Wound Management Flashcards
How do we class the age of a wound?
Class 1 = 0-6hrs (‘golden period’), minimal contamination
Class 2 = 6-12hrs, significant contamination
Class 3 = older than 12hrs, gross contamination
How do we classify contamination of a wound?
Clean = created under sterile conditions
Clean contaminated = minimal contamination, easily removed, can close after treatment
Contaminated = gross contamination with foreign debris, can close after treatment
Dirty/infected = infection already exists, never close primarily
What are the 5 types of wounds?
Incision = created by sharp objects, smooth edges, minimal surrounding trauma Abrasion = created by blunt trauma/shearing force, damage to skin including epidermis Avulsion = tearing of tissue from attachment, avulsion of limbs, degloving Laceration = irregular wound created by tearing, variable damage to tissues Puncture = penetrating wound by sharp objects/missile, minimal superficial damage but substantial deeper damage
What are the 3 stages of wound healing?
Inflammatory phase
Proliferative phase
Maturation phase
Describe the inflammatory stage of wound healing.
Occurs within the first 72 hours post-injury
Haemorrhage occurs within minutes of injury
Vasoconstriction – reduces haemorrhage and allows clot to form
Vasodilation to release clotting elements into the wound
White blood cells leak from the blood vessels into the wound, initiating the debridement phase
Describe the early proliferative stage of wound healing.
Begins 3-5 days post-injury
Reconstruction phase
Granulation phase fills the wound
Fibroblasts lay network of collagen in the wound bed which gives strength to tissues
Epithelial cells from the wound margins migrate to cover the wound
Aims = maintain moist wound environment, prevent damage to cells
Describe the late proliferative stage of wound healing.
Wound contracts
Epithelialisation
Aims = exudate reduces, maintain moist environment
Describe the maturation stage of wound healing.
Begins 2-4 weeks post-injury
Remodelling phase
Begins when wound has filled in and resurfaced
Collagen fibres reorganise, remodel and mature to give wound tensile strength, forming scar tissue
What are the main goals of wound management?
Prevent further wound contamination Remove foreign debris and contamination Debride dead and dying tissue Promote viable vascular bed Provide drainage Select appropriate method of closure
How can we assess the viability of tissue?
Colour Warmth Pain sensation Bleeding Skin circulation can continue to deteriorate after injury/surgery because of oedema and other factors
Describe primary closure of a wound.
Minimal tissue contamination, loss or trauma
‘Golden period’ between 6-8hrs, if time of injury is unclear then assume this time has lapsed
Wounds should be explored, cleaned by lavage and surgically debrided, prior to closure
Fibrin seal forms within 4-6hrs - protects wound against invasion of microorganisms, prevents fluid leakage from wound
Epithelialisation of wound surface occurs 48hrs later
Once sealed, the wound increases its tensile strength (by 7-14 days)
Sutures generally removed at day 10
Describe delayed primary closure.
Indicated for wounds that have gone beyond the ‘golden period’ or require some further debridement
Wound should be explored, cleaned by lavage and debrided
Debridement involves removal of dead or damaged tissues, foreign bodies and microorganisms – inadequate debridement will delay wound healing
Describe secondary closure of a wound.
Heavily contaminated or dirty wounds
Managed as open until granulation bed is established
After this, wound edges are debrided and closed
Describe secondary intention healing of a wound.
Wounds that have significant tissue loss, contamination or infection
Managed as an open wound
Allowed to granulate and epithelialise
When should wounds be closed?
If there is sufficient tissue to allow reconstruction without dehiscence
No devitalised tissue or foreign material
Functional structures will be affected by contraction or delayed closure
No signs of infection or contamination
Adjacent skin is healthy
