The document provides an overview of the integumentary system, focusing on wounds, their classifications, and the healing process. It defines various types of wounds, including open and closed wounds, and details the phases of wound healing: inflammation, proliferation, and remodeling. Factors affecting wound healing and potential complications are also discussed, emphasizing the importance of nutritional support during the healing process.

1. Wounds
COURSE NAME: Basic Concepts of
Professional Nursing
CODE (NUR117)
Level: L1
Credit Hours (2+0+0)
Updated By
Associate Prof. Ohoud El-Sheikh
IbnSina National College for Medical Studies

2. Overview of the Integumentary System (Skin)
Define the term “Wound”
Enumerate the causes of wounds
Outline the classifications of wounds
Define the term of “Healing”
Highlight the types of wound healing
Phases of wound healing
Describe factors affecting wound healing
Outline the complications of wounds healing
Outlines

3. Overview of the Integumentary System (Skin)
•Skin is the largest organ in the
body and covers the body's entire
external surface.
•Made up of three layers, the
1.Epidermis.
2.Dermis.
3.Hypo-dermis

5. Epidermis: composed of several thin layers
Dermis: composed of a thick layer of skin that contains
collagen and elastic fibers, nerve fibers, blood vessels,
sweat and sebaceous glands, and hair follicles
.
Subcutaneous Tissue/hypodermis: composed of a fatty
layer of skin that contains blood vessels, nerves, lymph,
and loose connective tissue filled with fat cells
layers of Skin

7. Overview of the Integumentary System (Skin)
Skin's structure is made up of an intricate/complex
network that serves as the body’s initial
barrier against:
1. Pathogens
2. UV light and chemicals
3. Mechanical injury
Regulates temperature and the amount of water
released into the environment

9. Overview of the Integumentary System (Skin) cont…
•A skin wound results from the breakdown of the
epidermal layer integrity.
•Wound healing mostly means healing of the skin.
•Begins immediately after an injury to the epidermal
layer and might take years.
•Has 3 overlapping phases which are inflammation,
proliferation, and remodeling.
•Any disruption leads to abnormal wound healing.

10. Define the term “Wound”
The definition of a wound in general is:
• Damage to the integrity of biological tissue, including
skin, mucous membranes, and organ tissues.
• Wounds can be CLASSIFIED TO:
1. Open wounds.
2. Closed wounds.

11. Define the term “Wound”
Closed Wound:
The surface of the skin is
intact, but the underlying
tissues may be damaged. e.g.
contusions, haematoma.
Open Wounds:
The skin is split or cracked and the
underlying tissues are exposed to the
outside environment.

12. • Wounds can be classified according to :-
1. The etiology
2. The integrity of the skin
3. Wound depth (thickness of skin loss)
4. Degree of contamination
5. Severity
6. The duration of the wound healing
Wounds classifications

13. 1. The Etiology
Blunt injuries
Falls, Assault, Sport injuries, Bite injuries [animal or human]
Penetrating injuries
Stab wounds, Gunshot wounds
Surgical insult
caused by a surgical procedure
Burn injuries
Chemical burn, Electrical burn, Radiation burn, Cold injury

17. 2. The integrity of the skin
A. Open wounds
• Type of wounds in which the skin has been compromised and
underlying tissues are exposed
• Open wounds can be classified into a number of different types,
according to the object that caused the wound
• Examples include incised wounds, laceration,
Abrasion ,punctured, Avulsion wounds etc

18. Incised wounds
A clean, straight cut caused by a
sharp edge (i.e. a knife)
Laceration
Laceration: an irregular cut or
tear, typically made accidentally
or forcibly, or from trauma due to
a strike from a blunt object that
opens the skin

19. Abrasion( scrape)
Abrasion ( scrape): results
when the outer layer of skin is
scraped or rubbed away.
Exposure of nerve endings
makes this type of wound
painful, and makes abrasions
highly susceptible to infection.

20. •Avulsion
•Puncture
The skin is penetrating by a sharp object
such as a pencil, nail, or bullet. If a piece of
the object remains in the skin, or if there is
little bleeding due to the depth and location
of the puncture, infection is likely.
The skin or tissue is torn away from the body,
either partially or completely. The bleeding and
pain will depend on the depth of tissue
affected.

21. Closed wounds
The skin has not been compromised, but trauma to underlying structures
has occurred
Closed wounds have fewer categories, but are just as dangerous as open
wounds
Examples of closed wounds are:
Contusions - (more commonly known as a bruise) - caused by blunt force
trauma that damages tissue under the skin
Hematoma - (also called a blood tumor) - caused by damage to a blood
vessel that in turn causes blood to collect under the skin
2. The integrity of the skin cont…

22. Contusions
Hematoma

23. 3. Wound depth (thickness of skin loss)
A. Superficial wounds
•Only the epidermis is affected and has to be replaced
•A truly superficial wound does not bleed and heals
within a few days
•Examples include most abrasions and blisters

24. B. Partial-thickness wounds
• The epidermis and part of the dermis is affected
• A partial-thickness wound does bleed
• If left uncovered, a blood clot will cover the wound and a scar
will form The missing tissue will then be replaced, followed by
regeneration of the epidermis
• A partial-thickness wound can take from several days to several
weeks to heal, depending on the patient and the wound
treatments chosen
3. Wound depth (thickness of skin loss) cont…

26. c. Full-thickness wounds
• Involves the epidermis and the dermis
• The underlying fatty tissue, bones, muscles, or tendons may also be
damaged
• If full-thickness wounds cannot be sutured, the healing process will create
new tissue to fill the wound, followed by regeneration of the epidermis
• The full-thickness wound takes longer time to heal than does a partial-
thickness wound, sometimes as long as several months
3. Wound depth (thickness of skin loss) cont…

28. 4. Degree of contamination
A. Clean wounds
• No break in aseptic technique
• Incision is made under sterile conditions
• No inflammation is encountered
• The respiratory tract, alimentary, genital or uninfected urinary
tracts are not entered
• Primary closure
• No drain
Eg. Herniorrhaphy

29. A. Clean wounds
are intentional
wounds that were
created under
conditions in
which no
inflammation was
encountered
4. Degree of contamination cont…

30. B. Clean-contaminated
wounds are intentional
wounds that were created
by entry into the
alimentary, respiratory,
genitourinary, or
oropharyngeal tract
under controlled
conditions.
4. Degree of contamination cont…

32. C. Contaminated wounds are open, traumatic
wounds or intentional wounds in which there
was a major break in aseptic technique,
spillage from the gastrointestinal tract, or
incision into infected urinary or biliary
tracts. These wounds have acute non-
purulent inflammation present.
D. Dirty and infected wounds are
traumatic wounds with retained
dead tissue or intentional wounds
created in situations where purulent
drainage was present.
4. Degree of contamination cont…

33. 5. Severity
a. Simple wounds
The integrity of the skin is traumatized without loss or
destruction of tissue and without the presence of a foreign body
in the wound
b. Complex wounds
Tissue is lost or destructed by means of a crush, burn, or foreign
body in the wound

34. 6. The duration of the wound healing
1. Acute wounds : Are usually heal in the anticipated time
frame
•Duration of the wound: immediately to few weeks
•Examples are wounds acquired as a result of trauma or an
operative procedure

35. 2. Chronic wounds : fail to heal in the anticipated time frame and often
reoccur
• Duration of the wound > 4 weeks to 3 months
⇒
• Wounds occur as a result of an underlying condition such as extended
pressure on the tissues, poor circulation, or even poor nutrition
• examples: pressure ulcers, venous leg ulcers, and diabetic foot ulcers
6. The duration of the wound healing cont…

36. Define the term of “Healing”
Wound healing, or wound repair:
is the body's natural process of restoring normal
function and structure after injury
The entire wound healing process is a complex series of
events that begins at the moment of injury and can
continue for months to years

37. Types of Wound Healing
•Wound healing is classified as primary, secondary, and
tertiary wound healing.
•Primary Healing or primary intention
 Uncomplicated healing of a non-infected, well-
approximated wound is defined as primary healing.
e.g. Surgical wounds.

38. Types of Wound Healing
Secondary Healing or secondary intention
 If the wound healing course in this wound is disrupted by
infection, dehiscence, hypoxia or immune dysfunction, the
secondary healing stage begins.
 During secondary healing, granulation tissue formation and
epithelization over this new tissue take place. These types of
wounds are more susceptible to infections and poor healing.

39. Tertiary healing or third intention
 it is delayed primary wound healing after 4–6 days.
 This occurs when the process of secondary intention is intentionally
interrupted and the wound is mechanically closed.
 This usually occurs after granulation tissue has formed.
•Wound Healing Stages in Adults
• In adults, optimal wound healing should involve three continuous and
overlapping phases: inflammation, proliferation, and remodelling
Types of Wound Healing cont…

40. Inflammatory phase
Immediate to 2-5 days
Aim: to stop bleeding and to prevent further injury
Characterized by :-
 Clotting cascade-haemostasis
 Platelets aggregation
 Vasoconstriction and vasodilatation
 Increased polymorphonuclear neutrophils
A type of immune cell that has granules (small particles) with enzymes that are
released during infections
 Increased Macrophages
Phases of wound healing

41. • Proliferative phase
After the inflammatory stage
the proliferative stage lasts about 3 weeks (or longer, depending on the
severity of the wound)
Aim: repair of wounded tissue
Characterized by
• Angiogenesis
• Fibroplasia and granulation tissue formation
• Epithelialization
• Wound contraction
Phases of wound healing

42. Maturation and remodeling phase
• The maturation phase of tissue repair begin when the levels
of collagen production and degradation equalize
• The maturation phase can last for a year or longer,
depending on the size of the wound and whether it was
initially closed or left open
Phases of wound healing

43. Factors affecting wound healing
A. Local factors affecting wound healing
•Infection
•Surgical Technique
•Movement
•Hematoma formation
•Tissue ischemia
• Presence of foreign body
•Exposure to radiation

44. B. Systemic factors affecting wound healing
• Aging
• Nutritional status
• Diseases states
• Uremia
• Jaundice
• Diabetes
• Malignancies
• Immunosuppression
• Smoking
• Drugs
• Steroids
• anti-neoplastics
• NSAIDs
Factors affecting wound healing cont…

46. Complications of wound healing
•Evisceration (process of removing one or all of the organs
from the inside of a body)
•Hemorrhage
•Adhesions
•Infection
• Herniation
•Fistula formation
•Sinus formation
•Suture complications
•Hypertrophic scar
•Keloids (thick raised scar)

47. Nutrition
Carbohydrates,
Protein, and
Amino Acids
Vitamins,
Micronutrients, and
Trace Elements