dressing

1. Prepared by: Gianne T. Gregorio

2. are injuries that
break the skin or other body
tissues. They include cuts,
scrapes, scratches, and
punctured skin. They often
happen because of an accident,
but surgery, sutures, and stitches
also cause wounds.

3. ACUTE WOUND- is any
surgical wound that heals by
primary intention or any traumatic
or surgical wound that heals by
secondary intention. An acute
wound is expected to progress
through the phases of normal
healing, resulting in the closure of
the wound.
CHRONIC WOUND- is a wound
that fails to progress healing or respond to
treatment over the normal expected
healing time frame (4 weeks) and
becomes "stuck" in the inflammatory
phase. This pathologic inflammation is
due to a postponed, incomplete or
uncoordinated healing process. Wound
healing is delayed by the presence of
factors including medications, poor
nutrition, co-morbidities or inappropriate
dressing selection.

4. WOUND HEALING
PRIMARY INTENTION- the wound edges are held
together by artificial means such as sutures, staples,
tapes or tissue glue. There is minimal tissue loss and
wounds heal with minimal scarring. Most clean surgical
wounds and recent traumatic injuries are managed by
primary closure.
DELAYED PRIMARY INTENTION- when the wound is
infected or requires more thorough intensive cleaning or
debridement prior to primary closure usually 3-7 days
later. May be used for traumatic wounds or contaminated
surgical wounds.
SECONDARY INTENTION- spontaneous wound healing
occurs through a process of granulation, contraction and
epithelialisation. Results in scar formation and used as a
method of healing for pressure injuries, ulcers.

5. An incision, it is a cut through the skin
that is made during surgery. Some
incisions are small, others are long.
The size of the incision depends on
the kind of surgery you had.

6.  Surgical wounds (incisions) heal by primary intention when
the wound edges are brought together and secured, often
with sutures, staples, or clips. Wound dressings applied after
wound closure may provide physical support, protection and
absorb exudate. There are many different types of wound
dressings available and wounds can also be left uncovered
(exposed). Surgical site infection (SSI) is a common
complication of wounds and this may be associated with
using (or not using) dressings, or different types of dressing.

7. A laceration is a deep cut or tearing of
your skin. Accidents with knives, tools,
and machinery are frequent causes of
lacerations. In the case of deep
lacerations, bleeding can be rapid and
extensive.

8. TYPES OF
LACERATION
1. SPLIT
LACERATIONS
-caused by compression of
the skin between the
weapon & bone
e.g. a blow with a heavy
blunt weapon on head,
face, lateral & back of

9. TYPES OF
LACERATION
2. TORN
LACERATIONS
- caused by a projecting
surface of an object
being dragged over the
the skin
e.g. road traffic accidents
, machinery accidents

10. TYPES OF
LACERATION
3. STRETCH
LACERATIONS
- caused by a heavy
blunt impact on a fixed,
localized area of skin
causing the skin to
overstretch
The picture shows a laceration of the
scalp in a laborer working in a garment
factory.
Her hair got tangled with a rotating wheel
resulting in over stretching of the scalp.

11. TYPES OF
LACERATION
4. PERFORATED
LACERATIONS
- caused by objects
capable of penetrating
the skin
e.g. missiles of firearms,
shrapnel from explosions
The picture shows the entry wound of
a firearm injury below the left breast
over thorax in a suicidal injury. This
was caused by a twelve-bore
shotgun.

12. TYPES OF
LACERATION
5. BLAST
LACERATIONS
- caused by local blast
effect of expanding
gases
e.g. blast injuries

13. TYPES OF
LACERATION
6. CUT LACERATIONS
- caused by blunted
sharp weapons
e.g. ice picks, blade
FRONT VIEW
SIDE VIEW

14. TYPES OF LACERATION
7. CRUSH
LACERATIONS
-occurs as a result of
crush injury where the
injury is caused by
protruding bone fragments
e.g. crush injury of the
fingers

15. TYPES OF
LACERATION
8. DE-GLOVED
LACERATIONS -
caused by grinding force
over the body resulting
peeling off of the skin
from underlying tissues
e.g. road traffic accident
The picture shows the peeling
off of the skin and
subcutaneous tissues of the left
whole leg up to the groin,
exposing muscle and bone.

16.  Laceration repair options in the
outpatient setting include sutures,
tissue adhesives, staples, and skin-
closure tape. Physicians should
have a working knowledge of these
techniques, including how to choose
the correct closure method and how
to perform closures to obtain optimal
results.
 Wounds requiring extensive
debridement or multiple-layer
closure are best repaired with a
suture. Areas of high skin tension,
such as over joints, or areas with a
thick dermis, such as on the back,
should be repaired with sutures or
staples. Areas with low skin tension,
such as on the face, shin, and dorsal
hand, may be effectively repaired
with tissue adhesives, especially in
children.
Suture techniques for laceration repair. (A) Single
interrupted closure. (B) Running (“baseball”)
closure. (C) Subcuticular running closure.

17. Stitches are special threads that are sewn through the skin at an injury site to bring a wound together. Care
for stitches and wound as follows:
Keep the area dry for the first 24 to 48 hours
after stitches have been placed.
Then, you can start to gently wash around the
site 1 to 2 times daily. Wash with cool water
and soap. Clean as close to the stitches as you
can. DO NOT wash or rub the stitches directly.
Dab the site dry with a clean paper towel. DO
NOT rub the area. Avoid using the towel
directly on the stitches.
If there was a bandage over the stitches, replace
it with a new clean bandage and antibiotic
treatment, if so instructed.
The doctor should also tell when you need to have a
wound checked and the stitches removed.

18. Medical staples are made of special metal and are not the same as office staples. Care for staples and wound
as follows:
Keep the area completely dry for 24 to 48
hours after staples are placed.
Then, you can start to gently wash around the
staple site 1 to 2 times daily. Wash with cool
water and soap. Clean as close to the staples as
you can. DO NOT wash or rub the staples
directly.
Dab the site dry with a clean paper towel. DO
NOT rub the area. Avoid using the towel
directly on the staples. If there was a bandage over the staples, replace
it with a new clean bandage and antibiotic
treatment as directed by the doctor. The doctor
should also tell when you need to have a
wound checked and the staples removed.

19. An abrasion occurs when your skin
rubs or scrapes against a rough or
hard surface. Road rash is an example
of an abrasion. There’s usually not a
lot of bleeding, but the wound needs to
be scrubbed and cleaned to avoid
infection.

20. Abrasions can range from mild to severe. Most abrasions are mild and can easily be tended to at home.
Some abrasions, however, may require medical treatment.
FIRST-DEGREE ABRASION
A first-degree abrasion involves
superficial damage to the
epidermis. The epidermis is the
first, or most superficial, layer of
skin. A first-degree abrasion is
considered mild. It won’t bleed.
First-degree abrasions are
sometimes called scrapes or
grazes.
SECOND-DEGREE
ABRASION
A second-degree abrasion
results in damage to the
epidermis as well as the
dermis. The dermis is the
second layer of skin, just
below the epidermis. A
second-degree abrasion
may bleed mildly.
THIRD-DEGREE ABRASION
A third-degree abrasion is a
severe abrasion. It’s also known
as an avulsion wound. It
involves friction and tearing of
the skin to the layer of tissue
deeper than the dermis. An
avulsion may bleed heavily and
require more intense medical
care.

21. CHOICE OF
DRESSING
A wound will require different management and
treatment at various stages of healing. No
dressing is suitable for all wounds; therefore
frequent assessment of the wound is required.
Wound healing progresses most rapidly in an environment that is clean, moist (but
not wet), protected from heat loss, trauma and bacterial invasion.
Much research has demonstrated that moisture control is a critical aspect of wound
care.
The appropriate dressing can have a significant effect on the rate and quality of
healing.
The appropriate dressing will help to minimize bacterial contamination and pain
associated with wound care.

22. CHARACTERISTICS OF THE IDEAL DRESSING:
No single dressing is suitable for all types of wounds. Often a number of different types of
dressings will be used during the healing process of a single wound. Dressings should perform
one or more of the following functions:
 Maintain a moist environment at the wound/dressing interface
 Absorb excess exudate without leakage to the surface of the dressing
 Provide thermal insulation and mechanical protection
 Provide bacterial protection
 Allow gaseous and fluid exchange
 Absorb wound odour
 Be non-adherent to the wound and easily removed without trauma
 Provide some debridement action (remove dead tissue and/or foreign
particles)
 Be non-toxic, non-allergenic and non-sensitising (to both patient and
medical staff)
 Sterile

23.  HYDROCOLLOID DRESSINGS (INCLUDING HYDROFIBRES)
Hydrocolloid fibres are now available in the form of a hydrophilic, non-woven flat sheet,
referred to as hydrofibre dressings. On contact with exudate, fibres are converted from
a dry dressing to a soft coherent gel sheet, making them suitable for wounds with a
large amount of exudate.
TYPE OF DRESSING USES
Hydrocolloid sheets: Alione,
CombiDERM, CombiDERM N,
Comfeel,* Comfeel Plus, Cutinova
Thin,* DuoDERM Extra
Thin,* Granuflex,*Tegasorb, Tegasorb
Thin
Cavity or flat shallow wounds with
low to medium exudate; absorbent;
conformable; good in “difficult”
areas—heel, elbow, sacrum
Hydrocolloid paste: GranuGel Paste*
May be left in place for several days;
useful debriding agent; may cause
maceration
Hydrofibre: Aquacel (Hydrofibre),
Versiva
Useful in flat wounds, cavities,
sinuses, undermining wounds;
medium to high exudate wounds;
highly absorbent; non-adherent; may
be left in place for several days;
needs secondary dressing

24.  LOW ADHERENT DRESSINGS are cheap and widely available. Their
major function is to allow exudate to pass through into a secondary
dressing while maintaining a moist wound bed.
a. Tulles—Bactigras, Jelonet, Paranet, Paratulle, Tullegras, Unitulle,
Urgotul
b. Textiles—Atrauman, Mepilex, Mepitel, NA Dressing, NA Ultra,
Tegapore, Tricotex

25. HYDROGELS
Examples include Aquaform, Intrasite, GranuGel, Nu-Gel, Purilon,
Sterigel
• Supply moisture to wounds with low to medium exudate
• Suitable for sloughy or necrotic wounds
• Useful in flat wounds, cavities, and sinuses
• May be left in place several days
• Need secondary dressing
• May cause maceration

26.  SEMIPERMEABLE FILMS were one of the first major advances in
wound management and heralded a major change in the way wounds
were managed. They consist of sterile plastic sheets of polyurethane
coated with hypoallergenic acrylic adhesive and are used mainly as a
transparent primary wound cover.
a. Examples include Bioclusive, Mefilm, OpSite Flexigrid,* OpSite Plus, Tegaderm

27. FOAM DRESSINGS are manufactured as either a polyurethane or
silicone foam. They transmit moisture vapour and oxygen and provide
thermal insulation to the wound bed.
TYPE OF DRESSING USES
Adhesive sheets: Allevyn
Adhesive, Allevyn Lite Island,
Allevyn Thin, Allevyn Plus
Adhesive, Biatain Adhesive,
Lyofoam Extra Adhesive, Tielle
Plus, Tielle Lite, Tielle
Flat, shallow wounds (control
of exudate depending on type
of foam); give degree of
cushioning; may be left in
place for two to three days
Need secondary dressing
Non-adherent sheets:
Allevyn,* Allevyn Lite,
Lyofoam,*Lyofoam Extra*
Allevyn Cavity, Allevyn Plus
Cavity, Cavi-Care
Cavity wound with medium to
high exudate