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WOUND
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CLASSIFICATION
v

OPEN Incisionsorincised wounds :caused by a clean, sharp-edged object such as aknife arazoror a glass splinter. Lacerations: irregular tear-like wounds caused by someblunt trauma

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Abrasions : superficial wounds

Puncture wounds: caused by

an object puncturing theskin, such as a nail orneedle.

Penetration wounds: caused by

an object such as a knife entering and coming out from the skin

Gunshot wounds: caused by

abulletor similar projectile driving into or through the body

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CLOSED

Contusions: more commonly known asbruises, caused by a blunt force trauma that damagestissueunder the skin. Hematomas: also called a blood tumor, caused by damage to ablood vesselthat in turn causesbloodto collect under theskin. Crush injury: caused by a great or 4/22/12 extreme amount of force applied

MANAGEMENT

CLEANING CLOSURE DRESSINGS ANTIBIOTICS

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WOUND HEALING
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DEFINITION

Wound healing, orwound repair, is an intricate process in which the skin (or another organ) repairs itself after injury.

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PHASES:

(1)vascular response phase (2) inflammatory phase (3) proliferative phase (4) maturation or remodeling phase

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VASCULAR RESPONSE PHASE

Bloodvessels constrictto stop bleeding and to decrease exposure to bacteria Clotting process begins -platelets forms clot -Plasma proteins forms a fibrous meshwork

-Platelets sticks to fibrin meshwork and forms plug 4/22/12

Capillaries dilate 10-30 mts after injurythis is due to serotonin release by the platelet Plasma flow into the wounded area To dilute toxins

To bring oxygen and nutrients for the tissue repair To carry phagocytes to the area

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(2) INFLAMMATORY 2-5 days

The purpose of the phase is to limit the effect of harmful bacteria and limit the spread throughout the body

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Neutrophils

they squeeze through the capillary walls and enter into the site of injury and begins phagocytosis of the bacteria, dead cells and cellular debris. They become the predominant cells in the wound for the first two days after the injury occurs, with especially high numbers on the second day. 4/22/12

Mast cell

They replace neutrophils as the predominant cells in the wound by two days after injury. The macrophage's main role is to phagocyte bacteria and damaged tissue. They also releases histamine and serotonine which causes capillary 4/22/12 dilatation.

(3) PROLIFERATIVE
2 days to 3 weeks

The proliferative phase is characterized by

1. 2. 3. 4. 5.

angiogenesiS, collagendeposition, granulation tissueformation, epithelialization,

and wound contraction. 4/22/12

In angiogenesis-- new blood vessels are formed by vascular endothelial cells. fibroblastsbegin accumulating in the wound sitehelp to synthesise collagen and Granulation tissue Epithelializationformation of epithelial cells which helps for wound closure Wound contractionfacilitated by myofibroblast

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(4) REMODELING
3 weeks to 2 years

Remodeling is the process of collagen synthesis and lysis New collagen forms which increases tensile strength to wounds Scar tissue is only 80 percent as strong as original tissue
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Factors Affecting Wound Healing

Age of patient Hypovolemia Local factors Edema Inadequate dressing technique Tooloose Too tight
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Nutritional deficits Foreign bodies Oxygen deficit (tissue oxygenation insufficient) Drainage accumulation Medications Corticosteroids Anticoagulants

Broad-spectrum and specific 4/22/12 antibiotics

Patient overactivity Systemic disorders Hemorrhagic shock Acidosis Hypoxia Renal failure Hepatic disease Sepsis
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Immunosuppressed state

Wound stressors Vomiting Valsalva maneuver Heavy coughing Straining

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