This document discusses wound care essentials, including surgical incisions, wound drainage, wound closure techniques, and ideal wound dressings. It describes different types of incisions, surgical drains, suture materials, closure methods, and wound dressings. The goals of wound care are outlined as facilitating hemostasis, decreasing tissue loss, promoting healing, minimizing scarring, and maintaining a dry wound for the first 24-48 hours post-op unless drainage requires changing.

1. “WOUND CARE ESSENTIALS”
POSTOPERATIVE INCISION
MANAGEMENT
Dr. A.Seethalakshmi,M.Sc(N), Ph.D.,
Reader, Faculty of Nursing,
SRMC &RI (DU).

2. SURGICAL INCISION
A cut made through the skin to facilitate
access to the specific organ needed and
enable the performance of the desired
surgical procedure.

3. LANGER’S LINE
Langer’s Line
correspond to the
natural orientation
of collagen fibers in
the dermis, and are
generally parallel to
the orientation of
the underlying
muscle fibers
Incisions made
parallel to Langer's
lines may heal
better and produce
less scarring than
those that cut
across.

4. LAYERS OF ANTERİOR ABDOMİNAL WALL
• Skin
• Subcutaneous tissue
• Superficial Fascia
-Camper’s Fascia-fatty
superficial layer
-Scarpa’s Fascia-deep
fibrous layer
• Deep Fascia(Gallaudet’s
Fascia)
• Musculoaponeurotic
Layer
-External Oblique Muscle
-Internal Oblique Muscle
-Transverse Abdominal
Muscle
-Rectus Abdominis-
Pyramidalis Muscle
• Fascia Transversalis
• Preperitoneal Fatty Tissue
• Peritoneum

5. Abdominal & Pelvic incisions
Vertical
Incisions
-Midline
Paramedian
Transverse & Oblique
Incisions
Abdominothoracic
Incisions
-Kochler Subcostal Incision
-Transverse Muscle Dividing
-McBurney Incisions
-Oblique Muscle cutting
-Pfannenstiel Incision
-Maylard Incision

6. VERTICAL INCISIONS
MIDLINE PARAMEDIAN

7. ABDOMINAL QUADRANTS

8. TRANSVERSE INCISIONS
KOCHERSUBCOSTAL INCISION MODIFICATIONS

9. Mc BURNEY’S INCISION

10. TRANSVERSE INCISIONS

11. contd...

12. LOWER ABDOMINAL INCISIONS

13. THORACOABDOMİNAL INCISIONS

14. OTHER INCISIONS

15. THYROIDECTOMY INCISION

16. LAPAROSCOPIC PROCEDURES

17. Contd..

18. TYPES OF WOUND DRAINAGE
EXUDATE SEROUS
PURULENT SANGUINOUS

19. APPEARANCE OF WOUNDS
RED
• LATE
REGENERATION
PHASE
• CLEAN & PINK
• TOPICAL
ANTIMICROBIAL
YELLOW
• SLOUGH &
PURULENT
DISCHARGE
• CLEANSE
• WET TO WET
• HYDROGEL &
ABSORBENT
DRESSING
BLACK
• DEBRIDEMENT

20. Contd..

21. SURGICAL DRAINS
• Remove blood, pus , serous exudates, chyle,
bile gas or other fluids from a wound
Classification:
• Open vs closed
• Active vs passive

22. OPEN DRAINS- PENROSE DRAIN

23. DRAINS contd.....
CORRUGATED DRAINS SILICONE DRAIN SHEETS

24. DRAINS contd...
• LATEX DRAINS

25. ACTIVE DRAINS
JACKSON-PRATT DRAIN HEMOVAC DRAIN

26. Contd…
HEMOVAC DRAIN T-tube drain

27. ACTIVE DRAINS
ADVANTAGES
• Keep wound dry
• Efficient for fluid
removal
• Can be placed anywhere
• Evaluation and nature of
drain
• Prevents bacterial
ascension
DISADVANTAGES
• High negative pressure
may injure tissues
• Drain may be clogged
by tissue

28. PASSIVE DRAINS
ADVANTAGES
Evaluate nature of fluid
Prevent bacterial
ascension
Eliminate dead space
Quicker wound healing
DISADVANTAGES
• Gravity dependent
• Easily clogged

29. PIGTAIL DRAIN

30. DAVOL DRAIN

31. DRAIN CHARACTERISTICS

32. DRAIN REMOVAL
• Drain stops /<25ml (may be 24-48 hrs after
surgery or sometimes a week)
• Drain may be shortened 2cm a day
• Remove sutures if any
• Ask patient to inhale
• Pain medication before removal
• Remove the drain tubing- Comes out smoothly
• Apply occlusive dressing

33. WOUND CLOSURE

34. SUTURE MATERIALS

35. Skin
Face 5/0 or 6/0
Hands and Limbs 3/0 or 4/0
Elsewhere 2/0 or 3/0

36. TYPES OF SUTURES

37. contd…

38. TOPICAL SKIN ADHESIVE

39. STERISTRIPS

40. STAPLES

41. SUTURE REMOVAL GUIDELINES
Anatomic location Days (average)
face 3-5
arm 7
anterior trunk 7
back 10-14
feet and hand 10-14
joint 10-14
scalp 10-14

42. GOALS OF WOUND CARE
• Facilitate hemostasis
• Decrease tissue loss
• Promote wound healing
• Minimize scar formation
• Post op- maintain wound dry for 24 -
48 hrs unless need for change

43. HEALING
PRIMARY INTENTION
Clean
Sutures , staples
Secondary intention
Granulation& reduce infection
Wider scar
Tertiary intention
Cleaned, debrided
Observed, secondary suture / grafts

44. TIME TAKEN FOR WOUND HEALING

45. IDEAL WOUND DRESSINGS
• Provide mechanical and bacterial protection
• Maintain a moist environment at the
wound/dressing interface
• Allow gaseous and fluid exchange
• Remain nonadherent to the wound
• Nontoxic, nonsensitizing, and nonallergic
• Well acceptable to the patient (e.g., providing
PAIN RELIEF and not influencing movement)
• Cost effective

46. contd. . .
• Highly absorbable (for exuding wounds)
• Absorb wound odor
• Sterile
• Easy to use (can be applied by medical
personnel or the patient)
• Require infrequent changing
• Available in a suitable range of forms and sizes

47. TYPES OF DRESSINGS
CLASSIFICATION:
• Dry dressings
• Moisture-keeping dressings
• Bioactive Dressings
• Skin Substitutes

48. DRY DRESSINGS
• Most commonly available dressings
• Absorb wound moisture.
• Tightly Adherent to granulation Tissue – will
break upon removal
EXAMPLES:
• Gauze and bandages
• Membranes and foils
• Foams
• Tissue adhesives

49. MOISTURE KEEPING DRESSINGS
• Nonadherent to the wound
• Heals faster
• Do not break granulation tissue on removal
• Comparatively less painful
EXAMPLES:
• Pastes, creams and ointments
• Nonpermeable, semipermeable membranes or
foils,
• Hydrocolloids
• Hydrogels
• Combination products.

50. BIOACTIVE DRESSINGS
Active role in wound healing
• enhance granulation tissue formation
• Reduce slough formation
• Inhibits bacteria
• Some provide growth factors
EXAMPLES:
• Antimicrobial dressings
• Interactive dressings
• Single-component biologic dressings
• Combination products

51. TYPES OF DRESSINGS

52. Contd..

53. ABSORBENT DRESSINGS

54. TEGADERM DRESSINGS

55. POLYMERIC FILMS
• Semipermeable film dressings
• Primary adhesive
• transparent
• Waterproof
• Impermeable to bacteria
• Breathable
• Ultra thin & high elasticity
Examples:
• Opsite
• Bioclusive
• Tegaderm

56. Contd…

57. Contd..
Uses:
• General wound care
• Skin biopsies
• Donor sites
• Superficial partial thickness burns
• Surgical incisions
• Securing of peripheral IV lines
• central venous catheters
Contraindicted in highly exudative wounds

58. SURGICAL DRESSING PADS

59. VISIBLE OPSITE DRESSINGS

60. TULLES
• Tulle: A light, thin type of cloth that is like a net
• Gauze + paraffin for non-traumatic removal
• Antiseptics/Antibiotics
• Does not stick to wound surface
• Suitable for flat, shallow wound
• Useful in patient with sensitive skin
• Require a secondary dressing

61. Contd..

62. SUFRA TULLE . . .
• cotton fabric, impregnated with a base
composed of white soft paraffin, anhydrous
lanolin, and 1.0% framycetin sulphate
• framycetin is an antibiotic of the
aminoglycoside group
• infected wounds, low adherence +
antimicrobial activity.

63. HYDROCOLLOIDS
 absorb fluids,
 formation of gel covering the wound -
interactive dressings
 Provide moist wound environment
 Promote the formation of granulation tissue
 Provide PAIN RELIEF by covering nerve endings
with both gel and exudate.
 Constituents - methylcellulose, pectin, gelatin,
and polyisobutylene.

64. HYDROCOLLOIDS
 USES:
 acute wounds and chronic wounds
 desloughing
 different stages of light-to-heavily exuding
wounds
 Initially- changed daily, but once the exudate
has diminished, dressings may be left for up to
7 days
 Contra indication- infected wounds

65. COMPLICATIONS

66. Cont.d...
• INFECTION
• DELAYED HEALING
• NONHEALING
• SCAR
SURGICAL SITE INFECTION PREVENTION BUNDLE