Wound Care and Basic Wound Closure and Dressing Flashcards
What are the 3 methods of wound closure
Sutures
Steri-strips
Staples
Adhesive glue
Types of wound closure
- primary
- delayed primary
- secondary
Primary - closure of the wound soon after injury to prevent infection and good cosmetic outcomes
Delayed primary closure - delayed for 3-5 days to allow interventions (ABx) => surgical closure
Secondary - heals by granulation, no intervention needed
Key assessments to make before closing a wound
History
Wound exam
-depth
-underlying nerve, tendon, vascular, tissue damage
-any contamination
-xrays for radiopaque foreign bodies
-exploration under anaesthesia for radiolucent foreign bodies
How would you irrigate a wound
Removal of debris => reduce infection risk
When would you use tissue adhesives
Dry wounds that can be apposed
- Simple traumatic
- Scalp wounds
Equipment for wound cleaning
- sterile dressing pack
- sterile gloves and PPE
- tissue adhesive unit
WIPER
-check allergies and pain score
Sterile field
Examine wound - no underlying injury, foreign bodies, bleeding
Open tissue adhesive unit
Appose dry edge together with one hand, apply dots or a line of adhesive on edge
Avoid getting adhesive in wound
Hold wound together until the glue has dried
If needed, apply non adherent dressing to keep it clean and dry for 5 days
After this, can start to wash area with soap and water to dissolve adhesive
Document wound closure
When would you use steri-strips
Dry and static wounds
- Superficial/flap wounds
- Areas of thin, delicate skin
Equipment for wound cleaning
- sterile dressing pack
- sterile gloves and PPE
- steri-strips
WIPER
-check allergies and pain score
Sterile field
Examine wound - no underlying injury, foreign bodies, bleeding
Pull skin flaps back into position
Hold wound edges together
-1st strip along middle
-subsequent strips bisect resulting smaller wounds
3-5mm gaps between strips to allow exudate to escape
If needed, apply non adherent dressing to keep it clean and dry for 5-7 days
After this, can start to peel off strips
Document wound closure
When would you use staples
Larger wounds that can be apposed
-surgical wounds
Equipment for wound cleaning
- sterile dressing pack
- sterile gloves and PPE
- skin stapler, remover, sharps bins
- LA
WIPER
-check allergies and pain score
Sterile field
Examine wound - no underlying injury, foreign bodies, bleeding
LA
Align edges of wound with forceps or hand => staple
Depth of staple controlled by how hard to stapler is held against the skin
If needed, apply non adherent dressing to keep it clean and dry for 5-7 days
After this, need to have staples removed in GP or hospital
Document wound closure
When would you use sutures
Deep, large, jagged wounds under tension
Areas that are mobile or awkward
Equipment for wound cleaning
- sterile dressing pack
- sterile gloves and PPE
- suture pack, sutures, sharps bin
- LA
WIPER -check allergies and pain score Sterile field Examine wound - no underlying injury, foreign bodies, bleeding LA Interrupted sutures
If needed, apply non adherent dressing to keep it clean and dry for 5-7 days
After this, may need to have sutures removed in GP or hospital
Types of suture and when you would use them
Absorbable vicryl - broken down by the body (enzymes, hydrolysis)
-used for deep tissues, tissues that heal rapidly
Non absorbable ethilon - provide long term tissue support
-used for tissues that heal slowly
Monofilament prolene - single strand
- reduced risk of colonisation
- difficult to handle
Multifilament mersilk - multiple strands
- increased colonisation risk
- good handling
Local anaesthetic admin
Reversible conduction block
-add adrenaline if bleeding
LA
2 needles, syringes
Sharps bin
Sterile gloves, gauze
WIPERQQ
Insert LA around wound parallel to wound edge => wait for mins
