From dressing, wound cleaning and bandaging, B.C. It is mentioned in Sumerian tablets in 2100 BC. Sterilization of instruments began in the 1880s and the first commercial sterile dressing material was produced in 1891.
Studies state that wound healing occurs faster in a humid environment than in a dry environment (Hilman and Maibach 1962). Understanding the moist wound healing mechanism will be useful in understanding the differences between different dressing types in wound healing.
Features of an ideal dressing and dressing material
We can list it as follows: It must have a suitable aesthetic appearance.
Dressing properties vary depending on closed and open wounds. There is no need to apply frequent dressings on clean wounds where no dry discharge develops. They can be left on for 24-48 hours. However, depending on the location of the intervention, the wound can be covered with a thin dressing material to prevent contact with the external environment and protect it from new traumas.
Dressing intervals and observation of the wound may be for 24 hours or longer. The care of open wounds has certain characteristics. Cleaning the wound is an important step in aiding the healing process. It is very important to clean the wound of debris, necrotic tissue and residue, and dressing materials. It should be preferred to clean the wound bed with physiological saline without creating new traumas.
Efforts should be made to provide the patient with minimal discomfort and pain during the procedure. Cleaning the wound can be done carefully with gases moistened with physiological saline, or irrigation can be applied with the help of a syringe. Care should be taken to ensure that the needle is not stuck during irrigation.
This is important not only for the harm that may be caused to the patient, but also for the protection of the healthcare worker.
Factors that need to be considered in the evaluation and care of open wounds include T (Tissue): tissue properties (debris, necrotic tissue), I: infection or inflammation, M (Moisture): balance of moisture in the wound, E (epithelialization). A study that completes the "TIME" principle, defined as: observation of wound edges, stands out as an appropriate approach.
Dressing materials applied to wounds have become very diverse today. It is important to select and use them according to the characteristics of the wound and the patient.
Patients treated in surgical units should be given information to pay attention to when they are discharged from the hospital. In addition to information specific to the surgical intervention performed, information about wound care, periodic checks, movement, exercise, rest and starting work is also very important, as it will take a certain time to heal.
The healing process of the wound should be closely monitored to decide whether the dressing material is effective in wound treatment. In his study on chronic wounds, Eaglstein (2001) states that the absence of a significant reduction in wound size within 2-4 weeks of treatment is an indication that the dressing material used is ineffective.
The dressing material should be selected according to the wound and its size. (Nelson and Dilloway 2002). For fast and accurate treatment of the resulting wound, the dressing product should be selected according to the condition of the wound. When choosing a dressing product, the type of wound as well as the socio-economic status of the patient should be taken into consideration.
Its epithelialization stimulating effect is limited. For example; The effect of Bactigras product on gram (-) and gram (+) microorganisms and fungi has been proven. It can be used in infected minor burns and ulcers, and in graft-donor areas. Bactigras does not adhere to the wound, but also allows wound exudate to pass through its pores to the second wound dressing. It can be used in chronic and acute wounds.
İnadina is one of the options as a dressing product. The advantages of dressing products containing foam are that they are absorbent and non-stick. They can expand into the wound and adapt to irregular wounds and are easily removed. The dressing product should be removed or protected from water while the patient is bathing. Epitylation in foam dressings does not occur as well as in occlusive dressings. The dressing on the wound can remain for 4 - 7 days depending on the amount of wound exudate.
Depending on the condition of the wound, a polyurethane product that does not stick to the wound or is sticky can be chosen. A highly absorptive product with a hydropolymer foam structure creates thermal insulation in the wound and can provide wound care without leaving residue, without toxic effects, and by preventing leakage with the outermost polyurethane layer and impermeable to water. In short, when choosing a dressing, its properties such as insulation, moisture retention, mechanical protection and barrier function against bacteria should be taken into consideration.
The advantage of film dressings is that the wound can be monitored from the outside, the disadvantage is that exudate leaks, causing frequent dressing changes.
An Occlusive dressing is defined as a material that retains moisture in the injured tissue and thus ensures moist wound healing. Today, there are 1000 different types of occlusive dressings, and the sales of these dressings reached 350 million dollars in 1995. However, occlusive dressings are probably used in at most 30% of the cases in which they would be beneficial (Reiter 1994).
The history of occlusive dressings dates back to ancient times. One of the earliest records of occlusive dressing therapy is found in the Smith Papyrus from 1615 BC. In this papyrus, it is stated that closed wounds heal faster than open wounds and it describes how to make dressings from cloth strips covered with a gummy substance.
Hydrogels; It is a three-dimensional network of hydrophilic polymers consisting of polysaccharides such as carboxymethylcellulose, polyacrylamides or other polymers, and gelatin (Güneş and Eşer 2006). They are produced as flexible sheets (solid) or amorphous gel tubes. They are transparent, can be easily cleaned from the wound and do not stick to the wound (Kaymakçı 2004). While hydrocolloids require debridement of dry and black eschars before use, hydrogels moisten necrotic tissue and crusts (Hansson 1997). Dressings should be changed every 1-3 days, depending on the amount of exudate (Güneş and Eşer 2006, Cholate 1994).
It is prepared as an absorbent layer on a vapor-permeable film or foam. Hydrocolloids are very useful products in wound materials. They are generally composite plates containing a hydrophilic polymer, a pressure-sensitive adhesive layer and a layer that is not permeable to water but facilitates vapor transmission. The leakage in the application area is absorbed from the wound. Hydrocolloid dressings differ according to their composition and properties. The inner layer of the dressing in contact with the exudate consists of carboxymethylcellulose or polysaccharides and proteins to form a hydrophilic gel and provide a moist environment. The outer layer, consisting of foam or film, effectively protects the wound area from external contamination (Barnes 1993, Reiter 1994).
It is reported that the healing rate is increased in wounds treated with hydrocolloid dressing. (Görse and Messner 1987, HanField and Kerstein 1988, Smith et al. 1993). Hydrocolloids also increase the epithelialization rate and collagen production (Graumlich et al. 2003). Hydrocolloid dressings are changed less frequently due to their absorbent properties (Kannon and Garrett 1995, Varghase et al. 1986).
Due to the occlusive nature of its structure, it is not suitable for wounds that are infected or produce excessive exudate (Kaymakçı 2004). They need to be changed approximately every three days (Singhal et al. 2001).
Foams (sponge); They have water-loving (Hydrophilic) and water-hating (Hydrophobic) properties.
Foam dressings consist of two parts: an inner layer consisting of hydrophilic polyurethane sodium acrylate foam and an outer layer consisting of hydrophobic semi-occlusive film (Hasson 1997, Leipziger 1985). Foam dressings absorb exudate and create a moist wound environment thanks to the semi-occlusive film (Güneş and Eşer 2006). They range from products suitable for wounds producing small amounts of exudate to highly absorbent structures for wounds with excessive exudate.
However, foam dressings do not convert exudate into gel. As with many moist wound dressings, foam dressings have limited exudate absorbing properties. However, in the studies of Banks et al. (1997), it is stated that foam dressings leak less than hydrocolloid dressings and have more absorbent properties. Dressings should be changed when completely wet or when exudate appears on the dressing. Changing dressings too frequently or using them on dry wounds results in irritation and deterioration of the wound bed.
Products made of hydroactive polyurethane foam are available in forms that have an area that adheres to the tissue at the edges or that can be placed directly on the wound. It is possible to see varieties impregnated with antimicrobial agents such as silver, as well as forms impregnated with special gels/liquids (paraffin, etc.) that have moisturizing properties (Example brand Hartmann, German).
Hydrophilic means water-loving in Latin. PVP is a synthetic polymer that has been used in the pharmaceutical industry for years and has no known side effects. When PVP comes into contact with water, it traps water molecules in its structure and minimizes friction by using water, just like on the surface of a fish. For example: Hydrophilic catheters/catheters have significant advantages over ordinary gel lubricants.
They can also be used as secondary dressing (Kaymakçı 2004). It is changed every 3-7 days (Singhal et al. 2001, Choate 1994).
It is the most commonly used sponge group both in daily use and in industrial applications. They are widely used in furniture, textile, automotive, white goods, construction, cleaning, medical, marine, sports and packaging industries. Sponges produced on two main bases, polyesther and polyether, create wide usage areas with their hard and flexible types, with chemical additives added into them. They are produced in all shapes and sizes using low and high pressure production techniques.
It is appropriate to use hydrophobic foam materials in VAC treatment. Sponges consisting of a fully porous polyurethane structure that provides hydrophobic stability provide high performance under pressure and in a humid environment. Sponge increases perfusion and aids tissue granulation. In addition, it prevents abrasion and prevents unnecessary parts from remaining in the wound bed. The double-faced structure of sponges provides three-dimensional skeletal attachment to sponge cells. This feature provides a unique filtering ability throughout the treatment. The structure combination of the cells and their component content provide the sponge with non-stick properties, helping to remove the seal easily and minimizing the pain felt by the patient. In VAC treatments, the device includes a combination of connection port and drape materials.
It is another sponge structure specially designed for use in vacuum-assisted wound treatment. The fully porous polyurethane structure provides hydrophobic stability under pressure and in a humid environment and distributes the pressure homogeneously throughout the wound bed. World-class silver for wound treatment actively prevents the formation of microorganisms in the wound bed through ionization.
It is an advanced wound sponge that is versatile and comfortable. PVA sponge is actually a synthetic sponge composed of polyvinyl alcohol. This special biocompatible sponge is generally used in wounds and surgical operations in areas such as flaps, grafts and tendons.
Of course, it has a 3-dimensional open cellular structure similar to a sea sponge. All cells are interconnected, not independent. The biggest advantages of this physical structure are its high permeability effect, the ability to be reused after cleaning (only in non-medical situations) and impressive permeability and storage properties.
PVA sponge absorbs up to 12 times its own dry weight in water. When saturated with water, it becomes as soft and flexible as a sea sponge. Its wet volume is 20% larger than its dry volume. PVA shows equal and/or greater mechanical durability and abrasion resistance than all other synthetic sponge materials. Pore size and shape vary to suit specific application conditions. Wet PVA sponge can withstand heat up to 90 degrees without showing plastic deformation.
PVA is pure white in its raw form. It can be dyed in any color and has a high degree of color stability. Untreated PVA sponge neither supports the growth of bacteria and mold nor destroys such organisms. Wet-packed foam can be chemically treated to inhibit the growth of bacteria and mold.
Benefits
They are used in various industrial areas in different types and structures, and in various contexts in places that require high technical features such as high temperature, pressure, high strength, friction resistance and sound insulation.
Nonwoven provides high tensile breaking strength to the sponge on which it is applied, as well as qualities such as abrasion resistance, impermeability and fire resistance. In some applications, they are also used as a sealing gasket on their own. Some types are also used to filter dust and liquid. These types of filter felts are washable and can be used many times. By selecting the correct weight, thickness and pore structure for filtration applications, particles of various sizes can be filtered very easily. They are widely used in vacuum cleaner dust filters.
Although industrial felts are generally manufactured by needling method, many felts manufactured by pressing method are used as indispensable insulation elements of the industry. There are polyester, cotton, geotextile and phenolic types. Phenolic felts used in the automotive and white goods industries can be produced in two and three dimensions by forming with heat. These products have high heat resistance and are also good sound insulation materials.
Some species can be easily shaped with heat while making them flame resistant with the phenol added to their structure. Phenolic felts are widely used in the automotive industry due to their structure suitable for forming with heat.
In deep wounds, it may be appropriate to place a hydrophobic sponge between the wound and the sponge. Applications are made under the supervision of a physician.
Transparent dressings are thin, elastic, transparent, adhesive-taped plastic membranes often containing microporous polyurethane, which are generally used as secondary dressings. Most of these are semi-occlusive, maintaining a moist wound environment and providing an effective barrier against contamination. They are not absorbent and do not come into contact with the wound surface. There are names such as Drape, Medical Film, etc. Transparent dressings retain moisture on the wound surface, helping to soften necrotic tissues and increase growth factors and many beneficial effects on cell development. There are studies showing that transparent dressings are effective in wound healing (Leipziger et al. 1985, Lydon et al. 1989, Rubio 1991).
Transparent, protective dressing suitable for dry and slightly draining wounds, made of anti-bacterial and waterproof polyurethane film coated with hypoallergenic adhesive.
Benefits
Indications
Xerogels are dry dressings that turn into a gel-like substance when in contact with a draining wound. Dextranomer and alginates are in this group and are combined with Guluronic acid-Ca to form a gel form. Once the majority of the exudate is absorbed, the gel exhibits hydrogel-like effects and contributes to moist wound healing (Thomas 1985).
Alginates are complex polysaccharide dressings with high absorbency and are very suitable for wounds with high exudate. They do not adhere to the wound, but will damage the epithelial tissue if the wound is allowed to dry out. Since it is produced in strip form, it is easy to apply inside the cavity (Hutchinson and McGuckin 1990, Güneş and Eşer 2006). The gel-forming properties of alginate dressings vary depending on the product used. Some products gel to a limited extent, producing a partially gelled layer that can be lifted off. Requires a second cover. It should not be used on eschars or dry wounds (Kaymakçı 2004). Depending on the amount of exudate in the wound, it varies from 12 hours to 3 days (Singhal et al. 2001).
Alginate Hydrogel gently and effectively rehydrates the necrotic and fibrinous layer and provides natural autolytic debridement, providing a moist environment ideal for wound healing.
Research shows that alginate dressings accelerate healing. According to Hansson (1997), Thomas and Tuccer reported that the healing rate of leg ulcers dressed with calcium alginate was 4 times faster than that of paraffin-gauze dressing. In the study conducted by O'Donoghue et al. (1997), it was determined that 21 of 30 split skin graft donor areas dressed with calcium alginate healed completely in 10 days. Similarly, Thomas (1985), Basse et al. (1992), Sayag et al. (1996) state that alginate dressings increase the healing rate of wounds.
They are potassium, calcium, ammonium and sodium. Their positive effects on wound healing allow alginates to be used in the structure of dressing materials (especially bandages).
Calcium alginate (C6H7Ca1/2O6)n, ammonium alginate (C6H7O6NH4)n, potassium alginate (C6H7KO6)n and sodium alginate (C6H7NaO6)n have a polysaccharide structure and have high molecular weights. Sodium, potassium and ammonium salts are well soluble in water, while calcium salt is slightly soluble. The viscosity of alginate solutions depends on the ambient temperature, ion density, molecular weight and the presence of metal ions.
The first description of alginates, which have a hydrocolloid structure and water-soluble properties, was made by the British chemist E.C.C Standford on June 12, 1881 and was patented. Commercial production of alginates began in the 1920s for use in canned goods for sailors. Nowadays, alginates, which have applications in many food fields, are used as thickeners, emulsion stabilizers, gel formers, water absorbent inhibitors and create a feeling of fullness in the mouth.
Example of Calcium Alginate Dressing: With a dressing or tampon material consisting of calcium alginate fibers; Dressing: Alginate fibers turn into gel when in contact with wound secretion. Benefits: Cleaning and removal of secretions even in deep wounds, good wrapping quality thanks to the loose fiber composition. Dressing change: It is changed after Sorbalgon completely turns into a gel state.
E401 Sodium alginate, E402 Potassium alginate, E403 Ammonium alginate and E404 Calcium alginate are salts of alginic acid and are used as thickening additives in the food industry.
Alginic acid is obtained from the cell wall of brown seaweed (Laminaria, Macrocystis). Seaweeds used in the production of alginates grow on average 60 cm per day and can be harvested several times a year. Macrocystis pyrifera is one of the most used seaweeds in alginate production and is abundant along the coasts of California, Australia, New Zealand and Africa. Algae, which are tightly attached to the rocky floors of the oceans, are collected by cutting them from approximately 90 cm below the water surface, and after the sorting-cleaning process, they are kept in a hot alkaline environment to remove the alginic acid. After the product removed from the alkaline environment is filtered and precipitated with CaCl2, appropriate bases are added to obtain salt forms. Sodium, calcium, potassium and ammonium alginates are the main alginic acid salts obtained after the application of these processes.
Not all alginates can form gels, but they can form irreversible gels in cold water and in the presence of calcium ions. Small amounts of calcium ions increase the viscosity of alginate solutions, and high amounts cause gelation. The structure of alginates affects gelation, the hardness of the gels, and the gelation time. Alginate gels are highly resistant to heat.
Alginates are commonly used to provide high viscosity at low concentration. If effects such as mixing are not too great, much higher viscosity can be achieved by adding very little calcium ion to the solution. Alginates are frequently used in foods such as fruit juices due to these properties.
The ionization level of carboxyl groups in alginate molecules decreases as pH decreases. The decrease in ionization seen at low pH causes the loss of negative charges and the molecules react with each other, increasing the solution viscosity. At very low pH, alginic acid precipitates and separates from the solution as a result of the widespread interaction between the two. That's why alginates are not used in acidic products.