Wound

Classificati
on and
Care
Katherine Dart RVN BSc Hons
katherine.dart@sparsholt.ac.uk
FDSC Principles of
VETERINAR Veterinary
Y NURSING Nursing
SCIENCE
AIMS AND OBJECTIVES

1 2 3 4
Identify Discuss Outline the Evaluate
commonly stages of objectives of wound
seen wounds wound wound closure
healing healing options
 ‘An injury in which there is a
forcible break in the continuity of
the soft tissues’ (Hiscock, 1999)
WHAT IS An injury to living tissue caused by
a cut, blow or other impact,
A typically one in which the skin is
WOUND? cut or broken.

What types of wounds have you

seen?
TWO CLASSIFICATIONS
Open Closed
“injuries that involve a break in the skin and “occur when the skin remains intact
leave the internal tissue exposed. ”
and the tissue that lies underneath is
not exposed.”
For example:
Incision
For example:
Laceration
Puncture Contusion
Avulsion Haematoma
Abrasion
OPEN WOUND:
INCISION Edges are clean
cut – by sharp
instruments
Heal more rapidly
(minimal scarring)
– edges knit
together if
held/sutured
OPEN WOUND:
LACERATION
Irregular/jagged
shapes/edges,
haemorrhaging
Most common, usually
from RTA’s, dog fights
etc
Risk of infection,
slower to heal,
significant scarring
OPEN WOUND: Blows from
PUNCTURE sharp, pointed
instruments – by
nails, thorns, fish
hooks, teeth
Minimal
bleeding, prone to
infection, rapid
healing = abscess
OPEN WOUND
AVULSION:
Layer of skin torn off
completely or away from
It’s source.

A type of laceration but

tissue is completely torn
away, flap or large area
removed.
OPEN WOUND:
ABRASIONS
Graze, does not penetrate entire
skin thickness (not a true open
wound)

Capillary bleeding

Painful – nerve exposure

Crushing injury: Compression of flesh/bone
Pressure necrosis: Tight collar/bandage
Pressure sores: constant pressure or friction on one area
of the body
Discharging Sinus: blind-ended track that extends from
the surface of the skin to an underlying area or abscess
cavity
Fistula: an abnormal connection or passageway that
connects two organs or vessels that do not usually

OTHER OPEN
connect
Ulcer: sore on the skin or a mucous membrane,

WOUND TYPES:
accompanied by the disintegration of tissue
Sloughing: shedding of necrotic tissue
  Full thickness skin peeled/pulled
OPEN WOUND: DEGLOVING
off

 Difficult to manage due to lack of

skin to close
OPEN WOUND: Body part removed/detached

AMPUTATION
OPEN WOUND:
BURNS
Thermal, cold, chemical,
electric, radiation

Treatment – dependent on source

Thermal – cool running water,

NO cream/lotions etc, no bandage
CLOSED WOUND:
CONTUSION
Bruise

Blow with a blunt instrument/fall

Blood vessels/skin/soft tissue rupture

Discolouration (damage tissue heals RBC’s

broken down) – red – purple – yellow/green
 CLOSED WOUND:
HAEMATOMA
Pocket of connective tissue (under skin) fills
with blood

Ear pinnae/injection sites

Hard (blood clots contract)

Due to trauma or excessive shaking

 CLOSED WOUNDS
TREATMENT
Cold compress – to reduce blood flow to
damaged capillaries & reduce
inflammation
Bandage the area – support – more
comfortable
Surgery to release pressure
Aural Haematoma – must treat primary
cause to prevent reoccurrence
 ABSCESS – ACUTE
INFLAMMATORY
DISEASE
Discrete collection of purulent material
How do abscesses develop?
 Secondary to bacterial infection
 Closed environment e.g. cat bite abscess
Spontaneous/iatrogenic rupture releases pus
Internal abscesses: rupture can be fatal (e.g.
prostate) – toxaemia / septicaemia
Clinical Signs?
Treatment – Analgesics, draining, lavage,
antibiotics
ABSCESS
HAPPY,
RECOVERING
PIGGY!
ALSO CLASSIFIED BY
THE LEVEL OF
CONTAMINATION
Clean
Clean/contaminated
Contaminated
Dirty
 LOOK AT THE
FOLLOWING
PICTURES
AND CLASSIFY
EACH WOUND:
A) B)
C) D)
E) F)
Immediate care- ABC’s
Consider shock
Reduce pain and discomfort
Clipping (consider how to reduce hair falling into the wound)

1) Lavage
2) Debridement
3) Closure

OBJECTIVES OF
WOUND HEALING
 1) Lavage
“Dilution is the Solution to
Pollution!”
Reduces bacterial load
Most effective delivered
under pressure
Ideal pressure = 8 – 12psi @
a 30 - 45 degree angle
Can be achieved with a 30ml
syringe and a 19G needle.
Use 100ml per 1cm of
wound or until visibly clean.
Best to use Isotonic Solution
as least toxic to healing
tissue.
2) Debridement
Removal of
necrotic/devitalised tissue
Skin that is blue-black,
leathery, thin, or white is
usually not viable.
Sharp dissection
Maggots
Manuka Honey
Wet-to-dry dressing
3) Closure
Primary closure (first
intention)
Delayed primary closure
Secondary closure
Second intention healing
Materials include
sutures, staples, and skin
glue.
CLOSURE OPTIONS
Primary closure (first intention)
The wound is closed immediately after presentation once cleaned and debrided

Delayed primary closure

This is carried out 3 - 5 days after the initial injury.
The delay allows removal of contamination or any exudate that would compromise healing.
At this stage granulation tissue has not yet started to form

Secondary closure
Similar to delayed primary closure, except that it has taken longer to remove any infection
Therefore some granulation tissue has started to form

Second intention healing

Wound left open
Healing occurs by granulation tissue forming and contraction of sound edges and eventually
epithelialisation
Very slow
 1. INFLAMMATORY
STAGE
Starts immediately as soon as injury occurs.
Reaction of normal tissue to injury
Injured blood vessels leak transudate = localised swelling.
Fluid engorgement allows healing and repair cells to move to wound site.
Activation of platelets and fibrin to attract granulocytes (neutrophils)
Clot forms (haemostasis)
WBCs remove bacteria, necrotic tissue, foreign material
Inflammation= final debridement by macrophages

24-48 hours
 2. PROLIFERATIVE
STAGE
Wound is rebuilt with new tissue made from collagen and extracellular matrix
(disorganised and thick)

Triggered by macrophages

3+ weeks

Ne network of blood vessels constructed to feed granulation tissue

Wound contracts as new tissue is built.

Granulation occurs (bright red)

New endothelial cells= new blood vessels (very vascular)

Layer of skin formed (epithelial cells)

Resistant to infection

Days/weeks/months
3. MATURATION
AND REMODELLING Up to 2 years
New collagen forms and shape
changes (more organised
structure)
Strength increases, hair regrows
Results in scar (80% strength)
from new collagen
Diminished response in
immunocompromised/geriatrics
CLOSURE
Suturing

Staples

Tissue Adhesive
 FACTORS AFFECTING
WOUND HEALING
Age Tension

Area affected Interference with blood supply

Malnutrition Self trauma

Corticosteroids/NSAID tx Tumour cells

Anabolic steroids Oedema

Movement Dehiscence

Debris in wound Hair removal at operation site

Infection Systemic disease e.g. hypothyroidism,

diabetes
 Wound dressings:

DRESSIN Absorbent/non-absorbent Adherent/non-adherent

GS AND
Protect a wound from bacterial contamination
Absorb exudates
BANDAG Contribute to debridement: wet to dry dressings

ES Deliver antimicrobial agents: silver nitrate, honey

Maintain a controlled environment around the wound:
alginate

Bandages
More on Wound Keep a dressing in place
dressings next lesson!
Support area , reduce movement of the skin edges
Reduce the development of swelling and oedema
Provide a cosmetic appearance for the owner
Provide comfort
 BANDAGES
Four-layer bandage:

1. Primary or contact layer (dressing) - this

touches the wound and must be sterile

2. Secondary or intermediate layer - padding

usually added for comfort or absorption

3. Tertiary layer - applied over the other layers to

hold them in place, and provide some tension

4. Protective layer - prevent interference and

minimise contamination from the environment