Wound healing is determined by the general health of your patient, so a comprehensive assessment of your patient is crucial when planning and evaluating treatment.
If a wound contains dead (necrotic) tissue, it’s a sign that the wound is not healing normally.
The skin surrounding an wound is vulnerable. This may be associated with age, disease processes or exposure of the skin to wound exudate or dressing adhesives.
Whether a wound is low-, medium- or high-exuding, superior absorption and control of exudate are essential for optimal healing.
Necrotic tissue is often black or yellow. It may be soft or it may form a scab (eschar). Necrotic tissue can contain bacteria – and if the bacteria grow, the wound will become infected.
Necrotic tissue must be removed in order to support wound healing. Removal can be surgical, mechanical, enzymatic (such as maggot therapy), or it can be achieved by supplementing the body’s own ability to break down necrotic tissue (autolytic debridement).
The autolytic debridement process is optimized when the wound is moist. Coloplast has a range of dressings that support moist wound healing. For optimal moisture balance in the wound, the hydrocolloid Comfeel dressing, and the unique properties of the Biatain foam dressing each support the natural autolytic debridement process.
Purilon gel is ideal for gentle and effective autolytic debridement of tissue in both dry and moist necrotic wounds, when used in combination with a secondary dressing such as Comfeel or Biatain.
Exudate leaked from ulcers can cause maceration, a softening or sogginess and breakdown of the skin that results from on-going contact with excessive moisture. Maceration can lead to skin breakdown, causing the wound to grow or creating satellite ulcers. Macerated tissue is white in color.
Erythema is an abnormal redness of the skin caused by dilation of blood vessels. Redness of the periwound skin may be a sign of inflammation or wound infection.
As we grow older, the texture of our skin changes and our skin becomes thinner, weaker and less protective. If a wound is surrounded by fragile skin, dressings are more likely to cause skin irritation. You must examine the skin carefully before deciding to use either an adhesive or a non-adhesive dressing.
The Biatain dressing range offers dressings with superior absorption and exudate management properties for all types of skin conditions.
If a wound is surrounded by fragile skin, a dressing with silicone adhesive such as Biatain Silicone is an excellent alternative, as it can be used on both fragile and healthy skin.
Normal, healthy skin has a smooth and resilient structure. With proper wound treatment and use of dressings with superior absorption and exudate management, the skin surrounding a wound may be perfectly healthy and suitable for adhesive dressings such as Biatain Adhesive.
If the skin is very fragile, consider using a non-adhesive dressing such as Biatain Non-adhesive or Biatain Alginate.
1. White RJ and Cutting KF. British Journal of Nursing 2003;12(20):1186-1201
2. Adderly UJ. Wound Care, March 2010:15-20
3. Colwell JC et al. Wound Ostomy Continence Nursing 2011;38(5):541-53
4. Enoch B and Harding K. Wounds: A Compendium of Clinical Research and Practice 2003;15(7):213-29
5. Andersen et al. Ostomy/Wound Management 2002;(48)8:34-41
6. Thomas et al. http://www.dressings.org/TechnicalPublications/PDF/Coloplast-Dressings-Testing-2003-2004.pdf
7. White R and Cutting KF. worldwidewounds.com/2006/september/White/Modern-Exudate-Mgt.html
8. Romanelli et al. Exudate management made easy. Wounds International 2010;1(2).
In the inflammatory phase of wound healing, exudate levels are usually high. Non-healing, or chronic, wounds are often stuck in the inflammatory phase and may produce large amounts of exudate. Increased exudate levels can be a symptom of infection and increased edema.
Wound exudate is a fluid composed of plasma, blood cells and platelets. Most of the wound exudate filters from the blood and/or lymph system into the wound area, but red blood cells and platelets leak from injured capillaries. Composition and viscosity varies, from thin and clear plasma fluid to thick yellow secretion containing high concentrations of white blood cells and bacteria.
If wound exudate is not properly controlled, it can leak from the dressing and result in the periwound skin being exposed to the exudate (1). This causes over-hydration maceration of the skin and can ultimately delay healing (2,3).
Maceration is a softening or sogginess and breakdown of the skin caused by on-going contact with excessive moisture. Macerated tissue looks white and maceration can cause an ulcer to grow or create satellite ulcers.
It is therefore very important that excess exudate is removed from the wound by an absorbent dressing. (4)
Control of exudate, removal of unhealthy tissue by debridement and management of bacterial load are all part of good wound bed preparation. The optimal wound dressing keeps the wound moist and absorbs exudate, locking it inside the dressing to prevent maceration.
We recommend the Biatain dressing range, which provides superior absorption - of low to high exuding wounds. Biatain dressings effectively absorb and retain wound exudate, ensuring a moisture balance that is optimal for healing of exuding wounds.(7,8)
All wounds contain bacteria – even wounds that are healing normally. But if the bacteria count rises the wound may become infected.
1. Jørgensen et al. International Wound Journal 2005;2(1):64-73
2. Münter et al. Journal of Wound Care 2006;15(5):199-206
3. Reitzel & Marburger. EWMA 2009
4. Ip et al. Antimicrobial activities of silver dressings: an in vitro comparison. Journal of Medical Microbiology 2006;(55):59-63.
5. Basterzi et al. In-vitro comparison of antimicrobial efficacy of various wound dressings. Wounds 2010; July.
6. Data on file (Independent laboratory testing performed by Wickham Laboratories).
7. Thomas et al. www.dressings.org/TechnicalPublications/PDF/ Coloplast-Dressings-Testing-2003-2004.pdf
Wounds that are not healing normally may have a bacterial imbalance resulting in local infection of the wound.
Likely signs of wound infection are one or more of the following:
Additional clinical symptoms may arise if the infection spreads to the healthy tissue surrounding the wound. Depending on the type of bacteria, the wound exudate may become more puss-like, and the peri-wound skin may be tender, red and painful. The patient may also have a fever.
Please remember that diabetic foot ulcers do not always present with the classical signs of local infection.
If a wound is healing normally, a foam dressing with superior absorption such as Biatain or Biatain Silicone is ideal. If the wound is infected or there is risk of wound infection, we recommend silver dressings such as Biatain Ag, Biatain Silicone Ag. These provide superior absorption for infected wounds (1-7). If the infection is spreading beyond the wound, the silver dressing must be combined with systemic antibiotic treatment at the discretion of a physician.
For more information about Wound Care, you can contact the resources below.
The academy members include practicing dermatologists who are committed to excellence in patient care, medical and public education, research, professionalism and member services support . Learn more about this academy at www.aad.org.
APIC is a professional association dedicated to improving health and patient safety by reducing risks of infection and other adverse outcomes. Learn more about this association at www.apic.org.
AAWC is a non-profit association for anyone involved in wound care. Join in to learn more about wound care at www.aawconline.org.
The aim of the DFSG is to promote improvements in diabetic foot care. Read more about this group at www.dfsg.org.
EPUAP works to lead and support all European countries in the efforts to prevent and treat pressure ulcers. You can learn more about their activities at www.epuap.org.
The EWMA deals with all clinical and scientific issues related to wound healing. Each year, EWMA hosts one of the largest international events within wound management and wound healing in Europe. Learn more about this association at www.ewma.org.
IWGDF works to improve outcomes of diabetic foot problems and strengthen the communication between healthcare professionals. Learn more about their work at www.iwgdf.org.
IASP is the world's largest multidisciplinary organization working to support the study of pain and to translate that knowledge into improved pain relief worldwide. Read more about them at www.iasp-pain.org.
NPUAP is an American organization working for the prevention and improved treatment of pressure ulcers. Read more at www.npuap.org.
A consortium of executives representing healthcare providers; medical products, pharmaceuticals and supply chain distribution companies; and service businesses united to reengineer and advance the future of the healthcare supply chain for the purpose of improving the overall healthcare marketplace in the United States. Learn more by visiting www.smisupplychain.com.
World Wide Wounds is an electronic wound management journal dedicated to providing practical guidance and information on all aspects of wound management to healthcare professionals worldwide. Read the journal at www.worldwidewounds.com.
The Wound Healing Society is a non-profit organization for clinical and basic scientists dedicated to improve the area of wound healing. Learn more about their activities at www.woundheal.org.
The WOCN Society is a professional nursing society. It supports its members by promoting educational, clinical and research opportunities to advance the practice of expert healthcare to individuals with wounds, ostomies and incontinence. Read more about this society at www.wocn.org.
WUWHS is an international organization dedicated to improving the wound care standards for patients and the healthcare performance of professionals. It also works to ensure universal access in all healthcare systems. For more information go to www.wuwhs.org
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