Wound Assessment and

Dressing Choices

Meirizal MD
RSUP DR.SARDJITO
FKKMK GADJAH MADA YOGYAKARTA
 Anatomy of the Skin
• The largest organ of the
body.
• Skin has 3 layers :
1. Epidermis
2. Dermis
3. Hypodermis
(Subcutaneus tissue)
 Wound Classification
Acute Wound  Sudden disruption of skin integrity usually due to trauma or
surgery
 Wound Classification
Chronic Wound  wound that failed to proceed through an orderly and
timely process to produce anatomic and functional integrity
Wound Appearance
 Wound Appearance
• Callus • Eschar
Wound Fluid
Wound Fluid
 Normal Wound Healing

1. Gonzales ACO, Andrade ZA. Wound Healing – A literature Review. An Bras Dermatol. 2016;91(5):614-620
1. MacEwan MR, MacEwan S, Kovacs TR, Batts J. What Makes the Optimal Wound Healing Material? A Review of Current Science and Introduction of a Synthetic Nanofabricated Wound Care
Scaffold. Open access Review Article. 2017
 Wound dressing
Purposes of wound dressing :
 Give optimal environment for wound healing
 Absorb exudate
 Protect the wound and new epithelial tissue from
further mechanical injury.
 Prevent bacteria contamination
 To improve hemostasis
 Prevent bad odor from wound
 Optimal Wound Dressing
a) Provide or maintain moist environment
b) Enhance epidermal migration
c) Promote angiogenesis and connective tissue synthesis
d) Allow gas exchange between wounded tissue and
environment
e) Maintain appropriate tissue temperature to improve
the blood flow to the wound bed and enhances
epidermal migration
1. Dhivya S, Padma VV, Santhini E. Woun Dressing – A Review. Biomedicine. 2015;5(4):24-28
 Optimal Wound Dressing
f) Provide protection against bacterial infection and
g) Should be non-adherent to the wound and easy
to remove after healing
h) Must provide debridement action to enhance
leucocytes migration and support the
accumulation of enzyme and
i) Must be sterile, non-toxic and non-allergic.
1. Dhivya S, Padma VV, Santhini E. Woun Dressing – A Review. Biomedicine. 2015;5(4):24-28
 Wound Dressing
1. Convensional Wound Dressing
2. Honey Wound Dressing
3. Vacuum-Asissted Closure Dressing
4. Modern Wound Dressing
 Convensional Wound Dressing

Disadvantages : Advantages :
 Adherent  Indicated for the clean and dry
 Require frequent changes wounds with mild exudate levels
 Painfull removal or used as secondary dressings
 Low cost

1. Dhivya S, Padma VV, Santhini E. Woun Dressing – A Review. Biomedicine. 2015;5(4):24-28

 Convensional Wound Dressing
Characteristic :
• Cause more necrotic tissue
• Scab Inhibits epidermal
cells migration and
spreading
• Scab Reduce oxygenation
to the wound bed
• Scab disturb wound bed’s
nutrient transport.
• Increased risk of infection
 Honey Wound Dressing
• Honey has been used as a wound dressing for
thousands of years  its effectiveness has been
explained recently
• Honey is a biologic wound dressing with multiple
bioactivities that work in concert to expedite the
healing process
• Honey also has a broad-spectrum antibacterial
activity
1. Molan P, Rhodes T. Honey: A Biologic Wound Dressing. Wounds. 2015;27(6):141-151
 Honey Wound Dressing
Advantages :
1. Low cost
2. Easy to apply

Disadvantages :
1. Frequent changes
2. Less absorbing
 Vacuum-Asissted Closure Dressing
• VAC is a system that can provide negative
pressure on the wound.
• VAC had been introduced in 1940 and then
greatly developed in 1990s.
• The negative pressure help to fasten healing rate
of the wound by macrodeformation, removal of
excess fluid, stabilize wound environment and
microdeformation.
 Effects of VAC on Wound Healing
 Hemostasis  constrict small
vessel, but VAC is contraindicated
in this phase  risk of bleeding
 Inflammation  remove
infiltrating leukocytes and induce
inflammation simultaneously.
 Proliferation  MDWT include
robust tissue granulation, cell
proliferation, and blood vessel
sprouting.
 Remodelling  increases both
collagen production and
maturation
 Mechanism of VAC
• Macrodeformation
1

• Remove Fluid
2

• Stabilize the environment

3

• Microdeformation
4

1. Huang C, et al. Effect of Negative Pressure Wound Therapy on Wound Healing. Current Problems in Surgery.
2014;51:301-331
 VAC system components
VAC Components Gama VAC

1. VAC Device 5

2. Polyurethane foam
1
3. Canister 3
2
4. Hoses
5. Semipermeable Adhesive 4

1. Orgill DP et al. The Mechanism of Action of Vacuum Assisted Closure: More to Learn. Surgery. 2009;146:40-51
 Modern Dressing
Advantages Disadvantages
 Moist environment • High cost
 Less frequent changes • More difficult to apply
 Optimal temperature for compared to convensional
wound healing dressing.
 Faster healing rate
 More absorbing dressing
compared to convensional one.
 Modern Dressing
Characteristic :
 Focused to keep the wound from
dehydration and promote healing
 Keep the optimum temperature
and moisture on the wound
 Decreased fibrotic tissue
formation
 Promote faster wound healing
 Indicated for deep or chronic
wounds with exudates or
infection.
 Modern Dressing
• Semipermeable film and foam dressing
 Modern Dressing
 Hydrogels dressing
1. Autolytic debridement
Memberi hidrasi pada
jaringan nekrotik sehingga
jaringan nekrotik menjadi
lunak dan mudah diangkat
dari luka

2. Memberikan suasana
lembab pada luka (moist
wound healing)
 Modern Dressing
 Alginate dressing
1. Made from the sodium and
calcium salts comprising
mannuronic and guluronic acid
units
2. Absorbent and biodegradable
alginates are derived from
seaweed/algae
3. Limits wound exudates and
minimizes bacterial
contamination
 Modern Dressing
• Nanosilver dressing
1. Silver-coated polyester
2. Has antimicrobial
properties

1. Fong J, Wood F. Nanocrystalline Silver Dressing in Wound Management: A Review. Int J Nanomedicine. 2006;1(4):441-449
 Modern Dressing
 Cadexomer Iodine Dressing
1. Provide sustained release of
iodine at the wound site.
2. Has antimicrobial
properties, the ability of
cadexomer iodine to absorb
exudate, debride, stimulate
macrophages and increase
re-epithelialisation
1. Miller C. Examining the Efficacy of Silver and Cadexomer Iodine Dressing in Treating Wounds Compromised by Bacterial Burden: A Review of the literature.2011. Science
against microbial pathogens: communicating current research and technological advances.
Clinical Picture of Patient with Modern Dressing
Clinical Picture of Patient with Modern Dressing
 Clinical Pictures of patient with VAC dressing

Day-0 VAC Day-20 VAC Day-0 Post STSG Day-5 Post STSG
 Clinical Pictures of patient with VAC dressing

Day-0 VAC Day-13 VAC

Day-0 Post STSG Day-5 Post STSG

 Clinical Pictures of patient with VAC dressing

After Trauma H-0 VAC H-16 VAC H-0 Post STSG H-5 Post STSG
Clinical Pictures of patient with VAC dressing
Video of patient with VAC dressing
MATUR
NUWUN