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    Home > Active Ingredient News > Antitumor Therapy > Radioactive dermatitis: dry healing vs wet healing? After watching the video, I understand.

    Radioactive dermatitis: dry healing vs wet healing? After watching the video, I understand.

    • Last Update: 2020-07-18
    • Source: Internet
    • Author: User
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    After watching the video, you will understand! Radiodermatitis is the most common complication of radiotherapy for cancer. 95% of the patients with radiation dermatitis have different degrees of radiation dermatitis.according to the literature, about 49% of patients with head and neck radiotherapy will have grade 3 / 4 radiation dermatitis.a case of wound dressing change will be used to show the effect of dry healing and wet healing on wound healing.before entering the text, please watch this dressing change video.Case Sharing: a case of radiation dermatitis. Basic information: patient, male, 60 years old.admission diagnosis: 1. Tongue malignant tumor with lymph node metastasis; 2. Upper respiratory tract obstruction; 3. Respiratory failure; 4. Dermatitis; 5. Hypokalemia.brief history: the patient was admitted to ICU on March 25, 2020 for "two years after diagnosis of tongue cancer, dyspnea for 1 week after radiotherapy, and aggravation of 9 hours".admission physical examination: body temperature 36.8 ℃, pulse 83 times / min, blood pressure 86 / 55mmhg, NRS score: 3 points.the skin of the right neck is stiff, and part of the skin is red, ulcerated and exudated.CT showed that the right internal jugular vein was not clear, and the shape of right sternocleidomastoid muscle was abnormal.decreased density and denervation? Diagnosis and treatment: after admission, the relevant examination was improved, piperacillin tazobactam sodium injection was given 4.5g Q8H anti infection treatment, and tracheotomy ventilation under local anesthesia was given on March 27, 2020.after symptomatic treatment, the respiratory tract obstruction was relieved and the patient was transferred to oncology department for chemotherapy combined with targeted therapy.case characteristics: the patient went home after the last radiotherapy in a tertiary hospital in Shanghai on March 18, 2020. The patient developed grade 4 radiation dermatitis on his right neck, and local invasion and metastasis of the tumor were also found. Due to the infection after tracheotomy, the use of endotracheal tube frenulum increased the irritation to the damaged skin, which made it difficult to change dressing.after dressing, the local wound has healed 98%, and the patients are satisfied with the treatment effect.phase 1: dry healing dressing change: in view of the fact that radioactive dermatitis is still in acute phase, in order to avoid local skin damage caused by adhesive paste, the outer dressing does not seal the wound with glue and foam paste and other adhesive dressing.although silver ion alginate dressing is used in this stage, the first stage dressing change method belongs to dry healing because the wound is in open state.2020-04-04 wound assessment: the ulcer of the right neck was covered with sterile gauze. When the dressing was removed, the skin of the right neck became red and accompanied with ulcer, and the ulcer surface had yellow scab attachment (coated with aureomycin eye ointment). warning: slide left and right to see more local treatment: gently wipe the scab on the wound with normal saline cotton ball, and the wound is dark red. cover the wound and air cut wound with silver ion alginate dressing. warning: slide left and right to see more wound evaluation and treatment on April 6, 2020: after cleaning with normal saline cotton ball, the wound surface is fresher than before, but the amount of exudate is still more. continue to change the dressing of silver ion alginate dressing. warning: slide left and right for more evaluation and treatment of 2020-04-07 wound: the wound area of right neck is reduced, the wound edge is dry, Wet Peeling at the fold of anterior cervical area, and there is a mass at the lower right, which is easy to bleed. continue to change dressing according to the above method. warning slide left and right to see more wound assessment and treatment on April 8, 2020: the wound area of right neck is reduced, and the wound edge is dry. the silver ion alginate dressing is covered with 4 layers of sterile gauze. Continue to change the dressing according to the above method, warning to slide left and right to see more remarks: in the dry healing dressing change stage, the dressing change frequency is once a day. ▋ stage II: wet healing, dressing change, wound evaluation: radiation dermatitis of right neck has basically healed, but the wound at the fold of anterior cervical area is covered with thick and dry dead skin and desquamation, and the wound at tracheotomy has yellow white scab attachment. the patients complained of obvious neck traction, and NRS score was 3 points. warns the left and right slide to see more local processing: 1. clean the wound with normal saline cotton ball. After drying, use silver ion oil gauze to cover the ulcer area. Cut the middle part of another oil gauze silver dressing and fill it along the edge of the incision; warn the left and right slide to see more 2.; cut the middle side of the foam dressing (10cm*10cm), cut out a round hole, and fix it in the tracheotomy cannula. The right neck was sealed with colloidal transparent dressing (5cm * 10cm). warning slide left and right to see more 2020-04-15 wound assessment: uncovering the dressing, cleaning with normal saline and waiting to dry, the wound is fresh and ruddy, the exudate is significantly reduced, and there is no scab on the edge of the wound. the patients complained that the cervical traction was relieved, and the NRS score was 2 points. warns the left and right slide to see more local processing: continue dressing according to the above method, the inner layer uses silver ion oil gauze, and the outer layer is fixed with foam paste and hydrocolloid transparent paste. warning slide left and right to see more remarks: according to the leakage of dressing, the dressing change frequency in the second stage is generally three times a week (Monday, Wednesday and Friday). follow up: on May 7, 2020, the mass in the right neck had shrunk significantly, and the radiodermatitis had healed by 98%. The air incision wound should be treated according to the wet healing method. Due to severe radiation dermatitis, the wound surface is large, dry and painful, and there is a metastatic tumor in the neck. After tracheotomy, the wound ulcer is difficult to heal, and local or systemic infection is easy to occur. When 2. is infected, it can be treated with foam silver, oil sand silver or alginate silver combined with water colloid or foam paste to treat local infection according to the condition of oozing and combined with existing resources. Pay attention to the skin protection of the wound surface, and avoid secondary skin damage when removing the adhesive dressing. wound healing: dry healing vs wet healing is a complex process. Human exploration of wound healing has never stopped, and the concept of wound healing has also undergone some changes. let's look at the difference between dry healing and wet healing. ▋ the theory of dry wound healing and its deficiency the theory of dry wound healing holds that wound healing needs a dry environment, the participation of atmosphere can promote wound healing, and the air permeable dressing can make the wound obtain enough oxygen for various biochemical reactions of cell growth. the specific method is to open the wound, keep the wound dry and promote the wound scab. in the early stage, cotton, gauze and other dressings were used to cover the wound in order to keep the wound dry, fully contact with atmospheric oxygen, accelerate the wound scab, reduce the risk of infection, and promote wound healing. but in fact, atmospheric oxygen can not be directly used by the wound, and it needs the oxygen cooperation of hemoglobin. at the same time, the wound is dehydrated and forms scab, which will hinder the crawling of epithelial cells; when changing dressing, adhesion may cause injury and pain and delay the healing speed; because dry dressing cannot keep the temperature and humidity of the wound, the cell division and proliferation speed will be slowed down, and the biological active substances will be lost in the dry environment, so the wound healing time will be delayed; the wound has no resistance to the outside world Barrier, will make bacteria invasion. so far, most people still use this method to promote wound healing. here is a picture of a wound that has been changed through dry healing: warning slide left and right to see more ▋ wet healing theory and its advantages 1962 In animal experiments, Dr. winter found that the wound healing speed in wet environment was twice as fast as that in dry environment. This experimental conclusion laid the foundation for the theory of wet wound healing and was published in nature in the same year. Hinman and maibach confirmed the importance of wet wound healing in human partial cortical loss wounds. keep the wound locally moist and do not form scab. Compared with the dry environment, the wound healing speed will be faster, no secondary mechanical damage will be caused, and the wound scar after healing will be less. the modern wound healing theory is to use the sealing or semi sealing of wound dressing to keep the wound hypoxic, acid and moderately moist environment, increase the growth and migration speed of cells, accelerate the wound healing, and prevent the formation of scab. the following figure shows the comparison between dry healing and wet healing: a wet wound healing environment; B Dry wound healing environment: 1. Epithelial cell regeneration; 2. Neovascularization; 3. If the wound is continuously exposed to the air, it will gradually dry and scab; 4. The exudate will remain on the wound surface; 5. Closed or semi closed dressings ▋ wet healing and the selection of new dressings. The new dressings are based on the theory of wet healing, making full use of closed and semi closed dressings or providing moisture for the wound Environmental dressing for wound bed preparation. the new dressings include the inner dressing in direct contact with the wound bed and the middle dressing covering the inner dressing to play an auxiliary role. the inner dressing is selected according to the needs of the wound to treat and protect the wound. the middle dressing can play a role in exudate management and maintain a proper temperature and humidity environment. the outer dressing can play a fixed role and prevent the displacement of the inner dressing. From the perspective of clinical application, can be divided into the following categories: membrane dressing, hydrocolloid dressing, hydrogel dressing, alginate dressing, foam dressing, silver dressing and inert dressing according to their different structural and functional characteristics. up to now, there is no new type of dressing that can be applied to all kinds of wounds and wounds in different periods. Each dressing has its own shortcomings and indications. A correct understanding of the performance, indications and contraindications of each new dressing will help medical personnel make a scientific and correct choice. when choosing new dressings, attention should be paid to the following: 1. The operator needs professional training to correctly evaluate the wound and select modern dressings. The application of modern dressing can keep the wound moist and airtight. 3. The closed dressing should be used cautiously in patients with gangrenous diabetic foot ulcer and in patients with fungal wound covered with dry snake skin scab. At present, there are thousands of kinds of modern dressings to choose from in clinical practice. Clinical operators need to choose suitable dressings for specific wounds. References: 1. Wei Li, editor in chief. Handbook of rapid growth of wound care practice. Beijing: People's Health Publishing House, February 2019. Wang Qian, Li Zhen, et al. Evidence summary of prevention and management of radiation dermatitis. Journal of nursing, 2020, 35 (1). 3. Tong Jinjing. Nursing experience of wet healing in radiation dermatitis of nasopharyngeal carcinoma. China will continue
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