Wound healing lecture notes

1. WOUNDS
A.N Malik

2. Wound healing

3. Wound healing

5. Assignment
• Read and make notes on healing in:
• Bone
• Tendon
• Nerve

6. Types of wounds: Rank and Wakefield
classification

7. Management of an acute wound
Aims of management
• ATLS protocol must always be observed
• Healing without complications
• Wound care
• Relieve pain to enable L/E
• Arrest bleeding(elevate, apply pressure)
• Cleansing
• Exploration and diagnosis
• Debridement
• Repair of structures
• Replacement of lost tissues where indicated
• Skin cover if required
• Skin closure without tension
• Prophylaxis (T.T, antibiotics)

8. Compartment syndrome
https://surgeryreference.aofoundation.org/orthopedic-trauma/adult-trauma/tibial-
shaft/further-reading/compartment-syndrome#double-incision-4-compartment-dermato-
fasciotomy-after-mubarak

9. CHRONIC WOUNDS
A wound that fails to heal in the expected
time for a wound of that type.

10. Pressure sores/decubitus
ulcers
Tissue necrosis with ulceration due to
prolonged presure

11. Pressure sores
They denote a failure of proper
nursing care thus they are
preventable with optimum nursing
care and vigilance from the clinician
Risks
• Age: the elderly
• Paraplegia
• Being bed ridden
• Malnutrition
• Poor immunity

12. Common sites and staging of pressure sores
Sites commonly involved in
descending order
• Ischium
• Greater trochanter
• Sacrum
• Heel
• Malleolus (lateral then medial)
• Occiput

13. Pathophysiology
• External pressure exceeds capillary pressure (>30mmHg)
impedes blood flow to the skin leading to tissue anoxia,
necrosis and ulceration.

14. Management of pressure sores
Prevention is the best because they are very stubborn to heal
Prevention strategies
• Early recognition of patients at risk!!
• 2hrly turning of bed bound patients, wheel chair patients to lift
themselves for 10secs every 10 minutes
• Cushioning/padding of pressure areas
• Ripple mattress
• Frequent changing of beddings
• Urethral catheterization or urinary/fecal diversion in selected cases

15. Management of pressure sores
• For all pressure sores, treatment of the cause is the 1st step, surgical correction
is usually the last resort.
• Principles of treatment are the same as those for acute wound management
Surgical care may include
• Muscle flaps to cover the dead space and sensate skin
Prerequisites before any attempt at surgical correction
• Adequate nutrition
• Hgb above 10g%
• Non-infected pressure sores
• Adequate patient education

16. NECROTISING SOFT
TISSUE INFECTIONS
• Clostridial(gas gangrene)
• Non-clostridial(streptococcal gangrene
and nectrotising fascitis)

17. Leg ulcers
• An ulcer is a break in epithelial
continuity
• Chronicity of wounds commonly
is due to a defect in the
inflammatory phase of wound
healing
• Prolonged inflammatory phase leads
to overgrowth of granulation tissue
and attempts to heal by scarring
leaves a fibrotic margin
• Successful treatment should
always try to address the
aetiology

18. Aetiology of leg ulcers
• Venous disease leading to local venous hypertension (e.g.
varicose veins)
• Arterial disease, either large vessel (atherosclerosis) or small
vessel (diabetes)
• Arteritis associated with autoimmune disease (rheumatoid
arthritis, lupus, etc.)
• Trauma – could be self-inflicted
• Chronic infection – tuberculosis/syphilis
• Neoplastic – squamous or basal cell carcinoma, sarcoma

19. Pressure sores/decubitus ulcers

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