Wound & its management

1. WOUND & ITS MANAGEMENT
DR ABDUL SALAM KHOSO

2. WOUND
 A wound is defined as a breach or disruption in the normal continuity of tissue in any body
part. The wounds are mainly caused by physical, chemical or biological insult.

3. CLASSIFICATION
OF WOUNDS
1 Abrasions – are wounds in
which the
superficial layers of tissue have
been destroyed by friction
exposing the sensitive tissue.


4. CONTUSIONS OR
BRUISES
– There is injury to the skin but
without any break or gap in the
continuity of tissue surface.
Depending upon the extent of the
injury and the tissue involved,
contusions can further be subdivided
in to three categories.

5. DEGREE OF WOUNDS
1st degree - rupture of capillary vessels of the skin and subcutaneous tissue to form ecchymosis.
2nd degree - larger vessels are ruptured leading to the formation of hematoma.
3rd degree – tissues are damaged and gangrene may set in;
Seroma: it is a closed collection of serum probably as a result of chronic hematoma in body tissues.
Haematoma: is a collection of blood in an abnormal cavity.
Common sites:
In cow – mammary vein, vaginal
mucous membrane
In Bull – penis
Dog – ear flap, vaginal mucous
membrane

6. TYPES OF WOUND

7. INCISED WOUNDS
- Caused by sharp objects.
- Minimum loss of tissue.
- Such wounds heal by primary
intention

8. PENETRATING
WOUNDS
 Caused by long pointed objects
and may communicate with body
cavities e.g., gored wounds.

9. LACERATED
WOUNDS
- Caused by tearing of tissues.
Inflicted by barbed wires.
Such wounds have Jig-Jag
borders.

10. GUNSHOT
WOUNDS
Caused by firearms.
The wound may be incised,
lacerated or contused,
depending upon the velocity
of the missile and other
related factors

11. POISONED
WOUNDS
CAUSED BY VARIOUS
TYPES OF POISONS OR
TOXINS

12. BITE WOUNDS
CAUSED BY SNAKE, DOG
OR WILD ANIMAL BITE.

13. VIRULENT
WOUNDS
Caused by virus or bacteria
leading to the formation of
pustules or vesicles.
e.g. FMD virus, anthrax and
tuberculosis causing
organisms.

14. ULCERATIVE
WOUND

15. EROSIVE WOUND
In this type of wound, there is
shallow area of necrosis
confined only to the
epidermis.

16. PUNCTURED
WOUND
These wounds are usually
deep and are more prone to
anaerobic infection.

17. ENVENOMED
WOUND
INFLICTED BY SNAKES,
ANTS, WASP, SCORPION
ETC.

18. ASEPTIC
WOUND
NO INFECTION
ENCOUNTERED.

19. SEPTIC WOUND
OR INFECTED
WOUND
Micro-organism have invaded
the tissues and started
multiplying. A contaminated
wound may become infected
after a lag period of 6-8 hours.

20. CONTAMINATED
WOUND
Micro-organisms are present.
Strictly speaking all wound
other than aseptic wounds are
contaminated wounds.

21. CRUSH WOUND
Is one in which severity of
trauma is maximum and the
status of tissue is completely
distorted. Such types of
wounds are usually
encountered in accidents and
very much prone to necrosis/
gangrene.

22. MAGGOT WOUND

23. AVULSION
WOUND
wound in which substantial tissue from the
body is lost during injury. It occurs mostly in
horn and hoofs.

24. GRANULATED
WOUND
IS ONE IN WHICH
EXCESSIVE GRANULATION
TISSUE IS PRESENT.

25. WOUND HEALING
WOUND HEALING IS THE RESTORATION OF THE
CONTINUITY.

26. WOUND
HEALING
INTENSIONS
First Intension or primary healing: It occurs in clean incised wound with
proper apposition of the incised edges e.g. surgical incisions. Primary
healing results in to very little granulation tissue and minimal scarring and
contracture.
Second intension or secondary healing: It occurs if there is considerable
destruction or loss of tissue or when the edges of wound are widely
separated, necrosis or infection, the healing occurs by second intention.
The wound gap is filled by granulation tissue. Secondary healing results
into more scar, more granulation tissue, contracture and more time is
taken to heal
Third intension or Delayed primary closure: The closure is delayed about
3-5 days to treat local infection or contamination to allow therapy

27. PHASES OF
WOUND
HEALING
Inflammatory phase
Proliferative phase
Remodeling phase

29. FACTORS AFFECTING WOUND HEALING
There are 2 factors affecting of wound healing
1. Local factors
2. Systemic factors
Local factors
• Surgical technique Dehydration and edema
• Tissue vascularity or oxygen Radiation and cytotoxic drugs
• Mechanical stress Wound infection
• Movement Antiseptics
• Extent of wound surface Bandaging and biological dressing
• Hemorrhage
• Foreign bodies
• Dehydration and edema

30. SYSTEMIC FACTORS
• Age
• Obesity
• Vitamins deficiency
• Malnutrition / hyoproteinaemia
• Anemia and hypoxia
• Trace elements (zinc)
• Systemic diseases
• temperature

31. COMPLICATIONS OF WOUND HEALING
1. Hemorrhage
2. Wound dehiscence
3. Traumatic neuralgia
4. Traumatic fever and septicemia
5. Traumatic emphysema
6. Tetanus
7. Haematoma and seroma
8. Sinus
9. Fistula
10. Cellulites
11. Venous thrombosis
12. adhesions

32. MANAGEMENT OF SURGICAL / CLEAN / ASEPTIC WOUNDS
• Dry as possible.
• Blood clots and debris should be completely removed.
• use of antiseptic or antibiotic .
• Dressing.
• Suture should be removed after 10 days.
Management of contaminated wound
Traumatic wound of less then 5-6 hours is known as contaminated wound. A contaminated wound can be converted into clean
wound.
The wound should be protected by sterile gauze.
The area around the wound should be prepared aseptically.
The wound should be irrigated gently with lukewarm isotonic normal saline or antiseptics.
All necrosed and dead tissue or foreign material should be removed and irrigation of wound with nonirritant antiseptics should
be repeated.
The antiseptic lotion like per chloride of mercury and acriflavin lotion can be used.
The wound may be closed after providing proper drainage.

33. MANAGEMENT OF INFECTED WOUND
Wound of more than 5-6 h duration is designated as infected wound. Wound infection should be suspected
if:
• Signs of inflammation are present.
• Decreased appetite and alertness.
• Increased rectal temperature.
• Increased WBC count.
• Increased serum fibrinogen level.
Treatment of Infected Wound
• Debridement: Infected surgical incisions should be opened and all foreign material and necrotic debris
should be removed until clean healthy tissue is reached.
• Infected wound should be left open to heal by secondary healing.
• After debridement, the wound should be copiously irrigated with sterile isotonic fluids like normal saline.
• Surgical drains should be placed in the wounds. The drain should be removed when drainage decreases.

34. TREATMENT OF WOUND
• Surgical drain : Surgical drain is the device which is used to remove unwanted fluid or gas from a wound or body
cavity. It facilitates healing process and used to eliminate dead space.
• Antimicrobial therapy
• The infected wound should be bandaged until it is completely covered by epithelium.
• The dressing should be changed daily for 7 days.
• Generally, infected and deep penetrating wounds are not sutured unless infection is well controlled.
Treatment of maggots wound
• Maggots that are superficial are removed with the help of forceps and gauze dipped in chloroform, turpentine or
camphor in oil is allowed to remain in wound for about 24 h.
• Fly repellents like neem oil may be applied on the wound.
• Use of loraxene, himax cream and topicure spray.

35. SKIN GRAFTING
Skin grafting may be attempted in cases when the gap is quite large.
1. Autograft: The recipient and donor sites are on the same animal.
2. Allograft: The recipient and donor sites are on genetically different animal of same species.
3. Xenograft: The recipient and donor sites are on animal of different species.
4. Isograft: The recipient and donor sites are between identical twins.
• Parentral antibiotics for 4-5 days and antiseptic dressing till suture removal are indicated