Professional Documents
Culture Documents
Wound Care
Wound Care
Professor Magdy Amin RIAD Professor of Otolaryngology. Ain shames University Senior Lecturer in Otolaryngology University of Dundee
The parameters for measuring the strength of normal body tissue are: Tensile Strength Breaking Strength Burst Strength
Tensile Strength
The load per cross-sectional area unit at the point of rupture, relating to the nature of the material rather than its thickness.
Breaking Strength
The load required to break a wound regardless of its dimension, the more clinically significant measurement.
Burst Strength
The amount of pressure needed to rupture a viscus, or large interior organ.
RECOVERY OF TENSILE STRENGTH As collagen accumulates during the reparative phase, strength increases rapidly but it is many months before a plateau is reached. Until this time, the wound requires extrinsic support from the method used to bring it together usually sutures.
RECOVERY OF TENSILE STRENGTH While skin and fascia are the strongest tissues in the body, they regain tensile strength slowly during the healing process. The stomach and small intestine, on the other hand, are composed of much weaker tissue but heal rapidly.
Age Weight Nutritional status Dehydration Inadequate blood supply to the wound Chronic disease Radiation therapy
The direction in which wounds naturally heal is from side-to- side, not end-to-end. The arrangement of tissue fibers in the area to be dissected will vary with tissue type. The best cosmetic results may be achieved when incisions are made parallel to the direction of the tissue fibers.
DISSECTION TECHNIQUE
When incising tissue, a clean incision should be made through the skin with one stroke of evenly applied pressure on the scalpel. Sharp dissection should be used to cut through remaining tissues. The surgeon must preserve the integrity of as many of the underlying nerves, blood vessels, and muscles as possible.
TISSUE HANDLING
Keeping tissue trauma to a minimum promotes faster healing. Throughout the operative procedure, the surgeon must handle all tissues very gently and as little as possible. Retractors should be placed with care to avoid excessive pressure, since tension can cause serious complications: impaired blood and lymph flow, altering of the local physiological state of the wound, and predisposition to microbial colonization.
HEMOSTASIS
Achieving complete hemostasis before wound closure will prevent formation of postoperative hematomas.
Collections of blood (hematomas) or fluid (seromas) in the incision can prevent the direct apposition of tissue. these collections provide an ideal culture medium for microbial growth and can lead to serious infection. When clamping or ligating avoid excessive tissue damage. Mass ligation that involves large areas of tissue may produce necrosis.
Adequate debridement of all devitalized tissue and removal of inflicted foreign materials are essential to healing
Cellular response to closure materials Closing tension Postoperative distraction forces Immobilization Elimination of dead space in the wound
The respiratory, alimentary or genitourinary tracts are not entered. There is no break in aseptic operating theatre technique.
Clean-contaminated Operations
in which the respiratory, alimentary or genitourinary tracts are entered
Dirty Operations: In the presence of pus. where there is a previously perforated hollow viscus, or compound/open injuries more than four hours old.
Epithelialization phase, epidermal cells close the wound and form a complete scar. Regulated amounts of matrix metalloproteinases (MMPs) mediate many of the cellular processes that occur during epithelialization
Three traditional cornerstones concepts of wound management Moist wound healing. Debridement. Management of the wound fluid (exudate)
The Exudate
The exudate of chronic wounds has been found to inhibit wound healing. Studies have demonstrated that chronic wound fluid can inhibit the production of key woundhealing cells (e.g., keratinocytes, fibroblasts and vascular endothelial cells). Bacterial exudate also contains increased levels of MMPs, which can inhibit wound healing by degrading growth factors or reducing the number of active growth factor receptor sites on the cells. Removing or controlling exudate can lead to improved wound healing.
The Exudate
Compression continues to be one of the more common methods of exudate management. Negative pressure devices and vacuumassisted devices, are now being used to improve wound healing. Drains are important in preventing exudate from accumulating in wound site.
method of management of contaminated, as well as dirty and infected traumatic wounds with extensive tissue loss and a high risk of infection. The surgeon usually treats these injuries by debridement of nonviable tissues and leaves the wound open, inserting gauze packing which is changed twice a day.
Patients sedation or a return to the operating room with general anesthesia generally is only required in the case of large, complex wounds. Wound approximation using adhesive strips, previously placed but untied sutures, staples after achieving local anesthesia can occur within 3-5 days if the wound demonstrates no evidence of infection and the appearance of red granulation tissue.
Should this not occur, the wound is allowed to heal by secondary intention.
THE WOUND
Injury to any of the tissues of the body, especially that caused by physical means and with interruption of continuity is defined as a wound.
Wound healing is a natural and spontaneous phenomenon. When tissue has been disrupted so severely that it cannot heal naturally : dead tissue and foreign bodies must be removed, infection treated, and the tissue must be held in apposition
until the healing process provides the wound with sufficient strength to withstand stress without mechanical support. A wound may be approximated with sutures, staples, clips, skin closure strips, or topical adhesives.
Tensile Strength
The load per cross-sectional area unit at the point of rupture, relating to the nature of the material rather than its thickness.