Wound Healing Objectives: 1. 2. 3. 4. 5. Indicate terms relevant to wound healing Summarize the possible complications of wound healing
Recognize the classifications of surgical wounds Indicate and give examples of types of traumatic wounds Analyze the factors that influence healing and recognize the manner in which affect the healing process 6. Recognize the characteristics of inflammation Wound Any tissue that has been damaged by either intentional (surgical) or accidental (traumatic) means
Classification of Surgical Wounds Class I - Clean Incision made under ideal conditions No break in sterile technique during procedure Primary closure No wound drain No entry to aerodigestive tract or genitourinary tract
Class II Clean Contaminated Primary closure Wound drained Minor break in sterile technique occurred Controlled entry to aerodigestive, biliary or genitourinary tract Class III - Contaminated
Open traumatic wound (less than 4 hours old) Major break in sterile technique Acute inflammation present Entry to aerodigestive tract or genitourinary tract with spillage
Class IV Dirty/Infected Open traumatic wound (more than 4 hours old) Microbial contamination prior to procedure Perforated viscus Surgical Wound classification is subject to change during the procedure according to the situation. The final wound classification is assigned at the end of the procedure and is
included in the permanent documentation. TRAUMATIC WOUNDS Closed wound Open wound CLOSED WOUND The skin remains intact, but underlying tissues suffer damage
OPEN WOUND The integrity of the skin is destroyed Simple wound The integrity of the skin is destroyed, there is no loss or destruction of tissue and there is no foreign body in the wound. Complicated wound Tissue is lost or destroyed, or a foreign body remains in the wound. Clean wound Wound edges can be approximated and secured. A clean wound is expected to heal by first intention.
Contaminated wound Contamination occurs when a dirty object damages the integrity of the skin. Debridement of necrosed tissue may be necessary. Mechanism of Injury:
Abrasion Contusion Laceration Puncture Thermal Chronic Wounds Those that persist for an extended period of time. A chronic wound may develop because
of an underlying physical condition that the patient suffers from or it may be due to infection Inflammatory Response Inflammation is the bodys protective response to injury or tissue destruction, it serves to destroy, dilute, or wall off the injured tissue Classic local signs: Pain
Heat Redness Swelling Loss of function Types of Wound Healing First intention Second intention Third intention
Phase I Lag Phase/Inflammatory Response Phase Phase II Proliferation Phase Maturation or Differentiation phase Factors Influencing Wound Healing
Age Nutritional Status Disease (acute, Chronic) Smoking Radiation exposure Immunocompromised
Second Considerations (Intraoperative)
Length and direction of incision Dissection technique Duration of Surgery Amount of tissue handling Achievement of hemostasis Precise tissue approximation Elimination of dead space Secure wound closure Third consideration (Aseptic Technique)
Microbial contamination, could lead to infection, increase in morbidity or mortality Complications of the Healing Wound
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