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Chronic Wound Treatment

These patients should be treated with a multidisciplinary approach when a wound occurs. The treatment of progressive chronic wound patients is done in hospital.

In these chronic wound patients, first of all sugar is corrected and wound treatment is performed. Antibiotic is started according to the culture result. In wound care, in addition to daily dressing and debridement, additional treatments such as vacuum treatment and hyperbaric O2 treatment are applied. The vascular structure of the patients should be investigated and investigated with the necessary tests such as USG, CT, angiography. The interventional radiologist performs this procedure. If necessary, the vascular surgeon will intervene. The wound, which is under control, is then closed with grafts if necessary.

There is a 75% risk of recurrent wounds within 5 years. Therefore, it should be followed very closely.

In our clinic, inpatient treatment is applied with a multidisciplinary approach in order to protect the living tissues, eredicate the infection, and solve the problem with healing accelerating interventions.

The priority in chronic wound debridement is the removal of dead tissue. If necessary, amputations (dead tissue-blackened tissues) are applied. Debridement is performed until blood supply is seen in muscle tissue.

Since infection is one of the main reasons delaying wound healing, antibiotic treatment is started according to the culture results.

The patient is provided with diabetes treatment (by internal medicine specialists).

Psychological support (Psychiatrist, psychologist)

Vacuum treatment can be applied. It is a dressing method in which localized negative pressure is applied. Dressing is changed every 2-3 days. In addition to these treatments, hyperbaric oxygen and ozone are provided to these patients when necessary.

Hyperbaric O2 treatment is performed in special centers by breathing 0 O2. Hypoxigenization in blood and tissues is the main mechanism of action. While it is very beneficial in the early period, it decreases in the later periods.

Oxygen administration is controversial.

Medical ozone application is the regional or systematic application of 0.5-5% ozone / O2 gas mixture. The regionally ozonated material is applied for 15-20 minutes. Some growth factor increases the production of infection that has the effect of helping the treatment. It is the systematic removal of the patient's blood and ozonizing. It can also be applied rectally.

Some treatment methods are currently being followed.

Growth factor has a strong effect on wounds. Research is ongoing.

Gene therapy, stem cell applications are still in the early phase. The efficacy and safety of these treatments will be determined by long-term studies.

Pressure water, ultrasound and radiofrequency methods are also tried in various centers.


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How does a foot wound pass?

Wound healing occurs spontaneously. In other words, the ability and ability to heal the wound is found in the genetic structure of the body. However, if there are conditions that prevent the healing of wounds, the body is inadequate to heal the wounds. Thus, the first way to heal wounds that have delayed or stopped healing is to remove obstacles.

Infection
Infection is the most important factor that prevents wound healing. Normally, a solid skin is an important protection shield against bacteria, fungi and viruses that may cause infection. When the wound is opened, it cannot act as a shield. Microbes reach the open wound surface easily. Microbes reach the wound, infection does not mean infection. Not only do these germs get infected, they become important if they start to hold, feed, multiply and form a community. This is called colony formation of microbes. Even at this stage, microbes multiply only in the wound, they feed there, they do not spread to the body. When microbes begin to spread to the body, they cause systemic infection. Fever rises, fatigue becomes weakness, redness around the wound, swelling, pain, temperature becomes apparent. In the blood assay, values ​​reflecting infection are determined. In short, germs are first transmitted to the wound (contamination), then they begin to hold here, feed, live and multiply (colonization) and spread to the body, causing signs and symptoms that concern the whole system (infection).

Of course, if the germs spread to the body, it is not only about wound and wound healing. This means that the patient's limb may even endanger his life. Such situations should be taken seriously and all treatments recommended by the physician, including appropriate antibiotic therapy, should begin immediately. However, before the germ spreads to the body, it delays and heals the wound healing while it is still in the wound environment. In this case, it is necessary to remove the germ load from the wound to ensure wound healing. For this purpose, all the dead and bad tissues in which the microbes easily settle and multiply in the wound environment are removed. This removal pathway is called “wound debridement.. Debridement is most easily performed surgically. Wound treatment physician scalpel, scissors, curette with tools such as dead, dirty tissue cuts away. Dead tissues are cleaned by scrubbing, wiping and scraping during wound dressing. Some gels, wound care products containing substances that break down dead tissues, ultrasonic devices, high-speed water gushing devices, even fly maggots are used to clean the wound.

A wide variety of antimicrobial materials known to be effective against microbes are used in the fight against wound infection. The important point is that these substances should kill microbes easily and quickly, be effective against a wide variety of microbes, but should not be harmful to normal body cells, that is, they should not disrupt wound healing. There are various substances used in wound treatment for this purpose.

Discharge occurs when the wound is infected with microbes. This stream should be removed from the environment. If not removed, wound healing will not occur. Dressing materials with varying absorbency characteristics are selected and preferred depending on whether the stream is more or less. For example, if there is a very discharge wound, a highly absorbent foam sheet is preferred. If it is not possible to use such materials, and only dressing with gauze, then maybe the dressing is changed several times, not once a day.

bass
Both bed sores and wounds seen in the protruding areas of the feet of diabetic patients are pressure-related. Their recovery is only possible with the disappearance of the press. Whatever treatment is applied after the pressure has not been removed, they cannot heal. For this reason, the patient needs to be turned around periodically in bed wounds, suitable beds are used. Appropriate insoles, shoes, orthosis devices or even plaster casts are used to remove pressure in diabetic patients.

Vascular obstruction
Wounds on limbs with vascular occlusion become difficult to heal. Due to vascular obstruction, nutrients, oxygen, or even medications do not reach the cells. Wound careers may find it necessary to open it if they detect severe vascular occlusion in the patient's veins. In this case, the vessels should be opened either surgically or by intravenous procedures such as stents and balloons. Thus, sufficient oxygen and nutrients reach the tissues. When the cells receive enough blood, wound healing is possible.

Vein insufficiency
Due to various disorders of the veins, blood accumulates in the leg veins. Due to the expanding veins, a condition called varicose veins occurs. When the veins do not operate adequately, wounds are opened on the leg. These wounds are called venous ulcers. The way to heal these wounds is to prevent blood from accumulating in the veins. In such wounds, bandage, varicose veins, stockings applied to the leg and blood pressure return are applied if the devices provide pressure and the wound heals.

Protection of healing tissues
After removing the bad and dead tissues from the wound, a red, clean tissue develops on the wound base. The wound edges gradually shrink and the wound starts to shrink. Starting from the wound edges, the skin begins to cover the wound. At this stage, it is necessary to protect this red repair tissue that develops on the base of the wound and the thin skin covering the wound. Because these newly formed tissues can be easily damaged. During dressing, these tissues should be kept moist by covering, not drying and removing. Pits and recesses on the wound base impede healing. If the wound base swells and rises too high, the skin cannot cover this height. These surpluses should be corrected during dressing. If the wound edges are rounded, blistered, there is no space underneath, the skin cannot be covered again. When dressing, the edges of the wound base should be corrected.

Proper dressing and wound care

During wound dressing, the wound is wiped with a liquid that will kill the germs, the inside of the wound is washed with saline and wiped. In the meantime, dead, bad tissues are removed from the wound base. If there is excessive discharge during dressing, it is absolutely removed. If this is inadequate, it is necessary to either use a higher absorbency wound dressing material or to dress more frequently. The dressing is not only about cleaning. Cover the wound to prevent the wound from drying out. Because the best wound dressing is moist wound dressing. Wound healing is not preferred. But humid does not mean wet. When the wound is touched by hand, its wetness is indeterminately moist, if appropriate.

Closing the wound not only maintains its humidity, but is also useful for maintaining the proper temperature. Closing the wound also prevents microbes that can reach the wound surface.

General condition of the patient

Focusing only on the wound often means not seeing the barriers to the general condition of the patient in front of the wound healing. If the patient's nutrition and water intake are not sufficient, the wound will not heal. In this case, it should be ensured that the patient is fed sufficiently especially in terms of protein. If a diabetic patient's blood sugar is elevated, it is necessary to correct the sugar level before dealing with wound healing. If the patient has heart failure, it will prevent enough blood to go to the tissues, maybe it will cause the wound. Heart failure must be treated with medications, then the wound should be healed. Blood values ​​are low in patients with long-term disease. Even if the heart, veins work normally, the wound cannot get enough oxygen. In these cases, blood support is required to heal the wound.

How does a foot wound pass?

The wound actually heals itself. The body has the ability to heal the wound genetically. If the wound does not heal, you should consult a health center dealing with wound treatment. If there are reasons such as malnutrition, sugar imbalance, lack of blood, vessel failure that prevent healing of the wound, these are corrected first. Then local causes such as infection, vascular occlusion and compression that prevent wound healing are investigated and corrected. Finally, the wound passes through the foot wound with proper wound care and treatment.


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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.




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Bed Wound Care and Treatment

Stage I and II bed wounds usually heal within a few weeks and / or a few months with good care of the patient, comprehensive and meticulous care of the wound. Stage III and IV bed wounds are more difficult to heal.

TREATMENT TEAM
Wound Care usually requires a multidisciplinary approach. And members of a wound care team should:

Primary physician supervising the patient's treatment plan
A nurse specializing in wound care
A professional caregiver who will provide long-term care to the patient and share correct information with the family.
A physiotherapist helping to increase mobility
Dietitian observing nutritional needs and planning appropriate diet
Plastic surgeon in cases requiring surgery
PRESSURE REDUCTION
The first step in the treatment of bed sores relieves pressure in the area that is in constant contact with the bed. Strategies are as follows;

Positioning: If there is a bed wound, the patient should be given the correct positions regularly. If the patient is using a wheelchair, 15 min. one weight should be given to the other side, and the position should be changed every hour. If it is an inpatient, its position should be changed every two hours.
When positioning the patient, ask for support within the capacity of the patient. Caregivers can use intermediate sheets to lift and position the patient. Thus, friction and skin damage can be reduced.

Use of Supporting Materials: Special cushions and pads should be used in order to position the patient in the appropriate position, to position and to protect the wound and skin from pressure. If you are in a wheelchair, you can use foam, air and water cushions as buffers
CLEANING AND COVERING WOUND
The maintenance model that helps recovery should include;

Cleaning: To prevent injection, keeping the wound clean is essential. If skin integrity is not impaired (Grade I), gently wash the skin with a little soap and water and dry with a pad. Clean the wound with saline each time you change the dressing.
Closing the Wound: Closing the wound creates a barrier against infection by keeping the wound moist and keeps the surrounding tissue dry, thereby accelerating wound healing. Wound closure options can be gauzes, gels, wound films, barrier creams. The combination of these materials can also be used for wound dressing.
Your doctor chooses a wound closure material, taking into account many such variables, depending on the size and severity of the wound, the discharge, and the ease of insertion and removal of the material used.

REMOVAL OF DAMAGED TISSUE (WOUND DISPOSAL)
For proper healing, the wounds need to be recovered from damaged, dead and infected tissues. wound debridement is performed by applying different methods according to the general condition of the patient, the aims of the treatment and the severity of the wound.

Surgical Debridement: Removal of dead tissues
Mechanical Debridement: Loosens and removes wound debris. This can be done with pressure irrigation devices, low frequency ultrasound or special dressing materials.
Autolytic Debridement: The body's natural functioning is done using the ability of enzymes to destroy dead tissue. This method is used for uninfected and small wounds.
Enzymatic Debridement: It is made with the use of chemical enzymes and selection of suitable wound closure materials that destroy the dead tissue.
OTHER INTERVENTIONS
Other interventions that may be applied;

Pain Management: Bed sores can be painful. Ibuprofen or naproxen etc. Anti-inflammatory drugs such as lonsiteroid may reduce pain. These drugs can be very useful in debridement and dressing changes. It can also be used in pain relief creams for these procedures.

Antibiotics: Infected wounds, antibiotics taken by oral or cream support the treatment.

A Healthy Diet: To accelerate wound healing, your doctor may recommend a high-protein diet that increases calorie and fluid support rich in vitamins and minerals. It is recommended that the patient take supplementary foods containing vitamin C and zinc.

Urinary and Fecal Incontinence (Incontinence): Bladder and intestine incontinence problems caused by bacteria and excessive moisture in the skin causing bacteria to increase the risk of infection. Fighting incontinence accelerates wound healing. Strategies to assist the patient in urination, frequent diaper replacement, use of protective lotions on healthy skin and the use of a urinary catheter are some of the strategies.

Elimination of Muscle Spasm: Friction and injury due to spasm causes worsening of bed sores. In these cases muscle relaxants are useful.

Negative Pressure Therapy (Vacuum Assisted Closure - VAC Application): This treatment uses a device that applies negative pressure (suction function) to the clean wound. It accelerates healing in the treatment of pressure sores.

SURGICAL
Surgical procedures (surgery) may be necessary for the bed wounds that cannot be healed. The aim of surgical applications is to improve the hygiene and appearance of the wound, to protect and treat the infection, to reduce fluid loss from the wound and to reduce the risk of cancer.

If surgical intervention is required, the procedure to be performed is determined by the site of the wound and the presence of scar tissue. In general, many bed sores are covered using muscle, skin, and other tissues to buffer the underlying bone.

You can ask our certified wound care nurse to visit you for bed wound treatments.


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HOW TO MAKE THE CORRECT WOUND DRESSING?

Correct wound dressing is a very important issue. In daily life, at home, on the street, at work, with minor accidents, falls, bumps and traumas, even with a simple door squeezing, even under the skin and small openings, wounds can sometimes occur bleeding.

Correctly Known Mistakes in Wound Dressing
Classical practice in homes or workplaces: the direct contact of the iodine-containing compounds to the wound. But this is quite wrong practice.

How is the right dressing done?
Correct wound dressing should begin by cleaning foreign bodies and particles on the wound by first keeping your wound in running water. Then, iodine containing liquid should be applied to the healthy skin around the opened skin. Because it is a liquid that kills all living cells on the surface it comes into contact with, that is, good and bad bacteria. For this reason, liquid containing iodine is applied to the healthy skin of the wound and antibiotic ointments are applied only to the wound. After these procedures are completed, we close a clean dry dressing cloth to the wound. Day one dressing continues until the wound heals.


17AXX
Band-Aid Brand Hydro Seal Waterproof All Purpose Adhesive Bandages for Wound Care or Blisters, 10 ct

Ortopad Bamboo for Boys, Adhesive Eye Patches, Softer Material, (50 per Box) (Regular Size)

How to Dress Open Wounds?

After many operations, the wounds are left open and are expected to heal spontaneously. However, the most important issue to be considered in this process is to prevent the tissue from becoming infected. Dressings for open wounds are made to heal the wound faster and without infection. The location of the wound is very important. Wounds standing on the hand are open to germs from outside. Wounds on the genital and rectal areas are in danger of bacteria inside the body. Most typically, wounds in the breech region burned after hair rolling or cautery can become infected during defecation.

The dressing of open wounds may be painful depending on the depth of the wound. There are several ways to reduce this pain. Painkillers alleviate pain to some extent, but they are not fully effective. Instead, local anesthetic creams may work. The most common anesthetic is anesthetic. Anestol pomade cream is effective in the area where it is applied in 2-3 minutes and numb the area. Especially if it is used before dressing applications in breech and genital area, the patient is very comfortable. After the anesthetic cream is applied over the open wound, the wound is cleaned with serum water. Then, the baticon is applied to prevent microbial catching and after the gauze is placed, the top part is covered with a big band called patch.

Furacin ointment, which is used for faster healing of wounds after surgery, is also used as germ-breaking ointment in dressings. If dressing is applied with a layer of furacin during the dressing and covered with gauze, surgical wounds heal faster than microbes. It is especially useful in painful wounds that collect water. Finally, as the biggest problem in dressings is to remove the gauze from the wound, you can remove the gauze from the wound more comfortably if you put warm water in a sprinkled spray and squeeze the gauze before pulling.


16AXX
Ortopad Bamboo for Boys, Adhesive Eye Patches, Softer Material, (50 per Box) (Regular Size)

3M Steri-Strip reinforced Skin Closures - 1/2" x 4" - 10 pack of 6 strip envelope (60 strips)

Above Wound Can Be Cancer

Wounds that develop in certain parts of the body but do not last long may indicate not only dermatological problems, but also serious illnesses. Covering the wound with an ointment or bandage may cause negative symptoms such as allergies, infections, and may lead to late diagnosis of underlying diseases such as liver dysfunction, diabetes and cancer. Memorial Wound Analysis and Treatment Center Prof. Sisli Hospital. Dr. Orhan Babuçcu, gave information about the points to be considered in the treatment of wound.

Not every wound is just a wound
Wounds are often seen as a disease of their own. This may be relatively accurate in some cases, such as a bed wound. Wounds on the feet of patients with diabetes or limb wounds due to circulatory disorders are also a problem in themselves. However, not every wound is merely a wound and requires an accurate analysis and treatment process.

Blood and lymph cancer can manifest itself with a wound
Wounds that occur in our legs and do not respond to any treatment can sometimes be a harbinger of diseases in our internal organs, especially our digestive system, and even cancers. It is important to distinguish these wounds from the rash seen in liver disorders. The non-healing wound itself may be a cancer or a wound that lasts more than 20 years can turn into cancer. In contrast, various types of blood and lymph cancer can manifest itself as a skin wound. A major stain of rheumatic diseases is an inflammatory reaction of the vessel walls called vasculitis, which sometimes occurs as non-healing wounds.

Unconsciously applied ointments and creams may enlarge the wound further
Wounds on the body often cause anxiety. The reasons for this are investigated without any investigation, unconsciously applying the drug instead of the wound, causing allergies and creating larger wounds. In this case, the wound may get worse as it is tried to be treated.

The patient can also make a wound
In some cases, patients with psychological problems may cause self-healing wounds. The goal here can often be a little more interested or medical care. It is very important that this condition is diagnosed by specialist doctors and treatment is applied.

Investigate the source of the wound and determine the treatment plan
Every wound in the body should not lead to panic. However, if a wound does not heal within 3 months despite ideal wound care, the specialist should be consulted. The cause of the wound should be diagnosed and appropriate treatment planning made, and the person must follow the doctor's recommendations in full. If an underlying disease is detected, the treatment process should be initiated.


15AXX
3M Steri-Strip reinforced Skin Closures - 1/2"" x 4"" - 10 pack of 6 strip envelope (60 strips)