Prepared by:

Yasmin.vellani
Clinical Nurse Specialist (Wound & Stoma Care)
RN,BScN
Objectives
 At the end of this course, learners should be able to:
 Demonstrate an understanding of the structure and
function of the skin
 Define the term in relation to wound.
 Discussed the classification of wound.
 Differentiate healing by primary and secondary intention.
 Explain the normal healing process.
 Define SSI
 Discuss common complications of wound healing.
Wound?
wound?
A wound can be
defined as:
“A cut or break in
the continuity of
any tissue, caused
by injury or
operation”
(Baillière’s 23rd Ed)
Etiology of wounds?
Sharp injuries E.g. Knife and glass
Blunt Injuries e.g. contusions, abrasions, lacerations

A traumatic injury
caused by the
application of
mechanical force to the
body by a blunt force,
object or instrument—
e.g., an injury in which
the body strikes a
surface such as a wall
or the ground, in which
the skin was not
penetrated
Crush injury
crush injury occurs
when a body part is
subjected to a high
degree of force or
pressure, usually after
being squeezed
between two heavy
objects.
Degloving injury

A degloving injury is a
type of avulsion in which
an extensive section of
skin is completely torn off
the underlying tissue,
severing its blood supply
Burn wound
Gun shot/blast injuries
Classification of wounds

1. Intentional Vs. Unintentional.

2. Open Vs. Closed.
3 . Depth of the wound.
4. Degree of contamination.
Wound Classification
 BY CASE
 Intentional
 Occurs during treatment or therapy For example: operation or
venipuncture.

Unintentional occur accidentally.

 Unanticipated
 Result of trauma or accident

 Greater risk for infection

Example: fracture in arm in road traffic accident

(continued)
Open Vs. Closed wounds
Open wound: the mucous membrane or skin surface is
broken.

 Abrasion
 Incision
 Puncture wounds
Closed wound
the tissue are traumatized without a break in the skin.
 Hematoma
 Close fracture
 Contusion/ bruise
Classification of wound………
By severity of injury:
 Superficial
 Penetration
Classification of wound
( On the base of depth)
All wound are
either
 Superficial
 Partial thickness
or
 full Thickness
Superficial Wounds
 Involve epidermis
only

No bleeding
Can be painful
Ex- sunburn, “rug burn”or
first degree sore
Partial Thickness
( Distraction Epidermis & Dermis )

blisters, skin
tears
Full Thickness Wounds
 Epidermis, basement
membrane and
dermis breached

Extends into
subcutaneous fat,
muscles, bone, etc.
Primary closer:
 Done immediate (intra op )after surgery with
sutures, staples or sterile strips
Delayed closer
 Closer of wound done after 5-6 days of
surgery when wound show granulation and
free from exudates.
Secondary closer
 If there is significant tissue loss in the
formation of the wound, healing will begin by
the production of granulation tissue wound
base and walls
 Infection may cause

Delayed healing may cause

Hernia
Possible evisceration

Abscess
Fistula
Other procedures needed

King country hospital, 2005 hospital

Classification of wound……
Degree of contamination :
 Clean
 contaminated
 Clean contaminated
 Infected
• Clean :
No inflammation
No penetration
Closed or with closed drainage

(Odon,J.2005)

are uninfected wounds in which minimal inflammation exist, are primarily closed
wounds.

(has a 1% to 5% of developing SSI or deep tissue infection)

 • Clean Contaminated :

Respiratory, GI, genital or urinary tracts

entered under controlled conditions with no unusual
contamination.
Specific site: biliary tract, appendix, vaginal, oropharynx
(Odon,J.2005)

There is no evidence of infection.

(has 4%-10% risk)

• Contaminated :
Accidental wound with major breach in
asepsis Wound with massive GI spill
Sites entered in urinary, biliary infection
acute non- purulent.
(Odon,J.2005)

Dirty / Infected :
Old wound with devitalized tissue, foreign
bodies, fecal contamination, Perforated viscous, Pus
(Odon,J.2005)
Acute Surgical Wounds
 Often sutured or
stapled and heals
quickly
 Left open due to
swelling
 Infection, poor
nutrition can lead to
chronic wound
Acute and chronic wound
When the body
In acute wounds,
does not
the body
progress
advances
accordingly the
through healing
injury is known
phases in an
as a “chronic
orderly and
wound.”
timely manner.
Physiology of Wound Healing
Woun
d Blood leaks STOP Epithelial
occurs cells

Thickening and return Scab

to normal state causes
obstruction
Surgical complications of wound
 Complications - Infection
 • Spreading erythema of the
 skin around the incision line
 • Local pain
 • Local oedema
 • Heat
 • Pyrexia
 • Increased exudate /
 suppuration
 • Abscess formation
 • Cellulitis
Surgical complications……
 Dehiscence
Separation of
a surgical incision
or rupture of a
wound closure
Surgical complications……
 Evisceration
Protrusion of an internal
organ through a wound
or surgical incision
Surgical complications……
Fistula
 Abnormal track
connecting one
viscus with another
viscus, or
connecting a viscus
with a body surface
Surgical complications
 Sinus

 A track to the body

surface from an
abscess or some
material which has
an irritant effect
and becomes a
focus for infection
e.g sutures, fibres
from gauze
dressings
Hematoma
 Collection of extravasated
blood trapped in the tissues
or in an organ resulting from
incomplete hemostasis after
surgery
Other Known complications are
 Abscess – Cavity containing pus and surrounded by
inflamed tissue, formed as a result of suppuration in a
localized infection
 Adhesion – Band of scar tissue that binds together two
anatomical surface normally separated; most
commonly found in the abdomen
 (c) Cellulitis - Infection of the skin characterized by
heat, pain, erythema, and edema
Thank You
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