Today's Veterinary Practice

JUL-AUG 2015

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Today's VeTerinary PracTice | July/august 2015 | tvpjournal.com MoisT Wound Healing: THe neW sTandard of care Peer reviewed 36 polyurethane foam, increase in size. » Dressings that begin as a gel, or interact with wound fuid to become a gel, conform well to the nooks and crannies of an irregular wound surface (Figures 7 and 8). » Some MRDs have adhesive borders designed to adhere to the periwound skin and protect it from moisture (Figure 16, page 41). Adding a Semipermeable Cover When a semipermeable cover is not built into the MRD, adding an adhesive transparent polyurethane flm over the MRD can be desirable in some cases (Figure 16). The semipermeable flm allows gas exchange but serves as a barrier to bacteria and moisture. Thus, the flm: 7,9 • Helps protect wound from exogenous organisms • Keeps wound fluid in and environmental fluid out of the wound • Helps hold the MRD in place. Because the flm is waterproof and has no absorptive capability of its own, it prevents wicking of excess exudate into the cast padding. Therefore, it should not be used in situations in which the TablE 3. Characteristics of Common MRDs MRD EXUDATE LEVEL PROPERTIES INDICATIONS CONTRAINDICATIONS/ PRECAUTIONS Calcium alginate High; calcium alginate absorbs 20–30× its weight in fuid • Made from seaweed • Felt-like material that turns to gel as it absorbs wound fuid • Ca+2 stimulates macrophage and fbroblast activity, promotes hemostasis • Gel entraps bacteria • Especially good for autolytic debridement of contaminated, moderate to highly exudative wounds • Good stimulator of granulation tissue • Need for hemostasis in oozing wounds • If exudate insuffcient, product does not gel and dehydrates wound Polyurethane foam Moderate to high • Soft foam • Does not gel, but helps keep proper moisture level in contact with wound surface • Some have adhesive border • Particularly good for supporting epithelialization • Supports autolytic debridement and granulation • Can wick moisture out of macerated skin • Premoisten with saline to use on wound with lower exudate level • If exudate is insuffcient, wound dehydrates (unless foam is premoistened with saline) • Foam too soft to protect bony prominences Hydrocolloid Low to moderate • Sheet, paste, or powdered forms • All turn into a gel as wound fuid is absorbed • Sheets typically have occlusive backing/ adhesive perimeter to attach to periwound skin • Gel entraps bacteria • Good for autolytic debridement, granulation, and epithelialization • Hydrocolloid sheet with impermeable backing can be used to add occlusive cover over other dressings • Use caution if infection is present because occlusive backing creates hypoxic environment that can favor anaerobes Hydrogel Low to none • Up to 95% water • Comes as gel or sheet that turns to gel in wound • Add polyurethane flm cover (if not built into hydrogel sheet) to keep hydrogel's moisture in wound • Dry wounds requiring autolytic debridement, granulation, or epithelialization • May enhance contraction on limb wounds • Cooling effect may decrease pain • Maceration can result if exudate overwhelms hydrogel's low absorptive capacity Data obtained from references 4,6,7,9,12,14,16–19

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