This document discusses different types of acute and chronic wounds, as well as the normal process of wound healing. It describes primary intention healing, secondary intention healing, and tertiary intention healing. Signs and symptoms of wound infection are listed. Recommendations are provided for wound care and management, including maintaining sterility during dressing changes, using sterile water if the wound is infected with MRSA, ensuring proper wound swabbing for culture and sensitivity testing, practicing hand hygiene, and observing wound progression. References on wound dressing, management of surgical wounds, and prevention of hospital-acquired infections are also included.

1. Rosemarie Chung
B. Sc. Hons. Nursing Practice Development.

4. 1. Acute wounds
1. Surgical wound
2. Penetrating wound (e.g. knife or bullet
wound)
3. Avulsion Injury (e.g. finger tip amputation)
4. Crushing or shearing Injury
5. Burn Injury
6. Laceration
7. Bite wound (e.g. Animal and human bites)

6. 2. Chronic wounds
Arterial ulcer (Peripheral Vascular
Disease)
Venous Ulcer (Venous
Insufficiency)
Lymphedema
Pressure Ulcer (Decubitus Ulcer)
Neuropathic ulcer (Diabetes
Mellitus)

8. Primary intention
The edges of the wound are closed (in apposition)and
secured with sutures, clips or skin closure strips
usually within 24to 48hours. Simultaneously in 8to
10days, healing takes place throughout the depth, and
little new tissue is formed. For the first 2days, there
could be a little leakage of bloody exudate or of odour
from the wound. A warning sign of a potential
complication is beyond the normal signs that is a
prime consideration in management of risks
associated with the open phase of healing .

9. Secondary intention
The wound has to be left open to allow healing by
contraction and replacement of missing tissue with
granulation and epithelial tissue. This is a common
method of healing in surgical excisions or traumatic
wounds with tissue loss. However, the duration of
healing depends on the amount of tissue that must be
replaced which the resulting scar can be quite
extensive.

10. Tertiary intention healing / delayed
wound closure
Such wound is kept open to allow for drainage of
exudate, control of contamination or for further
surgical procedures to be completed. Usually within 7
days as bacterial contamination rises markedly from
the 8th day onwards, the wound is surgically closed
again. Wound that has to be kept open for longer
periods of time with significant bacterial
contamination has to be reduced before surgically
closed.

12. NORMAL PROCESS OF SURGICAL
WOUND HEALING

14. Redness
Pain
Heat
Swelling of
wound and
periwound area
Signs & Symptoms of
Wound Infection

18. Maintain sterility during dressing
Use sterile water only if the wound is infected with
MRSA
Ensure proper taking of wound swab for c+s
Always practice 5moment hand hygiene and standard
precaution.
Refer to website Family Practice notebook.com:
Wound Dressing for different types of wounds
Observe and document characteristic of wound /
progress of wound healing.

19. Wound. Available at:
http://www.fpnotebook.com/Surgery/DER/Wnd.htm
Management of surgical wounds. Available at:
http://docs.google.com/
Additional reference
Preventions of hospital acquired infections. Available at:
http://apps.who.int/medicinedocs/documents/s16355e/s16
355e.pdf
Wound Dressing. Available:
http://www.fpnotebook.com/Surgery/Pharm/WndDrsng.h
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