leading to collagen degradation in the wound is high, and the exudate also inhibits growth factors in the wound. However, the dryness of the wound also inhibits epithelialization. Therefore, in dressing changes, products that will absorb the exudate in the wound but do not leave the wound dry should be selected.
Since epithelization of the wound will begin at the wound edges, healthy wound edges are an indispensable part of wound healing. If the wound edges are unhealthy, it should be debrided and if there is maceration, it is necessary to choose care products to reduce it.
Gauze is the cheapest method to close the wounds left for secondary healing. In terms of wound healing, gauze is no different from new wound care products. However, gauze dressing requires more nursing time and causes more pain compared to new wound care products.
The presence of a large number of wound care products on the market leads to instability in healthcare personnel. It should be noted that there is no single product that is suitable for all wounds. It is important to choose the best product for each wound. Turkish sources Wound most detailed classification of products Wound Care and Tissue Repair Society (www.yaradernegi.org) wound care products is available on the website coding system Turkey. This site features the properties of most of the wound care products available on the market.
The hydrocolloid wound care products are produced from gelatin, pectin or carboxymethylcellulose. There are sticky cover, powder or paste forms. They absorb the exudate and turn into gel. Their absorbency varies from product to product. One's experience is important when choosing one of the hydrocolloid products.
The hydrofiber covers are non-woven fibers in the NaCMC structure and have high absorption capacity, as well as the risk of maceration on the wound edges as it traps the liquid. The foams are hydrophilic polyurethane and expand as the liquid absorbs the wound's three-dimensional shape and is easily separated from the wound during dressing change. Alginates, on the other hand, may cause maceration of the wound edges, although they have high absorbency.
The most important criterion in the selection of dressing material is whether the wound heals. For healing wounds it would be appropriate to continue with the same wound care product. Wounds that do not show any signs of healing within two weeks should be evaluated in terms of etiology, bacterial load, pressure, friction, circulation, maceration in terms of nutrition and comorbidity.
Objective methods should be used in the monitoring of wounds. The easiest of these is to take a digital photo of the wound. The size of the wound should also be noted. It is recommended that the wounds be evaluated in terms of the presence of infection and healing once a week.
Nevertheless, the easiest way to treat wounds is to prevent the formation of wounds.
26AXX
Band-Aid Adhesive Bandages, Flexible Fabric, All One Size 1"" X 3"" , 100 Count (Pack of 2)
