2. It is a circumscribed injury which is caused by an external
force and it can involve any tissue or organ.
surgical, traumatic
It can be mild, severe, or even lethal.
Simple wound
Compound wound
Acute
Chronic
Definition
24. Assessment of Wound.
Wound Irrigation.
Local Anesthesia.
Debridement.
Methods of Closure.
Dressings and Splints.
Anti-septics & antibiotics.
Removal of Sutures.
Management of Laceration
25. requires information in the following areas:
force of injury,
type of force (e.g. penetrating, hot oil burn)
extent and depth of injury
amount of blood loss
level of contamination of the wound
time from injury to presentation for treatment
involvement of deeper structures damaged (e.g. nerves,
tendons)
Direct communication from the outside to a fracture of the
bone (a compound fracture).
Assessment of the degree of damage
26. All wounds should be cleaned. Irrigation rids the
wound of contaminants, debris and bacteria and is
considered the most important means of reducing
the incidence of wound infection.
Cleaning with Anti-septic solutions like betadine is
standard method.
Local Anesthesia may be topical or infiltrated.
Debridement: Once the wound is adequately
anaesthetized and irrigated, devitalized wound edges
should be debrided using sharp scissors and/or a
scalpel blade. Irrigate the wound again after
debridement to remove tissue debris.
Wound Irrigation & Anesthesia
27. is also known as healing by primary intention. Wounds
that heal by primary closure have a small, clean defect
that minimizes the risk of infection and requires new
blood vessels and keratinocytes to migrate only a
small distance. Surgical incisions, paper cuts, and
small cutaneous wounds usually heal by primary
closure.
Primary wound closure
28. also known as healing by secondary intention,
describes the healing of a wound in which the wound
edges cannot be approximated. Secondary closure
requires a granulation tissue matrix to be built to fill
the wound defect. This type of closure requires more
time and energy than primary wound closure, and
creates more scar tissue.
Secondary wound closure
29. also known as healing by tertiary intention. Delayed
primary closure is a combination of healing by primary
and secondary intention, and is usually instigated by
the wound care specialist to reduce the risk of
infection. In delayed primary closure, the wound is
first cleaned and observed for a few days to ensure
no infection is apparent before it is surgically closed.
Examples of wounds that are closed in this way
include traumatic injuries such as dog bites or
lacerations involving foreign bodies.
Delayed primary closure
30. Types of Sutures.
natural and synthetic
synthetic materials
less reaction
less inflammatory reaction
absorbable and non-
absorbable
Non-absorbable sutures offer
longer mechanical support
monofilament and
multifilament
monofilaments have less drag
Infection is avoided
Absorbable suture materials
lose tensile strength before complete
absorption
gut last 4-5 days in terms of tensile
strength
chromic form, gut can last up to 3 weeks
Vicryl and Dexon
maintain tensile strength for 7-14 days
complete absorption takes several months
Maxon and PDS
long-term absorbable sutures
lasting several weeks
requiring several months for complete
absorption
Non-absorbable sutures
silk has the lowest strength
nylon has the highest
Polypropylene.
31. Running, or continuous stitch
made with one continuous
length of suture material
close tissue layers which
require close approximation
speed of execution, and
accommodation of edema
during the wound healing
process
greater potential for mal-
approximation of wound
edges with the running stitch
than with the interrupted
stitch
32. Interrupted Sutures.
needle at a 90° angle to the
skin within 1-2 mm of the
wound edge and in the
superficial layer
exit through the opposite side
equidistant to the wound edge
and directly opposite the initial
insertion
stitch is tied separately
used in skin or underlying
tissue layers
more exact approximation of
wound edges can be achieved
with this technique than with
the running stitch
33. Mattress suture
a double stitch that is made
parallel (horizontal
mattress) or perpendicular
(vertical mattress) to the
wound edge
advantage of this technique
is
strength of closure
each stitch penetrates each
side of the wound twice
inserted deep into the tissue
34. Purse string Suture.
continuous stitch
paralleling the edges of a
circular wound
wound edges are
inverted when tied
used to close circular
wounds, such as hernia or
an appendiceal stump
35. Smead-Jones/Far-and-Near
a double loop technique
alternating far and near
stitches
greater mechanical
strength than continuous
or simple interrupted
sutures
used for approximating
fascial edges, especially
for patients at risk for
fascial disruption or
infection
36. Continuous Locking, or Blanket Stitch
a self-locking running
stitch used primarily for
approximating skin edges
37. good approximation edges is paramount to proper
wound closure technique
deep sutures serve to eliminate the dead space and
relieve tension from the wound surface
deep sutures also ensure proper alignment of the
wound edges and contribute to their final eversion
wound closure may require sharp undermining of the
tissues to minimize tension on the wound
achieve hemostasis
eversion of all skin edges avoids unnecessary
depression of the resultant scar
Features of Good Closure
38.
39. Dressings function to protect the wound, absorb excess
exudate and improve comfort.
Most lacerations to the facial area and scalp do not need to
be dressed.
Most commonly, a non-adherent contact layer is placed,
followed by a gauze layer and then an adhesive outer layer.
Wounds adjacent to joints may require splinting of the joint
to prevent excessive tension on the wound.
Dressings should be kept clean and dry. Most dressings
should be removed in 2 days and the wound reviewed
Dressings and Splints
40.
41. Antibiotics are not indicated for simple lacerations.
Wounds which are contaminated require careful
cleaning and debridement.
Antibiotics are often given for human and animal
bites.
Amoxycillin/clavulanic acid for 5 days is a reasonable
choice if antibiotics are to be prescribed.
Tetanus prophylaxis.
Antibiotics
42. face: 3-4 days
scalp: 5 days
trunk: 7 days
arm or leg: 7-10 days
foot: 10-14 days
Suture removal
44. Immediate and delayed complications may occur with
wound closure
formation of hematoma
wound infection.
reduced by prophylactic antibiotics
Late complications
scar formation
excess tension
lack of eversion of the edges
hypertrophic scarring and keloid formation.
stitch marks
wound necrosis
Wound Complications.