WOUNDS & CARE OF WOUNDS

LECTURE DPT
Wound
Wound is a type of injury in
which the skin is torn,
cut or punctured or
when a blunt force
causes :contusion
Classification of wounds

 Tidy wounds

 Untidy wounds
Wound classification

 Tidy vs. untidy wounds

 Tidy Untidy
 Incised Crushed or avulsed
 Clean Contaminated
 Healthy tissues Devitalized tissues
 Seldom tissue loss Often tissue loss
Wounds:Classification

Acute Chronic
 Caused by external  Precipitated by
damage to intact skin predisposing conditions
that lead to compromise of
 Types dermal/epidermal tissue
 Surgical
 Types
 Bites  Impaired venous drainage
 Burns  Impaired arterial supply
 Minor cuts  Metabolic diseases eg.
 Abrasions diabetes
 Severe traumatic
Acute wounds

 Surgical wounds
 Clean

 Clean contaminated

 Contaminated

 Dirty
Specific wounds

 Abrasions
 Contusion
 Minor cuts
 Puncture wounds
 Laceration
 Degloving
 Bites
 Burns
 Severe traumatic wounds
 Compartment syndrome
 WOUNDS

Tidy wound Untidy wound

wounds

Bite Degloving injury

FACTORS THAT IMPAIR WOUND
HEALING
GeneralFactors

 Malnutrition: protein, calorie, vitamin C, zinc.

 Corticosteroid drugs.
 Immunosuppressant drugs.
 Antineoplastic chemotherapeutic agents.
 Uraemia.
 Jaundice.
 Diabetes Mellitus.
 Congestive cardiac failure.
 Anaemia.
Local Factors

 Infection: bacterial, fungal.

 Foreign body.
 Ischaemia: suture tension, anatomical site of
wound, type of wound, type of wound, tissue
tension, peripheral vascular disease.
 Haematoma.
 Tissue fixation.
Managing the acute wound

 ■ Cleansing
 ■ Exploration and diagnosis
 ■ Debridement
 ■ Repair of structures
 ■ Replacement of lost tissues where indicated
 ■ Skin cover if required
 ■ Skin closure without tension
 ■ All of the above with careful tissue handling
and meticulous technique
Initial Local care of
wounds
 Cover the wound with sterile gauze
 If bleeding.. stop it by application of pressure
Initial Local care of
wounds
 Cover the wound with sterile gauze
 If bleeding.. stop it by application of pressure
Initial Local care of
wounds
 Clean the wound:

 Saline
 Hydrogen peroxide
 Pyodine
Initial Local care of
wounds
 Definitive Initial Care:

 Abrasions Dressings only

 Lacerations (< 6hrs duration) stitching
 Lacerations(> 6hrs duration) No stitching
required except scalp/face wounds
 TERMINOLOGY

 Primary closure.
 Delayed primary closure.
 Secondary closure
Initial Local care of
wounds
 Tetanus Immunization
 WOUNDS

 SLOUGH
Local care of chronic wounds

 Clean the wound

 Apply sterilized gauze
 Apply cotton bandage
Wound Debridement

Removal of dead tissue, slough etc from the

wound to expedite healing process.
Wound Debridement

Removal of dead tissue, slough etc from the

wound to expedite healing process.
Wound Debridement

Removal of dead tissue, slough etc from the

wound to expedite healing process.
General Factors for wound care

 Avoid around a wound:

 Pressure
 Moisture

 Treat if present:
 Anemia
 Malnutrition
 Uremia
 Jaundice
 Hypoalbuminemia
FREE FLAPS
ANASTOMOSE B VESSELS.
 COMPLICATIONS OF WOUNDS

 Wound Infection
 Haematoma
 Dehiscence
 Hypertrophy
 Keloid
Where?

 Anterior Chest
Where?

 Shoulder
DPT LECTURE

STERILE DRESSINGS
 DRESSINGS

DEFINITION A dressing is an
adjunct used by a person for
application to a wound in order to
promote healing and/or prevent
further harm.
Dressings
 Cover
 Stop bleeding
 Aid healing
 Prevent infection
 Soft on granulation tissue
 Drug delivery
 Easy to remove
 Affordable
Aim
• Patient comfort
• Hygeinic & non toxic
• Ease of usage
• Safety
• Affordable
• Quality
• Ease of disposal
Wound Closures

 Staples – cause less trauma and provide extra

strength

 Sutures – external & internal (internal dissolve

on their own)

 Steri strips – sterile butterfly tape applied along

both sides of a wound to keep the edges closed
Steri Strips/Staples/Sutures
Suture Care

 Sutures – removed usually 7 days post-op

 Steri-strip – usually loosen after a few days

and are removed easily

 Staples – need staple remover

Document
(6 days post op C-section)
Debriding agents

 Benoxyl-benzoic acid
 Aserbine-benzoic acid
 Variclene-lactic acid
 Hydrogen peroxide
 Maggots
 Used only in necrotic sloughing skin ulcers
 Enhance healing with debriding action
opsite
Infected Surgical Wound
Requiring Dressing
After Dressing Change
Healing!