3. At the end of this session are expected to:
Define wound
Classify wound
Explain steps of wound healing
Explain genral management of wound
Identify the complication of wound
Objective
4. It is a circumscribed injury which is caused by an external force
and it can involve any tissue or organ.
surgical, traumatic
It can be mild, severe, or even lethal.
Simple wound
Compound wound
Acute
Chronic
Tidy and Untidy
Definition
20. Clean wound:
Operative incisional wounds that follow nonpenetrating (blunt) trauma.
Clean-contaminated wound:
Uninfected wounds in which no inflammation is encountered but the
respiratory, gastrointestinal, genital, and urinary tract have been entered.
Contaminated wound
Open, traumatic wounds or surgical wounds involving a major break in
sterile technique that show evidence of inflammation.
Infected wound
Old, traumatic wounds containing dead tissue and wound with evidence of
a clinical infection (e.g., purulent drainge).
According to the bacterial
contamination
21. Factors affecting wound healing
Local
Ischemia
Infection
Foreign body
Edema, elevated tissue
pressure
Systemic
Age and gender
Stress
Ischemia
Diseases (diabetes,
vascular diseases)
Obesity
Medication
Alcoholism and smoking
Immuno-compromised
conditions
Nutrition
25. Assessment of Wound.
Wound Irrigation.
Local Anesthesia.
Debridement.
Methods of Closure.
Dressings and Splints.
Anti-septics & antibiotics.
Removal of Sutures.
Management of Laceration
26. requires information in the following areas:
force of injury,
type of force (e.g. penetrating, hot oil burn)
extent and depth of injury
amount of blood loss
level of contamination of the wound
time from injury to presentation for treatment
involvement of deeper structures damaged (e.g. nerves,
tendons)
Direct communication from the outside to a fracture of the
bone (a compound fracture).
Assessment of the degree of damage
27. All wounds should be cleaned. Irrigation rids the
wound of contaminants, debris and bacteria and is
considered the most important means of reducing
the incidence of wound infection.
Cleaning with Anti-septic solutions like betadine is
standard method.
Local Anesthesia may be topical or infiltrated.
Debridement: Once the wound is adequately
anaesthetized and irrigated, devitalized wound edges
should be debrided using sharp scissors and/or a
scalpel blade. Irrigate the wound again after
debridement to remove tissue debris.
Wound Irrigation & Anesthesia
28. is also known as healing by primary intention. Wounds
that heal by primary closure have a small, clean defect
that minimizes the risk of infection and requires new
blood vessels and keratinocytes to migrate only a
small distance. Surgical incisions, paper cuts, and
small cutaneous wounds usually heal by primary
closure.
Primary wound closure
29. also known as healing by secondary intention,
describes the healing of a wound in which the wound
edges cannot be approximated. Secondary closure
requires a granulation tissue matrix to be built to fill
the wound defect. This type of closure requires more
time and energy than primary wound closure, and
creates more scar tissue.
Secondary wound closure
30. also known as healing by tertiary intention. Delayed
primary closure is a combination of healing by primary
and secondary intention, and is usually instigated by
the wound care specialist to reduce the risk of
infection. In delayed primary closure, the wound is
first cleaned and observed for a few days to ensure
no infection is apparent before it is surgically closed.
Examples of wounds that are closed in this way
include traumatic injuries such as dog bites or
lacerations involving foreign bodies.
Delayed primary closure
31. Types of Sutures.
Absorbable Sutures:
1. Catgut:
for soft tissue closure
2. Polyglycolic Acid:
for deep tissue closure
provides good tensile strength
3. Monocryl:
for Subcutaneous closure
Excellent cosmetic outcomes
Non-Absorbable Sutures:
1. Silk:
for skin closure
Excellent handling characteristics
2. Nylon:
for skin and soft tissue closure
provides good tensile strength
3. Polypropylene:
High tensile strength
Commonly used in General Surgery, CVS
and hernia repairs
4. Stainless Steel:
Used in orthopedic / plastic surgery
For wounds that require long-term tissue
support
33. Running, or continuous stitch
made with one continuous
length of suture material
close tissue layers which
require close approximation
speed of execution, and
accommodation of edema
during the wound healing
process
greater potential for mal-
approximation of wound
edges with the running stitch
than with the interrupted
stitch
34. Interrupted Sutures.
needle at a 90° angle to the
skin within 1-2 mm of the
wound edge and in the
superficial layer
exit through the opposite side
equidistant to the wound edge
and directly opposite the initial
insertion
stitch is tied separately
used in skin or underlying
tissue layers
more exact approximation of
wound edges can be achieved
with this technique than with
the running stitch
35. Mattress suture
a double stitch that is made
parallel (horizontal
mattress) or perpendicular
(vertical mattress) to the
wound edge
advantage of this technique
is
strength of closure
each stitch penetrates each
side of the wound twice
inserted deep into the tissue
36. Purse string Suture.
continuous stitch
paralleling the edges of a
circular wound
wound edges are
inverted when tied
used to close circular
wounds, such as hernia or
an appendiceal stump
37. Smead-Jones/Far-and-Near
a double loop technique
alternating far and near
stitches
greater mechanical
strength than continuous
or simple interrupted
sutures
used for approximating
fascial edges, especially
for patients at risk for
fascial disruption or
infection
38. Continuous Locking, or Blanket Stitch
a self-locking running
stitch used primarily for
approximating skin edges
39. good approximation edges is paramount to proper
wound closure technique
deep sutures serve to eliminate the dead space and
relieve tension from the wound surface
deep sutures also ensure proper alignment of the
wound edges and contribute to their final eversion
wound closure may require sharp undermining of the
tissues to minimize tension on the wound
achieve hemostasis
eversion of all skin edges avoids unnecessary
depression of the resultant scar
Features of Good Closure
40. The main purpose of wound dressing is to provide the
ideal environment for wound healing.
The dressing should facilitate the major changes
taking place during healing to produce an optimally
healed wound.
Covering a wound with a dressing mimics the barrier
role of epithelium and prevents further damage.
In addition, application of compression provides
hemostasis and limits edema.
Dressings
41. Promote wound healing
Pain control
Odor control
Non allergenic and nonirritating
Permeability to gas
Safety
Non traumatic removal
Cost-effectiveness
Desired characteristics of wound
dressing
42. Occlusion of a wound with dressing material helps:
Healing by controlling the level of hydration and oxygen tension
within the wound.
It also allows transfer of gases and water vapor from the wound
surface to the atmosphere.
Occlusion affects both the dermis and epiderms, and
it has been shown that exposed wounds are more
inflamed and develop more necrosis than covered
wounds.
43. As it may enhance bacterial growth, occlusion is
contraindicated in infected and highly exudative wounds.
Many types of dressings exist and are designed to achieve
certain clinically desired endpoints.
These includes.
Absorbent dressings
Non adherent dressings
Medicated dressings
Occlusive and semi occlusive dressings.
44. Antibiotics should be used only when there is an
obvious wound infection.
Most wound are contaminated or colonized with
bacteria.
Sign of infection to look for include:
Erythema,
Cellulitis,
Swelling, and
Purulent discharge.
Antibiotics
45. Antibiotics can also be delivered topically as part of
irrigation or dressing, although their efficacy is
questionable.
Indiscriminate use of antibiotics should be avoided to
prevent emergence of multidrug-resistant bacteria.
46. face: 3-4 days
scalp: 5 days
trunk: 7 days
arm or leg: 7-10 days
foot: 10-14 days
Suture removal
47. Immediate and delayed complications may occur with
wound closure
formation of hematoma
wound infection.
reduced by prophylactic antibiotics
Late complications
scar formation
excess tension
lack of eversion of the edges
hypertrophic scarring and keloid formation.
stitch marks
wound necrosis
Wound Complications.
49. Bailey and loves, short practice of surgery.
Schwartz's, principles of surgery.
Surgery lecture note for health officers.
Sabiston, textbook of surgery.
Reffrences