Indications: Used for wounds with moderate to heavy exudate, surgical wounds, and packing deep wounds
Contraindications: Not ideal for dry wounds (can cause adherence and delay healing)
Transparent film dressings
Names: Tegaderm, Opsite, Bioclusive
Indications: Superficial wounds, abrasions, and partial-thickness wounds with minimal exudate; also used for IV sites
Contraindications: Should not be used on heavily exudating wounds or infected wounds
Hydrocolloid dressings
Names: Duoderm, Comfeel, Tegasorb
Indications: Moderate exudating wounds, pressure ulcers, and venous leg ulcers. Helps maintain a moist wound environment.
Contraindications: Not suitable for infected wounds or wounds with heavy exudate.
Hydrogel dressings
Names: IntraSite Gel, Aquaform, Vigilon
Types: Gel, sheet, or beads (for deep wounds)
Indications: Dry wounds, burns, painful wounds, and wounds with necrotic tissue (autolytic debridement).
Contraindications: Should not be used on heavily exudating wounds as it can cause maceration.
Foam dressings
Names: Allevyn, Mepilex, Lyofoam
Indications: Moderate to heavily exudating wounds, venous ulcers, pressure ulcers, and diabetic foot ulcers. Provides cushioning.
Contraindications: Not ideal for dry wounds or wounds with minimal exudate.
Alginate dressings
Names: Kaltostat, Sorbsan, Algicell
Indications: Heavy exudating wounds, infected wounds, and wounds with tunneling. Derived from seaweed, absorbs large amounts of fluid.
Contraindications: Not recommended for dry wounds or wounds with minimal exudate.
Characteristics: When an alginate dressing is removed, it can have a yellowish, tan, or brown color and may have a mild, but unpleasant odor. While the appearance and smell can be alarming, they are often normal and result from the interaction between the seaweed-based dressing and the wound’s exudate.
Collagen dressings
Names: Promogran, Fibracol, Biostep
Indications: Chronic non-healing wounds, pressure ulcers, and wounds with granulation tissue. Encourages new tissue growth.
Contraindications: Not for dry wounds or wounds with eschar. Avoid in patients with collagen allergies.
Antimicrobial dressings
Names: Silvercel, Acticoat, Iodosorb
Indications: Infected wounds, burns, surgical wounds at risk of infection. Contains silver or iodine to reduce bacterial load.
Contraindications: Avoid in patients allergic to silver or iodine. Not recommended for long-term use due to potential cytotoxicity.
Types of debridement
Autolytic debridement
Definition: Uses the body’s own enzymes and moisture to break down necrotic tissue.
Methods: Hydrocolloid, hydrogel, or transparent film dressings.
Indications:
Wounds with necrotic tissue (eschar or slough).
Patients who cannot tolerate more aggressive debridement.
Minimal to moderate exudating wounds.
Contraindications:
Infected wounds.
Heavily exudating wounds.
Mechanical debridement
Definition: Uses physical forces to remove necrotic tissue.
Methods:
Wet-to-dry dressings (gauze applied wet and removed dry).
Hydrotherapy (whirlpool).
Pulsed lavage (pressurized irrigation).
Indications:
Moderate to heavily necrotic wounds.
Wounds with thick, adherent slough or debris.
Contraindications:
Painful wounds.
Granulating wounds (can damage healthy tissue).
Enzymatic debridement
Definition: Uses topical enzymatic agents to break down necrotic tissue.
Methods: Application of collagenase (e.g., Santyl).
Indications:
Wounds with thick, adherent necrotic tissue.
Patients unable to tolerate surgical or sharp debridement.
Contraindications:
Infected wounds without antibiotic coverage.
Clean wounds with no necrotic tissue.
Sharp debridement
Definition: Uses scalpels, scissors, or forceps to remove necrotic tissue manually.
Indications:
Wounds with extensive necrosis or thick eschar.
Infected wounds requiring immediate removal of necrotic tissue.
Contraindications:
Bleeding disorders or anticoagulated patients.
Poor vascular supply (risk of delayed healing).
Surgical debridement
Definition: Performed by a surgeon in an operating room to remove large amounts of necrotic tissue.
Layers Affected: Epidermis, dermis, fat, muscle, and bone
Appearance: Black, charred, necrotic tissue
Pain Level: Painless (complete nerve destruction)
Healing Time: Requires surgical intervention; amputation is possible
Use of grafts for burns
Autografts: taken from the individual
Allografts: taken from cadavers
Xenografts: taken from another species (i.e, pig, cow)
Interventions for burns
Classification of burns
First-degree burns
Cool the burn with cool water.
Apply over-the-counter pain relievers, such as NSAIDs or acetaminophen.
Use aloe vera gel or petroleum jelly to soothe the burn.
Second-degree burns
In addition to the above, apply a topical antibiotic cream, such as Bacitracin or Neomycin.
Cover the burn with a non-stick dressing.
Use silver sulfadiazine cream to prevent infection.
Third-degree burns
Intravenous fluids and pain relievers
Antibiotic therapy
Topical dressings, such as mafenide acetate or silver sulfadiazine
Surgery may be necessary to remove the burned skin and graft new skin.
Other medications
Corticosteroids may be used to reduce inflammation.
Antihistamines may be used to relieve itching.
Sedatives may be used to manage pain and anxiety.
Rule of Nines for burn assessment
The Rule of Nines is a quick method to estimate the total body surface area (TBSA) affected by burns. It differs for adults and children due to variations in body proportions.
Rule of Nines for adults
Rule of nines for adults
Rule of Nines for children
Other common skin conditions
Impetigo
Impetigo is a bacterial skin infection caused by Staphylococcus aureus or Streptococcus pyogenes. It is highly contagious and commonly affects children. The hallmark feature is honey-colored, crusted lesions that typically appear around the mouth, nose, and hands. Mild itching may be present, but systemic symptoms like fever are rare. Since impetigo is superficial, it does not cause deep tissue damage and is easily treatable with antibiotics.
Cellulitis
Cellulitis is a bacterial skin infection that occurs in the deeper layers of the skin and subcutaneous tissue. It is most commonly caused by Staphylococcus aureus or Streptococcus pyogenes. Unlike impetigo, cellulitis presents with diffuse redness, warmth, swelling, and pain, and it may be accompanied by systemic symptoms such as fever, chills, and malaise. It commonly affects the lower extremities, but can occur anywhere. Cellulitis can spread quickly and requires antibiotics, and in severe cases, hospitalization may be necessary.
Herpes Zoster (Shingles)
Herpes zoster, or shingles, is a viral infection caused by the reactivation of the varicella-zoster virus (the same virus that causes chickenpox). It presents as a painful, blistering rash that follows a dermatomal pattern—meaning it is limited to one side of the body along a nerve path. Before the rash appears, individuals may experience burning, tingling, or flu-like symptoms. Unlike impetigo and cellulitis, herpes zoster is not a bacterial infection and requires antiviral treatment. A significant complication is post-herpetic neuralgia, which can cause chronic nerve pain even after the rash has resolved.
Dermatitis (Eczema)
Dermatitis is a non-infectious inflammatory skin condition caused by an immune response to allergens, irritants, or chronic skin sensitivity. It presents as red, dry, scaly, and itchy skin and is often associated with pruritus (intense itching). Unlike the other conditions, dermatitis is not contagious and does not involve bacterial or viral pathogens. Common triggers include allergens, soaps, stress, and climate changes. Treatment involves moisturizers, corticosteroids, and avoiding triggers.
Psoriasis
Psoriasis is a chronic autoimmune skin condition that causes rapid skin cell turnover, leading to the buildup of thick, scaly plaques on the skin. It is characterized by red, inflamed patches with silvery-white scales, often appearing on the scalp, elbows, knees, and lower back. The condition is not contagious and can be triggered by stress, infections, medications, and environmental factors. Psoriasis is associated with immune system dysfunction, specifically involving T-cells and inflammatory cytokines. It can also be linked to psoriatic arthritis, which affects the joints. Treatment includes topical steroids, phototherapy, and systemic immunosuppressants.
Sclerederma
Scleroderma is a chronic autoimmune connective tissue disease characterized by abnormal collagen deposition, leading to skin thickening, fibrosis, and vascular dysfunction. It can affect the skin, blood vessels, and internal organs, including the lungs, heart, kidneys, and gastrointestinal tract.
There are two main types: 1. Localized Scleroderma — Primarily affects the skin and underlying tissues, often in morphea or linear forms. 2. Systemic Sclerosis (Systemic Scleroderma) — Involves widespread fibrosis affecting the skin and internal organs.
Common symptoms include tight, hard skin, Raynaud’s phenomenon, joint pain, and digestive issues. The exact cause is unknown, but it is believed to involve immune system dysfunction and genetic/environmental factors. There is no cure, but treatment focuses on managing symptoms and slowing disease progression with immunosuppressants, vasodilators, and physical therapy.
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