Wound

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Wound
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Factor influencing wound healing

• Local factors
• Tissue trauma
• Hematoma - associated with higher infection rate
• Blood supply
• Temperature
• Infection
• Technique and suture materials only important
• when factors 1-5 have been controlled
• General factors
• Systemic effect of steroids
• Nutrition
• Uncontrolled DM
• Chemotherapy
• Chronic illness

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Type of wounds and their treatment

• Cut wound
• Abrasion
• Contusion
• Laceration
• Avulsion
• Puncture wound

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Management of the clean wound

• Goal - close wound as soon as possible to prevent
  infection, fibrosis and secondary deformity.
• General principles
• Application of ATLS, examine the wound (type
  ,duration, and examine for related NAV)
• 1 -Immunization
• 2- Pre-anesthetic medication if needs
• 3- Local anesthesia use epinephrine adjuvant
  unless contraindicated, eg., digit , tip of penis
• 4- Tourniquet
• 5- Cleansing of surrounding skin do NOT use
  strong antiseptic in the wound itself
• 6- Debridement Remove clot and debris, necrotic
  tissue Copious irrigation good adjunct to sharp
  debridement
• 7- Closure - atraumatic technique to approx.
  dermis Consider undermining of wound edges to
  relieve tension.
• 8- Dressing must provide absorption,
  protection, immobilization, even compression,
  and be aesthetically acceptable.

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Suture materials
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Types of sutures
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• Wound management requires dressing materials and
  techniques that address the specific needs of the
  injury

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Wound dressings

• 1- Protect the wound from trauma
• 2 -Provide environment for healing
• 3 -Antibacterial medication provide moisture and
  control microorganism.
• 4- Splinting - casting
• For immobilization to promote healing
• Do not splint too long may promote joint
  stiffness
• 5- Pressure dressings
• May be useful to prevent dead space,
  seroma,hematoma
• Do NOT compress flaps tightly
• 6- Do NOT leave dressing on too long before
  changing

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Traditional Dressings

• Technique
• Layered Dressing (pressure or non-pressure)
  Contact/Interface layer non-adherent,
  fluid-permeable, in direct contact with wound
• Ex. Telfa/Cotton gauze/Cover-roll
• Advantages hemostasis, wound stability,
  decreased edema, low cost
• Disadvantages adherence to wound,
  ischemia/necrosis bulk frequent changes

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Post-Surgical Wounds

• Primary Closure Wounds are clean, free of
  debris, and sutured by aseptic technique
• Sutures provide hemostasis, reduce the chances of
  infection, and may improve ultimate cosmoses
• Upon suture removal, external splinting
  (Steki-Strips) supports the tissue may limit scar
  formation and tissue hypertrophy

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Type eg ccc
Simple Gauzes viscose/cotton withnon-adherent coating (Melolin) Tulles non-adherent paraffin impregnation Simple absorptive dressings only used as secondary dressings to absorb exudate. Relatively cheap but of questionable effectiveness
Polymeric films Opsite Primary adhesive transparent dressing for sutured wounds or donor sites
Fibrous polymers Kaltostat Sorbsan Absorptive alginate dressings. Derived from natural (seaweed) source. Like polymeric hydrocolloids and hydrogels, they can be used to pack deep wounds
Biological membranes Porcine skin, amnion Used for superficial chronic skin ulcers. No proven advantage
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Name Presentation Uses Comments
Povidoneiodine (Betadine) Alcoholic 10 Skin preparation Safe, fast-acting, broad spectrum.
Povidoneiodine (Betadine) Aqueous 7.5 Surgical scrub Safe, fast-acting, broad spectrum.
Alcohols 70 ethyl, isopropyl Skin preparation Should be reserved for use as disinfectants
(Savlon) Aqueous Hand-washing Instrument and surface cleaning Pseudomonas spp. may grow in stored contaminated solutions.