Diabetic wound dreasing.pptx

Wound classification and Pathophysiology
Different types modern dreasing Available
Diabetic foot Ulcer or disease

1. Medicated Dressing For Diabetic Wound Healing Seminar by Mr. Pavan S. Jagtap Department of Pharmaceutics Guided by Dr. Rajani B. Athawale Prin. K. M. Kundnani College of pharmacy, Mumbai

2. Table of Content Introduction Wound pathogenesis and Healing process Dressing Types of Dressing Conclusion References 2

3. Wound Wound is damage to the biological tissue including skin, mucous membranes, and organ tissues due to injury, trauma. It would be internal or external to body According to university of Texas classification of wound Grade Stage Pre ulceration 1 Superficial ulcer 2 Wound penetratiting tendons ligaments 3 Wound penetratiting bones and joints 3

4. Factor involve in wound pathogenesis Inflammatory mediators : Arachidonic acid derivatives : Leukotrienes and prostaglandins Vasoactive peptide cytokines : IL-1 β , TNF- α , IL-6 , chemokines Platelet activating factor and interleukins The wound-healing process consists of four highly integrated, continuous overlapping, programmed process :   (1) Coagulation/ Hemostasis – (2) Inflammatory phase -   (3) Proliferative / Migratory phase (tissue formation) – (4) Remodeling phase - 4

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7. Biomarker Wound biomarker Significance in wound Cytokines (IL-1, IL-6, TNF- Elevated levels of Cytokine Oxygen Decreased oxygen levels pH Alkaline nature (more than 7) Nitric Oxide Decreased levels of NO Bacteria Bacteria concentration levels are higher indicating extent of infection Growth Factors Decreased level Temperature Increased temperature 7

8. Factors Affecting Wound Healing SYSTEMIC LOCAL Factor Hypothermia Radiation Blood supply Infection Foreign Body In Oxygen Factor Lifestyle Comorbidities Age and Gender Medication Obesity Poor Nutrition 8

9. Diabetes Mellitus (DM) Chronic metabolic disorder, which is characterized by a deficiency of insulin secretion by the pancreas and or insulin resistance in peripheral tissues. Both of these conditions lead to the accumulation of glucose in the blood commonly referred to as hyperglycemia . Formation of HbA1C complex help in determine stage of diabetic Normal level is > 5.4 and Pre diabetic level 5.4-6.5 9

10. Physiologic factors contribute to wound healing deficiencies in individuals with diabetes Decreased or impaired growth factor production Peripheral arterial diseases Neuropathy Slow angiogenic response Ischemia Wound healing occurs as a cellular response to injury and involves activation of keratinocytes, fibroblasts, endothelial cells, macrophages, and platelets 10

11. W ound Dressing Dressing were prepared to provide moisture to the wound and consequently protect it. Modern dressing having ability of f aster re-epithelialization, making hypoxia, decreasing wound bed pH, which leads to less infection Dressing is selected based on the type, depth, location, and extent of the wound, the amount of discharge, infection, and wound adhesion. Cotton Gauze -1891 11

12. Ideal Wound Dressing Features 12

13. General Classification of Wound Dressing On the basis of 13

14. Special Design For Diabetic Wound Dressings Hydrocolloid dressing Hydrogel Alginate Foam Silver coated Polymer based 14

15. Hydrocolloid dressing These dressings are a combination of polymers such as gelatin , pectin and cellulose which form a waterproof adhesive dressing . They maintain a moist wound healing environment and promote autolytic debridement inhibition of bacteria growth hydrocolloids have been shown to retain growth factors under the dressing as well as promote granulation and Epithelialization The low pH created by the hydrocolloid is effective for the treatment of wounds infected by Pseudomonas species Marketed product : Duoderm , Granuflex , Comfeel . 15

16. Hydrogel dressings These dressings consist of cross-linked insoluble starch or carboxy methylcellulose polymers and water (96%). The term hydrogel implies that the material is already swollen in water. Hydrogels donate fluid to dry necrotic Wound promote autolysis These dressings are the best choice for the treatment of dry wounds with necrotic eschar more cost-effective, Biocompatible Hydrogel hydrates, cools the wound and provides an analgesic effect. Marketed product : aquaform , aquaflow ( covidian ) 16

17. Alginate dressings Alginate dressings are highly absorbent and are available in two forms; calcium alginate and sodium alginate. The use of alginate dressings as hemostatic agents was reported both in vitro and in clinical studies. They can absorb 15-20 times their own weight in wound fluid The alginate forms a gel when it comes into contact with the wound surface. It can be used in granulating, epithelializing, and cavity wounds. Marketed product : calcium alginate dressing (smith and newphew ) 17

18. Foam These dressings are extremely absorbent, non-adherent, and have a semi-permeable backing which allows moisture to escape. They maintain a moist wound environment which implies that they can be easily removed without pain. They are also used as outer dressings after application of topical antibiotics, such as metronidazole, or hydrogels. Polyurethane foam is widely used in diabetic foot wounds and is capable of absorbing light to heavy amounts of exudate, thereby preventing maceration, facilitating removal of slough, and promoting the proliferative stage of wound healing Marketed product : Cavicare , Tegaderm 18

19. Silver-coated dressings Silver-coated dressings that use elemental silver may be more efficacious at killing bacteria than is silver sulfadiazine or silver nitrate New silver-impregnated dressings may be suitable for use for infected diabetic foot ulcers. accelerated wound re-epithelialization and beneficial antibacterial action in the treatment of burns are encouraging. Medicated product : Acticoat and Urgosorb silver 19

20. Polymer based wound Dressing Cellulose : Easily available with low cost Forming a moist environment Releases GFs to stimulate fibroblas t proliferation Chitosan : Antimicrobial and hemostatic Collagen and Gelatin : Promotes tissue granulation and angiogenesis Inhibits bacterial growth and prolonged inflammatory response Hyaluronic Acid; Lubricative and water absorptive Popular drug delivery system and vehicle for growth factors 20

21. Common dis-advantages of polymer based Dressing Require additional antimicrobial substance Tissue damage due to excess exudates Extensive swelling in water Unable to dissolve in organic solvent (chitosan-crystalline nature) Might require secondary dressing 21

22. Conclusion Patients with DM are also at greater risk of wound tissue resection due to severe infection or irreversible ischemia of the wound area. Main components of management that can ensure successful and rapid healing of DFU include education, blood sugar control, wound debridement, advanced dressing smart dressing possess qualities that inhibit bacterial growth, manage excess exudate, and promote re-epithelialization, all while maintaining a moderately moist environment 22

23. REFERENCES Karakkattu Vijayan Kavitha , A practical approach by Journal of applied polymer science Wound dressings World journal of diabetes . Erfan Rezvani Ghomi,1 Shahla Khalili Current advances and future directions Choice of wound care in diabetic foot ulcer Hou Liu, Zuhao Li, Yue Zhao Novel Diabetic Foot Wound Dressing Based on Multifunctional Hydrogels with Extensive Temperature-Tolerant, Durable, Adhesive, and Intrinsic Antibacterial Properties ACS applied material and Iterfaces . 23

24. Thank you 24