Overview
The goal of managing chronic wound is to identify and address the conditions that impair wound healing. By correcting these condition, the wound behaves like an acute wound and can be managed as such through closure, skin graft, or flap.
In addition to correcting these condition, supportive management (proper wound care and dressing) aims to create a wound bed that is sufficient for epithelialization or support a skin graft. This can be done by:
- Reducing infection or colonization
- Maintaining appropriate moisture levels
- Improving oxygen tension in the tissue
- Promoting angiogenesis
Dressing
| Category of Dressing | Characteristic | Use | Example |
|---|---|---|---|
| Non-adherent dressing | Fine mesh gauze with coating (to prevent adherence) | To protect wounds and underlying tissue, maintain moisture | Vaseline gauze, Xeroform, Mepitel, Telfa, Tulle gras |
| Absorptive dressing | |||
| Gauze | Wide mesh gauze | To remove exudate, prevent maceration, and debride (wet-to-dry application) | Wide mesh gauze |
| Foams | Hydrophobic foam sheet | To protect wounds and absorb exudate | Allevyn, Curfoam |
| Occlusive dressing | |||
| Non-biologic | Made of polyurethane, cellulose, among others | To insulate, retain moisture, protect the wound and decrease bacterial contamination | Tegaderm, Opsite, Duoderm, Melgisorb |
| Biologic | Made from cadaver skin, pig skin, and human amniotic sac | To insulate, retain moisture, protect the wound and decrease bacterial contamination | Cadaveric skin, Bovine xenograft, Integra, Alloderm |
| Creams, Ointments, and Solutions | |||
| Antibacterial solution | A variety exist | Use on infected wounds | Acetic acid (gram negatives, Pseudomonas), Dakin’s solution (broad spectrum), Iodine-containing solution (broad spectrum, antifungal), Silve-containig solution (broad spectrum, antifungal) |
| Antibacterial ointments | A variety exist | Use on infected wounds, provides occlusion and soothes the wound | Bacitracin (gram positive), Neomycin (gram negative), polymyxin B (gram negative), Neomycin, Triple antibiotic ointment (bacitracin, neomycin, polymyxin B) |
| Enzymatic | A variety exist | To remove necrotic tissue | Collagenase, papain |
Hyperbaric Oxygen (HBO)
HBO therapy involves inhaling 100% O2 at 1.9-2.5 atm of pressure allowing tissue oxygen tension to be ten times normal. It can be given in an enclosed chamber or through a face mask. The oxygen is used in metabolism, induces the synthesis of nitric oxide synthase, and promotes angiogenesis.
HBO is useful in diabetic ischemic ulcers (reduces the amputation rates)
Negative Pressure Wound Therapy (Wound VAC)
Wound VAC applies negative pressure to the wound to remove chronic edema, increase local blood flow and stimulate the proliferation of granulation tissue. It may be used on acute or chronic wounds.
Unna Boot
An unna boot is made by wrapping the leg in gauze impregnated with zinc, glycerin, calamine, or a mixture. It is used to treat venous leg ulcers and lymphedema-related ulcers. The hardened gauze restricts the outward movement of the calf mucles and promotes edema resorption and venous return.
