Documente Academic
Documente Profesional
Documente Cultură
By:
dr. Agil Salim Sp. B (k) Trauma FICS, FINACS
Tujuan Covering
Epidermis
Corium of Dermis
Subcutis
Two layers :
1. Dermis
2. Epidermis
Keratin
Lucidum
Granulosum
Spinosum
Basal layer
Basal layers main source of
epithelial cells
Disruption dermal layers more
effort, energy, & longer time of healing
Wound < 1 cm heal in 1 week
Basal layer migrate slowly and
shortly
Sources of epithelial cells skin
appendages i.e hair follisle, sweet
glands, and sebaceous glands
Blood
Enables recognition of
abnormal healing
Recognition
the phases of healing
Assist w/ planning,
implementation, & evaluation
of wound management
Inflammatory Phase
Wound
Healing
Process
Systemic
Factors
Systemic factors :
Malnutrition Cancer Jaundice
Diabetes melitus Uremia Geriatric age
Systemic Chemotherapy Smoking
corticosteroids
Alcoholism Obesity Etc.
Local factors :
Insfection Venus insufficiency
Foreign bodies Local toxin
Hypoxia/iscemia Scars/previous
trauma
Radiation damage
Malnutrion
Glucose as Arginine & Methionine
the main fuel needed for matrix depo,
for collagen syntesis cell prolif, angiogen
Vit C influences
collagen
modification
Wound Healing
Glycine, arginine, Zn influences
methionine to control reepithealization
imflammation & collagen depo
Oncotic pressure
To prevent edema
Wound Healing
Obesity (BMI > 30,0 39, 9 & Morbid Obesity, BMI > 40
?
Poor Tissue Healing
Cardiovascular Disease
Impaired
Tissue
Hypoxemia Wound
Hypoxia
Healing
Respiratory Disease
Impaired
Tissue
Hypoxemia Wound
Hypoxia
Healing
Smoking
Multifactor
Nicotine
+ Hydrogen
Cyanide + CO
Impaired
Uremic Metabolic
Dialysis Immune System
Toxin Acidosis
Insfection Suspecttibility
Hepatic Failure
Clotting Factors
MALIGNANCY
Specific organ
Poor Nutrition Severe pain
compromise
Metabolic / Endocrine Disease
Hypothyroidism
Collagen Production
Diabetes Melitus
Infection
Impaired
Metabolic Vascular Neuropatic
Pathway Patheway Patheway Wound
Healing
Ideal Local Condition
Well
Minimal
Vascularized
exudate
Wound Bed
Optimal
Wound
Healing
Environment
The Barriers
Necrosis
Metabolic Load
Bacterial bioburden
Chronic Wound Exudate
Moisture
Control
Hydrotherapy treatments
Exudate Management
Maintaining moist
Environtment
Always Exudate
Venous ulcer
Artenal ulcer
Diabetic
Chronic gangrene
Wound Pressure sore
Exudate
Ideal Dressing
Creates a moist environment
Removes excess exudate
Prevents dessication
Allow for gaseous exchange
Immpermeable to microorganism
Thermally insulating
Prevents particulate contamination
Nontoxic to beneficial host cells
Provides mechanical protection
Nontraumatic
Easy to use
Cost effective
BURNAZIN PLUS
Introduction
What is Silver Sulfadiazine used for?
Summary
Introduction
The overall aim of wound management is to promote wound healing.
Introduction
Summary
Mechanism of Silver
Kjolseth D, Frank JM, Barker JH, et al. Comparison of the effects of commonly used wound agents on epithelialization and neovascularization. J Am College Surgeons 1994
Sept;179:305-12.
Role of Silver Sulfadiazine
Outlines
Introduction
Summary
HYALURONIC ACID (HA)
DISCOVERY
1934 - Karl Meyer and his assistant John Palmer isolated
new glykoaminoglycane from the vitreous humour of
bovine eyes
vitreous humour
bovine
Hyaluronic Acid
Is a polysaccharide An extracellular
matrix component, Synthesized in the plasma
is a membrane of fibroblasts
glycosaminoglycan and other cells
Regulation of its
biosynthesis is not well
understood; however,
many inflammatory
mediators and growths
factors activate HA
synthesis
Hyaluronic Acid in the Body
Dahiya P, Kamal R. Hyaluronic acid: A boon in periodontal therapy. North Am J Med Sci 2013;5:309-15
HYALURONIC ACID (HA)
IN WOUND REPAIR
REMODELING
HA PLAYS A ROLE
IN ALL PHASES OF TISSUE REPAIR
Introduction
Compositions:
0.2 % Hyaluronic acid
1 % Silver Sulfadiazine
Indications :
Management of skin lesions, especially those at high risk of infection. It is intended to cover acute and
chronic wounds (first and second degree burns, vascular and metabolic ulcers and pressure sores) and to
provide a moist microba-free wound environment.
Burnazin PLUS can be used on non-infected wounds to help prevent infection and following
successful treatment of infected wounds, to help prevent recurrence of infection.
BURNAZIN PLUS
Hyaluronic Acid 0,2 %
angiogenesis
keratinocytes
Silver Sulfadiazine 1 %
Wide spectrum antibacterial action
Baseline
After disinfection with 0.05% chlorexidine, BURNAZIN Plus was applied and
covered with a medium stretch compression bandage to treat edema. The
dressing was changed daily.
After 25 days
The size of the two major wounds decreased, with less edematous wound
margins and development of granulation tissue. The small wound in the lower
area is completely healed. The dressing was changed daily to prevent infection.
Female patient, 79 years old, IRC, atrial fibrillation and senile dementia. The patient has a multiple
venous wound on the internal malleolar zone of her right leg. The wound appeared in April
2009 and the patient came to the center on 10 August 2009. The wound is slightly exuding, with a
slightly fibrous bed, not very vital margins and edematous skin around the wound.
13 August 2009
The wound is cleansed with physiological solution and then Amukine Med 0.05 is
applied as an antiseptic. Decision to apply BURNAZIN Plus gauzes impregnated with
hyaluronic acid and silver sulfadiazine to stimulate the healing processes and prevent
infection, covered with a medium stretch compression bandage to treat the edema.
Medication change every 3 days.
7 September 2009
The size of the wound is smaller, the bed is cleaner with signs of granulation. Slightly
improved margins, but still partly edematous. The wound is cleansed with physiological
solution, Amukine Med 0.05 is applied as antiseptic, followed by BURNAZIN PLUS to
stimulate healing process and prevent infection. The wound is then covered with a
medium stretch compression bandage to treat edema. The dressing is changed every
3 days.
6 October 2009
The wound is completely healed and closed. Excellent repair result. Fisian cream is
applied to the leg, and a Gloria fix AD knee sock and class 1 compression stocking is
prescribed.
CLINICAL CASE (2)
Female patient, 66 years old, resident in RSA, affected by serious mental retardation, type II
diabetes, and venous insufficiency in her lower limbs. On admission the patient has an
extensive mixed wound on the front of her left leg, moderate exudation and bleeding.
13 November 2010
Decision to apply BURNAZIN PLUS to stimulate healing process and prevent
infection.
16 December 2010
The size of the wound has reduced drastically (95%) with extensive re-
epithelialization. Treatment continues with BURNAZIN PLUS to further stimulate
healing and prevent infection.
14 January 2011
The wound healed in 61 days, with excellent results.
CLINICAL CASE (3)
Male patient, 61 years old, former smoker, with chronic cerebral vascular insufficiency,
underwent femoral aorta bypass due to critical ischemia in the right leg. De-ambulation deficit. On
admittance, the patient has trophic wounds on his right knee and tibia. Here, we consider the
wound on the right knee.
14 June 2011
The wound shows medium exudation, fibrin in the wound bed and inflamed, fragile
skin around the wound. The patient complains of very intense pain (score of 9 on the
VAS). The wound is cleansed with physiological solution followed by application of
BURNAZIN Plus to stimulate healing and prevent infection. A non-adherent gauze is
used as secondary medication along with an elastic bandage to secure it in place.
The dressing is changed twice weekly.
15 July 2011
The wound shows advanced re-epithelialization, with no signs of inflammation and
correct healing structure. There is a reduction in the amount of self-reported pain
patient (score of 4 on the VAS).
20 July 2011
On discharge, the wound is completely healed, except for a very small zone of
approx. 0.5 x 0.3 cm with imperfect re-epithelialization, in line with the patella
(probably due to mechanical traction of the anatomical zone). The patient is
prescribed home medication, with a check-up after 2 weeks.
How to Use
Clean the wound Apply a 2 mm layer Cover with Non Apply a bandage to
using Physiological of Burnazin Plus stick medication, ensure the
solutions Control Cream once such as non necessary contact
a day. adherent dressing
A sterile spatula
can be used for
easier application
102
Outlines
Introduction
Summary
Summary
Silver sulfadiazine has been THE GOLD STANDARD for topical burn therapy
SSD cream in modern wound treatment besides being indicated for burn
wound treatment will be very beneficial for preparation of chronic wound beds
engineering.