Wound management Flashcards
open wounds
are when an injury causes a break in the covering of the body surface - may take weeks or months to heal
closed wounds
are where the injury does not cause a break in the body but causes damage to the underlying tissue resulting in bleeding
types of open wounds
incised (surgical)
Avulsed (degloving)
lacerated (tear)
punctured (bite)
abrasion ( scratch)
closed wounds
Haematoma
contusion
classification by contamination
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.
what is first intention healing
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.
what is second intention healing
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
Normal wound healing
- inflammatory phase
clots and form scab - inflammation encourages WBC and primary contraction - Proliferative phase
New cells produced which slide over the wound (days 3-7 post injury) - Remodelling phase - Epidermal growth - new collagen laid forming scar tissue - secondary wound contraction - scar size reduction
Inflammatory phase
- 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.
Proliferative Phase
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
proliferative phase
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
Remodeling phase
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
Reasons for delayed healing
- poor tissue perfusion
- seroma formation
- infection
-stress - suture reaction
Factors delaying healing
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
Factors delaying healing
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
Factors delaying healing
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
factors delaying healing
general poor condition - undernourished, old, has underlying diseases that prevent from healing
Nutrition
- vital for wound healing to occur
- should be a priority to trauma patients
glucose and protein are vital for the progression of wound healing
Lavage fluids
sterile
non toxic
isotonic - fluid reduces damage to fibroblasts preventing slowing of wound contraction
Debridement
removes all devitalised, contaminated tissue and any foreign debris which may be present within the wound
reduces the work of macrophages
speeds up healing
Antibiotics
antibiotics should be given to reduce the rate of invasion by bacteria
antibiotics should not be seen as an alternative to lavage and debridement
Wound healing progression
- 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
Primary Layer
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
Secondary layers
- used to hold the primary layer in place
- 50% overlap padding layer
- used to stabilise the padding layer
Tertiary bandage layer
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
