1. Wounds and their classification. Wound healing

Question 1

Definition of a wound

Answer 1

Wound: disruption of normal anatomical relations resulting in an injury. This might be
intentional (surgical wounds) or unintentional (traumatic wounds)

Question 2

Classifications of wounds

Answer 2

1. Superficial - only epidermis
2. Partial thickness - reaches dermis
3. Full thickness - reaches subcutaneous adipose tissue
4. Deep wound - through adipose and beyond

Question 3

Open wound types

Answer 3

Insicion - vulnus scissum - sharp, presice, clean cut

Lacerations - vulnus caesum - blunt trauma

Abrasions - vulnus abrasum - epidermis scraped off (from sliding/falling trauma)

Avulsions - vulnus contusum et lacerum - detachment of structure through force (traumatic amputation of extremities/limbs)

Puncture wounds - vulnus punctum

Penetration wounds

Gunshot wounds - vulnus sclopetarum

Animal bite - vulnus morsum

Question 4

Closed wound types

Answer 4

Contusions - painful bruises

Crush injuries

Haematomas

Question 5

Non mechanical wounds

Answer 5

Thermal/burn - vulnus thermicum - 1st, 2nd and 3rd degree

Question 6

Classification based on contamination

Answer 6

SSI - surgical site infection

Levels:

• superficial
• deep
• Organ/space

Question 7

Undermining in wounds

Answer 7

Undermining: tissue destruction underlying intact skin along wound margins. Big wound with a small opening.

Question 8

Tunneling in wounds

Answer 8

Tunnelling: pathway that can extend in any direction from the wound, resulting in dead space. Pontential for abscess formation

Question 9

Sinus tract in wounds

Answer 9

Sinus tract: a drainage pathway from a deep focus of acute infection through tissue and/or bone to an opening on the surface

Question 10

Describing a wound on a chart

Answer 10

1. Type of wound and location
2. Describe thickness
3. Describe stage of healing
4. Document size. Measure in centimetres: lengthxwidthxdepth
5. Describe any undermining, tunnelling or sinus tracts using the clock system. - I.E tunnelling at 3 o’clock.
6. Odour
7. Exudate
8. Describe the various types of tissue present in the wound bed
9. Describe wound edges according to definition, attachment, character (epibole, macerated, fibrotic, callused) and border shape
10. Describe surrounding tissue: colour, oedema, pallor, lesions etc
11. Describe any indicators of infection
12. Document pain
13. Document interventions for healing
14. Document any factors that would affect healing
15. Document current topical treatment

Question 11

Wound healing phases

Answer 11

I - inflammatory phase
II - proliferative phase
III - maturation phase

Question 12

Inflammatory phase of wound healing

Answer 12

Key players - macrophages
Removal of clot, debris and infection sources

Lasts approx. 4 days - results in edematous and erythemous wound appearance

Question 13

Proliferative phase of wound healing

Answer 13

Collagen production to the moon - scar formation

2 - 24 days

Question 14

Maturation phase of wound healing

Answer 14

Remodelling phase

The collagen fibers form cross links and the scar flattens and evens out

9-12 months

Question 15

Classification of healing wounds

Answer 15

Healing by primary, secondary or tertiary intention

Question 16

Primary intention

Answer 16

Closing of wound by sutures, staples, adhesives or other techniques to approximate the wound edges

Pros: cosmetically best option, easy management
Cons: prone to infection

Question 17

Secondary intention

Answer 17

Open wound covered with moist gauze combined under dry bandage, changed twice a day.

Is used when there is very high risk of infection or when the wound is severely contaminated, results in large scar

Question 18

Tertiary intention

Answer 18

“Delayed primary closure”

5 days of secondary intention, followed by wound closure.