The document discusses wound healing, including the classification of wounds, the stages of wound healing, and complications. It outlines treatment options for chronic ulcers, including local, regional, and systemic approaches, as well as various types of dressings for different wound conditions. The document emphasizes the importance of proper care, treatment, and dressing techniques to facilitate effective wound healing.

1. WOUNDS
Dr Joel Arudchelvam
consultant vascular and transplant surgeon

2. Wound /Ulcer / abrasion
 A full thickness breach in the continuity of the
skin
 Partial thickness - Abrasion

3. Skin Anatomy

4. Wound healing
 4 stages
 Haematoma formation
 Inflammation/ debridment
 Proliferation
 Remodelling / maturation

5. Stages of Wound Healing
Inflammatory Stage
 Characterized by redness, heat,
pain and swelling
 approximately 4 to 5 days
 Within 24 hours of the initial
injury, neutrophils, monocytes and
macrophages migrate to wound
 control bacterial growth and
remove dead tissue

6. Proliferative Phase
Granulation
•Fibroblasts - collagen
•new capillaries
Contraction
•Wound edges pull together to reduce defect
Epithelialization
•Crosses moist surface

7. Remodeling
 Reorganization of collagen (type III to type I)
 increase in tensile strength
 Tensile strength reaches only about 80% of
pre-injury strength

8. Phases overlap

9. “Overlapping terms”

10. Wound healing
 Primary intention
 Secondary intention
 Tertiary intention
 Delayed closure

11. Primary Intention
Primary intention
Healing of a clean linear wound /surgical
incision with sligth damage of tissues

12. Healing by second intention
extensive loss of tissue that is filled with granulation
tissue and replaced by scar.

13. Classification of Wounds
 1) Clean Wound:
 Operative incisional wounds t.
 2) Clean/ContaminatedWound:
 When respiratory, gastrointestinal, genital, and/or
urinary tract have been entered.
 3) ContaminatedWound:
 open, traumatic wounds or surgical wounds involving a
major break in sterile technique that show evidence of
inflammation.
 4) Infected Wound:
 old, traumatic wounds containing dead tissue and
wounds with evidence of a clinical infection (e.g.,
purulent drainage).

14. Complications of wound
healing
 Deficient scar formation
 wound dehiscence
 Excessive scar formation
 Hypertrophic scar
 keloid
 Exuberant granulation (proud flesh)

15. Non healing ulcer / chronic
ulcers
 Ulcers not showing signs of healing by 6
weeks are called chronic ulcers.

16. Causes for non-healing ulcers.
1. Local causes
-Repeated trauma
-Presence of foreign body / slough
-ongoing infection / osteomyelitis
2. Regional causes
-Venous
-Arterial
-Neuropathic
3. Systemic causes
-Diseases- diabetes mellitus, renal failure, etc.
- Drugs- immunosuppressive drugs, cytotoxic
-Nutritional deficiencies- hypo-albuminaemia, anaemia, vitamin and mineral

17. DifferentiatingArterial,Venous and Neuropathic Ulcers

18. Differentiating Arterial, Venous and Neuropathic Ulcers

19. Treatment for chronic ulcers
 Local
 Regional
 Systemic

20. Treatment for chronic ulcers
 Local
 Wound toilet
o Process of removal of slough, dead tissue,
foreign bodies and draining pus.
o Following a wound toilet the wound base is
made suitable for future granulation and
epithelialisation.

21. Treatment for chronic ulcers
 Regional causes
 Arterial- revascularization
 Venous - Strapping
 (i.e. multilayer compression
 cotton wool
 crape bandage
 Cohesive - Coban
 Adhesive - elasto-plaster.
 Neuropathic- off loading

22. Treatment for chronic ulcers
 Systemic causes
 Correct anaemia, vitamin deficiency and other
nutritional deficiencies.
 Optimization of underlying comorbidities.
 Role of antibiotics in wound - indicated only in
patients with evidence of local or systemic
infection.

23. Wound dressings
 The material which is applied to the surface
of the wound to cover it is called a dressing.
 1ry – dressing which touches the wound
 2ry – dressing used to cover the primary dressing

24. Ideal wound dressing
Dressings are applied to wounds for the following
reasons;
 To provide a protective cover
 To maintain moisture
 To reduce pain
 To absorb exudates
In addition an ideal dressing have the following features;
 does not induce pain or itching
 easy to change
 Allows gaseous exchange
 Cheap
 Freely available

25. Types of Wound Dressings
 Gauze dressings
 Tulle
 Hydrocolloid dressings
 Hydrogel dressings
 Alginate dressings
 Foam dressings
 Transparent film dressings
 Etc.

26. Gauze
 Cheap
 Freely available
 Dry
 Painful on removing
 Damages epithelium

27. Tulle
 Cheap
 Freely available
 Easy removal
 E.g :Vaseline

28. Hydrocolloid
Dressings

29. Hydrocolloid Dressings
 Made up of pectin based material
 Absorb exudate
 Occlusive – should not be used on infected
wounds
 Come in various shapes and sizes

30. Hydrogel Dressings

31. Hydrogel Dressings
 Made up of primarily water in a polymer to
maintain moist wound base
 used in dry wounds
 Should not be used in exudating wounds

32. Alginate Dressings

33. Alginate Dressings
 Made up of seaweed
 Absorb moderate amounts of drainage
 becomes a gel when it comes into contact with
wound fluid through Calcium/Sodium ion
exchange

34. Foam Dressings

35. Foam Dressings
 Made up of polyurethane foam
 Absorbs moderate to large amounts of fluid
 Available in various sizes and shapes
 Some types my macerate peri wound skin if it
allows drainage laterally

36. Silver Dressings
 Antimicrobial to reduce bio burden of wound
through slow release of silver ion into the
wound
 e.g.Acticoat, Biatin Ag,Atruman Ag

37. Vacuum assisted closure VAC

38. Vacuum assisted closure VAC

39. Vacuum assisted closure VAC
 Macrostrain - visible stretch that occurs when negative
pressure contracts the foam.
 Draws wound edges together
 Provides direct and complete wound bed contact
 Evenly distributes negative pressure
 Removes exudate and infectious materials
 Microstrain - micro deformation at the cellular level
 Reduces edema
 Promotes granulation tissue formation by facilitating cell
migration and proliferation

40. Vacuum assisted closure VAC
 Indications for use
 Large wounds
 Cavities
 Large amount of exudate

41. Summary
Wound type Dressing
Dry Hydrocolloid, Hydrogel
Exudating wound Hydrocolloid, foam
Slough Hydrocolloid, hydrogels
Dead space / cavity Alginate, foam

42. When to change dressings
 When there is an indication to change
 Soaking
 Pain
 Need to inspect
 Discuss with doctor before changing

43. Avoid in chronic wounds
 Iodine (Betadine)
 Hydrogen peroxide
 Other toxic agents

44. Avoid
• Do not tie gauze bandage
tightly around limbs,
digits – causes ischaemia
• Use – plaster , crepe
instead

45. ThankYou