Wound Healing, Dressing, and Drains

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Wound Healing, Dressing, and Drains

• Dr. Aidah Abu Elsoud Alkaissi

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Wound healing

• Etiology of wounds
• Surgical caused by an incision or excision
• Traumatic caused by an injury (mechanical,
  thermal, or chemical)
• Chroniccaused by an underlying pathophysiology,
  such as pressure sores, or venous leg ulcers,
  over time

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Exact biologic process that takes place in
orderly sequence

• An exudate containing blood, lymph, and fibrin
  begins clotting and loosely binds the cut edges
  together
• Blood supply to the area is increased, and the
  basic process of inflammation is set in motion
• Leukocytes increase in number to fight bacteria
  in the wound area and by phagocytosis help to
  remove damaged tissues
• The served tissue is quickly glued together by
  strands of fibrin and a thin layer of clotted
  blood, forming a scab

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Wound Healing

• Plasma seeps to the surface to form a dry
  protective crust
• This seal helps to prevent fluid loss and
  bacterial invasion
• During the first few days of wound healing, the
  seal has little tensile (The resistance of a
  material to a force tending to tear it apart)
  strength
• After 3-4 days , connective tissue cells
  (fibroblasts)rapidly proliferate and give
  strength to the wound by producing collagen, a
  tough fibrous protein responsible for the
  structural integrity of the skin

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Wound Healing

• At the same time small blood vessels regenerate
  and build new blood channels, granulation tissue
  (fibrous connective tissue) includes blood
  vessels and lymphatics that proliferate from the
  base of the wound
• Rapidly growing and multiple epithelial cells
  begin to restore the epithelial continuity of the
  skin
• At this stage the wound appears healed, healing
  is not complete until the granulation tissue
  organizes into scar tissue

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Wound Healing

• By the ninth or tenth day, the wound is
  moderately well healed and then becomes
  progressively stronger
• The whole process of repair takes 2 weeks or more
  depending on factors such as physical condition
  of the patient, size and location of the wound,
  and stresses put on the incisional area
• During this time the scar (cicatrix) strengthens
  as the connective tissue shrinks

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Wound Healing

• The amount of tissue loss, the existence of
  contamination or infection and damage to tissue
  are all factors that determine the type of wound
  healing that will occur
• Process of healing takes place in one of three
  ways
• Healing by primary (first) intention
• Healing by secondary infection (granulation)
• Healing by delayed primary closure (third
  intention)

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Healing by primary (first) intention

• Edges of an incised wound in a healthy person are
  promptly and accurately approximated
• Contmination is held to a minimum by impeccable
  (without fault or error) aseptic technique
• Trauma to the wound is minimal
• After suturing , no dead space is left to become
  site of infection
• Drainage is minimal

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Healing by secondary intention (granulation)

• When surgical wounds are characterized by tissue
  loss with inability to approximate wound edges,
  healing occurs through secondary intention
• This type of wound is left open and allowed to
  heal from the inside towared the outer surface
• In infected wound this process allows the proper
  cleansing and dressing of the wound as healthy
  tissue builds up from the inside

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Healing by secondary intention (granulation)

• The area of tissue loss gradually fills with
  granulation tissue (fibroblasts and capillaries)
• Scar tissue is extensive because of the size of
  the tissue gap that must be closed. Contraction
  of surrounding tissue also takes place
• Consequently this healing process takes longer
  than primary intention healing

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Healing by delayed primary closure (third
intention)

• This healing process takes place when
  approximation of wound edges is delayed by 3-5
  days or more after injury or surgery
• The condition contribute to a decision for a
  delayed closure are
• 1. Removal of an inflamed organ
• 2. Heavy contamination of wound

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Factors influencing wound healing

• The patients nutritional status and overall
  reoperative (To return to health or strength
  recover) power
• Especially significant is an adequate supply of
  protein, which is necessary for the growth of new
  tissues, the regulation of the osmotic pressure
  of blood and other body fluids and the formation
  of prothrombin, enzymes, hormones and antibodies

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• Vit C which aids connective tissue production and
  strong scar formation
• Scrupulous (extreme care and great effort)
  aseptic technique must be used to prevent any
  wound infection-the most common cause of delayed
  wound healing

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Factors influencing wound healing

• Theories abound as to the genesis of wound
  infection. Cross contamination from operating
  room, post anesthesia care unit and unit personel
  is believed to be a primary source
• Aseptic principles and maintenance of operating
  room environmental conditions are significant
  factors

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• Length of time that the wound is open in the
  operating room has also been mentioned
• The pat own endogenous flora
• Rough handling of tissue causes trauma that can
  lead to bleeding and other conditions conducive
  to the infection

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Factors influencing wound healing

• Other factors pat age, stress level, presxisting
  condition as diabetes, anemia, malnutrition,
  cancer , obesity, advanced age, cardiovascular,
  respiratory impairments. Overall physiacal and
  psychological condition

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Terms

• Keloid
• Proud flesh
• Gangrene
• Adhesions
• Dehiscence
• Evisceration
• Please read page 142

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Wound Classification

• Clean wound
• Clean contaminated wound
• Contaminated wound
• Dirty or infected wound
• Please read Page 143

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Dressing

• After surgery the dressing may be applied to the
  wound please read page 143, 144 145