AMPUTEE WOUND CAREAMPUTEE WOUND CARE

LOUISE WEBBERLOUISE WEBBER

AMPUTEE & REHAB CNCAMPUTEE & REHAB CNC

SSWAHSSSWAHS

AIMS OF POST-OP WOUND AIMS OF POST-OP WOUND CARECARE

• WOUND HEALING WITHOUT WOUND HEALING WITHOUT COMPLICATIONCOMPLICATION

POTENTIAL COMPLICATIONS:POTENTIAL COMPLICATIONS:

• WOUND BREAKDOWNWOUND BREAKDOWN

• DEHISCENCEDEHISCENCE

• INFECTIONINFECTION

WOUND MANAGEMENTWOUND MANAGEMENT

•NEED TO CLEAN THE WOUND NEED TO CLEAN THE WOUND BED – DEBRIDE NECROTIC BED – DEBRIDE NECROTIC TISSUETISSUE

•DECREASE THE BACTERIAL DECREASE THE BACTERIAL BURDEN OF THE WOUNDBURDEN OF THE WOUND

METHODS OF WOUND METHODS OF WOUND DEBRIDEMENTDEBRIDEMENT

•SURGICAL DEBRIDEMENTSURGICAL DEBRIDEMENT•AUTOLYTIC DEBRIDEMENTAUTOLYTIC DEBRIDEMENT

Advanced wound care productsAdvanced wound care products•BIOLOGICAL DEBRIDEMENT BIOLOGICAL DEBRIDEMENT

Maggot Debridement TherapyMaggot Debridement Therapy

Which fly?Which fly?

Maggots used are Maggots used are from the fly from the fly Lucilia Lucilia

sericatasericata

Life Cycle of the Fly

Fly

Egg

Maggot

Pupa

Fly

How do they work?How do they work?

•Contrary to popular belief Contrary to popular belief maggots do not have teeth, maggots do not have teeth, so they cannot bite or so they cannot bite or chew away dead tissue chew away dead tissue ( this is also why they ( this is also why they cannot be felt in a wound)cannot be felt in a wound)

How do they eat?How do they eat?

•They feed by extra-corporeal They feed by extra-corporeal digestion, secreting collagenases, digestion, secreting collagenases, trypsin-like, & chymotrypsin-liketrypsin-like, & chymotrypsin-like

•enzymes that break down necrotic enzymes that break down necrotic tissue into a semi-liquid form tissue into a semi-liquid form that the maggots can ingest.that the maggots can ingest.

These enzymes are only effective on devitalised tissue

Problems with maggot Problems with maggot therapytherapy

•Potential “yuk” factorPotential “yuk” factor•Run-away dressingRun-away dressing•Short shelf lifeShort shelf life

Perceived advantages of Perceived advantages of maggot therapymaggot therapy

•Rapid wound debridementRapid wound debridement•Reduction in odourReduction in odour•Control of infectionControl of infection•Maggots take their oxygen from Maggots take their oxygen from

the airthe air•Stimulation of granulation tissueStimulation of granulation tissue•Highly cost effectiveHighly cost effective

6 weeks post –op 22/01/10

12/02/10 Pre MDT

15/02/10 Post 1st Application

19/02/10 Post 2nd application

23/02/10 VAC Applied

26/02/10 After 3 days VAC

03/03/10 17/03/10

QUESTIONS?????QUESTIONS?????