Wounds Flashcards
Define wounds
It is defined as an area of compromised integrity. It is a disruption of normal physiology of tissue, organ or system. Wounds usually affect superficial tissue and
results from external factors unlike ulcer (ulcer is due to necrosis originating from w i t h i n )
Classification Of Wounds
- Involvement of viscera: Simple (only
skin is affected) and Complex wounds (affects
vessels, nerves, tendons, tendons or bone)
2 . B a s e d o n c l i n i c a l a p p e a r a n c e : C l o s e d and Open Wounds
Closed wounds (skin remains intact)
includes bruise, contusion, hematoma
Open wound (skin is broken) includes abrasion/friction burns, laceration (deep linear
cut), puncture wounds/bites, traction/avulsion (body portions torn away), crushing wound, penetrating wound (enters a body cavity), perforating wound (entirely pass through a hollow organ or cavity), blast wound - Tidy and Untidy Wounds
- Tidy wounds usually inflicted by sharp instruments and does not contain devitalized
tissue
- Untidy wounds result from crushing, tearing,
avulsion, vascular injury.
Wound is usually irregular, multiple and contains devitalized
tissue - Based on degree of contamination: Surgical and Non-surgical wounds
-Surgical wounds are intentional wounds made under asepticcondition. It includes
a. Clean wound (mastectomy, thyroidectomy, lipoma excision). Infection rate is 1.5-5%
b. Clean contaminated (bile, appendicectomy). Infection rate is 6-14%
c. Contaminated wound (typhoid perforation). Infection rate is 15-29%
d. Dirty wound (intra-abdominal abscess). Infection rate is 30-40%
- Non-surgical wounds are usually traumatic
wounds sustained by accident
PHASES OF Wound Healing
PHASES OF Wound Healing
1. Reactive phase (inflammatory phase) lasts 2-5 days Characterized by hemostasis, Inflammation, Epithelial migration & Demolition
2. Regenerative (proliferative phase) lasts up to 6 weeks characterized by Re-epithelization, synthesis & Neo-vascularization,
- Remodeling (maturation phase) up to 2 yrs. Characterized by Scar contraction, Collagen crosslinking, Shrinking and loss of edema
Factors affecting wound healing
Local causes
Local c a u s e s : recurrent trauma, underlying disease (osteomyelitis, malignancy), presence of hematoma, irradiation, pressure, presence o f necrotic tissue, contaminants (foreign body), poor apposition,tissue tension, vascular insufficiency,s i t e o f wound, structures involved
Systemic causes of poor healing
age, malnutrition,
anemia, jaundice, uraemia,
obesity,
vitamin and mineral deficiencies, o
besity,
malignancy, smoking/alcohol,
d r u g s
(steroids), Immunodeficiency states (HIV)
Complicationsof wound healing
Wound breakdown
Infection of wound
Hemorrhage
Fistula formation Abscess formation Keloids
Incisional hernia Contractures
Types of Wound Healing
A.Primary Healing (by
primary/first intention: normal healing occurs with minimal scar formation. Wound edges can be apposed using sutures, staples or skin tapes B.Secondary healing (by secondary/second intention): wound is left open (especially in cases of extensive tissue loss or presence of sepsis) and it heals by granulation,
contraction and epithelization. There is increased inflammation and proliferation.
There is formation of poor scar.
C. Delayed Primary Healing (by tertiary intention): wound initially is left open for some specific reasons (to allow infection to clear), edges are then later apposed when conditions are favourable
Wound closure 3 types
-Primary w o u n d closure: is that
which is closed at the time it was made (at surgery for surgical wounds, at presentation for non- surgical wounds)
-Delayed primary closure: is wound closure delayed for a maximum of 5 days because of inflammatory edema. You wait for edema to settle before closing the wound -
Secondary wound closure: is done beyond 5 days. The reason for the delay is presence of infection. Closure is done after infection has subsided
