Page 622 - WSAVA2018
P. 622

 25-28 September, 2018 | Singapore
the finger an imprint may be left for a few moments – this is called pitting oedema.
· Devitalised Tissue
If the tissue displays an abnormal colouring such
as purple, grey, white, green or black – the area is becoming devitalized. This means that the blood supply to the tissue is decreased or absent. The devitalized tissue will undergo necrosis and may liquefy or become dry and leathery. When the tissue becomes black and leathery, this is termed ‘eschar’.
· Dehiscence
This occurs when the wound repair breaks down and the
wound becomes open again. · ‘Proud’ flesh
Also termed exuberant granulation, this occurs when the granulation tissue is above the level of the skin edges.
· Infection
The wound will discharge an odourous exudate, with inflammation at the site and bacteria contained within the fluid.
· Seroma
Fluid accumulation at the wound site. A fluctuant swelling or mass containing fluid is palpable at the site. This can be a seroma, haematoma or abscess. A Fine needle aspirate would be required to determine the type of fluid and treatment course.
· Fistula
This is a persistent non-healing opening that often
produces exudates.
· Contracture deformity
This most often occurs when a wound is around or near a joint. As the wound contracts and undergoes maturation, the scar tissue may restrict the range of movement.
· Hypertrophic Scar
Over time the scar should become less obvious, however, a hypertrophic scar will become more obvious appearing raised, thickened and prominent.
The general objectives of a bandage are to: Provide support for:
· Fractures
· Disclocations
· Sprains, strains the fractures Protect against
· Self-mutilation
· Infection
· Environment · Further injury Pressure to:
· Stop haemorrhage
· Prevent or control swelling
Provide comfort and pain relief Immobilise
· Limit joint movement
· Limit mvement of fracture sites
Bandage Formula
A basic bandaging formula is:
Initial layer – dressing (applied directly over the wound)
Primary layer – padding (for comfort, support and absorbtion of any exudate)
Secondary layer – conforming (provides strength and conforms to the contours of limb and secures dressing and padding)
Tertiary layer – protection (protects the bandage and provides further security).
 Types of Dressings (Initial layer)
 Sterile plain gauze swabs
  E.g. with petroleum gel or antibiotic
Usually have a layer of permeable non-stick material on one or both sides. May have absorbant core. Some have adhesive section around the edge to enable stable and accurate placement of dressing
  Melolin® Cutiplast® Cutilin®
  these can be made of various materials and are usually quite thick – used for wounds with large amount of exudate
  Types of Padding (Primary layer)
   Cotton Wool
  Natural or man-made
  Cotton Wool Rolls
   Padding bandage
 Natural absorbant material supplied in rolls Easier application Great for limbs
   Velband® Soffban Natural ®
   Synthetic padding
Thinner and lighter than padding bandage and cotton wool
 Cotton wool and gauze
  Cotton wool that is sandwiched between layers of gauze and supplied in a roll
    Types of Con- forming Bandage (Secondary layer)
 has an elastic component to enable ‘conforma- tion’ care must be taken not to apply too tightly
 Loose open-weave
  has no elastic component loose weave assists with bandage conforming
washable cotton fibre on a role not commonly used
  elastic net bandage supplied in tubular format

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