 Session Objectives

At the end of this topic, the students will be able

to:-
Define the term “Wound”
Outline the classification of wounds
Explain wound closure
Discuss the management of wounds

By Jiregna D.(DVM,MVSc, Assist.

prof.), CVMA, AAU. 11/23/2023 1
 Isa type of injury in which skin is torn, cut or
punctured (an open wound) or where blunt force
trauma causes contusion (a closed wound).
 Wounds
can be classified as follows based on:
The etiology/origin/
Rank-Wakefield classification system
Duration of the wound healing
The integrity of the skin
Degree of contamination
 Wound depth
Severity of the wound

By Jiregna D.(DVM,MVSc, Assist.

prof.), CVMA, AAU. 11/23/2023 3
I. Mechanical: Abraded, Puncture, Bite, Incised wound, Shot
wound and Crush wound.

II. Chemical: Acid and base

III. Radiation

IV. Thermal forces: Burning and Freezing

V. Special: Exotic, poisonous animals
Toxins, venom - toxicologist
Skin necrosis

By Jiregna D.(DVM,MVSc, Assist.

prof.), CVMA, AAU. 11/23/2023 4
1) Abraded wound
Consists of frictional destruction of superficial part of skin due to
exposure of nerve endings (epidermal layer).
It is relatively painful and Hemorrhages is minimal
Good wound healing
2) Punctured wound
Sharp-pointed object
Seems negligible but: Anaerobic infection and Injury of big vessels
and nerves can occur.
3) Incised wound
Sharp object- Best healing.

By Jiregna D.(DVM,MVSc, Assist.

prof.), CVMA, AAU. 11/23/2023 5
4) Crush wound 5) Bite wound
Blunt force  Crushed tissue
Pressure injury  Infection
 Bone fracture
6) Shot wound
 Close - burn injury  Chemical wounds:
 Foreign materials  Acids and bases

By Jiregna D.(DVM,MVSc, Assist.

prof.), CVMA, AAU. 11/23/2023 6
 Symptoms and severity depend on:
Amount of radiation
Length of exposure
Body part that was exposed
Symptoms may occur immediately, after a few days, or even
as long as months.

By Jiregna D.(DVM,MVSc, Assist.

prof.), CVMA, AAU. 11/23/2023 7
1) Burning

1st degree – superficial injury (epidermis)

2nd degree –partial or deep partial thickness (epidermis+superficial
or deep dermis)
3rd degree – full thickness (epidermis + entire dermis)
4th degree – (skin + subcutaneous tissue + muscle and bone)

2) Freezing
 mild, moderate, severe (redness, bullas, necrosis)

By Jiregna D.(DVM,MVSc, Assist.

prof.), CVMA, AAU. 11/23/2023 8
 Tidy Wounds
These are wounds inflicted by sharp instruments and contain no
devitalized tissue
Such wounds can be closed primarily with the expectation of
quite primary healing
 They are usually single with clean cut
 Associated fractures are uncommon in tidy wounds
E.g: surgical incisions, cuts from glass and knife wounds

By Jiregna D.(DVM,MVSc, Assist.

prof.), CVMA, AAU. 11/23/2023 9
 Wounds resulting from crushing, tearing avulsion,
vascular injury or burns, and contain devitalized
tissue.
 They are usually multiple and irregular
 Commonly associated with fractures
 Such wounds can not be closed primarily and
therefore should be allowed to heal by second
intention

By Jiregna D.(DVM,MVSc, Assist.

prof.), CVMA, AAU. 11/23/2023 10
 Acutewounds
 Acute wounds are wounds that usually heal in the
anticipated time frame
Duration of the wound: immediately to few weeks
 Examples are wounds acquired as a result of trauma
or an operative procedure

By Jiregna D.(DVM,MVSc, Assist.

prof.), CVMA, AAU. 11/23/2023 11
 Wounds that fail to heal in the anticipated time frame and
often reoccur.

Duration of the wound ~~4 weeks to 3 months

Wounds occur as a result of an underlying condition such as

extended pressure on the tissues, poor circulation, or even
poor nutrition.

By Jiregna D.(DVM,MVSc, Assist.

prof.), CVMA, AAU. 11/23/2023 12
 1) Intentional (purposeful) as in surgical wounds
or
2) Accidental, as in trauma.
 Further classified in to:
A) Open accidental wound
 Skin or mucous membrane surface is broken
 Abrasion, laceration, puncture and avulsion.
B) Closed accidental wound.
 The damage is below the surface.
 Bruise (contusion) , rupture and haematomas
 All accidental wounds are contaminated.
By Jiregna D.(DVM,MVSc, Assist.
prof.), CVMA, AAU. 11/23/2023 13
 Contusion
An injury of apart without a break in a skin.
Plasma or blood may accumulate in a form of
circumscribed collection.

 Rupture
A wound where the tearing of muscle, ligament or
other structure occur in the absence of break on the
skin.

By Jiregna D.(DVM,MVSc, Assist.

prof.), CVMA, AAU. 11/23/2023 14
 Laceration
◦ The tearing of tissue that result in irregular edge.
◦ It is common after hyena bite and after injury by barbed
wire.

 Avulsion
◦ Forcible separation or tearing away of part or structure.
◦ It is relatively painless, because most of the time the
injury accompany denervation

By Jiregna D.(DVM,MVSc, Assist.

prof.), CVMA, AAU. 11/23/2023 15
 Puncture
A wound characterized by small external opening with deep tissue
injury.
It is caused by sharp objects like nail, bullet etc.
It provides an environment favorable for anaerobic organisms like
Clostridium tetani.
In this case, use of tetanus antitoxin is essential in the management
The opening has to be enlarged to provide drainage and to allow
oxygen to enter to the wound & prevent bacterial multiplication.
This type of wound should not be sutured (all penetrating wound
shouldn’t be sutured)

By Jiregna D.(DVM,MVSc, Assist.

prof.), CVMA, AAU. 11/23/2023 16
1) Clean wound
2) Clean contaminated wound
3) Contaminated
4) Dirty wound

By Jiregna D.(DVM,MVSc, Assist.

prof.), CVMA, AAU. 11/23/2023 17
 Non-traumatic wounds without inflammation or infection
 No breaks in aseptic technique and luminal organs (respiratory,
alimentary, genitourinary tracts) are not entered.
 Antibiotic prophylaxis is not indicated except
◦ Prolonged procedure is anticipated or
◦ When inexperienced personnel are performing the surgery.
 Examples include:
◦ Ovariohysterectomy in the absence of uterine infection
◦ Castration in the absence of orchitis.

By Jiregna D.(DVM,MVSc, Assist.

prof.), CVMA, AAU. 11/23/2023 18
 When non-sterile luminal organs are entered without
significant spillage of contents such as the following.
o Gastrointestinal or respiratory tracts, oropharynx, or vagina
is entered.
o Urinary or biliary tracts are entered in the absence of
infected urine or bile.
o Minor break in aseptic technique occurs (e.g., perforation of
a surgical glove).
 Antimicrobial prophylaxis is indicated
◦ Antibiotic selection is based on anticipated flora.

By Jiregna D.(DVM,MVSc, Assist.

prof.), CVMA, AAU. 11/23/2023 19
 Involve
◦ A major break in surgical technique, gross spillage of
gastrointestinal contents, fresh traumatic wounds, or entrance
of the urinary or biliary tract when gross infection is present.
 Antibiotic prophylaxis is indicated
 The fate of contaminated wounds
◦ Delicate debridement, copious lavage, and antibiotic therapy
can convert these wounds to "clean" ones.
◦ Inadequate therapy often results in a dirty infected wound.

By Jiregna D.(DVM,MVSc, Assist.

prof.), CVMA, AAU. 11/23/2023 20
 Wounds in which gross infection is present (e.g., traumatic
wounds with retained devitalized tissue, foreign bodies, or
fecal contamination) at the time of surgical intervention.
 Requires
◦ Antibiotic therapy
◦ Copious lavage, debridement, drainage
◦ Wet-to-dry bandages
 To further debride the wound during the early
postoperative period.

By Jiregna D.(DVM,MVSc, Assist.

prof.), CVMA, AAU. 11/23/2023 21
 Depends on the cleanliness of the surgery.
Clean surgery should be carried out first, followed by clean-
contaminated conditions.
Contaminated surgery should be carried out last.
Dirty procedures should not be carried out in the operation
theatre but in another area of the practice.

By Jiregna D.(DVM,MVSc, Assist.

prof.), CVMA, AAU. 11/23/2023 22
Superficial
Partial thickness
Full thickness
Deep wound

By Jiregna D.(DVM,MVSc, Assist.

prof.), CVMA, AAU. 11/23/2023 23
 ◦ Only the epidermis is affected and has to be replaced
◦ A truly superficial wound does not bleed and heals within a
few days
◦ examples include most abrasions and blisters

 Partial-thickness wounds
◦ The epidermis and part of the dermis is affected
◦ A partial-thickness wound does bleed
◦ If left uncovered, a blood clot will cover the wound and a scar
will form.

By Jiregna D.(DVM,MVSc, Assist.

prof.), CVMA, AAU. 11/23/2023 24
 The missing tissue will then be replaced, followed by regeneration
of the epidermis.
 A partial-thickness wound can take from several days to several
weeks to heal, depending on the patient and the wound treatments
chosen.

 Full-thickness wounds
Involves the epidermis and the dermis
The underlying fatty tissue, bones, muscles, or tendons may also
be damaged.

By Jiregna D.(DVM,MVSc, Assist.

prof.), CVMA, AAU. 11/23/2023 25
 If full-thickness wounds cannot be sutured, the healing
process will create new tissue to fill the wound, followed
by regeneration of the epidermis.

 The full-thickness wound takes longer time to heal than

does a partial-thickness wound, sometimes as long as
several months

 Deep wound : all layers affected

By Jiregna D.(DVM,MVSc, Assist.

prof.), CVMA, AAU. 11/23/2023 26
 Simple wounds
The integrity of the skin is traumatized without loss or
destruction of tissue and without the presence of a foreign body in
the wound.

 Complex wounds
Tissue is lost or destructed by means of a crush, burn, or foreign
body in the wound

By Jiregna D.(DVM,MVSc, Assist.

prof.), CVMA, AAU. 11/23/2023 27
◦ Considerations for decision either to close or to manage it as
open wound depends on:
Availability of skin for closure and
level of contamination or infection.
◦ Most skin wounds are handled by
1. Primary closure (Healing By Primary Intention)
2. Delayed primary closure
3. Secondary closure
4. Healing by second intention

By Jiregna D.(DVM,MVSc, Assist.

prof.), CVMA, AAU. 11/23/2023 28
 All Layers are closed (dead space).
 The incision that heals by first intention does so in a minimum
amount of time, with no separation of the wound edges, and
with minimal scar formation.

 Used only in ideal situations to avoid wound complications.

 Wound is closed immediately after presentation once cleaned

and debrided (suture, staples, wound sealant etc).

By Jiregna D.(DVM,MVSc, Assist.

prof.), CVMA, AAU. 11/23/2023 29
By Jiregna D.(DVM,MVSc, Assist.
prof.), CVMA, AAU. 11/23/2023 30
 Also referred to as healing by tertiary intention
 Is a useful option for managing wounds that are too heavily
contaminated for primary closure but has appearance of clean
wound.
 The wound is managed for short-term as an open wound until it
appears healthy and closed with minimal risk of complications.
 Suitable for minimally contaminated wounds that may be
closed after 24-72 hr.
 It is not appropriate for a grossly contaminated or infected
wound.

By Jiregna D.(DVM,MVSc, Assist.

prof.), CVMA, AAU. 11/23/2023 31
 ◦ Suitable for heavily infected wounds that require longer periods
until it appears healthy.
◦ Wounds that are closed >5 days after the initial wounding are
considered to be a secondary closure.
 Summary of types of wound closure and healing

By Jiregna D.(DVM,MVSc, Assist.

prof.), CVMA, AAU. 11/23/2023 32
◦ Appropriate when a wound cannot or should not be closed
◦ Such wounds include:
 Wounds with a loss of skin that makes closure impossible
or
 Wounds that are grossly infected to close
◦ Enables progressive debridement procedures and does not
require specialized equipment.

By Jiregna D.(DVM,MVSc, Assist.

prof.), CVMA, AAU. 11/23/2023 33
  However, it increases cost, prolongs time for healing, and
may create complications from wound contracture.
 Bandaging and debridement is needed until the wound heals
 Deep layers are closed but superficial layers are left to heal
from the inside out.

 Healing by second is appropriate in cases of infection,

excessive trauma, tissue loss, or imprecise approximation of
tissue

By Jiregna D.(DVM,MVSc, Assist.

prof.), CVMA, AAU. 11/23/2023 34
 Can be local and systemic factors
 Local/environmental factors affecting wound healing
 Surgical technique
 Tissue vascularity
 Mechanical stress
 Movement
 Extent of wound surface
 Haemorrhage
 Foreign bodies
 Oedema and dehydration
 Wound infection
 Topical applications
 Bandaging and biological dressings

By Jiregna D.(DVM,MVSc, Assist.

prof.), CVMA, AAU. 11/23/2023 35
 Systemic Factors
Age
Obesity
Malnutrition or specific deficiency of vitamins
Systemic disease
Temperature
Anti-inflammatory drugs

By Jiregna D.(DVM,MVSc, Assist.

prof.), CVMA, AAU. 11/23/2023 36
 Dehiscence  Suture complications
 Evisceration  Hypertrophic scar
 Hemorrhage  Keloids
 Adhesions  Malignant changes
 Infection  Sinus formation
 Herniation
 Fistula
formation

By Jiregna D.(DVM,MVSc, Assist.

prof.), CVMA, AAU. 11/23/2023 37
THANK YOU!

By Jiregna D.(DVM,MVSc, Assist.

prof.), CVMA, AAU. 11/23/2023 38