Adequate food is always essential to proper healing.

The wounds, especially chro nic, require a balanced diet and even suits their specific needs healing. The Di rectorate General of Health has some publications on your site with suggestions for healthy eating. Texts are available in PDF format, but clarifying the princi ples of healthy eating. Seem to me particularly useful for group training and to provide reading material to users. Help simplify the language and serve as an e lement of guidance for health professionals. http://www.dgs.pt?cr=7781 http://www.dgs.pt?cr=11243 http://www.dgs.pt?cr=11241 http://www.dgs.pt?cr = 11 242 http://www.dgs.pt?cr=11244 Pucla 2 April 30, 2008 By: cancels Category: Pressure ulcer, Evaluation / Measurement Wo und, Miscellaneous No Comments → EPUAP - Classification of pressure ulcers As promised, I present the second version of the program pucla (PUClas2) which i s available on the website of the European Pressure Ulcer Advisory Panel. (A tea ser for the force feedback did not result). The pucla is a program developed by EPUAP to serve as a tool to study the subject Pressure Ulcer, especially as rega rds its classificação.Um clear improvement over the original version. Very well organized and illustrated. A job not to be missed for a good understanding of th e dynamics surrounding the classification of ulceration of the tissues caused by excessive pressure. Tests are yet available for version 1 and 2. On the page of choice of language can also find some exercises on prevention of pressure ulcer s. Pena is not yet available in Portuguese. The test of version 2 adds pucla a b rief explanation of the wound, but enough to notice the position of Authors. The figures are the addresses for the Portuguese version and exercises in English. Wound Bed Preparation March 11, 2008 By: cancels Category: Concepts in the Treatment of Wounds, Miscel laneous 1 Comment → This is a fundamental theme in the debate on the healing of a wound. Although each wound being inserted in a global context of their individ ual carrier, to achieve the conditions necessary for their healing is essential for closure. Maintaining the ideal environment in the wound bed, is also a key f actor in healing. The delicate balance between the capacity to generate an appro priate and soaking wet tissue, is very tenuous. Requires observation skills and critical thinking on the part of health professionals. Preparing the wound bed w ill depend on several factors including the etiology of the wound, the condition s of the person and the material available for your treatment. The motivation of the professional is always a point to consider, but let's assume that is presen t and appropriate. Within this theme there are several concepts, such as the TIM E concept, which help to direct decisions about appropriate treatment. I will speak of these concepts in future opportunities. The issue has several articles published online. I'll p ut the addresses of some of these articles and the text will be updated as new p roducts emerge. If they become aware of an article or address that is not in the text please put in comment. The essential theme EWMA ... ... And more addresses with the same http://www.bu.edu/woundbiotech/woundcare/Woundbedpr.html http://www.thefreelibra ry.com/Wound+bed+preparation:+clinical+considerati-ons a0123515378 http://www.gu ideline.gov/ summary / summary.aspx? doc_id = 9830 & nbr = 5254 & ss = 6 & xl = 999

Exudate December 16, 2007 By: cancels Category: Books / Recommended Articles, Concepts i n the Treatment of Wounds, Miscellaneous No Comments → Exudate en las heridas y los Usefulness of dressings Wound exudate and the role of dressings An excellent paper on which is the exudate of wounds and their interaction with the dressings used. The document is divided into: Good practice, which is the oo ze?, Which tells us the exudate, evaluation and control of exudate exudate. A jo b truly systematizing the song produced by the World Union of Wound Healing Soci eties (WUWHS). Principios de las mejores prácticas: exudate en las heridas y los Usefulness of dressings. Un consensus document. London: MEP Ltd, 2007. http://w ww.gneaupp.org/docs/pos8_gneaupp.pdf ... and in English for those who prefer. PUSH Tool December 16, 2007 By: cancels Category: Pressure ulcer, Evaluation / Measurement Wound, Miscellaneous No Comments → P U S H Tool The PUSH tool for measuring and evaluating the progression of pressure ulcers wa s presented in 1998 by NPUAP (National Pressure Ulcer Advisory Panel), an associ ation of North American€dedicated to the study of pressure ulcers. A PUSH-PT, th e Portuguese version, which is the site of GAIF has validated for the Portuguese population. A partnership GAIF and CEIS. As a research tool, validated scales s hould not be changed. The addresses below are for sites where the scale and inst ructions. http://www.npuap.org/PDF/push3.pdf http://www.gaif.net/artigos/EscaladeCicatriza caoInstrAvaliacao.pdf http://www.lhcr.org/PDF/nh/PUSH% 20Tool_1.6.04_P187 . pdf http://www.novartisnutrition.com/pdfs/us/moreproductinfo/PUSH_Tool_03.pdf http:/ /www.cfmc.org/files/nh/PUSHTool_Frantz092603-rev.pdf http://www.o-wm. com/articl e/1868 http://www.scielo.br/pdf/rlae/v13n3/v13n3a04.pdf Visitrak December 08, 2007 By: cancels Category: Evaluation / Measurement Wound, Miscella neous No Comments → A system for measuring wound, very useful for those who want to do research. Allows you to use several methods for evaluating the progression of the wound, i ncluding measurement of height by width, the count of squares of a grid and accu rate measurement of the wound area. The latter has clear advantages for a study intended to be rigorous in assessing the progression of the wound. http://wound. smith-nephew.com/UK/node.asp?NodeId=3066 Surgical wounds: A review of concepts December 07, 2007 By: Ricardo Ribeiro Category: Concepts in the Treatment of Wou nds, Sores Acute / Traumatic 1 Comment → SURGICAL WOUNDS: REVIEW OF CONCEPTS Author: Ricardo Ribeiro Nurse Objective: To introduce concepts of surgical wounds Introduction The treatment o f wounds has long been one of the main areas of intervention of nurses. Since th e presence of a wound factor influencing the quality of life of individuals, nur ses aim of its action in wound healing the wound, providing the maximum possible quality of life for the individual. The purposes of wound treatment are to prev ent contamination, facilitate healing and relieve pain. Definition of surgical w ound (more ...) Rulers December 07, 2007 By: cancels Category: Evaluation / Measurement Wound, Miscella

neous No Comments → The usefulness of the simple things. For those who are accustomed to shooting wounds, will surely be satisfied with t hese images. They are A4 pages with rulers of various laboratories, for when the originals are gone. How often have despaired to spend the last ruler in days of photography ace injured in study ... These files are in JPEG format and the pri nt quality it seemed to me good. If they are not workable, inform, which substit ute for PDF files. 10cm: 3M (pdf) B Braun Convatec Johnson & Johnson Hartmann 15cm: Johnson & Johnson2 Convatec (pdf) 17cm: Smith & Nephew (PDF) Mousey December 04, 2007 By: cancels Category: Evaluation / Measurement Wound, Miscella neous No Comments → The popular program for measuring wound through digital imag es, is provided by the author. Visit your page. http://www.hope-academic.org.uk/ staff/rtaylor/ Gneaupp The author has a document with instructions, translated into Spanish. ht tp://www.gneaupp.org/documentos/externos/mouseyes.pdf Ulcers of venous leg September 26, 2007 By: cancels Category: ulcer of venous leg, Concepts in the Tr eatment of Wounds Comments Off Ulcer of venous leg ulcers Venous represent the largest number of chronic wounds treated in community health. Are an issue of great expense of material and huma n resources. The treatment of this problem should be performed by experienced an d trained in their correct approach. Venous ulcers cause great discomfort to his patients which implies that, beyond the healing, comfort is also an objective o f treatment. Require therefore special attention in order to optimize care. Carl os Cancela Holistic approach to wounds difficult to heal EWMA launched the document in May 2008. Focuses on the approach to be difficult to heal wounds. A text reference conducted by authors with impeccable quality. " While some attention has been placed on understanding the biological factors inf luencing the delay in healing, relatively little has been placed on the psychoso cial factors involved. This document aims to balance this balance and look at ho w all these factors may have an impact on healing and affect the patient's life. "C. Moffat (Free Translation) As usual, the picture has the link to the document. Good reading. Pucla 2 April 30, 2008 By: cancels Category: Pressure ulcer, Evaluation / Measurement Wo und, Miscellaneous No Comments → EPUAP - Classification of pressure ulcers As promised,€I present the second version of the program pucla (PUClas2) which i s available on the website of the European Pressure Ulcer Advisory Panel. (A tea ser for the force feedback did not result). The pucla is a program developed by EPUAP to serve as a tool to study the subject Pressure Ulcer, especially as rega rds its classificação.Um clear improvement over the original version. Very well organized and illustrated. A job not to be missed for a good understanding of th e dynamics surrounding the classification of ulceration of the tissues caused by excessive pressure. Tests are yet available for version 1 and 2. On the page of choice of language can also find some exercises on prevention of pressure ulcer s. Pena is not yet available in Portuguese. The test of version 2 adds pucla a b rief explanation of the wound, but enough to notice the position of Authors. The figures are the addresses for the Portuguese version and exercises in English. PUSH Tool

December 16, 2007 By: cancels Category: Pressure ulcer, Evaluation / Measurement Wound, Miscellaneous No Comments → P U S H Tool The PUSH tool for measuring and evaluating the progression of pressure ulcers wa s presented in 1998 by NPUAP (National Pressure Ulcer Advisory Panel), a North A merican association that is dedicated to the study of pressure ulcers. A PUSH-PT , the Portuguese version, which is the site of GAIF has validated for the Portug uese population. A partnership GAIF and CEIS. As a research tool, validated scal es should not be changed. The addresses below are for sites where the scale and instructions. http://www.npuap.org/PDF/push3.pdf http://www.gaif.net/artigos/EscaladeCicatriza caoInstrAvaliacao.pdf http://www.lhcr.org/PDF/nh/PUSH% 20Tool_1.6.04_P187 . pdf http://www.novartisnutrition.com/pdfs/us/moreproductinfo/PUSH_Tool_03.pdf http:/ /www.cfmc.org/files/nh/PUSHTool_Frantz092603-rev.pdf http://www.o-wm. com/articl e/1868 http://www.scielo.br/pdf/rlae/v13n3/v13n3a04.pdf Pucla December 08, 2007 By: cancels Category: Pressure ulcer, Miscellaneous No Comment s → Pressure Ulcer Classification Tom Defloor, Michael Clark. A classification of pressure ulcers presented in a f ormat that allows for deeper knowledge about the subject. Besides the theoretica l component, has a practical test with images that help to realize our capabilit ies in the evaluation of the wound. I must say that in some photos, especially w hen you have to choose whether or not the wound is a pressure ulcer or erythema Unbleached or not, the photos get in the way a bit. Probably in clinical practic e would be easier. Still a good test for our conhecimentos.Clicando the images a re the links of the English version (EPUAP) and Spanish (GNEAUPP). When you find the online version and the Portuguese version Puclas2, add. Good Practice. Lumte December 04, 2007 By: cancels Category: Leg ulcer venous No Comments → http://www.sjhc.london.on.ca/parkwood/programs/services/wound/keast1.pdf "lumte" an acronym that stirred my attention. "Leg Ulcer Measurement Tool". A relativel y new concept that involves the issue of records. This 2004 text presents some i nteresting data for USA. Read and comment. Understanding compression therapy September 29, 2007 By: cancels Category: Leg ulcer venous No Comments → A refere nce work produced by EWMA on compression therapy. It is of great value to all th ose who feel the need to understand the concepts that involve the compression th erapy. The document is in PDF. Guidelines EWMA Ulcers of venous leg September 26, 2007 By: cancels Category: ulcer of venous leg, Concepts in the Tr eatment of Wounds Comments Off Ulcer of venous leg ulcers Venous represent the largest number of chronic wounds treated in community health. Are an issue of great expense of material and huma n resources. The treatment of this problem should be performed by experienced an d trained in their correct approach. Venous ulcers cause great discomfort to his patients which implies that, beyond the healing, comfort is also an objective o f treatment. Require therefore special attention in order to optimize care. Carl os Cancela

Chronic Wounds September 26, 2007 By: cancels Category: Chronic Wounds Comments Off Chronic wounds represent a major challenge to a health professional. Since the r esistance to treatment of the condition imposed by the behavior of the user with a chronic problem, are numerous and various necessary skills. There are several definitions of chronic wounds and they all fit well the problem.€Soon will be a sked some definitions. Carlos Cancela Clean surgical wounds heal, overall, quickly. The chronic wounds, which include pressure ulcers and venous ulcers, hypertension, raise complex issues can be add ressed simultaneously. Bacterial colonization of chronic wounds is a constant, w ith the consequent risk to represent a gateway to deep or systemic infections (c ellulitis, osteomyelitis, septicemia). Thus it must be given greater attention t o local care, particularly in the surgical cleaning and use of appropriate dress ings, factors that reduce the risks mentioned and facilitate the healing process . There should be local or systemic antibiotic used to solve problems of coloniz ation. If there is infection involving deeper (erysipelas, cellulitis) Systemic antibiotics are indicated. Can you reduce the pain and faster recovery with alginate dressings, hydrocolloi ds, hydrogels and hydropolymers. The choice between different products varies ac cording to three main parameters: a) personal history (history of allergies or i ntolerances), b) clinical characteristics of the wound (edges, length, depth, lo cation, secondary infection and healing phase), c ) general symptoms of the woun d (pain, bleeding, inflammation). These different classes of dressings promote: 1 - healing in a humid climate, promotes cell migration, particularly of macroph ages and 2 - protection against spoilage by bacteria and other injuries, and gre ater comfort for the patient. Synthetically, these are the characteristics of ea ch type of thinking, Hydrocolloid - Composition: polymer of carboxymethylcellulo se (in pectin or gelatin) in polyurethane film - Properties: moderately absorben t, semi-permeable (allow gas exchange); adhere to healthy skin (non-adherent to the wound); good impression on uneven surfaces - Hints: low exuding wounds, prom otes granulation, can be used in all stages of healing - Adverse effects: macera tion at the edges; stench - Presentation: adhesive plaques of variable size or f older; - Method and application rate: replacement every 5-7 days did not require secondary dressing. Hydrogel - Composition: polymer cellulose (CMC), hydrated t o 75%, - Properties: release water in the wound bed, hydrating, not very absorbe nt, non-adherent, impermeable, transparent (allow inspection) - Indications: wou nds dried without exudate; promote re-epithelialization - Adverse effects: "real location" to think, when poorly occluded - Presentation: non-adhesive plates of varying lengths; gels; - Method and application rate: replacement every 3-5 days; require appropriate s econdary dressing (eg occlusive polyurethane film or hydrocolloid). Alginates Composition: alginic acid polymers (calcium alginate) - Properties: very absorbe nt and haemostatic; favor wound debridement, porous, non-members - Indications v ery exudative wounds or bleeding, can be applied to infected wounds, diminish od or; - Adverse effects: drying of the wound (can join hydrogel) - Presentation: n on-adhesive bandages - mode and pace of implementation: replacement every 3-5 da ys, require secondary dressing (occlusive polyurethane film) . Hydropolymers - C omposition: "foam" of hydrophilic polyurethane-coated waterproof film (also call ed "Hidrocelulares) - Properties: very absorbent, non-adherent to the wound; mol dable - Indications at all stages of the healing process, in all types of injuri es (including "cavities"); reduce the odor - Adverse effects: drying of the woun ds - Presentation: bandages, adhesive and non adhesive foam adaptable to cavitie s - Method and application rate: replacement 3-5 days; presentations do not requ ire adhesive secondary dressing. The activated charcoal activated charcoal dress ings are composed of two layers (internal and external) of nonwoven fabric withi n which there is an intermediate layer of activated carbon. This is characterize d by having a high deodorizing ability once adsorbed to the surface molecules re

sponsible for the stench. In addition to these molecules, absorbs water, bacteri a and other components present in the exudate. These properties make these dress ings are indicated for wounds with a bad odor, or infected with moderate amounts of exudates including pressure sores and leg (vascular or diabetic origin)€as w ell as oncologic wounds. In the case of exuding wounds the dressing may just sti ck to the skin so it can be applied hydrogel in the wound before applying the pa tch. For coal to remain active for longer associate with some activated charcoal dres sings alginate and carboxymethylcellulose (eg Carboflex ) for absorption of exu dates. Other dressings associate with activated charcoal silver, which has bacte ricidal properties (Actisorb Silver ). These dressings should not be cut becaus e of the risk of dispersing the carbon particles constituting foreign bodies in the wound. Require a secondary dressing and its daily change should be infected, and may stay longer in the cases and just exuding wounds. Aquacel - a hydrofiber "compress non-woven fibers composed of hydrocolloid (CMC) " - absorbs fluids from the wound (only vertically) to form a gel - used on woun ds with moderate to high exudate; - Hydrogel - composed of complex organic polym ers that contain a high percentage of water (between 30-90%) - for wounds with l ow to moderate exudate - creates a moist wound environment - facilitates autolys is, granulation, epithelialization, - not in use highly exudative wounds - some need secondary dressing (eg hydrocolloid) - can macerate the surrounding skin can be used with bandages with microbial activity. Already now one input on auto lytic debridement: "The autolysis is the natural degradation of the enzymes util izing devitalized tissues of the body and the moisture of the wound bed to rehyd rate, soften and liquefy the necrotic tissue" As in wounds with necrotic tissue and mild to moderate exudate . If we want a treatment, enhance the effect autolytic, the more accurate will pot entiate the action of the hydrogel with a hydrocolloid, thus keeping the wound b ed in an excellent moisture to give this type of debridement. If the nurse "try" a hydrogel to moisten the wound and then ..... then "stick" w ith a hydrofiber upon which will surely absorb all the moisture is undoubtedly a treat to blame! After admiring themselves dem when you take the half ... Aquace l wound comes with it (all dry). This gives to solve, just above the pads that a re on top of Aquacel is placed a layer of biofilm, which controls the perspirati on of the wound, not allowing them to stay dry so intensely. In the treatment of a chronic wound the wet is critical to the healing process so that when you wan t to debride devitalized tissue to the action of a hydrogel should be enhanced b y a kind of think that promotes moisture as is the case of hydrocolloids, ie fav oring fibrinolysis and simultaneously promote the growth of granulation tissue. In wounds with little exudate this is the best treatment in my view. To proceed with debridement of devitalized tissue can potentiate the action of the hydrogel with ulcerase, yet the use of collagenase're contraindicated in addition to dre ssings containing silver in its composition or zinc as has already been said. Ho wever, in the case of moderate to highly exuding wounds with presence of necroti c tissue and / or fibrinous not see why not use a hydrofiber with the hydrogel a s it has effect Dressing absorbent but its absorption is done vertically, not ma cerate the surrounding area contrary to hydrocoloidal ... Everything depends on the amount of exudate and the residence time of the dressing. Ferid AS Covering all types of injuries such as trauma and burns, pressure ulcers, venous ulcers and pressure, in addition to the surgical wound dehiscence. Use of treat ment resources specific to each type of wound, with evaluation of factors relate d to clinical conditions of each patient, the stage of wound. Pressure ulcer ven ous or arterial ulcer diabetic ulcer wounds Burns Trauma surgical characteristic s of a dressing for a good outcome of the healing of a wound are given by: Effic iency in its operations: it facilitates the removal of necrotic tissue, prevents

 

 

the formation of fibrin thickenings not adhere to the wound bed, to prevent con tamination and bacterial growth, maintain an adequate level of moisture in the w ound bed to stimulate the formation of granulation tissue, protecting the injury from external aggression and stimulate healing. Efficiency in the application: ease of use, ease of removal, which extends the time inter-trade. Good acceptanc e: do not be irritating or allergenic, does not produce pain, easy and comfortab le use. The products used are organic, such as calcium alginate, hydrocolloid ge l or plate, activated carbon, among others.€The product is selected according to the type and condition of the wound. healing process, the type, size and shape of UL WAX IS PRES The pressure for a prolonged period in a particular area of the body leads to lo cal ischemia, which is aggravated by the continuing pressure by preventing the p roper local blood circulation, causing a scar. The evaluation of a patient's wou nd requires scientific knowledge and professional acumen. The following guidelin es are basic and has no intention of running any treatment, leaving it to each o f the professional responsibility of individual conduct. Preventing the rise of pressure ulcers Changing position every 2 hours; adequate oral nutrition and hydration, moisturi zing the skin with emollient; Do not massage the bony protrusions to prevent the rupture of small blood vessels; prevent the shear force (body slides making fri ction between skin and muscle or bone) in position fowler and sitting in an armc hair; Use proper mattress as physical condition of the patient; Use appropriate cushion to the chair. DEALING WITH A PRESSURE ULCER GRADE IO stage I pressure ulcer is assessed by obs ervation of intact skin, erythema does not regress after removal of the pressure with decreased sensitivity in the area. All guidelines of the previous item, le aving the transparent film for up to seven days. Grade I pressure ulcer DEALING WITH A PRESSURE ULCER GRADE II Stage II pressure ulcer is assessed by th e commitment of the epidermis and / or dermis can be observed abrasion and / or flictemas and erythema. All Item prevention guidelines; Possible dressings as wo und assessment: hydropolymer; movie transparent screen non-adherent hydrogel pla te; hydrocolloid. Colonized or infected with frame: Dressing iodinated non-adher ent. Grade II pressure ulcers Dressing hydropolymer TREATING A LEVEL III Pressure Ulcer Stage III pressure ulcer presents total loss of skin, cellulite, erosion, exposed muscle fascia, necrosis, exudate. All Item prevention guidelines; Attention to clinical examination and complementary exam inations, following medical advice. Alternative healing as assessment of the wou nd, observing the healing process: With With With With With dry necrosis: hydrog el associated with the transparent film or hydrocolloid devitalized soft tissue (gray, brown or yellow): hard to devitalized tissue hydrogel: hydrogel devitaliz ed tissue soft and moist: alginate hydrogel or framework for colonization or inf ection: coal dressing activated and silver, associated with hydrogel if necessary. With granulation ti ssue: collagen wound dressing with alginate - cell regenerator; hydrogel - maint ains the humidity alginate - maintains the humidity hydropolymer - protection an d absorption of exudate Phase Epitelization - hydropolymer - Film transparent -

non-adhesive screen - Card hydrogel Pressure ulcer grade III DEGREE OF TREATING ULCER Stage IV pressure sore Grade IV presents the destructio n of muscle and may affect tendons and bones, infection, necrosis, exudate and f oul smell. All guidelines of the previous item; Alternative dressings as wound s tatus assessment: With With With With With dry necrosis: hydrogel associated wit h transparent film or hydrocolloid devitalized soft tissue (gray, brown or yello w): hydrogel slough tough: hydrogel tissue devitalized soft and moist: alginate hydrogel or framework for colonization or infection: coal dressing activated and silver, together with the hydrogel if necessary. With exposure of bone or tendon: protect with hydrogel or screen With non-adherent granulation tissue - collagen dressing with alginate cell rege nerator; hydrogel - maintains the humidity - alginate - maintains the humidity hydropolymer - protection and absorption of exudate. Phase Epitelization - hydr opolymer - Movie Pressure ulcer stage IV UL WAXES VENOUS D The PERN The Venous disease is the main contributing factor for ulcers of the lower limbs. Ot her common causes of ulcers, lower limbs, are: arterial insufficiency, pressure, and neuropathy. When venous return is compromised due to malfunction of the val ves or muscle pump, the blood pressure in the lower limbs increases and remains high (venous hypertension). Prolonged venous hypertension can lead to edema, tis sue changes and, finally, ulceration. The factors that disrupt the normal functi on of the venous system may be: deep vein thrombosis, congestive heart failure, valvular incompetence, obesity, pregnancy and muscle atrophy. The healing of suc h ulcers is usually slow.€Venous ulcers also have a very high rate of recurrence . Potential causes of leg ulcers can be: Venous insufficiency, arterial insuffic iency, diabetic neuropathy, pressure, sickle cell anemia, rheumatoid arthritis, systemic lupus, squamous cell carcinoma, malignant melanoma, basal cell carcinom a Proper diagnosis of venous ulcers is essential, so as the medical monitoring o f venous hypertension and its effects. In terms of ulcer treatment, it is important to eliminate or control the barrier s to healing such as infection, devitalized tissue or foreign material in the wo und bed, maintaining an ideal environment for wound healing with the use of abso rbents, moisturizers appropriate protective or curative. Ulcer with necrotic tis sue Venous ulcers rarely have significant devitalized or necrotic tissue, but wh en present must be removed through some type of debridement. One method is autol ytic debridement, using dressings that retain moisture to keep the endogenous en zymes in the wound surface, so that the digest devitalized tissues. This method is more selective and less invasive, yet it is the most time consuming. Ulcer infected or colonized To allow the healing process, the ulcer should be with the bacterial levels in a controlled environment. To accomplish that we have the alternative of dressing activated charcoal and silver, which consists of a pad of nonwoven fabric surrou nding a charred impregnated with silver. Bacteria and odor molecules are adsorbe d in the pores of the charred fabric and silver kills bacteria. While there are superficial ulcer colonized have the alternative of iodinated non-adherent dress ing.

Venous ulcers with slough Treated with alginate hydrogel for autolytic debridement and dressing of activat ed charcoal and silver for decolonization. After four days, with dressing change every two days. Superficial ulcer clean this stage the excess moisture must be controlled to avo id hipergranulação and allow the process of healing. The alternatives for achiev ing this purpose are the hydropolymers dressings, fabrics and non-adherent colla gen. Superficial venous ulcer with granulation tissue After dressing screen with non-adherent to exchange every 3 days, changing only the secondary dressing (gauze or padded) daily to prevent an excessive age. Can be associated with the collagen dressing to speed healing. The ulcers hipergranuladas hipergranulação is the result of excess moisture in t he process of healing. In hipergranulações discrete telanão can use the stick. O n the highest we can use the dressing iodinated non-adherent. In both cases, cha nges to the screen every 2-3 days, changing the coverages are only secondary (or padded gauze) daily, avoiding excess moisture in the wound. One of therapies fo r venous insufficiency are compression bandages and prolonged external graduate, applied from the forefoot to just below the knee. The compression counteracts m any of the effects of hypertension, especially edema. For the patient, instructi ons, support and reinforcement of the need and a lifelong commitment to therapy are essential not only to treat an ulcer, but even prevent future occurrences. DIABETIC FOOT ULCERS The diabetic foot ulceration is a complication in diabetic patients. The most se rious complications such as infection, gangrene or amputation can be prevented t hrough early intervention and aggressive, with regular medical examinations and instructions on an ongoing basis. The type of conduct selected for the treatment of the wound depends on the evaluation of the wound. The standard of care of th e wounds are the same as applied to maintain the wound bed moist, they are absor bent and protective. The goals of treatment are located include: removal of necrotic tissue wound Pro tection Maintenance of moisture from the wound bed protection of the surrounding tissue absorption of exudate Prevention of infections Disposal of dead spaces A basic concept for the selection of dressings is: if in exudation , absorb it. I f it is dry, provide moisture. Because of the diversity of dressings available, it will be easier to group them by type and function and then undertake the sele ction according with the evaluation of the wound. Hydrogels: are water-based products and polyme rs. Hydrate dry wounds, moisturize and soften the necrotic tissue and assist in autolytic debridement. Activated charcoal and silver cushion containing activate d carbon impregnated with silver 0.15%, with coverage of low grip.€The activated carbon absorbs exudate, bacteria and retains the odor filters, silver exerts a bactericidal action. Collagen: When combined with an alginate, facilitate hemost asis, stimulate the autolytic debridement and attract granulocytes and fibroblas ts to the wound bed, promoting cell proliferation. In patients with chronic woun d or compromised, it is beneficial, because the natural production of collagen b y the body is often below normal. Impregnated Gauze: are impregnated with petrol eum jelly, oily emulsions or with antimicrobial, provide adequate moisture, prot ection and allows the passage of exudate. The non-adherent dressing iodine relea

ses PVPI gradually decreasing the bacterial load site. Alginates: are boards or branches of absorbent fibers and combined, made from seaweed salts which are con verted into gel as they absorb exudate, keeping the wound bed moist, stimulates autolytic debridement. Some find themselves with alginate dressings combined wit h collagen, which is beneficial in promoting homeostasis, regeneration and recon struction of the wound. Foams: absorbent pads are made of polyurethane or hydrop olymers and designed to drive out the exudate, protecting the tissue surrounding the wound, some gently expands to fill the dead space, thereby presenting an ad hesive edge. The foam dressings can be used both as primary and secondary dressi ngs. Growth Factors: platelet-derived, usually found in the blood is distributed in the form of gel to be applied to the wounds. Promotes cell migration and pro liferation of cells necessary for healing. Transparent films: films are transparent polyurethane, elastic and sterile. Occl ude the wound and adhering only to intact skin and have a transmission rate of w ater vapor because the pore diameter and may be impermeable or semipermeable, al lowing the release of gases and water evaporation. Bacterial and viral barrier, maintains moist environment between the wound and coverage, promoting healing. B y being transparent, allowing a preview of ferida.Também used as a secondary dre ssing. CARING FOR THE FEET Besides all the important parameters to be controlled in a diabetic patient, as the blood glucose level, diet, smoking, exercise, etc.. We have to provide basic care for prevention of ulcers: Examine your feet daily, if necessary, use a mir ror. Wash your feet daily and dry it well, especially between the toes. Always t est the water temperature first with your hands. Moisturize the skin after bathi ng when skin is dry. Do not spend moisturizer between your toes. Cut toenails st raight cut or ask your doctor or specialist nurse that the court, if you have th ick or hard. Use everyday socks that do not have holes or coarse darning. Check the presence of foreign objects inside shoes before reuse. Before purchasing sho es, always measure your feet, preferably in the afternoon when your feet hit its largest size. If deformities, the best choice will be therapeutic footwear / or thotic. Consult a doctor immediately observe the development of blisters or inju ries UL WAXES VENOUS D The PERN The Venous disease is the main contributing factor for ulcers of the lower limbs. Ot her common causes of ulcers, limb below, are: arterial insufficiency, pressure, and neuropathy. When venous return is compromised due to malfunction of the valves or muscle pump, the blood press ure in the lower limbs increases and remains high (venous hypertension). Prolong ed venous hypertension can lead to edema, tissue changes and, finally, ulceratio n. The factors that disrupt the normal function of the venous system may be: dee p vein thrombosis, congestive heart failure, valvular incompetence, obesity, pre gnancy and muscle atrophy. The healing of such ulcers is usually slow. Venous ul cers also have a very high rate of recurrence. Potential causes of leg ulcers ca n be: Venous insufficiency, arterial insufficiency, diabetic neuropathy, pressur e, sickle cell anemia, rheumatoid arthritis, systemic lupus, squamous cell carci noma, malignant melanoma, basal cell carcinoma Proper diagnosis of venous ulcers is essential, so as the medical monitoring of venous hypertension and its effec ts. In terms of ulcer treatment, it is important to eliminate or control the bar riers to healing such as infection, devitalized tissue or foreign material in th e wound bed, maintaining an ideal environment for wound healing with the use of absorbents,€moisturizing or protective dressing appropriate.

Ulcer with necrotic tissue Venous ulcers rarely have significant devitalized or necrotic tissue, but when present must be removed through some type of debrideme nt. One method is autolytic debridement, using dressings that retain moisture to keep the endogenous enzymes in the wound surface, so that the digest devitalize d tissues. This method is more selective and less invasive, yet it is the most t ime consuming. Ulcer infected or colonized To allow the healing process, the ulcer should be with the bacterial levels in a controlled environment. To accomplish that we have the alternative of dressing activated charcoal and silver, which consists of a pad of nonwoven fabric surrou nding a charred impregnated with silver. Bacteria and odor molecules are adsorbe d in the pores of the charred fabric and silver kills bacteria. While there are superficial ulcer colonized have the alternative of iodinated non-adherent dress ing. Venous ulcers with slough Treated with alginate hydrogel for autolytic debridement and dressing of activat ed charcoal and silver for decolonization. After four days, with dressing change every two days. Superficial ulcer clean this stage the excess moisture must be controlled to avo id hipergranulação and allow the process of healing. The alternatives for achiev ing this purpose are the hydropolymers dressings, fabrics and non-adherent colla gen. Superficial venous ulcer with granulation tissue After dressing screen with non-adherent to exchange every 3 days, changing only the secondary dressing (gauze or padded) daily to prevent an excessive age. Can be associated with the collagen dressing to speed healing. The ulcers hipergranuladas hipergranulação is the result of excess moisture in t he process of healing. In hipergranulações discrete telanão can use the stick. O n the highest we can use the dressing iodinated non-adherent. In both cases, cha nges to the screen every 2-3 days, changing the coverages are only secondary (or padded gauze) daily, avoiding excess moisture in the wound. One of therapies fo r venous insufficiency are compression bandages and prolonged external graduate, applied from the forefoot to just below the knee. The compression counteracts m any of the effects of hypertension, especially edema. For the patient, instructi ons, support and reinforcement of the need and a lifelong commitment to therapy are essential not only to treat an ulcer, but even prevent future occurrences. DIABETIC FOOT ULCERS The diabetic foot ulceration is a complication in diabetic patients. The most se rious complications such as infection, gangrene or amputation can be prevented t hrough early intervention and aggressive, with regular medical examinations and instructions on an ongoing basis. The type of conduct selected for the treatment of the wound depends on the evaluation of the wound. The standard of care of th e wounds are the same as applied to maintain the wound bed moist, they are absor bent and protective. The goals of treatment are located include: removal of necrotic tissue wound Pro tection Maintenance of moisture from the wound bed protection of the surrounding tissue absorption of exudate Prevention of infections Disposal of dead spaces A

basic concept for the selection of dressings is: if in exudation , absorb it. I f it is dry, provide moisture. Because of the diversity of dressings available, it will be easier to group them by type and function and then undertake the sele ction according with the evaluation of the wound. Hydrogels: are water-based products and polyme rs. Hydrate dry wounds, moisturize and soften the necrotic tissue and assist in autolytic debridement. Activated charcoal and silver cushion containing activate d carbon impregnated with silver 0.15%, with coverage of low grip. The activated carbon absorbs exudate, bacteria and retains the odor filters, silver exerts a bactericidal action. Collagen: When combined with an alginate, facilitate hemost asis, stimulate the autolytic debridement and attract granulocytes and fibroblas ts to the wound bed, promoting cell proliferation. In patients with chronic woun d or compromised, it is beneficial, because the natural production of collagen b y the body is often below normal. Impregnated Gauze: are impregnated with petrol eum jelly, oily emulsions or with antimicrobial, provide adequate moisture, prot ection and allows the passage of exudate. The non-adherent dressing iodine relea ses PVPI gradually decreasing the bacterial load site.€Alginates: are boards or branches of absorbent fibers and combined, made from seaweed salts which are con verted into gel as they absorb exudate, keeping the wound bed moist, stimulates autolytic debridement. Some find themselves with alginate dressings combined wit h collagen, which is beneficial in promoting homeostasis, regeneration and recon struction of the wound. Foams: absorbent pads are made of polyurethane or hydrop olymers and designed to drive out the exudate, protecting the tissue surrounding the wound, some gently expands to fill the dead space, thereby presenting an ad hesive edge. The foam dressings can be used both as primary and secondary dressi ngs. Growth Factors: platelet-derived, usually found in the blood is distributed in the form of gel to be applied to the wounds. Promotes cell migration and pro liferation of cells necessary for healing. Transparent films: films are transparent polyurethane, elastic and sterile. Occl ude the wound and adhering only to intact skin and have a transmission rate of w ater vapor because the pore diameter and may be impermeable or semipermeable, al lowing the release of gases and water evaporation. Bacterial and viral barrier, maintains moist environment between the wound and coverage, promoting healing. B y being transparent, allowing a preview of ferida.Também used as a secondary dre ssing. CARING FOR THE FEET Besides all the important parameters to be controlled in a diabetic patient, as the blood glucose level, diet, smoking, exercise, etc.. We have to provide basic care for prevention of ulcers: Examine your feet daily, if necessary, use a mir ror. Wash your feet daily and dry it well, especially between the toes. Always t est the water temperature first with your hands. Moisturize the skin after bathi ng when skin is dry. Do not spend moisturizer between your toes. Cut toenails st raight cut or ask your doctor or specialist nurse that the court, if you have th ick or hard. Use everyday socks that do not have holes or coarse darning. Check the presence of foreign objects inside shoes before reuse. Before purchasing sho es, always measure your feet, preferably in the afternoon when your feet hit its largest size. If deformities, the best choice will be therapeutic footwear / or thotic. Consult a doctor immediately observe the development of blisters or inju ries BURNS treatment of burns involves the active participation of many professionals , doctors and paramedic and is a multidisciplinary team to assist an efficient a nd conducive to a quick rehabilitation. Degree Burn Degree burn means determining the depth of burn injuries to the skin.

• • • Injury first degree: reaches the outermost layer of skin, the epidermis, which i s presented hyperemia in the absence of bubbles or blisters. EX: erythema by sun light or warm water; Injury second degree: it affects both the epidermis and der mis and has a surface and pink bubbles or blisters. Ex: blisters caused by therm al injury caused by superheated liquid; Injury third grade: it affects all the l ayers of the dermis, may also affect other tissues such as subcutaneous tissue, muscle and bone tissue. The appearance is pale and with a surface hardened. Eg e lectrical or thermal burns.; The service covers the burned a huge assistance from the evaluation of respirato ry insufficiency, venous access to an efficient hemodynamic support, analgesia a nd immediate cooling of the burned area. Topical treatment follows the protocol of each institution, paying attention to each client features a case with indivi dual assessment. The alternatives range from coverage of the wound as needed: • Impregnated Gauze: are impregnated with petroleum jelly, oily emulsions or with antimicrobial, provide adequate moisture protection, and allow the passage of ex udate. The non-adherent gauze is a viscose rayon, impregnated with petrolatum, which al lows the dressing change without pain, being changed every 2-5 days. Should be c overed with a secondary coverage for absorption of exudate, which should be repl aced when saturated. Also used for protection of tendon or bone. The iodinated n on-adherent dressing is impregnated with 10% polyvinylpyrrolidone, releasing PVP I gradually decreasing the bacterial load site. Used in small regions necessary to exchange every 2-3 days, up to four exchanges, trading is only the secondary dressing when saturated. • Hydrogel on board: it is an occlusive dressing consisting of polyvinylpyrrolidon e and water, coated with a polyethylene film that protects both sides. Maintains moist environment that encourages autolytic debridement; hydrates the bed minim izing pain and discomfort of the patient. Used in burns of first and second degr ee; sunburn; donor and recipient graft, can be fixed with a transparent film or tape. Alginate Hydrogels: are water-based products and polymers. Hydrate dry wou nds, moisturize and soften the necrotic tissue and assist in the debridement aut olítico.O component alginate increases its consistency facilitating its applicat ion and residence within the lesion. Activated charcoal and silver cushion conta ining activated carbon impregnated with silver 0.15%, with low coverage aderênci a.Utilizada in infected wounds, • • • • • •

• may be associated with the hydrogel. The activated carbon absorbs exudate, bacte ria and retains the odor filters, silver exerts a bactericidal action. Collagen: When combined with an alginate, facilitate hemostasis, stimulate the autolytic debridement and attract granulocytes and fibroblasts to the wound bed, promoting cell proliferation. In patients with chronic wound or compromised, it is benefi cial, because the natural production of collagen by the body is often below norm al. At the stage of epithelization may be associated with non-stick gauze or hyd ropolymer. Alginates: are boards or branches of absorbent fibers and combined, m ade from seaweed salts which are converted into gel as they absorb exudate, keep ing the wound bed moist, stimulates autolytic debridement. Some find themselves with alginate dressings combined with collagen, which is beneficial in promoting homeostasis, regeneration and reconstruction of the wound. Foams: absorbent pad s are made of polyurethane or hydropolymers and designed to drive out the exudat e, protecting the tissue surrounding the wound, some gently expands to fill the dead space, thereby presenting an adhesive edge. The foam dressings can be used both as primary and secondary dressings. Growth Factors: platelet-derived, usual ly found in the blood is distributed in the form of gel to be applied to the wou nds. Promotes cell migration and proliferation of cells necessary for healing. D ermal Regeneration Matrix: is a system of two layers, used for dermal replacemen t, with a layer of regenerating dermal and epidermal layer provisional. It is in dicated for the treatment of post-excisional full-thickness lesions and partial, for which no autograft enough available at the time of excision, or autograft i s not desirable due to the physiological condition of the patient. Traumas The traumatic wound care, medical evaluations should follow as with surgical or clinical needs. In major trauma to wound cleaning is done under anesthesia and s hould be washed with saline to remove foreign bodies, hematomas and other debris , and unbridled any necrotic material. Traumatic wound unable to surgical recons truction, it follows the procedure a bandage that maintains a moist environment to prevent necrosis and facilitate cellular proliferation, and protects it from infections. The alternatives range from coverage of the wound as needed: • Impregnated Gauze: are impregnated with petroleum jelly, oily emulsions or with antimicrobial, provide adequate moisture protection, and allow the passage of ex udate. The non-adherent gauze is a viscose rayon, impregnated with petrolatum, which al lows the dressing change without pain, being changed every 2-5 days. Should be c overed with a secondary coverage for absorption of exudate, which should be repl aced when saturated. Also used for protection of tendon or bone. The iodinated n on-adherent dressing is impregnated with 10% polyvinylpyrrolidone, releasing PVP I gradually decreasing the bacterial load site. Used in small regions necessary to exchange every 2-3 days, up to four exchanges, trading is only the secondary dressing when saturated. • • Alginate Hydrogels: are water-based products and polymers. Hydrate dry wounds, m oisturize and soften the necrotic tissue and assist in the debridement autolític o.O component alginate increases its consistency facilitating its application an d residence within the lesion. Hydrogel on board: it is an occlusive dressing co nsisting of polyvinylpyrrolidone and water, coated with a polyethylene film that protects both sides. Maintains moist environment that encourages autolytic debr idement; hydrates the bed while minimizing pain and

patient discomfort.€Used in superficial injuries, burns first and second degree; sunburn, areas of graft donors and recipients, can be secured with a transparen t film or tape. • • • • Activated charcoal and silver cushion containing activated carbon impregnated wi th silver 0.15%, with low coverage aderência.Utilizada in infected wounds, and m ay be associated with the hydrogel. The activated carbon absorbs exudate, bacter ia and retains the odor filters, silver exerts a bactericidal action. Collagen: When combined with an alginate, facilitate hemostasis, stimulate the autolytic d ebridement and attract granulocytes and fibroblasts to the wound bed, promoting cell proliferation. In patients with chronic wound or compromised, it is benefic ial, because the natural production of collagen by the body is often below norma l. At the stage of epithelization may be associated with non-stick gauze or hydr opolymer. Alginates: are boards or branches of absorbent fibers and combined, ma de from seaweed salts which are converted into gel as they absorb exudate, keepi ng the wound bed moist, stimulates autolytic debridement. Some find themselves w ith alginate dressings combined with collagen, which is beneficial in promoting homeostasis, regeneration and reconstruction of the wound. Foams: absorbent pads are made of polyurethane or hydropolymers and designed to drive out the exudate , protecting the tissue surrounding the wound, some gently expands to fill the d ead space may submit an adhesive edge. The foam dressings can be used both as primary and secondary dressings. Surgical Wounds The surgical incisions and lacerations are taken to clean the wound healing by f irst intention, which is when the edges of a wound are reapproximated at the tim e of injury and approximated with sutures, staples or adhesive, where the re-epi thelialization occurs rapidly. The choices of coverage will depend on the charac teristic of the incision. In cases of incisions that can suffer postoperative dr ainage, we use covers that are absorbent and exchanged in 24 hours or 48 hours. After this period, if the edges are well approximated and the suture line is dry , the incision can be left open to air, or use transparent film to prevent exoge nous infection, and accelerate the epithelialization, reduce pain and provide co mfort and sense of protection for the patient. When the edges of the wound are n ot possible approach and a space is left to be filled with granulation tissue he aling occurs by secondary intention, as the procedure for resection of pilonidal cyst. In cases of wounds that are programmed the delayed primary closure, heali ng occurs by third intention, ie, keep the wound open, allowing healing by secon dary intention is realized and then bringing the edges. Happens in cases of dehi scence of incision infection, fasciotomies, edema, and others. In these cases, t he alternative coverage of the latest generation products should retain adequate moisture in the wound bed, promoting cell regeneration and bactericidal when ne cessary. Among them are: Collagen with alginate: Applied on wounds clean and moi st, facilitating hemostasis, stimulate the autolytic debridement and attract gra nulocytes and fibroblasts to the wound bed, promoting cell proliferation. Hydrog els: are water-based products and polymers. Hydrate cavity wounds and assist in autolytic debridement. The alginate component in helping a longer period of rete ntion of moisture in the wound bed. Activated charcoal and silver: Applied in cases of colonized or infected wounds.

Pad containing activated carbon impregnated with silver 0.15%, with low coverag e aderência.O activated charcoal absorbs exudate, bacteria and retains the odor filters, silver exerts a bactericidal action. Gauze non-adherent: an alternative coverage in the more superficial lesions, it is a viscose rayon, impregnated wi th petrolatum, favors adequate moisture, protection and allow the passage of exu date. Alginates: are boards or branches of absorbent fibers and combined, made f rom seaweed salts which are converted into gel as they absorb exudate, keeping t he wound bed moist, stimulates autolytic debridement. Some find themselves with alginate dressings combined with collagen, which is beneficial in promoting home ostasis, regeneration and reconstruction of the wound. Foams: absorbent pads are made of polyurethane or hydropolymers and designed to drive out the exudate, pr otecting the tissue surrounding the wound;€some are expanding gently to fill the dead space, thereby presenting an adhesive edge. The foam dressings can be used both as primary dressings in cases of superficial wounds or as secondary in cas es of deeper wounds associated with another product to fill the dead space.