Download - Challenged By Dehisced Surgical Wounds?
![Page 1: Challenged By Dehisced Surgical Wounds?](https://reader033.vdocuments.us/reader033/viewer/2022051506/587cb2b41a28aba42d8b94c9/html5/thumbnails/1.jpg)
Presenter: Kara Couch, MS, CRNP, CWS The George Washington University
Hospital, Washington D.C.
Challenged by Dehisced Surgical Wounds? Its time for operation MEDIHONEY®
This presentation was executed as a live webinar series and is available on demand as a video presentation on the Derma Sciences website at http://www.dermasciences.com/medihoney-webinars. For complete and accurate context of the content contained in this slide deck,
please view the video presentation. See Instructions for Use for complete product indications and uses.
![Page 2: Challenged By Dehisced Surgical Wounds?](https://reader033.vdocuments.us/reader033/viewer/2022051506/587cb2b41a28aba42d8b94c9/html5/thumbnails/2.jpg)
Agenda
• My Clinical Practice
• The Challenge of Dehiscence
• Why I use MEDIHONEY®
• Case Review
• Application Tips & Pointers
• Q&A
![Page 3: Challenged By Dehisced Surgical Wounds?](https://reader033.vdocuments.us/reader033/viewer/2022051506/587cb2b41a28aba42d8b94c9/html5/thumbnails/3.jpg)
My Clinical Practice
Urban, Level 1 Trauma Center• Acute Care • Wound Center (Ulcers – Venous, Pressure, Diabetic)• Surgery (Wound Referral Source)
![Page 4: Challenged By Dehisced Surgical Wounds?](https://reader033.vdocuments.us/reader033/viewer/2022051506/587cb2b41a28aba42d8b94c9/html5/thumbnails/4.jpg)
Wound Healing Challenges of Dehiscence
Dehisced Groin Incisions
Post Arterial Bypass Surgery
Post Inguinal Hernia Repair
Risk Factors:• Diabetes Mellitus
• COPD
• Obesity
• Smoking
• Advanced Age
• Low Serum Albumin
• Autoimmune Disease
13% incidence of femoral site graft
infections after bypass procedures
3-5% wound infection rate after open
hernia repair
![Page 5: Challenged By Dehisced Surgical Wounds?](https://reader033.vdocuments.us/reader033/viewer/2022051506/587cb2b41a28aba42d8b94c9/html5/thumbnails/5.jpg)
Wound Management after Dehiscence
…”Let’s do wet to dry”
• Surgical debridement with possible removal of
the foreign body and flap coverage
• Negative pressure wound therapy. • V.A.C. Must use non-adherent when placed directly
over blood vessel or vascular anastomosis
• Absorptive dressings (Calcium alginates)
• Anti-infectives (Silver)
• Topical debridement (Manuka, hydrogel,
enzymatic)
![Page 6: Challenged By Dehisced Surgical Wounds?](https://reader033.vdocuments.us/reader033/viewer/2022051506/587cb2b41a28aba42d8b94c9/html5/thumbnails/6.jpg)
WHY MEDIHONEY®?
• Derived from the pollen and nectar of the Leptospermum species of plant in New Zealand
• Unique among honey/even Manuka honey• Effective even in the presence of wound fluid
• Rigorous sourcing and processing controls; sterile
• Two key mechanisms of action support autolytic debridement of devitalized tissue and healing: Low pH and High Osmolarity
1. MEDIHONEY Reference List. Derma Sciences.
![Page 7: Challenged By Dehisced Surgical Wounds?](https://reader033.vdocuments.us/reader033/viewer/2022051506/587cb2b41a28aba42d8b94c9/html5/thumbnails/7.jpg)
MEDIHONEY® Mechanisms of Action
H+ LOW pH: 3.5-4.5 pH – it’s Acidic1
impacting wound healing conditions
High Osmolarity: High sugar low water pulls
fluid from deeper tissues to the wound
surface, getting the wound moving.
1. Milne, S.D. and P. Connolly, J Wound Care, 2014. 23(2): p. 53-4, 56-7
Video
![Page 8: Challenged By Dehisced Surgical Wounds?](https://reader033.vdocuments.us/reader033/viewer/2022051506/587cb2b41a28aba42d8b94c9/html5/thumbnails/8.jpg)
OVER 160 pieces of evidence showing MEDIHONEY® is an effectiveproduct for promoting the removal of necrotic tissue and healing.1
Where’s the Evidence?
1. MEDIHONEY Reference List. Derma Sciences.
![Page 9: Challenged By Dehisced Surgical Wounds?](https://reader033.vdocuments.us/reader033/viewer/2022051506/587cb2b41a28aba42d8b94c9/html5/thumbnails/9.jpg)
MEDIHONEY® Paste MEDIHONEY® Gel
MEDIHONEY®
HCSMEDIHONEY®
Calcium AlginateMEDIHONEY®
Honeycolloid
Different Configurations to assist Wound Bed Preparation & Healing
![Page 10: Challenged By Dehisced Surgical Wounds?](https://reader033.vdocuments.us/reader033/viewer/2022051506/587cb2b41a28aba42d8b94c9/html5/thumbnails/10.jpg)
Case Review
![Page 11: Challenged By Dehisced Surgical Wounds?](https://reader033.vdocuments.us/reader033/viewer/2022051506/587cb2b41a28aba42d8b94c9/html5/thumbnails/11.jpg)
32 year old - dismounted IED (Improvised Explosive Device) blast
Triple amputation, polymicrobialwound infection
Right upper extremity, after traumatic transhumeral amputation with multiple attempts at closure.
After neurectomy, incision healing by secondary intention
Case 1 – Dehiscence of Transhumeral Amputation Closure
![Page 12: Challenged By Dehisced Surgical Wounds?](https://reader033.vdocuments.us/reader033/viewer/2022051506/587cb2b41a28aba42d8b94c9/html5/thumbnails/12.jpg)
Left TranshumeralAmputation Wound
• Wound bed 70% slough, 30% granulation
• MEDIHONEY® Calcium Alginate
Day 1
Case 1 – Dehiscence of Transhumeral Amputation Closure
![Page 13: Challenged By Dehisced Surgical Wounds?](https://reader033.vdocuments.us/reader033/viewer/2022051506/587cb2b41a28aba42d8b94c9/html5/thumbnails/13.jpg)
Rapid improvement
• After 1 week of MEDIHONEY® + Mepilex® dressings changed daily
• Fully granulated wound bed
• Rapid epithelialization at wound edges
Day 7
Case 1 – Dehiscence of Transhumeral Amputation Closure
![Page 14: Challenged By Dehisced Surgical Wounds?](https://reader033.vdocuments.us/reader033/viewer/2022051506/587cb2b41a28aba42d8b94c9/html5/thumbnails/14.jpg)
Healed
• Arm is now ready to be fitted for prosthesis
Day 14
Case 1 – Dehiscence of Transhumeral Amputation Closure
![Page 15: Challenged By Dehisced Surgical Wounds?](https://reader033.vdocuments.us/reader033/viewer/2022051506/587cb2b41a28aba42d8b94c9/html5/thumbnails/15.jpg)
Day 14Day 7Day 1
Case 1 – Dehiscence of Transhumeral Amputation Closure
Summary
![Page 16: Challenged By Dehisced Surgical Wounds?](https://reader033.vdocuments.us/reader033/viewer/2022051506/587cb2b41a28aba42d8b94c9/html5/thumbnails/16.jpg)
Case 2 – Dehisced Abdominal Wound Following Surgery
• Initial presentation
• Wound measurement 20 x 10 x 5cm
• 5 days post surgery with NPWT in place
Day 1
![Page 17: Challenged By Dehisced Surgical Wounds?](https://reader033.vdocuments.us/reader033/viewer/2022051506/587cb2b41a28aba42d8b94c9/html5/thumbnails/17.jpg)
Wound Management:
– Debridement
• MIST ultrasound
• MEDIHONEY® Calcium alginate/bordered foam
– Pain control
• MIST ultrasound therapy
• Pre-med 1 hour prior to wound care with oral meds
– Infection risk
• Immunosuppressed
Case 2 – Dehisced Abdominal Wound Following Surgery
![Page 18: Challenged By Dehisced Surgical Wounds?](https://reader033.vdocuments.us/reader033/viewer/2022051506/587cb2b41a28aba42d8b94c9/html5/thumbnails/18.jpg)
Day 21
Case 2 – Dehisced Abdominal Wound Following Surgery
• MEDIHONEY® helped to clean up the wound bed
• Proceeded to put patient back on NPWT
![Page 19: Challenged By Dehisced Surgical Wounds?](https://reader033.vdocuments.us/reader033/viewer/2022051506/587cb2b41a28aba42d8b94c9/html5/thumbnails/19.jpg)
Healed!
Case 2 – Dehisced Abdominal Wound Following Surgery
4 Months laterWound Management, Part II
• Time for NPWT again
• Use of contact layer between
NPWT sponge and wound bed
• Healed 4 months later
• 1 year later: wound still healed,
cancer re-occurred
![Page 20: Challenged By Dehisced Surgical Wounds?](https://reader033.vdocuments.us/reader033/viewer/2022051506/587cb2b41a28aba42d8b94c9/html5/thumbnails/20.jpg)
Case 2 – Dehisced Abdominal Wound Following Surgery
Day 1 4 Months laterDay 21• MEDIHONEY®
Calcium Alginate to clean up wound
• Clean wound bed• NPWT initiated
• Healed
Summary
![Page 21: Challenged By Dehisced Surgical Wounds?](https://reader033.vdocuments.us/reader033/viewer/2022051506/587cb2b41a28aba42d8b94c9/html5/thumbnails/21.jpg)
• 26 yo 4th year medical student
• Had 4 compartment fasciotomy for exercise induced compartment syndrome
• Developed cellulitis 1 month postop at medial calf incision
• Dehisced in 3 areas
• MEDIHONEY® Paste and foam
Case 3 – Dehisced Fasciotomy Wound
Day 1
![Page 22: Challenged By Dehisced Surgical Wounds?](https://reader033.vdocuments.us/reader033/viewer/2022051506/587cb2b41a28aba42d8b94c9/html5/thumbnails/22.jpg)
Day 15
• Minimal adherent slough
• Edges closing in
Case 3 – Dehisced Fasciotomy Wound
![Page 23: Challenged By Dehisced Surgical Wounds?](https://reader033.vdocuments.us/reader033/viewer/2022051506/587cb2b41a28aba42d8b94c9/html5/thumbnails/23.jpg)
Day 30
• Smaller wounds healed• Larger wound nearly closed
Case 3 – Dehisced Fasciotomy Wound
![Page 24: Challenged By Dehisced Surgical Wounds?](https://reader033.vdocuments.us/reader033/viewer/2022051506/587cb2b41a28aba42d8b94c9/html5/thumbnails/24.jpg)
Day 30
Day 15
Day 1
Case 3 – Dehisced Fasciotomy Wound
![Page 25: Challenged By Dehisced Surgical Wounds?](https://reader033.vdocuments.us/reader033/viewer/2022051506/587cb2b41a28aba42d8b94c9/html5/thumbnails/25.jpg)
Case 4 – Dehiscence Complex Below Knee Amputation Closure
DAY 1
• 25 year old with Bilateral below knee amputation (B- BKA)
• Complex closure to preserve length
• Epidermolysis at the juncture of the incisions
• Incision was known to be threatened at time of closure
• Alternative was conversion to above knee amputation (AKA)
• Initiated MEDIHONEY® Gel
![Page 26: Challenged By Dehisced Surgical Wounds?](https://reader033.vdocuments.us/reader033/viewer/2022051506/587cb2b41a28aba42d8b94c9/html5/thumbnails/26.jpg)
DAY 21
• Tissue is declaring itself
• Central area is key to prevent major revision surgery
• Watchful waiting at this time
Case 4 – Dehiscence Complex Below Knee Amputation Closure
![Page 27: Challenged By Dehisced Surgical Wounds?](https://reader033.vdocuments.us/reader033/viewer/2022051506/587cb2b41a28aba42d8b94c9/html5/thumbnails/27.jpg)
DAY 28 DAY 30
Case 4 – Dehiscence Complex Below Knee Amputation Closure
Good debridement progressContinued MEDIHONEY® Gel
![Page 28: Challenged By Dehisced Surgical Wounds?](https://reader033.vdocuments.us/reader033/viewer/2022051506/587cb2b41a28aba42d8b94c9/html5/thumbnails/28.jpg)
DAY 40 DAY 50
100% granulation tissue
Case 4 – Dehiscence Complex Below Knee Amputation Closure
![Page 29: Challenged By Dehisced Surgical Wounds?](https://reader033.vdocuments.us/reader033/viewer/2022051506/587cb2b41a28aba42d8b94c9/html5/thumbnails/29.jpg)
DAY 60
70% epithelization
DAY 75
Case 4 – Dehiscence Complex Below Knee Amputation Closure
![Page 30: Challenged By Dehisced Surgical Wounds?](https://reader033.vdocuments.us/reader033/viewer/2022051506/587cb2b41a28aba42d8b94c9/html5/thumbnails/30.jpg)
Summary
• 3 months progressive healing• Saved limb at below knee amputation level
Case 4 – Dehiscence Complex Below Knee Amputation Closure
![Page 31: Challenged By Dehisced Surgical Wounds?](https://reader033.vdocuments.us/reader033/viewer/2022051506/587cb2b41a28aba42d8b94c9/html5/thumbnails/31.jpg)
DAY 4Post Surgery
Case 5 – Dehisced Total Knee Arthroplasty Wound
Left Total Knee Arthroplasty (TKA) Replacement
![Page 32: Challenged By Dehisced Surgical Wounds?](https://reader033.vdocuments.us/reader033/viewer/2022051506/587cb2b41a28aba42d8b94c9/html5/thumbnails/32.jpg)
DAY 14
Danger Zone• Dehisced• 100% slough• MEDIHONEY Gel®
Case 5 – Dehisced Total Knee Arthroplasty Wound
![Page 33: Challenged By Dehisced Surgical Wounds?](https://reader033.vdocuments.us/reader033/viewer/2022051506/587cb2b41a28aba42d8b94c9/html5/thumbnails/33.jpg)
DAY 30
80-90% adherent slough <10% adherent slough
DAY 42
Case 5 – Dehisced Total Knee Arthroplasty Wound
![Page 34: Challenged By Dehisced Surgical Wounds?](https://reader033.vdocuments.us/reader033/viewer/2022051506/587cb2b41a28aba42d8b94c9/html5/thumbnails/34.jpg)
DAY 60 DAY 72
Moved from inflammatory phase to wound healing
Case 5 – Dehisced Total Knee Arthroplasty Wound
![Page 35: Challenged By Dehisced Surgical Wounds?](https://reader033.vdocuments.us/reader033/viewer/2022051506/587cb2b41a28aba42d8b94c9/html5/thumbnails/35.jpg)
DAY 80 DAY 90
Good wound edge advancement
Case 5 – Dehisced Total Knee Arthroplasty Wound
![Page 36: Challenged By Dehisced Surgical Wounds?](https://reader033.vdocuments.us/reader033/viewer/2022051506/587cb2b41a28aba42d8b94c9/html5/thumbnails/36.jpg)
DAY 100 DAY 110
Wound Closure Achieved
Case 5 – Dehisced Total Knee Arthroplasty Wound
![Page 37: Challenged By Dehisced Surgical Wounds?](https://reader033.vdocuments.us/reader033/viewer/2022051506/587cb2b41a28aba42d8b94c9/html5/thumbnails/37.jpg)
Summary
Case 5 – Dehisced Total Knee Arthroplasty Wound
• 4 month journey to healing• Save Knee Replacement
![Page 38: Challenged By Dehisced Surgical Wounds?](https://reader033.vdocuments.us/reader033/viewer/2022051506/587cb2b41a28aba42d8b94c9/html5/thumbnails/38.jpg)
Case 6 - Dehisced Groin Incision after bypass surgery
Initiated MEDIHONEY® Calcium Alginate
• Wound depth 0.4cm• Zero slough• Goal – healing
1 Day Later
• Wound depth 0.1cm• Improved appearance to
gran tissue
![Page 39: Challenged By Dehisced Surgical Wounds?](https://reader033.vdocuments.us/reader033/viewer/2022051506/587cb2b41a28aba42d8b94c9/html5/thumbnails/39.jpg)
When to use and What to Expect Upon Application
When/What type of dehisced wound:
– Acute dehiscence = healing
– Eschar, Slough = debridement to granulation
What will MEDIHONEY® do:
– Osmotic engine = Increased outflow of fluid
– pH modulation = Low pH promotes acidic environment, create pathway out of inflammatory phase, allows body to take over the healing
Few Contraindications:– Known allergy or hypersensitivity to honey or alginate
products if using the MEDIHONEY® Calcium Alginate
![Page 40: Challenged By Dehisced Surgical Wounds?](https://reader033.vdocuments.us/reader033/viewer/2022051506/587cb2b41a28aba42d8b94c9/html5/thumbnails/40.jpg)
Application Tips & Pointers
What not to do…
In the wound bed please!
NOT, around the wound bed.
![Page 41: Challenged By Dehisced Surgical Wounds?](https://reader033.vdocuments.us/reader033/viewer/2022051506/587cb2b41a28aba42d8b94c9/html5/thumbnails/41.jpg)
Product Tips & Pointers
MEDIHONEY® Gel:
– Thicker consistency, promotes autolytic debridement in timely fashion
– Use in conjunction with other modalities
MEDIHONEY® HCS:
– Comfortable “closing” dressing: Progressing the healing until epithelization is complete
MEDIHONEY® Calcium Alginate:
– Great absorption and continuous honey donation. Ideal for partial and full thickness, for gently packing into wounds
![Page 42: Challenged By Dehisced Surgical Wounds?](https://reader033.vdocuments.us/reader033/viewer/2022051506/587cb2b41a28aba42d8b94c9/html5/thumbnails/42.jpg)
Questions?
Click on Event Resources tab at left to download:
Today’s Slides
MEDIHONEY® Wound Protocol Guide
Certificate of Attendance
For more information email:
Presenter: Kara Couch, MS, CRNP, CWS The George Washington University
Hospital, Washington D.C.