This document defines wounds and classifies them, discusses wound healing processes and factors that affect healing, and outlines principles of wound management and dressing. It defines a wound as a break in tissue continuity and classifies wounds as intentional vs unintentional, open vs closed, by degree of contamination, and depth. The main stages of wound healing are hemostasis and inflammation, proliferation, and remodeling. Dressings are used to provide an ideal environment for healing and characteristics of effective dressings are described.

1. WOUND
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2. DEFINITION
Wound is defined as a break in the normal continuity of a tissue.
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3. Parts of the wound
Wound edge Wound
corner
Surface of
the wound
Base of the wound
Cross section of a simple wound
Skin surface
Subcutaneus tissue
Superficial fascia
Muscle layer
Base of the wound
Wound edge
Surface of
the wound
Wound
cavity
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4. Classification of wounds
• 1. Intentional Vs. Unintentional.
• 2. Open Vs. Closed.
• 3. Degree of contamination.
• 4 . Depth of the wounds

5. Open Vs. Closed wounds
• Open wound: the mucous membrane or skin
surface is broken.
• Closed wound: the tissue are traumatized without a
break in the skin
Intentional Vs. Unintentional wounds
• Intentional wound: occur during therapy. For
example: operation
• Unintentional wound: occur accidentally. Example:
fracture in arm in road traffic accident

6. Degree of contamination
Clean wounds: are uninfected wounds in which minimal
inflammation exist, are primarily closed wounds.
Clean –contaminated wound: are surgical wounds in
which the respiratory, alimentary, genital, or urinary tract
has been entered. There is no evidence of infection.
Contaminated wounds: include open, fresh, accidental
wounds. There is evidence of inflammation.
Dirty or infected wounds: includes old, accidental
wounds containing dead tissue and evidence of infection
such as pus drainage.

7. Wound healing
• It is a mechanism whereby the body attempts to
restore the integrity of the injured part.
• Steps:-
• Hemostasis and Inflammation
• Proliferation
• Remodelling

8. Hemostasis and Inflammation
• The inflammatory phase begins immediately
after wounding and lasts 2–3 days
• Injury of blood vessels in the wound activates
platelet aggregations and coagulation cascade.
• Polymorphonuclear leukocytes (PMNs)
are the dominant inflammatory cells in the
wound for the first 24 to 48 hours

9. 2. proliferation
• fibroblast migration
• collagen deposition
• angiogensis
• granulation tissue formation
3. Remodelling
• regression of many capillaries
• collagen degeneration and synthesization
• new epithelium
• Scar formation

10. Types of wound healing
1.Healing by Primary Intention:
• All Layers are closed. The incision that heals by
first intention does so in a minimum amount
of time, with no separation of the wound edges,
and with minimal scar formation

11. healing by secondary intention:
Deep layers are closed but superficial layers are left to heal from the
inside out. Healing by second is appropriate in cases of infection,
excessive trauma, tissue loss, or imprecise approximation of tissue.
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12. Healing by tertiary intention:
• Also referred to as delayed primary
closure Wound initially left open
• is a useful option for managing wounds that are too heavily
contaminated for primary closure but has appearance of clean
wound.
•
•
•
•
the wound will be well vascularized after 4 to 5 days of open
observation so thatt the cutaneous edges can be approximated at
that time
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13. Factors affecting wound
healing
• Age
• Nutritional state
• Diseases: anemia , diabetes, cancer.
• Drugs :steroids, chemotherapy
• Vascularity
• Alcoholism and smoking

14. General principles of wound
management
• Examinations of the wound
• Anti tetanus prophylaxis
• Antibiotic prophylaxis
• Wound dressing and debridment with anesthesia

15. DRESSING
The main purpose of wound dressings is to provide the ideal
environment for wound healing.
The dressing should facilitate the major changes taking place
during healing to produce an optimally healed wound.
Covering a wound with a dressing mimics the barrier role of
epithelium and prevents further damage.
In addition, application of compression provides hemostasis
and limits edema.
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16. Desired Characteristics of Wound Dressings
Promote wound healing
Pain control
Odor control
Non allergenic and nonirritating
Permeability to gas
Safety
Non traumatic removal
Cost-effectiveness
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17. Occlusion of a wound with dressing material helps:
Healing by controlling the level of hydration and oxygen
tension within the wound.
It also allows transfer of gases and water vapor from the
wound surface to the atmosphere.
Occlusion affects both the dermis and epidermis, and it
has been shown that exposed wounds are more inflamed
and develop more necrosis than covered wounds.
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18. MANAGING CHRONIC WOUNDS
A chronic ulcer, unresponsive to dressings and simple
treatments, should be biopsied to rule out neoplastic
change.
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19. PRESSURE SORES
These can be defined as tissue necrosis with ulceration
due to pro-longed pressure. Less preferable terms are
bed sores, pressure ulcers and decubitus ulcers. They
should be regarded as preventable but occur in
approximately 5% of all hospitalised patients.
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20. Staging of pressure sores
Stage 1 : Non-blanchable erythema without a breach
in the epidermis
Stage 2 : Partial-thickness skin loss involving the
epidermis and dermis
Stage 3 : Full-thickness skin loss extending into the
subcutaneous tissue but not through underlying fascia
Stage 4 : Full-thickness skin loss through fascia with
extensive tissue destruction, maybe involving muscle,
bone, tendon or joint.
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21. Complications of wound healing
I. Early complications
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Seroma
Hematoma
Wound disruptin
Superficial wound infection
Deep wound infection
Mixed wound infection

22. Complications of wound healing
II. Late complications
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Hyperthrophic scar
Keloid formation
Necrosis
Abscesses
Foreign body containing abscesses

23. Wound dressing
• Greetandacknowledgepatient
• Informpatientandexplain procedureandassesspain
• Provideprivacy
• Placepatientincomfortableposition
• Performhandhygiene
• Discardsoileddressingwithnonsterile
• Handwashingagain
• Prepareyoutablebyremovingouterlayer

24. • Wear sterile gloves
• Perform dressing by maintaining sterile field