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  Excision
  Application
    Neodermis formation
    Signs of mature Neodermis
    Dressing regimen
    Bolstering and splinting
    Frequency of dressing changes
    Positioning the patient
    Moving and turning the patient
    Anti-shear techniques
    Physical Therapy
    Large Hematoma
    Small, late forming Hematoma
    Fluid accumulation
    Infection
    Infection at staple
    Areas of non-take
 
  Summary
   


Post-Op Care - Section Summary
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In this section, you have learned:

  • Each dressing is designed to perform a specific function. Ultimately, the goal of the dressings is to protect the grafts by preventing shearing and dislodgement, while still enabling routine visual examination. The use of antimicrobials is essential in reducing the risk of infection. Acticoat*, silver nitrate 0.5% and Sulfamylon® Solution 5% are most commonly used.
  • Dressings should be built in layers to protect the INTEGRA Template site from shear and infection

    A: Sterile elastic net dressing is applied in OR.

    B: The antimicrobial layer (e.g., moistened Acticoat*) is applied over the elastic net dressing. It is important to remoisten or re-apply antimicrobial dressings as needed. The antimicrobial layer is most critical during the first week after application.

    C: A bulky gauze dressing is applied over the antimicrobial layer to protect the site and to help reduce the potential of shearing and graft dislodgement. It also helps keep the antimicrobial dressing moist and in contact with INTEGRA Template.

    D: A compression bandage is applied over the bulky dressing. The compression wrap provides additional support and protection. As edema subsides, the wrap should be re-applied to ensure it is snug.

  • The adjunctive use of bolsters and splints help achieve intimate contact with the wound bed and immobilize graft sites. Bolsters provide padding in concave areas, enhancing intimate contact between INTEGRA Template and the wound bed. Splinting also aids in keeping the INTEGRA Template site in a fixed position, particularly when the matrix is applied across a joint.
  • When making a dressing change: Take down the dressing, but leave elastic net in place (do not remove sutures or staples). Inspect INTEGRA Template by checking seams, interstices, and edges for signs of hematomas, infection, fluid accumulation, silicone layer separation, and areas of non-take. Re-apply or re-moisten the antimicrobial layer as needed.
  • The techniques deployed in positioning and moving the patient may help to reduce the chance that this mechanical dislodgement will occur when the patient is transported or positioned. It is important to plan your strategy for moving the patient ahead of time.
  • Your visual inspection regimen should include recognition of maturing Neodermis as well as the ability to identify the various complications that may arise. Although developing Neodermis can be described as ranging in color from red to pink to orange/peach to vanilla, your ability to distinguish healthy neodermis from that which requires intervention will come largely from your own experience.

To continue your review of the COURSE, select from the course outline on the left side of your screen
or simply click on “Next.”

*Acticoat is a trademark of Smith & Nephew.

 
 
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