Burn Prevention

BURNSURGERY.ORG

Educating the burn care professionals around the world

Overview

Diabetic Ulcer

Venous Ulcer

Pressure Ulcer

Pressure Ulcer (continued)

Local WounD CARE:

The local wound care used is based on the severity or stage of the ulcer. Debridement of necrotic tissues and removal of excess exudates are needed to avoid progression of the wound. Moist wound healing should be maintained while avoiding excess moisture which can lead to maceration.

A variety of specialty dressings have been developed to control exudates while maintaining a moisture layer at the wound surface. Included are hydrogels, hydrocolloid and alginate dressings.

The use of a tissue engineered matrix dressings on clean stage 3 or 4 wound beds will add the missing matrix components thereby improving the wound healing environment.

A secondary dressing which controls exudate and fills any wound dead space would then be applied. Once the wound bed is healthy, healing will occur if contraction or with a large wound using a surgical approach (usually a soft tissue flap).

The most common places for pressure ulcers are over bony prominences close to the skin such as elbows, heels, hips, ankles, shoulders, back and back of the head.

Signs of Infection

Foul odor from ulcer

Increased exudates

Redness and tenderness around the ulcer

Progression of the degree of necrosis

Systemic symptoms

Figure 14: Stage 2 Pressure Ulcer on shoulder

Note thinning of all the skin due to malnutrition. Consider closure of this partial thickness wound with a bioactive wound matrix dressing

Figure 15: Stage 3 Pressure Ulcer

The wound is full thickness. Black eschar needs to be debrided. There is also undermining of the wound edges evident.

Figure 16: Stage 3 Pressure Ulcer (post-debridement)

One week after debridement all wounds are closing by the acute wound healing process. Consider coverage of clean wounds with OASIS® wound matrix dressing.

Figure 17: Stage 3 Pressure Ulcer on bony prominence

Wound is full thickness with granulation tissue on the wound bed prior to application of OASIS® wound

Figure 18: Stage 3 Pressure Ulcer 3 weeks late

(after placement of matrix deressing)

Note the presence of OASIS® wound matrix. The wound is nearly healed.

Figure 19: Stage 4 Pressure Ulcer Post Debridement

Note the presence of muscle and absence of any matrix at the wound bed. The wound flaps are not yet adhered to the wound base

Figure 20: Stage 4 Wound after use of OASIS wound matrix

Note presence of a dermal-like structure now covering the wound bed. Several applications of OASIS® wound matrix have now been incorporated and a wound matrix has developed. Wound depth has been decreased.

Prev Chronic Wounds

Supported by the International Association of Fire Fighters