wound and types wound healing and dressing.pptx

Wound and it's types

1. WOUNDS Dr . A yesha J amshaid

2. Objectives Classification Wound healing Types Phases Delayed healing Abnormal healing Wound care

3. Introduction Disruption of tissue integrity, leading to division of blood vessels It is caused by a transfer of any form of energy into the body.

4. Classification 1- Closed Vs Open Closed wounds Skin Intact / Underlying tissue damaged e.gs contusion, bruise, hematoma . Open wounds - Complete break of the epithelial protective surface. e.gs abrasion, laceration, puncture, bites.

5. 2- Tidy Vs Untidy Tidy Untidy - Incised - Crushed - Clean - Contaminated - Healthy tissue - Devitalized tissue - Seldom tissue loss - Often tissue loss

6. 3- Acute Vs Chronic Acute wounds Wounds that heal in expected period of time Eg . Lacerations Chronic wounds - Wound that fails to heal over an extended period of time - Caused by inadequate circulation or in which healing is delayed as a result of vascular compromise - eg . Ulcers

7. 4- Tetanus Prone Vs Tetanus Non-prone Tetanus Prone wound age >6hrs wound depth > 1cm presence of devitalized tissue contaminated wounds Animal bites Tetanus Non-prone wound age <6hrs wound depth <1cm absence of devitalized tissue non contaminated wounds

8. Classification of Surgical Wounds Based on the risk of infection & degree of contamination - Clean ( Class-I ) - Clean-contaminated ( Class-II ) - Contaminated ( Class-III ) - Dirty ( Class-IV )

9. 1- Clean wounds No inflammation No break in sterile technique Wound primarily closed/Not drained Potential infection rate 1%-5% Examples Thyroidectomy Mastectomy Lipoma excision

10. 2- Clean-contaminated Wound No inflammation/Infection present Minor break in sterile technique Potential infection rate 8% - 10% Examples Simple appendectomy Prostatectomy Cholecystectomy

11. 3- Contaminated Wound Traumatic wounds Acute inflammation present Major break in sterile technique Gross spillage/contamination from respiratory, gastrointestinal, biliary , or genitourinary tracts Potential infection rate 15% - 20% Example Traumatic wounds Cholecystectomy with bile leak

12. 4- Dirty/Infected Wound Organisms present at surgical site prior to procedure/Existing infection Presence of pus Perforation (Gastrointestinal, biliary , respiratory, genitourinary tract) Potential infection rate 27% - 40% Example abcess Peritonitis

13. Wound Healing A complex mechanism involving cellular & chemica l activity Healing Vs Regeneration Wound repair is the effort of injured tissues to restore their normal function and structural integrity after injury. Regeneration is perfect restoration of the preexisting tissue architecture in the absence of scar formation . In adult humans the accuracy of regeneration is sacrified for the speed of repair

14. Types of Clinical Wound Healing Primary Intention Secondary Intention Tertiary Intention (Delayed Primary Closure)

15. Primary Intention For clean wounds Wound is sutured/closed Healing occurs from side-to-side Healing occurs rapidly with little inflammation and minimal scarring

16. Secondary Intention For contaminated / dirty wounds Wound is intentionally left open Healing occurs from the bottom–up Granulation tissue containing myofibroblasts forms wound contraction Scar formation is extensive

17. Tertiary Intention (Delayed Primary Closure ) For contaminated / dirty Wound is left open until clean for 4-6 days Then, wound is closed Suturing Skin grafting Flap

18. Phases of Wound Healing Hemostasis & Inflammation phase Proliferative phase Maturation & Remodeling phase

19. Hemostasis & Inflammation phase Begins within minutes of the injury and lasts 3 days Hemostasis Vasoconstriction Fibrin clot formation Inflammation manifested by heat, redness, swelling, pain, loss of function Platelets, Neutrophils & Monocytes Goals of this phase are Arrest bleeding Remove dead tissue & foreign bodies Stimulate next phase of wound healing

20. Proliferative phase Begins about the 3rd post injury day & continues up to 3wks Fibroblasts & Endothelial cells Collagen(type-3) & new blood vessels formation(angiogenesis)

21. Maturation & Remodeling phase Lasts until the wound is completely healed, (may take up to 1-2 yr) Tensile strength increased by interweaving of collagen fibers Conversion of type-3 collagen to Type-1 collagen Collagen density increases & formation of new blood vessels decreases Mature scar is formed

22. Factors affecting wound healing Local Ischemia Infection Foreign body Edema Systemic Age Stress Ischemia Diabetes Steroids Smoking Immunocompromise Maln utritio n

23. Abnormal wound healing Hypertrophic scar Keloid

24. Wound Management 1- Assessment of wounds - duration since injury - identification of possible contamination & Fb . - extent of wound - associated neurovascular or tendon injury - need of tetanus prophylaxis - identification of risk factors that might affect healing.

25. 2- Wound preparation - irrigation helps in: - to visualize areas of the wound. - to remove Fb - foreign body removal - necrotic tissue debridement - evacuation of hematoma

26. 3-Wound Closure Timing The choices are: (1) close at the time of initial presentation (2) delay closure until after a period of healing or wound care, and (3) to allow the wound to heal on its own. Methods The closure methods available include: (1) primary closure by direct approximation (2) delayed primary closure, (3) secondary closure-left to heal on its own. (4) skin grafting; and (5) the use of local or distant flaps.

27. 4- Dressing maintain a clean environment prevent pressure and mechanical trauma reduce edema stimulates repair comfort and aesthetic appearance

28. Other adjuncts Antibiotics Prophylactic Therapeutic Tetanus Prophylaxis

29. Special wounds Human bites Management Thorough irrigation with saline or plain water Adequate debridement Leave wound open Broad-spectrum antibiotics Tetanus Prophylaxis Wound observation Dog bites Management Vigorous irrigation Leave wound open Tetanus prophylaxis Antibiotics Post exposure anti rabies prophylaxis (1ml, IM) on the 1st, 3rd, 7th, 14th and 28 th day of bite.

30. Thank You