WOCN Refractory Wounds: Questions & Solutions
Role of protease inhibitors Right Ans - MMPs are enzymes that control
levels of growth factors and cytokines
Roll of protease inhibitors Right Ans - Some promote inflammation, others
reduce inflammation
Role of protease inhibitors Right Ans - Persistent high levels of pro-
inflammatory MMPs characteristic of non healing wounds
MMPs Right Ans - Most are pro inflammatory
Protease inhibitors - mechanism of action Right Ans - -Attract/bind MMPs
to dressing (ORC)
-reduce MMP production (dressings have PHI)
-Botton line is to reduce levels of MMPs to reduce interference in repair
(Data supports venous, pressure, and diabetic wounds)
Example dressings used in protease inhibitors Right Ans - Promogram,
prisma, puracol, puracol plus are the most common
Acellular matrix dressings Right Ans - -Provides scaffolding for cell
(fibroblasts) migration and attachment (to the dressing)
-Provides cellular communication
-Provides proliferative signals to cells
What do matrix dressings consist of? Right Ans - Collagen, glycoproteins,
growth factors.
Acellular matrix dressings Right Ans - Dressings that provide structure
Types of Acellular Dressings Right Ans - Porcine, bovine, avian, or cadaver
source dressings
Areas studied in RCT that show limited evidence in Acellular matrix dressings
Right Ans - Leg and pressure ulcers, surgical wounds
, 2 types of matrix dressings used in abdominal wall reconstruction Right
Ans - Modified an Unmodified
Unmodified matrix dressings Right Ans - -Non cross linked
-7-14 days for vascularization and granulation tissue
-provides support only
-resistance to bacteria
- monitor for adherence or non adherence
Modified matrix dressing Right Ans - -cross-linked
-provides strength and resistance to bacteria
-takes 4 weeks or more for vascularization (pink to red)
-monitor for adherence or non adherence
Which active dressing does not have living cells? Right Ans - Acellular
matrix dressings in abdominal wall reconstruction
Bioengineered skin substitutes Right Ans - Matrix dressings with living
cells embedded
Bioengineered skin substitutes Right Ans - Derived from neonatal foreskin
or amniotic membrane
living cells Right Ans - Need to minimize antibody and antigen response
Etiologic factors that can lead to a refractory wound Right Ans - -
Unrelieved pressure
-Inadequate circulation
-Inaccurate diagnosis
Cellular factors that can lead to a refractory wound Right Ans - -Low levels
of growth factors
-High-level of MMP's
Local factors that can lead to a refractory wound Right Ans - -closed wound
edges
-Traumatic dressing changes
-High bacterial burden
Role of protease inhibitors Right Ans - MMPs are enzymes that control
levels of growth factors and cytokines
Roll of protease inhibitors Right Ans - Some promote inflammation, others
reduce inflammation
Role of protease inhibitors Right Ans - Persistent high levels of pro-
inflammatory MMPs characteristic of non healing wounds
MMPs Right Ans - Most are pro inflammatory
Protease inhibitors - mechanism of action Right Ans - -Attract/bind MMPs
to dressing (ORC)
-reduce MMP production (dressings have PHI)
-Botton line is to reduce levels of MMPs to reduce interference in repair
(Data supports venous, pressure, and diabetic wounds)
Example dressings used in protease inhibitors Right Ans - Promogram,
prisma, puracol, puracol plus are the most common
Acellular matrix dressings Right Ans - -Provides scaffolding for cell
(fibroblasts) migration and attachment (to the dressing)
-Provides cellular communication
-Provides proliferative signals to cells
What do matrix dressings consist of? Right Ans - Collagen, glycoproteins,
growth factors.
Acellular matrix dressings Right Ans - Dressings that provide structure
Types of Acellular Dressings Right Ans - Porcine, bovine, avian, or cadaver
source dressings
Areas studied in RCT that show limited evidence in Acellular matrix dressings
Right Ans - Leg and pressure ulcers, surgical wounds
, 2 types of matrix dressings used in abdominal wall reconstruction Right
Ans - Modified an Unmodified
Unmodified matrix dressings Right Ans - -Non cross linked
-7-14 days for vascularization and granulation tissue
-provides support only
-resistance to bacteria
- monitor for adherence or non adherence
Modified matrix dressing Right Ans - -cross-linked
-provides strength and resistance to bacteria
-takes 4 weeks or more for vascularization (pink to red)
-monitor for adherence or non adherence
Which active dressing does not have living cells? Right Ans - Acellular
matrix dressings in abdominal wall reconstruction
Bioengineered skin substitutes Right Ans - Matrix dressings with living
cells embedded
Bioengineered skin substitutes Right Ans - Derived from neonatal foreskin
or amniotic membrane
living cells Right Ans - Need to minimize antibody and antigen response
Etiologic factors that can lead to a refractory wound Right Ans - -
Unrelieved pressure
-Inadequate circulation
-Inaccurate diagnosis
Cellular factors that can lead to a refractory wound Right Ans - -Low levels
of growth factors
-High-level of MMP's
Local factors that can lead to a refractory wound Right Ans - -closed wound
edges
-Traumatic dressing changes
-High bacterial burden
