WOUND HEALING Wound : Any disruption of cells, be it tissue or skin - PowerPoint Presentation

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WOUND HEALINGSlide2

Wound

: Any disruption of cells, be it tissue or skin

Wound Healing

: Restoration of that disruptionSlide3

Types of Wounds

Surgical Wounds (intentional)

Traumatic Wounds (accidental)

Chronic Wounds (

persistant

) -

result of underlying conditionSlide4

Surgical Wounds

Patient sustains this type of wound any time a surgeon cuts into the skin to perform a surgical procedure

Are classified according to the

CDC:

Class 1 (clean)

-

Carries low risk of infection <5%

- Conditions are ideal (aseptic without prior break in skin)

- Primary closure

- Drains placed in wound are closed systems

-N

o

respiratory, alimentary, oropharyngeal, or genitourinary

s

ystem

entry

-Does include blunt trauma that is non-penetratingSlide5

Surgical Wounds Continued

Class 2 (clean-contaminated)

- infection risk 8-11%

- respiratory, alimentary, or

genitourinary tracts are entered

under

aseptic

, controlled conditions

- no infection or break in aseptic technique

- drains placed in wound are closed systems

- examples: biliary, appendix (prior to rupture),

vagina, oropharynxSlide6

Surgical Wounds Continued

Class 3 (contaminated)

- infection risk 15-20%

- traumatic, fresh, open wounds

<

4 hours old

- inflammation may be present

- injury could have resulted in spilling of

organ contents

-Includes spillage of GI tract content or break

in sterile technique intra-operativelySlide7

Surgical Wounds Continued

Class 4 (dirty/infected)

- infection risk 27-40%

- infection was present before the

surgical procedure

- includes traumatic wounds

>

4 hours old

- can be a ruptured or perforated organ (ex. ruptured appendix)

- tissue may appear necrotic, (dead),

have a purulent (pus) drainage, and foul

odor

Slide8

Traumatic Wounds

Chemical, thermal, physical, or outside force that has caused injury to the body tissue

Types of traumatic wounds:

abrasion laceration

avulsion perforation

chemical puncture

contusion thermal

crushed Slide9
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Incised Wound Cont.Slide18

Chemical Wound/Burn

The chemical burn is a part or an entire destruction of the molecules, the cells or the structure of the skin due to an irritant or corrosive chemical product. The importance of the tissue modification will characterize the degree of the burn.Slide19

Thermal Burn

This patient received a thermal burn to the buttocks, and there was complete destruction of the skin and some of the underlying fat. This shows the exposed fat after the MD

debrided

the necrotic skin. Normal fat appears yellow.Slide20

Traumatic Wounds Continued

Classifications of:

Closed

- outside skin intact, tissue

under skin is not

Open

– outside skin broken

Simple

Complicated

Clean

ContaminatedSlide21

Closed Wounds

Simple fractures

Torn ligaments

Blisters Slide22

Open Wounds

Simple

Skin interruption without loss or destruction of the underlying tissue

LacerationsSlide23

Open Wounds

Complicated

Skin and underlying tissue injury or destroyed

Burns

Crushing injury

Foreign object (bullet or foreign object that is present such as knife or nail)Slide24

Complicated WoundSlide25

Complicated Wound cont.

Pt. from Nigeria.

Machete wound to the scalp.

Patient survived wound and surgery. Slide26

Open Wounds

Clean

Object or conditions surrounding injury were clean

Wound cared for within 6 hours of injury

Heals by primary intention

Cut that happens when loading a dishwasherSlide27

Open Wounds

Contaminated

Conditions surrounding injury not clean or care given 6 hours after injury

Heals by 2

° or 3° intention

Injury occurs when handling feces from an animal or personSlide28

Chronic Wounds

An underlying condition of the patient is causing their wound to not heal

Delayed healing results from persistent infection or disease processes:

Diabetes (gangrenous ulcer)

PVD

MRSA/VRSA

Pressure sores

Immuno-compromised (Cancer/chemotherapy/AIDS/steroid therapy)Slide29

Wound Healing/Closure

Types of:

Primary Intention/First Intention

- Surgical wound

- Edges are closely approximated

- Closed by suture, staples, or

adhesive tapes/gels

- No tissue lost

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Healing by First or Primary IntentionSlide31

Healing by First or Primary Intention? Maybe not!Slide32

Wound Healing/Closure

Secondary Intention/Second Intention

Trauma or Chronic wounds

Wound is not closed

A. Wounds that cannot be re-approximated

B. Infection risk too high to close by 1

° intention

Must remove dead or necrotic tissue by process of debridement prior to allowing healing by this means

Healing occurs from the inside out and is prolonged as a result

Tissue is lost

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Wound Healing/Closure

Tertiary Intention/Third Intention

Surgical, Trauma, or Chronic wound

Closure by primary intention must be delayed due to swelling, inflammation, contamination, or patient’s condition (unstable)

May require debridement before closure

Closure delayed 4 to 6 daysSlide35
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Physiological Consequences

Of A Wound

Sympathetic Nervous System Response (Fight or Flight):

↑ HR hyperventilation

↑ BP ↑ mental status

↑ clotting ↑ muscle tension

* Results in vasoconstriction and decrease in blood being delivered to the abdominal organs as bleeding is attempted to be minimized by the body and delivered to vital organs

Slide37

Wound Healing

Natural and Spontaneous Phenomenon

If cannot occur naturally, must remove dead tissue or foreign bodies, treat for infection, and re-approximate the tissue until healing can take place

May occur with sutures, stapling devices, clips, steri-strips, or topical adhesive

(Derma-bond)Slide38

Tissue

Collection of cells that are similar as well as the intercellular substance around them

Four Tissues of the Body:

Epithelium

Connective tissue (blood vessels, bone, and cartilage)

Muscle

Nerve Slide39

Stages of Normal Wound Healing

Lag (Inflammatory) Phase

Healing (Proliferative) Phase

Maturation (Remodeling) PhaseSlide40

Lag/Inflammatory Phase

Lasts 1 to 4 days

Fluid called exudate, containing blood, fibrin, and lymph accumulates in wound

Clotting begins as the exudate binds the wound edges together

Inflammation, a vascular and cellular reaction gets rid of bacteria, foreign matter, and dead tissue

Inflammation causes site to be red, swollen, warm, and painful

Scab (dry, protective layer) forms

Wound strength limited at this timeSlide41

Healing/Proliferative Phase

Begins day 5, lasts two weeks

Epithelialization, new cell formation

Strength of wound increases due to collagen fibers that are produced

Directly related to tensile strength of the wound

Edges of wound continue to be brought closer together Slide42

Tensile Strength

Affects ability of tissue to withstand injury

not

how long it takes the wound to

heal

This is the term referring to the pull strength of a wound or the ability to resist rupture.

As

collagen forms, tissue strength rapidly increases, but it may take months for a plateau to be reached

Until that plateau is reached, wound tissue requires extrinsic support, usually sutures to bring it back togetherSlide43

Remodeling/Maturation Phase

Begins after 2

nd

week of wound and lasts about 4 weeks and can last over a year if the wound is extensive

Scar tissue forms (collagen formation becomes dense)

Scars have limited vascularization, hence they are pale in color

Ultimate strength of wound is 80% of the nonwounded tissueSlide44

Physiological Consequences

Of A Wound Continued

Contamination/Potential Infection

Hemorrhage and Excessive Clot Formation

Complete or total loss of organ function

Cell or Tissue DeathSlide45

Factors Influencing Wound Healing

Wound Type

Patient’s Physical Condition

Type of OperationSlide46

Wound

Complications

Adhesions

Debridement

Dehiscence

Evisceration

Fistula

Gangrene

Granulation

Hematoma

Hemorrhage

Herniation

Infection

Ischemia

Keloid

Necrosis

Proud Flesh

Sinus

Suture breakdown or sensitivitySlide47

Other Wound Terms

Cicatrix

Collagen

Serous -

thin, watery

liquid, usually clear

Sero-sanguinous -A serum-like exudate which is blood-stained (i.e. Pink fluid)

Sanguinous – fluid containing mostly blood (i.e. Red fluid)

Tensile strength Slide48

Patient’s Physical Condition

Smoking

Circulation

Age

Nutritional status

Obesity

Immunologic status

Pre-existing disease

processes:

Respiratory

Diabetes

Drug therapies

Cancer

Anemia

CardiovascularSlide49

Type of Operation

Aseptic technique

Handling of tissue involved

Methods of achieving hemostasis

Security of the wound

How the wound was approximated

Where the wound is anatomicallySlide50

Surgical Site Infections

Incisional

- at the site of incision

Deep Wound

- within the tissue or in the cavity where the operation occurred

Nosocomial

- acquired while in the hospitalSlide51

Wound Care

Aseptic Technique

Prophyllactic

antibiotics

Antiseptics/antimicrobials

used for skin

prep

Adequate

oxygenation

of tissues by maintaining patient oxygenation

Closed wound drain systems

when drains are used

Sterile technique/supplies

with dressing changes

Dressings secured

with clean tape or sterile packaged dressings (tegaderm/primapore) Slide52

Summary

Definitions

Physiological Consequences of a Wound

Wound Types

Mechanisms of Wound Healing

Stages of Wound Healing

Factors Influencing Wound Healing

Surgical Site Infections

Wound Care