Dressing Surgical Wounds, Abrasion and Lacerations

dressing

1. DRESSING SURGICAL WOUNDS, ABRASIONS AND LACERATIONS Prepared by: Gianne T. Gregorio

2. WOUNDS are injuries that break the skin or other body tissues. They include cuts, scrapes, scratches, and punctured skin. They often happen because of an accident, but surgery, sutures, and stitches also cause wounds . introduction

3. WOUND CLASSIFICATION ACUTE WOUND - is any surgical wound that heals by primary intention or any traumatic or surgical wound that heals by secondary intention. An acute wound is expected to progress through the phases of normal healing, resulting in the closure of the wound.   CHRONIC WOUND- is a wound that fails to progress healing or respond to treatment over the normal expected healing time frame (4 weeks) and becomes "stuck" in the inflammatory phase. This pathologic inflammation is due to a postponed, incomplete or uncoordinated healing process. Wound healing is delayed by the presence of factors including medications, poor nutrition, co-morbidities or inappropriate dressing selection.

4. Wound healing PRIMARY INTENTION - the wound edges are held together by artificial means such as sutures, staples, tapes or tissue glue. There is minimal tissue loss and wounds heal with minimal scarring. Most clean surgical wounds and recent traumatic injuries are managed by primary closure. DELAYED PRIMARY INTENTION - when the wound is infected or requires more thorough intensive cleaning or debridement prior to primary closure usually 3-7 days later. May be used for traumatic wounds or contaminated surgical wounds. SECONDARY INTENTION - spontaneous wound healing occurs through a process of granulation, contraction and epithelialisation . Results in scar formation and used as a method of healing for pressure injuries , ulcers.

5. 1. SURGICAL WOUND An incision, it is a cut through the skin that is made during surgery. Some incisions are small, others are long. The size of the incision depends on the kind of surgery you had .

6. Surgical wounds (incisions) heal by primary intention when the wound edges are brought together and secured, often with sutures, staples, or clips. Wound dressings applied after wound closure may provide physical support, protection and absorb exudate. There are many different types of wound dressings available and wounds can also be left uncovered (exposed). Surgical site infection (SSI) is a common complication of wounds and this may be associated with using (or not using) dressings, or different types of dressing.

7. 2. LACERATION A laceration is a deep cut or tearing of your skin. Accidents with knives, tools, and machinery are frequent causes of lacerations. In the case of deep lacerations, bleeding can be rapid and extensive.

8. Types of laceration SPLIT LACERATIONS -caused by compression of the skin between the weapon & bone e.g . a blow with a heavy blunt weapon on head, face, lateral & back of elbow, shin of the leg / hip

9. Types of laceration 2. TORN LACERATIONS - caused by a projecting surface of an object being dragged over the the skin e.g. road traffic accidents , machinery accidents

10. Types of laceration 3. STRETCH LACERATIONS - caused by a heavy blunt impact on a fixed, localized area of skin causing the skin to overstretch The picture shows a laceration of the scalp in a laborer working in a garment factory. Her hair got tangled with a rotating wheel resulting in over stretching of the scalp.

11. Types of laceration 4. PERFORATED LACERATIONS - caused by objects capable of penetrating the skin e.g. missiles of firearms, shrapnel from explosions The picture shows the entry wound of a firearm injury below the left breast over thorax in a suicidal injury. This was caused by a twelve-bore shotgun.

12. Types of laceration 5. BLAST LACERATIONS - caused by local blast effect of expanding gases e.g. blast injuries

13. Types of laceration 6. CUT LACERATIONS - caused by blunted sharp weapons e.g. ice picks, blade FRONT VIEW SIDE VIEW

14. Types of laceration CRUSH LACERATIONS - occurs as a result of crush injury where the injury is caused by protruding bone fragments e.g . crush injury of the fingers

15. Types of laceration 8. DE-GLOVED LACERATIONS - caused by grinding force over the body resulting peeling off of the skin from underlying tissues e.g. road traffic accident The picture shows the peeling off of the skin and subcutaneous tissues of the left whole leg up to the groin, exposing muscle and bone.

16. Laceration repair options in the outpatient setting include sutures, tissue adhesives, staples, and skin-closure tape. Physicians should have a working knowledge of these techniques, including how to choose the correct closure method and how to perform closures to obtain optimal results. Wounds requiring extensive debridement or multiple-layer closure are best repaired with a suture. Areas of high skin tension, such as over joints, or areas with a thick dermis, such as on the back, should be repaired with sutures or staples. Areas with low skin tension, such as on the face, shin, and dorsal hand, may be effectively repaired with tissue adhesives, especially in children . Suture techniques for laceration repair. ( A ) Single interrupted closure .   (B)  Running (“baseball”) closure.   (C)   Subcuticular running closure .

17. HOW TO CARE FOR STITCHES (SUTURES) Stitches are special threads that are sewn through the skin at an injury site to bring a wound together. Care for stitches and wound as follows: Keep the area dry for the first 24 to 48 hours after stitches have been placed. Then, you can start to gently wash around the site 1 to 2 times daily. Wash with cool water and soap. Clean as close to the stitches as you can. DO NOT wash or rub the stitches directly. Dab the site dry with a clean paper towel. DO NOT rub the area. Avoid using the towel directly on the stitches. If there was a bandage over the stitches, replace it with a new clean bandage and antibiotic treatment, if so instructed. The doctor should also tell when you need to have a wound checked and the stitches removed.

18. HOW TO CARE FOR STAPLES Medical staples are made of special metal and are not the same as office staples. Care for staples and wound as follows: Keep the area completely dry for 24 to 48 hours after staples are placed. Then, you can start to gently wash around the staple site 1 to 2 times daily. Wash with cool water and soap. Clean as close to the staples as you can. DO NOT wash or rub the staples directly. Dab the site dry with a clean paper towel. DO NOT rub the area. Avoid using the towel directly on the staples. If there was a bandage over the staples, replace it with a new clean bandage and antibiotic treatment as directed by the doctor. The doctor should also tell when you need to have a wound checked and the staples removed .

19. 3 . ABRASION An abrasion occurs when your skin rubs or scrapes against a rough or hard surface. Road rash is an example of an abrasion. There’s usually not a lot of bleeding, but the wound needs to be scrubbed and cleaned to avoid infection.

20. Abrasions can range from mild to severe. Most abrasions are mild and can easily be tended to at home. Some abrasions, however, may require medical treatment. FIRST-DEGREE ABRASION A first-degree abrasion involves superficial damage to the epidermis. The epidermis is the first, or most superficial, layer of skin. A first-degree abrasion is considered mild. It won’t bleed. First-degree abrasions are sometimes called scrapes or grazes. SECOND-DEGREE ABRASION A second-degree abrasion results in damage to the epidermis as well as the dermis. The dermis is the second layer of skin, just below the epidermis. A second-degree abrasion may bleed mildly. THIRD-DEGREE ABRASION A third-degree abrasion is a severe abrasion. It’s also known as an avulsion wound. It involves friction and tearing of the skin to the layer of tissue deeper than the dermis. An avulsion may bleed heavily and require more intense medical care.

21. Choice of dressing A wound will require different management and treatment at various stages of healing. No dressing is suitable for all wounds; therefore frequent assessment of the wound is required. Wound healing progresses most rapidly in an environment that is clean, moist (but not wet), protected from heat loss, trauma and bacterial invasion. Much research has demonstrated that moisture control is a critical aspect of wound care. The appropriate dressing can have a significant effect on the rate and quality of healing. The appropriate dressing will help to minimize bacterial contamination and pain associated with wound care.

22. Characteristics of the ideal dressing: No single dressing is suitable for all types of wounds. Often a number of different types of dressings will be used during the healing process of a single wound. Dressings should perform one or more of the following functions: Maintain a moist environment at the wound/dressing interface Absorb excess exudate without leakage to the surface of the dressing Provide thermal insulation and mechanical protection Provide bacterial protection Allow gaseous and fluid exchange Absorb wound odour Be non-adherent to the wound and easily removed without trauma Provide some debridement action (remove dead tissue and/or foreign particles) Be non-toxic, non-allergenic and non- sensitising (to both patient and medical staff) Sterile

23. HYDROCOLLOID DRESSINGS (INCLUDING HYDROFIBRES) Hydrocolloid fibres are now available in the form of a hydrophilic, non-woven flat sheet, referred to as hydrofibre dressings. On contact with exudate, fibres are converted from a dry dressing to a soft coherent gel sheet, making them suitable for wounds with a large amount of exudate. TYPE OF DRESSING USES Hydrocolloid sheets: Alione , CombiDERM , CombiDERM N, Comfeel , *   Comfeel Plus, Cutinova Thin, *   DuoDERM Extra Thin, *   Granuflex , * Tegasorb , Tegasorb Thin C avity or flat shallow wounds with low to medium exudate; absorbent; conformable; good in “difficult” areas—heel, elbow, sacrum Hydrocolloid paste: GranuGel Paste * May be left in place for several days; useful debriding agent; may cause maceration Hydrofibre : Aquacel ( Hydrofibre ), Versiva Useful in flat wounds, cavities, sinuses, undermining wounds; medium to high exudate wounds; highly absorbent; non-adherent; may be left in place for several days; needs secondary dressing

24. LOW ADHERENT DRESSINGS are cheap and widely available. Their major function is to allow exudate to pass through into a secondary dressing while maintaining a moist wound bed . Tulles — Bactigras , Jelonet , Paranet , Paratulle , Tullegras , Unitulle , Urgotul Textiles — Atrauman , Mepilex , Mepitel , NA Dressing, NA Ultra, Tegapore , Tricotex

25. HYDROGELS Examples include Aquaform , Intrasite , GranuGel , Nu-Gel, Purilon , Sterigel • Supply moisture to wounds with low to medium exudate • Suitable for sloughy or necrotic wounds • Useful in flat wounds, cavities, and sinuses • May be left in place several days • Need secondary dressing • May cause maceration

26. SEMIPERMEABLE FILMS were one of the first major advances in wound management and heralded a major change in the way wounds were managed. They consist of sterile plastic sheets of polyurethane coated with hypoallergenic acrylic adhesive and are used mainly as a transparent primary wound cover. Examples include Bioclusive , Mefilm , OpSite Flexigrid , *   OpSite Plus, Tegaderm

27. FOAM DRESSINGS are manufactured as either a polyurethane or silicone foam. They transmit moisture vapour and oxygen and provide thermal insulation to the wound bed. TYPE OF DRESSING USES Adhesive sheets: Allevyn Adhesive, Allevyn Lite Island, Allevyn Thin, Allevyn Plus Adhesive, Biatain Adhesive, Lyofoam Extra Adhesive, Tielle Plus, Tielle Lite, Tielle Flat, shallow wounds (control of exudate depending on type of foam); give degree of cushioning; may be left in place for two to three days Need secondary dressing Non-adherent sheets: Allevyn , *   Allevyn Lite, Lyofoam , * Lyofoam Extra * Allevyn Cavity, Allevyn Plus Cavity, Cavi -Care Cavity wound with medium to high exudate