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 Wound Care - Types of Dressings
 
A mother whose son  with Juvenile Huntington's Disease developed bed sores wrote: Info needed please.  My son has three places on his back where the skin has down broken down.  One is on his sacrum.   They have put deuoderm on them.  Should I take him to a wound care specialist???  Does anyone know the best treatment for this.  He is very uncomfortable.  Can these become infected??? I appreciate any suggestions. 

~

YES.........insist a wound care specialist see him in the nursing home!! Pressure sores are hideous and terrible and YES they can become infected and if not treated properly, get larger and terribly  painful.  The BEST care in the world sometime cannot stop them when someone is bedridden 24/7 and can't be moved to reposition their body.  Kelly had some horrendous ones the last 6 months of her life that I know contributed to her overall rapid decline, even with a wound care specialist and clinical dietician involved in her care.


Debridement is the removal of necrotic tissue, exudate, and metabolic waste from a wound. Accumulation of necrotic tissue results from a poor blood supply at the wound site or from increased interstitial pressure, a typical scenario in patients with pressure ulcers.
 
Exudate usually results from infection. Staphylococcus aureus, for example, is known to produce a fibrin-rich biofilm that is resistant to the body's natural immune response to foreign bodies.

Optimal wound management requires the selection of treatment options according to wound and patient characteristics and resources. This article will highlight the options available for non-surgical wound debridement.

If a pressure sore is located in a place that cannot be healed quickly due to positioning,  etc.,  they do have some wound care methods of suspending the person off the bed, or at least the portions affected by the wound.  A friend of Kelly's who was a paraplegic went into a rehab facility several times for a wound on his spine.  Kelly couldn't handled that type of treatment due to her inability to be positioned on her side or face down.  Plus, her inability to verbalize her needs made out-of-home care very traumatic for her .  This type of therapy is usually done in a rehab type facility and can take months.

There are several air mattresses that are the "deluxe" of bedridden patients that the nursing home should have available or be able to order.  Also the specialized padding for wheelchair/chairs (Roho pads)

Deuoderm is okay for new wounds that haven't gotten too bad.  But, the FIRST thing is DEMAND a wound care specialist assess your sons wounds immediately and prescribe a plan of action to start healing them.  Then don't just let them walk away and turn the care over to the nursing home.  Insist on weekly visits to see his wounds to determine the progression of their healing, suggested alternative treatments if the previous ones aren't working.

Did a search for what's new in skin care and below is some things I found.  I know you don't have time to look at some of these, so I've pasted some brief explanations below of the types of wound treatments.

Jean Miller
===================================
Pressure ulcers occur in all age-groups from children to young adults, from middle age to elderly. In the sitting dependent, 75% of all patients will experience breakdown, and by far the most common sites for these pressure ulcers will be the ischials, coccyx, and sacrum.  Of these patients, 75% will have a recurrence of that same breakdown.
 
WOUND TYPE AIM DRESSING
Yellow necrotic with high exudate Remove slough and absorb exudate Hydrocolloid with hydrocolloid paste if deep. Hydrogels. Alginates or enzymatic (elase)removal of slough.
Yellow necrotic with low exudate Remove slough and absorb exudate Hydrogels (rehydrate toaid removal or slough). Hydrocolloids. Enzymatic removal.
Cavity wound with high exudate Absorb exudate, maintain moist environment Alginate or foam cavity dressings.
Cavity wound with low exudate Hydrate to maintain moist environment Hydrogel.
Malodorous wound Clear infection, reduce odour, absorb exudate, protect Systemic antibiotics only if clinical signs of infection seen. Foam or alginate with activated charcoal. Flagyl Gel with caution.
 
 
Charts are from an excellent article "Principles of Wound Management and Topical Therapies " from Home Health Care Consultant http://www.mmhc.com/hhcc/articles/HHCC0004/waldrop.html
 
 
TYPES OF DRESSINGS

Amorphous hydrogels

Are packaged in tubes, foil packets, and spray bottles. The hydrogel varies in thickness and viscosity. Because the gel can cause maceration, the practitioner should avoid applying it on the periwound skin.  Applying an amorphous hydrogel facilitated autolytic debridement of the devitalized tissue

Hydrogel Dressings
 
Hydrogels are indicated for management of pressure ulcers, skin tears, surgical wounds, and burns, including radiation therapy burns. Because they contain up to 95% water, hydrogels cannot absorb much exudate and should be reserved for dry wounds or wounds with minimal to moderate drainage.

An impregnated-gauze hydrogel, which is an amorphous hydrogel impregnated into a gauze pad, can be used to fill dead space in a large wound.

Hydrocolloid Dressings

Because they are occlusive, hydrocolloid dressings do not allow water, oxygen, or bacteria into the wound. This may help facilitate angiogenesis and granulation. Hydrocolloids also cause the pH of the wound surface to drop; the acidic environment can inhibit bacteria growth.

Like hydrogels, hydrocolloids can help a clean wound to granulate or epithelialize and encourage autolytic debridement in wounds with necrotic tissue. However, because of their occlusive nature, hydrocolloids cannot be used if the wound or surrounding skin is infected.

Alginate Dressings

Previous columns have addressed products that are appropriate for dry wound beds or wounds with minimal exudate or drainage-namely, hydrogels and hydrocolloids. In contrast, alginate dressings absorb moderate to high amounts of wound drainage.

In wounds with moderate to heavy drainage, the alginate forms a gel when it comes in contact with wound fluid. Capable of absorbing up to 20 times its weight in fluid, an alginate can be used in infected and noninfected wounds. Because an alginate is highly absorbent, it should not be used with dry wounds or wounds with minimal drainage; it could dehydrate the wound, delaying healing.

(above was used in Kelly's later stages of wound/was newest at time)

Composite Dressings

Composite dressings have multiple layers and can be used as primary or secondary dressings. They are appropriate for wounds with minimal to heavy exudate, healthy granulation tissue, necrotic tissue (slough or moist eschar), or a mixture of granulation and necrotic tissue (Figure 1).

Use composite dressings cautiously if the patient is dehydrated or has fragile skin. Keep in mind that some insurers will not reimburse a facility or provider if a composite dressing is used as a secondary dressing with a hydrogel or impregnated gauze.

Transparent Films 

 Film dressings are flexible sheets of transparent polyurethane coated with an acrylic adhesive. They can be used as a primary or secondary dressing.

These dressings are semipermeable, vary in size and thickness, and have an adhesive that holds the dressing on the skin. They conform easily to the patient's body but do not hold well in high-friction areas, such as the sacrum or buttocks. Because films are transparent, the wound can be easily monitored.

Because films are semiocclusive and trap moisture, they allow autolytic debridement of necrotic wounds and create a moist healing environment for granulating wounds.

(above was used on Kelly in early signs of a pressure sore)

PRODUCTS
Wound Care Strategies, Inc [http://www.woundcarestrategies.com/] has prepared a comprehensive list of products and the companies that make skin and wound care products.
 
 

OTHER INFO

Advances in Skin & Wound Care
Non-surgical Options-Debridement Necrotic Wounds

INSURANCE COVERAGE

Medicare Allowable Surgical Dressing in PDF format explains what dressings are covered by Medicare, how many per day, etc.

Aetna: Surgical Dressings (Wound Care Supplies) One insurance (Aetna's) policy on coverage for wound care supplies.