management of the wounds. complications that can araise.types of wounds and the different approaches that can be used

1. WOUNDS
PRESENTED BY
INTERN DOCTOR
MUGABI BARNABAS

2. OUTLINE
1. Case presentation.
2. Definition
3. Classification
4. Pathophysiology
5. Management
6. Complications
7. Workup
8. Chronic
9. History

3. CASE PRESENTATION
Namyalo Aidah,68 years.
A two weeks history.
Remembered to have been pierced by a thorn in her left
foot that she left in for 3 days.
PMHx:Diabetic and hypertensive.
PDHx:Glibenclamide, metformin,lasix and nifedipine.
Vitals:Temp-37.8C. Pulse-135b/m. B.P-144/85mmHg.
Investigations:CBC. RBS-23.7mmol. U/S scan and X-ray.

4. DEFINITION
A wound is a type of injury which happens
relatively quickly in which skin is torn,cut ,or
punctured(an open wound),or where blunt force
trauma causes a contusion(a closed wound).

5. CLASSIFICATION
According to the level of contamination
Open
Closed

6. CLASSIFICATION
According to the level of contamination:
 Clean
 Contaminated
 Infected
 Colonized

7. CLASSIFICATION
Open,according to the object that caused the wound:
 Incisions or incised wounds
 Lacerations-regular or irregular.
 Abrasions(grazes)
 Avulsions
 Puncture
 Penetration wounds
 Gunshot

8. CLASSIFICATION

9. CLASSIFICATION
Closed
 Hematomas
 Crush injury

10. PATHOPHYSIOLOGY
When the epidermis or dermis is broken,an
orchestrated cascade of biochemical events is
set into motion to repair the damage:
1. Haemostasis
2. Inflammation
3. Proliferation
4. Maturation

11. PATHOPHYSIOLOGY

12. MANAGEMENT
Depends on the type,cause and depth of the wound
and whether other structures beyond the skin(dermis)
are involved.
o Recent lacerations.
o Minor wouds like bruises.
o Abrasions
o Punctures

13. MANAGEMENT
Cleaning:
Also known as wound toilet,evidence to support
cleaning of a wound before closure is scant:
 Tap water
 Sterile saline solution
 Betadine
 Hydrogen peroxide.
 Savron

14. MANAGEMENT
Closure:
 Timing;6-24 hours.
 Techniques;bandages,sutures,glue,…
 Anaesthesia.
 Gloves

15. MANAGEMENT
DRESSINGS:
 Ointments.
 Creams containing silver.
 Honey

16. COMPLICATIONS
 Bacterial infection.
 Light to detect the presence of bacteria.
 Current labaratory methords

17. WORK UP
A. Evaluating the wound,its extent and severity.
B. Cultures
C. X-rays
D. Tetanus shot.

18. CHRONIC
Diabetic foot:
o 25% of diabetic patients will develop foot ulcers
o Associated with inadequate circulation,poorly functioning
veins,and immobility
o Amputation every 30 seconds somewhere in the world
o Interdisciplinary approach to treatment.

24. HISTORY
 The body and the soul were believed to be intimately connected.
 Wounds on the body were believed to correlate with wounds to the soul and vise
versa
 Wounds were also seen as a writing on the ‘’tablet’’ of the body.

25. REFERENCES
 Fernandez R., Griffiiths R.(15th February 2012). « Water for wound
dressing ».
 Eliya-Masamba, Martha C.;Banda,GraceW.(2013-10-22). »Primary closure
versus delayed closure for non bite traumatic wounds within 24 hours post
injury ».
 “The Clinical Case for Use of Hyperbaric Oxygen The therapy in the
Treatment of Diabetic Wounds,” Diversified Clinical Services,copyright 2009.
 Reichardt,Paul F.(1984). “Gawain and the image of the wound”.
 Sheth,V.M.;Weitzul,S. (2008). “Postoperative topical antimicrobial
use”.Dermatitis: contact,atopic,occupational,drug.

26. THANK YOU.