L8: Wound management Flashcards
When wound management need intervention?
If it’s very large, necrotic or infected.
What is included to wound management? (3)
1.Stabilization of the patient
2.Stopping the bleeding (pressure, special dressings for minor wounds)
3.Reduce the level of contamination, clipping the area (ideally in 4-6h after wounding to prevent bacterial infection)
1 & 2 usually at the same time
What is necessary before initiating treament?
Identification of the causative agent, trauma, dermatological disease, parasitosis, neoplasia etc..
It’s important to treat underlying cause in case of non-traumatic wounds. Some wounds are untreatable.
Wound irrigation
Administer fluid with pressure to wash debris, necrotic tissue, dirt and bacteria.
Pressure should not be too high because it may damage tissue and push contamination further.
Minimal to moderate contamination - isotonic saline or Ri-Lac
In some patients dilute antiseptic solutions like 0.05% chlorhexidine can be used.
Debridement
Removal of debris or necrotic tissue. Anaesthesia usually required. Convert open contaminated wounds into surgically clean wound
Different methods: Surgical, mechanical, enzymatic, chemical. More than one procedure might be needed.
Surgical debridement
-Most commonly used
-Remove all obvious necrotic tissue and debris
-During inflammation recognition is difficult (viable vs nonviable)
-Removal to active bleeding level
-Questionable viable tissue should be left in place to re-evaluation
Mechanical debridement
Wet-to-dry or dry-to-dry dressings.
With wet isotonic saline used.
Autolytic depridement
-Creation of moist wound environment to allow endogenous enzymes to dissolve nonviable tissue.
-Preferred in wounds with questionable tissue viability.
-Interactive dressing like hydrogels, hydrocolloids, hydrofibers
-Sugar or honey topically to attract fluid
-Painless but slow
Enzymatic debridement
-Proteolytic enzymes applied to wound to break down necrotic tissue
-Small amount of necrotic tissue or debris
-Slow and effectiveness questionable
Chemical debridement
-Nonselective method, damage also important cells
-Performed to antiseptics
-Not recommended
Biosurgical debridement
-Placement of medical maggots (Lucilia sericata) into wound
-Maggots produce enzymes that dissolve necrotic tissue but spare healthy tissue
-Specially bred and expensive
Topical antibiotics and antiseptics
Systemic AB preferred but only to infected wounds.
Use of topicals is controversial, no benefit once infection is established
Don’t replace proper debridement
Wound healing enhancers
Remember couple of them, like honey and aloe vera.
Open wound management
-Superficial wounds
-Some dressing or bandage?
-Wound-healing enhancers used
-Process is time consuming
-Might need surgical intervention
Sometimes open wound management is used until wound is clean enough for surgical closure.
Wound closure
Whether or not to close to wound?
-Primary closure
-Delayed primary closure
-Secondary closure
-Drainage
Incisions/closure parallel to tension lines if possible
