2. WOUNDS
• The skin is the body’s largest organ and is the
primary defense against infection.
• A disruption in the integrity of body tissue is
called a wound.
Physiology of Wound Healing
• When an injury is sustained, a complex set of
responses is set into motion, and the body begins a
three-phase process of wound healing.
3. Defensive (Inflammatory) Phase
• The defensive phase occurs immediately after
injury and lasts about 3 to 4 days.
• The major events that occur in this phase are
hemostasis and inflammation.
• Hemostasis
Cessation of bleeding, occurs by vasoconstriction
of large blood vessels in the affected area.
• Platelets, activated by the injury, aggregate to form
a platelet plug and stop the bleeding.
• Inflammation
is the body’s defensive adaptation to tissue injury
and involves both vascular and cellular responses.
4. Reconstructive (Proliferative) Phase
• The reconstructive phase begins on the third or fourth
day after injury and lasts for 2 to 3 weeks.
• This phase contains the process of collagen
deposition(for formation of connective tissues),
angiogenesis(formation of blood vessels), granulation
tissue development, and wound contraction.
Maturation Phase
• Maturation, the final stage of healing, begins about
the twenty-first day and may continue for up to 2
years or more, depending on the depth and extent of
the wound.
• Although the scar tissue continues to gain strength, it
remains weaker than the tissue it replaces.
5. Types of Healing ; Tissue may heal by one of three
methods, which are characterized by the degree of
tissue loss.
• Primary intention healing occurs in wounds that have
minimal tissue loss and edges that are well
approximated (closed).
• Secondary intention healing is seen in wounds with
extensive tissue loss and wounds in which the edges
cannot be approximated.
• Tertiary intention healing occurs when there is a delay
in the time between the injury and closure of the wound.
For example, a wound may be left open temporarily to
allow for drainage or removal of infectious materials.
• This type of healing some times occurs after surgery.
6. Factors Affecting Wound Healing
• Age- Blood circulation and oxygen delivery to the
wound, clotting, inflammatory response, and phagocytosis
may be impaired in the very young and the elderly; thus,
the risk of infection is greater.
• Nutrition- A balanced diet with adequate amounts of
protein, carbohydrates, fats, vitamins, and minerals is
needed to increase the body’s resistance to pathogens and
to decrease the susceptibility of skin and mucous
membranes to infection and trauma.
• Malnutrition reduces humoral and cell mediated factors,
leading to immunocompromise, thus impairing wound
healing and increasing the risk for infection.
7. • Oxygenation- Decreased arterial oxygen tension
alters the synthesis of collagen and the formation
of epithelial cells, causing wounds to heal more
slowly.
• Reduced hemoglobin levels (anemia) decrease
oxygen delivery to the tissues and interfere with
tissue repair.
• Smoking- Functional hemoglobin levels
decrease, impairing oxygenation to tissues.
8. • Drug therapy Steroids reduce inflammatory
response and slow collagen synthesis.
• Anti-inflammatory drugs suppress protein
synthesis, wound contraction, epithelialization,
and inflammation.
• Prolonged antibiotic use, with development of
resistant strains of bacteria, may increase the
risk of superinfection.
9. • Diabetes-mellitus- Small-vessel disease
(microvascular changes) can impair tissue
perfusion and oxygen delivery.
• Hemoglobin in poorly controlled diabetes has an
increased affinity for oxygen, allowing less to be
released to the wound bed.
• Elevated blood glucose levels impair leukocyte
function and phagocytosis.
• The high-glucose environment is an excellent
medium for the growth of bacterial, fungal, and
yeast infections.
10. Dehiscence and Evisceration
• Wound healing may be disrupted by dehiscence,
the partial or complete separation of the wound
edges and the layers below the skin.
• Evisceration occurs when the client’s viscera
protrude through the disrupted wound.
• Factors that may predispose a wound to
dehiscence include obesity, poor nutrition,
problems with suturing, excessive coughing,
vomiting, straining, and infection.
• Wound dehiscence is most likely to occur 4 to 5
days postoperatively, before extensive collagen is
deposited in the wound.
11. Wound Classification
• The following are commonly used classification
systems.
Cause of Wound
Intentional wounds occur during treatment or
therapy.
• These wounds are usually made under aseptic
conditions. Examples include surgical incisions and
venipunctures.
Unintentional wounds are unanticipated and are
often the result of trauma or an accident.
• These wounds are created in an unsterile environment
and therefore pose a greater risk of infection.
12. Cleanliness of Wound
• This classification system ranks the wound
according to its contamination by bacteria and risk
for infection
Clean wounds are intentional wounds that were
created under conditions in which no inflammation
was encountered and the respiratory, alimentary,
genitourinary, and oropharyngeal tracts were not
entered.
Clean-contaminated wounds are intentional
wounds that were created by entry into the
alimentary, respiratory, genitourinary, or
oropharyngeal tract under controlled conditions.
13. Contaminated wounds are open, traumatic
wounds or intentional wounds in which there was
a major break in aseptic technique, spillage from
the gastrointestinal tract, or incision into infected
urinary or biliary tracts. These wounds have acute
nonpurulent inflammation present.
Dirty and infected wounds are traumatic wounds
with retained dead tissue or intentional wounds
created in situations where purulent drainage was
present.
14. Dressing of a Clean Wound
Purpose
• To keep wound clean
• To prevent the wound from injury and
contamination
• To keep in position drugs applied locally
• To keep edges of the wound together by
immobilization
• To apply pressure
Technique
• Aseptic technique to prevent infection
15. Method of Application
• Ointment and paste must be smeared with spatula
on gauze and then applied on the wound.
• Solutions or powder can be applied direct on the
wound.
• Make sure that the wound is properly covered.
• Fix dressing in place using adhesive tape or
bandage.
Leave patient comfortable and tidy
Record state of wound
Clean and return equipment to proper place
16. Dressing of Septic Wound
The purpose is to
• Absorb secretions being discharged from the
wound
• Apply pressure to the area
• Apply local medication
• Prevent pain, swelling and injury
17. • N.B.
• If sterile forceps are not available, use sterile gloves
• Immerse used forceps, scissors and other instrument
in strong antiseptic solution before cleansing and
discard soiled dressing properly.
• In a big ward it is best to give priorities to clean
wounds and then to septic wounds, when changing
dressings, as this might lessen the risk of cross
infection.
• Consideration should be given to provide privacy for
the patient while dressing the wound.
• Wounds should not be too tightly packed in effort to
absorb discharge as this may delay healing.
18. Dressing with Drainage Tube
Purpose
• Aids to prevent haematoma or collection of fluid
in the affected area.
Note.
• Safe method should be used for disposing old
dressing. Gauze and cotton used for cleaning
wound.
• Take preventive measures to avoid skin irritation
and excoriation.
• If drainage tube is attached to the bottle precaution
must be taken to secure the tube in place and avoid
the risk of cross infection.
19. Wound Irrigation
Purpose
• To cleans and maintain. Free drainage of infected
wounds.
Note:
• Keep patient in a convenient position. According
to the need so that solution will flow from wound
down to the receiver.
• Use sterile technique and warn solution for
irrigating the wound.
20. Suturing
• Definition: The application of stitch on body
tissues with the surgical needle & thread.
Purpose
• To approximate wound edges until healing occurs
• To speed up healing of wound
• To minimize the chance of infection
• For esthetic purpose
21. • Note:
• Do not suture wounds that are over 12 hrs old.
However, such wounds have to be seen by a
doctor since excision of all dead & devitalized
tissue and eventual suturing may be required.
• Check that the patient gets his order for T.A.T
before he leaves the hospital.
• Do not suture deep wound.
• Before you suture any wound, make sure it is free
of any foreign bodies.
