The document discusses the history of wound care from ancient times to modern practices. Some key points covered include: - Ancient civilizations used remedies like honey, grease, and herbs to treat wounds. Hippocrates advocated cleaning wounds with wine or vinegar. - Different types of wounds are discussed like acute, chronic, pressure ulcers, venous ulcers, and diabetic foot ulcers. - Modern wound care includes debridement, dressings, antibiotics, growth factors, skin substitutes, and addressing underlying patient issues. - Wound etiology, staging, and treatments are described for various chronic wounds. Biofilms, infection, and other complex wound factors are also addressed.

1. Wafer Aldulaimi

3. Wash the wound
Sumerians used beer and oil to the wound
Oil –bacteria grow poorly in oil and dressings become
non adherent

5. Honey: Now known to be antibacterial
Grease (animal fat): Barrier to bacteria
Wound edges were held together with thorns or linen
strips soaked in gum (steri strips!) or ant pincers
Also bound ulcerating lesions with figs that contain
papain( proteinase)

8. Hippocrates (2500 years ago) wrote of:
Washing wound with wine and vinegar (acetic acid)
Relieving pressure to avoid cutaneous wounds
(pressure ulcers)
Described surgical drainage of pus with piece of tin
pipe

10. Aurelius Celsus :Described four cardinal signs of
inflammation Rubor, Calor, Dolor and Tumor
Believed in keeping wound moist so wound would
close
Wound cavities were filled with sea sponges
,sometimes soaked in wine or vinegar

12. Pare’ was official royal surgeon to kings Henry
II.
Pare’ –cauterized amputation’s with red-hot
iron or oil.

13. Alexander Fleming : penicillin in 1929

14. Topical products :Hydrocolloids , Hydrogels ,Calcium
alginates/hydrofibers , Foams , Starch dressings , Enzymatic debriders
Antibiotics
Surgical debridement
Renewed interest in ancient remedies honey→
Renewed interest in maggots (“Biosurgery” )
Ultraviolet light
Laser
Hydrotherapy
Electrical stimulation
Ultrasound
Growth factors impregnated dressings

16. Skin substitutes synthetic and biologic→
Growth factor revolution –actively manipulate wound
healing angiogenesis→
Gen therapy
Nanotechnology : Drugs directed to specific aspects of
wounds , Manipulating of angiogenesis

17. By time of healing
By morphology
By etiology

18. Acute
An acute wound is an injury to the skin that occurs
suddenly rather than over time.
It heals at a predictable and expected rate according to
the normal wound healing process

19. Examples:
Surgical wounds (surgical)
Traumatic wounds (puncture wounds, cuts, abrasions,
burns, frostbite, chemical burns , radiation etc.)
Infection-related wounds

20. Chronic Wounds
A chronic wound develops when any acute wound fails
to heal in the expected time frame for that type of
wound, which might be a couple of weeks or up to 12
weeks in some cases.

21. The black, yellow and red wound

22. Black necrotic wound

23. Yellow wound

24. Red wound

25. Decubitus (pressure ulcers / sores)
Venous ulcer (venous-related wounds)
Arterial ulcer (ischaemic wounds)
Arterio-venous ulcer cruris (mixed wounds)
Diabetic ulcers (ulcers caused by diabetes mellitus)
• Infected wounds
• Immunological wounds
• Cancer wound

27. Etiology
In 1860, Florence Nightingale wrote :
“If he has a bedsore, it is generally the
fault not of the disease but of the nursing.”
The main cause is unrelieved pressure to a location of skin
on the body. This constant pressure inflicts damage by
decreasing the area’s blood supply and traumatizing the skin.

28. • Stages

29. • Treatment
– Debridement of all necrotic tissue
– Maintenance of a favorable moist wound environment
– Relief of pressure
– Addressing host issues such as nutritional, metabolic, and
circulatory status

31. • Venous ulcers are the most common type of ulcers
occurring in the lower limbs.
• Venous insufficiency  leakage of :
– Fibrinogen perivascular cuffing that affects oxygen
exchange  loss of subcutaneous fat
– Leakage of hemoglobin  brownish pigmentation

32. This combination lead to characteristic skin changes called
lipodermatosclerosis

33. Treatment
Compression therapy + wound care

36. • Symptoms of peripheral ischemic changes :
– Intermittent claudication
– Rest pain
– Night pain
– Diminished or absent pulses,
– Decreased ankle-brachial index
Poor formation of granulation tissue
– Dryness of skin
– Hair loss ,Scaling
– Pallor
– The wound itself usually is shallow with smooth margins, and a
pale base and surrounding skin

37. Ankle brachial pressure index = 0.9 - 1,2

38. Treatment
Revascularization + Wound care

40. • These ulcers cause considerable pain and distress for patients
and pose a difficult wound-management problem for health
professionals.
• Many patients have significant oedema due to venous
insuficiency that needs to be controlled but also have some
degree of arterial disease (atherosclerosis) where compression
bandaging is contraindicated.

41. Treatment
• Reduced compression strength
• No compression when ankle pressure below 80 mmHg or ABI
below 0.7
• If the ankle pressure is below 60 mmHg or the ABI is below
0.5, revascularization is recommended.
• Wound care

43. Etiology
• 60 to 70% are due to neuropathy
• 15 to 20% are due to ischemia
• 15 to 20% are due to a combination of both

44. • The neuropathy is both sensory and motor, and is secondary to
persistently elevated glucose levels
• The loss of sensory function allows unrecognized injury to occur
from ill-fitting shoes, foreign bodies, or other trauma
• The motor neuropathy or Charcot foot leads to collapse or
dislocation of the tarsometatarsal or metatarsophalangeal joints
• There is also severe micro- and macrovascular circulatory impairment

45. Charcot foot

46. Treatment
• Adequate blood sugar levels
• Wound care
• Charcot foot: splinting and non weight bearing
• Prevention: regular check , non compressing shoe , etc.

47. Traditionally, wound microbiology has been described in
three phases:
– Contamination refers to the presence of bacteria that
are not multiplying.
– Colonization refers to bacteria which are growing within
the wound but not causing tissue damage.
Infection : Bacteria causing tissue damage and clinical
signs of infection.

48. Treatment
• Debridment
• Antibiotics
• Consider biofilm !

49. Biofilm
• It is an aggregate of microorganisms embedded within a self-
produced matrix of extracellular polymeric substance (EPS).
• Bacteria embedded within biofilms are resistant to both
immunological and non- specific defence mechanisms of the
body.
• Treatment is by mechanical removal

51. • Vasculitis

52. • Pyoderma gangraenosum

53. Treatment
1. Corticosteroids and immune modulators
2. Gentle wound care
3. Avoid surgery ! It make it worse !

54. Either from a primary skin cancer or as metastasis

55. Treatment
1. Elective Surgery
2. Elective Radiation
3. Elective chemotherapy
4. Wound care