Wound Care & Dressing
Third year DMS Team
and
Department of Surgery
2009
Types of Wound Healing
Primary intention
Surgical / incisional wound, reapproximated.
Absence of complication
Heal with scar; no special wound care needed
Secondary intention
Not reapproximated
Defect fill in with granulation tissue and later reepithelized
Delay healing; Require special dressing and
treatment
Gurtner GC. Wound Healing: Normal and Abnormal. In: Grabb and Smiths Plastic Surgery, 6 th edition.
Lippincot William and Wilkins. 2007;2:15-22
Anal injury, cleaned and reapproximated by suturing
Primary intention healing by suturing in surgical incision
Acute Infected Wound caused by insect bite in diabetic patient
Clean and Debridement; expect the wound to heal with secondary intention
Types of Wound Healing
Acute Wound
Occurred within 3-4 weeks
Chronic Wound
Persist beyond 4-6 weeks
Include wound that present for months or years
Nonhealing or delayed healing Wound
Term use interchangeably to describe chronic
wound
Gurtner GC. Wound Healing: Normal and Abnormal. In: Grabb and Smiths Plastic Surgery, 6 th edition.
Lippincot William and Wilkins. 2007;2:15-22
Chronic Wound caused by
Pressure Sores (decubitus) in
paraplegic patient
Chronic wound caused by
Chronic Venous Insufficiency
Phases of Normal Wound Healing
Following the injury:
Inflammatory phase
Proliferative phase
Remodelling phase
Gurtner GC. Wound Healing: Normal and Abnormal. In: Grabb and Smiths Plastic Surgery, 6 th edition.
Lippincot William and Wilkins. 2007;2:15-22
Inflammatory phase
Immediately following tissue injury
Functional priorities:
Hemostasis
Removal of dead and devitalized tissue
Prevention of colonization and invasive
infection by microbial pathogens
Provisional of Fibrin matrix
Inflammatory cells are recruited to the
wound site
Gurtner GC. Wound Healing: Normal and Abnormal. In: Grabb and Smiths Plastic Surgery, 6 th edition.
Lippincot William and Wilkins. 2007;2:15-22
Proliferative phase
Occurred 4-21 days following injury
Replace of fibrin matrix by granulation
tissue; composed of three cells:
Fibroblasts
Macrophages
Endothelial cells
Keratinocytes migration
Re-epithelialization
Gurtner GC. Wound Healing: Normal and Abnormal. In: Grabb and Smiths Plastic Surgery, 6 th edition.
Lippincot William and Wilkins. 2007;2:15-22
Remodeling phase
Last from 21 days and up to 1 years
Programmed regression of blood
vessels and granulation tissue
Wound contraction
Collagen remodeling
Gurtner GC. Wound Healing: Normal and Abnormal. In: Grabb and Smiths Plastic Surgery, 6 th edition.
Lippincot William and Wilkins. 2007;2:15-22
Basic wound care
The basics of wound care are the following:
1) Keep the wound clean
2) Keep the wound moist
3) Keep the wound well nourished
Keep the wound clean
The wound can simply be washed once or
twice daily with soap to help achieve and
maintain wound cleanliness
Wound irrigation with normal saline (NaCl
0.9%)
Wound debridement; to remove the necrotic
or death tissues, foreign material
The only exception to immediate debridement
is a dry, chronic, arterial insufficiency eschar
without evidence of infection
It may promote further ischemia and lead to the
formation of larger ulcer
These type of wounds should be
revascularized before debridement
Lorentz HP. Longaker MT. Wounds: Biology, Pathology, and Management. In: Norton, Bollinger, Chang et
al. Surgery: Basic Science and Clinical Evidence. Springer-Verlag New York. 2001;12:233-235
Buergers disease
Atherosclerosis obliterans
Digital gangrene due to Raynauds disease
Dry, uninfected, chronic wound
Caused by arterial insufficiency.
Debridement should not be performed
Before revascularization
Keep the wound moist
Second principle is to keep the wound moist
Obviously, it has the dual function of helping
keep the wound clean
Moist Wound dressing:
To provide the ideal environtment for wound
healing
To mimics the barier role of epithelium and to
prevent further damage
Keep the wound well nourished
The third principle of wound care is to
ensure good nutrition
Which implies reducing or eliminating
edema and keeping pressure off the
wound
Particularly if the patient is immobilized
and can't move spontaneously to relieve
pressure on the wound
Wound culturing
Wound culturing using cotton swab
If the tissue around
the wound is red
and tender
suggesting
infection, then the
wound should be
cultured
Wound dressing
This shows a bulky dressing applied on top
of the non-adherent dressing to absorb the
bleeding that will occur over the next hour
or two after debridement
Wound dressing
The optimal open wound dressing:
Maintains a moist, clean environment that
prevents pressure and mechanical trauma,
reduces edema, stimulates repair, and
inexpensive.
Less frequent dressing changes and
prevention of skin irritation
No ideal dressing exists
Lorentz HP. Longaker MT. Wounds: Biology, Pathology, and Management. In: Norton, Bollinger, Chang et
al. Surgery: Basic Science and Clinical Evidence. Springer-Verlag New York. 2001;12:233-235
Wound dressing
Numerous dressing products
Plain gauze and normal saline (moist to dry
gauze) with or without antibiotic ointment remain
the simplest and least expensive dressing
Major disadvantages:
Frequent need for changes
Painful changes
Lorentz HP. Longaker MT. Wounds: Biology, Pathology, and Management. In: Norton, Bollinger, Chang et
al. Surgery: Basic Science and Clinical Evidence. Springer-Verlag New York. 2001;12:233-235
Infected wound after primary suture
Case
Second degree burn
Necrotomy and debridement in OR
(General anesthesia)
Application of Silver Sulfadiazine ointment
Dressing with Saline Moist Gauze
Case
Extending submandibular abscess;
The wound dressing had been removed
To clean and irrigate using normal saline
Application of saline moist gauze and dry gauze
July 8th 2008, day 0
Case
Diabetic foot abscess
Day 29
Secondary healing intention:
Granulation tissue and epithelialization
Day 4
Necrotomy and debridement,
abscess drainage
Day 50
Wound contraction; and the wound heal
Case
Severe tissue damage Diabetic wound
Repeated Necrotomy and debridement
Daily wound care is only application of saline moist gauze and dry gauze
Secondary healing intention:
Granulation tissue and epithelialization
Wound contraction; and the wound heal
Schwartzs Principles of Surgery
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