A MINI PROJECT:

Wound Management
PESERTA INTERNSHIP DOKTER INDONESIA
PUSKESMAS WA N I A - 2021
BACKGROUND

Most of the cases in the emergency

room at PKM Wania are wound-related
problem and each health care provider has
their own way to care plan. Wound
management should be standardized. In
other way, to gain knowledge on wound
management skills.
DEFINITION

WHAT IS
WOUND?
A wound is defined as a disruption in the continuity of the epithelial lining of the skin or mucosa
resulting from physical or thermal damage. According to the duration and nature of healing
process, the wound is categorized as acute and chronic wound.
© 2014 WebMD, LLC. All rights reserved
 Clean Contaminat
Wounds ed Wounds

TYPES OF WOUNDS

Clean- Dirty-
contaminate contaminate
d Wounds d Wounds
WOUND HEALING PROCESS

How a wound heals itself - Sarthak Sinha.mp4

C AT E G O R I E S O F W O U N D
HEALING

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P R I M A RY I N T E N T I O N

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C AT E G O R I E S O F W O U N D
HEALING

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S E C O N D A RY I N T E N T I O N

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C AT E G O R I E S O F W O U N D
HEALING

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T E RT I A RY I N T E N T I O N

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WOUND CLEANSING

Solutions for wound cleansing include

• Referred as it is isotonic • Needed to activate • Can be used to cleanse chronic

wounds if:
(physiologically metallic/nanocrystalline • 1. The quality is acceptable, i.e. it is
compatible), non-toxic, silver dressings . potable
• 2. There are no systemic or local
and inexpensive factors that increase
• 3. the person’s risk of infection (see
the chart below)
• Tap water is cost effective and easily
accessible

Normal Steril
Tap water
saline water
WOUND CLEANSING
Commercial wound
Povidone iodine
cleansers
Commercial wound
cleansers are increasingly
used in irrigation.
Detergent irrigation is
meant to remove, rather
than kill, bacteria and has
seen promising result an
animal models of the
complex contaminated
musculoskeletal wound.
Hydrogen peroxide Sodium hypochlorite
Povidone iodine is a A 3% solution of Sodium hypochlorite
broad spectrum hydrogen peroxide is has been classically
antimicrobial solution acommonly used udes in pressure ulcers
effective against a wound anticeptic. with necrotic tissue to
variety of pathogens help control infection.
including
Staphylococcus
aureus.
 WOUND CLEANSING
TECHNIQUES

Swabbing or scrubbing
•
Use of gauze to wipe/scrub away non-
viable tissue and to wipe off the wound
surface
Irrigating or flushing
Use of cleansing solutions delivered at
pressures less than 15PSI to loosen/flush
away non-viable tissue from the wound
bed, and to stimulate granulation tissue
formation

Compress or soaking
Use of gauze soaked in a cleansing
solution applied directly to the surface of
awound with or without pressure to
soften/loosen necrotic tissue and/or to
remove gross contaminants
WOUND DRESSING

Interactive Passive
Dressing Dressing

Moist (+) Moist (-)

Absortion Absortion
 

Primary Secondary

Flanagan M (2013) Wound Healing and Skin Integrity – Princliple and Parctice. Wiley-Blackwell
PA S S I V E D R E S S I N G
INTERACTIVE DRESSING
METRONIDAZOLE

ANTIBIOTIC

Topical
Oral IV
(Gel, Cream,
(Tablet) (Infusion)
Ointment)

Skin Intestine Vascular

METRONIDAZOLE

Oral
Passive Dressing
(Tablet)

Crushed
Control

Powder

Excess fluid Malodor

Skin

Bergstorm (2016) Assessment and Management of Fungating Wounds. JWOCN. Vol.38(1) : 31-
37
 T E TA N U S
PROPHYLAXIS
Tetanus-prone wound :
 More than 12 hours after injury

 Vulnus punctum

 Contamination of soil, dirt, feces

 Animal bites

 Inflammation sign

CDC (2020). Tetanus for Clinical – Guide to Tetanus Prophylaxis

 T E TA N U S
PROPHYLAXIS
1. Unknown or < 3 doses
 Not tetanus-prone wound : TT
 Tetanus-prone wound : TT + TIG
2. ≥ 3 doses
≥ 10 years
 Not tetanus-prone wound : TT
 Tetanus-prone wound : TT
5-9 years
 Not tetanus-prone wound :-
 Tetanus-prone wound : TT
CDC (2020). Tetanus for Clinical – Guide to Tetanus Prophylaxis
W O U N D E VA L U AT I O N

• Debridement
• Mouisture balance
• Mouisture balance

Cambridgeshire & Peterborough (2020). Wound Care Guidelines and Dressing Fromulary. NHS United Kingdom
 TIMING OF SUTURE
R E M O VA L

Randall et al (2017). Laceration Repair : A Practical Approach. American Familly Physician. Vol 95(10) : 628-636