Basic wound management Flashcards by Olivia Jones

What are the 3 phases of wound healing (some overlap)?

Lag or inflammatory phase
Repair phase
Remodelling

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What 3 components make up the repair phase of wound healing?

Connective tissue repair
Wound contraction
Epithelialisation

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What local factors affect wound healing?

Wound perfusion 
Tissue viability - trauma, dehydration
Fluid accumulation - haematoma, seroma
Infection 
Mechanical factors - tension, motion, pressure

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What systemic factors affect wound healing?

Impaired immune function - systemic disease, glucocorticoids

Neoplasia

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What 3 factors are used to classify wounds?

Degree of contamination
Aetiology
Location

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What are the degrees of classification for a wound?

Clean (no break in asepsis)
Clean-contaminated (minor break in asepsis)
Contaminated (major break in asepsis)
Dirty (abscess, foreign material, old traumatic wounds)

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Give examples of wound aetiologies

Abrasion 
Avulsion 
Degloving injury 
Incision 
Laceration 
Puncture wound 
Burn

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What is an avulsion wound?

Wound involving partial/complete tearing away of skin

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What is a degloving injury?

Type of avulsion - extensive section of tissue torn away, severing its blood supply

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What is the difference between an incision and a laceration?

Incision - sharp force trauma

Laceration - blunt force trauma

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What are the two types of wound management?

Closed management

Open management

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What is surgical debridement?

Surgical removal of dead/damaged/infected tissue

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What is the purpose of surgical debridement? What should it be followed with?

To improve the healing of the remaining healthy tissue

Lavage

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What is the purpose of wound lavage/irrigation?

Remove debris
Decrease number of bacteria
Prevent further contamination

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A surgical drain may be required for wound closure. What is a surgical drain?

Tube placed during surgery to allow drainage of pus/blood/fluid

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What are the layers of dressing?

Contact
Padding
Conforming
Cohesive

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Are adherent or non-adherent dressings used for the contact layer?

Non-adherent

Adherent = slow healing, no longer meet stand of care

Give examples of non-adherent dressings that can be used for the contact layer

Calcium alginate
Fenestrated polyester dressing
Hydrocellular foam dressings
Hydrocolloid dressings
Polethylene/polyurethane film 
Petrolatum-impregnated gauze
Hyperosmoar agents
Maggots
Silver dressings

How can maggots be used to aid wound healing? What species is used?

Used for wound debridement

Lucilia sericata maggots

How does calcium alginate work as a non-adherent dressing?

Absorbs exudate and water on wound surface

Forms gel that doesn’t adhere to wound

Calcium alginate is extremely absorbent and can be used as a non-adherent dressing. How long can it be left in place?

7 days

If non-infected

When are fenestrated polyester dressings mainly used?

For protecting wounds with an intact surface e.g. primarily closed surgical wounds
Polyester film stops adherence

Hydrocellular foam dressings are often used for what types of wounds?

Open wounds

Especially ulcers

What are hydrocolloid dressings mainly composed of? How do they work?

Cellulose

Forms gel as absorbs moisture - barrier to bacteria

Polyethylene/polyurethane film dressings are used for what types of wounds?

Wounds with an intact surface | Left on for longer than an absorbent dressing

What are the disadvantages of petrolatum-impregnated gauze as a contact layer?

May slow epitheliasagtion | Not used for wounds in late stages of repair

When may petrolatum-impregnated gauze be used as a contact layer?

To protect wounds with an intact surface, but fragile epidermis

Give an example of hyperosmolar agent used as a contact layer

Manuka honey

How can hyperosmolar agents (honey) be useful for contact layers of a wound?

Dehydrates bacteria | Inhibits their growth

What are the benefits having silver dressings as a contact layer?

Silver has direct antibacterial effect

What is the purpose of the secondary (intermediate) layer of a wound dressing?

Draw XS fluids away from wound Obliterate dead space by providing pressure Protecting the wound by padding/supporting/imbolising

What may be included in the secondary layer of a wound dressing?

Splint

What is the purpose of the tertiary (outer) layer of a wound dressing?

Secure rest of bandage in place | Provide some pressure and support

What happens if the tertiary (outer layer) of a wound dressing is too loose?

Wound may slip and lose contact with the primary/contact layer

What happens if the tertiary (outer layer) of a wound dressing is too tight?

Compromises circulation | Causes venous congestion

What materials are most commonly used for a tertiary outer layer of a wound dressing?

Gauze bandage covered with Vetrap

What is the appropriate management technique for clean or clean contaminated wounds?

Primary closure | Immediate sutures without tension

What is the appropriate management technique for contaminated wounds?

Delayed primary closure Close 1-5 days after injury, before granulation Lavage and debride daily whilst open

What is the appropriate management technique for a contaminated to dirty wound?

Secondary closure Close >5 days post injury after granulation. Excise wound edge/granulation tissue margin and epithelialise skin edges, then close

What is the appropriate management technique for a wound unsuitable for closure (large skin deficits)?

Second intention healing | No closure - heal by granulation, epithelialisation and contraction