Baqai Medical University Community Pharmacy

3. WOUND MANAGEMENT AND SURGICAL PRODUCTS

4. CONTENTS:
• INTRODUCTION
• TYPES OF WOUND
• WOUND MANAGEMENT
• SURGICAL PRODUCTS
• SURGICAL DRESSINGS
• TYPES OF SURGICAL DRESSINGS

5. INTRODUCTION TO WOUND

6. “Discontinuity of the skin or mucous
membrane”

7. CAUSES:
• Intentional: wound resulting from a therapeutic procedure
Eg: incision or injection
• Unintentional: wound unexpected usually a traumatic, physical
and chemical injury.
Eg: burn, accidental injury.

8. FACTORS THAT AFFECT WOUND HEALING:

9. “DIDN’T HEAL”

10. D= Diabetes
I= Infection
D= Drugs
N= nutritional problems
T= Tissue necrosis
H= Hypoxia
E= Excessive tension on wound edges
A= Another wound
L= Low temperature

11. CLASSIFICATION OF WOUND A/C TO LEVEL OF CONTAMINATION:

12. According to level of contamination, a wound
can be classified as:
Clean wound:
• made under sterile conditions
• no organisms interruption

13. • Contaminated wound
• Accidental injury.
• Pathogenic organisms and foreign bodies in the wound.

14. • Infected wound
• exhibiting clinical signs of infection (yellow appearance, soreness,
redness, oozing pus).

15. Colonized wound
• a chronic situation, containing pathogenic organisms, difficult to heal

16. OPEN WOUNDS

17. OPEN WOUNDS:
• An open wound is a break in the outer layer of skin.
• They can be minor for example a scrape or small paper cut or major for example
an amputated arm or something penetrating deeply in the body.
 Bleeding that occurs can be severe or mild.

18. CLASSIFICATION

19. •Abrasions
•Lacerations
•Incisions
•Puncture
•Avulsion
•Amputation

20. ABRASIONS:
This is caused by the skin being scraped or
dragged across a hard uneven surface causing
the outer layer of skin and tiny blood vessels to
be exposed.

21. CUTS (INCISION):
• A cut is caused by
something sharp, piercing
the skin injuring skin, soft
tissue or muscle.

22. LACERATIONS:
•Lacerations are skin
being torn, resulting in
skin and tissue
damage.

23. PUNCTURES:
• Punctures are caused by a blunt
or pointed object/instrument
piercing through skin and
causing skin and tissue damage
and often internal organ
damage.

24. AVULSIONS:
• IN an avulsion, a portion of
skin is torn. This can be
partial, with a portion of
skin remaining as a “flap”
• In a total avulsion, a body
part is completely torn off.

25. AMPUTATIONS:
• Occurs when a body part is
cut off or torn off
• Bleeding can be extensive

26. CLOSE WOUNDS

27. “Close wound is an injury in which no blood escape from
the body, although there may be some bleeding under
the skin. Continuity of skin is maintained”

29. TYPES

30. CONTUSIONS:
• A region of injured tissue or skin in which
blood capillaries have been ruptured; a bruise
CAUSES:
• Muscle rupture
• Stress fracture
• Leukemia
• Thrombocytopenia

31. BLISTERS:
• Fluid filled pockets under the skin
CAUSES:
• Chickenpox
• Cold sores –caused by a virus
• Burns

32. SEROMA:
• A fluid filled area that develops under
the skin or body tissue (commonly occur after blunt
trauma or surgery)

33. Causes:
•Body contouring, such as liposuction or arm,
breast, thigh, or buttocks lifts
•Hernia repair
•Abdominoplasty, or a tummy tuck

34. HEMATOMA:
A blood filled area that develops under the skin or body tissue (occur
due to internal blood vessel damage to an artery or vein)

35. Causes:
• Surgery
• Injury
• Greater trauma

36. CRUSH INJURIES:
Can be caused by extreme forces or lesser forces over a long period of
time.

37. WOUND MANAGEMENT

38. HISTORY
• Ancient Greece:
• Galen, a Greek surgeon made many contributions to the field of
wound care

39. •ANCIENT EGYPT:
• Treatment of acute and chronic wounds.
•Ebers Papyrus, 1500 BC (the oldest preserved medical documents)
 use of lint, animal grease, and honey as topical treatments for wounds.
 The lint-natural absorbent,
the animal grease-a barrier to environmental pathogens.
 And the honey served as an antibiotic agent.

40. NECESSARY AND IMMEDIATE STEPS AFTER WOUND INJURY

41. Seek Help Immediately After an Injury Occurs
Remove any visible objects in the wound that are easy to remove.
Direct pressure on the wound, if possible, and elevate the injured
area.
Remove or cut clothing from around the wound.
Apply ice if you have bruising or swelling, and avoid picking at
scabs.
Pain Management Medication

43. ROLE OF COMMUNITY PHARMACIST

44. ROLE OF COMMUNITY PHARMACIST:
Treatment protocol
• WWHAM
Who is the patient?
What are the symptoms?
How long has the condition been present?
What Action has already been taken?
What other Medicines are they taking or do they have other medical
conditions?

45. Some Basics:
Judge the wound- Type, cause and depth
“gather as much information as possible from the patient and advise
the patient of the appropriate steps to take.”
“If the wound involved a dirty or rusty object--tetanus injection and
possible antibiotics,”
Avoid aspirin products, since they can cause or prolong bleeding.
Many antibiotics will interfere with other medications.
“Good nutrition and diet is one of the most important factors in
wound repair.
Prescribe vitamin C and vitamin A supplements, as these foods supply
the body with nutrients essential to wound healing.

46. SURGICAL PRODUCTS

47. What includes surgical products?

48. Surgical products include basically
everything in the list of surgical
instruments (graspers, retractors, dilator)
as well as products like dressings,
sutures, and so on….

49. SURGICAL INSTRUMENTS

50. Surgical scissors
Surgical scissors, are surgical
instruments usually used for cutting.
It include;
1. BANDAGE SCISSORS
• helps in cutting bandages without gouging
the skin.

51. 2. Iris scissors
• a type of scissors with short blades that was
originally developed for opthalmic surgery.
3. Tenotomy scissors
• used to perform delicate surgery like ophthalmic
surgery, oral and maxillofacial surgery, or
in neurosurgery.

52. 4. Mayo’s Scissors
• Used to cut delicate structures like hollow viscus, investing
layer of deep fascia of the neck in thyroid surgery.
5. Heath’s Suture Cutting scissors
• Used to cut sutures on skin and mucous membrane

53. Surgical forceps
1. Vessel cannulation forceps
• Vessel cannulation forceps are designed to insert small
catheters into vessels.
2. Kocher’s Haemostatic Forceps
• Used to do sub total thyroidectomy.

54. 3. Lister’s Sinus Forceps
• Used to hold gauge swab to clean abscess cavity.
4. Babcock’s Tissue Forceps
• Used in appendectomy.

55. 5. Plain Dissecting Forceps
• Used to hold blood vessels and nerves while dissecting.
• Used to hold the hernial sac in hernia repair.

56. Retractors
1. Langenbach’s Retractor
• They are used to help better visualization of the operative
field

57. 2. Deaver’s Retractor
• Used in Cholecystectomy
• Used in kidney operations
3. Joll’s Thyroid Retractor
• It is a self retaining retractor used in thyroid surgeries

58. Catheters
1. Red Rubber Catheter
• Used to drain urine.
• Used to administer chemotherapy drugs for Ca bladder.

59. 2. Foley’s Self Retaining Catheter
• Used to drain urine.
• Used for urethral catheterization
3. Malaecot’s Catheter
• Used to drain abscess cavities.

60. Tube
1. Fuller’s Metallic tube
• For acute laryngeal edema

61. Bone cutter
• used to cut or remove bones.

62. Caliper
• Used to measure the distance between two
opposite sides

63. Curette
• For scraping excision, or cleaning procedure.

64. Needle holder
• To hold a suturing needle for closing wounds
during suturing and surgical procedures.

65. SURGICAL DRESSINGS:

66. DEFINITION:
•A dressing is a sterile pad or compress applied to
a wound to promote healing and protect the
wound from further harm.
OR
This is a process of cleaning and covering the
wound.

67. AIMS OF SURGICAL DRESSINGS:
• To keep the wound clean.
• To lessen spread of micro-organism.
• To hasten tissue healing.
• To absorb or localize drainage of wound.
• to control any postoperative bleeding,
• absorb exudate if anticipated,
• ease pain
• provide protection for newly formed tissue.

68. INDICATIONS:
• Open wounds
• Infected wounds
• Removal of stitches, staples or clips.
• Shortening or removing drains.

69. Q. HOW DO YOU DRESS A WOUND?
• Follow these steps to put a new dressing on:
• Put on a new pair of non-sterile gloves.
• Pour saline into a clean bowl. Place gauze pads and any packing tape you will use
in the bowl.
• Squeeze the saline from the gauze pads or packing tape until it is no longer
dripping.
• Place the gauze pads or packing tape in your wound. Carefully fill in the wound
and any spaces under the skin.
• Cover the wet gauze or packing tape with a large dry dressing pad. Use tape or
rolled gauze to hold this dressing in place.
• Put all used supplies in the plastic bag. Close it securely, then put it in a second
plastic bag, and close that bag securely. Put it in the trash.
• Wash your hands again when you are finished.

70. CLASSIFICATION OF SURGICAL DRESSING:
PRIMARY DRESSING:
• A dressing that touches the
wound.
SECONDARY DRESSING (BANDAGE):
• keeps the primary dressing in
site

71. TYPES OF SURGICAL DRESSINGS:
• Gauzes
• Foams
• Polymeric films (Opsite)
• Tissue adhesives
• Hydrocolloids
• Hydrogels
• Aliginates
• Enzymatic dressings
• Silicone dressings etc

72. WOUND DRESSING

73. FOAM:
Made of polyurethane foam.
Abrasions, Incisions, Pressure ulcers
Granulating wound
ADVANTAGES:
High absorptive capacity and the fact that they
conform to the shape of the wound
Non adherent

74. •Semi-permeable film dressings
 Minor injuries (abrasions)
 IV sites.
ADVANTAGES:
•Promote autolytic debridement
•waterproof
•Impermeable to bacteria
FILM:

75. ALGINATES/HYDROFIBERS:
•Derived from seaweed.
Highly exuding wounds
Infected wounds, deep wounds, sinuses and cavities.
ADVANTAGES:
•They can stay in place for several days.
•Highly absorbent
•Hydrophilic

76. HYDROGELS:
•Matrix of various types of synthetic polymers.
Dry wounds
ADVANTAGES:
•They initially lower the temperature of the
wound environment they cover, which provides
cooling pain relief for some patients.

77. HYDROCOLLOIDS:
•Made up of pectin based wafer material.
Low/moderate exuding wounds
Necrotic wounds
ADVANTAGES:
•Don’t adhere to wound.
•Available in various shape and sizes.

78. GAUZES:
• Generally made of cotton
 especially useful for dressing wounds
where other fabrics might stick to the
burn or laceration.
ADVANTAGE:
• Non-adherent coating
• Absorbs exudate
• Can be used as a primary or secondary
dressing

79. TISSUE ADHISIVES:
• Consist of CYANOACRYLATE
 Used for simple lacerations, which
otherwise might require the use of fine
sutures, staples, or skin strips.
ADVANTAGE:
• Needleless & Painless method of
wound repair
• Does not require follow-up visits for
suture removal

80. SILICONE DRESSING:
• Silicones are inert synthetic polymers
made up long chains of siloxanes.
 useful in covering split-skin donor
sites or fresh mesh grafts.
ADVANTAGE:
 May reduce Hypertrophic scarring
and Keloid formation

81. SUTURES:
ABSORBABLE SUTURES:
• Made up of Polyglycolic Acid sutures,
Catgut or Polydioxanone sutures.
• Use in procedures of:
 oral cavity,mucosal layer
 superficial blood vessels
 lower layers of skin,sub-cuticular stitches
ADVANTAGE:
• No painful removal of suture is required.

82. Contd….
NON-ABSORBABLE SUTURES:
• Polypropylene sutures, Nylon (polyamide) or
silk sutures.
 Used for closure of skin, surgical incisions or
drainage tubes
 Typically used to tie off blood vessels or bowel
segments.
ADVANTAGE:
• They are sometimes preferred because they are resistant to
body chemicals which may dissolve them too early in the
healing process.
• maintaining long-term tissue wound closure

84. SURGICAL CAST (plaster):
• Consist of a cotton bandage that has
been combined with plaster of paris.
 stabilize and hold anatomical structures,
most often a broken bone (or bones), in
place until healing is confirmed.
ADVANTAGE:
• Immobilize the fractured area which
decreases the healing time.