Chronic Wound Care With Modern Dressings

Chronic Wound Care With Modern Dressings

a) Inflamase phase:

• Days 0 to 5.
• The immediate response after the jury occurs is blood clots to prevent blood loss.
• Karakteristik: tumor, rubor, dolor, color, functio laesa.
• The initial phase occurs hemostasis.
• The final phase occurs phagocytosis.
• The length of this phase can be short if no infection occurs.

b) Proliferative or epithelial phase

• Days 3 to 14.
  It is also called the granulation phase because of the formation of granulation tissue; The wound appeared fresh red, shiny.
• Granulation tissue consists of a combination of: fibroblasts, inflammatory cells, new blood vessels, fibronectin, and hyaluronic acid.
• Epithelization occurs in the first 24 hours characterized by thickening of the epidermal layer at the edges of the wound.
• Epithelization occurs in the first 48 hours of incision wounds.

c) Maturation or remodeling phase

• Lasts from a few weeks to 2 years.
• New collagen is formed that changes the shape of the wound and increases tissue strength (tensile strength).
• Scar tissue is formed 50-80% as strong as the previous tissue.
• Gradual reduction of cellular activity and vascularization of repaired tissues. 

C.    FACTORS AFFECTING THE WOUND HEALING PROCESS 

• Immunological or immune status: Wound healing is a complex biological process consisting of a series of events aimed at repairing damaged tissue. The role of the immune system in this process is not only to recognize and combat neoplastic antigens in wounds, but also to participate in the process of cell regeneration.
• Blood sugar levels: Elevated blood glucose levels due to insulin resistance, as seen in diabetics, also mean that nutrients are not transported into the cells, resulting in a decrease in protein and calories in the body.
• Rehydration and wound washing: By rehydrating and cleansing the wound, the number of bacteria in the wound will increase, as a result the number of bacterial exudate will decrease.
• Nutrition: The role of nutrition in wound healing is very important. For example, vitamin C is essential for collagen synthesis, vitamin A increases cell epithelialization and zinc is necessary for cell proliferation and mitosis. The elderly need all nutrients, including proteins, carbohydrates, lipids, vitamins and minerals. Malnutrition is associated with various metabolic changes that affect wound healing. Blood albumin levels: albumin is useful in the prevention of oedema and plays a major role in determining plasma oncotic pressure. Albumin levels targeted for wound healing are 3.5-5.5 g/dl.
• Oxygen supply and vascularization: Oxygen is a prerequisite for repair processes such as cell proliferation, bacterial defense, angiogenesis, and collagen synthesis. Wound healing is impaired when tissue hypoxia occurs.
• Pain: Pain is one of the triggers of an increase in glucocorticoid hormones that inhibit the wound healing process.
• Corticosteroids: Steroids have antagonistic effects on growth factors and collagen deposition in wound healing. Steroids also suppress the immune system / immune system which is needed in wound healing.

D.    HOW TO CARE FOR WOUNDS WITH MODERN DRESSINGS

More and more wound care methods use the principle of moisture balance and are said to be more effective than traditional methods. Wound care that uses the principle of moisture balance is known as the modern method of dressing. Until recently, it was believed that wounds would heal faster when dry. However, in reality, the moist environment of the wound promotes cell proliferation and collagen growth in a healthy non-cellular matrix. In acute wounds, moisture balance promotes cell proliferation and the action of growth factors, cytokines, and chemokines that stabilize the wound tissue matrix. Therefore, the wound must be kept moist. Too humid environment leads to maceration of the wound edges, while excessive wetting leads to cell death and displacement of epithelial tissue and matrix. Modern wound care involves three steps: wound cleaning, removal of dead tissue, and selection of dressing materials. The purpose of wound cleaning is to reduce the number of bacteria, remove residues of old dressings, destroy necrotic tissue and remove dead tissue and cells from the wound surface. While traditional wound care requires frequent dressing changes, modern wound care is based on keeping the wound moist by using materials such as hydrogels. The hydrogel creates a moist wound environment, softening and breaking down necrotic tissue without damaging healthy tissue, and necrotic tissue absorbed into the gel structure is removed by the dressing material (spontaneous autolysis). The dressing material can be used for 3-5 days, with minimal trauma and pain during the change of dressing. Modern dressings include calcium alginate, in which calcium helps with hemostasis. Hydrocellulose absorbs twice as much moisture as calcium alginate. In addition, hydrocolloids protect against moisture and bacterial contamination and can be used as primary and secondary dressings. Modern dressings are adapted to the type of wound. Hygroscopic foam-like dressings are chosen for wounds with high levels of exudate, while gels are used to create a moist atmosphere that promotes wound healing in wounds where granulation has already begun to grow.

E.    WOUND STUDY

• Status nutrisi borderen: BMI (body mass index), kadar albumin
• Status vascula: Hb, TcO2
• Immune status: corticosteroid therapy or other immunosuppressant drugs
• Underlying disease: diabetes or other vascularization abnormalities7
• Wound condition:

a. Base color of the wound 

   Basic assessment based on color: slough (yellow), necrotic tissue (black), infected tissue (green), granulating tissue (red), epithelializing (pink).

b. Location, size, and depth of wound

c. Exudate and smell

d. Signs of infection

e.The condition of the skin around the wound: color and moisture

f. Supporting laboratory test results 

F.     Based on the condition of the wound, it can be divided into several color methods, namely RYB / res yellow black (red, yellow, black)

• Red base sores
  The goal of red-based wound care is to maintain a moist wound environment, prevent trauma/bleeding and prevent exudate.
• Luke Dasar Kuning
  The goal of this treatment is to improve the autodigestive debridement system so that the wound does not become red, control exudate, eliminate odor, and reduce / avoid infection.
• Black base wounds
  The goal of treatment is the same as for yellow base wounds: removing dead tissue, either by autodigestive debridement or surgery.