The document is a wound care training module developed by the Ministry of Health Malaysia, focusing on the principles of wound care, the structure and functions of the skin, and the classification and healing processes of wounds. It covers various topics including the anatomy of the skin, types of wounds, and factors affecting wound healing, emphasizing the importance of moisture-balanced dressing and appropriate treatment methods. The module also discusses scar formation, types of scars, and essential clinical considerations in wound management.

1. Basic Wound Care
Principles
WOUND CARE
TRAINING MODULE
FOR PRIMARY HEALTH
CARE

2. OBJECTIVES
Wound Care Training Module for Primary Health Care | Ministry of Health Malaysia
Able to
discuss the
functions and
different layer
of the skin
To understand
the
classification
of wound by
timing and
etiology
To understand
the different
stages of
wound healing
Factors
affecting
wound healing
categorized by
local and
systemic

3. CONTENT
Wound Care Training Module for Primary Health Care | Ministry of Health Malaysia
Part 1: Introduction
Part 2: What Is The Skin
Part 3: Definition Of Wound And Ulcer
Part 4: Classification Of Wound
Part 5: Wound Healing
Part 6: Principal Of Wound Care

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Part 1: Introduction

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Introduction
• The skin is the body's largest organ and serves pertinent functions
such as maintaining a physical barrier, thermoregulation, and
participating in the regulation of water loss
• Damage to the skin barrier initiates a complex healing process
through the interactions of many cell types within various
microenvironments.
• Wounds can be present over different anatomical parts of the body.
• However, the basic principles of choosing a wound dressing remain
the same.

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Part 2: What Is The Skin?

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What Is The Skin?
• Skin is the outer covering of the body and
thus provides protection.
• It is the largest organ; because it consists
of different tissues that are joined to
perform several essential functions; in our
body in term of weight and surface areas.
• Its thickness ranges from 0.5mm to
4.0mm depending on location.
• It is a dynamic organ in a constant of
change; whereby the outer layers are
continuously shed and replaced by the
inner cells moving to the surface.

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What Is The Skin?
• Structurally, the skin consists of 3
principal layers.
⮚Epidermis: outer most layer, thinner
portion, composed of epithelium.
⮚Dermis: middle layer, thicker,
consists of connective tissue.
⮚Subcutaneous: deepest layer, also
known as superficial fascia or
hypodermis; consists of areola and
adipose tissues.

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What Is The Skin?
• Fibers from the dermis extend
down into the subcutaneous
layer and anchor the skin to it
• The subcutaneous layer, in
turn, attaches to underlying
tissues and organs.

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What Is The Skin?
3 PRINCIPAL LAYERS OF SKIN

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What Is The Skin?
EPIDERMIS
•Epidermis is a labile tissue which is continuously
regenerate.
•It is avascular.
•Receives nutrients from the dermis below.
•Comprised of stratified squamous epithelium and
contains four principal types of cells.
⮚ Keratinocytes- produce proinflammatory mediators,
participate in wound healing, and contribute in
ultraviolet radiation protection.
⮚ Melanocytes: modulate skin colour through
melanogenesis (melanin production).
⮚ Langerhan Cell: role in immune response to
pathogens.
⮚ Meckel’s Cell: ” touch cells”- responsible to sensation.

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What Is The Skin?
DERMIS
• The second principal layer of skin.
• Composed of connective tissue containing
collagen, elastic fibers which provides strength,
extensibility, and elasticity.
• Thickness depending on the anatomical site (e.g.
very thick in the palms and soles and very thin in
the eyelids, penis, and scrotum).
• Contains nerves, glands, hair follicles and also
receptors for heart, cold, pain, pressure, itch and
tickle.

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What Is The Skin?
BLOOD SUPPLY OF THE SKIN
• It is rich in blood supply from
vascular plexus in the deep
dermis. Through extensive
vascular network (ascending
arterioles and capillary loops),
the blood supply eventually
reaches upper layers of dermis.
SUBCUTANEOUS
LAYER
DERMIS
EPIDERMIS
RETE VENOSUM
RETE ATERIOSUM
CUTANEUM

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What Is The Skin?
• The deepest layer, also known as subcutis or
hypodermis.
• Varies in thickness and depth.
• It is the structure that binds the skin to the
underlying structures.
• Comprised of adipose tissue, connective tissue
and blood vessels. Forms a network of
collagen and fat cells.
• Responsible for conserving the body's heat and
protects body organs from pressure injury.
SUBCUTANEOUS LAYER

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What Is The Skin?
FUNCTION OF THE SKIN
a) Body temperature regulation
b) Elimination of waste products (Excretion) - cellular waste products are
excreted via sweat glands.
c) Sensation - nerve endings originating from dermis sense pain, cold,
heat, touch and pressure.
d) Barrier function - to protect underlying tissue from mechanical injury,
dehydration, ultraviolet ray, chemicals and pathogens.
e) Immune function
f) Blood reservoir
g) Ultra-violet light protection h) Vitamin D is synthesized by the skin from
sunlight.

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What Is The Skin?
SKIN AND WOUND
• Superficial wound that damage the
epithelium only, can heal by epithelial
regeneration (reconstitute) and may have
little scar formation.
• Deeper wound; incisional and excisional
skin wounds that damage the dermis will
heal through the formation of a collagen
scar.

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What Is The Skin?
SKIN AND WOUND
• Regeneration requires an intact connective tissue
scaffold.
• Scar formation occur if the extracellular matrix
framework is damaged, causing alteration of the
tissue architecture.
• Epidermal appendages do not regenerate and there
remains as connective tissue scar.

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Part 3: Definition Of Wound And Ulcer

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Definition Of Wound And Ulcer
• A wound is a break in the integrity of the skin
or tissues often associated with disruption of
structure and function.
DEFINITION OF WOUND
DEFINITION OF ULCER
• An interruption of continuity of an epithelial
surface with an inflamed base.
• It is usually a result of an underlying or
internal etiology.

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Definition Of Wound And Ulcer
TYPES OF WOUND

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Part 4 : Classification Of Wound

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Classification Of Wound
Wounds can be classified in many ways; By
• wound chronicity,
• timing,
• etiology (e.g., pressure, trauma, venous leg ulcer, diabetic
foot ulcer),
• the depth of tissue involvement, or
• other characteristics such as closure (primary or secondary
intention).

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Classification Of Wound : Timing
NO CLASSIFICATION DESCRIPTION
1 ACUTE Acute wound are those that heal within a predictable
amount of time usually not more than 2 to 4 weeks
2. CHRONIC Chronic wounds that persist for more than 2 to 4 weeks.
They tend to develop after minor injuries, in the setting of
advanced age and medical comorbidities such as
atherosclerosis and diabetes.
3 HARD TO HEAL
WOUND
A hard-to-heal wound has been defined as one that fails to
heal with standard therapy in an orderly and timely
manner.
This definition applies equally to both acute and chronic
wounds and is independent of the wound type and
etiology.

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Classification Of Wound : Aetiology
Traumatic Wound Pressure Injury Vasculitic Ulcer

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Classification Of Wound : Aetiology
Burn Wound Surgical Wound Diabetic Foot Ulcer

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Classification Of Wound : Aetiology
Venous Ulcer Neuropathic Ulcer Malignant Wound

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Classification Of Wound : Aetiology
Arterial Ulcer

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Part 5: Wound Healing

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Wound Healing
• A complex series of reactions and interactions
among cells and “mediators” during four distinct
and overlapping phases.

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Moist Wound Healing
• The new concept of moist wound healing and moisture-balanced
dressing are accepted as best practice.
• Epithelial cells require moisture to migrate from the wound edges to
re-epithelialize or resurface the wound.
• Choosing the correct wound care product become very important to
ensure the wound has the best chance of healing quickly

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Phases of Wound Healing

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Phases of Wound Healing

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Types of Wound Healing
1 Wound healing by
primary intention:
Primary healing: when a clean
surgical/traumatic wound is closed primarily
healing with minimal scar formation.
2 Wound healing by
secondary intention:
Secondary healing: When there is extensive
tissue loss with inability to oppose edges.
Healing is with granulation, contraction and re-
epithelialisation; resulting in scar formation.
3 Wound healing by
Tertiary intention:
Delayed primary healing: closure of wound 35
days after the initial debridement and dressing
of the wound (before granulation tissue
formation).

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Difference Between Acute and Chronic Wounds

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Factors Affecting Wound Healing

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Clinical Features of Wound

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Scars and Your Skin
• Scars are a natural part of the body's
healing process.
• A scar results from the biologic process
of wound repair in the skin and other
tissues.
• Most wounds, except for very minor
ones, result in some degree of scarring.
• Scars can result from accidents,
diseases, skin conditions such as acne,
or surgeries.

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How Do Scars Form?
• Scars form when the dermis (deep,
thick layer of skin) is damaged.
• The body forms new collagen fibers (a
naturally occurring protein in the body)
to mend the damage, resulting in a
scar.
• The new scar tissue will have a
different texture and quality than the
surrounding tissue.
• Scar form after a wound is completely
healed.

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Types of Scars
• Most scars are flat and pale. However, in cases
when the body produces too much collagen, scars
can be raised.
• Raised scars are called hypertrophic scars or
keloid scars.
• Some scars can have a sunken or pitted
appearance. This kind of scarring occurs when
underlying structures supporting the skin (for
example, fat or muscle) are lost
• Scars also can appear as stretched skin. Such
scars result when the skin stretches rapidly (for
example, as in growth spurts or during pregnancy)

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Part 6: Principles Of Wound Care

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Clinical Considerations In Wound Management
Include:
1. Preventing and controlling infection and
contamination
2. Maintaining adequate moisture
3. Treating edema
4. Preventing further injury

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Principles Of Wound Care

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1) Wound Care Quick Reference, First Edition 2019. NWCC & MOH
2) Modul Latihan National Wound Care Committee ,MOH
3) Wound Care Manual, 1st Edition, 2014. MOH
4) Garispanduan Perkhidmatan Penjagaan Luka Di Fasiliti Kesihatan Primer 2019. MOH
5) Wound Care Essentials , 5th Edition
References:

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Prepared by:
∙ Dr. Hanihaselah binti Mohd Salleh, Pakar Perunding Perubatan
Keluarga, Jusa C , Klinik Kesihatan Kulai
∙ Pn. Ros Rafidah binti Mat Darus , Jururawat Kesihatan U29, KK
Jelebu