TABLES AND QUICK-AIDES

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QUICK ASSESSMENT MNEMONIC

In general, factors that adversely affect wound healing can be remembered by using the mnemonic device DIDN’T HEAL, as follows¹:

• D = Diabetes: The long-term effects of diabetes impair wound healing by diminishing sensation and arterial inflow. In addition, even acute loss of diabetic control can affect wound healing by causing diminished cardiac output, poor peripheral perfusion, and impaired polymorphonuclear leukocyte phagocytosis.
• I = Infection: Infection potentiates collagen lysis. Bacterial contamination is a necessary condition but is not sufficient for wound infection. A susceptible host and wound environment are also required. Foreign bodies (including sutures) potentiate wound infection.
• D = Drugs: Steroids and antimetabolites impede proliferation of fibroblasts and collagen synthesis.
• N = Nutritional problems: Protein-calorie malnutrition and deficiencies of vitamins A, C, and zinc impair normal wound-healing mechanisms.
• T = Tissue necrosis, resulting from local or systemic ischemia or radiation injury, impairs wound healing. Wounds in characteristically well-perfused areas, such the face and neck, may heal surprisingly well despite unfavorable circumstances. Conversely, even a minor wound involving the foot, which has a borderline blood supply, may mark the onset of a long-term nonhealing ulcer. Hypoxia and excessive tension on the wound edges also interfere with wound healing because of local oxygen deficits.
• H = Hypoxia: Inadequate tissue oxygenation due to local vasoconstriction resulting from sympathetic overactivity may occur because of blood volume deficit, unrelieved pain, or hypothermia, especially involving the distal extent of the extremities.
• E = Excessive tension on wound edges: This leads to local tissue ischemia and necrosis.
• A = Another wound: Competition between several healing areas for the substrates required for wound healing impairs wound healing at all sites.
• L = Low temperature: The relatively low tissue temperature in the distal aspects of the upper and lower extremities (a reduction of 1-1.5°C [2-3°F] from normal core body temperature) is responsible for slower healing of wounds at these sites.

1. Richard M Stillman, MD, FACS
Wound Care: eMedicine General Surgery (19 July 2009)

http://emedicine.medscape.com/article/194018-overview

http://snipurl.com/nj1obhttp://emedicine.medscape.com/article/194018-overview

OTHER TABLES AVAILABLE:

CLINCIAL SCIENCES BACKGROUND

HISTORY OF WOUND MANAGEMENT:

http://www.globalwoundacademy.com/GWA/usa/popup1module9.htm

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TREATMENT ALGORITHMS

TABLE OF DRESSINGS¹:

Category	Examples	Description	Applications
Alginate	AlgiSite, Comfeel, Curasorb, Kaltogel, Kaltostat, Sorbsan, Tegagel	Alginate dressings are made of seaweed extract contains guluronic and mannuronic acids that provide tensile strength and calcium and sodium alginates, which confer an absorptive capacity. Some can leave fibers in the wound if they are not thoroughly irrigated. These dressings are secured with secondary coverage.	These dressings are highly absorbent and useful for wounds have copious exudate. Alginate rope is particularly useful to pack exudative wound cavities or sinus tracts.
Hydrofiber	Aquacel, Aquacel-Ag, Versiva	An absorptive textile fiber pad, hydrofiber is also available as a ribbon for packing of deep wounds. This material is covered with a secondary dressing. The hydrofiber combines with wound exudate to produce a hydrophilic gel. Aquacel-Ag contains 1.2% ionic silver that has strong antimicrobial properties against many organisms, including methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci.	Hydrofiber absorbent dressings used for exudative wounds.
Debriding agents	Hypergel (hypertonic saline gel), Santyl (collagenase), Accuzyme (papain urea)	Various products provide some chemical or enzymatic debridement.	Debriding agents are useful for necrotic wounds as an adjunct to surgical debridement.
Foam	LYOfoam, Spyrosorb, Allevyn	Polyurethane foam has absorptive capacity.	These dressings are useful for cleaning granulating wounds with minimal exudate.
Hydrocolloid	CombiDERM, Comfeel, DuoDerm CGF Extra Thin, Granuflex, Tegasorb	Hydrocolloid dressings are made of microgranular suspension of natural or synthetic polymers, such as gelatin or pectin, in an adhesive matrix. The granules change from a semihydrated state to a gel as the wound exudate is absorbed.	Hydrocolloid dressings are useful for dry necrotic wounds, wounds with minimal exudate and for clean granulating wounds.
Hydrogel	Aquasorb, DuoDerm, Intrasite Gel, Granugel, Normlgel, Nu-Gel, Purilon Gel, KY Jelly	Hydrogel dressings are water-based or glycerin-based semipermeable hydrophilic polymers; cooling properties may decrease wound pain. These gels can lose or absorb water depending upon the state of hydration of the wound. They are secured with secondary covering.	These dressings are useful for dry, sloughy, necrotic wounds (eschar).
Low-adherence dressing	Mepore, Skintact, Release	Low-adherence dressings are made of various materials designed to remove easily without damaging underlying skin.	These dressings are useful for acute minor wounds, such as skin tears, or as a final dressing for chronic wounds that have nearly healed.
Transparent film	OpSite, Skintact, Release, Tegaderm, Bioclusive	Transparent films are highly conformable acrylic adhesive films with no absorptive capacity and little hydrating ability. They may be vapor permeable or perforated.	These dressings are useful for clean, dry wounds with minimal exudate. They also are used to secure an underlying absorptive material, to protect high-friction areas and areas that are difficult to bandage (eg, heels) and to secure intravenous catheters.

1.http://emedicine.medscape.com/article/194018-treatment