Wound Care

1. Wound Management.
Dr Imran Javed.
Associate Professor Surgery.
Fiji National University.

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

3. Wound Shape

4. Incised Wound

5. Abrasions

6. Punctured Wound

7. Lacerated Wounds.

8. Crushed wounds

9. Bite Wounds.

10. Gunshot Wounds.

11. Burn Wounds.

12. Acid Burn Wounds.

13. Frost Bite.

14. Radiation Wounds

15. Clean wound
Clean-contaminated wound
Contaminated wound
Heavily contaminated wound
Classification of the wounds

16. Skin Histology

17. Wound Healing

18. Healing By Tertiary Intention

19. Factors affecting wound healing
 Local
 Ischemia
 Infection
 Foreign body
 Edema, elevated tissue
pressure
 Systemic
 Age and gender
 Sex hormones
 Stress
 Ischemia
 Diseases
 Obesity
 Medication
 Alcoholism and smoking
 Immuno-compromised
conditions
 Nutrition

20. The wound healing

21. Hemostasis-inflammation
Granulation-proliferation
Remodeling.
Stages of wound healing

22. The main steps of the wound healing
 1. Hemostasis-inflammation
 vasoconstriction
 fibrin clot formation
 Pro-inflammatory cytokines and
 growth factors releasing
 vasodilatation
 infiltration PMNs, macrophages
 cytokines releasing
 → angiogenesis
 → fibroblast activation
 → B- and T-cells activation
 → keratinocytes activation
 → wound contraction
 2. Granulation-proliferation
 fibroblast migration
 collagen deposition
 angiogenesis
 granulation tissue formation
 epithelisation
 contraction
 3. Remodeling
 regression of many capillaries
 physical contraction myo-
fibroblasts
 collagen degeneration and
synthetisation
 new epithelium
 tensile strength – max. 80%

23. Wound Closure.

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

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

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

43. Keloid & Hypertrophic Scars.

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.