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DVA Wound Care ModuleOctober 2016 P03202AcknowledgementsDepartment of Veterans’ Affairs (DVA) acknowledges Monash University and Associate Professor Geoff Sussman OAM in developing andproducing the previous versions of the DVA Wound Care Module.DVA acknowledges Associate Professor Geoff Sussman OAM in developing this revised edition in consultati on and review with fellowmembers of the Advisory Wound Care Committee: Associate Professor Michael Woodward AM (Chair) and Ms Judith Barker .Disclaimer:Information contained on the website, chart and module are advisory only. Any suggestions should be used in conjunction with clinicalknowledge and skills.NB: The products listed in the website, chart and module are examples only and are listed on the Repatriation Schedule of PharmaceuticalBenefits at the time of publication. For more information see www.pbs.gov.au/browse/rpbs.i

Table of ContentsIntroduction . 11.11.21.3What is wound care? . 1What is a wound? . 1Common types of wounds . 2General overview of wounds . 32.12.22.3Acute wounds . 3Chronic wounds . 3Complex and chronic wounds . 3Healing . 43.13.2How does the body heal? . 4Phases of healing . 43.3Control factors affecting healing . 7The inflammatory phase . 4The proliferative phase . 5The maturation phase . 5Moist wound management . 6Intrinsic factors . 7Extrinsic factors . 8Wounds . 104.1Acute wounds . 104.2Chronic wounds . 14Skin tears . 10Difficult wounds (i.e. animal or insect bites) . 13Post-operative wounds . 13Burns . 13Ulcers . 14Wounds in diabetics . 16Risk factors in diabetes . 17Pressure injury . 18Incontinence associated dermatitis and skin injury (IAD) . 19Neoplasia . 19Wound Dressings and Bandages . 205.15.2Introduction . 20Passive dressings . 205.3Interactive dressings . 215.4Antiseptics . 305.55.65.75.85.95.10Hypertonic Saline. 31Burns dressings . 31Keloid and hypertrophic scar management . 32General rules for sheet dressing use . 32Frequency of dressing changes . 32Bandages . 335.11A modern inert absorbent dressing . 21The non-absorbent tulle passive dressings . 21Non-absorbing dressings . 22Absorbent dressings . 23Miscellaneous Dressings . 28Honey . 31Retention bandages . 33Support bandages . 33Other Bandages . 34Compression bandages . 34Zinc paste bandages . 37General Rules . 386.16.26.36.4Acute wounds . 38Chronic wounds . 38Management plan . 38The Department of Veterans’ Affairs - Veterans' Affairs Pharmaceutical Advisory Centre (VAPAC). 38Bibliography . 39

Introduction1.1 What is wound care?Wound care is “the provision of the appropriate environment for healing by bothdirect and indirect methods together with the prevention of skin breakdown”1. Inother words, wound care means more than just putting a dressing onto a wound. Itmeans looking into the patient’s general health, lifestyle and factors that might slowhealing down.1.2 What is a wound?A wound is a physical injury to the body consisting of: a laceration or breaking of the skin or mucous membrane;an opening made in the skin; ora membrane of the body incidental to a surgical operation or procedure.Wounds may be acute or chronic trauma resulting from an injury where, becauseof a number of factors, the injury does not heal. Acute wounds may be a plannedor unplanned event, and healing typically proceeds in an orderly and timely fashion.Examples of acute wounds include a cut, graze or burn. Examples of chronicwounds include leg ulcers, pressure injuries and diabetic wounds.1

1.3 Common types of woundsNON-DIABETIC BLACKNECROTIC WOUNDYELLOW NECROTIC WOUNDWITH HIGH EXUDATEYELLOW NECROTIC WOUNDWITH LOW EXUDATECAVITY WOUNDWITH HIGH EXUDATEEXUDATING WOUND WITHSLOUGH AND CLINICALSIGNS OF INFECTIONSUPERFICIAL WOUNDWITH CLINICAL SIGNSOF INFECTIONMALODOROUS WOUNDSCAVITY WOUNDWITH LOW EXUDATESUPERFICIAL GRANULATINGWOUND WITH HIGHEXUDATESUPERFICIAL GRANULATINGWOUND WITH LOWEXUDATEEPITHELIALISINGSKIN TEARSNEUROPATHICDIABETIC WOUNDISCHAEMICDIABETIC WOUNDHYPERGRANULATINGWOUNDThis dressing selection chart is a guide only and does not replace clinicaljudgement or constitute endorsement of any dressing, product or organisation.For specific instructions regarding use of dressings, always refer to manufacturer'sguidelines.

General overview of wounds2.1 Acute woundsAcute wounds show the following characteristics: higher risk of infection if there is debris in the woundinflammationhealing by primary intentionmay require antiseptic use if wound contaminated2.2 Chronic woundsChronic wounds show the following characteristics: lower risk of infection with the exception of diabetic woundssymptom of an underlying conditionhealing by secondary intentionnot steriledevitalised tissue.2.3 Complex and chronic woundsA large proportion of wounds seen in clinical practice are chronic in nature.Epidemiological studies indicate one percent of the population has a chronicwound, and of that group some twenty percent have had the wound for more thantwo years. Further studies indicate the level of chronic wounds in older patients isconsiderably higher 2.Chronic wounds may be classified into the following groups: Leg ulcersPressure InjuryNeoplasia (Cancer)Chronic infected woundsDiabetic woundsThe difficulty in the management of any chronic wound is that there is always anunderlying physiological cause of the wound which must be treated, but manypatients have multi-factorial issues and co-morbidities. For best results the basiccause of the problem must be addressed, and any negative factors altered.It must be understood that some patients may never heal due to the basicpathophysiology of the disease process and the inability to alter some or all of themajor factors influencing the non-healing wound. However, even in the mostextreme cases, effective wound care can assist in minimising the worst effects ofsuch chronic wounds.

Healing3.1

Wounds may be acute or chronic trauma resulting from an injury where, because of a number of factors, the injury does not heal. Acute wounds may be a planned or unplanned event, and healing typically proceeds in an orderly and timely fashion. Examples of acute wounds include a cut, graze or burn. Examples of chronic wounds include leg ulcers, pressure injuries and diabetic wounds. 1.3