2. Wounds and it's management Flashcards
Define a wound.
A wound is a tissue defect characterised by a breach in the continuity of the skin and it’s deep tissue, which is secondary to an injury, in which the deeper tissues (Fat, Muscle, Bone or Vessels) may or may not be injured.
How do you classify different wounds?
- Duration
- Closed/Open Wound
- Simple/Complex Wound
- Contamination of Wound
Classify wounds according to their duration.
- Acute (< 6 weeks)
2. Chronic (> 6 weeks)
State 2 types of Closed wounds.
- Contusion
2. Haematoma
State 4 types of Open wounds.
- Abrasions
- Incised wounds
- Lacerated wounds
- Crushed wounds
State 4 types of wounds based on their contamination.
- Clean wound
- Clean contaminated wound
- Contaminated wound
- Dirty wound
Give an example of a Clean wound.
An operative wound ex; Thyroidectomy
Give an example of a Clean Contaminated wound.
A wound in a Cholecystectomy
Give an example of Contaminated wound.
A wound in a Hemicolectomy
Give an example of Dirty wound.
A wound in a Laparotomy for a case of peritonitis
State the 3 phases of Wound Healing.
- Inflammatory Phase
- Proliferative Phase
- Remodelling (Maturation) Phase
State 5 local factors affecting wound healing.
- Foreign bodies
- Infections
- Lack of Rest
- Ischaemia
- Sutured under tension
State 7 systemic factors affecting wound healing.
I A McDAD
- Immunocompromised State (Chemo, AIDS)
- Anaemia
- Malnutrition (Proteins, Vit. C, Zinc)
- Co-existing Diseases (Cancer, Liver/Kidney diseases)
- Drugs (Steroids)
- Age (Old age)
- Diabetes Mellitus
- Smoking
A wound commonly heals by …… ?
- Healing with Primary Intention
- Healing with Secondary Intention
- Healing with Tertiary Intention
Explain Healing with Primary Intention.
It is usually seen in clean, incised wounds where the tissue is well-approximated (opposed) and there isn’t major tissue loss. The tissues has to be viable with no tension. It occurs when the wound isn’t infected. Healing w. Primary Intention has minimal scarring and has a best result, functionally and cosmetically.
Explain Healing with Secondary Intention.
It is usually seen in crushed, lacerated, devitalised wounds where the tissue is not well-approximated and there is major tissue loss. It usually occurs when the wound is infected. Healing w. Secondary Intention has a lot of scarring and won’t have the best result, functionally and cosmetically.
A patient arrives to the OPD with a wound, what treatment regime do you think is the best?
- Resusitate the patient, if necessary
- Hospitalize the patient
- Examine and diagnosis the wound (Site, size and damage structures)
- Assess movement and sensations while watching for pain and listening to the patient
- Provide a tetanus shot
- If the wound is large, book an OR for operative treatment to repair damaged structures
- Administer adequate and appropriate anaesthesia
- If the limb is injured, apply a tourniquet
- Start debridement of the Wound
- Apply skin cover if required
- Start skin closure (suturing) w/o tension
How do you debride a wound?
- Ensure wound is adequately exposed
- Extend the incision, if necessary
- Secure bleeders by haemostasis
- Start removal of foreign bodies
- Excise all dead/devitalized tissues
- Excise dead muscles
- Tendons and nerves are left alone
- Once done, the wound is washed with warm, sterile normal saline solution
How do you know if a muscle is dead?
Muscle viability is assessed by the colour (pink), bleeding pattern and contractility.
How do you know if you’ve removed all the devitalized tissue?
The devitalized tissue is excised until bleeding occurs, with the exception of nerves, vessels or tendons.
State the 3 types of wound repairs applied in Skin Closure?
- Primary Suture
- Delayed Primary Suture
- Secondary Suture
When is a Primary Suture done?
It is done if patient presents with a wound within 6 hours of being injured and is able to heal with primary intention.
When is a Delayed Primary Suture done?
It is done if the patient presents with a wound after 6 hours of being injured. The wound is placed under antibiotic cover and left open. This is to ensure there isn’t any infection before closing it. A delayed primary suture is applied after 4-7 days.
When is a Secondary Suture done and how?
A secondary suture is done when a wound is severely infected
- First, start debridement and remove as much pus as possible.
- Excise the dead, devitalized tissues
- Clean the edges of the wound
- Insert drains to drain out the pus
- Leave the wound open with dressings
- When appropriate, apply suture/skin cover.
