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WOUNDS-WOUND HEALING & CARE

WOUNDS-WOUND HEALING & CARE. Begashaw M . Layers of Skin. DEFINITION. Wound - break in normal continuity of a tissue cause - transfer of any form of energy. WOUND HEALING. is a complex biologic process of restoring normal tissue continuity

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WOUNDS-WOUND HEALING & CARE

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  1. WOUNDS-WOUND HEALING & CARE Begashaw M

  2. Layers of Skin

  3. DEFINITION • Wound - break in normal continuity of a tissue • cause - transfer ofany form of energy

  4. WOUND HEALING • is a complex biologic process of restoring normal tissue continuity • integrated sequences of events leading to cellular proliferation and remodeling • starts immediately following the event of wounding

  5. Wound Healing

  6. Phases of healing 1-Coagulation phase • first phase • is induced immediately following injury • characterized by vaso-constriction, clot formation and release of platelets

  7. 2- Inflammatory phase • takes place from time of wounding up to 3 days • Characterized: inflammatory response vasodilatation and pouring out of fluid migration ofinflammatory cells and leukocytes rapid epithelial growth

  8. 3- Proliferative Phase • phase of fibroplasia • starts around the 3rd day of injury • staysfor about 3 weeks • is characterized -fibroblast, epithelial and endothelial proliferation -Collagensynthesis &ground substance -blood vessel production

  9. 4- Maturation phase • phase of remodeling • takes the longest period - up to 1 yr • Equilibrium between protein synthesis and degradation occurs • with cross linking of collagen bundles leading to slow and continuous increase in tissuestrength

  10. Stages of Wound Healing

  11. Stages of wound healing

  12. Cells in Wound Healing

  13. Clinical types of healing • Healing by first intention - clean wound closed primarily - healingby epithelialization - minimal scar - <6 hours, longer with facial • Healing by Second intention - in wide, contaminated wounds - not primarily closed - healing by granulation tissue formation - tissue contraction and epithelialization - inferior cosmetic result

  14. Healing by third intention: -left open initially -closed later-delayed primary closure -In contaminated -long time lapse since initial injury -severe crush wound

  15. Factors affecting healing • Local factors -Ischemia -decreased oxygen tension -foreign bodies -tension -Infection -Irradiation • Systemic factors -Systemic diseases-DM, cirrhosis, renal failure, malignancy -malnutrition -immunosupression -Drug- steroids, cytotoxic agents

  16. WOUND ASSESSMENT AND CLASSIFICATION • Assessment History • Mechanism of injury • Time • Place and circumstance • past and current medical • immunization history

  17. physical examination • Extent of skin loss • Degree of circulation • soft tissue injury • The degree of contamination • foreign body • tissue necrosis

  18. Classification of wounds • Closed wound - an intact epithelial surface - skincover not completely breeched e.gContusion Bruise Hematoma • Open wounds - complete break of theepithelial protective surface E.g Abrasion Laceration Puncture Bites

  19. Open wounds Tidy Untidy crushed Contaminated Devitalised tissue Often tissue loss • Incised • Clean • Healthy tissue • Seldom tissue loss

  20. Classification of Wounds

  21. Classification of Surgical Wounds • Clean(no viscus opened) • Clean-contaminated(viscus opened minimal spillage) • Contaminated(open viscus with gross spillage or inflammatory ds) • Dirty(pus or perforation or incision via abscess)

  22. WOUND MANAGEMENT -Priority: ABC -Stabilize-correct life threatening conditions • history & P/E -associated injuries • Assess wound • treatment • Follow up

  23. Proper wound care: • stop bleeding • irrigation • debridement • decision -to close -leave the wound open • antibiotics • tetanus prophylaxis • correcting systemic disease

  24. primary wound closure • Clean wounds • Clean-contaminated wounds -if they can be convertedinto clean wounds • all missile wounds, animal & human bites should never be primarily closed • in woundswithin 6-8 hours

  25. Delayed primary closure • for traumatic or contaminated wounds • within 3 days

  26. Secondary closure • wound left open to heal spontaneously • contraction (myofibroblasts) and granulation • requires dressing change • inferior cosmetic result • indication: when 1° closure not possible or indicated

  27. Specific management • Bruises -Superficial -no specific management -localcompress -analgesics • Hematoma • collection of extravasated blood • Management: - absorbed spontaneously - Local compress to alleviate pain - aspiration-very large/ over a cosmetic area

  28. Abrasion • is rubbing or scraping of skin or mucous membrane -variable depth • affect only a part orfull layer of skin • Management - Cleanse using scrubbing brushes - Use antiseptic or clean tap water and soap - Analgesic

  29. Punctures • involve deeper structures • opening relatively small as compared with depth (e.g. needle) • Management: - Evaluate the depth - Remove - Excise damaged tissue - Cover with antibiotics - Tetanus prophylaxis

  30. Lacerations • open wounds - knife, or glass • cut or torn tissue • Management: - cleansing - Closure - wound debridement - antibiotic - Tetanus Prophylaxis - Analgesics

  31. Laceration

  32. Crush and avulsion wounds • complicated wounds • have more extensive damage • caused by compression • Management: - life threatening conditions - debridement • Early skin cover • late graft - wound left open if contaminated - antibiotics - Tetanus Prophylaxis - Analgesics

  33. Crush & avulsion

  34. Debridement

  35. Missile injuries • compound , complicated • excessive tissuedamage • high degree of contamination • severe life threatening • Management - stabilize - debridement • Antibiotics • Tetanus Prophylaxis • analgesics - avoid primary closure

  36. Human bites • heavily contaminated • due topolymicrobial-Staph> a-hemolytic Strep > Eikenellacorrodens >Bacteroides • Management - culture • Scrubbing • irrigation with saline - debridement - Leave wound open - Broad-spectrum antibiotic-augmentin - Tetanus Prophylaxis

  37. Dog bites • can transmit the rabies virus • animal observation for 10 days • Local • irrigation and repeated swabbing • flushing -soap &water/antiseptics - anti-rabies serum infiltration - leave wound open • Systemic - Post exposure anti rabies prophylaxis (1ml, IM) on the 1st, 3rd, 7th, 14th and 28thday - Tetanus prophylaxis - Antibiotics

  38. Dog bite

  39. Snake Bites • First aid : - irrigation - pressure bandage proximally - Immobilize - Transport tohospital

  40. Hospital Measures - Identify species - lab- hemoglobin, renal function - Anti-venom injection - Supportive care - Rest - IV-infusions to combat shock - Antibiotics - Blood transfusion - Tetanus Prophylaxis - Wound excision - Fasciotomy for compartment syndrome

  41. WOUND COMPLICATIONS • Local - Hematoma - Seroma - Infection - Dehiscence - Granuloma - Scar - Contracture • systemic - shock -massive bleeding • bacteremia& sepsis • death

  42. Hypertrophic Scar

  43. Hypertrophic Scars

  44. Keloid

  45. Keloids

  46. Questions?

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