ADVANCED WOUND CARE PROGRAM

ADVANCED WOUND CARE PROGRAM

WOUND CLASSIFICATION SYSTEMS There are two methods of classification of wounds, by color and by wound stage. The Stage System The oldest and most frequently used method of identifying and classifying wounds is by wound stage. The stages are as follows: Stage 1 A reddened area of intact skin Stage 2 A shallow open ulcer without drainage Stage 3 Full-thickness skin loss; may be necrotic, may have minimal to moderate drainage or slough Stage 4 Full thickness tissue loss with exposed bone and/or tendon; moderate to heavy drainage; may have been necrotic and malodorous The wound staging method of product selection is the system utilized in this guide. Comprehensive examples of each stage wound will be found on the pages to follow. 1 MPM MEDICAL, INC.

The Color System The color system of wound classification describes the wound condition as a black, yellow or red wound. We do not devote space in this guide to this method of product selection; however, examples of wound classification by color are reflected below. RED WOUNDS are in the healing phase and are granulating and/or epithelializing. The color may range from pale pink to deep red and the amount of exudate will vary. Select dressings that will provide protection for the healing wound and maintain a moist wound environment. YELLOW WOUNDS are in the inflammatory phase, usually moist necrotic tissue (slough), and may have varying amounts of exudate. Though moist slough will most often be yellow, it may also appear brown or tan color. The wound may also be infected. Select a product which will absorb, cleanse, fill dead space, protect surrounding skin, and maintain a moist wound environment. BLACK WOUNDS contain dry or softened eschar or other hardened necrotic tissue (usually black in color, but possibly also brown, tan, yellow, gray, or variations thereof). Exudate levels can vary. For these wounds, you would select a product that supports the process of debridement. 800-232-5512 www.mpmmed.com 2

STAGE 1 Description: An observable pressure-related alteration of intact skin whose indicator as compared to the adjacent or opposite area on the body may include changes in one or more of the following: Skin temperature (warmth or coolness) Tissue consistency (firm or boggy feel) Sensation (pain, itching). The ulcer appears as a defined area of persistent redness in lightly pigmented skin, whereas in darker skin tones, the ulcer may appear with persistent red, blue, or purple coloration. Treatment Goal: Protection of intact skin Suggested Products: 1. Apply Excel-Gel to moisturize area and help maintain intact skin. 2. If protection is needed, apply Excel Hydrocolloid. Turn patient frequently to reduce pressure. Monitor daily. 3 MPM MEDICAL, INC.

Definition: Intact skin with non-blanchable redness of a localized area usually over a bony prominence. Darkly pigmented skin may not have visible blanching; its color may differ from the surrounding area. Symptoms: Area may be painful, firm, soft, warmer or cooler as compared to adjacent tissue May indicate at risk persons Difficult to detect in dark skin tones. 800-232-5512 www.mpmmed.com 4

STAGE 2 Light to Moderate Draining Description: Partial thickness skin loss involving epidermis and/or dermis. The ulcer is superficial and presents clinically as an abrasion, blister, or shallow crater. Treatment Goal: Closure/re-epithelialization of ulcer Suggested Products: 1. Apply Regenecare if painful wound or Excel-Gel to promote moist wound healing. 2. Cover with Excel Hydrocolloid for protection and to absorb minimum drainage. 5 MPM MEDICAL, INC.

Definition: Partial thickness loss of dermis presenting as a shallow open ulcer with a red/pink wound bed, without slough. May also present as an intact or open/ruptured serum-filled blister. Symptoms: Presents as a shiny or dry shallow ulcer without slough or bruising. This stage should not be used to describe skin tears, tape burns, perineal dermatitis, maceration or excoriation. 800-232-5512 www.mpmmed.com 6

STAGE 3 Moderate to Heavy Drainage Description: Full thickness skin loss involving damage to, or necrosis of, subcutaneous tissue that may extend down to, but not through, underlying fascia. The ulcer presents clinically as a deep crater with or without undermining adjacent tissue. Treatment Goal: Closure/re-epithelialization of ulcer Suggested Products: 1. Cleanse the wound. 2. Pack Hydrogel Saturated Gauze Dressing loosely into the wound to soften slough, to ease the removal of debris and reduce pain. If there is no debris or pain, apply Excel-Gel. 3. Cover with Repel, an absorbent waterproof dressing, or for heavy drainage, apply MPM Foam Dressing. 7 MPM MEDICAL, INC.

Definition: Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. Slough may be present but does not obscure the depth of tissue loss. May include undermining and tunneling. Symptoms: May be shallow on ear, nose, occiputal, & malleolus as they have minimal subcutaneous tissue May be deep in areas of significant adipose tissue Bone, tendon not visible or directly palpable 800-232-5512 www.mpmmed.com 8

STAGE 4 Heavy Drainage, Slough or Eschar May be Present Description: Full thickness skin loss with extensive destruction, tissue necrosis or damage to muscle, bone, or supporting structures (eg. tendon, joint capsules). Undermining and sinus tracts may also be associated with Stage 4 pressure ulcers. Treatment Goal: Promotion of granulation tissue free of necrotic tissue Suggested Products: 1. Cleanse the wound. 2. Depending on amount of drainage, apply topical dressing (see 3 and/or 4). 3. Apply Regenecare Gel if painful. If eschar is present, use MPM Excel-Gel or Saturated Pad to soften and facilitate removal. 4. If infected, apply MPM SilverMed to destroy microbes. 5. Apply Excelginate to absorb drainage and cover with MPM Multi-layer dressing. If there is no drainage, apply MPM Multi-Layered Dressing only. 6. If undermining or tunneling present, fill dead space with MPM GelPad Saturated Gauze, then cover with MPM Foam Dressing. 9 MPM MEDICAL, INC.

Definition: Full-thickness tissue loss with exposed bone, tendon or muscle. Slough or eschar may be present on some parts of the wound bed. Often include undermining and tunneling. Symptoms: Depth will vary with location Osteomyelitis may occur Exposed bone/tendon visible or directly palpable 800-232-5512 www.mpmmed.com 10

Skin Tear Description: Multiple areas of partial thickness skin damage with loss of epidermis secondary to friction, trauma, etc. Exudate Level: Depth: Treatment Objective: None to Moderate Shallow Protect. Hydrate Suggested Products: Primary Dressing: Excel-Gel - Moisturizes, enhances healing Regenecare Wound Gel - Relieves pain, enhances healing CoolMagic Gel Sheet - Relieves pain, protects wound Secondary or Cover Dressing: Multi-Layered Dressing - Absorbs moderate drainage, protects wound Excel Hydrocolloid - Protects wound, absorbs minimal drainage 11 MPM MEDICAL, INC.

Eschar - Unstageable Description: Avascular, black/brown tissue welladhered to wound bed Exudate Level: Depth: Treatment Objective: None to Moderate Unknown Debride Suggested Products: Primary Dressing: Excel-Gel - Moisturizes and softens eschar for easy removal Regenecare Wound Gel - Softens eschar and relieves pain Gel Pad Hydrogel Saturated Gauze Dressing - Relieves pain, protects wound Secondary or Cover Dressing: Repel Bordered Dressing - Waterproof, absorbs moderate drainage Excel Hydrocolloid - Helps soften eschar for easy removal 800-232-5512 www.mpmmed.com 12

Infected Wound Description: highly colonized, wound with granulation tissue; moderate drainage Description: wound with necrotic tissue; advancing erythema; and increased drainage/odor Exudate Level: Depth: Treatment Objective: Moderate Unknown Debride, absorb, fill dead space Suggested Products: Primary Dressing: ExcelGinate - Absorbs heavy to moderate drainage SilverMed Antimicrobial Hydrogel - Anti-bacterial and fungicide Secondary or Cover Dressing: Excel Bordered Foam Dressing - To absorb moderate to heavy drainage 13 MPM MEDICAL, INC.

Slough Description: Yellow, stringy avascular tissue: liquified eschar Exudate Level: Depth: Treatment Objective: None to Moderate Unknown Debride, absorb and relieve pain Suggested Products: Primary Dressing: Excel-Gel Hydrogel Dressing - Moistens wound and enhances healing Regenecare Wound Gel - Relieves pain, moistens wound and enhances healing Gel Pad Hydrogel Saturated Dressing - Relieves pain, protects wound Secondary or Cover Dressing: Repel Dressing - Waterproof and absorbs moderate drainage Excel Foam Dressing - Absorbs moderate to heavy drainage 800-232-5512 www.mpmmed.com 14

Granulating Description: Pink-red, firm, moist, viable granulating tissue Exudate Level: Depth: Treatment Objective: None to Moderate Unknown Protect, hydrate, relieve pain Suggested Products: Primary Dressing: Excel-Gel Hydrogel Dressing - Moistens wound and enhances healing Regenecare Wound Gel - Relieves pain, moistens wound and enhances healing ExcelGinate - Absorbs drainage Secondary or Cover Dressing: Excel Hydrocolloid Dressing - protects and absorbs minimal drainage Multi-Layered Dressing - Absorbs moderate to heavy drainage and protects 15 MPM MEDICAL, INC.

Epithelializing Description: Epidermal cells migrating across wound bed to reepithelialize the wound Exudate Level: Depth: Treatment Objective: None to Moderate Unknown Protect, hydrate, fill dead space Suggested Products: Primary Dressing: Excel-Gel Hydrogel Dressing - Moistens wound and enhances healing Regenecare Wound Gel - Relieves pain, moistens wound and enhances healing Gel Pad Hydrogel Saturated Dressing - Relieves pain, moisturizes wound and enhances healing Secondary or Cover Dressing: Repel Dressing - Waterproof and absorbs drainage Excel Hydrocolloid Dressing - Protects and absorbs minimal drainage 800-232-5512 www.mpmmed.com 16

Venous Stasis Ulcer Description: Venous ulcers on lower extremity; increased discoloration; uneven edges; dry scaly skin; palpable pulse; edema present Exudate Level: Depth: Treatment Objective: None to Moderate Unknown Debride, hydrate, protect Suggested Products: Primary Dressing: Excel-Gel Hydrogel Dressing - Moistens wound and enhances healing Regenecare Wound Gel - Relieves pain, moistens wound and enhances healing CoolMagic Gel Sheet - Moisturizes and relieves pain Secondary or Cover Dressing: Multi-Layered Dressing - Absorbs moderate drainage and protects Excel Foam Bordered Dressing - Absorbs moderate to heavy drainage and protects 17 MPM MEDICAL, INC.

Heel Ulcer Description: Stage IV heel ulcer that probes to bone. There is yellow tissue present in wound bed; slight erythema & maceration noted along wound edges. More absorbent dressing will be started that will facilitate packing and prevent maceration. Exudate Level: Depth: Treatment Objective: None to Moderate Unknown Debride, protect, hydrate, absorb drainage Suggested Products: Primary Dressing: Excel-Gel Hydrogel Dressing - Moistens wound, enhances healing Regenecare Wound Gel - Relieves pain, moistens wound and enhances healing Gel Pad Hydrogel Saturated Dressing - Relieves pain, protects wound ExcelGinate - Absorbs moderate to heavy drainage Secondary or Cover Dressing: Multi-Layered Dressing - Absorbs moderate drainage, protects Excel Foam Dressing - Absorbs moderate to heavy drainage and protects Repel Dressing - Waterproof and absorbs moderate drainage 800-232-5512 www.mpmmed.com 18

Surgical Wound Description: Full thickness abdominal surgical wound (8 x 4.5 x 2.5cm). Pink, healthy granulation tissue present; edges open. Exudate Level: Depth: Treatment Objective: None to Low Unknown Protect, hydrate, absorb drainage Suggested Products: Primary Dressing: Excel-Gel Hydrogel Dressing - Moistens wound and enhances healing Regenecare Wound Gel - Relieves pain, moistens wound and enhances healing ExcelGinate - Absorbs moderate to heavy drainage Secondary or Cover Dressing: Repel Dressing - Waterproof and absorbs moderate drainage Excel Hydrocolloid Dressing - Protects and absorbs minimal drainage 19 MPM MEDICAL, INC.

Healed Wound Description: Healing full thickness abdominal surgical wound. Granulated to skin level; some denuded epidermis. Exudate Level: Depth: Treatment Objective: None None Protect and moisturize Suggested Products: Primary Dressing: Excel-Gel Hydrogel Dressing - Moistens wound and enhances healing Secondary or Cover Dressing: Multi-Layered Dressing - Absorbs moderate drainage, protects 800-232-5512 www.mpmmed.com 20

Hydrogel Gels MPM Excel-Gel Hydrogel Dressing Indications*: Pressure ulcers, Stages I-IV 1st and 2nd degree burns Stasis ulcers Leg ulcers Diabetic ulcers Directions: Apply Excel-Gel to the wound bed approximately ¼ thick and cover with secondary wound cover Why it works: Polysaccharides in aloe vera reduce inflammation and moisturize. Stimulates micro-circulation and immune factors for quick healing Glycerin is a natural humectant which provides moisture to the wound Maintains moist wound environment Clear gel allows visualization of the wound bed Non-toxic Will not harm healthy tissue * Under the supervision of a healthcare professional, this product may be used as indicated. * Not all products are available for all patients. Reorder # Size UPN MPMMP00026 1 oz. 366977006019 MPMMP00006 3 oz. 366977006033 21 MPM MEDICAL, INC.

Hydrogel Gels MPM Regenecare Wound Gel with 2% Lidocaine Indications*: Abrasions and skin tears Burns and cuts Diabetic and vascular ulcers Partial and full thickness wounds Pain associated with debridement Why they work: 2% Lidocaine HCl reduces pain, inflammation, breaks itch and scratch cycle Aloe Vera moisturizes Regenecare contains Calcium Alginate to absorb drainage Directions: 1) Cleanse the irritated area to remove extraneous material. 2) For topical use, apply to dry, painful skin or tissue three times a day or as needed to assist in pain relief and provide a moist environment for healing.for open wounds apply as needed or with ordered dressing changes. Reorder # Size UPN MPMMP00100 3 oz. 366977100038 800-232-5512 www.mpmmed.com 22

Hydrogel Gels MPM GelPad Saturated Gauze Indications*: Pressure ulcers, Stages I-IV 1st and 2nd degree burns Stasis ulcers Directions: 1) Pack wound with appropriate size GelPad and cover with secondary wound cover. 2) Change dressing daily. Why it works: Reduces painful dressing removal Contains Aloe Vera & glycerin which provides moisture Non-injurious to healthy tissue Designed for wound packing Easily removed Reorder # Size UPN MPMMP00009 4" x 4" 366977009447 23 MPM MEDICAL, INC.

Hydrogel Gels MPM CoolMagic Gel Hydrogel Sheet Indications*: 1st and 2nd degree burns Vascular ulcers Diabetic ulcers Abrasions Skin tears Pressure ulcers, Stages I-II Directions: 1) Apply over wound for a cool, soothing effect. 2) Change every 24 to 36 hours. 3) Hold in place with tape or stretch gauze. Why it works: Semi-occlusive: allows flow of oxygen Prevents bacteria and foreign matter from entering wound Hydrophilic and absorptive absorbs three times its weight Cools live nerve endings due to 90% water-10% polyethylene formulation Will not damage tissue when removed Reorder # Size UPN MPMMP00206 3¾" x 3¾" 366977206334 MPMMP00208 6" x 8" 366977206686 800-232-5512 www.mpmmed.com 24

Hydrogel Gels MPM SilverMed Amorphous Hydrogel Antimicrobial Silver Indications*: Pressure ulcers, diabetic foot ulcers, and leg ulcers Skin abrasions, lacerations, and tears Chemical or thermal burns (1st and 2nd degree) surgical wounds, grafted wounds, and donor sites Directions 1) Cleanse wound of dirt, debris, and necrotic tissue. 2) Spread silver hydrogel throughout the wound to approximately ¼" thickness. 3) Cover with dressing, preferably waterproof, with good M.V.T.R. 4) Change in accordance with your protocol. Why it works: Binds Matrix Metallo Protease (MMP s) (Allowing the body to heal itself) Reduces bioburden (Creates a favorable environment for wound healing) Long lasting antimicrobial barrier (Unique Dynamic Matrix Technology allows for sustained release of microbial silver ions) Regulates hydration (SilverMed Gel donates moisture as needed to keep a favorable moisture level) Extended protection (SilverMed Gel may continue to provide antimicrobial effects in the wound for up to six days) Will not stain or irritate the tissue Reorder # Size UPN MPMABSM 1406 1.5 oz. 366977140157 MPMABSM 1410 3 oz. 366977140034 25 MPM MEDICAL, INC.

Hydrocolloid Dressings MPM Excel Hydrocolloid Indications*: Pressure ulcers, Stages I-IV 1st and 2nd Degree burns Leg ulcers Superficial wounds Directions: Cleanse wound, select dressing that overlaps wound by 1", apply dressing over wound and press down. Why it works: Absorptive Wicks away drainage Protective Cushions wound bed from pressure and trauma Reorder # Size UPN MPMMP00600 2" x 2" 366977600224 MPMMP00606 3.6" x 4" 366977600347 MPMMP00602 4" x 4.25" 366977600453 MPMMP00608 6.5" x 6" 366977600668 800-232-5512 www.mpmmed.com 26

Alginate Wound Filler MPM ExcelGinate Alginate Indications*: Pressure ulcers Trauma wounds Donor sites Diabetic ulcers Arterial venous ulcers Directions: 1) Cleanse wound, apply ExcelGinate to the wound bed and cover with a non-occlusive secondary dressing. 2) Change dressing daily. Why it works: Tightly woven to maintain its integrity upon removal Recommended for moderate to heavy exudating wounds Highly absorptive, absorbs four times its weight Reorder # Size UPN MPMMP00812 Rope 12" 366977800129 MPMMP00800 2" x 2" 366977800228 MPMMP00801 4" x 4" 366977800440 MPMMP00802 4" x 8" 366977800488 27 MPM MEDICAL, INC.

Foam Dressings MPM Non-Bordered Foam Reorder # Size UPN MPMMP00510 2" x 2" 366977500227 MPMMP00511 4" x 4" 366977500241 MPMMP00512 6" x 6" 366977500265 Indications*: Chronic and acute, moderate to heavy exudating, partial and full thickness wounds including superficial wounds 2nd degree burns Pressure ulcers, Stages II-IV Why it works: Reduces pressure on the wound Specialty foam quickly absorbs large amounts of fluid Waterproof top layer Directions: 1) Cleanse wound, remove release liner from dressing, place dressing on wound, secure by gently pressing on tape border. 2) Secure non-bordered with secondary dressing. MPM Bordered Foam Reorder # Size UPN MPMMP00500 4" x 4" Overall 2" x 2" Pad 366977500449 MPMMP00501 Circular Fenestrated 4" Diameter, 2" Pad 366977500258 MPMMP00502 6" x 6" Overall 4" x 4" Pad 366977500661 MPMMP00503 5" x 5" Overall 3" x 3" Pad 366977500333 MPMMP00506 9" x 9" Overall 6" x 6" Pad 366977500999 800-232-5512 www.mpmmed.com 28

Composite Dressings MPM Repel Bordered Composite WATERPROOF Indications*: Leg ulcers Moderate to heavy draining wounds Pressure ulcers, Stages I-IV Skin Tears Cuts, burns and abrasions Directions: 1) Cleanse the wound. 2) Peel back dressing backing to expose pad and apply over wound. 3) Remove backing and smooth dressing into place. Why it works: Center layer absorbs exudate, reducing number of dressing changes Top layer allows gaseous exchange Absorptive qualities virtually eliminate maceration Can be used on infected wounds Dressing is non-adherent to tissue, reducing trauma during dressing changes Protects wound from urine and feces Reorder # Size UPN MPMMP00082 4" x 4" Overall 2" x 2" Pad 366977082440 MPMMP00084 6" x 6" Overall 4" x 4" Pad 366977082660 MPMMP00086 6" x 8" Overall 4" x 6" Pad 366977082686 29 MPM MEDICAL, INC.

Composite Dressings MPM Multi-Layered Bordered Composite Indications*: Heavily draining wounds Deep partial thickness or full thickness draining wounds Ulcers, Stages II, III, IV Maintains moist wound environment Leg ulcers Why it works: Dressing is non-adherent to tissue Center layer absorbs exudate, reducing number of changes Top layer allows gaseous exchange while protecting the wound from contaminants Directions: 1) Cleanse wound, peel back and release the dressings backing to expose the pad. 2) Apply pad over wound and remove backing, smooth dressing into place. Reorder # Size UPN MPMMP00072 4" x 4" Overall 2" x 2" Pad 366977072441 MPMMP00074 6" x 6" Overall 4" x 4" Pad 366977072663 MPMMP00076 6" x 8" Overall 4" x 6" Pad 366977072653 800-232-5512 www.mpmmed.com 30

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