Prof. DavidWound Care Guidelines 2020 - Compressed

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Prof. Dr. David S Perdanakusuma, dr., SpBP-RE(K)

Plastic Reconstructive and Aesthetic Surgery Department
Faculty of Medicine Universitas Airlangga- Soetomo General Hospital
Surabaya - Indonesia
Diabetic Ulcer
Pressure Ulcer
Burn
Degloving Injury
3
WOUND
ACUTE CHRONIC
Inflammation -  Bacterial
ECM -  Non vital / necrotic
Epithelialization -  Exudate
HEAL DIFFICULT HEAL NOT HEAL
STABLE CHRONIC
4
Acute Inflammation è Chronic Inflammation
•  Neutrophils é
•  inflammatory cytokines é
•  Matrix degrading proteases é
•  Protease inhibitors ê
•  Degradation of growth factors
•  Impaired epithelialization
•  Breakdown of new tissue synthesis
•  Matrix deficiency state
•  Cell senescence (unresponsiveness)
THE GOALS OF
WOUND MANAGEMENT
Wound healing with stability and return to optimal function with
the least pain and least health care expenditure.
saving Infection pain

saving limb management
live control
optimal cost
complete and durable
function efficiancy
wound healing or stable
chronic wound the best cosmetic result
6
WOUND PROBLEM
DIABETIC
ULCER NECROTIC VARICOSUM
ULCER
PROBLEM

CRUSH
INJURY
DEHISENCE
BACTERIAL/ EXUDATE
PRESSURE
ULCER
INFECTION PROBLEM
PROBLEM
DEGLOVING
BURN
8
Patient
assessment
Algorhythm of
Wound Management Wound

diagnosis
Chronic
Prepare wound
Acute bed
Bacterial Management of Exudate

balance necrosis management
Antimicrobial Debridement Absorptive

therapy products
Prepared
wound
Primary Secondary Graft Flap
Healing wound
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Principal of Wound Bed Preparation
Inflammation Moisture Edge

Tissue
Infection Balance Wound
Does the wound Does the wound have signs Does the wound have Are the edges of the
contain non viable of bacterial contamina5on, excess exudate or is wound undermined and
5ssue such as infec5on or inﬂamma5on? the wound too dry? is the epidermis failing
necro5c 5ssue, to migrate across the
slough, non-viable granula5on 5ssue?
10
tendon or bone?
Assesment
SKIN AROUND
Color, moisture, flexibility
WOUND
SIZE & DEEP BED
Necrotic,
granulation,
fibrin, exudate,
bacterial
colonization
EDGE OF THE WOUND

Wound Management
Wound Bed Preparation
Wound Closure
15
Wound Bed Preparation
•  Surgical debridement
•  Mechanical debridement
Debridement •  Autolytic debridement
Discarding dead tissue •  Enzymatic debridement
Discarding foreign material
Cleansing contaminated tissue
•  Biological debridement
Bacterial Control (Bacterial Balance) •  Anti Bacterial
Exudate Management •  Moist

SURGICAL DEBRIDEMENT AUTOLYTIC DEBRIDEMENT

MECHANICAL DEBRIDEMENT
ENZYMATIC DEBRIDEMENT
BIOLOGICAL DEBRIDEMENT
MAGGOT DEBRIDEMENT THERAPY
The treatment of chronic wound is based on the

presen5ng problems, wound color and the hydra5on
level of the wound surface.
Furthermore, the moist condi5on will accelerate

epithelializa5on and will op5mize the environment for
self healing.
18
DRESSING
Not Only Wound Cover
19
Material Modern Dressing PDF Compressor Free Version
Hydroc
olloids

Hydrogels

Alginates

Antimicrobial silver
Absorbent Dre
ssing
Foams

Transparent Film

Black Necro5c
WET WOUND PROBLEMDRY
MOIST
WOUND WOUND
Yellow Necro5c Slough ABSORPS
Absorbent MANTAINS PROVIDE
Dressing Hydrocolloid Hydrogel/cream
Yellow Green Infec5on Hydroﬁbre Transparent
Calcium Dressing
Alginate
Foam
Red Granula5on

Pink Epitelializa5on
2
4
Minimalize Wound Expansion
Minimalize Site Infection
Minimalize Amputations
Minimalize Delay Wound Healing
Minimalize Recurrence
Minimalize Readmissions
Factors That Adversely Affect Wound healing
DIDN’T HEAL
D = Diabetes : diminishing sensation & arterial inflow, poor peripheral perfusion
I = Infection potentiates collagen lysis
D = Drugs : Steroid and antimetabolites impede proliferstion fibroblasts
and collagen synthesis
N = Nutritional Problems : Protein-calorie malnutrition, def. Vit A, C and Zinc
T = Tissue necrosis
H = Hypoxia : inadequate tissue oxygenation
E = Excessive tension : lead tissue ischemia and necrosis
A = Another wound : competition healing
L = Low temperature : slower healing
Assesment
Acut Chronic
Appearance Others
Problem Color Surface Odor
Infection/Bacterial Black Dry Bleeding

Necrotic Yellow
Wet Pain
Exudate Yellow Green
Moist
Red
27 Pink
Debridement
Epitelializa5on
Accelerate Healing
Silver/Ag
An5bio5c
Exudate Control
Thank You

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Prof. Dr. David S Perdanakusuma, dr., SpBP-RE(K)

HEAL DIFFICULT HEAL NOT HEAL

saving Infection pain

Wound Management Wound

Bacterial Management of Exudate

Antimicrobial Debridement Absorptive

Primary Secondary Graft Flap

Principal of Wound Bed Preparation

Inflammation Moisture Edge

EDGE OF THE WOUND

Wound Bed Preparation

Bacterial Control (Bacterial Balance) • Anti Bacterial

Exudate Management • Moist

SURGICAL DEBRIDEMENT AUTOLYTIC DEBRIDEMENT

The treatment of chronic wound is based on the

Furthermore, the moist condi5on will accelerate

Not Only Wound Cover

Minimalize Wound Expansion

Minimalize Site Infection

Minimalize Delay Wound Healing

Problem Color Surface Odor

Infection/Bacterial Black Dry Bleeding

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Bacterial Control (Bacterial Balance) •  Anti Bacterial

Exudate Management •  Moist