Lecture 7: Wound Assessment and Management Flashcards
5 main functions of the skin
-protection
-storage
-absorption
-heat regulation
-sensation/perception
3 part structure of skin…
skin
1. epidermis
2. Dermis
3.Subcutaneous tissue
muscle
wound classifications (5)
- Cause (surgical vs non surgical)
- Duration (acute vs chronic)
- Level contamination
- Depth of tissue affected
- Colour of wound
L CD CD
Acute wound
Any surgical wound that heals by primary intentions or secondary intention (normal healing phases)
Chronic wound
Wound that fails to progress through normal healing phases. Stuck in inflammatory phase.
Level of contamination of wounds (4):
clean wound: no inflammation, operative incision
Clean/contaminated no inflammation but has resp, GI, urinary tract as been entered.
contaminated wound: open traumatic wounds or surgical wound, beak in sterile field, shows signs of inflammation.
Infected wound: Old, traumatic, dead tissue and wound evidence of infection
Types of tissue colour
-Red
-yellow
-black
Red: Granulation tissue (clean, superficial or deep)
Yellow: Slough tissue (ideal for bacterial growth)
Black: Eschar or necrotic tissue
(gangrenous ulcers)
what are 3 types of wound debridement
- Conservative sharp wound debridement: Use an instrument to remove wound tissue
- Surgical debridement
- Non-surgical debridement:
-autolytic
-enzymatic
-Mechanical
-Maggot therapy
Serous drainage
Clear or straw coloured
-Protein and fluid
Sanguineous
Red,thin,watery
-blood drainage
Serosanguinous
-Pink,thin,watery
-blood cells mixed with serous drainage
-expected drainage few hours post surgery
Purulent
yellow, grey,green
Hemorrhage
Thick!!!
-leaking blood vessel
most wounds heal by_____
tissue repair
wounds usually result in what
Scar tissue
What’s the wound healing process…
- Initial hemostasis/inflammatory
3-5 days
2.Granulation proliferative) phase
5 days-3 weeks
3.Maturation
remodeling
several months or years
Homeostasis inflammation
-lasts several days
-occurs immediately after injury
-platelet aggregation
-edema
-macrophage engulf and remove debris
-release of cytokines
clinical manifestations of inflammation:
-local response
-systemic response
-exudate formation
local: redness, heat,swelling, loss function
systemic response: leukocytosis,nausea,anorexia,fever
exudate formation: fluid and leukocytes move from the circulation to the site of injury
major events of granulation phase of wound healing
1.Epithelization
2.Collagen formation
3. Granulation tissue formation
4. Contraction
maturation phase
- can last up to 2 yrs
- collagen reorganization
- increased tensile strength of the scar
- colour of scar changes from red to white
methods of wound closure
primary - 1st intention
secondary - 2nd intention
tertiary - 3rd intention
1st intention
- closing the wound by mechanical means i.e: sutures staples, tape, skin glue
indicated:
- minimal tissue loss
- skin edges are well approx
- clean lacerations
most surgical incisions closed using primary intention: 3 phases of healing occur quickly w minimal scarring
2nd intention
the wounds usually are large w either:
- significant tissue loss/damage
- bacterial concentration
take more time to heal - uses same phases of healing
3rd intention - delayed primary intention
- is a method of wound closure that uses a combo of primary and secondary intention
- the wound is left open for short period (usually a few days) to allow edema and infected exudate (pus) to resolve, then closed by primary intention or secondary intention