How to Select Wound Care Products

MedicalContinuing Education WOUND MANAGEMENT Goals and Objectives Primary Goal: To help the podiatric HowHow toto SelectSelect physician understand the factors involved in selecting an appropriate dressing for a particular wound. Further, to address specific patient issues to provide WoundWound CareCare information regarding wound management. After reading this article, the podiatric physician should be able to: Products:Products: 1) Appreciate the history of wound care dressings. 2) Recognize the stages of wound A Review for healing and the factors that impede A Review for wound healing. 3) Identify reasons for wound closure thethe PodiatricPodiatric failure as well as the podiatric treatment. 4) Describe wounds with regard to ac- cepted definitions and classifications. Physician 5) Be able to select the most appropri- Physician ate wound healing product with regard to a presenting wound type. 6) Recognize wound product dressing considerations for lower extremity ulcers. Here are some guidelines 7) Be able to develop a wound care to help choose the product formulary for use in a clinical to help choose the practice. appropriate treatment. 8) Appreciate the clinical data regarding medicinal alternative wound care products. Welcome to Podiatry Management’s CME Instructional program. Our journal has been approved as a sponsor of Contin- uing Medical Education by the Council on Podiatric Medical Education. You may enroll: 1) on a per issue basis (at $20.00 per topic) or 2) per year, for the special introductory rate of $139 (you save $61). You may submit the answer sheet, along with the other information requested, via mail, fax, or phone. In the near future, you may be able to submit via the Internet. If you correctly answer seventy (70%) of the questions correctly, you will receive a certificate attesting to your earned credits. You will also receive a record of any incorrectly answered questions. If you score less than 70%, you can retake the test at no additional cost. A list of states currently honoring CPME approved credits is listed on pg. 198. Other than those entities currently accepting CPME-approved credit, Podiatry Management cannot guarantee that these CME credits will be acceptable by any state licensing agency, hospital, managed care organization or other entity. PM will, however, use its best efforts to ensure the widest acceptance of this program possible. This instructional CME program is designed to supplement, NOT replace, existing CME seminars. The goal of this program is to advance the knowledge of practicing podiatrists. We will endeavor to publish high quality manuscripts by noted authors and researchers. If you have any questions or comments about this program, you can write or call us at: Podiatry Management, P.O. Box 490, East Islip, NY 11730, (631) 563-1604 or e-mail us at [email protected]. Following this article, an answer sheet and full set of instructions are provided (p. 198).—Editor 2,3 By Robert G. Smith, D.P.M., Msc, R.Ph., C.Ped United States suffer from burn etiology is astonishing. Therefore, wounds yearly1; while the preva- a podiatric physician, as a clinical Introduction lence of patients suffering from provider, may be asked to treat pa- Literature reports have revealed chronic skin ulcers caused by either tients as well as offer suggestions to that 1.25 million people in the pressure, venous stasis, or diabetic Continued on page 184 www.podiatrym.com JANUARY 2007 • PODIATRY MANAGEMENT 183 Wound Care... man discovered the multitude of vented their healing. Although he wound coverings or ointments that advocated that the majority of Continuingother healthcare providers on were probably used. It can only be wounds be kept dry, moist wounds the selection of the most appro- speculated that prehistoric man were covered with fat or oil-based Medical Education priate lower extremity wound care probably observed that a covered ointments after being washed in product. This selection is a wound bled less, and that applying wine or vinegar. The most widely thought-provoking one involving pressure to a more serious hemor- used ointments were honey, oil, many factors such as the wound rhage could stop the bleeding. and wine; wool boiled in water or environment, ef- There are three wine was considered a useful dress- fectiveness, pa- major problems ing. Bandaging had become an art tient acceptabili- with the presence by the fifth century BC and sur- ty, and cost. Throughout history, of an open geons knew that bandaging a limb Currently, a wounds have been wound: hemor- too tightly could cause gangrene. plethora of rhage, mechani- wound care prod- dressed in an cal disruption of The Mystery of Infections ucts are available attempt to prevent tissues, and infec- The problem of infection was for use. Thus, the tion. Historical considered a great mystery for podiatric physi- contamination, records indicate 4,000 years due to its insidious na- cian is chal- that Samarians ture. Wound redness, swelling with lenged with the infection, and identified these heat, and pain were described by task of selecting morbidity. problems and set Celsus in De Medicinia in approxi- the most appro- forth the tech- mately 25 A.D. A dichotomy pre- priate product to niques of washing sented itself to early physicians meet the patien- wounds, bandag- with regard to wound presentation. t’s needs. Podiatric physicians ing wounds, and preparing of plas- A patient usually survived a wound must understand that the essential ters to treat these wounds.4 if it was localized with thick creamy goal of a wound care dressing is to Also, other records indicate discharge; but then another would provide an optimum healing envi- that in Mesopotamia, wounds die when the wound presented ronment. Further, they should un- were washed with water or milk with a thin watery, brown, foul- derstand the principles involved and then were dressed with honey smelling discharge.4 when formulating a wound care or resin, conifer, myrrh and frank- Early accounts from 1650 BC plan. This empowers them in un- incense. It can be speculated that describe the standard treatments derstanding the factors involved bandages could have been made for wounds to include grease, when selecting a particular wound of wool or linen; however, noth- honey, and lint. The reason oil or care product given a particular ing is known of the ways that grease were used was that they pre- wound type. A brief chronicled bleeding was controlled during vented sticking of the bandages to perspective highlighting the evolu- this time.5 the wound and they did not spoil tionary hallmarks of wound care By 3000 B.C., minor hemor- over time. Honey provided antibac- products should allow the podia- rhage was controlled by cauteriza- terial properties, while lint promot- tric clinician to realize the phe- tion. The practice of bandaging ed capillary action and packed the nomenal progress that has taken wounds to ap- wound. Later place during the development of proximate dis- both wine and wound care products. rupted tissues, as vinegar were used Secondly, a vivid narrative de- well as taping of The problem of because of their scribing the wound healing process, wounds to assist infection was antibacterial wound type classification, and with skin approxi- properties. Vari- wound assessment is offered to mation, appears considered a great ous metallic salts serve as a foundation for product to be over 4,000 were used as an- selection. Finally, to enable the years old. Other mystery for 4,000 cient topical an- podiatric physician to formulate a means of closing years due to its tibacterial treat- wound care product formulary, wounds included ments.4 both a narrative section and de- using insect insidious nature. The Egyptians scriptive tables of specific product mandibles as introduced a classes are offered as easy, readable clamps. Finally, number of miner- references. the art of suturing als to be used as traumatic wounds is documented treatment alternatives for infected History as early as the third and fourth cen- wounds. For instance, green copper Throughout history, wounds tury B.C.4 pigment (obtained from malachite) have been dressed in an attempt to Hippocrates advanced medicine and chrysocolla had powerful as- prevent contamination, infection, by describing diseases and their tringent and antiseptic properties. and morbidity. Because of the lack natural history. He considered that Mercury compounds were also used of records, it is understandably dif- wounds were diseases and thus, by by the Egyptians for their antibac- ficult to determine how prehistoric analogy, a humoral imbalance pre- Continued on page 185 184 PODIATRY MANAGEMENT • JANUARY 2007 www.podiatrym.com MedicalContinuing Education Wound Care... wound care products to choose underlying support from since Winter’s observations. structures of fascia, muscle terial properties.5 The Greeks intro- Therefore, it is essential that when and bone.9-11 duced the use of verdigris as an an- the podiatric physician selects a Wound healing is a complex tiseptic which showed to be more wound care product the decision is biologic process that involves powerful than either malachite or ground in science and not an arbi- chemotaxis and division of cells, chrysocolla.5 trary one. neovascularization, synthesis of ex- During the middle ages, Paulus tracellular matrix, proteins, and re- Aegineta’s work set forth the treat- The Wound Healing Process modeling of scar tissue. The process ment of many kind of wounds as Human skin is composed of two of wound healing begins when dis- well as a variety of skin diseases. distinct fused lay- ruption of skin During this time, treatment selec- ers, each with dif- integrity occurs tion was based on the product’s ferent tissue cell below the epider- curative properties. First, copper types which have Human skin is mis.

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