WOUNDS AND THEIR

MANAGEMENT
 Inflammation, epitheliallization,
granulation, fibroplasias,
contraction
 Processes occur simultaneously
rather than a series of discrete
steps
WOUNDS
 A DISRUPTION OF NORMAL
ANATOMIC RELATIONSHIPS
 AS A RESULT OF AN INJURY
 THE INJURY - INTENTIONAL
- ACCIDENTAL
WOUNDS
 DISRUPTION OF TISSUE
INTEGRITY
– SURGICAL
– TRAUMATIC
 STIMULATES A SERIES OF
CELLULAR AND MORPHOLOGIC
EVENTS- SPONTANEOUS WOUND
CLOSURE
WOUNDS
 IMPAIREMENT OF NORMAL
HEALING, ESPECIALLY BY
INFECTION

 IS A MAJOR SOURCE OF SURGICAL

MORBIDITY
WOUND REPAIR
THREE BASIC
PROCESSES
 1. Epithelial coverage of the
wound

 2. Collagen formation

 3. Contraction in the tissues

WOUND REPAIR
THREE BASIC PHASES

 1. THE LAG PHASE

 2. THE PROLIFERATIVE PHASE

 3. THE MATURATION PHASE

WOUND HEALING
 For 2-6 months the scar is
described immature or active
 Scars become fully mature from
1-3 years after the surgery or
injury
WOUND HEALING

 When a scar matures:

– The color fades
– The scar softens
– It becomes flatter
– It is less itchy
HEALING WOUNDS
CLASSIFICATION

 1. PRIMARY HEALING

 2. SECONDARY HEALING
NUTRITION
 PROTEIN DEPLETION
 VIT. C – FIBROBLASTS PRODUCE
LESS COLLAGEN
 VIT A
 VIT B6 DEFICIENCY IMPAIRS
COLLAGEN LINKING
 VIT B1 – B2
 ZINC DEFICIENCY
WOUNDS
TREATMENT OPTIONS
 Delayed primary closure

 Healing by secondary intention

 Skin grafting
IMPAIRED WOUND
HEALING
 Systemic risk factors

 Local risk factors

Systemic risk factors
 1. Malnutrition
 2. Diabetes mellitus
 3. Sepsis
 4. Chemotherapy
 5. Immunosuppressant
Local risk factors
 1. Local ischemia- PVD
 2. Radiotherapy- ischemic vasculitis
 3. Obesity
 4. Local edema
 5. Tension suture on wound edges
 6. Pressure over a bony prominence
 7. Dry environment
 8. Presence of necrotic tissue
WOUNDS
CLASSIFICATION
 1. Incised wound
 2. Punctured wound
 3. Laceration
 4. Shear wound
 5. Missile wound
LACERATION
 A wound that is produced by the
tearing of soft body tissue
 This type of wound is often
irregular and ragged
 Often contaminated with bacteria
and debris from whatever object
caused the cut
PUNCTURED WOUND
 It is caused by a sharp pointy
object
 This type of wound usually does
not bleed excessively
 Can appear to close up
 Also prone to infection
GUN SHOT WOUND
CLOSE RANGE
GUN SHOT WOUND
INTERMEDIATE RANGE
MULTIPLE KNIFE STAB
WOUNDS
EMERGENCY WOUND
CARE
 1. Anesthesia & wound cleansing
 2. Hemostasis
 3. Wound exploration
 4. Debridement
 5. Wound closure
 6. Antibiotics
WOUND FAILURE
 1. Wound fibrosis
 2. Wound infection
 3. Dehiscence
HYPERTROPHIC SCAR
HYPERTROPHIC SCAR

 During the active phase the scar

may:
– become firm to the touch,
– may rise from the surrounding
unbroken skin,
– but remain within the boundaries of
the original wound
HYPERTROPHIC SCAR
 This type of scar generally
improves with time
 Tends to occur more frequently in
people with darker skin
HYPERTROPHIC SCAR
KELOIDS
KELOIDS
 An overgrowth of fibrous tissue on
the skin
 Keloids occur due a defective or
overactive healing process in
which an excess of collagen forms
at the site of healing scar
KELOIDS
SIGNS AND SYMPTOMS
 Firm, raised, hard scars
 Slightly pink
 May itch, cause pain, are tender to the
touch
 May continue to grow and develop
“claw-like” projections over a period of
time
 It looks ugly and does not improve
with time
KELOIDS- CAUSES
 Skin injury:
– Surgical incisions
– Traumatic wounds
– Vaccination sites
– Burns
– Chickenpox
KELOIDS AFTER
THERMAL RADIATION
SUTURE MATERIAL
 1. Needles
– Straight or curved
– Cutting or circular tips
 2. Suture
– Absorbable or non absorbale
– Braided or monofilament
 3. Metal staples
 4. Skin tapes
TYPES OF STITCHES
 1. Simple interrupted stitches
 2. Running locked stitches
 3. Running sub cuticular stitches
 4. Vertical mattress sutures
 5. Horizontal mattress stitches
KNOTS
 1. Granny knot
 2. Square knot
 3. Surgeon’s knot
SUTURE REMOVAL

 2 DAYS POSTOP.- HEAD, NECK

 7 DAYS POSTOP- ABDOMEN,

THORAX

 9 DAYS POSTOP- WHERE THERE

IS ANY RISK OF SEPARATION