Transcript Document

Sutures & Wound Dressings
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Wound Care and Management
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More than a million Americans suffer from non-healing
wounds annually, at a cost of $750 million;
Etiology: trauma, inactivity, disease and surgery;
3,852 wound care products on the market;
Some classified as drugs or biologics, while others are
classified as devices;
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Wound Care Products
Goals:
 Bind surface epithelium and underlying connective
tissues when possible;
 Protect wound from infection;
 Maintain moist wound environment;
 Permit gas exchange; and,
 Promote rapid epithelialization.
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Principles of Wound Healing
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Hemostasis
Inflammation
Granulation Tissue
Tissue remodeling or maturation
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Keys to Wound Care
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Identify the causative factors
Improve the local environment
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Common Underlying Causes of
Wounds
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Trauma-accident or intentional (surgery)
Scalds and burns (chemical and physical)
Animal bites or insect stings
Pressure (spinal injured)
Vasculature related, arterial, venous, mixed
Immunodeficiency
Malignancy
Connective tissue disorders
Metablolic or endocrine disorders (diabetes)
Nutritional deficiencies
Psycho social
Adverse effects of medications
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Timetable of Wound Healing
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Hemostasis
Inflammation
Granulation Tissue
Tissue remodeling
or maturation
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immediate
1-4 days
4-21 days
21 days-2 years
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Chronic Wound diagnosis
Treat
cause
Debride
Local
Wound
Care
Patient Centered
Concerns
Cleanse and
absorb-Bacterial
Management
Protect-Moist
Interactive
Healing
Non-healing
Wounds
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Biological agents
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Wound Color
Black. Necrotic tissue is non-viable, and it must be removed
before healing can take place.
Yellow. Yellow wounds may contain moist necrotic tissue
(slough) and/or contain purulent drainage. The primary objective
is to remove unhealthy tissue, any contaminants, debris and
excess exudate which deter the healing process. Once a clean,
moist and viable wound bed is achieved, healing can begin.
Red. Is good-the actively healing phase of a wound, cells
proliferate, fibroblasts form collagen and eventually small, red,
fleshy masses called granulation tissue (angiogenesis) begin to
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form.
History of Biomaterials in
Medicine
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Ancient cultures used primitive materials from their
natural surroundings to heal their wounds and to cure
diseases.
The oldest known use of bandages -Sumeria (2100 BC).
a medical manuscript written on stone tablets describes
detailed procedures of washing wounds, making plaster,
and bandaging.
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“Early Wound Dressing”
Natural adhesive bandages
were used 4,000 years ago by
the Egyptians.
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In the Edwin Smith papyrus,
Egyptians wrote of using
woven bandages soaked in a
quick setting plasters used as
adhesive tapes were
discussed in the manuscript.
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The oldest bandages that
have been found were in the
tombs of the Pharaohs.
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Sutures
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Used as the means of
repairing damaged
tissues, cut vessels, and
surgical incisionsInitially a variety of
natural materials were
used: flax, hair, linen
strips, pig bristles,
grasses, mandibles of
pincher ants, cotton, silk,
and the gut of an animal
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Sutures
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The largest group of devices implanted in humans;
By definition, a suture is a filament that either
approximates or maintains tissues in juxtaposition until
the natural healing process has provided a sufficient
level of wound strength or compresses blood vessels in
order to stop bleeding;
Classified into one of two groups, absorbable and
nonabsorbable;
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Commercially Available
Sutures
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cellulose based (cotton)
protein-cellulose (silk)
processed collagen
(catgut)
nylon
Polypropylene
Aramid
Alha-hydroxy acids
polyglycologic acid
polyglycolide-lactide
polymer
polytetraflourethylene
Stainless steel
aluminum alloys
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Test Specifcation for Sutures
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breaking strength
elongation-to-break
Young's modulus
knot security
viscoelastic properties
tissue reaction
cellular response
cellular enzyme activity
suture metabolism
chronic toxicity
teratologics
mutagenicity
carcinogenicity
allergenicity
Immunigenicity
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Suture Size
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Staples
Thin metal used to
approximate the edges of the
skin (area must be
anesthetized);
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Staple appliers push the two
prongs of the staple down
through the epidermis and
dermis into the subdermal
layer and then bend these
prongs inward;
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Once these prongs have
been bent inwards, the
positions of the skin edges
are fixed;
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The major advantages are
speed of closure and less
scarring.
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Indicated on scalp and
abdomen (tendons, nerves
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deep)
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Stapling a Craniotomy Skin
Incision
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Staples
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Staple Considerations
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If the edges are not lined
up flush, misalignment
will be maintained during
the healing process and
may impede the
formation a skin layer
across the skin surface or
result in excessive scar
tissue formation.
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Removal
• removed by
your health care
provider 3 to 14
days after they
are put in.
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Materials Used for Hemostais
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Surgical cellulose is a
material that is comes in
thin sheets of interwoven
specially treated cellulose
that provides a matrix to
which platelets and
clotting factors can
adhere leading to
formation on the cellulose
of a dense clot which can
act as a patch over an
area of bleeding.
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Tissue Adhesive
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Indicated for the closure of topical skin incisions
including laparoscopic incisions, and trauma-induced
lacerations in areas of low skin tension that are simple,
thoroughly-cleansed, and have easily approximated skin
edges.
INDERMILTM Tissue Adhesive Receives FDA Approval
for Closure of Topical Skin Incisions and Lacerations
Indermil may be used in conjunction with, but not in
place of, deep dermal stitches.
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Device Description
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Tissue adhesives are sterile, liquid topical
composed of n-Butyl or octyl-2-Cyanoacrylate
monomer supplied in a 0.5g single patient use,
plastic ampule.
Each ampule is sealed within a foil packet so the
exterior of the ampule is also sterile.
Remains liquid until exposed to water or watercontaining substances / tissue, after which it cures
(polymerizes) and forms a film that bonds to the
underlying surface.
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Traditional Wound Care
Products
Protective and gas permeable
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Transparent Films
Foams
Hydrocolloids or Hydrogels
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Alginates
Specialty Absorptive Dressings
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Transparent Films
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Acu-derm
Bioclusive
Blisterfilm
Polyskin II
Pro-Clude
Op-Site
Opraflex
Tegaderm
Transeal
Transite
Uniflex
Ventex
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Infection Control Products
-Dressings to Secure Catheters
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a thin, semi-occlusive,
transparent polyurethane
film dressing that
provides a bacterial/viral
barrier and helps secure
catheters, reducing
mechanical irritation.
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Transparent Films
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Advantages:
 Waterproof and Bacteria-proof
 Allows visualization of the wound.
 Won’t traumatize wound when removed.
Disadvantages
 Not rec. for wound with moderate/heavy
exudate.
 Not rec. for wound with fragile surrounding
skin.
 Provides no cushioning to wound.
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Foams
Examples
 Allevyn
 Cutinova Foam
 Epilock
 Flexzam
 Hydrasorb
 Lyofoam
 Mitraflex
 Nu-derm
 Polymem
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 Tielle
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Foams-polyurethane pads
-Indications: Noninfected, draining granular
wound
 Advantages
 Non-adherent
 Won’t injure surrounding skin
 Can repel contaminants
 May be used under compression
 Cushions wound surface
 Maintains moist wound evironment
 Highly conforming
 Gas permeable
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Hydrocolloids
in pad,sheet or filler form for occlusive use.
Forms a “gel” as it absorbs water from the
wound bed that sits on wound
Indications: Small, solitary non-draining ulcers
or light-to-moderate exudate wounds
 Advantages
 Impermeable to bacteria and other
contaminants
 Promotes autolysis, angiogenesis, and
granulation
 Self-adhesive and molds well
 Limited-to-moderate absorption
 Creates moist environment
 May be left in place for up to 5 days
 May be worn in the shower
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Hydrocolloids
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AquaCel
Comfeel
Cutinova Hydra
Duoderm
Hydrapad
Intrasite
J&J Ulcer
Dressing
Procol
Replicare
Restore
Triad
Ultec
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Hydrogels
-cross-linked hydrophilic matrix impregnated into gauzetype pads which allows transmission of water, vapor and
CO2 but discourages dehydration.
Indications: full thickness wounds with moderate drainage
 Soothing and conforms to wound
 Fills in dead spaces
 Highly absorptive
 Can be used on infected wounds
 Disadvantages
 Difficult to keep in place
 Encourages gram negative organisms
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Hydrogels
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AquaSorb
Carrington Gel
Carrasyn-V
Clear-Site
Curasol Gel
Flexderm
Hydron
Intrasite Gel
Solosite
SAF-Gel
Transorb
WounDres
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Adhesive Gel Sheets for Scar
Treatment
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Flexible, adhesive, semiocclusive silicone gel sheet.
Reduces raised scars and
redness of the scar so it
fades and becomes less
noticeable.
Self-adhesiveness and
durability mean that
application is simple and
the gel sheet can be
washed and used several
times.
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Resorbing Matrices
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Matrix is a primary dressing
which transforms into a soft,
conformable gel, allowing
contact with the entire wound
bed;
Consists of 45% regenerating
cellulose and 55% type I
collagen
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Resorbing Matrices
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The persisting inflammatory
phase in chronic wounds
contributes to exudate with
high concentrations of matrix
metalloproteases (MMPs);
Excess MMPs result in
degradation of extracellular
matrix proteins;
Excess MMPs inactivate
growth factors;
cellulose/collagen combination
binds more MMPs than ORC
or collagen alone
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Apligraf®
human skin-like products comprised of living human skin cells
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Organogenesis
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Living Skin Equivalents
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Living bi-layered skin substitutes
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Apligraf (formerly Graftskin)
 Type I bovine collagen, extracted and purified from bovine
tendons, and viable allogenic human fibroblast and
keratinocyte cells.
Dermagraft
 Human neonatal fibroblasts derived from fetal foreskin,
extracellular matrix and a bioabsorbable suture like
scaffold.
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Living Skin Equivalents
Indications: diabetic foot ulcer care of full-thickness ulcers of
neuropathic etiology of at lease three weeks duration and
burns
Contraindications:
-infections
-exposed bone, capsule, muscle or
tendon
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