Wound Healing Objectives:

1. Wound HealingObjectives: Indicate terms relevant to wound healing Summarize the possible complications of wound healing Recognize the classifications of surgical wounds Indicate and give examples of types of traumatic wounds Analyze the factors that influence healing and recognize the manner in which affect the healing process 6. Recognize the characteristics of inflammation

2. Wound • Any tissue that has been damaged by either intentional (surgical) or accidental (traumatic) means

3. Classification of Surgical Wounds Class I - Clean • Incision made under ideal conditions • No break in sterile technique during procedure • Primary closure • No wound drain • No entry to aerodigestive tract or genitourinary tract

4. Class II – Clean Contaminated • Primary closure • Wound drained • Minor break in sterile technique occurred • Controlled entry to aerodigestive, biliary or genitourinary tract

5. Class III - Contaminated • Open traumatic wound (less than 4 hours old) • Major break in sterile technique • Acute inflammation present • Entry to aerodigestive tract or genitourinary tract with spillage

6. Class IV – Dirty/Infected  • Open traumatic wound (more than 4 hours old) • Microbial contamination prior to procedure • Perforated viscus

7. Surgical Wound classification is subject to change during the procedure according to the situation. The final wound classification is assigned at the end of the procedure and is included in the permanent documentation.

8. TRAUMATIC WOUNDS • Closed wound • Open wound

9. CLOSED WOUND • The skin remains intact, but underlying tissues suffer damage

10. OPEN WOUND • The integrity of the skin is destroyed • Simple wound – The integrity of the skin is destroyed, there is no loss or destruction of tissue and there is no foreign body in the wound. • Complicated wound – Tissue is lost or destroyed, or a foreign body remains in the wound. • Clean wound – Wound edges can be approximated and secured. A clean wound is expected to heal by first intention. • Contaminated wound – Contamination occurs when a dirty object damages the integrity of the skin. Debridement of necrosed tissue may be necessary.

11. Mechanism of Injury: • Abrasion • Contusion • Laceration • Puncture • Thermal

12. Chronic Wounds • Those that persist for an extended period of time. A chronic wound may develop because of an underlying physical condition that the patient suffers from or it may be due to infection

13. Inflammatory Response Inflammation is the body’s protective response to injury or tissue destruction, it serves to destroy, dilute, or wall off the injured tissue… Classic local signs: • Pain • Heat • Redness • Swelling • Loss of function

14. Types of Wound Healing • First intention • Second intention • Third intention

15. Phase ILag Phase/Inflammatory Response Phase • Phase II Proliferation Phase • Maturation or Differentiation phase

16. Factors Influencing Wound Healing • Age • Nutritional Status • Disease (acute, Chronic) • Smoking • Radiation exposure • Immunocompromised

17. Second Considerations (Intraoperative) • Length and direction of incision • Dissection technique • Duration of Surgery • Amount of tissue handling • Achievement of hemostasis • Precise tissue approximation • Elimination of dead space • Secure wound closure

18. Third consideration (Aseptic Technique) • Microbial contamination, could lead to infection, increase in morbidity or mortality

19. Complications of the Healing Wound • Dehiscence • Friable • Evisceration • Hemorrhage • Infection • Adhesion • Herniation • Fistula • Sinus tract • Suture complications • Keloid scar

20. Intraoperative Wound Care • Sterile Techniques • Proper suturing techniques • Wound drains • Different types of dressings

21. Postoperative Wound Care • Wound Drains • Dressings • Packing