presentation regarding management of wound and it types

1. WOUND MANAGEMENT
UNDERSTANDING WOUNDS & HEALING

2. GOAL OF WOUND MANAGEMENT
✓UNDERSTANDING NATURE AND TYPES OF WOUNDS
✓PROVIDING PAINLESS, QUICK WOUND CLOSURE
✓EXCELLENT COSMETIC RESULT
✓ AVOIDING INFECTION
DEFINITION
A wound is a physical trauma where the skin is torn, cut or punctured. An
injury which breaks the skin or other tissues and which can allow blood to
escape from the body and germs to enter it .
a wound is considered as minor when it is:
• superficial;
• away from natural orifices;
• there is only a minor bleeding;
• it was not caused by a tool or an animal.
Any other wound should be considered as severe.

3. TYPES OF WOUNDS
• TYPES OF WOUNDS
Wounds
Open Closed

4. • ALLOWS BLOOD TO ESCAPE FROM THE BODY
• THERE IS DISRUPTION IN THE CONTINUITY OF THE SKIN THEREFORE SUSCEPTIBLE TO
EXTERNAL BLEEDING AND CONTAMINATION
TYPES OF OPEN WOUND :
❖ INCISION
❖LACERATION
❖ABRASION
❖PUNCTURE
❖ AVULSION
❖AMPUTATION
OPEN-WOUND

5. • INCISION : CAUSED BY SHARP CUTTING INSTRUMENT MINIMUM
LOSS OF TISSUE EDGES ARE REGULAR HEALS BY PRIMARY
INTENTION HEALING.
• LACERATION: CAUSED BY TEARING OF SOFT TISSUE IRREGULAR
JAGGED EDGES LOSS OF TISSUE LIMITED TO SKIN AND
SUBCUTANEOUS TISSUE.
OPEN-WOUND

6. ABRASION :
• SUPERFICIAL WOUND CAUSED BY RUBBING OR SCRAPPING
• RESULTS IN PARTIAL LOSS OF SKIN SURFACE
PUNCTURE
• IS A STAB FROM A POINTED OBJECT.
• EXAMPLE: NAILS, NEEDLES, FORK, KNIFE AND EVEN TEETH
• RISK OF INFECTION IS HIGH IF WOUND IS DEEP BECAUSE
GERMS AND DIRT MAY HAVE CARRIED INTO IT
• SPECIAL TREATMENT IS REQUIRED WHEN THE OBJECT
CAUSING THE INJURY REMAINS IMPALED IN THE WOUND
OPEN-WOUND

7. AVULSION
• IS THE TEARING OF A PATCH OF SKIN OR OTHER
TISSUES
• NOT TOTALLY TORN FROM THE BODY BUT CREATES A
LOOSE, HANGING FLAP
• INVOLVES BODY PARTS SUCH AS EYEBALLS,
EARS,FINGERS, OR HANDS
AMPUTATION
• INVOLVES CUTTING OR TEARING OFF A BODY PART
• EXAMPLE: FINGERS, TOES, HANDS,FEET, ARMS OR
LEG.
OPEN-WOUND

9. ONLY DEEPER TISSUES BARRING THE SKIN OR
MUCOUS MEMBRANE ARE DAMAGED
CONTUSION/BRUISES:
• CAUSED BY BLUNT OBJECTS
• DAMAGE TO SUBCUTANEOUS TISSUE
WITHOUT BREAKING THE CONTINUITY OF
SKIN SURFACE
• CLASSIFIED ACCORDING TO SEVERITY OF
DAMAGE
CLOSED / INTERNAL WOUND

10. CONTUSSION / BRUISES
CLASSIFICATION
• 1ST DEGREE: ECHYMOSIS – DAMAGE TO
CAPILLARIES TO SKIN AND SUBCUTANEOUS
TISSUE
• 2ND DEGREE: HEMATOMA- DAMAGE TO
LARGER VESSELS
• 3RD DEGREE :TISSUE/ORGAN DAMAGE,
MAY CAUSE GANGRENE AND SHOCK
CLOSED / INTERNAL WOUND

11. CLASS I: CLEAN
• NON TRAUMATIC, NO INFLAMMATION,
• INTACT TECHNIQUES, GU/GIT/RESP TRACTS NOT BREACHED
EG. : LUMP EXCISION
CLASS II: CLEAN CONTAMINATED
• NON TRAUMATIC
• MINOR BREAK IN TECHNIQUES
• TRACTS BREACHED WITHOUT SPILLAGE
EG. : APPENDICECTOMY
CLASS III: CONTAMINATED
• FRESH TRAUMATIC WOUND
• MAJOR BREAK IN TECHNIQUES
• TRACTS ENTERED WITH SPILLAGE
EG. : OPEN FRACTURE
SURGICAL WOUND CLASSIFICATION

12. ULCER:
• A LESION THAT IS ERODING AWAY THE SKIN OR
MUCOUS MEMBRANE USUALLY COMPLICATED BY
DELAYED HEALING OR RECURRENCE
VENOUS STASIS ULCER
• ASSOCIATED WITH VARICOSE VEINS
• BELOW THE KNEE, INNER PART OF LEG JUST ABOVE
ANKLE
• BORDER: IRREGULAR, DISCOLORED SURROUNDING
SKIN, SWELLING
• BASE: RED COVERED BY YELLOWISH FIBROUS TISSUE
LEG ULCER CLASSIFICATION

13. NEUROTROPHIC ULCER
ASSOCIATED WITH DIABETES MELLITUS
PRESSURE AREAS AT PLANTAR ASPECT OF
FOOT
BORDER: PUNCHED OUT, CALLOUSITY
BASE: VARIABLE: PINK/BROWN/BLACK
ARTERIAL ULCER
ON THE FEET: HEEL, TIP OF TOES, NAILBED
BORDER: PUNCHED OUT
BASE: GREY/ BROWN/ BLACK
PAINFUL ESPECIALLY AT NIGHT
CLOSED / INTERNAL WOUND

14. 1ST DEGREE: FIERY RED, VERY PAINFUL, NOT BLISTERED
2ND DEGREE : PARTIAL THICKNESS, EXTEND TRU EPIDERMIS AND
DERMIS, FULL HEALING EXPECTED
3RD DEGREE: FULL THICKNESS, EXTEND TRU DERMIS AND
SUBCUTANEOUS LAYER. HAIR FOLLICLES/ SWEAT AND SEBACEOUS
GLANDS DAMAGED. HEALING TRU SCAR FORMATION
4TH DEGREE: COMPLETE BURNS EXTEND TO SUBCUTANEOUS TISSUE,
MUSCLE, FASCIA OR BONE MAY CAUSE SYSTEMIC TOXICITY,
INFECTION/SEPSIS
BURNS

15. GRADE 0 (PRE OR POST ULCERATIVE LESION)
GRADE 1 (PARTIAL/ FULL THICKNESS ULCER, I.E. SUPERFICIAL
ULCER)
GRADE 2 (PROBING TO TENDON OR CAPSULE, I.E. DEEP
ULCER)
GRADE 3 (PRESENCE OF OSTEOMYELITIS)
GRADE 4 (PARTIAL FOOT GANGRENE)
GRADE 5 (WHOLE FOOT GANGRENE)
DIABETIC FOOT ULCER

16. • GRADE 0 (PRE OR POST ULCERATIVE ULCER THAT HAS HEALED)
• GRADE 1 (SUPERFICIAL WOUNDS NOT INVOLVING TENDON, CAPSULE OR BONE)
• GRADE 2 (WOUND PENETRATING TO TENDON OR CAPSULE)
• GRADE 3 (WOUND PENETRATING BONE OR JOINT)
WITHIN EACH GRADE, THERE ARE 4 STAGES
• A (CLEAN WOUNDS)
• B (NON ISCHEMIC INFECTED WOUNDS)
• C (ISCHEMIC NON INFECTED WOUNDS)
• D (ISCHEMIC INFECTED WOUNDS)
Diabetic foot ulcer

17. GOLDEN PERIOD FOR WOUND REPAIR
THE ACCEPTED INTERVAL FROM INJURY TO WOUND CLOSURE IS UP TO
6 HOURS FOR WOUNDS TO THE EXTREMITIES AND UP TO 24 HOURS
FOR FACE AND SCALP WOUNDS.
Tetanus-Prone Wounds
• Age of wound greater than 6 hours
• Stellate wound or avulsion
• Depth of wound greater than 1 cm, mechanism of injury is a missile,
crush, burn, or frostbite
• Signs of infection are present
• Devitalized tissue is present
• Presence of contaminants (dirt, feces, soil, or saliva)
• Presence of denervated or ischemic tissue

18. FACTORS AFFECTING WOUND HEALING
HEALING IS INFLUENCED BY SYSTEMIC CONDITIONS OR BY LOCAL
CONDITIONS IN THE WOUND
Local
▪ Ischemia
▪ Infection
▪ Foreign body
▪ Edema, elevated tissue
▪ pressure
Systemic
▪ Age and gender
▪ hormones
▪ Stress
▪ Ischemia
▪ Diseases
▪ Obesity
▪ Medication
▪ Alcoholism and smoking
▪ Immuno-compromised
▪ conditions
▪ Nutrition
Stages of wound healing
In general,
remember
“DIDN'T HEAL”
D = Diabetes
I = Infection
D = Drugs:
N = Nutritional
problems
T = Tissue necrosis
H = Hypoxia
E = Excessive tension
on wound edges
A = Another wound
L = Low temperature

19. 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
Types of Wound Dressings
❑ Gauze dressings
❑ Tulle
❑ Hydrocolloid dressings
❑ Hydrogel dressings
❑ Alginate dressings
❑ Foam dressings
❑ Transparent film dressings
❑ Etc

20. MATERIALS AVAILABLE
✓ STAPLES : for closure of linear lacerations of the scalp, trunk, or extremities.
more rapid wound repair and lower rate of reactivity and infection.
Stages of wound healing
✓ TISSUE ADHESIVES Less painful and faster than closure with sutures.
Limited to linear lacerations less than 4 Cm in length in wounds devoid of
significant tension or repetitive movement

21. MATERIALS AVAILABLE
✓ ADHESIVE TAPES Less risk of infection than either staples or sutures.
Stages of wound healing
✓ TISSUE ADHESIVES Less painful and faster
than closure with sutures. Limited to linear
lacerations less than 4 Cm in length in wounds
devoid of significant tension or repetitive
movement
✓ Sugical instruments Like :
Surgical scissors , Forceps ,
catheters , cutters , calipers,
needle holders etc
Dressings
• Absorption characteristics: none – films, low –
hydrogels, moderate - hydrocolloids, high – foams,
alginates, collagen.
• Hydrogels (eg. starch) rehydrate wounds (benefit in
small amounts of eschar, infected wounds).
• Hydrocolloids promote wound debridement by
autolysis.
• Antimicrobial dressings: silver, cadexomer iodine,
mupirocin, neomycin.

22. DRESSINGS - AVAILABLE OPTIONS
• Collagen & chondroitin sulphate : integra
• It was initially used to safely cover large areas of burned tissue where skin needed to be
regrown. However, integra is now used far more widely as part of skin grafts in
reconstructive surgery. Integra is sometimes referred to as a dermal matrix or dermal
scaffold
Stages of wound healing
Click on the documents to open it .

23. SURGICAL DRESSINGS More prospects
• Alloderm: immunologically inert, non-living, allogenic, acellular dermal
matrix With intact basement membrane prepares wound bed for grafting
Stages of wound healing
The Alloderm skin substitute is essentially formed from acellular matrix
derived from a cadaveric dermis. The allodermis is processed by salt to
remove the epidermis and then extracted with a solution to remove any
cellular material. It is then freeze-dried to render it inert
immunologically, although its basement membrane remains intact. It
has no epidermal layer. However, the acellular matrix provides a good
natural medium for fibroblast and endothelial cells to regenerate from
the neodermis.
https://www.biohorizons.com/Products/BioPlugBioStrip

24. SURGICAL DRESSINGS / SKIN SUBSTITUE
• Apligraf trade: skin substitute containing collagen and seeded cells
https://videos-apligraf-com-prod.s3.amazonaws.com/apligraf-moa_1024.mp4
The bilayered bioengineered skin substitute (BBSS) [Apligraf] is used for
the treatment of venous leg ulcers and diabetic foot ulcers. It has an
epidermal layer formed from human keratinocytes and a dermal layer
composed of human fibroblasts in a bovine type I collagen matrix.

25. SURGICAL DRESSINGS More prospects
Stages of wound healing
Tegaderm Used for simple shallow wound dressing Protects from
water loss mechanical injury and drying

26. SURGICAL DRESSINGS More prospects
Stages of wound healing
Tegaderm Used for simple shallow wound dressing Protects from
water loss mechanical injury and drying

27. SURGICAL DRESSINGS More prospects
Stages of wound healing
Indications for use
– Large wounds – Cavities – Large amount of exudate

28. SURGICAL DRESSINGS Silver Dressings
Stages of wound healing
Antimicrobial to reduce bio burden of wound through slow release of silver
ion into the wound
e.g. Acticoat, Biatin Ag, Atruman Ag

29. MATERIALS More prospects
✓TRANSCYTE (ECM matrix
generated by Allogenic human
dermal fibroblasts serves As a
matrix for neodermis
generation
Stages of wound healing
ORCEL: Composite cultured skin.
Fibroblasts, keratinocytes seeded
on opposite sides of bilayered
matrix of bovine collagen.

30. MATERIALS - DERMAGRAFT
✓DERMAGRAFT living
allogenic dermal
fibroblasts grown on
a degradable
scaffold. Good
resistance to tearing
Stages of wound healing

31. MATERIALS - More prospects
Stages of wound healing

32. MATERIALS - More prospects

33. MATERIALS - BIOLOGIC DRESSINGS
✓HONEYSOFT
Natural dressing honey-impregnated
dressing chronic unhealing wounds.
Impregnated into a compress of eva
(ethylenevinylacetate) mesh
Stages of wound healing
Honey cleans the wound without disturbingit Removing
the dressing causes no damage no known side effects

34. WOUND HEALING PHYSIOLOGY
WOUND HEALING IS A PHYSIOLOGIC PROCESS IN WHICH THE SKIN OR ORGAN OR
TISSUE REPAIRS ITSELF AFTER INJURY.
Skin healing goes through 4 phases in order as follow:

35. MATERIALS - BIOLOGIC DRESSINGS
Stages of wound healing

36. WOUND HEALING PHASES
Stages of wound healing

37. WOUND HEALING
Stages of wound healing

38. WOUND APPEARANCE & treatment
Stages of wound healing

39. MARKET OF WOUND DRESSING
Stages of wound healing

40. MARKET OF WOUND DRESSING
Stages of wound healing

41. MARKET TOP 5 COMPETITORS:
Stages of wound healing

42. MARKET TOP 5 COMPETITORS:
Stages of wound healing

43. THANK YOU