Epidermis

-Stratum corneum

-Stratum germanium

-Keratinocytes

-Melanocytes

-Langerhans cells 

Vernix caseosa & Brown fat

the waxy or cheese-like white substance found coating the skin of newborn human babies.

brown fat is one of two types of fat or adipose tissue (the other being white adipose tissue) found in mammals.

Moisture associated skin damage (MASD)

            -Abrasion

            -Abscess

            -Contusion

            -Crushing

            -Incision

            -Laceration

            -Penetrating

            -Puncture

            -Tunnel

            -Pressure ulcers

            -Arterial ulcers

            -Venous stasis ulcers

Phases of Healing

inflammatory,proliferative, maturation

            -Adhesive strips

            -Sutures

            -staples

            -surgical glue

            -negative-pressure closure

            -compression

Advanced wound treatment

            -Surgical options

            -Hyperbaric oxygen therapy

            -Platelet-derived growth factor

Pyogenic

Hemostasis

Fistula

Reactive hyperemia

In epiboly, the wound edges thicken and the pressure ulcer becomes chronic, with little or no evidence of new tissue growth.

In undermining, which occurs when necrosis of subcutaneous fat or muscle occurs, a pocket extends beneath the skin at the ulcer's edge.

•  negative pressure wound therapy

•  electrical stimulation

•  hyperbaric oxygen

•  radiant heat

•  tissue growth factors

•  ultrasound

•  bioengineered

•  skin equivalents

•  surgical options

Senescent

5 Types of debridement

1.1.      Sharp or surgical

1.2.      Mechanical

1.3.      enzymatic

1.4.      autolytic

1.5.      maggot debridement

Primary and Secondary dressings

Absorbent dressings

a sterile dressing of any material applied to a wound or incision to absorb secretions.

Use: appropriate for wounds with moderate to large amounts of exudate. Can be used as a primary or secondary dressing to manage drainage from partial- or full- thickness wounds.

Cautions: Do not use to pack undermining wounds. Do not use if the wound is not draining. 

Alginate dressings

hydrophilic wound dressings that absorb large volumes of wound exudate and maintain a moist wound interface without tissue maceration

Use: should be reserved for wounds with large amounts of exudate. Ideal for wounds that have depth, tracts, tunneling, or undermining

Technique: when the alginate comes in contact with exudate, a non-adhesive gel is created. You must irrigate this gel from the wound before placing the next dressing.

Cautions: alginate dressing are extremely absorptive and will adhere to the wound bed if there is no drainage

antimicrobial dressings

covers that deliver the effects of agents, such as silver and Polyhexamethylene Biguanide (PHMB), to maintain efficacy against common infectious bacteria. 

Use: can be used on partial- or full- thickness wounds, malodorous wounds with little to large amounts of drainage, or highly contaminated or infected wounds

Purposes: to control or decrease the amount of bacteria in a wound, which helps to decrease exudate and prevent infection.

•  triangular arm binder or sling

-Used to support the upper extremities. Because commercial slings are readily available, you will use the triangle sling infrequently. 

•  T-binder

-Used to secure dressing or pads in the perineal area. 

•  Abdominal binder

-Used to provide support to the abdomen. It is often ordered when there is an open abdominal wound that is healing by secondary intention. The binder decreases the risk of dehiscence. Abdominal binders may be straight or multitailed. 

collagen dressings

made from bovine(cow) or porcine (pig) sources and made into sheets, pads, powders, and gels.

Use: use with partial or full thickness wounds, in contaminated or infected wounds

Purposes: collagen dressings, stimulate wounds, to produce collagen fibers, granulation tissue in the wound bed. Some collagen dressings are absorptive and help maintain a moist wound bed.

Advantages: These dressings do not stick to the wound bed and are easy to apply and remove.

gauze dressings

The simplest and most widely used dressings. Is available in a variety of forms and textures. Is made of woven and non-woven fibers of cotton, rayon, polyester, or a combination of these. Some impregnated with anti-microbial agents, medications, or moisture and others contain petrolatum to keep the wound moist. 

Use: Gauze dressings can be used for packing large wounds, cavities or tracts, deep or dirty wounds, or heavily draining wounds.

Disadvantages: Gauze dressings, in the past, been considered the standard of care in advanced wound management. However, they have proven to be labor intensice and less cost effective than other advanced dressings, even though their initial cost of purchase may be less. 

Made from semi-permeable hydrophilic foam that forms an impermeable barrier over the wound. They are made into wafers, rolls, and pillows; have film coverings, and are adhesive or non-adhesive. 

Use: Foams can absorb minimal to heavier exudates

Purposes: They provide a moist environment and thermal insulation. The non-adhesive form protects periwound skin. 

Techniques: when applyin a foam dressing, choose one that is approx. 2-3cm (1-1.5in) larger than the wound. The dressings may be changed up to three times a week.

Advantages: conformable; can be shaped around body contours. They do not stick to the wound bed

Cautions: Do not use with wounds that have tunneling or tracts. Foam is not recommended for dry, desiccated wounds. If the dressing becomes saturated, it may macerate periwound skin. 

hydrocolloid dressings

Are wafers, pastes, or powders that contain hydrophilic (water loving particles). 

Use:When applied to a wound, the hydrophilic particles interact with exudate to form a gel that keeps the wound moist. The dressing forms a protective layer against friction and bacteria. This type of dressing is ideal for wounds with minimal drainage, such as partial-thickness wounds or stage 2 pressure ulcers. Hydrocolloid pastes or granules may be used to fill shallow cavities around stomas to create an even surface on which to place the ostomy appliance.

Advantages: Wafers easily mold to the shape of the body, making them useful for difficult areas. The protective layer also decreases pain. They promote autolytic debridement.

hydrogel dressings

Sheets, granules, or gels with a high water content, creating a jelly-like consistency that does not adhere to the wound bed. 

Uses: Their soft, cooling texture promotes patient comfort. Enhance epithelialization by providing to the wound bed. They may also be used to soften slough or eschar in the necrotic wounds, and they can be used in infected wounds. 

Techniques: Because they are not adhesive, you will need to apply a secondary dressing over the hyrdogel to maintain the moisture level in the wound and hold the product in place. 

Cautions: They have limited absorptive capabilities, they are not practical for wounds with significant exudate. Their high moisture content can easily macerate periwound skin.

transparent film dressings

Thin film dressings that are clear and semi-permeable. They allow exhange of air and water vapor between the wound and the environment while preventing external bacteria contamination. 

Uses: transparent dressings are non absorbent, so they keep the wound moist. They are useful for wounds with minimal or no drainage. They are often used to dressed IV sites. 

Advantages: the transparent dressing allows you to view the wound without removing or disturbing the dressing. Because they are thin and flexible, transparent films can be placed over joints without inhibiting movement. 

Cautions: if used over wounds that are draining, the tissues will become macerated. Transparent dressings adhere to the skin, so you should not use them on friable skin. 

• Skin sealants are made from liquid transparent copolymer that can be wiped or sprayed on skin to protect it from wound exudate, and moisture, friction, and skin stripping from adhesives. 
• Moisture barriers - petrolatum dimethicone, or zinc-based products that can be applied to skin to protect it from exudate, moisture, urine, and feces. 
• Both are simple and fast to use, and if needed, should be used with each dressing change. 

Uses: provide a barrier of protection over vulnerable skin from the effects of moisture and mechanical and chemical skin injury.

Cautions: ointments impair the adhesion of wound dressings or tapes. 

• Braden: evaluates six major risk factors- sensory perception, moisture, activity, mobility, nutrition, and friction and shear. The final score reflects the patients risk; the lower score, the more likely the patient will develop a pressure ulcer. A score of 18 or less for hospitalized patients indicates risk. Use this scale to assess the patient on admission to the facility and again in 48-72 hours. The second score is usually more predictive. The Braden Q is a modified scale used in children.
• Norton: assesses risk based on the patient's physical condition, mental state, activity, mobility, and incontinence. A low score indicates a high risk.