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Infected Wounds Clinical infection occurs when the bacterial colonisation in and around the wound site rises

to a critical level. This can lead to a deterioration of the wound condition and, if systemic infection occurs, flu-like symptoms such as fever for the patient. Infection can also increase the cost of treatment dramatically, with systemic antibiotics often a necessary and essential part of the treatment regime. Wound healing may be severely compromised or absent in the presence of infection, so it is crucial that infection is identified and controlled appropriately. Clinical signs of infection include redness, heat, swelling, pain, increased levels of exudate, discoloured granulation tissue, a delay in healing or wound breakdown1. Many products, including some film and hydrocolloid dressings, are semiocclusive, thereby offering protection from outside contaminants and helping to reduce the risk of infection. Wound dressings containing silver are also now manufactured. The silver acts as an antimicrobial agent, killing the majority of the bacteria that cause problems in wound healing2. For wounds that do become clinically infected, the selection of wound dressing again depends on a holistic assessment including the condition of the wound3. Copious exudate and unpleasant odour are common to infected wounds and dressings with high absorptive properties (i.e. polyurethane foams) or offering odour control (i.e. containing charcoal), are often selected. For deeper cavity wounds an alginate dressing such as 3M Tegagen Alginate Dressing can be used to pack the wound and encourage granulation. High levels of pain are also associated with infected wounds and to reduce trauma during dressing changes a wound contact dressing such as 3M Tegapore Wound Contact Material can be left in place whilst some secondary absorbent dressings are replaced. 3M Cavilon No Sting Barrier Film can also offer protection from maceration to the peri-wound area. 3M Tegaderm Foam Dressing may be used on infected wounds only under the supervision of a health care professional.

1. Cutting KF, White R.J, Mahoney P, Harding K (2005) Clinical identification of wound infection: a Delphi approach. Identifying criteria for wound infection EWMA Position Document MEP London 2. Lansdown,A.B.G. (2002) Silver 1: its antimicrobial properties and mechanism of action. J Wound Care; 11(4) , 125-130 3. Timmons J, Bell A (2000) Wound Infection. Prim Health Care, 10(2), 31-38 Necrotic Wounds Necrosis is the dead tissue in a wound that is devitalised and black in appearance. Under normal circumstances dead tissue softens through autolysis to be shed as slough, but can dehydrate and harden if this is affected by unfavourable conditions (dry atmosphere). Necrotic tissue is not only associated with high levels of pain but can interrupt the wound healing process. Many products therefore are designed to prevent this dehydration by providing or maintaining moisture, including hydrogels. Film dressings such as 3M Tegaderm Film Dressing and Hydrocolloid dressings such as 3M Tegaderm Hydrocolloid Dressing will also help to maintain moisture and promote autolytic debridement. Enzyme preparations may be used to cleanse wounds by dissolving tissue debris and slough.

Sloughy Wounds Where wounds have thick layers of sloughy tissue, this is usually removed so that granulation can occur. This can be done surgically but where this is not possible other methods are available. Enzyme preparations may be used to clean infected wounds by dissolving tissue debris and slough. Larval therapy (maggots) is another method for rapid wound cleansing that is becoming increasing popular. Autolytic debridement is a commonly used form of debridement. It is where the body is facilitated to use its own enzymes to break down and separate dead tissue. In moist conditions the enzymes soften and liquefy devitalized tissue 2. Dressings such as hydrogels help with this process. Sloughy wounds can produce exudate, so absorbent dressings such as a foam dressing (3M Tegaderm Foam Dressing) or alginate dressings (3M Tegaderm Alginate Dressing) can be of use in the context, Hydrocolloid dressing like 3M Tegaderm Hydrocolloid and 3M Tegaderm Hydrocolloid Thin Dressing will also promote autolytic debridement. Where there is very little exudate Film dressings such as 3M Tegaderm Transparent Film Dressing can be used. 1. Thomas S., Jones M., Shutler S. Jones S. (1996) Using larvae in modern wound management, J of Wound Care, 5(1), 60-69

Granulating Wounds Granulation is the natural replacement of dead or lost tissue in the dermis. It represents the most prolific and complex stage of wound healing, involving heightened cellular activity. Granulation tissue is red / pink and moist in appearance and can appear in various different wound types and shapes. For deep cavity wounds containing a significant degree of exudate, these can often be dressed with alginates such as 3M Tegaderm Alginate Dressing . It is important that granulation occurs sufficiently to replace tissue to the level of the peri-wound area before significant epithelialisation from the wound edges takes place. Other dressings such as polyurethane foams (see 3M Tegaderm Foam Dressing) and hydrocolloid dressings can be significant on more shallow granulating wounds where significant wound exudate is still in evidence. (See 3M Tegaderm Hydrocolloid Dressing and 3M Tegaderm Hydrocolloid Thin Dressing).

Epithelialising Wounds Epithelialisation is the regeneration of the skin surface across the wound. Epithelialisation can occur from the wound edges or around natural islands (i.e. hair follicles) following the migration of epithelial cells. Epithelialisation progresses most effectively over a flat wound surface therefore raised granulation tissue or scabs may delay healing. The process of epithelialisation has been shown to occur more rapidly in the moist wound environment created by occlusive dressings such as film dressings and

hydrocolloids (See 3M Tegaderm Film Dressing, 3M Tegaderm Hydrocolloid Dressing and 3M Tegaderm Hydrocolloid Thin Dressing). Epithelial tissue is particularly fragile and care must be taken during the removal of dressings to ensure that the new tissue is not unnecessarily damaged. 3M Cavilon No Sting Barrier Film is an extremely effective skin protectant that can be applied under dressings and around the peri-wound area to prevent unnecessary trauma to new tissue. 1. Winter G.D et al (1964) Movement of epidermal cells over the wound surface In: Montagna W. & Billingham R.E Advances in Biology of the skin. Vol 5. Wound Healing. New York. The MacMillan Company, 1964)