Wound Healing, Wound Types, Wound Dressings, & Drainage DevicesST230Concorde Career College
Wound Types & Wound HealingObjectives:
List and define the four types of wound classifications and provide examples of wound types for each category.List and describe the types of wounds and provide examples of each.List and describe the types of wound healing and explain the mechanism for each type.
Objectives:
Identify the factors that influence wound healing and understand how to implement techniques that promote optimal wound healing.Describe Halsteds principles of tissue handling and explain the relationship of those principles to todays methods of suturing.List and describe the techniques used for suturing and provide examples of when each may be utilized.Wound Types & Wound Healing
Wound Types & Wound HealingObjectives:
Outline the dressing application process and identify the optimal time for dressing placement.Identify basic abdominal incisions and identify the tissue layers of the abdominal wall.
Wound Types & Wound Healing
Wound Types & Wound Healing
Wound Classifications
Wound Types & Wound Healing
Surgical Wound Classifications
Type I Clean WoundType II Clean-contaminated WoundType IIIContaminatedType IVDirty/Infected
Wound Types & Wound HealingType I - Clean Wound (Potential infection rate 1%-5%)
No inflammationNo break in sterile techniqueWound primarily closed/Not drainedAerodigestive and genitourinary tract not entered
Wound Types & Wound HealingType II - Clean-contaminated Wound(Potential infection rate 8% - 11%)
No inflammation/Infection presentMinor break in techniqueWound primarily closed/Not drainedAerodigestive or genitourinary tract entered under controlled circumstances
Wound Types & Wound HealingType III - Contaminated Wound (Potential infection rate 15% - 20%)Traumatic wound (less than 4 hours old)Acute inflammation presentMajor break in techniqueGross spillage/contamination from respiratory, gastrointestinal, biliary, or genitourinary tracts
Wound Types & Wound HealingType IV - Dirty/Infected Wound (Potential infection rate 27% - 40%)
Traumatic wound (more than 4 hours old)Organisms present at surgical site prior to procedure/Existing infectionPerforation (Gastrointestinal, biliary, respiratory, genitourinary tract)
Wound Types & Wound Healing
Types of Wounds
Wound Types & Wound HealingTypes of Wounds
Intentional (Surgical)
Accidental (Traumatic)
Chronic
Wound Types & Wound HealingIntentional (Surgical)
IncisionPurposeful cut through intact tissue for the purpose of exposure or excisionWounds
ExcisionalRemoval of tissue
Wound Types & Wound Healing
Six Types of Accidental
Closed
Simple
Clean
(Traumatic) Wounds
Open
Complicated
Contaminated
Wound Types & Wound HealingClosed Traumatic WoundSkin Intact / Underlying tissue damaged
Examples:
Blister Simple Fracture
Wound Types & Wound HealingOpen Traumatic WoundSkin Disrupted
Examples:
Laceration Compound Fracture
Wound Types & Wound HealingSimple Traumatic WoundSkin Disrupted/No loss or destruction of tissue/No foreign body implanted
Examples:
Minor penetration Cut with sharp object
Wound Types & Wound HealingComplicated Traumatic WoundSkin disrupted/Underlying tissue lost or destroyed/Foreign body implanted
Examples:
Severe burnStab or bullet wound
Wound Types & Wound HealingClean Traumatic WoundSimple wound caused by a sharp edged object Expected to be sutured and heal by first intention without infectionExample:
Laceration
Wound Types & Wound HealingContaminated Traumatic WoundComplicated wound caused by a dirty object
May need debridement and has a high potential for becoming infectedExamples: Crush Type Injury Foreign Body Implantation
Wound Types & Wound Healing
A SINGLE WOUND MAY BE CLASSIFIED IN MORE THAN ONE CATEGORY
Wound Types & Wound HealingChronic Wound - Wound that fails to heal over an extended period of timeExamples:Decubitus ulcer (Pressure sore)Wound caused by inadequate circulation or in which healing is delayed as a result of vascular compromiseInfected wounds
Wound Types & Wound Healing
Wound Healing
Wound Types & Wound HealingTypes of Wound Healing
First Intention (Primary Union)
Second Intention (Granulation)
Third Intention (Delayed Primary Closure)
Wound Types & Wound HealingFirst Intention (Primary Closure)
Wound is sutured closedHealing occurs from side-to-sideHealing occurs rapidly with little inflammation and minimal scarringWound heals in three phases
Wound Types & Wound HealingPhases of Wound Healing by First Intention
Phase I - Lag Phase or Inflammatory Response PhasePhase II - Proliferation PhasePhase III - Maturation or Differentiation Phase
Wound Types & Wound HealingPhase I - Lag Phase or Inflammatory Response Phase Begins within minutes of the injury and lasts 3-5 daysInflammation is present (manifested by heat, redness, swelling, pain, loss of function)Inflammation is a result of increased blood flow to the area caused by arterial dilation
Wound Types & Wound HealingPhase I (continued)
Bleeding controlled by platelet aggregationOxygenated blood delivered to the siteEpithelial cells for repair formedScab formedPhagocytosis occurs
Wound Types & Wound HealingPhase I (continued)
Basal cells seal wound surface
Fibroblasts begin reconstruction of nonepithelial tissue
Wound Types & Wound HealingPhase II - Proliferation Phase
Begins about the 3rd postoperative day and continues up to 20 daysFibroblasts multiply (proliferate) and bridge wound edgesCollagen secreted from fibroblasts
Wound Types & Wound HealingPhase II (continued)
Collagen fibers begin to restore tensile strength of tissue
Capillary networks established and lymphatic networks reformed
Wound Types & Wound HealingPhase II (continued)Definition:Tensile Strength: Ability to resist rupture
During the proliferation phase (phase II) of wound healing by first intention the wound regains 25%-30% of its original tensile strength
Wound Types & Wound HealingPhase III - Maturation or Differentiation Phase Begins on the 14th postoperative day and lasts until the wound is completely healed, (may take up to 12 months)
Tensile strength increased by interweaving of collagen fibers
Wound Types & Wound HealingPhase III (continued)
Collagen density increases and formation of new blood vessels decreases
Cicatrix is formed
Wound Types & Wound HealingSecond Intention (Granulation)
Wound is intentionally left openHealing occurs from the bottom - upHigh risk of infection (if not already present)Union is weak and scar formation extensive
Wound Types & Wound HealingSecond Intention (Granulation) (continued)
Granulation tissue containing myofibroblasts forms in the woundGaps in tissue fill from bottom upward closing the wound by contractionEpithelial growth is secondary
Wound Types & Wound HealingThird Intention (Delayed Primary Closure)Two granulated surfaces are approximatedWound is left open to heal by second intention for 4-6 daysThen, wound is closedEquation 2+1=3(Second Intention plus First Intention equals Third Intention)
Wound Types & Wound HealingFactors Affecting Wound HealingThree main factors influence wound healing:
Physical condition of the patientIntraoperative tissue handlingApplication of the principles of asepsis
Wound Types & Wound HealingPhysical Condition
Age
Nutritional Status
Disease (Chronic or Acute)of the Patient
Smoking
Radiation Exposure
Immunocompromised or Immunosuppressed Patients
Wound Types & Wound HealingIntraoperative
Length and direction of the incisionDissection technique (sharp or blunt)Length of surgery
HemostasisTissue Handling
Minimal and gentle tissue handlingPrecise tissue approximationElimination of dead spaceSecure wound closure
Wound Types & Wound HealingHalsted's Methods of Tissue HandlingStrict aseptic techniqueGentle handling of tissueUse of the finest suture materialSmall stitches and low tension on the tissueComplete closure of wounds whenever possible
Wound Types & Wound HealingThese basic procedures had a far-reaching effect on the practice of surgery, making it safer and more effective than it had been previously.William S. Halsted
Wound Types & Wound HealingDead Space Dead space is a separation of wound edges, which have not been closely approximated or air that has become trapped between tissue layers. This space may allow for serum or blood to collect and provide a medium for microbial growth that may result in infection.
Wound Types & Wound HealingDead SpaceReduce or eliminate dead space with the use of:
Proper suturing techniquesWound drainsPressure dressings
Wound Types & Wound HealingApplication of the Principles of Asepsis Through the Use of Sterile Technique A sterile field is created for each surgical procedureSterile team members must b
