Surgery Practical 2. Wound management

Question 1

Classification of wounds by cause

Question 2

Classification of wounds by contamination

Question 3

Clean wound?

Answer 3

Surgical sterile wound

Question 4

Clean-contaminated wound — ?

Question 5

Contaminated wound — ?

Question 6

Dirty wound — ?

Question 7

Classification of wounds by time factor

Answer 7

Grade 1: mild contamination in a traumatic wound not older than 6 hours (‘Golden period’)
Grade 2: moderate contamination 6 to 12 hours
Grade 3: severe contamination, older that 12 hours

Question 8

Do timorous wounds heal?

Answer 8

No !

Question 9

Types of wound healing

Answer 9

• primary wound healing - no scar, nor functional loss
• secondary (or second intention) wound healing — nit the perfect healing. Scar formation. Some extend of functional loss

Question 10

Biology of wound healing

Answer 10

Wound —> bleeding —> vasoconstriction and clot formation —> inflammation —> pus and exudate —> (this stage is very susceptible to secondary infection)

—> angioneogenesis, new tissue formation (granulational/proliferational tissue) —> (here antimicrobial treatment is not needed already)

—> maturation of tissue, looking the vessels

Question 11

Description of stages

Question 12

Factors affecting wound healing

Question 13

If presence of multiresistent microbe is presumed…

Question 14

Wound management step by step

Question 15

Lavage

Question 16

Close or not to close the wound? How to decide?

Answer 16

Primary closure has NO granulational tissue

Question 17

What cases should NOT be closed?

Answer 17

• from bite (drainage!)
• penetrating wound
• wound is severely confused
• there is a suspect for a retained foreign body