Wound Care Treatment

What is wound care ?

In wound care is attempted to obtain an optimal state, so that a wound heals as quickly as possible. Wounds always start as an acute wound. Most heal itself, but there may be factors that hinder healing. As a result, can become chronic wounds.

Acute injuries

Staunching bleeding (print, possibly electric cautery or suture)
Removal of foreign material (with tweezers or rinsing with water)
Remove dead tissue (because that is a breeding ground for bacteria)
With clean perforation, cuts or tear injuries can sometimes wound edges are bonded together. The aim is to reduce the wound surface (faster healing), and a neater or smaller scar.

Constraining factors in wound healing

Some wounds prove difficult to close or show little tendency healing. This may be due to:

-A bad load or unload of blood and nutrients

arterial insufficiency
hypertension
atherosclerosis
venous insufficiency
lymphedema

-Due to poor nutritional status of the patient
-Because of diabetes mellitus
-By an inflammatory process on the spot

sterile: for example vasculitis or pyoderma gangrenosum.
non-sterile: infection with bacteria or other micro-organisms.

-A single time appears to be a non-healing wound caused by skin cancer.

In order to let chronic wounds heal all of these factors must be taken into account in the eye. When leg wounds will almost always ambulatory compression therapy (bandage) are performed.

Wound Policy in chronic wounds

The aim is for a red (healthy granulation tissue) wound bed with the proper moisture content (not too dry and not too wet).

Remove necrosis
A black or yellow wound bottom indicates the presence of dead tissue. This should be removed. This may be mechanical (curette or with knife and tweezers). Also, by dressing properly can choose the removal of dead tissue can be speeded up, particularly alginates have been identified (see: types of dressing). Wound Hardware dissolving enzymes (collagenase) appear to have no purpose. Recently also be maggots (thus the larvae of insects) used to remove necrosis (made therapy).

Infection
Increasing pain, abnormal odor, yellow or green batter, pus in the wound or inflammation (redness, swelling, heat, pain) may indicate an infection. In addition, there occurs a loss of function in the affected area. This can be countered by

local antiseptics (eg medicinal honey (ointment), povidonjoodgazen, EUSOL-pads). However, increasingly the use of antiseptics for cleansing so that the number of decrease of micro-organisms and organic material is removed. Cleaning can be with physiological solution, a wound cleanser or running water. The operation of antiseptics can be prevented by organic material.
Local antibiotics: fusidic, tetracyclinezalf, mupirocin ointment, zilversulfadiazinezalf

Risk of resistance, allergy.

systemic antibiotics: per orally, via injection or IV is preferred to local treatment.

Correct humidity
Ensure optimal humidity for wound healing (not too wet or too dry). Again, the choice of type of wound dressing help. A foam dressing absorbs more and provides a drier wound. A (previously moistened) hydro fiber allows for a more moist environment.

Pain
Pain can be caused by the wound itself or by an additional infection. There are wound dressings that pain relief (e.g. ibuprofen) to the wound.

Bandaging
One of the reasons why wounds to the legs worse cure, is the increased venous pressure to the legs. Bandaging (ambulatory compression therapy) of the legs almost always has a stimulating effect on the wound healing. This should be done with a short rekwindel. Use two walls, one turning to the right, the next turning to the left.

Types of wound care dressings

Of some wound dressings is claimed that they have an influence on the wound environment. To what extent this will actually accelerated wound healing is often not investigated.

Alginates contain seaweed and would be advantageous in a wound with many wound batter.
Silver dressings contain colloidal silver, which would inhibit bacterial growth, so beneficial in an infected wound.
Hydrofiber and foam dressings are more absorbent dressings, so for wounds that produce a lot of moisture. Some also contain carbon, to absorb odor as well.
Gauzes ensure that the dressing is not too much soil from sticking to the wound. here are

-Fat gauze
-Antibacterial mesh: fusidic or povidone
-Silicone wire: less adherent to the wound bed