Principles Of Wound Management

Question 1

What is the difference between an open and closed wound?

Answer 1

Closed wound - crushing injuries and contusions

Open wound - lacerations or skin loss

Question 2

What are the different categories of duration of wounds?

Answer 2

Class I - clean laceration, 0-6h, minimal contamination

Class II - 6-12h, significant contamination

Class III - 12+h, gross contamination

Question 3

How can wounds be classified based on degree of contamination?

Answer 3

Clean
Clean contaminated
Contaminated
Dirty or infected

Question 4

When should muscle be removed when doing debridement?

Answer 4

IF it does not bleed or twitch on stimulation

Question 5

What should always be preserved during debridement?

Answer 5

Nerves, tendons, ligaments

Question 6

What is the goal of passive dressings?

Give examples

Answer 6

Passive dressings protect the wound and provide an environment to support healing

Adherent (WD, DD)
Absorbent 
Non-adherent
Vapour permeable 
Barrier films

Question 7

What is the goal of active dressings?

Give examples

Answer 7

Protect the wound and alter or enhance the environment in an attempt to improve wound healing

Hydrocolloids 
Hydrogels 
Alginates 
Collagens 
Skin substitutes 
Sugar and Manuka honey (bit shit)

Question 8

What are the options for wound closure?

Answer 8

Primary
Delayed Primary
Secondary closure
Secondary intention healing (contraction and epithelialisation)

Question 9

When shouldn’t you close a wound?

Answer 9

Puncture wounds early in healing process

Infected wounds

Wounds under tension

Question 10

What will impair granulation tissue formation?

Answer 10

Necrotic or devitalised tissue in wound 
Infection 
Movement 
Poor blood supply 
Mechanical abrasion

Question 11

How can you improve formation of granulation tissue?

Answer 11

Remove impediments (necrotic tissue etc)
Excise old granulation tissue bed
Enhance blood supply (muscle, omentum, vascular skin)
Reconstruct using tissue with good blood supply
Support/immobilisation

Question 12

What can impair epithelialisation?

Answer 12

Necrotic or devitalised tissue in the wound 
Infection 
Eschar 
Movement 
Poor blood supply 
Mechanical abrasion surface trauma

Question 13

Describe the basic cutaneous blood supply

Answer 13

Superficial plexus (dermis)
Middle plexus (dermis)
Deep/subdermal plexus
Direct cutaneous artery and vein