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AADO Then 8th Orthopaedic Nursing Conference 2014
Pre-conference Workshop Wound Management Workshop
12 October 2014
Current Trend In Wound Management
Kwok Wai Yu APN, O&T, PWH
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Wound Healing Process
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Facilitates the wound-healing process:
prevention of tissue dehydration and cell death accelerated angiogenesis ↑breakdown of dead tissue and fibrin potentiating the interaction of growth factors with their
target cells
↓ Pain
Charles KF and others, 1994, Overview of wound healing in a moist environment
Moist Wound Environment
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GREGORY SS & others, Wound bed preparation: a systematic approach to wound management, WOUND REP REG 2003;11:1–28
An ongoing debridement phase Autolytic debridement Surgical and sharp debridement Enzymatic debridement Mechanical debridement Biological therapy
Management of exudate Dressing selection
Resolution of bacterial imbalance Wound contamination Wound colonization Critical colonization Wound infection
Wound Bed Preparation
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GREGORY SS & others, Wound bed preparation: a systematic approach to wound management, WOUND REP REG 2003;11:1–28
An ongoing debridement phase
• Autolytic debridement
• Surgical and sharp debridement
• Enzymatic debridement
• Mechanical debridement
• Biological therapy
Management of exudate
Resolution of bacterial imbalance
Wound Bed Preparation
Endogenous proteolytic enzymes
Moist environment
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GREGORY SS & others, Wound bed preparation: a systematic approach to wound management, WOUND REP REG 2003;11:1–28
An ongoing debridement phase
• Autolytic debridement
• Surgical and sharp debridement
• Enzymatic debridement
• Mechanical debridement
• Biological therapy
Management of exudate
Resolution of bacterial imbalance
Wound Bed Preparation
Exogenous proteolytic enzymes that are manufactured
Collagenase-based debridement
Papain-based debridement
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GREGORY SS & others, Wound bed preparation: a systematic approach to wound management, WOUND REP REG 2003;11:1–28
An ongoing debridement phase
• Autolytic debridement
• Surgical and sharp debridement
• Enzymatic debridement
• Mechanical debridement
• Biological therapy
Management of exudate
Resolution of bacterial imbalance
Wound Bed Preparation
Wet to dry gauze Pressurized
irrigation Whirlpool therapy
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GREGORY SS & others, Wound bed preparation: a systematic approach to wound management, WOUND REP REG 2003;11:1–28
An ongoing debridement phase
• Autolytic debridement
• Surgical and sharp debridement
• Enzymatic debridement
• Mechanical debridement
• Biological therapy
Management of exudate
Resolution of bacterial imbalance
Wound Bed Preparation
Sterile maggots
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Dowsett C, Ayello E., TIME principles of chronic wound bed preparation and treatment, Br J Nurs. 2004 Aug 12-Sep 8;13(15):S16-23.
TIME principles
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Biofilm Theory
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Wound Healing Approach
Patient Centered Understand Patient’s concerns Motivate Patient’s willingness Gain Patient’s compliances
Holistic Assess whole patient, not “hole” in patient
Explore contributing factors Apply preventive measures
Multidisciplinary O&T Surgeons, Dermatologists, Vascular surgeons
Nurses, PT, OT, P&O, Podiatrist, Dietitians GOPC, CGAT, Wound clinics, DM clinics,
Home helpers
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Foam / Gauze
Negative Pressure Wound Therapy
Mechanism: – Reduces localized edema
– Stimulates localized blood flow
– Promotes granulation tissue formation
– Reduces bacterial load
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Maggot Debridement Therapy (MDT)
• The beneficial effects of using larvae in wounds were first noticed in 1557; first clinical application was during American Civil War (1861-1865)
• Not a NEW discovery: being rediscovered with reduced effectiveness of antibiotics
• FDA approval in 2004
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TopClosure Method
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Hyperbaric Oxygen Therapy
Administration of oxygen at pressure greater than sea level
Rationale for Hyperbaric Oxygen in Problem Wounds: Enhances fibroblast replication ↑ collagen synthesis ↑ neovascularization ↑ leukocyte bactericidal activity ↑ O2 tension → greater capillary
oxygen diffusion distances
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In conclusion, this study shows the effectiveness of HBO in improving wound healing and reducing repetitive surgery. We believe that HBO is a useful adjunct in the management of severe (grade III) crush injuries of the limbs in patients more than 40 years old.
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• Portable, Ambulatory, Small Size Products to facilitate
In hospital Care → Home / Community Care
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Not HBO!!!
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NPWT machines and
products decrease in size
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Single product → Combinations
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Medihoney + NPWT 2010
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High Osmolarity (high sugar level):
causes a mass outflow of bacteria, endotoxins &
sloughy material away from wound bed;
increases autolytic debridement & reduce inflammatory
response (e.g. oedema & exudate) & odour
Low Water Content:
insufficient water to
support bacteria
growth
Acidity (pH 3.2-4.5):
inhibits microbial growth & improves
oxygen diffusion; control protease
activity; stimulate angiogenesis & healing
Antioxidants:
scavenge free radicals
that arise from
inflammation ; reduces
cellular damage
Medihoney
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• F/5 • PHx: good • Fell from motorcycle with left heel caught
by the wheel in 07/2012 • Attended China hospital with wound
exploration, debridement & tendon repair performed, then came back to HK for further mx in 08/2012
• Option for conservative mx • Wound Culture: no growth
Portable NPWT Device ~ 6 weeks
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Combined NPWT and TopClosure in management of diabetic foot
Cited from: http://www.ijps.org/article.asp?issn=0970358;year=2012;volume=45;issue=2;spage=291;epage=301;aulast=Topaz on date 2014.10.10
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Acknoledgement
Choi Kah Leng, APN, O&T, PWH
9ABC O&T staffs
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Reference Field, C. K., & Kerstein, M. D. (1994). Overview of wound healing in a moist environment.
The American journal of surgery, 167(1), S2-S6. Chong SJ & others. (2011). Maintenance of negative-pressure wound therapy while
undergoing hyperbaric oxygen therapy. Diving Hyperb Med, 41(3),147-50. Doctor, N., Pandya, S., & Supe, A. (1992). Hyperbaric oxygen therapy in diabetic foot.
Journal of postgraduate medicine, 38(3), 112. Dowsett C, Ayello E. (2004). TIME principles of chronic wound bed preparation and
treatment, Br J Nurs. 13(15),S16-23 Rolee K and others. (2003) .Topical oxygen as an adjunct to wound healing: a clinical
case series. Pathophysiology, 9 81-87 GREGORY SS & others.(2003). Wound bed preparation: a systematic approach to wound
management, WOUND REP REG, 11:1–28 Rodriguez PG & others. (2008). The role of oxygen in wound healing: a review of the
literature. Dermatology Surgery, 34(9),1159-69 Edna FG. Active Leptospermum Honey and Negative Pressure Wound Therapy for
Nonhealing Postsurgical Wounds. Ostomy Wound Management 2010; March:10-12. Glenn S. Management of Wounds with Antibacterial Medical Honey (Leptospermum sp)
and Topical Negative Pressure (TPN). Wounds UK 2010; 6(1):143-145.
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