DR NOR SUNIHALIZA BINTI SALIMUAN @ SULAIMAN MEDICAL OFFICER, MBBS (IMU) WOUND CARE COORDINATOR KLINIK KESIHATAN SENAWANG SEREMBAN, NEGERI SEMBILAN.

1. “MODERN WOUND CARE
COURSE”
17TH -18TH DECEMBER 2018
ILKKM SEREMBAN, NS.

2. DR NOR SUNIHALIZA BINTI
SALIMUAN @ SULAIMAN
MEDICAL OFFICER, MBBS (IMU)
WOUND CARE COORDINATOR
KLINIK KESIHATAN SENAWANG
SEREMBAN, NEGERI SEMBILAN
INTRODUCTION TO THE WORLD OF WOUND
AND PHYSIOLOGY OF WOUND HEALING

3. HOW DID WOUND CARE START IN KLINIK
KESIHATAN SENAWANG?
INITIALLY, BELIEVE IT OR
NOT?
I HAVE ZERO KNOWLEDGE
ABOUT WOUND CARE!!
MY EXPERIENCES ARE JUST FROM 8MONTHS HOUSEMANSHIP
AT HTAA KUANTAN IN ORTHOPEDIC AND SURGICAL
DEPARTMENT (2009-2011)
START
UP!

4. MY WOUND CARE JOURNEY
TRANSFERED FROM
KK LUKUT TO KK
SENAWANG.
GIVEN THE
RESPONSIBILITY TO
BE IN CHARGE OF
WOUND CARE BY
FMS
AUGUST 2016
OFFICIALLY APPOINTED AS
“ WOUND CARE
COORDINATOR” FOR
SEREMBAN DISTRICT
REVISE WOUND CARE
CLERKING SHEET
SEPTEMBER 2017
NOW I AM HERE, SHARING MY KNOWLEDGE
WITH YOU GUYS
DECEMBER 2018
HELD A BASIC WOUND CARE
COURSE FOR 2DAYS AT JKNNS
BY DR MARIAM FMS AND THE
JKNNS PRIMER UNIT.
INVITED WOUND CARE TEAM
FROM KOTA TINGGI AND
ENCIK HAMIZAL
JANUARY 2017
AFTER HAVING SECOND
THOUGHTS ABOUT PURSUING
MASTER IN FAMILY MEDICINE,
STARTED TO FULLY CONCENTRATE
IN WOUND CARE
JUNE 2018
I AM BORN TO BE A
WOUND CARE CLINICIAN!!
I’VE DISCOVERED MY
PASSION

5. “KNOWLEDGE IS IMPORTANT”
“YOUREYES
CAN’TSEE
WHATYOUR
MIND
DOESN’T
KNOW”

6. WHAT IS THE SKIN?
6
THE OUTER COVERING OF THE BODY AND THUS PROVIDES PROTECTION
THE LARGEST ORGAN IN OUR BODY IN TERMS OF WEIGHT AND SURFACE AREA
THICKNESS RANGES FROM 0.5MM TO 4MM DEPENDING ON LOCATION
CONSISTS OF DIFFERENT TISSUES THAT ARE JOINT TOGETHER TO
PERFORM SEVERAL ESSENTIAL FUNCTIONS
DYNAMIC ORGAN IN A CONSTANT CHANGES; THE OUTER LAYER ARE
CONTINUOUSLY SHED REPLACED BY THE INNER CELLS MOVING TO
THE SURFACE.

7. THREE PRINCIPAL LAYERS OF SKIN
7
EPIDERMIS
DERMIS
MIDDLE LAYER, THIICKER AND
CONSISTS OF CONNECTIVE TISSUES
OUTER MOST LAYER, THINNER
PORTION AND COMPOSED OF
EPITHELIUM.
SUBCUTANEOUS / HYPODERMIS
DEEPEST LAYER CONSISTS OF AREOLA AND
ADIPOSE TISSUES.

8. WHAT IS WOUND?
“A wound is defined as
a disruption of the
integrity and function
of tissues in the body”
- WOUND CARE ESSENTIALS PRACTICE PRINCIPLES (THIRD EDITION)

9. WOUND DEFINITION BY WOUND CARE
MANUAL
“A wound is an injury to the
integument or to the underlying
structures”
It is visible result of individual cell
death or damage; that may or may not
result in a loss of skin integrity
whereby physiological function of the
tissue is impaired.

10. ULCER
“AN INTERRUPTION OF
CONTINUITY OF AN
EPITHELIAL SURFACE
WITH AN INFLAMED
BASE”
IT IS USUALLY A RESULT
OF AN UNDERLYING OR
INTERNAL ETIOLOGY
-WOUND CARE MANUAL-

11. CLASSIFICATION OF WOUND
TIMING
ETIOLOGY

12. TIMING
01
02
03
ACUTE
SUDDEN DISRUPTION OF SKIN INTEGRITY USUALLY
DUE TO TRAUMA OR SURGERY
CHRONIC
WOUND THAT FAILED TO PROCEED THROUGH AN
ORDERLY AND TIMELY PROCESS TO PRODUCE
ANATOMIC AND FUNCTIONAL INTEGRITY.
NON-HEALING WOUND
ANY WOUND THAT HAS NO SIGNS OF HEALING
PROCESS WITHIN 4-6 WEEKS AFTER APPROPRIATE
INTERVENTION.

13. POST
SURGICAL
WOUND
VENOUS
ULCER BURN
DIABETIC
FOOT
ULCER
PRESSURE
INJURY
ETIOLOGY

14. TRAUMATIC
WOUND
MALIGNANT
WOUND
NEUROPATHIC
WOUND
VASCULITIC
WOUND
ARTERIAL
WOUND
ETIOLOGY

15. WOUND
HEALING
WOUND HEALING IS A
COMPLEX SERIES OF
REACTIONS AND
INTERACTIONS AMONGS
CELLS AND MEDIATORS IN
FOUR DINSTINCT AND
OVERLAPPING PHASES.

16. PHASES OF WOUND HEALING
HAEMOSTASIS INFLAMMATION PROLIFERATION MATURATION
IMMEDIATE DAY 1 - 3 DAY 2 – WEEK 3 WEEK 1 TO
SEVERAL WEEKS

17. HAEMOSTASIS
VASOCONSTRCITION
PLATELET ADHESION AND
DEGRANULATION
PLATELET AGGREGATION
ACTIVATION OF COAGULATION
CASCADE
FIBRIN CLOT
THE KEY CELL INVOLVED IS
PLATELETS!!!

18. VASODILATATION
ACTIVATION OF
COMPLEMENT
CASCADE
INFILTRATION OF
WOUND WITH
NEUTROPHILS
AND MONOCYTES
PHAGOCYTOSIS OF
BACTERIA, FOREIGN
BODY AND CELL DEBRIS
INFLAMMATIONKEY CELLS ARE NEUTROPHILS AND MACROPHAGES!!
HEALTHY
WOUND
BED

19. FIBROBLAST MIGRATION
RECONSTITUTION OF DERMIS
-FIBROPLASIA
-ANGIOGENESIS
EPITHELIALIZATION
WOUND CONTRACTION
PROLIFERATION
KEY CELLS IS FIBROBLASTS!!
• GRANULATION TISSUE
• NEW EPITHELIUM
• CONTRACTED WOUND

20. 01
02
03
• COLLAGEN
DEGRADATION(TYPE
III)
• COLLAGENSYNTHESIS
(TYPEI)
• INCREASEDTISSUE
STRENGTH
MATURATION
PHASES

21. WOUND
HEALING
PHASES

22. TYPE OF WOUND HEALING
2
1
3
WHEN A CLEAN SURGICAL OR
TRAUMATIC WOUND IS CLOSED
PRIMARILY; HEALING WITH
MINIMAL SCAR FORMATION
PRIMARY HEALING
CLOSURE OF WOUND 3-5DAYS
AFTER THE INITIAL DEBRIDEMENT
AND DRESSING OF THE WOUND
(BEFORE GRANULATION TISSUE
FORMATION)
DELAYED PRIMARY
HEALING
WHEN THERE IS EXTENSIVE TISSUE
LOSS WITH INABILITY TO OPPOSE
EDGES. HEALING WITH
GRANULATION, CONTRACTION
AND RE-EPITHELISATION
SECONDARY HEALING
WOUND HEALING BY
PRIMARY INTENTION
AND SECONDARY
INTENTION

23. LOCAL
FACTORS
SYSTEMIC
FACTORS
FACTORS AFFECTING WOUND
HEALING

24. VENOUS INSUFFICIENCY
TISSUE OXYGENATION
INFECTION
FOREIGN BODY
LOCAL FACTORS

25. ADVANCING AGES OBESITY ISCHEMIA MALNUTRITION
DISEASES
DIABETES MELLITUS, ANAMEIA
MEDICATIONS
GLUCOCORTICOIDS, NSAIDS,
CHEMOTHERAPY
ALCOHOL AND
SMOKING
IMMUNODEFIENCY
AIDS, CANCER,
RADIATION THERAPY
SYSTEMIC FACTORS

26. INITIAL PRESENTATION AFTER 2WEEKS AFTER 4 WEEKS
NORMAL PHASES OF
WOUND HEALING

27. 5 KEYWORDS TO SUCCESS IN A
TEAM
Good deed is far better teaching than any book
or any wise philosopher's saying

28. GET IT IN TOUCH
THANK YOU FOR YOUR ATTENTION
Address
KLINIK KESIHATAN SENAWANG,
JALAN PERSIARAN SENAWANG 2,
70450 SENAWANG,
SEREMBAN. N.S.
Phone & Fax
Direct Line: 06-6766000
Social Media
Email me at :
sunihaliza@gmail.com