Latest Wound Treatments
Wound is the disruption of the integrity of the skin for various reasons and the inability to maintain the structure and functional function of the living tissue. The history of wound care began with the history of humanity. Purpose of wound care; to provide tissue repair in the shortest time possible, to correct the impaired skin structure or functional condition, to prevent infection, ie to catch microbes, to reduce discharge and edema, to reduce pain and to achieve the best aesthetic result. In recent years, studies on the wound mechanism have been intensified and many different options are offered for wound care.
In the past, linen, gauze and cotton products used in wound care were aimed at absorbing the wound discharge, keeping the wound dry and thus preventing the growth of bacteria. It was recorded in the papyrus which was determined to belong to 1500 BC leştir If the wound is disturbing, calm down, soften if hard, cool if hot, extinguish if swollen, relieve if painful 'summarizes the approach in wound care.
It is now known that heat and moisture are directly proportional to wound healing, and when there is sufficient heat, moisture and oxygen, the restructuring of cells in tissues is accelerated. The concept of Wound Bed Preperation (WBP) stands out on the basis of current approaches in wound care.
The preparation of the wound bed is the preparation of the most favorable conditions for the already self-healing wound.
It was previously known that the healing of the wound bed would accelerate the healing and the bad side effects would decrease. Nowadays, by eliminating the factors preventing the wound healing, leaving the wound to heal according to its natural process is the basis of current approaches.
In the preparation of the wound bed;
Control of wound causing diseases
Removal of dead tissue from wound
Reduction of germ load
Wound management
Correction of cellular functions are included in the steps.
In wound care, the first step is to evaluate the cause of the wound and the patient's history and to eliminate the causative agent.
The preparation of the wound bed will then bring with it a well-blooded, ready-to-heal wound.
There are many approaches to this:
ADVANCED AND BEST WOUND DRESSINGS
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Modern dressings have more functions than covering the wound. They are products used to cover wounds to protect the wound against infection, to absorb blood and wound fluid, to provide wound healing and to apply medication on the wound.
Nowadays, the most important innovation in dressings is the development of "moist healing" materials that can protect the wound from moisture. In the 1980s and 1990s, many moist-healing products such as hydrocolloid, alginate, polyurethane foams and hydrogel were developed.
These improved dressings are more painless and comfortable, provide faster healing compared to old dressings, and require less frequent dressing changes, as well as cheaper costs and prevent germ contamination to the wound.
Ideal wound dressings should include;
1. Should form an obstacle against microbes,
2. Should not cause trauma to the tissues around the wound,
3. Must have heat insulation,
4. Gas permeability should be ideal,
5. Provide optimal moisture instead of wound,
6. Dispose of excess fluid and harmful tissue,
7. Compatible with body tissue,
8. Fully fill the gaps existing in the wound,
9. Reduce pain,
10. Should be aesthetic and ergonomic,
11. Should not remove the wound tissue during removal,
12. Should be economic,
13. No odor formation.
Modern dressings can be classified under five main groups. These products are usually applied on a variety of wounds, either alone or in combination, in different healing processes. These dressings:
1. Alginate covers
2. Polyurethane transparent films
3. Hydrogels covers
4. Hydrocolloid covers
5. Foams.
ALGINATE WOUND DRESSINGS
Calcium Alginate fibers are commonly used, absorbent and have unique ion exchange properties. When applied to the wound, calcium ions in the fiber are replaced with sodium ions in the body, and some of the fibers are converted to alginate. They can absorb the discharge from the wound by 20-30 times their own weight.
The fibers swell and gel is formed on the wound surface. This formed hydrophilic alginate gel provides a moist wound environment for wound healing. However, if they are not immediately removed when saturated, they can cause moisture damage in healthy tissues.
The microbicide effects are low and the bacteria can be passively trapped in the gel and removed by cover change. Alginates also have pain-reducing and anti-bleeding effects. Alginate varieties with different properties obtained from different seaweeds are used today. In addition, many salts of alginate, such as zinc-containing and silver-containing alginates, can also be used in humans suffering from zinc deficiency and to provide germicidal properties, respectively.
Also; zinc can also be added to the alginate dressings in order to improve the bleeding property. As the connective tissue develops in the wound in alginate dressings, the amount of fluid absorbed decreases. When the gel reaches saturation, leakage occurs. There are varieties of alginates that can be used dry or wet and also developed for wounds with cavities. Alginate covers; and full-thickness wounds, hollow wounds, moderate and severe leakage wounds, infectious wounds, some are suitable for low-bleeding wounds. In dry wounds, it requires a second cushioned cover to prevent drying.
POLYURETHANE TRANSPARENT WOUND DRESSINGS
Acrylic on one side and polyurethane on the other, these transparent synthetic dressings are semi-permeable. In this way, it prevents the airborne microbes from reaching the wound while providing oxygen to the wound from the air.
These dressings are mostly used in dry wounds and can create a moist wound environment. As they are transparent, it provides the opportunity to observe the wound area. Modern semi-permeable dressings are generally made from various mixtures of polyurethane. These films can supply moisture vapor to the wound at a rate of 3000 g / m2 / 24 hours or more. It can be used in postoperative wounds, burn wounds, pressure wounds, areas where skin is taken for surgery, and intravenous catheter applications. In addition, these dressings help to remove wounds that contain dead tissue.
It is light and flexible, good compatibility with the wound surface, prevents skin damage against friction and does not adversely affect the comfort of the patient. These covers; hydrogel, hydrocolloids and alginates.
The disadvantages of these covers are; they need to be replaced frequently and there is a need for a solid skin around the wound to be applied.
WOUND DRUGS WITH HYDROGEL
Hydrogels consist of polymers containing 90-95% water. It absorbs the discharge of the wound which is found in high degree. Does not stick to the surface of the wound. They reduce the fever of the wound and have a cooling effect.
As their ability to resist microbes is poor, they require a second cover for protection.
Although hydrogels used today have many of the ideal dressing properties, they can cause weakening of sensitive skin. When applied to the dry wound surface, the hydrogel covers moisten the wound to form a moist wound environment for wound healing. These covers can absorb some amount of wound fluid. It is water and vapor permeable and can be easily separated from the wound because the moist interface between the dressing and the wound prevents the dressing from sticking to the wound. In addition, the wound can be treated with hydrogel dressings.
HYDROCOLLOID WOUND DRESSINGS
The hydrocolloid dressings consist of dissolved hydrophilic polymer particles. When in contact with the wound discharge, the hydrophilic particles absorb the excess liquid and turn into gel and remain on the wound for 7 days. These covers tend to adhere to both wet and dry tissues.
They also increase the rate of skin lining of the wound and connective tissue production. They do not require a second dressing as they adhere directly to the wound. It also has features such as reducing pain and keeping germs out of the wound. It is used in partial and complete wounds, mild and moderate discharge wounds and is not preferred in case of infection. They are sticky and can damage sensitive skin during removal.
FOAMS
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The foams are polymeric and silicone based dressings that are both flexible and have high absorption capacity. They are used in combination with sponges. In deep wounds, they fill the gaps and expand over time to fully adapt to the wound. By applying a gentle pressure to the wound, they reduce the edema by increasing wound closure and oxygenation. When placed on the wet wound surface, the wound fluid is sucked into the foam and sent to the other side of the dressing.
When placed on a relatively dry wound surface, moisture reduces vapor loss and prevents drying of the wound surface. These coverings allow air to pass and do not seal the liquid. It can be easily removed from the wound, but its ability to prevent the germ is limited. They are used in wounds with dead tissue and moderately leaking wounds. It is not suitable for dry and crusted wounds. Reinforcing the cover
extra product is needed for.
It is used in some foams to infect microbial, inflammatory wounds by impregnating silver or placing it in a sheet to improve germ killing performance.
GROWTH ENZYMES AND GROWTH FACTORS
It is known that growth factors are involved in all stages of wound healing. Especially
growth factors in the process of impaired wound healing are drugs used to restore the wound to its normal course.
At the beginning of the injury, the cells in our blood secrete TGF-β (Transforming Growth Factor) enzyme, which provides blood clotting in the blood. This substance helps in the development of new veins in the wound and draws repair cells into the wound. Platelets also secrete PDGF (Platelet Derived Growth Factor).
PDGF; growth factor. PDGF increases the formation of connective tissue in the wound. Becaplermin is the first growth factor that has been approved for the use of PDGF in wound treatment in humans.
Other cells in the blood secrete factors such as TNF-α (Tumor Necrosis Factor) and FGF (Fibroblast Growth Factor) and play an important role in vascular increase.
Epidermal growth factor (EGF) is the growth enzyme responsible for covering the outer surface of the wound.
FGF (Fibroblast Grovth Factor) and KGF (Keratinocyte Growth Factor) also stimulate skin development.
They are used in the treatment of chronic wounds along with growth factors to stimulate wound healing.
Angiopoietins allow the continuation or remodeling of vessels with. Blood flow in wound
is an important step. Because despite all the wound treatments, the weakening of the vascular development in the wound is a problem that can turn the wound into a chronic wound.
PRP (platelet-rich plasma, Platelet-rich plasma) has been used in wounds for more than 20 years and is one of the cheapest and fast techniques for reintroduction of wound factors.
Because PRP contains growth factors. Response to normal wound healing
similarly, it produces platelet stimulation.
OXIPLASMA and OXIPRP is a system that is used recently and gives all growth factors in need of wound with oxygen. OKSİPLASMA and OKSİPRP are registered products and Dr. It belongs to Ahmet .
BIOMECHANICAL WOUND CARE (ACTIVE CLOSING PRODUCTS)
In recent years, the use of Biosurgical Mechanical Wound Care has come to the fore in wound treatment and care. The disadvantages of these tools are that they are expensive and their use requires expertise. However, it is an advantage that it is suitable for re-use. The most important applications in this field are;
-VAC (Vacum Assisted Closure) Treatment,
- Larval Treatment (Biyosurgery, Maggot Debridement System),
- Electrical Stimulation,
- Laser Beams,
- Ultrasound Therapy,
- Hyperbaric Oxygen Therapy,
- Topical Oxygen Therapy,
- Topical Ozone Therapy.
VAC (VACUM ASSISTED CLOSURE) TREATMENT
The application of negative pressure in wound treatment was first described in the 1940s.
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The VAC application consists of sponges of polyurethane and polyvinyl for filling the wound, semi-permeable wound dressings to cover the wound, a device for regulating and connecting the wound with the device, a collecting vessel and a device for providing negative pressure. The pump system on the wound absorbs the wound discharge by applying a negative pressure in the range of -75 to -125 mmHg intermittently or constant, and heals the wound bed.
The application of VAC increases blood flow and skin development in the wound area, decreases microbes by controlling excessive discharge and inflammation and accelerates wound healing.
The most important disadvantage of VAC is that the patient is hospitalized or requires home monitoring.
It is also not recommended for use in patients at high risk of bleeding and in patients receiving blood thinners.
LARVA DEBRIDMAN THERAPY- LDT (MAGGOT DEBRIDMAN THERAPY, WOLF TREATMENT)
It is a form of treatment that can be used only during the "debridement" process of wound treatment. Calliphoridae family of the genus of Lucilia fly larvae attack only dead tissues and necrotic and microbial tissues by cleaning the wound by cleaning the wound is called Larval Debridement Treatment (LDT) or WOLF TREATMENT. The larvae dissolve the dead tissue on the wound with the enzymes and antimicrobial agents they produce, as well as disinfect the wound and stimulate the tissue to heal.
In recent years, LDT has been used successfully in the treatment of pressure sores, venous stasis sores, temporal mastoiditis, Fournier's gangrene, necrotizing tumor masses and other soft tissue wounds. It has been reported to be particularly successful in the treatment of infected wounds and diabetic wounds and to reduce amputations, especially in those with resistance to antibiotics.
The disadvantage of this treatment is the tickling and disturbing sensation caused by the movements of the larvae. Sometimes pain can be experienced during the treatment of superficial wounds.
It is possible to apply it in small packs ready to pack.
WOUND THERAPY WITH ELECTRIC WARNING
Electrical warning; It can be used for chronic wounds in the treatment of pain and edema with electromagnetic vibration technology that does not disturb the patient and does not cause pain. Splints, dressings, dressings and clothes can be applied on the wound or can be applied directly. This application creates micro-current in the injured tissues and increases the normal electrochemical activity in the body.
Electrical stimulation, easy to use, easy to carry and applicable by the patient, hospitalization at home, such as providing the continuation of treatment in addition to features such as accelerating the healing of chronic wounds. It increases blood vessel formation especially in inflammatory wounds and anemia.
WOUND TREATMENT WITH LASER
At a low level (640 to 940 nm wavelength) and at appropriate doses, it is stated that the laser beams given by a specially developed laser device stimulate cellular functions. It also has inflammation and inflammation and pain relief in the tissue.
WOUND TREATMENT WITH ULTRASOUND
The effect of ultrasound on tissues is two groups, thermally and thermally. Accelerates wound healing. Increases blood flow in the wound area. Ultrasound therapy, dressing
can be applied directly to the wound or around the wound.
WOUND TREATMENT WITH HYPERBARIC OXYGEN
Hyperbaric oxygen therapy is a method of breathing oxygen in a closed pressure chamber by breathing oxygen through a mask, hood or tube placed in the patient under a pressure higher than 1 atmosphere (1 ATA = Absolute Atmosphere = 760 mmHg). The aim here; increase the solubility of oxygen in blood and body fluids. In this way, wound healing is increased by increasing the oxygenation of the wound area. However, in order to apply this method in chronic wound, it is necessary to have an appropriate vascular structure in the wound.
Hyperbaric oxygen therapy is used in crush injuries and acute trauma wounds, compartment syndrome, diabetic foot wounds, recurrent osteomyelitis, gas gangrene, necrotizing soft tissue infections, skin grafts and reimplantations, osteonecrosis and sports injuries.
This treatment can be preferred especially in difficult wounds that cannot be healed by medical and surgical treatment methods, shortens the length of hospital stay and reduces the cost of treatment. It should NOT be used in patients with a history of pneumothorax, upper respiratory tract infection, epilepsy, chronic obstructive pulmonary disease (COPD) and thoracic surgery.
OXYGEN TREATMENT TO WOUND
It is a system that takes 21% oxygen in the air and converts it to 100% concentration oxygen. Seven days 24 hours with preferred dressing material or compression
available.
It can be used in addition to other wound care treatments in chronic wounds.
WOUND OZONE (O3) TREATMENT
Ozone application is the use of 5% (O3) + 95% (O2) mixture in the wound. While ozone is disinfected at high concentrations, it provides wound healing and RESTORATION when applied at low concentrations. The wound is applied with bags. Ozone destroys both bacteria and fungi.
It can be used especially in chronic wounds and diabetic foot wounds.
HONEY APPLICATION
Use of honey in wound treatment; Although it has been known since the past, it has been re-introduced with Australian manuka (Leptospermum scoparium) in recent years. The efficacy of antibiotic-resistant bacteria in inflammatory wounds reintroduced the importance of honey in wound treatment.
Effect of honey on wound; The density in the structure is due to the hydrogen peroxide enzyme it contains, its acidicity, and its antimicrobial effect.
Honey's water is low and microbes cannot develop in this case. The pH of honey is between 3.2-4.5 and this value is so acidic that bacteria cannot develop in the wound. The most important antimicrobial effect in honey depends on the hydrogen peroxide enzyme that occurs in honey.
A small amount of water in the honey provides the moisture required for the wound and absorbs liquid
With the effect of the wound gets the discharge. It also prevents the wound from sticking to the dressing material, reducing pain in dressing change. Honey is an additional source of nutrition for tissues.
By reducing edema and pain, honey accelerates circulation through the capillaries and increases oxygenation in the wound area.
WOUND TREATMENT WITH ARTIFICIAL LEATHER
Making human skin or equivalent skin takes place in two ways.
These; containing keratinocytes and dermal elements
collagen matrix fibroblasts. The basic mechanism in artificial skin applications is to provide epithelization by stimulating and releasing growth factors in the wound. They also provide skin-like protection on the wound and provide protection against trauma and infections. Artificial leathers are used in diabetic foot wounds and venous leg ulcers.
The forms available today; Alloderm containing normal human fibroblasts; and Integral containing collagen, chondroitin sulfate and silicon designed as artificial skin.
19AXX
Band-Aid Brand Hydro Seal Extra Large Waterproof Adhesive Bandages for Wound Care and Blisters, 3 ct
