Basic principles of wound management 100% VERIFIED ANSWERS 2024/2025 CORRECT, Exams of Nursing

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Basic principles of wound

management 100% VERIFIED

ANSWERS 2024/

CORRECT

Wound bed preparation For optimal wound healing, the wound bed should be:

• well vascularized
• free of devitalized tissue
• clear of infection
• moist Debridement Sharp surgical debridement is recommended over nonsurgical methods for the initial debridement of devitalized tissue associated with acute and chronic wounds or ulcers when feasible ( Grade 2C ) Topical Therapy
• Agents such as antiseptics and antimicrobial agents can be used to control locally heavy contamination.
• Significant improvements in rates of wound healing have not been found, and toxicity to the tissues might be a significant disadvantage. Antisceptics Typically should NOT be used in open wounds
• kills both bacteria and healing cells
• betadine
• hydrogen peroxide
• Dakin's Solution (sodium hypochlorite)

Role of antibiotics

• All wounds are colonized with microbes; does not indicate the presence of an acute infection
• Abx not indicated for all wounds; reserved for wounds that appear clinically infected.
• No evidence to support Abx prophylaxis in noninfected chronic wounds, or to improve the healing potential of wounds without clinical evidence of infection. Clinical signs of wound infection that might warrant antibiotics
• Local - cellulitis, lymphangitic streaking, purulence, malodor, wet gangrene, osteomyelitis
• Systemic - fever, chills, nausea, hypotension, hyperglycemia, leukocytosis, change in mental status Glycemic control
• Most clinicians make glycemic control a priority when treating wounds, although there is no robust clinical evidence in support of short-term glycemic control as directly affecting wound healing potential.
• However, clinical studies suggest that intensive glycemic control can reduce incidence of diabetic foot ulceration by approximately 23 percent.
• Patients at risk for the development of chronic wounds often have comorbid conditions associated with immunocompromised states (eg, diabetes) and may not have classic systemic signs of infection such as fever and leukocytosis on initial presentation. In these patients, hyperglycemia may be a more sensitive measure of infection. Wound Debridement Methods
• Irrigation
• Surgical
• Enzymatic
• Biologic Irrigation
• part of routine wound management
• Low-pressure irrigation <15 psi using a syringe or bulb
• act and volume of irrigant probably provides the primary positive benefits

• Warm, isotonic (normal) saline is typically used; systematic reviews show no significant differences in rates of infection for tap water compared with saline for wound cleansing.
• addition of dilute iodine or other antiseptic solutions is generally unnecessary antiseptic solutions chlorhexidine, hydrogen peroxide, sodium hypochlorite Biofilm bacterial overgrowth on the surface of the wound Characteristics of chronic wounds that prevent an adequate cellular response to wound-healing
• accumulation of devitalized tissue
• decreased angiogenesis
• hyperkeratotic tissue
• exudate
• biofilm formation *majority of wounds often require planned serial debridement to restore an optimal wound healing environment Bleeding during wound care
• impairs the ability to see what tissue should be debrided
• should be stopped before commencing debridement
• an occur from the healing surfaces or from the deep layers of the skin at the wound edge
• from healing surfaces --> gentle pressure
• from deep payers--> subdermal vessel can be coagulated w/ electrocautery or a silver nitrate stick. Surgical Debridement
• Sharp excisional debridement (scalpel,scissors or curette)
• removes devitalized tissue and accumulated debris (biofilm).
• decreases bacterial load and stimulates contraction and wound epithelialization
• most appropriate choice for removing large areas of necrotic tissue
• indicated whenever there is any evidence of infection (cellulitis, sepsis).
• indicated in the management of chronic nonhealing wounds to remove infected tissue, handle

undermined wound edges, or obtain deep tissue for culture and pathology.

• associated with an increased likelihood of healing. chronic critical limb ischemia surgical debridement should be coupled with revascularization in order to be successful Enzymatic debridement
• involves applying exogenous enzymatic agents to the wound. - results of clinical studies are mixed and their specific effect remains unclear.
• Ulcer healing rates are not improved with the use of most topical agents, including debriding enzymes.
• However, collagenase may promote endothelial cell and keratinocyte migration, thereby stimulating angiogenesis and epithelialization as its mechanism of action, rather than functioning as a strict debridement agent.
• It also remains a good option in patients who require debridement but are not surgical candidates. Enzymatic Debridement Agents
• Collagenase (Santyl Ointment)
• Papain
• Bromelain Collagenase
• Enzymatic Debridement Agent
• Strain of Clostridium histolyticum
• Selective for collagen
• Generally pain-free delivery
• May be combined with a variety of other topical dressings Collagenase Disadvantages & Precautions

• Enzymatic Debridement Agent
• Effectiveness compared with other forms of debridement may be questionable
• Prescription based on wound area
• High cost
• Relatively slow acting
• Moist wound environment required for activation
• Topical silver dressings significantly inhibit collagenase activity Papain
• Enzymatic Debridement Agent
• Papaya derived
• Provides relatively "aggressive" enzymatic debridement
• Generally pain-free delivery
• May be combined with a variety of other topical dressings Papain Disadvantages & Precautions
• Not readily available in the United States
• Nonselective (ie, will cleave any protein containing cysteine)
• Relatively slow acting
• Agent is often combined with a chlorophyll complex that causes green wound discoloration following application
• Need to avoid adjacent healthy tissues Bromelain
• Enzymatic Debridement Agent
• derived from pineapple
• Relatively rapid acting
• Selective for nonviable tissue Bromelain Disadvantages & Precautions
• Removal from base of wound required after several hours
• Inhibits platelet function but is reversible
• Evidence of efficacy is based on acute wounds or burns, not chronic wounds

Biologic Debridement Maggot Therapy

• can be used as a bridge between debridement procedures
• may also reduce the duration of antibiotic therapy
• Larvae are generally changed every 48 to 72 hours.
• only beneficial for ~one week Wound Packing
• considered for area of dead space between the surface of intact healthy skin and the wound base. These wounds are described as tunneled or undermined.
• no specific trials comparing packed versus unpacked wounds, wound packing is considered basic standard care
• important to reduce physiological dead space (in undermined wounds) -->absorb exudate/seroma collection, and reduce the potential for infection. Undermined Extension of the wound under intact skin edges such that the wound measures larger at its base than is appreciated at the skin surface.
• When describing and documenting undermined wounds on the plantar aspect of the foot, use a clock face analogy to illustrate the direction and location of undermining.
• 12 o'clock is distally (direction of the toes)
• 6 o'clock is proximally (direction of the heel)
• 3 o'clock is medial (? what if its there left foot?)
• 9 o'clock is lateral (? what if its there left foot?) How to Pack a Wound
• little consensus over what constitutes the best material for wound packing.
• topical dressings for wounds (foams, alginates, hydrogels) can be molded into the shape of the wound and are useful for wound packing
• traditional gauze dressing is often used to aid in continuing debridement of devitalized tissue from the wound bed.

• gauze is moistened with normal saline or tap water and placed into the wound and covered with dry layers of gauze. --As the moistened gauze dries, it adheres to surface tissues, which are then removed when the dressing is changed.
• Dressing changes should be frequent enough that the gauze does not dry out completely, which can be 2 - 3 times daily.
• disadvantage of gauze dressings is that they can also remove developing granulation tissue, resulting in reinjury,
• dressings are discontinued when all the necrotic tissue has been removed and granulation is occurring. Topical Therapy for Wounds After appropriately addressing debridement of necrotic tissue, pressure offloading, infection, and ischemia, adjunctive topical therapies that may be helpful to augment wound healing.
• Growth Factors
• Antiseptic agents
• Antimicrobial agents
• Beta Blockers Topical Growth Factors
• platelet-derived growth factor (PDGF)
• fibroblast growth factor (FGF)
• granulocyte-macrophage colony stimulating factor (GM-CSF), Platelet-derived growth factor (PDGF) Regranex (becaplermin)
• gel preparation that promotes cellular proliferation and angiogenesis
• approved for adjuvant therapy for diabetic foot ulcers and is the only pharmacological agent approved for the treatment of chronic wounds.
• delivered in a topical aqueous-based sodium carboxymethylcellulose gel.

• indicated for noninfected diabetic foot ulcers that extend into the subcutaneous tissue and have an adequate vascular supply * black box warning mentions a concern for malignancy; however, the overall malignancy risk is believed to be low, post-marketing study found an increased rate of mortality secondary to malignancy in patients treated with three or more tubes of becaplermin (3. versus 0.9 per 1000 person years) compared with controls Epidermal growth factor Topical Growth Factor
• In a study of chronic venous ulcers, topical application of human recombinant epidermal growth factor was associated with a greater reduction in ulcer size and higher ulcer healing rate compared with placebo, but these differences were not statistically significant. Epithelialization was not significantly affected. Granulocyte-macrophage colony stimulating factor Topical Growth Factor
• Intradermal injections of GM-CSF promote healing of chronic leg ulcers, including venous ulcers.
• four weekly injections with GM-CSF 200 mcg, 400 mcg, or placebo found significantly higher rates of healing at 13 weeks
• GM-CSF has been used in various types of chronic wounds to promote healing Antiseptics and antimicrobial agents Iodine-based Silver-based Honey Beta Blockers Iodine-based Agents
• Antimicrobial Cadexomer iodine (eg, Iodosorb)

• reduces bacterial load within the wound and stimulates healing by providing a moist wound environment.
• bacteriocidal to all gram-positive and gram-negative bacteria.
• For topical preparations, there is some evidence to suggest that cadexomer iodine generates higher healing rates than standard care but should likely only be considered for use on a short-term basis. Silver Based Agents Antiseptics and antimicrobial agents
• silver is toxic to bacteria,
• NO demonstrated significant benefits in comparison with other topical wound dressings.
• One trial compared silver-containing foam ( Contreet ) with hydrocellular foam (Allevyn) in patients with leg ulcers. The second compared a silver-containing alginate ( Silvercel ) with an alginate alone (Algosteril). The third trial compared a silver-containing foam dressing (Contreet) with best local practice in patients with chronic wounds.
• Nevertheless, silver dressings are used by many clinicians to decrease the heavy bacterial surface contamination Honey Antiseptics and antimicrobial agents
• used since ancient times for the management of wounds.
• has broad-spectrum antimicrobial activity due to its high osmolarity and high concentration of hydrogen peroxide.
• Medical-grade honey products are now available as a gel, paste, and impregnated into adhesive, alginate, and colloid dressings
• insufficient data to recommend routine use of honey for all wound types; burns may benefit, whereas others, chronic venous ulcers, may not Medihoney (manuka honey)

Beta Blocker Antiseptics and antimicrobial agents

• Topical Timolol has limited evidence that it promotes keratinocyte (which have beta-adrenergic receptors) migration and epithelialization of chronic wounds, that are unresponsive to standard wound interventions. Benefits of Wound Dressings
• can arguably have a significant impact on the speed of wound healing, wound strength and function of the repaired skin, and cosmetic appearance of the resulting scar when applied and changed appropriately.
• No single dressing is perfect for all wounds; ra
• wounds must be continually monitored as their characteristics and dressing requirements change over time
• little clinical evidence to aid in the choice between the different types of wound dressings. Consensus opinion supports the following general principles for chronic wound management [100], but similar principles may be used for acute wound management: General principles for chronic wound management Consensus opinion supports the following general principles for chronic wound management:
• Hydrogels for the debridement stage
• Low-adherent dressings that maintain moisture balance for the granulation stage
• Low-adherent dressings for the epithelialization stage Importance of Moisture in Wound Healing Moist (occluded) wounds heal up to 40 percent more rapidly compared with wounds that are dried out and associated with less prominent scar formation MOA for Occluded Acute Wounds to heal faster
• easier migration of epidermal cells in the moist environment created by the dressing

• exposure of the wound to its own fluid acute wound fluid is rich in platelet-derived growth factor, basic fibroblast growth factor, and has a balance of metalloproteases serving a matrix custodial function.These interact with one another and with other cytokines to stimulate healing
• On the other hand, MOA for Moisture to hinder Chronic Wound Healing
• Chronic wound fluid is very different from acute wound fluid and contains persistently elevated levels of inflammatory cytokines that may inhibit proliferation of fibroblasts
• Excessive periwound edema and induration contributes to the development of chronic wound fluid and should be managed to minimize this effect. Categorization of Common Dressings Most useful to classify by water-retaining abilities; primary goal is maintenance of moisture in wound environment.
• open
• semi-open
• semi-occlusive Open Dressing Primarily, gauze, typically moistened with saline before placing it into the wound.
• Available in (2 x 2), (4 x 4) and 3 or 4 inch rolls.
• Dried gauze dressings are discouraged.
• Wet-to-moist gauze dressings are useful for packing large soft-tissue defects until wound closure or coverage can be performed.
• inexpensive but often require frequent dressing changes. Semi-Open Dressing
• fine mesh gauze impregnated with petroleum, paraffin wax, or other ointment ( Xeroform, Adaptic, Jelonet, and Sofra Tulle).
• initial layer covered by secondary dressing of absorbent gauze and padding
• third layer of tape or other method of adhesive.

• Benefits of semi-open dressings include their minimum expense and their ease of application.
• Disadvantage of this type of dressing is that it does not maintain a moisture-rich environment or provide good exudate control. Fluid is permitted to seep through the first layer and is collected in the second layer, allowing for both desiccation of the wound bed and maceration of the surrounding tissue in contact with the secondary layer. Other disadvantages include the bulk of the dressing, its awkwardness when applied to certain areas, and the need for frequent changing. Benefits of Semi-occlusive dressings Wide variety of:
• occlusive properties
• absorptive capacities
• conformability
• bacteriostatic activity. Semi-occlusive Dressings Films Foams Alginates Hydrocolloids Hydrogels Hydroactive Films Tegaderm, Cutifilm, Blisterfilm , Bioclusive Polymer films - transparent sheets of synthetic self-adhesive dressing
• permeable to gases (water vapor and oxygen)
• impermeable to larger molecules, (proteins and bacteria). This property enables insensible water loss to evaporate, traps wound fluid enzymes within the dressing, and prevents bacterial invasion.
• found to provide the fastest healing rates, lowest infection rates, and to be the most cost- effective method for dressing split-thickness skin graft donor sites in a review of 33 published studies.

Advantages of Films Ability to maintain moisture

• encourage rapid reepithelization
• transparency
• self-adhesive properties. Disadvantages of Films
• Limited absorptive capacity
• Not appropriate for moderate to heavy exudative wounds.
• If remain in place with heavy exudates, the surrounding skin is likely to become macerated. --If the wound dries out, film dressings may adhere to the wound and be painful and damaging to remove. Foams Allevyn, Adhesive, Lyofoam, Spyrosorb
• thought of as film dressings with addition of absorbency.
• consist of two layers
• hydrophilic silicone or polyurethane-based foam, lies against wound surface
• hydrophobic, gas-permeable backing, prevents leakage and bacterial contamination. Some foams require a secondary adhesive dressing. Advantages of Foams
• high absorptive capacity
• conform to the shape of the wound
• can be used to pack cavities Disadvantages of Foams opacity of the dressings and the fact that they may need to be changed each day. Foam dressings may not be appropriate on minimally exudative wounds, as they may cause desiccation. One small trial compared foams to films as dressings for skin tears in institutionalized adults and found that more complete healing occurred in the group using foams

Alginate Dressing Natural complex polysaccharides from various types of algae form the basis of alginate dressing

• activity as dressings is unique--> insoluble in water, but in sodium-rich wound fluid environment these complexes exchange calcium ions for sodium ions and form an amorphous gel that packs and covers the wound.
• Alginates come in various forms including ribbons, beads, and pads.
• absorptive capacity ranges depending upon the type of polysaccharide used.
• more appropriate for moderate to heavy exudative wounds. Advantages of Algenates
• good for highly exudative wounds (can absorb up to 20 times their weight in fluid)
• augmentation of hemostasis
• can be used for wound packing
• most can be washed away with normal saline to minimize pain during dressing changes
• can stay in place for several days Disadvantages of Algenates
• require a secondary dressing that must be removed in order to monitor the wound
• can be too drying on a minimally exudative wound, and they have an unpleasant odor. *Patients treated with alginates were found to have significantly superior granulation tissue coverage at four weeks of treatment, significantly less pain, and fewer dressing changes than the petroleum gauze group. Hydrocolloid Dressing DuoDERM, Tegasorb, J&J Ulcer Dressing, Comfeel
• usually consist of a gel or foam on a carrier of self-adhesive polyurethane film.
• traps exudate and creates a moist environment.

• bacteria and debris are also trapped and washed away with dressing changes in a gentle, painless form of mechanical debridement
• ability to use them for packing wounds Disadvantages of Hydrocolloid Dressings
• malodor
• potential need for daily dressing changes
• allergic contact dermatitis has been reported Cadexomer iodine Paste type of hydrocolloid in which iodine is dispersed and slowly released after it comes in contact with wound fluid.
• concentration of iodine released is low & does not cause tissue damage
• more cost-effective than non-iodinated hydrocolloid dressing or paraffin gauze dressing in patients with exudating venous ulcers.
• Iodine-induced hyperthyroidism has been documented with use of cadexomer iodine for leg ulcers Hydrogel Dressing Intrasite Gel, Vigilon, Carrington Gel, Elastogel
• matrix of various types of synthetic polymers with >95 percent water formed into sheets, gels, or foams that are usually sandwiched between two sheets of removable film.
• inner layer is placed against the wound
• outer layer can be removed to make the dressing permeable to fluid. (Sometimes a secondary adhesive dressing is needed.)
• can absorb or donate water depending upon the hydration state of the tissue that surrounds them. Hydrogel products include
• most useful for dry wounds

• initially lower the temperature of the wound environment they cover, which provides cooling pain relief for some patients Disadvantages of Hydrogels although there have been no reports of increased wound infection, hydrogels have been found to selectively permit gram-negative bacteria to proliferate Hydroactive Dressing
• most recently developed synthetic dressing
• a polyurethane matrix, combines properties gel and foam.
• selectively absorbs excess water while leaving growth factors and other proteins behind
• equally effective at promoting ulcer healing and alleviating ulcer-associated pain after 12 weeks of treatment compared to hydrocolloids.
• combined with enzymatic debridement, more cost-efficient than gauze alone in dressing pressure ulcers and venous stasis ulcers Liquid Dressings
• Lotions
• Ointments
• Creams (silvadine)
• Gels (hydrogel) Lotions usually water mixed with oil typically has less alcohol than solutions Creams
• emulsion of water and oil (and other substances ) in equal proportions
• penetrates stratum corneum
• thicker than lotion, maintains its shape when taken out of container.
• less greasy than ointments and usually absorbed by the skin

Silvadine cream 1% cream that contains silverdiazine micronized (antimicrobial silver agent)

• may inhibit healing in granulating wounds b/c silver causes cell stasis and inhibits migration Flagyl Gel
• metronidazole 0.75%
• controls bacterial growth on surface
• controls odor & drainage from gram negative & anaerobic bacteria
• LAST RESORT to control a fungating or declining foul wound.
• Major indication is to CONTROL WOUND ODOR Polysporin cream or Ointment Commonly used
• also comes as powder
• composed as bacitracin and polymyxin B
• topical antibiotic for surface management of bacterial colonization (not for systemic infection)
• effective against pseudomonas, staph & strep
• efficacy in preventing infections not proven Gentamicin Cream
• 0.1% cream Triple Antibiotic Ointment
• Neosporin
• bacitracin, neomycin, polymyxin B Bactroban (mupirocin) Cream
• effective against some MRSA Betadine (povidone-iodine)

• antiseptic that kills both bacteria and healing cells within a wound
• most commonly used prep solution that is nonirritating to skin or mucous membranes; contains iodine
• DO NOT use on clean wounds that are granulating b/c it impairs healing
• used in wound care primarily for maintenance of dry ulcers that are not expected to heal
• or for which moist wound healing is contraindicated (eg arterial ulcers) Hydrogen Peroxide (H2O2)
• impedes healing
• leads to scarring b/c it destroys newly formed skin cells
• good for cleaning surfaces or getting blood out of lab coat Dakin's solution an aqueous solution of sodium hypochlorite (bleach)
• used as an antiseptic for wound irrigation
• chlorine is the active ingredient
• strong antiseptic, kills most bacteria and viruses
• not used at Skilled Wound Care if used on Cadexomer iodine (Iodosorb) Iodosrb/Iodoflex/Iodophor
• absorbs exudate and particulate matter from surface of GRANULATING wounds
• as it becomes moist, iodine is released
• dual effect of cleansing the wound and exerting bactericidal action.
• used sparingly in SNF, more in hospitals Powders

• corn starch
• corn cob powder

Xenaderm/Vasolex Cream BCT Agent Proderm Spray BCT Agent (but without the T - trypsin) and cheapest of BCT's Granulex Spray BCT Agent:

• balsam peru (increases blood flow and prevents bacteria)
• castor oil (prevents skin cell breakdown)
• Trypsin (helps shed damages cells)
• BCTs are for treatment of dry lower extremity wounds; Deep Tissue Pressure Injuries, if slough or necrosis occurs, may need to switch to debriding agent. Wound Closure (Types of Wound Healing) Primary closure Delayed primary closure Healing by secondary intention Third Intention Primary Wound Closure
• direct apposition of skin edges of acute surgical or traumatic wounds after appropriate wound preparation with sutures and/or staples
• chronic wound should never be closed primarily Delayed primary closure
• wound is purposefully left open for a period of time (eg. interval of wound management) and then the edges are directly apposed with sutures and/or staples.

• still represents primary closure
• surgical wounds without evidence of infection, delayed closure is widely accepted
• delayed closure or coverage of chronic wounds is acceptable. Secondary Intention of Wound Closure
• purposefully left open and fills in with granulation tissue and eventually epithelization over a period of time.
• At no point are the skin edges brought together by external means
• process of healing by secondary intention might be assisted by the use of negative pressure wound therapy. Negative Pressure Wound Therapy
• enhances wound healing by reducing edema surrounding the wound, stimulating circulation, and increasing the rate of granulation tissue formation
• involves the application of a controlled subatmospheric pressure to a wound covered with a foam dressing.
• useful to manage large defects until closure can be performed
• modest success in the treatment of pressure ulcers and diabetic wounds Wound Coverage Options
• Biologic cell-based dressings (live allogenic cells)
• Skin Grafts (Split-thickness and full-thickness, depending upon the amount of dermis included in the graft.)
• used to prevent fluid and electrolyte loss and reduce bacterial burden and infection.
• choice between full- and split-thickness skin grafting depends upon the condition of the wound, location, size, and need for cosmesis
• Tissue Flap autogenous skin graft (autograft)

Skin transplanted from one location to another on the same individual split thickness skin graft for Wound Coverage contains a variable thickness of dermis Full-thickness skin graft for Wound Coverage

• contains the entire dermis
• characteristics of normal skin are maintained with a thicker dermal component
• thicker grafts require a more robust wound bed due to the greater amount of tissue that needs to be revascularized. Biologic cell-based dressings
• aka "skin substitutes"
• composed of a live-cell construct that contains at least one layer of live allogenic cells.
• Skin substitutes can be used when traditional dressings have failed or are deemed inappropriate.
• use considered when a chronic wound fails to heal at an appropriate rate of closure (ie, 55 percent reduction in wound area within four weeks of treatment).
• ideal for the treatment of chronic ulcers because additional cells and growth factors are added to a deficient wound-healing environment. Accelerated wound healing reduces the risk of wound infection. (See "Skin substitutes".) Tissue Flap Wound Coverage For larger wounds or loss of multiple tissue components (skin, subcutaneous tissue, muscle), a tissue flap may be required to provide adequate wound coverage. Adjunctive Therapies Primarily for treatment of pressure ulcers or chronic venous wounds Hyperbaric oxygen therapy (HBOT) Topical oxygen therapy Low-frequency ultrasound Electrical stimulation

Electromagnetic therapy Phototherapy HBOT MOA

• systemic mechanism of action (MOA) through increased binding of oxygen to red blood cells, which potentially leads to increased peripheral cellular diffusion Endothelial progenitor cells play an important role in wound healing because they participate in the formation of new blood vessels in areas of hypoxia. Although hyperoxia induced by HBOT effectively improves endothelial progenitor cells' mobilization, therapy is not targeted to the wound site. Hyperbaric oxygen therapy (HBOT)
• specific indications are relatively unclear
• used in variety of acute and chronic wounds
• may benefit some types of wounds (eg, diabetic ulcers), there is insufficient evidence to support routine use
• HBOT might be considered in chronic wounds that failed conventional interventions, in relatively ischemic states where revascularization is not an option, and in the setting of subacute osteonecrosis not amenable to surgical excision. Periwound treatment Calmoseptine
• barrier ointment/cream
• zinc oxide and menthol Topical Oxygen Therapy
• unlike HBOT which is systemic, topical oxygen therapy is local
• increased levels of oxygen might also be delivered locally with topical oxygen therapy, albeit likely without the direct cellular effects. The local hyperoxic state more likely generally affects the wound bed environment and might have some bactericidal properties. Like most topical interventions, the

direct effects of topical oxygen therapy on wound healing are difficult to specifically elucidate, but it represents an option with some marginal potential benefits and relatively minimal complications.