wound Careby

prof/ gouda ellabban scu hospital / egypt

Wounds

Definition it is a rapture of soft tissue Causes mechanical agent trauma chemical fraction heat or cold

Wounds

chronicacute

Types of Wounds

Acute Wounds

Acute Wounds

Acute wounds usually occur in a normal, health person.

Most of the organs or tissue injuries can be consider as acute wounds.

Acute wounds

open close

Open Wounds

Laceration Abrasion

Penetrating Gun shot

Puncture

Incision

Open Wounds

Incised wound It is a result of pressure

and sliding(weapon slides over body, or body slides over weapon)

Axis direction is parallel to body

Wound is superficial Length expands more

than width , and depth External entrance is like V

shape

Open wound

Laceration It produces by applying blunt

instrument that has big surfaces on body areas which have soft tissue and bone

Body areas (scalp, leg, hand, skin overlies bones)

Mechanism: impact the skin between the blunt weapon and the bone

Common causes are falling from high or traffic accidents

Open wound

Puncture wound It cause by puncture

instrument, knife, screw. It seem un dangerous but

it is very dangerous because of deep internal injuries ( psleen,stomach).

It is called perforating or penetrating.

Open Wound

Hacking wounds Cause by heavy sharp

weapon ( axe , hatchet ) It is dangerours because it

is deep It damaged the internal

organ and bones It accompanied with

fractures Sever bleeding Fetal

Open wound

Gun shot They are injuries caused by metallic

or none metallic projectiles thrown off devices, which is known as firearms

In the U.S. for 1998, there were 30,708 deaths from firearms, distributed as follows by mode of death:

Suicide 17,424; Homicide 12,102; Accident 866; Undetermined 316 This makes firearms injuries one of

the top ten causes of death in the U.S.

Close Wounds

Contusion

Close

Contusion (BRUISE) Rapture of subcutaneous blood

vessels Blood forms hematoma Hematoma color varies according to

its age Mechanism Attack by vertical direction

strength on skin Kinds of contusion Traffic Human weapon Special factors Immigrated Falling from high

Chronic Wounds

Chronic Wounds

Is one that fails to heal because of some underlying pathologic condition .

Like: ischemic ulcer neuropathic ulcer These complex wounds will not heal until the underlying

cause is corrected. The cause of chronic ulcer: Infection Repeated trauma Oedema Denervation localized destructive disease

Chronic Wounds

Ischemic ulcer: Is secondary to vascular

disease The ulcer and surrounding

tissues are tender and cold

the edge of an ischemic ulcer is punched out

The base is grey-yellow sloughing tissue and often infected

Chronic Wounds

Neuropathic ulcer Ulcers are secondary to a

loss of sensation Peripheral nerve lesion

Diabetes

Nerve injuries

Lebrosy Spinal cord lesions

spina bifida

tabes dorsalis

Surgical Wounds

Complication of Surgical Wounds

Infectious complications May arise in the surgical wound itself They maybe initiated by changes in the

physiologic state respiratory , genitourinary or immune systems associated with surgery

Risk factors for infectious complication after surgery can be group into factor arising from the type procedure or patient-specific factors

Classification of surgical wounds

Wounds class Examples of typical procedures

Wound infection rate(%)

Clean Wide local excision of breast mass

2

Clean contaminated

Gastrectomy, hysterectomy <10

contaminated Ruptured appendix 20

Dirty Intestinal fistula resection 28-70

Classification of operative wounds

Clean :

Uninfected operative wound

No acute inflammation Respiratory,

gastrointestinal, biliary, and urinary tracts not entered

No break in aseptic technique

Infective risk : 2%

Classification of operative wounds

Clean-contaminated Urgent or emergency case

that is otherwise clean Elective entry into respiratory,

biliary, gastrointestinal, urinary tracts and with minimal spillage

No evidence of infection or major break in aseptic technique

Example:appendectomy Infective risk :10%

Classification of operative wounds

Contaminated Nonpurulent

inflammation present

Gross spillage from gastrointestinal tract

Penetrating traumatic wounds <4 hours

Infective risk :20%

Classification of operative wounds

Dirty-infected Purulent inflammation

(e.g. abscess) preoperative

perforation of respiratory, gastrointestinal, biliary or genitourinary tract

penetrating trauma >4 hours old

Infective risk :40%

Risk Factors for wound infection

immunosuppression Old age Obesity Prolong preoperative hospitalization Excessive blood loss Prolong operative time Poor nutrition Excessive devitalize tissue Failure to use prophylactic antibiotic Surgery of an infected operative site Diabetes mellitus

Pathogens Commonly Associated with Wound Infections

Pathogen Frequency (%)Staphylococcus aureus 20Coagulase-negative staphylococci 14Enterococci 12Escherichia coli 8Pseudomonas aeruginosa 8Enterobacter species 7Proteus mirabilis 3Klebsiella pneumoniae 3

Investigations

Lab Studies: Staining methods Culture techniques Test for antigens from the organism through

enzyme-linked immunoassay (ELISA) or radioimmunoassay

Detection of RNA or DNA sequences or protein from the infective organism by Northern, Southern, or Western blotting

Polymerase chain reaction (PCR)

Investigations

Imaging Studies: Ultrasound can be applied to the infected

wound area to assess whether any collection needs drainage

Complications of Wounds

Hemorrhage Infection Dehiscence Evisceration Fistula formation Abscess Bacteramia and septicemia

Wound Assessment

Location size Undermining and Sinus Tract Formation Tissue Viability Exudate Periwound Condition Pain Stage or Extent of Tissue Damage

Aims of Wound Treatments

1. Cleanse 2. Treat infection 3. Debride 4. Provide optimal environment for healing 5. Relieve pain/discomfort 6. Prevent complications

Treatment of infected wound

Evacuate the pus Cleansing the wound Irrigation

(if irrigation alone is ineffective in removing contaminants from a wound, the wound should be lightly scrubbed)

Debridement Close the wound Dressing the wound Swab Use antibiotics (the choice of antibiotics is empirical until

sensitivities are available)

WOUND DRESSING

To maintain high humidity at the wound surface. To remove excess exudates and toxic

components To allow gaseous exchange To provide thermal insulation To afford protection from secondary infection To be free from particles or toxic contaminates

Surgical dressingsType Example Indications

Debriding agents

Benoxyl-benzoic acid,aserbine-benzoic acid

Only in necrotic sloughing skin ulcers (acidic environment)

Enzymatic agents

Varidase-streptokinase, streptodornase

Activate fibrinolysis and liquefy pus on chronic ulcers

Bead dressings

Debrisan, idosorb Remove bacteria and excess moisture in deep granulation wound

Polymeric films

Opsite, bioclusive, tegaderm

Transparent dressing for suture wounds

foams Silastic, lyofoam, allevyn Shaped to fit deep cavities and granulation wounds

Surgical dressingsType Example Indications

Hydrogels Geliperm, intrasite Maintain moist environment, polymers can absorb exudate

Hydrocolloids Comfeel, granuflex Complete occlusion.Promote epithelialisation and granulation tissue and maintain moisture

Fibrous polymers Kaltostat, sorbsan Absorptive dressings

Biological membranes

Porcin skin, amnion

For superficial chronic ulcer

Simple miscellanous

Gauzes, tulles Simple absorptive dressings to absorb exudate

Preventive Measures

Preoperative: Patient preparation

Identify and treat all infections Do not remove hair unless it is on the surgical field. Patients should cease tobacco consumption Optimize blood glucose level Prophylactic antibiotics Enhanced nutritional intake

Preventive Measures

Preoperative : Surgical team members

Keep fingernails short Scrub hands and forearms as high as the elbows

with appropriate antiseptic After scrub, keep hands up with elbows flexed

and away from the body The hair on the head and face is to be covered surgical gowns and sterile gloves are to be worn

postoperative wound care

Asepsis is necessary in the insertion of indwelling catheters

Handle tissues gently with good hemostasis, minimize foreign bodies, and minimize devitalized tissue and dead space.

Primary closed incisions should be protected with a sterile dressing for 24-48 hours

Hands are to be washed before and after wound dressing

Use sterile technique for wound dressing change

THANK YOU