Wound Healing and Open Wound Management Flashcards
3 phases of wound healing
- Inflammation
- Repair
- Maturation
Wound classification: Clean
No hollow viscous entered, atraumatic (ex. skin incision)
Wound classification: Clean contaminated
Operative wounds of contaminated organ system (ex. enterotomy)
Wound classification: Contaminated
Open traumatic wounds, operative wounds without asepsis, incisions into contamination (ex. enterotomy with loss of aseptic technique or minor spillage)
Hasn’t been contaminated long enough for infection to seed
Wound classification: Dirty or Infected
Old traumatic wounds, infected wounds, perforated viscera (ex. older puncture wound with stick foreign body)
Enough time has passed that contamination has turned into infection
Class 1 contamination
≤ 6 hours
Class 2 contamination
6-12 hours
Class 3 contamination
> 12 hours or gross contamination
6 steps of wound management
- Prevent further contamination/nosocomial infection
- Remove foreign contamination/lavage/irrigation
- Debridement– ABSOLUTELY NECESSARY
- Drainage
- Promote a vascular bed– bandaging techniques + topical agents
- Closure selection– “when in doubt, wait it out”
Wound management: Inflammation phase
- reduce contamination
- prevent infection
- cleaning and debriding
Wound management: Repair phase
- protection
- topical stimulants (moist wound healing)
- epithelialization and contraction– immobilization and prevention of contracture
Wound management: Maturation
Protect fragile epidermis
Advantages of bandaging
- maintain moist environment
- provide local energy source
- reduce edema
- increase growth factors
- increase inflammatory response
- improve oxygen content
- improve blood flow
Hydrocolloid properties (e.g. Duoderm, Tegasorb)
- moisture retentive + considerable absorption
- partial and full thickness wounds
- ≤ 7 days
Hydrogels (e.g. Aquacel, Aquasorb)
- moisture retentive but minimal absorption– does donate fluid to wounds
- minimal-to-moderately draining wounds
- ≤ 5 days
