classification acute wound chronic wound - oud-studenten · chronic wound ychronic wound is defined...
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Edward JamaluProduct Management
BELGIUM FEDERATION OF WOUND CAREOCTOBER 12TH 2010
Indonesia at A Glance
Indonesia at A Glance
Islands : 17.508 islandsWide Range : 1.904.569 km sqPopulation : 237.556.363 person
(More 50% in Java)Density : 124 person/ km sqGDP Average : $ 3,979/ yr
€ 3,000
€ 3,200
€ 3,400
€ 3,600
€ 3,800
€ 4,000
€ 4,200
€ 4,400
1 2 3
MARKET SITUATION ON IPA‐IHPA (NON IDA):VALUE TREND OF FIRST LINE WOUND CARE
2008 2009 2010
Gr. 10.30%
Gr. 8.28%
IPA –IHPA = Indonesian Pharmaceutical Audit – Indonesian Hospital Pharmaceutical audit. IDA = Indonesian Drugstore Audit. (/1000)
MAT Q2
MARKET SITUATION (VALUE):BASED ON IPA‐IHPA MAT Q2 2010 (NON IDA)
VALUE MS % GR % VALUE MS % GR % VALUE MS % GR % VALUE
1 SELECTED TOTAL 1,172,755€ 100.00 11.90 4,197,567€ 100.00 10.30 3,805,600€ 100.00 8.28 3,514,590€ 1 BETADINE MKB 536,080€ 45.71 15.85 1,795,288€ 42.77 2.65 1,748,866€ 45.96 20.39 1,452,642€ 2 DARYANT-TULLE D.V 125,365€ 10.69 29.94 441,121€ 10.51 -2.09 450,557€ 11.84 60.62 280,516€ 3 BIOPLACENTON KLB 124,431€ 10.61 -2.98 499,273€ 11.89 0.10 498,767€ 13.11 32.11 377,551€ 4 SOFRA-TULLE S.A 101,141€ 8.62 56.57 318,090€ 7.58 119.90 144,650€ 3.80 -63.79 399,460€ 5 MEBO COM 89,743€ 7.65 55.75 324,295€ 7.73 39.05 233,219€ 6.13 134.58 99,421€ 6 BURNAZIN D.V 64,742€ 5.52 -32.47 247,232€ 5.89 15.43 214,190€ 5.63 93.94 110,442€ 7 MADECASSOL CRA 54,926€ 4.68 -1.00 228,947€ 5.45 -9.16 252,024€ 6.62 -6.67 270,049€ 8 ISODINE MKB 26,180€ 2.23 -43.36 146,005€ 3.48 1.35 144,061€ 3.79 -45.22 262,977€ 9 SANOSKIN OXY IBT 16,448€ 1.40 160.91 54,240€ 1.29 732.92 6,512€ 0.17 999.00 -€
10 CERPLAST G2P 11,852€ 1.01 5.90 61,900€ 1.47 78.58 34,663€ 0.91 581.67 5,085€ 11 SANOSKIN M.DERM + IBT 8,375€ 0.71 34.55 29,030€ 0.69 358.96 6,325€ 0.17 999.00 -€ 12 DERMAZIN LEK 6,680€ 0.57 -41.07 29,084€ 0.69 -36.23 45,610€ 1.20 -69.27 148,423€ 13 BETADINE FOR KIDS MKB 3,414€ 0.29 57.02 10,777€ 0.26 -11.07 12,119€ 0.32 -18.77 14,919€ 14 SOLCOSERYL SLC 3,378€ 0.29 -4.62 12,285€ 0.29 -12.48 14,037€ 0.37 -84.92 93,106€
MAT Q2 09 MAT Q2 08RANK Q2 10 PROD DESC
Q2 10 MAT Q2 10
MAT = Moving Annual TrendMS = Market Share, GR = Growth Value vs Value Last Year
Classification
Acute woundChronic wound
Chronic WoundChronic wound is defined as a break in the skin of long duration, more than 6 weeks or frequent recurrenceTrapped in an ongoing inflammatory phase
Fowler E. Chronic wounds: an overview. In: Krasner D, editor.Chronic wound care: a clinical source book for healthcareprofessionals. King of Prussia, PA: Health Management Publications,Inc; 1990. pp. 12‐8.
Chronic woundCommon cause
Venous stasisDiabetes mellitus Pressure necrosisIschemia
Other cause Malignancy VasculitisPyoderma gangrenosum
Assessment & Wound CareJakarta (Cipto Mangunkusumo National General Hospital is An Ideal Model)
Vascular Surgeon making assessment of wound and consult to Endocrinologist (Diabetic patient), Orthopedic if need amputation, Plastic Surgeon (Skin Graft and flap), Neurologist or Pediatric (as a Team) and nurses take over wound care of patient supervised by Vascular Surgeon
Big Cities (Surabaya, Medan, Bandung, Makassar, Manado etc)Assessment is done by Specialist/ GP‐ER who is caring patient and sometime consult to Plastic or vascular surgeon (as a team) but nurses take over wound care of patient supervised by the doctor
Small Cities/ VillageWound care is done by GP‐ER and Nurses or only nurses
Nursing EducationStart from 18 yo (after High School) and take 3 years (Academy)Method: Theory lesson and practical/ hands on start from 1st year90% female nurses and 10% male nursesHave Nurse Organization/ UnionHave A Special Organization for nurses that work at Surgeon Room (HIPKABI), under supervised by Indonesian Surgeon Association (PABI)HIPKABI gave them Training & Workshop about Wound care, continuously.
Management
Management of UlcersWound Care
DebridementWound cleansingDressings ( Moist)Adjuvant therapies
Pressure reductionOr it will not heal
Risk factors addressedContinence careNutritional improvementMobility
Consider operative repair
BasicsOptimize systemic parametersDebride nonviable tissueReduce wound bioburdenOptimize blood flowReduce edemaUse dressings appropriatelyUse pharmacologic therapyClose wounds with grafts/flaps as indicated
Optimize systemic parametersAge: cannot be reversed, usage of growth factors, aggressive optimization of systemic parameters & supplementation.Avoidance of ischemia & malnutrition.Correction of diabetesAvoidance of steroids, alcohol, smoking.Avoidance of reperfusion injury: total contact casting, compression therapy.
Debridement & Reduction of Bioburden
Surface irrigation with saline.Debridement: surgical, enzymatic (papain with urea, collagenase), mechanical (pressurized water jet), autolytic, maggots.Antibiotics: cellulitis, decreased rate of healing, increased pain, straw colored oozing from skin, contaminated wounds, mechanical implants.Removal of FB.
Recent DevelopmentsHoney Product in leg ulcers.Hydrogel in deep 2nd deg burns.LASER therapy enhances tissue repair?Nitric oxide containing nanoparticles
Focus on Diabetic Wound
Diabetes in Indonesia WHO: 2007: Indonesia is 4th Rank in the world of Diabetic Patient (After USA, India and China)2000 : 8.4 Million Diabetic patient2007: 11 Million Diabetic patient2030: 22 Million Diabetic patient (11% of population)
Co‐Morbidity in Diabetes
Peripheral vascular disease occurs in 11% of diabetic patientsPeripheral neuropathy occurs in 42% of diabetic patientsPVD is associated with delayed ulcer healing and increased rates of amputation
Treatment of DU:What Works
Must surgically debride ulcer to allow healing: the wound edges are deadWeekly debridement down to healthy bleeding tissue gives best resultsMust keep pressure off the ulcers to allow healing
Pressure Reduction Off DUOrthopedic shoes: drop recurrence rate from 83% to 17%SandalsSplintsCrutches/wheelchairsTotal contact casting
Diabetic Gangren
Honey Base Product For Wound Care
Received US Federal Drug Administration approval in 2007Anti‐inflammatory and Anti‐bacterial effects without antibiotic resistancePromote moist wound healingLow pHFacilitate debridement
Therapeutic Effects of Honey Dressings
2Antimicrobial
31Anti-inflammatory Debridement
4ReducesMalodour
5Promoteshealing
6Scarlesshealing
Pieper B, J Wound Ostomy Continence Nurs 2009; 36(1): 60‐6
Female,56thBlood pressure: !40/100ABI Right: 1Left: 0.6Albumin: 2.8
Pre op IGD 27.3.2010
Post Debri IGD 30.3.2010 Post Re debri IBP 16.4.2010
Post Re Debri IBP 2.5.2010Post STGS 6.5.2010
FemaleBlood pressure: 120/80
ABI Right:1.08Left:1.08
Albumin: 3.0
Pre Op,March 10th
Post Debridement,March 13th Post STSG ,March 21th
FemaleBlood pressure: 150/80
ABI Right:0.91Left:1.0
Pre Op, March 10th
Post Op March 18th Post STSG April 15th
Male50 yo
Blood pressure: Normal
First Come
After 2 weeks Wound Care After 4 weeks Wound Care
Summary
Wound Care Management is good enough but Health service and human resources must be improvedThe risk factors must be evaluated by the doctor especially in diabetes patientModern wound care products are being used more and more in modernwound care (Sanoskin)
Bunaken Sea Park, Manado, North Sulawesi, Indonesia