Wound Management Flashcards
What are adnexia?
Glands, hair etc. present in healthy skin tissue
What is the objective of care of accidental wounds?
- convert an open wound to a surgically clean than can be closed (ideally within 6-12hours)
- minimal scarring, normal function and no infection
What are the 2 broad categories of wound? What else should be thought about?
> Closed - crushing and contusion injuries eg. mm. avulsion, fx > Open - skin lacerations or loss - duration - degree of contamination - aetiolgogy - depth of tissue damage
Why is duration of wound exposure important?
bacteria multiply quickly
- “golden period” after which wound cannot be sutured as clean
What are the classes of wound duration?
- clean lcerations 0-6 hours with minimal contamination
- wounds 6-12hrs duration with significant contamination
- wounds 12hrs + with gross contamination AND bite wounds even if fresh
What are the majority of wounds classified as?
2
How is degree of contamination defined?
- clean
- clean contaminated
- contaminated
- dirty
What is a dirty wound defined as in a lab?
> 10^5 organisms per gram of tissue
What are potential wound aetiologies?
- abrasion
- avulsion/degloving
- incision
- laceration
- puncture
- crushing
- burns
What may discolouration around a seemingly small wound indicate?
underlying trauma
What trauma are we most worried about with neck wounds?
laryngeal and tracheal trauma
How should accidental wounds be managed first aid
- control haemorrhage using pressure not tourniquet
- fresh steril pressure bandage
- topical Abx (tetracycline or neomycin &bacitracin in 0.9% saline)
- chlorhexidine v dilute 0.05% can be sued but is damaging to fibroplasia
What is the first thing that should be done to accidental wounds?
DO NOT PROBE
- fill with KY jelly
- clip hair around wound
- prepare aseptically
- irrigate
Should accidental wounds be lavaged under pressure?
No
- effect is proportional to volume
- do not drive debris further into tissues
- no need for ABx added
What guage needle should be used to prevent too much pressure being applied when lavaging a wound?
19G
How may wounds be debrided?
- surgery gold standard
- bandages - wet-dry, dry-dry, wet-wet (adjubnct to surgery or when debridement not possible)
- Hydrogel and enzymes improve effects of debriding bandage
How can you decide which muscles to remove when debriding a wound?
if it does not twitch or bleed when touched it can go
What are the 2 main types of dressings?
> passive
- adherent/absorbent/non-adherent/vapour permeable/barrier films
- protection and environment to support healing
active
- hydrocolloids/hydrogels/alginates/collagens/skin substitutes
- provide cytokines and alter wound environment to ^ healing
When is vacuum assisted wound closure commonly used?
abdo and thoracic wounds
^ quality of granulation tissue
What are the advantages of adherent passive dressings?
- excellent debridement
- wide mesh allows dessication and tissue adherence
- good at combatting infection
- cheap
What are the disadvantages of adherent passive dressings?
- painful to remove
- changed frequently q24hrs
- delay fibroplasia and epithelialisation
- detrimental if used after debridement period
What are the differnet types of adherent passive dressings called? When are they indicated?
dry - dry (if wound effusive)
wet - dry
What sare the different wound closure options?
> 1* intention (incisions)
delayed 1* closure (leave 24-48hrs for necrosis then debride and close)
2* closure (leave granulation tissue to form then remove all)
2* intention (contraction and epithelialisation)
- may need a combination and can change your mind
If in doubt,should you close the wound?
No
