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