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1. ARTICLE REFERENCE TYPES AND MANAGEMENT OF WOUNDS DEPARTMENT OF GENERAL SURGERY SEBELAS MATER UNIVERSITY / DR. MOEWARDI REGIONAL HOSPITAL SURAKARTA 1 d r. Egi Ghilman Islami NIM S562408006 d r. Dewi Haryanti, Sp.BP-RE, Subsp. KM(K)

2. Department of General Surgery Sebelas Maret University Page # Index & Content Definition Classification Type of wound Management Conclusion

3. Introduction Department of General Surgery Sebelas Maret University Page # Wounds are a frequent clinical concern encountered across various medical settings. Each type of wound presents distinct challenges regarding infection risk, healing progression, and therapeutic strategy. For physicians, a deep understanding of wound types and their management is crucial. It informs clinical decision-making, reduces morbidity, and improves patient outcomes 3

4. Department of General Surgery Sebelas Maret University Page # Definition; wound A disruption in the normal anatomical structure and function of the skin or underlying tissues, typically caused by physical, chemical, thermal, or microbial injury (Bryant & Nix, 2016)

5. Department of General Surgery Sebelas Maret University Page # Clasification Etiology Duration Contamination involvement 5

6. Surgical Wounds Etiology reated intentionally under sterile conditions; low infection risk; heal by primary intention (Bryant & Nix, 2016). Traumatic Wounds Caused by mechanical forces (e.g., blunt or sharp trauma); vary from minor to severe (Guo & DiPietro, 2010). Burn Wounds Due to thermal, electrical, chemical, or radiation exposure; healing depends on depth and area (Bryant & Nix, 2016). Pressure Injuries Result from prolonged pressure over bony areas; common in immobile patients (NPIAP, 2016). Department of General Surgery Sebelas Maret University Diabetic Ulcers Chronic wounds from neuropathy and poor circulation in diabetes; slow healing (EWMA, 2004). Venous Ulcers Caused by venous insufficiency; recurrent, often in lower legs with edema (Leaper & Harding, 2015). Arterial Ulcers Due to poor blood flow in peripheral arteries; typically painful, with well-defined edges (Bryant & Nix, 2016). Infectious Wounds Caused or worsened by microbial invasion; delays healing (Guo & DiPietro, 2010).

7. Department of General Surgery Sebelas Maret University Page # Acute Healing delayed >4–6 weeks Often stalled in inflammatory phase Associated with infection, ischemia, or comorbidities Examples: diabetic foot ulcers, pressure injuries, venous leg ulcers Chronic 7 Heal in a timely (within 2–4 weeks) Follow normal healing phases Common causes: trauma or surgery Examples: surgical incisions, minor lacerations, abrasions

8. Contaminant Involvement Department of General Surgery Sebelas Maret University Page # 1. Clean Wounds (NIH, 2020a) Surgical wounds made under sterile conditions No entry into respiratory, GI, GU, or genital tracts No signs of infection or inflammation Low infection risk 2. Clean-Contaminated Wounds (NIH, 2020b) Controlled entry into respiratory, GI, GU, or genital tracts No unusual contamination Slightly increased infection risk 3. Contaminated Wounds (NIH, 2020a) Major breach in sterile technique or fresh traumatic wounds Presence of debris or bacterial contamination High infection risk 4. Dirty or Infected Wounds (FACS, 2022) Contains pus, necrotic tissue, or active infection Often from delayed treatment or perforated organs Very high infection risk 8

9. Type of Wounds Department of General Surgery Sebelas Maret University Page # For Employee Name 10

10. Incision Caused by sharp objects (e.g., scalpel, knife) Clean, straight-edged; often surgical Heals by primary intention (sutured or glued) Fast healing with minimal scarring if aseptic technique is maintained Complications: infection, hematoma, or wound dehiscence if improperly managed (Bryant & Nix, 2016)

11. Laceration Caused by blunt trauma or shearing forces Irregular, torn wound edges Disruption of the epidermal/dermal junction Higher risk of tissue damage and contamination than incisions Requires mechanical support (e.g., sutures) for closure Important to assess for infection and underlying injury (Frank et al., 2015; Myers, 2019; Guo & DiPietro, 2010)

12. Abrasion Caused by friction against a rough surface Involves superficial skin loss (epidermis only) Typically painful but heals without scarring Risk of infection due to open surface Requires thorough irrigation to remove debris (Leaper & Harding, 1998; Myers, 2019)

13. Avulsion Caused by traumatic tearing or pulling forces Tissue forcibly detached from its normal position Involves skin, subcutaneous tissue, sometimes muscle or bone Often results in heavy bleeding and high infection risk May require surgical repair or skin grafting Potential for disfigurement or functional loss (Bryant & Nix, 2016; Gao et al., 2020)

14. Burn Wounds Burn injuries result from the transfer of energy from a heat source to the body.

15. Burn Wounds They are classified by depth

16. Pressure Ulcers Mechanism

17. Pressure Ulcers

18. Diabetic Ulcers Typically occur on feet of diabetic patients Caused by neuropathy, poor circulation, and delayed healing High risk of infection and amputation if untreated Pathogenesis: Chronic inflammation Impaired re-epithelialization & angiogenesis HIF-1α suppression from hyperglycemia Neutrophil extracellular traps contribute to tissue damage Management: Pressure offloading, infection control, vascular support (Singh et al., 2005; Sinwar, 2015; Catrina & Zheng, 2016; Ma et al., 2023)

19. Radiation Caused by prolonged/high-dose ionizing radiation Lead to skin and deep tissue damage, delayed healing, and fibrosis Early effects (2–4 weeks): Dermatitis, erythema, edema Caused by capillary permeability and vascular congestion Severe cases: Radiation necrosis due to poor perfusion Ulceration may occur from minor trauma Chronic effects: Radiation fibrosis from collagen imbalance (Myers, 2019)

20. Management Department of General Surgery Sebelas Maret University Page # For Employee Name 21

21. Department of General Surgery Sebelas Maret University Page # Three Principles of Wound Care Offload pressure (e.g., special footwear or cushions) Reduce friction and shear Protect from moisture Use compression for venous ulcers Prevent trauma to insensate (numb) areas Control or Eliminate Causative Factors Provide Systemic Support Optimize nutrition and hydration Reduce edema Control blood glucose levels Promote blood flow: Avoid cold, Control pain, Eliminate nicotine & caffeine Maintain Local Physiologic Wound Environment Remove biofilm Cleanse wound Debride nonviable tissue Maintain proper moisture Eliminate dead space Control odor & pain Protect periwound skin 22

22. Department of General Surgery Sebelas Maret University Page # Debridement Purpose & Benefits ✂️ Removes necrotic tissue & foreign material 🧬 Reduces bacterial load & infection risk 👁️ Improves wound visualization & assessment ⚖️ Restores healing balance (protease & cytokine levels)

23. 🔄 Autolytic – Body’s own enzymes under moist dressing 🧪 Enzymatic – Topical agents (e.g., collagenase) 🔪 Conservative Sharp – Scissors or scalpel, precise removal 🪱 Biosurgical – Sterile maggots digest necrotic tissue 🌫️ Ultrasonic Mist – Low-frequency sound waves via saline Team Name Page # Selective Methods (target only dead tissue) Nonselective Methods (may remove healthy tissue) 🏥 Surgical Sharp – Aggressive operative removal 💦 Hydrotherapy – Whirlpool, may harm viable tissue 🩹 Wet-to-Dry Dressings – Gauze pulls away tissue when removed 25

24. Other Factor of Wound Closure Closure Material The zip-type closure led to shorter procedure times without affecting pain or cosmetic results. Sterile vs non sterile gloves Repairs are commonly done using sterile gloves, but a controlled trial involving 493 patients undergoing minor skin excisions concluded that non-sterile gloves were not inferior to sterile ones in preventing wound infections. Irrigation Irrigation is thought to cleanse the wound of dirt and debris and lessen the bacterial load prior to closure. Suturing Technique Many lacerations are repaired in the ED, an RCT studies found that superficial wound dehiscence may be reduced using continuous subcuticular sutures. W-plasty is to minimize scarring for lacerations which deviate more than 30 degrees from the relaxed skin tension line, as this degree of deviation makes lacerations more prone to noticeable scar formation Department of General Surgery Sebelas Maret University

25. Role of Moisture in Healing Dr. Winter demonstrated that wounds heal faster in a moist environment. Moisture plays a crucial role in epithelial cell migration, which is essential for wound resurfacing. This understanding spurred the development of modern dressings designed not only to protect wounds but also to support healing by retaining moisture, absorbing excess exudate, and preventing bacterial contamination. Traditional methods like wet-to-dry gauze are still frequently used, particularly by surgeons, , even though its effectiveness is inferior to modern alternatives. Department of General Surgery Sebelas Maret University

26. Team Name Page # Drug Used Moisture- retaining Agent (Hydrofibers and Alginates) Novel Agents (Topical phenytoin) Honey (medical grade) reducing infection rate and promoting healing Topical insulin (still under investigation, but show promise in accelerating wound healing Topical 28 Topical Antibiotic (Mupirocin and gentamicin) Antiseptic (Silver sulfadiazine and cadexomer iodine) Growth Factors (Recombinant Human Platelet-Derived Growth Factor (rhPDGF) and Epidermal Growth Factor (EGF))

27. Team Name Page # Drug Used Nutritional Supplement (Vitamin C (ascorbic acid) is vital for collagen production) Systemic Growth Factors, systemic administration is being explored as a potential method to enhance wound healing, particularly in chronic or non-healing wounds. Systemic 29 Systemic Antibiotic (Amoxicillin and ciprofloxacin) Analgesik (NSAID such as Ibuprofen) Corticosteroid, Occasionally prescribed for chronic wounds where inflammation is a major issue. Long term used may impair collagen synthesis and delay healing

28. Urgent surgical debridement is critical to manage rapidly spreading infections and reduce mortality. Clinical signs: crepitus, skin discoloration, disproportionate pain, systemic toxicity. Necrotizing Soft Tissue Infections (NSTIs) Do We Need Surgery? Team Name Advanced Pressure Ulcers (Stage III & IV) Surgical decisions must consider patient comorbidities and recurrence risk. Require surgical debridement to remove necrotic tissue and biofilm. Severely Contaminated Traumatic Wounds Open fractures, crush injuries, or penetrating trauma often demand early surgical debridement. Aims to prevent infection, evaluate tissue viability, and facilitate closure or grafting. Infected Wounds Unresponsive to Antibiotics Surgical debridement helps reduce bacterial load and restore perfusion. Prevents complications like abscess, sepsis, or amputation (Kim et al., 2023).

29. Sharp surgical debridement is the most effective method to rapidly remove non-viable tissue. Extensive Necrotic Tissue or Biofilm Do We Need Surgery? Team Name Chronic Non-Healing Wounds with Functional or Aesthetic Impact Particularly considered when conservative therapy fails over extended periods. Surgical Revision for Failed Wound Closures May involve scar excision, advanced closure methods, or adjuncts like Negative Pressure Wound Therapy (NPWT). Targets previous issues like infection, tension, or poor perfusion.

30. Conclusion Team Name Page # Understanding the principles of wound management is essential for all healthcare professionals. Each type of wound presents unique characteristics and challenges that require specific treatment approaches. Ultimately, effective wound care contributes significantly to improving patients’ quality of life (QoL), enhancing both their physical comfort and psychological well-being. 32

31. Thank you & welcome again 33