Wound and

Wound Care
DR. ARAIB KALEEM
What is a Wound?

 Injury in which skin is torn, cut or punctured (open

wound) or where blunt force trauma causes a contusion
( a closed wound).

 Sharp injury to the dermis of skin.

 Examples:
Burns, surgical incisions, stabs, leg ulcers,
decubitus ulcers ( pressure sores)
Classification according to
level of contamination:
 Clean wound – made under sterile conditions where there
are no organisms present, and the skin is likely to heal
without complications.
 Contaminated wound – usually resulting from accidental
injury; there are pathogenic organisms and foreign bodies in
the wound.
 Infected wound – the wound has pathogenic organisms
present and multiplying, exhibiting clinical signs of
infection (yellow appearance, soreness, redness, oozing
pus).
 Colonized wound – a chronic situation, containing
pathogenic organisms, difficult to heal (i.e. bedsore).
Open Wound
Classified according to the
object that caused the wound

 Incisions or incised wounds – caused by a clean, sharp-

edged object such as a knife, razor, or glass splinter.
 Lacerations – irregular tear-like wounds caused by some
blunt trauma. Lacerations and incisions may appear linear
(regular) or stellate (irregular). The term laceration is
commonly misused in reference to incisions. Paper cuts are
shallow lacerations.
 Avulsions – injuries in which a body structure is forcibly
detached from its normal point of insertion. A type of
amputation where the extremity is pulled off rather than cut
off.
 Puncture wounds – caused by an object puncturing the skin,
such as a splinter, nail or needle.
 Penetration wounds – caused by an object such as a knife
entering and coming out from the skin.
 Gunshot wounds – caused by a bullet or similar projectile
driving into or through the body. There may be two wounds, one
at the site of entry and one at the site of exit, generally referred to
as a "through-and-through."
Closed Wound
 Hematomas (or blood tumor) – caused by damage to a
blood vessel that in turn causes blood to collect under the
skin. Hematomas that originate from internal blood vessel
pathology are petechiae, purpura, and ecchymosis. The
different classifications are based on size. Hematomas that
originate from an external source of trauma are contusions,
also commonly called bruises.
 Crush injury – caused by a great or extreme amount of
force applied over a long period of time
Stages of Wound Healing

 Stage 1 - traumatic inflammation ( 0-3 days)- redness,

heat, swelling
 Stage 2 -destructive phase ( 2-5 days)- polymorphs
and macrophages clear the wound of debris and
stimulate new growth
 Stage 3- the proliferative phase( 3-24 days increased
collagen formation
 Stage 4- maturation phase ( 24 days-1 year) scar
tissue decreases granulating tissue gets stronger and
changes from reddish to pale
Closure of Surgical Wounds

 Primary closure - first intention

( direct suture- if no tissue loss
 Delayed primary closure- usually when a drain is left in
situ.
 Secondary intention - wound closes by a process of
contraction and epithelialisation e.g ulcers and pressure
sores
Factors Influencing Wound
Healing
 Good blood supply: ( oxygen, nutrients)
 Good nutrition:
 Rest: skin cells multiply more rapidly during
sleep
 stress: increased levels of adrenaline and steriods
delay healing
 infection:
 Age : children heal more rapidly than older people
 Site of wound: face and neck heal more rapidly
Factors Delaying Wound
Healing
General factors  Jaundice
 poor diet  malignant disease
 anaemia  high blood urea
 pulmonary disease  stress
 cardiac insufficiency  lack of sleep
 arteriosclerosis  drug therapy e.g. steroids and
 cytotoxic
diabetes mellitus
 radiotherapy
 smoking
Factors Delaying Wound
Healing
Local to patient/wound

 skin edges not lined  infection

up  irritant material for
 dead tissue in wound suturing
 foreign bodies in  too tight suturing
wound
 tension on wound
Complications of wounds

 Haemorrhage ( surgical wounds)

 Infection
 non union
 rupture
 pressure and strain ( coughing vomiting)
 over granulation of scar tissue
 contractures
Caring for Wounds

Assess for:
 type of wound
 location of wound
 size of wound
 shape of wound
 level of exudate
 condition of wound bed
 condition of surrounding skin
Caring for Wounds

Recognising inflammation
 redness over area and surrounding tissue
 swelling
 heat
 pain/ tenderness
 loss of function
Caring for Wounds

 cleansing wounds
 How should it be done?
Cleansing wounds: Main
reasons
 Excess exudate and signs of infection
 Foreign body contamination
 Presence of devitalised tissue ( slough or necrotic tissue)
 To assess the wound
 psychological reasons
Types of Cleansing Fluids

 Antiseptics: generally discouraged now- can be toxic to

tissue healing
 Saline solutions: normal saline sachets commonly used
 Tap water: Why not!!
tip: cleansing fluids should be at body temperature
Methods of Cleansing

 Swabbing: not particularly effective, mainly redistributes

organisms
 Bathing: useful for chronic wounds such as leg ulcers. Take
care with equipment to avoid cross contamination
 Irrigation: shower head, waterjug, syringes - don’t be
overzealous
Choice of Dressing

The concept of moist wound healing

Modern dressing technology is based on the principle that

the wound /dressing interface should be moist rather than
dry.

In other words scabs are bad!

Common characteristics of wound
dressings
 Capable of maintaining  Impermeable to bacteria
high humidity at wound  thermally insulating
site
 capable of allowing
 free of particles and gaseous exchange]
contaminants]
 able to withstand
 non toxic / non infrequent changes
allergenic
 cost effective
 capable of protecting the
wound from further  long lasting
trauma
Patient Factors Influencing the
choice of dressing:
 Age
 Lifestyle
 Medical History
 Care environment
 Ability to maintain /change own dressing
 Competence and willingness of potential carers
Minimising Cross Infection
 Dressing and cleansing wounds is at the very minimum a Clean
Procedure and is often an Aseptic Procedures
 Thorough hand-washing and use of gloves are the most effective
methods of preventing contamination of the wound
 If wounds are infected then care must be taken to prevent cross
contamination