Wound management

Question 1

open wounds

Answer 1

are when an injury causes a break in the covering of the body surface - may take weeks or months to heal

Question 2

closed wounds

Answer 2

are where the injury does not cause a break in the body but causes damage to the underlying tissue resulting in bleeding

Question 3

types of open wounds

Answer 3

incised (surgical)
Avulsed (degloving)
lacerated (tear)
punctured (bite)
abrasion ( scratch)

Question 4

closed wounds

Answer 4

Haematoma
contusion

Question 5

classification by contamination

Answer 5

clean - no break in sterility

clean - contaminated - surgical wounds of the respiratory , urogenital or gastrointestinal systems where complete sterility can’t be achieved

contaminated - wounds which have been contaminated but are fresh enough for bacterial multiplication not to be a problem yet.

Dirty - active infection present, contaminated wounds more than 6 hours old.

Question 6

what is first intention healing

Answer 6

occurs in clean surgical wounds which are sutured. it occurs over a period of 14 days.

signs
-blood clots seal the wound
-granulation tissue and collagen fibrils fill the space below the epithelium.

Question 7

what is second intention healing

Answer 7

happens when the wound edges are unable to be sutured together because of tissue loss

signs
- base and margins of the wound are filled with granulation tissue

• granulation tissue moves from the wound edges towards the centre
• wound contraction begins

Question 8

Normal wound healing

Answer 8

1. inflammatory phase
   clots and form scab - inflammation encourages WBC and primary contraction
2. Proliferative phase
   New cells produced which slide over the wound (days 3-7 post injury)
3. Remodelling phase - Epidermal growth - new collagen laid forming scar tissue - secondary wound contraction - scar size reduction

Question 9

Inflammatory phase

Answer 9

• triggered by platelets, and fibrin in the blood clot. wound is swollen and red

neutrophils are then attracted to the damaged tissue

neutrophils clear up the bacteria, necrotic tissue and foreign material.

Question 10

Proliferative Phase

Answer 10

Granulation
- bright red and firm, but easily damaged

• important tissue
• resistant to local infections

serves as a barrier

excellent blood supply for healing

fibroblasts lay down bed of collagen

Question 11

proliferative phase

Answer 11

Contraction
- wound edges pull together - up to 30% of the wound can close during this phase

epithelialisation
- epithelial cells proliferate and migrate - reattach to granulation tissue

Question 12

Remodeling phase

Answer 12

Can take 3 weeks to 2 years depends on severity and nature of injury

• new collagen forms and increases tensile strength of wound - scar tissue is only about 80% the strength of original tissue

Question 13

Reasons for delayed healing

Answer 13

• poor tissue perfusion
• seroma formation
• infection
  -stress
• suture reaction

Question 14

Factors delaying healing

Answer 14

bacterial contamination

• established by infection

-the contamination is in the wound, but the infection is when they begin to live on the tissues

• bacteria slows down healing process by breaking down blood clots and the newly formed tissues

Question 15

Factors delaying healing

Answer 15

contamination - foreign bodies slow down healing

necrotic tissue - tissue slows down healing

movement of the wound
- joint is moving so fibrin being formed is broken down

scar becomes bigger as it is stretched so better to splint the leg to prevent movement

Question 16

Factors delaying healing

Answer 16

poor circulation - lack of oxygen and nutrients to the wound caused by
- bandages are too tight
- extent of the injury

dead space
- holes must be filled so the skin is stitched to the underlying tissues. Dead space will fill with fluid and prevent blood supply from reaching the surface

Question 17

factors delaying healing

Answer 17

general poor condition - undernourished, old, has underlying diseases that prevent from healing

Question 18

Nutrition

Answer 18

• vital for wound healing to occur
• should be a priority to trauma patients

glucose and protein are vital for the progression of wound healing

Question 19

Lavage fluids

Answer 19

sterile

non toxic

isotonic - fluid reduces damage to fibroblasts preventing slowing of wound contraction

Question 20

Debridement

Answer 20

removes all devitalised, contaminated tissue and any foreign debris which may be present within the wound

reduces the work of macrophages

speeds up healing

Question 21

Antibiotics

Answer 21

antibiotics should be given to reduce the rate of invasion by bacteria

antibiotics should not be seen as an alternative to lavage and debridement

Question 22

Wound healing progression

Answer 22

• wound exudes less as time goes on
• the wound does not smell
• wet, smelly wounds have necrotic tissue in them or are infected
• that granulation tissue forms and is bright red in colour

Question 23

Primary Layer

Answer 23

layer in contact with wound itself

layer should not harm the wound and ideally improve the rate of healing

dressings
-absorbent/non-absorbent
-adherent/non- adherent
passive/ interaction/ bioactive

Question 24

Secondary layers

Answer 24

• used to hold the primary layer in place
• 50% overlap padding layer
• used to stabilise the padding layer

Question 25

Tertiary bandage layer

Answer 25

primarily to protect other layers of the bandage from soiling and mutilation by the animal

50% overlap

should not be used on bare skin or the animals coat