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Wound and Types

The document discusses wound classification, healing, and care. It outlines four main classifications of wounds: closed vs open, tidy vs untidy, acute vs chronic, and tetanus prone vs non-prone. It also describes the phases of wound healing as hemostasis and inflammation, proliferative, and maturation/remodeling. Key aspects of wound care discussed are wound assessment, preparation through irrigation and debridement, closure methods, dressing, and use of adjuncts like antibiotics. Special considerations are given to human and dog bites.

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Sameeha Abbass
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661 views

Wound and Types

The document discusses wound classification, healing, and care. It outlines four main classifications of wounds: closed vs open, tidy vs untidy, acute vs chronic, and tetanus prone vs non-prone. It also describes the phases of wound healing as hemostasis and inflammation, proliferative, and maturation/remodeling. Key aspects of wound care discussed are wound assessment, preparation through irrigation and debridement, closure methods, dressing, and use of adjuncts like antibiotics. Special considerations are given to human and dog bites.

Uploaded by

Sameeha Abbass
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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WOUNDS

M.Khan
Objectives
Classification

Wound healing
o Types
o Phases
o Delayed healing
o Abnormal healing

Wound care
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.
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.
2- Tidy Vs Untidy

Tidy Untidy
- Incised - Crushed
- Clean - Contaminated
- Healthy tissue - Devitalized tissue
- Seldom tissue loss - Often tissue loss
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
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
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)
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
2- Clean-contaminated Wound

 No inflammation/Infection present
 Minor break in sterile technique

 Potential infection rate 8% - 10%


 Examples
 Simple appendectomy
 Prostatectomy
 Cholecystectomy
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
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
Wound Healing
A complex mechanism involving cellular & chemical 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
Types of Clinical Wound Healing

o Primary Intention

o Secondary Intention

o Tertiary Intention (Delayed Primary Closure)


Primary Intention
 For clean wounds

 Wound is sutured/closed

 Healing occurs from side-to-side

 Healing occurs rapidly with little


inflammation and minimal scarring
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


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
Phases of Wound Healing
Hemostasis & Inflammation phase

Proliferative phase

Maturation & Remodeling phase


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
Proliferative phase

Begins about the 3rd post injury day & continues up to 3wks

Fibroblasts & Endothelial cells

Collagen(type-3) & new blood vessels


formation(angiogenesis)
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


Factors affecting wound healing

Local Systemic
 Ischemia  Age
 Stress

 Infection
 Ischemia
 Diabetes
 Foreign body

 Steroids
 Edema
 Smoking

 Immunocompromise
 Malnutrition
Abnormal wound healing
Hypertrophic scar
Keloid

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.


2- Wound preparation
- irrigation helps in:
- to visualize areas of the wound.
- to remove Fb
- foreign body removal

- necrotic tissue debridement

- evacuation of hematoma
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.
4- Dressing
 maintain a clean environment

 prevent pressure and mechanical trauma

 reduce edema

 stimulates repair

 comfort and aesthetic appearance


Other adjuncts

Antibiotics
o Prophylactic
o Therapeutic

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

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