Dressing materials by Dr. Vedant Patil

Dressing material

1. Dr. Vedant Patil Junior Resident-1 Dept. of Orthopaedics Dr. Deepak Agrawal Professor and HOD  Dept. of Orthopaedics Dr. Pramod Sarkelwad Associate Professor and HOU  Dept. of Orthopaedics

2. Dressing Dr. Vedant patil JUNIOR RESIDENT-1 DEPT. OF ORTHOPAEDIC

3. introduction Antisepsis : Process of destruction of disease causing microorganism to prevent infection on patient body surface. Disinfection : Process of killing pathogenic organism from innominate objects like instruments. Asepsis : Practice to reduce or eliminate infection causing agents from entering the human flora.

4. dressing Material applied to wound with or without medication to give protection and assist in wound healing. Ideal dressing should be :- 1.absorbent, remove excess exudate 2. maintain moist environment 3. aid tissues to remove necrotic material . 4 promote healing 5. prevent trauma to underlying healing graulation tissue. 6. leak-proof, prevent passage of organisms to wound 7.maintain temperature & gaseous exchange 8. allow easy pain free dressing change 9. odourless 10. cosmetically acceptable &comfortable 11. inexpensive

5. Ideal topical agent

6. Passive/ active/ interactive 1. Passive- for protection as protective dressing 2. Active - promotes healing through the creation of moist wound environment. 3. Interactive dressing- not only creates a moist wound environment but interact with the wound bed component to further enhance wound healing.

7. Classification of dressing Primary dressing .1 Also called contact layer 2. It comes in direct contact of wound Ex. Band aid • Secondary dressing Is placed over primary dressing to provide increased protection. Ex. Self-adhesive elastic bandage

8. Interactive dressing 1.Reduces bacterial colonization count In wound bed 2.Reduces the level of exudate 3.Improves wound bed moisture retention 4. Improves wound collagen matrix 5.Removes cellular debris 6.Provide protection to the epithelial bed

9. Why do Moist wounds heal faster ? Moist wound heals faster than dry wounds. Prevent scab or crust formation over the wound bed, it eliminates the energy and time for the body to break this down. Reduce travel time for keratinocytes as they easily migrate across the moist wound bed. Traps enzyme at the wound bed facilitating autolytic debridement. Preserve growth factors and promotes collagen synthesis.

10. Aim of wound dressing To keep the wound sterile To reduce the spread of micro organisms To enhance tissue healing To absorb or localize drainage of wound To support injured tissue

11. Indication of wound dressing Open wounds Infected wounds Removal of stitches, staples or clips Drain removal

12. Purpose of wound dressings 1 . To protect the wound from mechanical injury 2 . To protect the wound from microbial contamination 3 . To provide or maintain high moisture of the wound 4 . To provide thermal insulation 5 . To absorb exudate 6 . To prevent heamorhage and speed up process of clotting 7 . Reduce patient pain either by analgesic added in them or by compression or preventing further trauma to wound 8 . Reduce Psychological stress of patient by obscuring the wound

13. Layers of dressing CONTACT LAYER- covers the wound and collects blood, discharge, fibrin, debris ie - Cotton gauze ABSORPTIVE LAYER- Collects excess drainage. Dressing pads with adsorbent property are kept in this layer. It is the THICKEST layer. COMPRESSIVE LAYER- Protects the wound from external contamination. Cotton/elastic roller bandages are applied to keep the underlying layers in place.

14. Types of wound drainage EXUDATE- material, such as fluid and cells, that has escaped from blood vessel during the inflammatory process and is deposited in tissue or on tissue surfaces . 1 . Serous exudate – Consists chiefly of serum or the clear portion of the blood derived from the blood and serous membranes. 2. Purulent Exudate - It is thicker than serous exudate due to presence of pus cells 3. Sanguineous exudate - Consist of large amounts of red blood cells , indicating damage to capillaries that is severe enough to allow the escape of red blood cells.

15. General rules of dressing care No tight dressings- compromise blood supply. Tight dressing only to control bleeding temporarily Pressure should be equally distributed Never allow tight banding around limbs or fingers. While changing one shouldn't damage tissues of healing wound.

16. Instructions for wound dressing Take utmost care to prevent cros infection. Al instruments used ni dressing should be sterlised . Wash hands thoroughly before and after dressing Use instruments for one dressing only. After dusting, sweeping dressing should not be done for 15 MINUTES. AVOID coughing, talking and sneezing while dressing. * Clean the wound from centre to periphery * If dressing is sticking then apply saline or savlon to remove it. * Wound and drain area should be dressed separately * Amount of discharge should be examined for colour , odour , consistency. • Give analgesis before painful dressing. * Isolate the wound by spreading sterile towel.

17. Basic dressing material 1.Gauze 2. Gamgee 3. Bandage 4.Elastic Adhesive 5. Surgical wool

18. Surgical wool • Clean, long fibred • Bleached white - discharge can be seen clearly Defattened by passing in 10% КОН Ideal surgical cotton should sink in water in 10 seconds Available in (a) sterile rolls (b) unsterile rolls Uses: for painting the parts for dressing for swabbing deep cavity for benzoin seal to make orthopedic padding before applying plaster of paris keep the bottom of a bottle intact

19. Gauze piece Piece of woven surgical cotton Types : (a)closed: 16x16 fibers/sq inch used in making bandage (b)open: 8x8 fibers/sq inch in making peanuts- blunt dissection Uses: 1 .dressing 2 . heamostatic purpose 3 . painting the parts 4 . tissue dissection 5 . drainage and package of absess cavity.

20. Surgical pad Made by wrapping cotton within gauze piece Usually have size of 4x6 qs inch Uses: 1 . in dressing of drained abscess 2 in dressing for burns and ulcers 3. padding to avoid direct pressure and trauma to wound

21. gamgee Invented by Dr. joseph Samson Gamgee A layer of cotton is sandwiched between gauze piece and rolled High absorbent property Promotes quick healing of wound Skin friendly • Uses: 1.In dressing of wound with discharge 2 In dressing of burns patients Available sizes- 5cm x 5cm, 7.5 cm x 7.5 cm, 10cm x 10cm

22. Bandages Soft ,light, porus TURNS:- (a) CIRCULAR-, horizontally across the part mainly used in beginning to secure the bandage it interferes with circulation so should be avoided in limb. (b)SPIRAL: spiral fashion across the limb each turn should cover half to 2/3 of preceding turn used in parts with uniform thickness e.g. arm, fingers (c) REVERSE SPIRAL- reverse turn useful when thickness is not uniform e.g. forearm (D)FIGURE OF EIGHT over joints (e)SPICA: type of figure of eight bandage but one loop is much larger than other e.g. hip spica (f) RECURRENT : series of alternating turns are taken e.g. amputation stump dressing

23. Elastic bandage (crepe bandage) Composition- cotton, polyester and elastic yarns Bandage creates even stable pressure around area of application leading to reduction of blood flow and thus reduces swelling around the injured area. Hemostatic effect due to compression Uses:- Strapping of sprain and strain around joints Splinting of fractures Post operative compression bandages

24. Adhesive surgical tapes 2 types – Cotton tape ( Leukoplast ) – Paper tape (micropore) Zinc oxide ( white colour ) is adhesive material Breathable tapes allow air to reach the skin Elastic or stretchable tapes are also available ( Dynaplast / Elastoplast) Uses:- Holds dressing or bandages over the wounds Strapping around joints

25. Tincture benzoin Composition- Benzoin resin in alcohol Effect- Adhesive and antiseptic Uses: Before application of cotton during casting, especially in infants and children Before skin traction application Before application of tourniquet As wound sealant after dressing of pin tract infection It can be applied to minor cuts Act as oral mucosal protectant.

26. Magnesium sulphate cream Chief composition:  Sumag (magnesium sulfate and urea)  Magsulf (magnesium sulfate and glycerin ). Effect: Hygroscopic. Reduces- edema .

27. Paraffin gauze (jelonet/ sofra- tulle) Two types 1. PLAIN- Without any impregnated antibiotic 2. Antibiotic impregnated- framycetin , betadine, 0.5% chlorhexidine acetate, neomycin, polymyxin, nitrofurazone, etc. Functions: Keeps wound moist Prevents adhesion of dressing with wound Antiseptic property Promotes in granulation tissue formation. Uses: On granulating wounds In skin grafting (donor or recipient site) Over burn wounds.

28. Alginates (algisite-m) Composition: Sodium and calcium salt of alginic acid and naturally found in brown algae. Action: Biofilm formation leading to- Absorbent property  Hemostatic property Keep surrounding environment moist. Uses: For dressing of wound with large amount of exudates, chronic ulcers, burn wounds, skin grafting sites and surgical wounds

29. Hydrocolloids (duoderm) Composition: A layer of gelatin , pectin, and carboxymethylcellulose undercover of adhesive sealant-like polyurethane. Function: The polysaccharides material when come in contact of wound exudates; polymers absorb water and form gel, which is immobile. This moist condition promotes fibrinolysis, angiogenesis, and wound healing. Uses: For dressing of clean wounds, bed sores, venous ulcers, superficial to deep burns, and eczema.

30. Hydrogen peroxide Composition: 6% 20 volumes of H, 2, i.e., 1 volume of such H, produces 20 volumes of nascent oxygen. Effects: Cleansing H202--catalase-- → H,0 + 1/202 This oxygen comes out as bubble and produces froth. The nascent oxygen acts as an oxidizing agent. Uses: Frothing brings debris out of wound Destroy anaerobic organism Used for chemical cauterization Removes blood stain from clothes. Note: The contact time for H202 for contaminated wound is maintained for 2-3 minutes.

31. Savalon (tartrazine yellow colour) Composition: Strong cetrimide: 16% (w/v) Chlorhexidine gluconate: 7.5 (v/v) Isopropyl alcohol: 6.8% (v/v). Effects: Cleansing and disinfectant. Uses: 1:30 dilution (35 mL of Savlon in 1 L of water) for cleansing and disinfection of dirty wounds 1:100 dilution (10 ml of savlon in 1L) for operative site scrubbing, storage of thermometer etc

32. Surgical spirit Composition: 70% alcohol (isopropyl alcohol or ethanol). Effect: Antiseptic. Uses: For cleaning of infection site For cleaning of stitched wound during wound dressing For dry dressing For removal of betadine paint during surgical site preparation. Note: The natural alcohol is colorless. Its blue color is due to various colour additives that prevents the alcohol abuse.

33. Chlorhexidine solution Chief constituent: Chlorhexidine gluconate. Effects: Antiseptic in lower concentration Bactericidal in higher concentration. Uses: For surgical hand scrub For handwashing by healthcare personnel Postoperative wound cleaning. Commonly available forms: 2% and 4%.

34. Edinburgh university solution of lime (eusol) Composition (acidic pH): Boric acid: 1.25 g Bleaching powder ( CaOCl ,): 1.25 g Sterile water: 100 mL. Mechanism- release of nascent chloride. Effects- desloughing agent. Uses: To separate slough from infected wounds, bed sores, ulcers, and burns. Useful for dressing of wounds infected with Pseudomonas due to its acidic 

35. Oxoferin solution Chief composition: Tetrachlorodecaoxide Mechanism of action: Release nascent oxygen, which is immunomodulator, mitogenic, chemotactic, and accelerator of phagocytosis Effect: Cleansing action Use: For infected and contaminated wounds. Note: 1% sodium hypochlorite solution (Daikin solution) is comparable to oxoferin solution.

36. Silver ions solution (qurion) Chief component- Silver ions (0.01 silver nitrate) Effect: Kill bacteria. Destroy biofilm. Stimulate growth of granulation tissue. Use: For infected and contaminated wounds.

37. Collagen granules and collagen sheet Chief component: Collagen protein (types I, II, and III) Effect: Inhibit matrix metalloproteinases (MMPs) that promote extracellular matrix (ECM) and granulation tissue formation Chemotactic effect Absorb wound exudates and maintain moist environment. Use: For chronic and nonhealing wound.

38. Mercurochrome solution Merbromin NF Solution is a topical antiseptic used for minor cuts and scrapes. Merbromin is used as a topical antiseptic to treat minor wounds, burns, and scratches. It is also used in the antisepsis of wound of difficult scar formation, like neuropathic ulcers, and diabetic foot sores. Merbromin NF Solution contains Mercurochrome. Mercurochrome due to its antiseptic properties is used widely in the treatment of burns and blisters. It is non-irritating and is used topically on cuts, wounds, skin, and mucosa. Merbromin is useful on infections of the finger and toe nails because it is an antibacterial which kills bacteria and reduces the risk of infection.

39. Directions for use: Take little solution on a cotton swab or put on wound dropwise and spread upto 0.5cm-1 cm around wound Apply on open wounds after cleaning them thoroughly.

40. Antibiotic of topical use Commonly used antibiotics:- Framcyetin sulphate ( soframycin ) Neomycin + polymyxin + bacitracin (Neosporin) Fusidic acid ( Fucidin_ Metronidazole ( Metrogyl ) Silver sulfadiazine ( Silvrex )

41. Dressing trolley Total number of dressing trolley in ward: Two; one for clean wound and other for infected wound. Materials kept over dressing trolley: Surgical drum with sterile: Gauze pieces, dressing pads, and cotton rolls roller bandage.  Cidex tray with: Scissor, artery forceps, needle holder, and thumb-forceps. Kidney-tray: Concavity of tray confines the curvature of body part. Transparent glass bottle with Cheatle's forceps: Other dressing materials: Cotton • It contains roll, cotton roll bandage, adhesive • Change th tape, surgical gloves, surgical blades; • Used for st normal saline bottles, hydrogen peroxide, Savion sol, surgical-spirit, betadine, eusol, Oxoferin solution, magsulf cream, etc.

42. Cut open tray It contains: B-P (Bard-Parker) blade handle, artery forceps, thumb forceps, needle holder, scissor, suture materials, cotton gauze, and cotton pad. Sterilized by autoclaving.

43. Pus culture tube Two components: Sterile cotton swab Sterile tube. Sample collection: From all parts of wound with help of sterile cotton swab for both dead and live organism. Swab should not touch the adjacent normal skin otherwise sample would be contaminated from normal flora of skin.

44. references Bedside clinics in Orthopaedics by Upendra Kumar

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