Wounds

1. WOUND
Presented by miss e chavula

2. GENERAL OBJECTIVES
 At the end of the lesson, students should gain knowledge
on the management of patients with wounds.

3. SPECIFIC OBJECTIVES
 At the end of the lesson students should be able to;
 1. define the term wound
 2. state the classification of wounds
 3. state the types of wounds
 4. outline the process of wound healing
 5. outline the classification of wound healing and factors
affecting it
 6. state wound management and complications of wound
healing

4. INTRODUCTION
 A wound is a loss of continuity of the skin or mucous membrane which
may involve soft tissues, muscles, bone and other anatomical structure.
Any disruption to layers of the skin and underlying tissues due to
multiple causes including trauma, surgery, or a specific disease state
(Manley, Bellman, 2000).

5. TYPES OF WOUNDS
 Incisions or incised wounds, caused by a clean, sharp-edged object
such as a knife, a razor or a glass splinter.
 Lacerations, Tissues torn apart, usually caused by irregular objects
from accidents (e.g, machinery), results in swelling
 Contusion Blow from a blunt instrument
 Abrasions , superficial wounds in which the top most layer of the skin
(the epidermis) is scraped off
 Punctured wounds, results in small opening in the skin, caused by an
object puncturing the skin, such as a nail or needle or bullet


6. VARIOUS CLASSIFICATION OF
WOUNDS
Acute or chronic
Open or closed
Classified based on clinical appearance
Penetrating or non-penetrating
Based on contamination: Clean or contaminated

7. Classification by wound contamination
Clean wounds: This category includes non- traumatic,
uninfected wounds where no inflammation is encountered
and no break in technique has occurred.
Clean-contaminated: This category included non- traumatic
wounds where a minor break in technique has occurred.
No evidence of infection.
Contaminated: Gross spillage has occurred or a fresh
traumatic wound from a relatively clean source. Acute
non-purulent inflammation may be evident.
Dirty or infected : Old traumatic wounds from a dirty

8. Classification of wounds by depth
Partial-thickness: Confined to the skin, the dermis and
epidermis.
Full-thickness : Involve the dermis, epidermis, subcutaneous
tissue, and possibly muscle and bone

9. THE NORMAL PROCESS OF WOUND
HEALING
The inflammatory phase
The regenerative (Proliferative) phase
The Maturative (Remodeling) phase

10. THE INFLAMMATORY PHASE
 Initiated immediately after injury and lasts 3 to 4 days
 Two major processes:-
- Homeostasis
- Phagocytosis

11. THE INFLAMMATORY PHASE
 Hoemestasis is characterized by:
 Vasoconstriction of blood vessels in the affected area
 Deposistion of fibrin (connective tissue)
 Formation of blood clots.
 Increased blood supply to the area. Area appears reddened and
oedematous

12. THE INFLAMMATORY PHASE
 Phagocytosis
 Macrophages( neutrophil) engulf micro Organisms and secrete
angiogenesis factor which stimulate formation of new blood
vessels.

13. THE REGENERATIVE PHASE
 Begins on the 2nd day of inflammation and last up to 24 days
Signs of inflammation often reduces although the wound will
often remain red in color. Here, the wound is usually covered
by the skin cells( epithelial) cells.

14. THE MATURATIVE PHASE
 Begins about day 28 and can extend up to 6 months up to one
or two years after the injury.
 Fibroblasts( a cell from which connective tissue form)
continue to synthesize collagen( structural protein found in skin
that is responsible for skin strength). In about the 3rd week,
fibroblasts start to leave the wound, this reduces the scar but
increases its strength.
 The scar become a thin and less elastic.

15. CLASSIFICATION OF WOUND
HEALING
 (According to the amount of tissue loss)
Primary intention healing
Secondary intention healing
Tertiary intention healing

16. CLASSIFICATION OF WOUND
HEALING CONT..
 PRIMARY INTENTION HEALING
 Occurs where the tissue surfaces have been closed and
there is minimal or no tissue loss
 Characterized by the formation of minimal granulation
tissue and scarring
 Example of such wound is a surgical incision
 SECONDARY INTETION HEALING
 Wound is extensive and involves considerable tissue loss
 Edges can not be approximated (closed). Here, the wound

17. CLASSIFICATION OF WOUND HEALING
CONT..
 TERTIARY INTENTIONAL HEALING
 Require more connective tissue. Occurs if a deep wound is not
sutured early allowing more micro organisms to penetrate the
wound. This leaves a deeper and wider scar.
 Example is an abdominal wound that is left open for drainage

18. FACTORS AFFECTING WOUND HEALING
Age
Wound healing tends to be faster in young people as compared
to old people due to increased metabolism and circulation.
Diabetes mellitus
Provides good media for growth of bacteria thus delays wound
healing
Immune status
Poor immune status of an individual can lead to poor wound
healing
Nutritional status
Proteins and vitamin c are important nutrients needed for
wound healing

19. FACTORS AFFECTING WOUND HEALING CONT..
Presence of infection
Local infection delays wound healing. It increases the local
tissue injury because infected wound will not heal until the
infection is removed.
Reduced blood supply to the wound
Resting of the affected part
Over activity of the affected part delays wound healing as
this can disrupt wound closure
Size of wounds

20. WOUND MANAGEMENT
Surgical management of a wound whether elective or post-
traumatic requires strict adherence to certain basic precepts if a
successful outcome is to be expected, these include:
History taking
 When-time
 What-circumstance
 Which-type of object causing injury
 Other associated factors

21. Physical Examination
 General condition: vitals
 Full physical examination recommended
 quick head to toe assessment is helpful
 local examination of site of wound
 Resuscitation very important- ABC, you can
suture a wound but yet loose a patient
 Position, Suction, O2, IV fluids,

22.  The patient must be stabilized
 Blood supply to the tissue must be adequate in order for
the wound to heal.
 Analgesics to reduce pain
 Debridement: all necrotic tissue must be debrided as it
provides an excellent medium for bacterial growth. (This is
applicable to infected wounds).
 Wound irrigation with normal saline is necessary to
remove foreign matter ,hematoma and decrease

23.  Give tetanus prophylaxis
 Suturing: deep structures maybe repaired as
appropriate to help restore function
 Time factor important: avoid suturing a
wound which has occurred 6 hrs before
presentation

24.  Carry out aseptic wound dressing
 Antibiotics to kill bacteria
 Resting of the affected part so as to avoid disruption of wound
healing
 Provide well balanced diet rich in proteins and vitamin c to
promote wound healing

25. COMPLICATIONS OF WOUND HEALING
Haemorrhage. May be due to dislodged clot or slipped ligature
Hematoma- collection of blood under neath the skin
Infection
Dehiscence- partial or total rupturing of wound
Evisceration – protrusion of internal viscera through an
incision

26. REFERENCES
 1. Black J and Hankinson J (2009) Medical
Surgical Nursing, 8TH edition ,Mosby Elsevier
 2. Lewis (2007) Medical Surgical Nursing,
Assessment and Management of problems,
7TH edition ,Mosby Elsevier USA
 3. Monahan et al (2007) Phipps Medical
Surgical Nursing, 8TH edition Mosby Elsevier

27. THE END
 ZIKOMO