A limited access dressing (LAD)

A Limited Access Dressing (LAD) is an advanced wound care solution combining moist wound healing principles with intermittent negative pressure therapy and a unique instillation capability. This multifaceted approach promotes faster healing, reduces dressing changes, and enhances infection control, particularly for complex wounds.

LADs create a closed environment that maintains optimal moisture levels, crucial for cell migration and tissue regeneration. This moist environment minimizes pain and scarring compared to traditional dry dressings. Simultaneously, intermittent negative pressure, applied via a connected suction device, removes excess exudate, reduces edema, and stimulates blood flow to the wound bed. This enhanced perfusion delivers essential nutrients and oxygen, accelerating the healing process.

A key feature of LADs is the inclusion of an instillation port. This allows healthcare professionals to introduce topical solutions, such as antimicrobials or other therapeutic agents, directly to the wound site without disrupting the dressing. This minimizes the risk of contamination and reduces patient discomfort associated with frequent dressing changes. This targeted delivery can be particularly beneficial in managing infected wounds or creating a specific wound microenvironment conducive to healing.

The benefits of LADs include:

* **Infrequent Dressing Changes:** The sealed system reduces the need for frequent disruptions, minimizing pain and trauma to the wound bed while also saving valuable healthcare resources.
* **Accelerated Healing:** The combined effects of moist wound healing and negative pressure therapy promote faster wound closure compared to conventional dressings.
* **Enhanced Infection Control:** The instillation port allows for targeted delivery of antimicrobials, aiding in infection management and prevention.
* **Improved Patient Comfort:** Fewer dressing changes and reduced pain contribute to improved patient comfort and quality of life.
* **Cost-Effectiveness:** While the initial cost might be higher, the reduced frequency of dressing changes, faster healing times, and potential for fewer complications can lead to overall cost savings.

LADs are suitable for a variety of complex wounds, including:

* Diabetic foot ulcers
* Pressure ulcers
* Surgical wounds (e.g., dehisced wounds, flaps, and grafts)
* Traumatic wounds
* Chronic wounds

It is crucial that LAD application and management are performed by trained healthcare professionals. Proper assessment, dressing selection, and monitoring are essential to maximize the benefits and prevent potential complications. LADs represent a significant advancement in wound care, offering a more effective and patient-friendly approach to managing challenging wounds.

1. LIMITED ACCESS DRESSING LAD combines the principle of moist wound healing and the advantage of negative pressure dressings along with a provision of an additional port for instilling anti-microbials without any need to change the dressing.

2. MOIST WOUND HEALING Moist wound healing is a technique that uses occlusive dressings. Occlusive dressings that trap moisture on intact skin can cause a rapid increase in bacteria growth. Occlusive hydrocolloid dressings are waterproof. The colloid gels in these dressings absorb wound fluid. This absorption creates a gradient that draws out harmful substances produced by cell and bacteria breakdown from the wound.

3. Bad odor from these dressings can be caused by: Growth of anaerobic bacteria Gelatin breakdown in the gel itself.

4. NEGATIVE PRESSURE WOUND DRESSING Application: Used for treating both chronic and acute wounds. Mechanism: Creates negative pressure within the wound bed using a vacuum pump. Function of the negative pressure: Removes excess fluid (exudates) from the wound. Helps eliminate infectious materials. Overall goal: Prepares the wound for optimal healing and closure.

5. LAD: CONCEPT Combines two techniques: Intermittent negative pressure: Applied for 30 minutes at a pressure of up to 30 mmHg. Moist wound dressing: Maintained for 3.5 hours without negative pressure and It is covered with a transparent polyeth ene material.

6. LAD: DESIGN LAD is classified into 2 groups: Hydrocolloid material contacts the wound (LAD 1) Polythene sheet contacts the wound (LAD 1B & LAD II)

7. LAD 1: APPLICATION Minimal wound debridement is performed. A closed suction drain and one feeding tube are inserted either superficially or through a puncture wound. Surrounding skin is cleansed with ether and the wound is covered with hydrocoll . An adhesive polyurethane film is applied to secure the LAD. If necessary, the hydrocolloid is stitched to the surrounding skin using a 3-0 non-absorbable monofilament suture.

8. LAD 1B: APPLICATION After placement of the two tubes, the wound is covered with a suitable-sized polyethene sheet. A layer of hydrocolloid is then applied over the polyethene. A central hole is cut in the hydrocolloid to improve visibility through the polyethene sheet. The polyurethane film is applied as described in LAD 1.

9. LAD II APPLICATION Customized bags or tubes are created based on wound size and shape and sealed using a semi-automatic machine. These are sterilized by immersing in a 2.45% glutaraldehyde solution for 20 minutes. After placing two tubes, the wound is covered with a water and bacteria-impermeable polyethylene sheet. The sheet is sealed with hydrocolloid. An adhesive polyurethane film is applied to secure the hydrocolloid and create a waterproof seal.

10. INDICATIONS To avoid infections in chronic and acute wounds. Post-operative wounds in immune-compromised patients or patients with diabetes. Temporary covering for exposed bone, tendon, cartilage, joints. Abdominal wall reconstruction. Infra LAD – tissue expansion adjacent to the wound (external fixator with exposed bone through fracture site as well as through fasciotomy to relieve compartment pressure).

11. COMPLICATIONS & PREVENTIVE MEAURES HEMATOMA : Apply a pressure bondage or continuous suctioning cause Hematoma formation. Prevention : Intra LAD physiotherapy, H 2 2 wash and intermittent suctioning. INFECTIONS : To avoid wound infection & to control bad odour , the surface bacteria can be removed by mechanical saline wash through LAD tubes. EDEMA, IMMOBILITY, INFLAMMATION : Early intra LAD-physiotherapy helps minimize stiffness.