Engidaw Ambelu

1. Dr solomon HB
Dept of surgery

2.  Definition of wound
 Classification of wound
 Healing process and complication
 Wound management

3.  Wound is a break in normal continuity of
tissue
 It can be closed( eg.abscess, bruise,
hematoma…)
 Open wound like laceration ,abrasion
,puncture, bite ,avulsion/degloving ,crushing)

5.  Clean ….non traumatic wound, no break in
sterility tech., non infected wound
 Clean contaminated…minor break in sterility
tech. ,GIT, GUS and respiratory system are
entered but absence of infected bile and
urine spillage
 Contaminated ….major break in sterility
tech, great spillage of infected bile and urine
,fresh traumatic wound

6.  Dirty or infected…..presence of foreign body
,devitalized tissue,surgery done to access
puss

7.  Wound management is generally fastening
the normal wound healing process
 There are four phases of wound healing
process
 Coagulation phase … immediately after
injury the time when clot
formation,vasoconstriction and platelate
agregation

8.  Inflamatory phase….is the process occur with
in the first three days of injury inflamatory
cells migrate to the site of injury
vasodilation
 Proliferative phase….the process occur in the
first three weeks characterized by fibroblast
proliferation ,vasculogenesis and endothelial
proliferation

9.  Remodeling/maturation phase …..process
occur in the first one year of injury the time
of of increasing tensile strength done by
keeping equilibrium between protein
synthesis and degradation

10.  Healing by primary intention….clean wound
edge approximated primarily and heal with
minimal scar formation
 Healing by secondary intention…. left open
and heal by itself with tissue contracture and
granulation
 Healing by tertiary intention…. also called
delayed primary wound healing

12.  Local factors
 Site and size of wound
 Degree of vascularity
 Presence of foreign body
 Presence of devitalized tissue
 Degree of infection
 Radiation
 Closure under tension

13.  Systemic disease
Dm,malignancy,vasculopathy,RVI
 Drugs…steriods ,immunosupresive drugs
 Poor nutritional history …hypoprotienemia,
vitamin def. and mineral def.

14.  Acut like bleeding and sepsis
 Chronic ..scar formation ,kelloid and
hypertrophic scar,contracture

16.  General wound management
 Using aseptic technique
 Prophylaxis antibiotics
 Stabilize the patient
 Do rapid PE and HX to classify wound
 secure hemostasis,
 Adequate irrigation

17.  Removing devitalized tissue
 TAT
 Antiboitics
 Decide whether to left open or closed

18.  Bruise …only analgesia
 Hematoma…..evacution may be needed if
there is mass effect ,infectionv,at cosmotic
area other wise no need of intervention
 Abrasion ….depends on the degree cleansing
and and antibiotics

19.  Laceration …adequate cleansing and
approximation if possible
 Bite …all bite wound should not be closed
broad spectrum antibiotic coverage
 Avulsion ….homeostasis should be secured
,debridment,skin graft

20.  Abscess ….drainage ,appropriate antibiotic
with drug sensitivity test
 Necrotizing fascitis……invasive subcutaneous
tissue and fascia infection leads to necrosis
 It needs broad spectrum antibiotic coverage
and debridment

21. Thank u