Special Wound Therapy
Special wound therapy include wound lavage, wound debridement, surgical drains, wound excision and bandages.
Wound lavage
Copious Lavage and thorough debridement are most Special wound therapy to manage contaminated or infected wounds. Initial wound management begins with copious lavage using warm, sterile saline or balanced electrolyte solution is preferred lavage solutions. Wound lavage reduces bacterial numbers mechanically, by loosening and flushing away bacteria and associated necrotic debris. Antibiotics or antiseptics like povidone iodine or chlorhexidine, added to the lavage solution, reduces the bacterial numbers. Lavaging is preferred to scrubbing the wound with sponges, since they inflict tissue damage and subsequent infection. Bacteria are effectively removed from the wound surface by high-pressure lavage using 50 ml syringe and 18-gauge needle, which generates approximately 7 to 8 psi of pressure. The irrigation by jet or bulb lavage has shown good results.
Wound debridement
Debridement is the process of removing devitalized tissue from a wound. The objective is to convert the wounds to a clean status, containing tissue with adequate blood supply for normal healing. Wound debridement classified in-
- Surgical debridement
- Mechanical wound debridement
- Enzymatic wound debridement
1. Surgical debridement
The layered debridement begins on the surface and progress to the deeper aspects of the wound. Extensive tissue damage may require aggressive debridement. Complete wound excision is removal of wound, resulting in surgical margins suitable for immediate closure.
2. Mechanical wound debridement
Mechanical wound debridement accomplished by the use of bandage after surgical debridement or gross debris (wet to dry).
3. Enzymatic wound debridement
Trypsin and chymotrpsin are used topically for this purpose. It is used in places where important healthy structures (nerves) are present. It is expensive.
Surgical drains
Surgical drains are implants placed, usually on temporary basis, to channel away-unwanted fluid or gas from the wound or body cavity. They facilitate the healing process. They are used to eliminate dead space. They may however increase the risk of ascending infection. Drains can be passive or active-
- Passive drains
- Active drains
1. Passive drains
Passive drains are constructed of either soft latex (Penrose drain) or more rigid materials. They rely on gravity to evacuate and hence should be placed in a dependant position and are fixed by penetrating sutures on the outside of the skin.
2. Active drains
Active drains remove fluid by applying negative pressure to the tube drains. This is most efficient for removing large quantity of fluid from the wound cavity, usually removed with 24 hours.
Wound excision
The entire wound can be excised en block, if there is sufficient healthy tissue in the surrounding area. The danger of surgical debridement is removal of excessive amounts of potentially viable tissue. After surgical debridement, wounds are often treated as open wounds with medications and wet-dry bandages. The wound should be closed when it appears healthy or when a bed of granulation tissue has formed.
Bandages
Bandage is a piece of cloth material, in the form of a pad or strip, applied to a wound or used to bind around an injured or diseased part of the body.
Functions of Bandages are-
- Control of haemorrhages
- Allow gaseous exchange
- Remove exudates and toxins
- Keep wounds warm
- Give aesthetic appearance
- Absorb wound secretions
- Provide comfort
- Minimize scar tissue
- Control of wound environment
- Wound cleanliness
- Decrease the edema
- Obliteration of dead space
- Immobilizing injured tissue
- Decrease pain
- Protect from secondary infections
- Debriding action
- Provide vehicle for topical medications
Components of bandages
Bandages having three layers-
- Primary layer or Contact layer
- Secondary or Intermedial layer
- Tertiary layer or Outer layer
Primary layer or Contact layer directly contacts the wound or lesion. Secondary or Intermedial layer Covers the primary layer, serves to absorb wound fluids.
Tertiary layer or Outer layer; provides additional support and pressure.
The primary layer of the bandage may be adherent or non-adherent, and should remain in contact with the wound during movement.