WOUNDS

Mrs. Muyunda
Chibochi
DEFINITIONS
•A wound is a cut or break in
the continuity of any tissue
caused by injury or operation.
•Healing is the replacement
of dead tissue (necrotic) by
living tissue.
Cause of a Wound

•A wound is caused by the

transfer of any form of energy
into the body which can be
either to an externally visible
structure like the skin or deeper
structures like muscles, tendons
or internal organs.
CLASSES OF WOUNDS
• Wounds are generally grouped into two
main categories or classes, namely:
• Closed wounds: these are wound
types, which have an intact epithelial
surface and the skin cover is not
completely breeched. Examples are
contusion, bruises, and haematomas.
• Open Wounds: these are wounds caused
by injury which leads to a complete break
of the epithelial protective surface.
Examples are abrasion, laceration,
puncture, missile injuries, and bites
TYPES OF WOUNDS

1. Lacerated wound: This is a type

of injury that has rough or jagged
edges e.g. that which is sustained
in an RTA, barbed wire injury etc.
2. Incisional wounds: These are
types of injuries made by sharp
objects.
•They have edges that are evenly
separated e.g. those wounds made
by surgeons during surgery.
TYPES OF WOUNDS

3. Punctured wounds: These are

wounds that are caused by sharp
pointed objects causing a small
opening through the skin. These are
commonly caused by such objects such
as nails, knives, gun shots etc. they
appear small superficially but involving
deeper structures such as nerves, blood
vessels or viscera which may be
damaged and contamination carried
into deeper tissues.
TYPES OF WOUNDS

4. Contused wounds: These are a type of

wounds that involve superficial injuries
without damage to the skin surface. They
are commonly caused by blunt surface
forces and are characterized by a
considerable soft pad. These are known
common causes of haematomas.
5. Poisoned wounds: These wounds are
those type of wounds that involve direct
contamination by the source of the injury
such as snake bites, insect stings, dog
bites especially where rabies organisms
exists.
TYPES OF WOUNDS

6. Abrasions: These are wounds that

result from rubbing a body tissue
especially the skin against a rough
surface leading to loss of superficial
tissue due to friction.
• These are characteristically painful
and superficial.
SURGICAL CLASSIFICATION OF WOUNDS

1. Contaminated Wounds
• These are wounds which are exposed to
excessive amounts of bacteria. These
wounds have a higher risk of infection
e.g. unprepared colon surgery, dirty
laceration etc.
2. Infected Wounds
• These are wounds that have infected
material in them. They usually have pus
or slough on their surfaces. Common
infecting organisms include
streptococci, staphylococci etc.
SURGICAL CLASSIFICATION OF WOUNDS
3. Clean Wounds
• These are wounds that have been
rendered clean by cleaning with the
use of disinfectants such as savlon,
povidone iodine, methylated spirit, etc.
4. Debrided Wounds
• These are wounds whose top infected
(necrotic tissue and pus) tissue has
been removed surgically by a process
known as SLOUGHECTOMY or
DEBRIDEMENT.
PROCESSES OF WOUND HEALING

• Wound healing occurs in three

phases thus inflammatory,
proliferative and maturation.
1. Inflammatory/Lag/Exudative
Phase: In this phase of wound
healing, a blood clot forms, the
wound becomes oedematous and
debris of damaged tissue and the
blood clot are phagocytosed. It
usually takes 1 – 4 days.
PROCESSES OF WOUND HEALING
2.Proliferative/Fibroblastic/
Connective Tissue Phase: In
this phase collagen is
produced, granulation tissue is
formed and there is increased
wound tensile strength. It
takes about 4 – 24 days.
PROCESSES OF WOUND HEALING
3.Maturation/Differentiation/Resorptive/
Remodeling Phase
• Also known as Plateau Phase, it is
characterized by leaving of fibroblast
with more tensile strength.
• Collagen fibres are reorganised and
tightened to reduce the scar size. It
occurs from 21 days to months or even
years. This phase ensures the prevention
of big wounds leaving very big scars.
TYPES OF WOUND HEALING

1. Healing By First Intention

or Primary Union
•This is type of wound healing
which takes place aseptically
with minimum or no tissue
destruction.
•The wound margins (edges) are
neatly approximated with little
granulation and scar formation.
TYPES OF WOUND HEALING

2. HEALING BY SECOND INTENTION OR

GRANULATION
• This is type of wound healing that occurs on
wounds that result from trauma (laceration),
ulceration, infection and with irregular wound
edges.
• There is extensive tissue loss that makes
wound edges difficult to approximate.
• Tissue growth starts from the depth to the
surface upwards and from sides to the centre.
Granulation becomes the primary feature of
secondary intention wound healing and
scaring.
TYPES OF WOUND HEALING

3. Healing By Third Intention or

Secondary Suture
• Also called healing by Tertiary
Intention is a type of wound healing
which occurs when there is delayed
suturing of a wound or if there is a
breakdown of the initial suture with
massive infection and loss of tissue.
• Two opposite granulation tissues are
brought together with the result of a
deeper wider scar.
FACTORS INFLUENCING WOUND HEALING

LOCAL FACTORS
•These are factors that directly
influence the characteristics of
the wound itself.
1. Oxygenation
•Oxygen is important for cell
metabolism especially for
energy production and is
important in all wound healing
processes.
FACTORS INFLUENCING WOUND HEALING

2. INFECTION
• Bacterial colonization of the wound
may delay the healing process of the
wound. Infection delays healing by;
• Mechanical separation of wound
edges
• Decrease blood supply
• Prolong inflammatory and
debridement phase
• Bacteria produce proteolytic enzymes
which digest the tissues.
FACTORS INFLUENCING WOUND
HEALING
3. BLOOD SUPPLY
•Adequate blood supply to the
affected area is essential.
•This will promote wound
healing because blood carry all
the necessary nutrients
required in wound healing
FACTORS INFLUENCING WOUND
HEALING
4. FOREIGN BODIES
•The presence of a foreign body
inhibits wound healing as the
body’s reaction to foreign body
begins immediately after an
injury leading to accumulation of
exudate at the site of the injury.
•This leads to formation of foreign
body gaint cells, encapsulation of
foreign object and chronic
inflammation
FACTORS INFLUENCING WOUND HEALING
SYSTEMIC FACTORS
1. Age
•The physiological changes that
occur with aging place the older
patient at higher risk of poor
wound healing. Reduced skin
elasticity and collagen
replacement influence healing.
•The immune system also declines
with age, making older patients
more susceptible to infection.
FACTORS INFLUENCING WOUND
HEALING
• Older people can also present with
other chronic diseases, which affect
their circulation and oxygenation to
the wound bed..Children wounds
heal faster than the elderly.
• Advanced age slows collagen
synthesis by fibroblasts,impairing
circulation requires long time for
epithelialisation of the skin,and
alters phagocytic and immune
responses
FACTORS INFLUENCING WOUND
HEALING
2. Dehydration
• This leads to an electrolyte imbalance and
impaired cellular function.
• It is a particular problem in patients with
burns
3. Drugs
• Antibiotics decrease frequency of infection
but decision to use systemic, local or any
should be based on patients condition, type,
length and environment of surgery, wound
contamination, and immune status
FACTORS INFLUENCING WOUND
HEALING
•NSAIDS anti inflammatory effects
has a positive influence
•Corticosteroids retard wound
healing particulary if given
before inflammation begins
Corticosteroid therapy – impairs
phagocytosis, inhibit fibroblast
proliferation and function,
depress formation of granulation
tissue, inhibit wound contraction
etc.
FACTORS INFLUENCING WOUND
HEALING
4. NUTRITION
• Good nutrition boosts the immunity and
there by promote wound healing.
• Nutritional Deficiencies; e.g.
• Vitamin C – which delays formation of
collagen fibres and new capillaries
• Protein – which impairs or decreases
amino acid supply for tissue repair
• Zinc – which impairs epithelialization.
FACTORS INFLUENCING WOUND HEALING

5. METABOLIC STATUS
• Diabetes mellitus: Diabetes mellitus
decreases collagen synthesis, retards early
capillary growth, impairs phagocytosis (as
a result of hyperglycaemia), reduces
supply of oxygen and nutrients secondary
to the disease
6.IMMUNITY
• Poor general health causes generalized
absence of factors necessary to promote
wound healing.
MANAGEMENT OF A CLIENT WITH
WOUNDS
ASSESSMENT
• Determining when and how the
wound occurred is important
because a treatment delay exceeding
3 hours increase infection risk.
• Using aseptic technique, the
clinician inspects the wound to
determine the extent of damage to
underlying structure.
MANAGEMENT OF A CLIENT WITH
WOUNDS
•Sensory, motor, and vascular
functions are evaluated for
changes that might indicate
complications.
MANAGEMENT OF A CLIENT WITH
WOUNDS
• Any small bleeding vessels are clamped
and tied. After wound treatment a non
adhesive dressing is commonly applied
to protect the wound.
• Antibacterial agents such as povidone
iodine (Betadine) or hydrogen peroxide
are used on the wound but these should
be allowed deeper into the wound.
MANAGEMENT OF A CLIENT WITH
WOUNDS

• They are used initially in the treatment

of wounds.
• Disinfectants are commonly and
routinely used in the management of
wounds and they include savlon,
chloherxidine, hibitane.
• They help in reducing the population
of microbes by inhibiting their growth
or killing them by their microstatic or
microcidal effects.
MANAGEMENT OF A CLIENT WITH
WOUNDS
• The area around the wound should be
kept clean i.e. hair around should be
removed especially if it is anticipated that
the hairs will interfere with wound
healing and closure.
• The wound is irrigated with normal saline
solution or polymer to remove surface
dirt.
• Devitalized tissue and foreign matter are
removed because these impede wound
healing and may encourage infection.
MANAGEMENT OF A CLIENT WITH WOUNDS

A dressing is applied to a wound

for one or more of the following
reasons;
•To provide a proper environment
for wound healing
•To absorb excessive drainage
•To splint or immobilise the
wound
MANAGEMENT OF A CLIENT WITH WOUNDS

• To protect new epithelial tissue from

mechanical injury
• To protect the wound from bacterial
contamination and from soiling by faeces,
vomitus, and urine etc.
• To promote haemostasis, as in a pressure
dressing
• To provide mental and physical comfort of
the patient.
MANAGEMENT OF A CLIENT WITH WOUNDS

• As a wound heals many elements

such as adequate nutrition,
cleanliness, rest, and position
determine how quickly the process
occurs.
• Although post operative dressings
are initially changed by a member of
the surgical team, subsequent
dressing changes in the immediate
post operative period are usually
done by a nurse.
TYPES OF WOUND DRESSINGS

•Wound dressing is done

according to the immediate
assessment, the state of the
wound, and objective of the
surgeon concerned. Thus
dressings may be described as;
•Wet dressings
•Moisture retentive dressings
•Occlusive dressings
TYPES OF WOUND DRESSINGS

•Pressure dressings
•Medicated dressings
•During your clinical
experience you have to learn
how to dress wounds using
the specific methods as
described in your procedure
manual.
COMPLICATIONS
•Bleeding.
•Shock.
•Fracture.
•Injury to deep organs.
•Infection.
•Tissue death