Wound Management and Reconstruction Flashcards
what is a class 1 wound?
0-6 hours since occurrence?
minimal contamination and tissue trauma
what is a class 2 wound?
6-12 hours since occurrence
microbial burden has not reached critical level
what is a class 3 wound?
occurred more than 12 hours ago
wound infection
which wound class is not suitable for surgical closure?
class 3
what considerations would we have for a patient presenting with an open wound?
when it happened
exactly how it happened
overall stability of the patient
consider effects of shock
what should we consider in out initial assessment of a patient presenting with a wound?
general assessment and history
possibility of trauma
vital signs
analgesia required?
first aid required?
regular monitoring to stabilise patient if necessary
what are the main phases of wound healing?
inflammatory phase
debridement phase
repair/proliferative phase
remodelling
when is the inflammatory phase?
0-5 days
what occurs during the inflammatory phase?
haemorrhage
vasodilation
increased vascular permeability
when is the debridement phase?
day 0 onwards
what occurs in the debridement phase?
phagocytosis
migration of WBC
removal of cellular debris
when is the repair/proliferative phase?
day 3 to 4 weeks
what occurs in the proliferative phase?
fibroblasts proliferate
collagen synthesis
epithelialisation and contraction
when is the remodelling phase?
day 20-ongoing
what occurs in the remodelling phase?
wound contraction and remodelling of collagen fibres
what is the purpose of wound lavage?
reduction of bacterial load (50% for every hour earlier)
allows for visualisation of underlying tissues
what equipment should be used for wound lavage?
35/40ml syringe and 19G needle - pressures still widely unclear
approx how much fluid should be used for wound lavage?
50-100ml per square cm of wound
why is it important not to use too much pressure during wound lavage?
can encourage bacteria further into the wound
what solution should be used for wound lavage?
isotonic saline
can start with tap water if finishing with saline
why must we consider warmth of the lavage solution?
patient often sedated/under GA - warm fluid to avoid getting any colder
what are the different overall options for wound management?
primary wound closure (first intention healing)
delayed primary closure/secondary closure (third intention healing)
second intention healing (contraction and epithelialisation)
what considerations do we have when choosing second intention healing?
use of topical agents, dressings, types of bandage material
client compliance
cost
expertise
what are the 5 general principles of wound management?
non-introduction of anything harmful
tissue rest
wound drainage
avoidance of venous stasis
cleanliness