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Wound care (PowerPoint)

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					Wound care
Object of proper wound
          care
 To minimized the possibility of
     infection and scarring
      Principle of wound care
   Remove impediment of repair
    :debride necrotic tissue
    :identify and treat infection
    :wick and absorb exudates
    :eliminate trauma to wound bed
      Principle of wound care
   Maintain an environment conductive to
    repair
    :maintain moist wound surface
    :maintain open wound edge
    :insulate wound
    :protect wound surface
       Wound management
 Assess your patient and the wound
 Treat underlying pathology and the wound
 Reassess the wound to evaluate the
  effect of treatment. If the wound is healing
  as expected, continued the treatment
  planned. If not, adjusted new treatment
  plan
            Wound assessment
   Assess the patient       Assess the wound
    :medical history          :location of wound
    :nutritional status       :wound size
    :quality of life          :characteristic of wound
    :life style               bed
                              :exudates
                              :odor
                              :sign of local infection
                              :condition of surrounding
                              skin
              Treatment
 Reducing or eliminating causative factor
 Providing systemic support for healing
     Systemic support for healing
   Adequate oxygenation
   Adequate nutrition
    :protein
    :vitamin A relate to fibronectin on wound surface, cell
    chemotaxis, adhesion and tissue repair
    :vitamin C require for proline hydroxylation and
    subsequent of collagen synthesis
    :vitamin E protect polyunsaturated fatty acid of cell
    membrane from free radical oxidation, inhibit PG
    synthesis
    :zinc component of enzymes including DNA polymerase,
    superoxide dismutase
              Treatment
 Reducing or eliminating causative factor
 Providing systemic support for healing
 Apply appropriated topical therapy
    Appropriated topical therapy
 Treat infection
 Remove foreign body
 Irrigation
 Provide moist wound bed with dressing
 Compression therapy in case of edema
Topical antibiotic vs. non-
   antibiotic ointment

    Which one more
       benefit ?
    Aquaphor Healing Ointment
 Skin protectant ointment
 Semiocclusive dressing

 Indicated for damaged skin and minor
  wound
 Formula : 41% petrolatum, humectants,
  skin conditioner, barrier lipid
    Treatment of minor wounds from dermatologic
procedures : A comparison of three topical wound care
        ointments using a laser wound model

   20 subject, average age 37 years, skin type 1-3
   Excluded
    :any known allergy or sensitivity to skin care
    product
    :history of or current disease or skin condition
    that may affect the assessment of test product
   2 passes of 5 w CO2, followed by 1.7 J/cm2 of
    erbium at forearm
   4 uniform circular wound, 5 mm diameter
    Treatment of minor wounds from dermatologic
procedures : A comparison of three topical wound care
        ointments using a laser wound model

 Cleaned wound with cleanser once daily
 Aquaphor healing ointment, Neosporin,
  Polysporin, untreated control each wound,
  3 times/day
 Covered wound until day 7
 Evaluate erythema, edema, epithelial
  confluence, crusting, scabbing and
  general wound appearance on day 1, 4, 7,
  11, 14, 18
    A comparison of postprocedural wound care
     treatments : Do antibiotic-based ointments
                 improve outcomes?
   30 subject, average age 61 years, skin type 1-3
   Excluded
    :any known allergy or sensitivity to skin care
    product
    :history of or current disease or skin condition
    that may affect the assessment of test product
   2 SK on opposite side at chest or abdomen, size
    6-10 mm, removed with blade no. 15
    A comparison of postprocedural wound care
     treatments : Do antibiotic-based ointments
                 improve outcomes?
 Dressing with AHO or Polymyxin B on
  opposite site twice daily
 Keep covered for 7 days postwounding
 Evaluate erythema, edema, epithelial
  confluence, crusting, scabbing and
  general wound appearance on day 7, 14,
  28
     Postprocedural wound-healing efficacy following removal of
      dermatosis papulosa nigra lesions in an African American
    population : A comparison of a skin protectant ointment and a
                          topical antibiotic

   20 subject, average age 50 years, skin type 4-6
   Excluded
    :any known allergy or sensitivity to skin care
    product
    :history of or current disease or skin condition
    that may affect the assessment of test product
   Fine-curved blade scissor removed 2 similar
    lesion size 3-5 mm on opposite side of face
   Treated and covered wound for approximately
    12 hrs.
     Postprocedural wound-healing efficacy following removal of
      dermatosis papulosa nigra lesions in an African American
    population : A comparison of a skin protectant ointment and a
                          topical antibiotic

   Cleanse with gentle liquid cleanser and
    dressing with AHO and Polysporin on the
    opposite side of face twice daily
   Evaluate erythema, edema, epithelial and
    melanin confluence, crusting, scabbing
    and general wound appearance on day 1,
    3, 7, 14, 21
   Irritation and allergy patch test analysis of topical
treatments commonly used in wound care : Evaluation
            on normal and compromised skin
   Study 1 : Modified human repeat insult patch test to
    evaluate cumulative irritation and predictive allergy
   108 subject, 18-70 years, skin type 1-4
   Excluded
    :any known allergy or sensitivity to skin care product
    :history of or current disease or skin condition that may
    affect the assessment of test product
   Induction phase : apply test product (AHO, BTE,
    polysporin, polymyxin) on normal back skin 9 times at
    48-72 hrs interval
   Challenge phase : apply test product to original and
    naïve sites for 48 hrs. after induction phase 12-24 days
    Biafine Topical Emulsion
 Oil in water emulsion
 Recruitment of macrophage to wound site
 Indicated for superficial wound, minor
  abrasion, dermal ulcer, donor site, 1° and
  2° burn, radiation dermatitis
 Ingredients : purified water, liquid paraffin,
  propylene glycol, paraben based
  preservative, fragrance
   Irritation and allergy patch test analysis of topical
treatments commonly used in wound care : Evaluation
            on normal and compromised skin

   Positive control with 1% sodium lauryl
    sulfate and undosed patch for negative
    control
   Evaluate for erythema and type 4
    hypersensitivity
   Irritation and allergy patch test analysis of topical
treatments commonly used in wound care : Evaluation
            on normal and compromised skin

   Study 2 : 48 hour exaggerated irritation patch
    study
   16 subject
   Inclusion and exclusion criteria same as study 1
   Skin barrier disruption by tape-stripped, followed
    by occlusive patch application of test product for
    48 hrs.
   Evaluate irritation, transepidermal water loss at
    48, 72 hrs.
      A comparison of wound healing between a skin
     protectant ointment and a medical device topical
    emulsion after laser resurfacing of the perioral area
   20 women age 40-80 years with perioral rhytides, skin
    type 1-3
   Excluded
    :any known allergy or sensitivity to skin care product
    :history of or current disease or skin condition that may
    affect the assessment of test product
   Prophylactic antiviral and antibiotic 1 day before and
    continued to 9 day after treatment
   Before resurfacing, cleansed with cetaphil and occlude
    with topical anesthesia mix (bupivacaine, lidocaine,
    tetracaine) 30 min
      A comparison of wound healing between a skin
     protectant ointment and a medical device topical
    emulsion after laser resurfacing of the perioral area

   Fractional CO2 :20-30 w, pitch 200-500 µm,
    dwell time 500-2000 µs, 1-3 pass depend on
    severity
   Cleanse with supplied cleanser and treat with
    AHO and BTE on opposite side of face, 4
    times/day
   Evaluate erythema, edema, epithelial
    confluence, crusting, scabbing, general wound
    appearance and subjective irritation on day 2, 4,
    7, 14
              Conclusion
 No different infection rate and healing
  process between topical antibiotic and
  topical non antibiotic
 Topical antibiotic
  :increase resistant rate
  :can cause allergic contact dermatitis
               Zinc paste
 Zinc oxide
 Treat or prevent minor skin irritation e.g.
  burn, cut, diaper rash
 Property
  :inhibit bacterial and viral growth
  :accelerate healing in acute and chronic
  wound
  :low risk of allergic or contact dermatitis

				
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posted:7/28/2011
language:English
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