Traumatic Wounds

Traumatic Wounds

Wounds caused by accident or design that result in damage to the integrity of the skin following penetrating, avulsion, crushing, and shearing injuries are often very painful and can be a source of significant anxiety.

Traumatic wounds present a spectrum of tissue damage that, by their very nature and variety, pose considerable management hurdles. A variety of different traumatic wounds have been shown to respond favorably to treatment regimes involving dressings with Safetac technology.

Hand Injuries & Mepitel     

Hand injuries are common in children and can be a source of considerable pain and stress to the patient, as well as being difficult to dress. This issue was considered in a prospective RCT in which Mepitel was compared with paraffin gauze in the treatment of 45 children with isolated fingertip injuries.1 Patients were randomly allocated to one of two treatment groups, either Mepitel (n=20) or paraffin gauze dressings (n=25), regardless of whether the injury was treated conservatively or surgically, with a common outer layer of dry gauze and cotton bandage secured by adhesive tape. Although no differences between the two dressings were found in terms of healing rates, important statistically significant differences in favour of Mepitel were recorded in relation to dressing adherence (p<0.01) and the stress exhibited by the patient over the first 3 weeks of treatment (p<0.01), leading the authors to conclude that Mepitel offers a less painful and easier alternative to traditional dressings for the treatment of fingertip injuries.

In a subsequent RCT involving both adult and pediatric patients, Mepitel was compared with paraffin gauze and an aperture cellulose acetate dressing coated with a petrolatum emulsion in the management of hand surgery wounds.2 A total of 108 patients were randomly assigned to treatment with one of the three dressing regimes. The selected primary dressing was covered with gauze and a crepe bandage together with a plaster of Paris splint as appropriate. In line with the results of the other reported study,1 Mepitel was found to be easier to remove than the paraffin gauze. It was also observed that Mepitel could be used with advantage on wounds such as raw nail beds, as reported some years earlier by Williams, who also described its use following amputation of the fingers.3 Photographs of a traumatic wound treated with a dressing utilizing Safetac are presented in Figure 10.

Traumatic Wounds Figure 10

Skin Tears

Traumatic Wounds Figure 11

As a consequence of structural and functional changes in the skin of older people, a progressive atrophy occurs and the slightest trauma can cause the skin to tear.4 Care of skin tears is often painful, and wound healing can be prolonged.5 An ideal skin tear dressing should be able to maintain a moist wound environment; secure the skin flap; manage a wide range of wound exudates levels; not cause trauma on removal; conform to the wound; be cut without impacting the integrity of the dressing; provide pain-free dressing application and removal; and be cost-effective.6 Dressings with Safetac have been shown to fulfil these criteria in a number of clinical evaluations described below.4,5,7,8

In an observational study involving 59 elderly patients, Mepitel was applied to 88 skin tears, in conjunction with a simple absorbent secondary dressing.5 The dressing combination was associated with a high healing rate (i.e. 83% of wounds healed by day eight of the study). The author also highlights the ability of Mepitel to reduce patient discomfort during dressing changes, compared with paraffin gauze dressings. Figure 11 shows a sequence of photographs relating to the use of Mepitel in treating a skin tear.

Barrows et al9 compared an existing protocol for skin care management (consisting of antibiotic ointment covered with non-adherent gauze and secured with a sterile gauze wrap, changed every other day), with a proposed regime involving the use of Mepitel Compared with the existing protocol, the regime involving Mepitel was associated with reduced trauma and pain for the patients, a 33% reduction in healing time, and a 62% reduction in dressing change frequency/ skilled intervention, equating to an average cost saving per skin tear of US$872.9 Mepitel's cost-effectiveness has also been demonstrated in other wound types.10,11,12

In a review of the management of skin tears at a specialist wound care centre in Belgium, Mepitel was reported to be a good wound covering for skin tears without tissue loss and those with partial thickness loss. In the case of skin tears with total tissue loss, the review states that Mepilex, Mepilex Border or Mepilex Transfer can be used to manage large amounts of exudate.7

See Skin Tear Management Guidelines 

Road Rash

Road rash is a term used to describe the abrasive injury that occurs when a casualty comes into contact with, for example, a road surface, resulting from a traffic accident. They are generally partial thickness wounds and are frequently painful, particularly at the time of dressing change when parenteral analgesia is routinely administered. They are also at risk of infection due to the ingress of foreign matter.

A clinical evaluation by Dunbar et al13 describes how the introduction of Mepilex Border and Mepilex Lite compared favourably with previous treatment regimes involving semi-occlusive film dressings, normal saline dressings, or silver sulphadiazine (SSD) cream covered with gauze dressings. The dressings with Safetac demonstrated good absorption characteristics and provided protection for wound healing. After the introduction of the new regime, the frequency of dressing changes decreased, supply costs and nursing time were reduced by 50% per day, pain levels decreased from an average of 8 to 3 (on a scale of 1–10), and parenteral analgesia was eliminated.13

References

1.      O'Donovan, D.A., Mehdi, S.Y., Eadie, P.A. The role of Mepitel silicone net dressings in the management of fingertip injuries in children. J Hand Surg (Br) 1999; 24: 6, 727-730.

 

2.      Terrill, P.J., Varughese, G. A comparison of three primary non-adherent dressings applied to hand surgery wounds. J Wound Care 2000; 9: 8, 359-363

 

3.      Williams, C. Mepitel: a non-adherent soft silicone wound dressing. Br J Nurs 1995; 4: 1, 51-55.

 

4.      Meuleneire, F. Skin tears. A simple procedure to reach an efficient treatment. Poster presentation at the European Wound Management Association conference, Granada, Spain, 2002.

 

5.      Meuleneire, F. The management of skin tears. J Wound Care 2002; 11: 10, 365-369

 

6.      Kennedy-Evans, K.L. An innovative solution for skin tears: a case study. Ostomy Wound Management 2004; 50: 2, 9-10

 

7.      Meuleneire F. Skin tear management. Accurate intervention to achieve an optimal result. Poster presentation at the European Wound Management Association conference, Glasgow, United Kingdom, 2007.

 

8.      Kennedy-Evans, K.L. An innovative solution for skin tears: a case study. Ostomy Wound Manage 2004; 50: 2,

9-10 Barrows, C., McQueeney, M., Lemiska, L. Repair the tear – value analysis of a skin tear protocol. How CWCNs changed clinical and financial management of wounds for a homecare agency. Poster presentation at the 20th

 

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