This presentations reviews the most necessary issues in wound management.

1. Wound Management
SEPEHR ROOZDAR M.D.

2. Wound Types
1. Clean : Primary Intention
2. Clean-Contaminated : Tertiary Intention
3. Contaminated : Secondary Intention
4. Dirty ( Infected ) : Secondary Intention

3. Intentions

4. Steps
1. Hemorrhage Management ( Hemostasis )
2. Cleansing and Irrigation
3. Conservative Debridiment
4. Closure
5. Dressing
6. Follow Up

5. 1. Hemostasis
 Firm Pressure
 Tourniquet
 Vasoconstrictors ( Epinephrine )

6. Tourniquet

7. 2. Cleansing and Irrigation
 Cleansing the Skin ( NOT the Wound ) by
Anti-Septics
 High Pressure Normal Saline Irrigation
( By 30-60 cc Syringes )
 Hydrogen Peroxide and Povidine should
NOT be used for Irrigation

8. 3. Conservative Debridiment
 Excision of Devitalised Skin and
Subcutaneous Tissue
 Conserving Viable Tissue ( Specially in
Face and Hands )

9. 4. Closure
 Local Anaesthetics ( LET : Lidocaine ,
Epinephrine , Tetracaine )
 Chosing Suturing Material
 Chosing Suturing Technique
 Skin Adhesives ( As Needed )

10. Staple

11. 5. Dressing
 Goal : Optimal Hydration of Wound
Margins
( Moisture Improves Epithelization )

12. 6. Follow Up
 Patient Home Care
 Suture Removal

13. Optimal Time for Suture Removal
Location Number of Days
Face 3-5
Scalp 7
Chest and Extremities 8-10
High Tension ( Joints , Hands ) 10-14
Back 10-14

14. Factors Affecting Wound Healing
Systemic Local
Age Mechanical Injury
Nutrition Infection
Trauma Edema
Metabolic Diseases Ischemia
Immunosuppression Topical Agents
Connective Tissue Disorders Ionizing Radiation
Smoking Low Oxygen Tension