Basic Wound Management

7/31/2019 Basic Wound Management

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Basic Wound ManagementBasic Wound Management


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Aims and ObjectivesAims and Objectives

Understand the stages of wound healingUnderstand the stages of wound healing

Understand the different types of woundUnderstand the different types of wound

Have some knowledge of the types ofHave some knowledge of the types of

dressing available and their usesdressing available and their uses Be able to apply a basic dry dressingBe able to apply a basic dry dressing

Understand the importance of good ANTTUnderstand the importance of good ANTT

techniquetechnique Know what constitutes a complex woundKnow what constitutes a complex wound

and who to refer on toand who to refer on to


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4 stages of wound healing4 stages of wound healing

1.1. HaemostasisHaemostasis2.2. InflammationInflammation

3.3. ProliferationProliferation4.4. MaturationMaturation


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HaemostasisHaemostasis

Initial bleedingInitial bleeding

Injured vessels constrict to minimise bloodInjured vessels constrict to minimise blood

lossloss

Coagulation cascade is activatedCoagulation cascade is activated Temporary clot formationTemporary clot formation

(Oesey, K & McIntosh C 200&)(Oesey, K & McIntosh C 200&)


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InflammationInflammation

Release of inflammatory mediatorsRelease of inflammatory mediators

VasodilationVasodilation

PhagocytosisPhagocytosis

Increased permeability of vesselsIncreased permeability of vessels

Localised heat, redness and swellingLocalised heat, redness and swelling



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ProliferationProliferation

Promotion of new tissuePromotion of new tissue

Breakdown of necrotic tissueBreakdown of necrotic tissue

Proliferation of connective tissueProliferation of connective tissue

Wound decreases by size by granulation,Wound decreases by size by granulation,contraction andcontraction and epitheliastaionepitheliastaion



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MaturationMaturation

This phase can last for many months (evenThis phase can last for many months (even

years in complex wounds)years in complex wounds)

Initially the scar is red and raisedInitially the scar is red and raised

In time the blood supply to the areaIn time the blood supply to the areadecreases and the scar will become paledecreases and the scar will become pale

and flattenedand flattened



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GranulatingGranulating

Rough, pink tissueRough, pink tissue

Containing newContaining new

connective tissueconnective tissue

and capillaries,and capillaries, Clearly definedClearly defined

edge to the woundedge to the wound


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ExcoriationExcoriation

Breakdown of theBreakdown of the

skin caused byskin caused by

constant contact withconstant contact with

moisture.moisture.


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Sloughy woundSloughy wound

This is not dead tissue, but aThis is not dead tissue, but acomplex mixture of fibrin,complex mixture of fibrin,deoxyribonucleicdeoxyribonucleic--protein,protein,serousserous exudateexudate, leucocytes, leucocytes

and bacteria.and bacteria. Slough can build up rapidly onSlough can build up rapidly on

the surface of a previouslythe surface of a previouslyclean wound.clean wound.

It has been shown that sloughIt has been shown that slough

and devitalized tissue willand devitalized tissue willpredispose a wound topredispose a wound toinfection by acting as ainfection by acting as abacteriological culture mediumbacteriological culture mediumand inhibiting the action ofand inhibiting the action ofleucocytes in the wound.leucocytes in the wound.

In order to achieve anIn order to achieve anacceptable rate of healing,acceptable rate of healing,


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NecroticNecrotic

Areas of tissue haveAreas of tissue have

dieddied leaving areas ofleaving areas ofnecrosisnecrosis

Necrotic areas needNecrotic areas need

debridement todebridement topremotepremote wound healingwound healing

Larval therapy may beLarval therapy may be

considered in someconsidered in some

casescases


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Infected necrotic woundInfected necrotic wound

A combination ofA combination of

infection andinfection and

necrotic areasnecrotic areas Once again,Once again,

maggot therapy ismaggot therapy isideal for this typeideal for this type

of woundof wound


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Cavity woundCavity wound

Often formed from aOften formed from a

sinus tracing backsinus tracing backinto the tissue orinto the tissue or

after debridement ofafter debridement of

an abscessan abscess

Cavity wounds oftenCavity wounds often

need packing toneed packing toencourage healing.encourage healing.


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CellulitisCellulitis DiffuseDiffuse inflammatinflammation ofion of

connective tissue with severeconnective tissue with severe

inflammation of dermal andinflammation of dermal andsubcutaneous layers of the skinsubcutaneous layers of the skin

Can be caused by normal skinCan be caused by normal skinfloflora or byra or by exogenous bacteriaexogenous bacteria,,and often occurs where the skinand often occurs where the skin

has previously been broken.has previously been broken. The mainstay of therapy remainsThe mainstay of therapy remains

treatment with appropriatetreatment with appropriateantibiotics.antibiotics.


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Procedure for simple woundProcedure for simple wound

dressingdressing


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RevisionRevision


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Aims and ObjectivesAims and Objectives Understand the stages of wound healingUnderstand the stages of wound healing

Understand the different types of woundUnderstand the different types of wound

Have some knowledge of the types ofHave some knowledge of the types of

dressing available and their usesdressing available and their uses

Be able to apply a basic dry dressingBe able to apply a basic dry dressing

Understand the importance of good ANTTUnderstand the importance of good ANTT

techniquetechnique Know what constitutes a complex woundKnow what constitutes a complex wound

and who to refer on toand who to refer on to

Basic Wound Management

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