Biomedical subjects
Publications and source records attributed to Jacqui Fletcher.
Specific terms such as infection, odour and exudate may be helpful for informing the course of patient care. However, classification of wounds as acute or chronic, although frequently used in practice, is a less useful way of characterising wounds. This paper challenges us to review the way we think about the types of wounds that are generally classified as either acute or chronic.
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Chronic wounds such as leg ulcers and pressure sores are a burden on resources and patients who have to live with them. Surveys of prevalence and incidence attempt to clarify the problem. However, it is vital that researchers give appropriate definitions and measurements, take case mix into account and compare like with like when publishing their findings.
A great deal of research into the number of patients with leg ulcers, pressure sores and other chronic wounds has been undertaken. However, researchers may fail to define research terms, and may collect superfluous data. In order for research to be meaningful and useful a number of organisations have developed data sets that can be used to gather such information.
When contained within the wound space, exudate performs a valuable role in wound healing. However, managing wounds with high levels of exudate is a commonly cited clinical problem. High levels of exudate cause problems in terms of selecting appropriate dressings and also in preventing potential damage to the surrounding skin caused by contact with exudate.
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A common complication of diabetes is the occurrence of foot ulcers. Good foot care can, in many instances, prevent ulcers or increase the potential to heal in those patients who do ulcerate. All healthcare professionals working with patients with diabetes should reinforce the importance of caring for the feet each time they see the patient. A focus on foot care reiterates to the patient the importance of self care and prevention of ulceration. Examination of the feet and timely referral to appropriate specialist teams are of particular importance.
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The principles of wound bed preparation in the management of chronic wounds are described using the Tissue, Infection, Moisture, Edge (TIME) framework. TIME offers a systematic approach to wound healing, which involves eliminating non-viable tissue, controlling infection, restoring moisture balance and promoting epithelial advancement. The application of each of these principles to wound management in the clinical setting is discussed.
Wound exudate is produced as a normal part of the healing process. During the inflammatory response blood vessel walls dilate and become more porous allowing leakage of protein-rich fluid into the wounded area (White, 2000). Managing exudate and maintaining a wound environment that is moist but not wet is a constant challenge.
Hydrocolloids are interactive dressings that absorb fluids, and when this happens the physical state of the dressing changes to form a gel. Hydrocolloids contain carboxymethyl cellulose and a range of other polymers, which vary between brands. They are suitable for use on necrotic, sloughy, granulating and epithelializing wounds. Health professionals should consult individual manufacturers' instructions before using hydrocolloids on infected wounds.
Film dressings were one of the first modern wound-dressing products. They are extremely flexible, transparent and adhesive. They have no capacity to absorb fluid but are able to 'breathe off' small amounts of fluid by a process known as moisture vapour transpiration (MVT). The rate of MVT varies between brands but is, at best, minimal. This means that such dressings are not suitable for wounds that produce anything more than a minimal amount of exudate. Film dressings should not be used interchangeably with film products designed for intravenous cannula retention. Intravenous cannula dressings are designed to keep the cannula site dry and have a much higher MVT rate, whereas film dressings are designed to keep the wound moist.
Foam dressings are used for their absorbency and ability to conform to a wound. The way they handle fluid varies between brands. Simple foam dressings allow fluid to pass straight through while maintaining non-adherent contact with the wound. Other foams absorb fluid within the structure of the dressing and have horizontal wicking which spreads the fluid throughout the dressing, allowing greater absorbency (Thomas, 1990).
Bandaging is a basic procedure but if carried out incorrectly it has the potential to cause considerable harm, for example by restricting movement or blood flow. Bandages may be used for: Retaining primary dressings; Support; Compression; As a vehicle for administering medication, for example zinc oxide bandages.
A variety of wound dressing groups is currently available on prescription. In a series of six articles, Jacqui Fletcher looks at the different groups of dressings, their composition, and indications for use. This first article looks at alginates. The second article in the series discusses foam dressings, and will appear in the Wound Care Supplement of 7 June.
Foam dressings vary in composition and levels of absorbency. They are available in both adhesive and non-adhesive options and in a wide variety of sizes and shapes (Boxes 1 and 2). Some products have film backings that are waterproof.
In the third article in this series looking at wound dressings, Jacqui Fletcher describes hydrocolloid dressings.
There have been significant developments in the dressings available to treat infected wounds; this increased choice can, however, be confusing. Jacqui Fletcher outlines the key considerations for using an antimicrobial dressing and describes the key dressing groups that can be used to treat wound infection.