WOUNDS AND THEIR WOUNDS AND THEIR MANAGEMENTMANAGEMENT

Inflammation, epitheliallization, Inflammation, epitheliallization, granulation, fibroplasias, granulation, fibroplasias, contractioncontraction

Processes occur simultaneously Processes occur simultaneously rather than a series of discrete rather than a series of discrete steps steps

WOUNDSWOUNDS

A DISRUPTION OF NORMAL A DISRUPTION OF NORMAL ANATOMIC RELATIONSHIPSANATOMIC RELATIONSHIPS

AS A RESULT OF AN INJURYAS A RESULT OF AN INJURY THE INJURY - INTENTIONALTHE INJURY - INTENTIONAL

- ACCIDENTAL- ACCIDENTAL

WOUNDSWOUNDS

DISRUPTION OF TISSUE DISRUPTION OF TISSUE INTEGRITY INTEGRITY – SURGICALSURGICAL– TRAUMATICTRAUMATIC

STIMULATES A SERIES OF STIMULATES A SERIES OF CELLULAR AND MORPHOLOGIC CELLULAR AND MORPHOLOGIC EVENTS- SPONTANEOUS WOUND EVENTS- SPONTANEOUS WOUND CLOSURECLOSURE

WOUNDSWOUNDS

IMPAIREMENT OF NORMAL IMPAIREMENT OF NORMAL HEALING, ESPECIALLY BY HEALING, ESPECIALLY BY INFECTION INFECTION

IS A MAJOR SOURCE OF SURGICAL IS A MAJOR SOURCE OF SURGICAL MORBIDITYMORBIDITY

WOUND REPAIRWOUND REPAIRTHREE BASIC THREE BASIC PROCESSESPROCESSES

1. Epithelial coverage of the 1. Epithelial coverage of the woundwound

2. Collagen formation2. Collagen formation

3. Contraction in the tissues3. Contraction in the tissues

WOUND REPAIRWOUND REPAIRTHREE BASIC PHASESTHREE BASIC PHASES

1. THE LAG PHASE1. THE LAG PHASE

2. THE PROLIFERATIVE PHASE2. THE PROLIFERATIVE PHASE

3. THE MATURATION PHASE3. THE MATURATION PHASE

WOUND HEALINGWOUND HEALING

For 2-6 months the scar is For 2-6 months the scar is described immature or activedescribed immature or active

Scars become fully mature from Scars become fully mature from 1-3 years after the surgery or 1-3 years after the surgery or injuryinjury

WOUND HEALINGWOUND HEALING

When a scar matures:When a scar matures:– The color fadesThe color fades– The scar softensThe scar softens– It becomes flatterIt becomes flatter– It is less itchy It is less itchy

HEALING WOUNDSHEALING WOUNDSCLASSIFICATIONCLASSIFICATION

1. PRIMARY HEALING1. PRIMARY HEALING

2. SECONDARY HEALING2. SECONDARY HEALING

NUTRITIONNUTRITION

PROTEIN DEPLETIONPROTEIN DEPLETION VIT. C – FIBROBLASTS PRODUCE VIT. C – FIBROBLASTS PRODUCE

LESS COLLAGENLESS COLLAGEN VIT A VIT A VIT B6 DEFICIENCY IMPAIRS VIT B6 DEFICIENCY IMPAIRS

COLLAGEN LINKINGCOLLAGEN LINKING VIT B1 – B2VIT B1 – B2 ZINC DEFICIENCYZINC DEFICIENCY

WOUNDSWOUNDSTREATMENT OPTIONSTREATMENT OPTIONS Delayed primary closureDelayed primary closure

Healing by secondary intentionHealing by secondary intention

Skin graftingSkin grafting

IMPAIRED WOUND IMPAIRED WOUND HEALINGHEALING Systemic risk factorsSystemic risk factors

Local risk factorsLocal risk factors

Systemic risk factorsSystemic risk factors

1. Malnutrition1. Malnutrition 2. Diabetes mellitus2. Diabetes mellitus 3. Sepsis3. Sepsis 4. Chemotherapy4. Chemotherapy 5. Immunosuppressant5. Immunosuppressant

Local risk factorsLocal risk factors

1. Local ischemia- PVD1. Local ischemia- PVD 2. Radiotherapy- ischemic vasculitis2. Radiotherapy- ischemic vasculitis 3. Obesity3. Obesity 4. Local edema4. Local edema 5. Tension suture on wound edges5. Tension suture on wound edges 6. Pressure over a bony prominence6. Pressure over a bony prominence 7. Dry environment7. Dry environment 8. Presence of necrotic tissue8. Presence of necrotic tissue

WOUNDSWOUNDSCLASSIFICATIONCLASSIFICATION 1. Incised wound1. Incised wound 2. Punctured wound2. Punctured wound 3. Laceration3. Laceration 4. Shear wound4. Shear wound 5. Missile wound5. Missile wound

LACERATIONLACERATION

A wound that is produced by the A wound that is produced by the tearing of soft body tissuetearing of soft body tissue

This type of wound is often This type of wound is often irregular and raggedirregular and ragged

Often contaminated with bacteria Often contaminated with bacteria and debris from whatever object and debris from whatever object caused the cutcaused the cut

PUNCTURED WOUNDPUNCTURED WOUND

It is caused by a sharp pointy It is caused by a sharp pointy objectobject

This type of wound usually does This type of wound usually does not bleed excessivelynot bleed excessively

Can appear to close upCan appear to close up Also prone to infectionAlso prone to infection

GUN SHOT WOUNDGUN SHOT WOUNDCLOSE RANGECLOSE RANGE

GUN SHOT WOUNDGUN SHOT WOUNDINTERMEDIATE RANGEINTERMEDIATE RANGE

MULTIPLE KNIFE STAB MULTIPLE KNIFE STAB WOUNDSWOUNDS

EMERGENCY WOUND EMERGENCY WOUND CARECARE 1. Anesthesia & wound cleansing1. Anesthesia & wound cleansing 2. Hemostasis2. Hemostasis 3. Wound exploration3. Wound exploration 4. Debridement4. Debridement 5. Wound closure5. Wound closure 6. Antibiotics6. Antibiotics

WOUND FAILUREWOUND FAILURE

1. Wound fibrosis1. Wound fibrosis 2. Wound infection2. Wound infection 3. Dehiscence3. Dehiscence

HYPERTROPHIC SCARHYPERTROPHIC SCAR

HYPERTROPHIC SCARHYPERTROPHIC SCAR

During the active phase the scar During the active phase the scar may:may:– become firm to the touch,become firm to the touch,– may rise from the surrounding may rise from the surrounding

unbroken skin,unbroken skin,– but remain within the boundaries of but remain within the boundaries of

the original woundthe original wound

HYPERTROPHIC SCARHYPERTROPHIC SCAR

This type of scar generally This type of scar generally improves with timeimproves with time

Tends to occur more frequently in Tends to occur more frequently in people with darker skinpeople with darker skin

HYPERTROPHIC SCARHYPERTROPHIC SCAR

KELOIDSKELOIDS

KELOIDSKELOIDS

An overgrowth of fibrous tissue on An overgrowth of fibrous tissue on the skinthe skin

Keloids occur due a defective or Keloids occur due a defective or overactive healing process in overactive healing process in which an excess of collagen forms which an excess of collagen forms at the site of healing scarat the site of healing scar

KELOIDSKELOIDSSIGNS AND SYMPTOMS SIGNS AND SYMPTOMS Firm, raised, hard scars Firm, raised, hard scars Slightly pinkSlightly pink May itch, cause pain, are tender to the May itch, cause pain, are tender to the

touchtouch May continue to grow and develop May continue to grow and develop

“claw-like” projections over a period of “claw-like” projections over a period of timetime

It looks ugly and does not improve with It looks ugly and does not improve with time time

KELOIDS- CAUSESKELOIDS- CAUSES

Skin injury:Skin injury:– Surgical incisionsSurgical incisions– Traumatic woundsTraumatic wounds– Vaccination sitesVaccination sites– BurnsBurns– ChickenpoxChickenpox

KELOIDS AFTER KELOIDS AFTER THERMAL RADIATIONTHERMAL RADIATION

SUTURE MATERIALSUTURE MATERIAL

1. Needles1. Needles– Straight or curvedStraight or curved– Cutting or circular tipsCutting or circular tips

2. Suture2. Suture– Absorbable or non absorbaleAbsorbable or non absorbale– Braided or monofilamentBraided or monofilament

3. Metal staples3. Metal staples 4. Skin tapes4. Skin tapes

TYPES OF STITCHESTYPES OF STITCHES

1. Simple interrupted stitches1. Simple interrupted stitches 2. Running locked stitches2. Running locked stitches 3. Running sub cuticular stitches3. Running sub cuticular stitches 4. Vertical mattress sutures4. Vertical mattress sutures 5. Horizontal mattress stitches5. Horizontal mattress stitches

KNOTSKNOTS

1. Granny knot1. Granny knot 2. Square knot2. Square knot 3. Surgeon’s knot3. Surgeon’s knot

SUTURE REMOVALSUTURE REMOVAL

2 DAYS POSTOP.- HEAD, NECK2 DAYS POSTOP.- HEAD, NECK

7 DAYS POSTOP- ABDOMEN, 7 DAYS POSTOP- ABDOMEN, THORAXTHORAX

9 DAYS POSTOP- WHERE THERE IS 9 DAYS POSTOP- WHERE THERE IS ANY RISK OF SEPARATIONANY RISK OF SEPARATION