surgical dressing and the steps of dressing wound

the steps to be followed while dressing a wound and the principles of wound dressing

1. SURGICAL DRESSINGS

2. What is surgical dressing? Surgical dressing: sterile pad or compress applied to a wound to promote healing and prevent further harm Bandage: piece of material used either to support a medical device such as a dressing or splint

3. History Material like fabric, leaves, cobweb, dung etc. Ancient Eqyptians (1500BC)- honey Hippocrates (460BC)- vinegar & fig leaves Roman physicians (100)- spices like saffron, thyme, mint; silver & lead (antiseptic) but were lost to Dark Ages

4. History.. Joseph Lister (1860s)- Introduced antiseptic dressings ( carbolic acid) Decreased mortality

5. History.. “Johnson & Johnson”(1886)- Iodinated dressings Debuted commercial first aid kit

6. History.. “Johnson & Johnson”(1920)- e Earle dickson - a cotton buyer invented BAND- AID (brand adhesive bandage)

7. History.. George Winter (1962)- Pioneered concept of moist healing & occlusive dressings

8. History to modern dressings.. 1990 onwards- Hydrogels Hydrocolloids Alginates Synthetic foam dressings Vapor permeable adhesive films Anti adhesives: silicon meshes Tissue adhesives Barrier films Silver/collagen dressings Miscellaneous: Combination products Engineered skin substitutes

9. PURPOSE To promote wound healing To prevent infection To assess the wound healing process To protect the wound from mechanical trauma To absorb drainage To prevent contamination from bodily discharge

10. Ideal wound dressing Creates moist environment Removes excess exudate Prevents desiccation Allows for gaseous exchange Impermeable to microorganisms Thermally insulated

11. Ideal wound dressing.. Prevents particulate contamination odorless Non toxic to benefit host cells Provides mechanical protection Non traumatic Easy to use Cost effective

12. PRINCIPLES

13. How to select appropriate surgical dressing? Occlusive dressing- Principle of moist healing faster wound healing by reducing pH and oxygen tension Stimulating fibroblast proliferation Harmful in infected wounds Absorptive dressing- Preferred in wounds with high bacterial counts & ↑ exudate

14. How to select appropriate surgical dressing?

15. Types of dressings Simple vs. Composite dressings Simple- Saline gauze dressings Film dressings Parrafin gauze dressings Composite- Multilayered dressing – outer, middle & inner layer

16. Types of dressings.. Nonadherent fabrics Absorptive dressings Occlusive dressings Creams, ointments, and solutions

17. Types of dressings..

18. Types of dressings.. Non adherent fabrics Fine mesh gauze supplemented with substance to augment occlusive property/ antibacterial properties E.g. Paraffin gauze, Scarlet Red, Xeroform

19. Types of dressings.. Non adherent fabrics E.g. Paraffin gauze

20. Types of dressings.. Non adherent fabrics E.g. Xeroform

21. Types of dressings..

22. Types of dressings.. 2. Absorptive dressings Wounds with significant amount of exudate E.g. Wide mesh gauze, Foams

23. Types of dressings.. 2. Absorptive dressings E.g. Wide mesh gauze- not effective when saturated, Foams

24. Types of dressings.. 2. Absorptive dressings E.g. Foams-

25. Types of dressings.. 2. Absorptive dressings E.g. Foams-

26. Types of dressings..

27. Types of dressings.. 2. Occlusive dressings Two types- Non biological-e. g. Films, Hydrocolloids, Alginates, Hydrogels Biologic-e.g. Homograft, Xenograft , Amnion, Skin substitutes

28. Types of dressings.. 2. Occlusive dressings Non biological- Films

29. Types of dressings.. 2. Occlusive dressings Non biological- Hydrocolloid matrix gelatin , pectin, carboxymethylcellulose

30. Types of dressings.. 2. Occlusive dressings Non biological- Hydrogels Polyethylene oxide or carboxymethylcellulose polymer and water (80%) Rehydrating agents for dry wounds ;little water absorption

31. Types of dressings.. 2. Occlusive dressings Non biological- Alginates derived from brown algae contain long chains of polysaccharides ( mannuronic and glucuronic acid) Processed as the calcium form, alginates turn into soluble sodium alginate

32. Types of dressings.. 2. Occlusive dressings Biologic- Homograft, Xenograft , Amnion, Skin substitutes- Integra, Alloderm , Apligraf

33. Types of dressings..

34. Types of dressings.. 2. Creams, Ointments & Solutions Traditional materials- zinc oxide paste Antibacterial creams and ointments Acetic acid, Silver nitrate, Silver sulfadiazine, iodine containing ointments( iodosorbs ), bacitracin Enzymes Growth factors Indicated in infected wounds

35. Types of dressings.. 2. Creams, Ointments & Solutions Zinc oxide paste Antibacterial creams and ointments Acetic acid, Silver nitrate, Silver sulfadiazine, iodine containing ointments( iodosorbs ), bacitracin

36. Types of dressings.. 2. Creams, Ointments & Solutions Nano silver Betadine

37. Bibliography Sabiston 21 st ed., Chap. 6, Wound Healing, wound dressings SRB 5 th ed., Chap 36-G, Dressings and Bandages Additional reading- Science of wound healing and dressing material- Vibhakar & Payal Surgical wound healing and management- Mark & Luc