1. Unerstanding skin and woUnd
Unerstanding skin and woUnd
mangement
mangement
PrePared by
dr/ mohamed mohsen
dr/ mohamed mohsen

2. Objectives
• To know Anatomy and Physiology of related to
wound Care .
• To know the wound classifications.
• To know the wound healing process .
• identify Types of wound dressing and drainage.
• identify Factors affecting wound healing.
• To know the Wound assessment.
• Identify the common complications of wound.

3. outlines
1. Definition of wound
2. Types of wounds
3. Wound healing
4. Wound assessment
5. Kinds of wound drainage
6. Complications of wound healing

4. CONT,
7. Wound dressing
 Changing a dry sterile dressing
 Applying wet- to- dry dressing
 Applying a moist transparent wound barrier
 Applying a hydrocolloid dressing
8. Wound irrigation
9.Preventing wound infection

7. Functions of the skin
Thermoregulation
Vitamin D
synthesis
Function of
The skin
Fluid & electrolyte
protection
balance sensation

8. Functional physiology of the skin
• Protection
• Regulation of temperature
• Regeneration
• Absorption
• Communication
• Excretion /secretion
• Vitamin D production
• Sense of self-esteem
• Health indicator

9. WOUND
A break or “ disruption” in
the continuity of a body
tissue that followed by
restoration of that continuity
(wound healing).

10. Classification of wounds
Wound my be classified in to different
ways:
1. Mechanism of injury:
Intentional Vs. Unintentional.
 Open Vs. Closed.
Incised, contused, lacerated or puncture.
3. Degree of contamination.
4 . Depth of the wound.

11. Intentional Vs. Unintentional
wounds
Intentional wound:
occur during therapy. For example: operation or
venipuncture.
Unintentional wound:
occur accidentally.Example: fracture in arm in
road traffic accident.

12. Open Vs. Closed wounds
Open wound:
the mucous membrane or skin surface is broken.
Closed wound:
the tissue are traumatized without a break in the
skin.

13. Types of wounds
 Incised wounds:
 Made by a clean cut with a sharp instrument.
 Example, those made by the surgeon in every
surgical procedure and usually closed by sutures “
clean surgical wound”.
 Contused wounds:
 closed wound are made by blunt force.
 Characterized by considerable injury of the soft parts
, hemorrhage and swelling.

14. Types of wounds cont-
Puncture wounds:
 open wound, penetrating of the skin and often
the underlying tissues by a sharp instrument.
Stab wound:
 open wound, penetration of the skin and the
underlying tissues, usually unintentional.

15. Types of wounds cont-
 Laceration:
 open wound edges are often jagged, irregular
edges.
Often from accidents that made by glass or
barbed wire .سلك الشائك
 Abrasion:
 open wound involving skin only, painful, due
to surface scrape.

16. Degree of contamination
Wounds may be described as “ clean, clean-contaminated,
contaminated or dirty or infected”
Clean wounds:
 are uninfected wounds in which minimal
inflammation exist, are primarily clean closed
wounds; if necessary, a closed drainage system .
The respiratory, alimentary, genital, or uninfected
urinary tracts are not entered.
The relative probability of wound infection is
” 1% to 5%”.

17. Degree of contamination
Clean –contaminated wound:
are surgical wounds in which the respiratory,
alimentary, genital, or urinary tract has been entered.
There is no evidence of infection.
 The relative probability of wound infection is
” 3% to 11%”.

18. Degree of contamination
Contaminated wounds:
include open, fresh, accidental wounds and surgical
procedures with major breaks in a septic technique or
gross spillage from the gastrointestinal tract.
There is evidence of inflammation.
 The relative probability of wound infection is
“ 10% to 17%”.
Dirty or infected wounds:
 includes old, accidental wounds containing dead tissue
and evidence of infection such as pus drainage.
 The relative probability of wound infection is
over 27%.

19. Depth of the wound
Partial thickness:
the wound involves epidermis and dermis.
Full thickness:
 involving the epidermis, dermis, subcutaneous
tissue, and possibly muscle and bone.

20. Wound Healing
 Healing is regeneration (renewal) of tissues.
The time needed for healing depends on location,
and size of wound, and health status of the client.
The response of tissue to injury goes through
several phases.

21. Wound healing
Inflammatory
phase
Proliferative
phase
Maturation
phase

22. Timetable of Wound Healing
• Hemostasis immediate
• Inflammation 1-4 days
• Granulation Tissue 5-20 days
• Tissue remodeling 21 days-2 years
or maturation

23. Inflammatory
phase
Also called exudative phase
1-4 days
Blood clots forms
Wound becomes edematous
Debris of damaged tissue and blood clot are
phagocytized

24. Proliferative phase
Also called fibroblastic or connective tissue phase
5-20 days
Collagen produced
Granulation tissue forms
Wound tensile strength increases.
After 2 weeks, the wound has only 3% to 5% of the
original skin strengths.
 by the end of a month, only 35% to 59% of wound
strength.
Never more than 80% of strength is regained.

25. Maturation
phase
Also called resorptive or remodeling phase
21 days to months or even years
Fibroblasts leave wound
Maximum tensile strength increases
Collagen fibers reorganize and tighten to
reduce scar size

26. Forms of 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 intention(granulation)
Healing by delayed primary closure (third intention)

27. Healing by primary (first) intention
Wound is clean, in a straight line, with little
loss of tissue.
All wound edges are well approximated with
sutures.
Usually rapid healing with minimal scarring.
Drainage is minimal

28. Healing by secondary intention
(granulation)
 When surgical wounds are characterized by tissue loss
with inability to approximate wound edges, the process of
repair is less simple and takes longer.
 This type of wound is left open and allowed to heal from
the inside toward 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

29. Healing by secondary intention
(granulation) cont-
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

30. Healing by delayed primary
closure (third intention)
 This healing process takes place when approximation of
wound edges is delyed by 3-5 days or more after injury or
surgery.
 There is greater granulation , greater risk of infection,
greater inflamatory reaction and more scars.
 The condition contribute to a decision for a dalyed closure
are:
 Traumatic Wound
 Heavy contamination of wound
 Surgical Debridement of a wound

31. Wound assessment
 Determine the client’s allergies to wound-cleaning
agents and tape
 Assess the wound for:
 Appearance
 Size
 Depth
 Drainage
 Swelling
 Pain
 Drains or tubes

32. Cont,
 Assess the client for factors that
hinder wound healing
 Malnutrition
 Obesity
 Medications
 Smoking
 Compromised host

33. Cont,
Determine results of laboratory
data pertinent to healing:
 Leukocyte count
 Blood coagulation studies

34. Factors affecting wound healing
Age of patient
Hemorrhage
Hypovolemia
Local factors
• (too small or too tight dressing)
• edema
Nutritional deficits: : ( malnutrition, alcoholic)
Foreign bodies
Oxygen deficit (tissue oxygenation insufficient)

35. Cont,
Medications “Chemical effects “ as
anticoagulants , prolonged use of steroids)
Patient over activity
Caffeine and Smoking
Systemic disorders(renal failure, sepsis, liver
disease, DM, immune disease, cancer)
Procedural considerations( type of surgery, skin
preparation, duration of procedure, tissue
handling techniques, dressing methods)
Radiation and chemotherapy

36. Kinds of wound drainage
Sanguineous exudate
( Dark or bright red)
Serosanguineous exudate
(mix between two pervious types)
Serous exudate
(watery , clear)
Purulent exudate
(viscous fluid varies in color e.g blue ,
white , green)

37. Complications of wound healing
1. Hemorrhage:
2. Haematoma:.
3. Infection
4. Abnormal scar formation as
 Adhesion , Granuloma
 Keloid , Neuroma
 Hypertrophic scar , Contractures
5. Disruptions of wounds as
 Hernia
 Dehiscence,
 Evisceration,
 Fistula,
 Sinus tract

38. Complications of wound
healing
Clinical signs of hemorrhage
Increased pulse rate
Increased respiratory rate
Lower blood pressure
Restlessness
 thirst
 cold clammy skin

40. Cont,
Clinical signs of infection
Redness
Pain
 fever
 increased leukocyte count
 Swelling
indurations (hardening of the tissues)

41. Wound infection

42. Wound Dehiscence
• Disruption of surgical incision or
wound.
• Clinical signs of dehiscence
-Unexplained fever
-Unexplained tachycardia
-Unusual wound pain
 -prolonged paralytic ileus

43. WOUND DEHESCENCE

44. Wound Evisceration
Protrusion of wound contents.
Are especial serious when they involve
abdominal incisions or wounds.

45. Wound Evisceration

46. Wound dressing
Changing a dry sterile dressing
Applying wet- to- dry dressing
Applying a moist transparent wound
barrier
Applying a hydrocolloid dressing

47. Wound irrigation
An irrigation (lavage):
 is the washing or flushing out of an area. sterile
technique is required because there is a break in the
skin integrity.
 Using piston syringes instead of Asepto syringes to
irrigate a wound reduces the risk of aspirating
drainage.
 For deep wounds with small openings, a sterile
straight catheter may be used.
 Frequently used irrigation solutions are:
 Normal saline ,lactated ringer’s, antibiotic solutions
 Dakin’s solutions , hydrogen peroxide solutions

48. Preventing wound infection
Wash hands before and after caring for
surgical wounds.
Touch an open or fresh surgical wound only
when wearing sterile gloves or using sterile
forceps.
Remove or change dressings over open and
closed wounds when they become wet.
Take a specimen of any drainage from the
wound that is suspected of being infected.
Apply universal precautions.

49. WWoouunndd DDrreessssiinngg
Major dressings properties
–Moist environment
–Debriding potential
–Comfort and analgesia
–Exsudation management
–Ease of application

50. The Principal Reasons for Applying a
Dressing
• To produce rapid and cosmetically acceptable healing,
• To remove or contain odour,
• To reduce pain,
• To prevent or combat infection,
• To control exudate,
• To control bleeding
• To cause minimum distress or disturbance to the patient,
• To hide or cover a wound for cosmetic reasons.
• To clean and debride the wound.

51. days 21
Diabetic ulcer for
5 month
Hydroc
olloid
Hydrocolloid

52. AAbbssoorrppttiioonn bbaassee
ddrreessssiinngg
AAllggiinnaattee
HHyyddrrooffiibbrree
MMMMooooiiiisssstttt wwwwoooouuuunnnndddd hhhheeeeaaaalllliiiinnnngggg

53. Alginate : Indication
•For moderate to heavily exudating wounds
• Help to debride (in addition with mechanical
debridement

54. HHyyddrrooffiibbrree :: AAqquuaacceell
• CMC fiber : gel formation
• Same indications than
alginate
• Non haemostatic

55. Foam dressing : Indication
• For light to medium
exuding wounds
• Granulating and
epithelializating
wounds

56. For
Cavity Wounds

57. Foams
• Examples
– Allevyn
– Cutinova Foam
– Epilock
– Flexzam
– Hydrasorb
– Lyofoam
– Mitraflex
– Nu-derm

58. Hydrocolloids
– AquaCel
– Comfeel
– Cutinova Hydra
– Duoderm
– Hydrapad
– Intrasite
– J&J Ulcer
Dressing
– Procol
– Replicare
– Restore

59. Hydrogels
– AquaSorb
– Carrington Gel
– Carrasyn-V
– Clear-Site
– Curasol Gel
– Flexderm
– Hydron
– Intrasite Gel
– Solosite
– SAF-Gel

60. Any question?