Wounds classification, care & sugical site sepsis

By

prof/ GOUDA ELLABBAN

SFACULTY

Definition

• A wound occurs when the integrity of any tissue is compromised (e.g. skin breaks, muscle tears, burns, or bone fractures). A wound may be caused by an act (such as a gunshot, a fall, or a surgical procedure), by an infectious disease, or by an underlying condition.

Causes

• Gunshot• Fall• Surgical procedure• fraction • chemical

Classification

• The most useful classification of wounds from practical point of view is that of Rank and Wakefield :

• Tidy• Untidy

Tidy wounds

• These are clean wounds caused by cutters, knives and choppers and contain no devitalised tissue.

• Many tidy wounds can be dealt with in the emergency room, and discharged with instruction for follow-up

Untidy wounds

• Untidy wounds are those that involve crushed, avulsed, burned or mangled parts. These wounds are often dirty and contaminated.

• In general, large untidy wounds require operative debridement and hospital admission.

Tidy vs Untidy woundsTidy wounds Untidy wounds

Generally caused by sharp weapons

Generally caused  by blunt and crushing weapons

No skin loss Varying degrees of skin loss common

Tendons and nerves are invariably cut

Tendons and nerves are rarely injured

Bones not commonly damaged

Bones are invariably damaged

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Types of wounds

ACUTE

Bruise, contusion and haematoma Puncture wounds Abrasion and friction burns Laceration Traction and avulsion Crush

CHRONIC

Ischemic ulcer Neuropathic ulcer

Bruise, contusion and haematoma

• A bruise is an area of skin discoloration. A bruise occurs when small blood vessels break and leak their contents into the soft tissue beneath the skin.

Puncture wounds

• A wound that is deeper than it is wide, produced by a narrow pointed object .

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Puncture wounds

• A puncture wound does not usually result in excessive bleeding. Usually, these wounds close fairly quickly on their own.

Puncture wounds

• Infection may cause redness, swelling, pus, or watery discharge from a puncture wound that is not noticed or not treated properly.

Abrasion and friction burns• A friction burn occurs when skin is

scraped off by contact with surfaces such as roads, carpets, or other hard floor surfaces. It is usually both a scrape (abrasion) and a heat burn.

Abrasion and friction burns• Friction burns can occur on any part of

the body but these types of scrapes usually affect bony areas, such as the hands, forearms, elbows, knees, or shins.

Abrasion and friction burns• Scrapes are usually more painful than

cuts because scrapes tear a larger area of skin and expose more nerve endings.

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Laceration

• A laceration or cut is the result of contact with a sharp object.

Laceration

• With a deep cut, the skin slit may reveal deeper tissues such as fat, tendon, muscle, or bone.

Traction and avulsion

• A scrape that removes all of the layers of skin is called an avulsion injury. Fat, muscle, or bone may be seen in a full-thickness avulsion injury.

Traction and avulsion

• Avulsion injuries are usually treated in one of the following ways:

• Allowing the wound to heal on its own, growing new skin from the edges into the middle

• Stitching the edges of the wound together, if the wound is small

• Reattaching the avulsed skin • Grafting skin over the wound

Crush injury

• A crush injury occurs when a body part is subjected to a high degree of force or pressure, usually after being squeezed between two heavy or immobile objects.

Crush injury

• A crush wound may have irregular margins like a laceration; however, the wound will be deeper and trauma to muscle and bone may be apparent.

Crush injury

• A compressing force may cause CRUSH INJURY SYNDROME. This force, if applied to a large muscle mass, eg. the thigh, causes the body to produce large quantities of acid and complex electrolytes, especially potassium, around the affected muscles.

Crush injury

• On release of the compressing force, the liberated blood takes the concentrated chemicals to the heart, with often fatal results. In addition, there is often a sudden loss of blood on release of the compressing force.

Crush injury

• Crush injuries can also lead to compartment syndrome.

• The compartment syndrome is a condition in which increased pressure within a muscle compartment causes a decrease in blood supply to the affected muscles.

Chronic wounds

Ischemic ulcer

Chronic wounds

Neuropathic ulcer

Wound management & care• The first aim is stop the bleeding

Minor cuts and scrapes usually stop bleeding on their own. If they don't, apply gentle pressure with a clean cloth or bandage.

Wound management & care• Clean the wound : to prevent infection and promote

healing by : clean fresh water or a solution of

diluted povidone-iodine . Alcohol to remove small, superficial

particles. Do not disrupt viable granulation

tissue

Wound management & care• Apply an antibiotic : After cleaning the wound, apply a thin

layer of an antibiotic cream or ointment to help keep the surface moist and prevent infection.

Wound management & care• Wound closure : using needle and sutures, staplers,

tapes or adhesives.

Wound management & care• Dressing : Exposure to air speeds healing, but

bandages can help keep the wound clean and keep harmful bacteria out.

Wound management & care• Change the dressing regularly : Do so at least daily or whenever it

becomes wet or dirty.

Wound management & care• Watch for signs of infection : Signs of infection are increasing pain,

redness, and swelling, draining of pus from the wound, and systemic fever.

Surgical wound infection• Classification of risk of wound infection :

Type Definition Example

Clean No breech of GI tract

Hernia, varicose vien

Clean-contaminated

Prepared GI tract opened

Elective colectomy

Contaminated

Unprepared bowel opened

Emergency colectomy

Dirty Pus at operation site

Perforated appendicitis

Preoperative care

• Preventive Measures• Identify and treat all infections • Do not remove hair unless it is on the surgical

field.• Patients should cease tobacco consumption • Optimize blood glucose level • Prophylactic antibiotics• Enhanced nutritional intake

postoperative care

• Asepsis is necessary in the insertion of indwelling catheters

• Handle tissues gently with good hemostasis, minimize foreign bodies, and minimize devitalized tissue and dead space.

• Primary closed incisions should be protected with a sterile dressing for 24-48 hours

• Hands are to be washed before and after wound dressing

• Use sterile technique for wound dressing change

Thank you