This document provides definitions and classifications of wounds. It discusses the pathophysiology of wound infection, including the signs of inflammation. It describes the management of wounds, including wound assessment, cleansing, and surgical debridement. It covers types of wound healing, factors affecting healing, and complications and their management. Some key points include classifications by degree of contamination and mechanism of injury. It discusses the cardinal signs of inflammation. It also outlines wound closure techniques and factors influencing wound healing such as nutrition, diabetes, and chronic diseases.

1. Zanzibar university
• Faculty of health and allied sciences
• Department of nursing and midwifery
• Prepared by:-
• Abdullah khamis ngwali
• Supervised by
• Dr, zhu
• General surgeon at abdulla mzee hospital Pemba
• 20th bench medical team of china

3. Contents
 Definition
 Classification of wounds
 Pathophysiology of a Wound
Infection
 Cardinal Signs of Inflammation
 Management of Wounds
 Social Toilet
 Wound Closures
 Surgical debridment
 Types of wound healing
 Factors affecting wound
healing
 Complication of wound and
their managements'

4. Wounds
RN,BSN. ABDULLA KHAMIS NGWALI

5. Wound
• Definition :-
• Disruption of the continuity of soft tissues
(skin and mucous membranes) produced by
external mechanical force

6. Classification of Wounds
• Classification by degree of contamination:
• Clean wounds are mostly those made in the
operating rooms in hospitals.
• They have clear sharp edges, not contaminated
and have minimal tissue damage.
• E.g- Neurological procedures, Endocrine
procedures, Eye surgery, Orthopedic
procedures

7. Classification by degree of contamination cont...
• Clean contaminated wounds occur outside
the operation rooms, they are potentially
contaminated thus liable to develop infection.
Tissue damage may be extensive.
• Gastrointestinal, respiratory or genitor-urinary
tracts entered without significant spillage

8. Classification by degree of contamination cont...
• Infected wounds show obvious signs of infection like pus
and necrotic tissue.
• Fresh traumatic wound from clean source
• Gross spillage from the gastrointestinal tract
• Dirty - infected
• Traumatic wound from dirty source
• Traumatic wound with delayed treatment
• Fecal contamination
• Foreign body
• Retained devitalized tissue

9. Classification according to onset
• Acute
• Chronic

10. Classification according to mechanism of injury
• Cut wound
• Penetrating wound
• Stub / Puncture wound
• Gun short wound
• Laceration
• Abrasion
• Crush wounds
• Avulsions

11. Classification according to mechanism
of injury cont..
• Lacerations, irregular tear-like wounds caused
by some blunt trauma
• Abrasions (grazes), superficial wounds in
which the topmost layer of the skin (the
epidermis) is scraped off.
– Abrasions are often caused by a sliding fall onto a
rough surface.
• Puncture wounds, caused by an object
puncturing the skin, such as a nail or needle.

12. PICTURE OF WOUND
• Abrasion Crush wound

13. CONTINUE..................
• Laceration stub wound

14. Classification according to mechanism
of injury cont..
• Penetration wounds, caused by an object such
as a knife entering the body
• Gunshot wounds, caused by a bullet or similar
projectile driving into or through the body.
There may be entry and exit wounds, such is
generally known as a through-and-through.
• Avulsion injury - Soft tissue injury where
a flap of tissue has been removed or is barely
attached

15. Avulsion wound

16. CONTINUE......
• penetrating head trauma
• Penetrating chest trauma
• Penetrating abdominal trauma

17. Pathophysiology of a Wound Infection
• Most wounds are contaminated except for
surgical wounds made under aseptic
conditions.
• Wound infection follows contamination by
dirt, damaged tissue, and foreign bodies.
• The bacteria invade tissues and cause more
damage while tissues which have not been
damaged resist infection by a process called
inflammation.

18. Pathophysiology of a Wound Infection cont...
• When a wound is inflamed, blood vessels dilate to
bring more blood to the injured part.
• The capillary walls change so that antibodies and
white cells can pass through more easily.
• The result is the part becomes warmer and redder
because there is more blood in it, and swollen
because there are more white cells and fluid.
• Pain is partially due to increased swelling in the
part, and partially due to the effects of the
inflammation process.

19. Signs of Acute Inflammation
(Cardinal Signs of Inflammation)
• Heat (Calor )
• Redness (Rubor )
• Pain (Dolor )
• Swelling (Tumor )
• Loss of function (Functio laesa)

20. Pathophysiology of a Wound Infection cont...

21. Management of Wounds
• Wound Assessment
• Cleansing the Wound (Social Toilet)
• Surgical Toilet

22. Wound Assessment
History
• How long ago was the wound sustained?
• How was the wound sustained?
• What is the status of active immunization against
tetanus?
• Document any pain – location, causative factors,
intensity, quality, duration, alleviating factors,
patterns, variations, interventions

23. Wound Assessment cont..
• Examination of the wound; look for:
• Site
• Depth and describe tissues involved
• Edges
• Active bleeding
• Contamination
• Document Size. Measure in centimeters –
ALWAYS Document Length x Width X Depth

24. Wound Assessment cont..
• Describe any drainage (exudate) – type,
amount, or odo
• Sanguineous – thin, bright red
• - Serosanguineous – thin, watery, pale red to pink
• - Serous – thin, watery, clear
• - Purulent – thick or thin, opaque tan to yellow
• - Foul Purulent – thick opaque yellow to green with
offensive odor

25. Wound Assessment cont...
• Describe surrounding tissue: Color, edema,
firmness, intact, induration, pallor, lesions,
texture, scar, rash, staining, moisture

26. Management of Wounds
• Wound Assessment
• Cleansing the Wound (Social Toilet)
• Surgical Toilet

27. Cleansing the Wound (Social Toilet)
• Clean the wound and surrounding skin with
soap and water.
• Do not use hard brush, sponge should suffice

28. Surgical Toilet
• All contaminated wounds need to undergo
surgical toilet.
• Clean the wound by debridement (remove
dead and damaged tissues using a knife and
apply antiseptic solution).

29. Classes and Indications for Wound Closures
• Primary wound closure
• Clean post operative wounds
• Surgically clean wounds after surgical toilet
• Delayed primary closure
• Done for contaminated wounds after surgical toilet
• Wound is observed for three to four days observing for
onset of infection
• If there is no infection then wound closure is
performed

30. CONTINUE...........
• Secondary closure
• Indicated for obviously infected wounds
• Closure is deferred until infection is under
control

31. CT,.........
• Close clean wounds immediately to allow
healing by primary intention

32. CT..........
• Do not close contaminated and infected
wounds, but leave them open to
– heal by secondary intention
• In treating clean contaminated wounds and
clean wounds that are more
• than six hours old, manage with surgical toilet,
leave open and then close 48 hours later.
– This is delayed primary closure.

33. • Contraindications to Secondary Closure
• wounds that are associated with exposure of an
important underlying structure or are located in
areas where a tight scar will be
• particularly problematic
• Fracture sites,
• Tendons
• Prosthetic devices (e.g. artificial joints)

34. Types of wound healing
• Primary intention healing
• When wound edges are re-approximated by
sutures (stitches), staples, or adhesive tape
• Minimizes scarring
• Example - Most surgical wounds

35. Secondary intention healing
• The wound is allowed to granulate
• Healing process can be slow due to presence
of drainage from infection
• Results in a broader scar

36. Tertiary intention healing
• Occur in delayed primary closure or secondary
suture.
• contaminated wound
• If the cleansing" of the wound is incomplete,
chronic inflammation can ensue, resulting in
prominent scarring.

37. Factors that affect wound healing
Patient factors
• Age
• Weight
• The patient’s nutritional status
• Dehydration
• Adequate blood supply to the wound site
• Underlying illnesses or disease:
– anemia, diabetes or immunocompromised
• Effect of the injury on healing (e.g.
devascularization)

38. Factors that affect wound healing cont..
• Wound factors (Local factors)
• - Organ or tissue injured
• - Extent of injury
• - Nature of injury (for example, a laceration
will be a less
• complicated wound than a crush injury)
• -Contamination or infection
• -Time between injury and treatment (sooner
is better)

39. • Foreign bodis
• Ultravolet light
• Faulty technique in wound closure

40. Systemic factors
• Hormones such as glucocorticoids - inhibit
collagen synthesis and have well-documented
anti-inflammatory effects
• Inadequate blood supply
• Metabolic status can change wound healing.
Diabetes mellitus - consequence of the
microangiopathy
• Nutrition – protin, vit C,A,Zn, Ca, Mn

41. • Chronic diseases. Coronary artery disease,
peripheral vascular disease, cancer, and
diabetes mellitus, jaundice, uraemia.

42. Vitamin C
• Collagen synthesis and subsequent
crosslinking as well as the formation of new
blood vessels (angiogenesis)
• help the immune system
• increases the absorption of iron.

43. Vitamin A
• increases the inflammatory response in
wounds, stimulating collagen synthesis.
• can restore wound healing impaired by
longterm steroid therapy or by diabetes.

44. Trace elements
• Zinc plays a key role in protein and collagen
synthesis, and in tissue growth and healing
• Iron
• provides oxygen to the site of the wound
(haemoglobin)

45. Complications of Wounds and Their
Management
• Cellulitis
• Non suppurative invasive infection of
surrounding tissues by organisms such as ß-
haemolytic streptococci, staphylococci and
Clostridium perfringens.
• Treatment - application of local antiseptic and
systemic antibiotics

46. Septicemia
• Multiplication of bacteria in the blood with
the production of severe systemic symptoms
such as fever and hypotension.
• It has an extremely high mortality
• It demands immediate and appropriate
attention.
• It is managed by adequate rehydration,
systemic antibiotics and antipyretics

47. • Soft tissue injuries are those injuries excluding
fractures, affecting the joints and muscles of
the limbs
• Ligaments connect bone to bone
• Tendons connect muscle to bone
• Strains: Injuries to the musculotendonous unit
• Sprains: Ligamentous injuries associated with
the overextension of a joint

48. • The treatment of soft tissue injuries is based
on resting the injured part, applying ice packs
to limit swelling and reduce pain by
prescribing analgesics or local analgesic cream
or gel.
• R= Rest I= Ice C= Compression E=
Elevation

49. Complications of Soft Tissue Injuries
• Compartment Syndrome
• Increased tissue pressure within a muscle
compartment compromising the blood supply
and the function of structures within that space.
Causes
• Tight casts or dressings
• External limb compression
• Burn eschar
• Fractures

50. Clinical presentation
• Pain out of proportion to the injury
• Puffy/tense muscle compartments to palpation
• Parasthesia (decreased sensation)
• Paralysis (weakness of the involved muscle
groups)
• Pallor
• Pulselessness (decreased capillary refill, late
finding)

51. Management
• Split the cast and remove dressings, if present
• Place limb in neutral position; elevation may be
harmful
• Support circulation with IV fluids or blood where
indicated
• Observe carefully for improvement i.e. colour,
pulse and pain
• If signs and symptoms persist, refer for
immediate surgical decompression (fasciotomy)
• Fasciotomy must be performed early, ideally
within six hours of the onset of symptoms

52. Myositis Ossificans
• Myositis ossificans is an unusual condition
that often occurs in athletes who sustain a
blunt injury that causes deep tissue bleeding.
• Severe bleeding into the muscle creates a
hematoma, which may trigger a healing
pathway that leads to formation of ectopic
bone in the muscle.
• Treatment of myositis ossificans consists of:
• Rest
• Immobilization in a stretched position

53. Complication of wound healing
• Implantaton cyst
• Painfull scar
• Keloids
• Neoplasia squamous cell carcinoma

54. AHSANTENI