Classification and Management of Wounds

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Questions and Answers

Which of these are types of wounds? (Select all that apply)

Puncture wound (correct)

Concussion

Abrasion (correct)

Laceration (correct)

Define an abrasion.

Loss of varying levels of tissue by friction from blunt trauma or shearing forces.

Define avulsion.

Tearing of tissue from its attachment.

Define crush/entrapment injury.

Injury compromises blood supply to the area. Signup and view all the answers

Define degloving injuries.

Severe type of avulsion injury. Signup and view all the answers

Define incision.

Usually iatrogenic. Signup and view all the answers

Define laceration.

An irregular wound caused by a sharp object that results in minimal tissue loss. Signup and view all the answers

Define puncture wounds.

A stab-like injury where a foreign body penetrates into the tissue. Signup and view all the answers

What are open wounds? (Select all that apply)

Lacerations Signup and view all the answers

Match the classification of wounds to their type:

Clean = Wound created surgically without entry into a contaminated space. Clean contaminated = Surgical wound with minimal contamination. Contaminated = Operations on traumatic wounds older than 4 hours. Dirty or infected = Presence of infection with significant bacterial presence. Signup and view all the answers

Define a clean wound.

A wound created surgically with minimal trauma. Signup and view all the answers

Define a clean-contaminated wound.

Urgent or emergent case that is otherwise clean. Signup and view all the answers

Define a contaminated wound.

Operations on traumatic wounds older than 4 hours. Signup and view all the answers

What is wound contamination?

Bacteria are present but not replicating. Signup and view all the answers

What did Swaim say about wound care?

The length of time a wound has been open is not as important as an accurate assessment of defenses. Signup and view all the answers

Which of the following are hallmarks of inflammation for diagnosing infection? (Select all that apply)

Rubor Signup and view all the answers

Define healing by first intention.

Primary closure used for clean wounds. Signup and view all the answers

Define delayed primary closure.

Wound is closed 48-72 hours after occurrence. Signup and view all the answers

What are the 8 basic steps of wound care?

Prevent contamination, assess the patient, practice aseptic technique, debridement, remove foreign material, manage dead space, promote viable vascular bed, select closure. Signup and view all the answers

Study Notes

Types of Wounds

Abrasion: Loss of tissue due to friction or shearing forces, common in blunt trauma.
Avulsion: Tearing away of tissue from attachment; often creates skin flaps, particularly in tendons or ligaments.
Crush/entrapment injury: Compromises blood supply without an external wound; often has severe underlying damage.
Degloving injury: Severe avulsion resulting in stripped skin down to bone or tendon, exposing underlying structures.
Incision: Iatrogenic wound created by a sharp object with smooth edges and minimal trauma.
Laceration: Irregular wound from a sharp object; leads to minimal tissue loss, depth impact varies.
Puncture wound: A deep stab-like injury from a foreign object; often at risk for infection due to sealing of the wound.

Open vs. Closed Wound

Open wounds include lacerations, puncture wounds, and degloving injuries.
Closed wounds involve crush injuries and contusions; skin remains intact but underlying tissues are damaged.

Wound Contamination Degrees

Clean: Surgical wounds with minimal trauma and no contamination.
Clean-contaminated: Urgent cases or controlled surgeries entering a contaminated environment with minimal spillage.
Contaminated: Traumatic wounds older than 4 hours, or those with significant bacterial load.
Dirty or infected: Presence of infection in the wound.

Healing and Infection

Contamination: Presence of bacteria that are non-replicating.
Colonization: Bacteria are present and replicating.
Infection: Bacteria replicate and cause tissue damage.
Bacterial interference: Competes for oxygen/nutrients, produces byproducts that hinder healing.
Factors influencing infection: Bioburden, bacterial virulence, wound microenvironment, host health, injury mechanism.

Swaim’s Observation

Assessment of natural defenses is crucial; duration of wound opening is less critical than evaluation of treatment received.

Golden Period of Wound Management

Class 1: Clean lacerations within 0-6 hours; optimal time to close.
Class 2: 6-12 hours with some contamination.
Class 3: Greater than 12 hours with significant contamination.

Hallmarks of Infection

Peri-wound cellulitis, erythema, swelling, increased temperature, and pain indicate possible infection.
Presence of exudate and odor may confirm infection.
A deep, friable, maroon wound is at risk for infection and might require thorough cleaning before skin grafting.

Wound Healing Intentions

First intention: Primary closure; ideal for clean and clean-contaminated wounds.
Second intention: Healing without closure; appropriate for large or unsuitable wound edges.
Third intention: Delayed or secondary closure; performed after granulation tissue forms.

Principles of Wound Closure

Primary closure for clean wounds, extensive debridement for contaminated wounds.
Delayed primary closure allows for better outcomes with questionable tissue viability.
Secondary closure involves excising epithelialized skin edges and closing primarily, usually done after granulation tissue is prominent.

Halstead’s Principles for Surgical Success

Gentle tissue handling, meticulous hemostasis, preservation of blood supply, strict aseptic technique, minimum tension, accurate tissue apposition, and obliteration of dead space reduce infection risk.

Additional Surgical Principles

Adequate debridement, prudent judgement to eliminate dead space, ensure proper drainage, and minimize surgery time through technique mastery.

Basic Steps for Wound Care

Prevent contamination, comprehensive patient assessment, apply aseptic technique, debride necrotic tissue, remove foreign matter, manage drainage, promote vascular health, and select appropriate closure method.
Use sedation for patient comfort during procedures.

Wound Cleaning Procedure

Wear gloves and probe wounds carefully.
Clip hair around the wound and protect it with gauze.
Clean using sterile agents like povidone-iodine; rinse with saline.
Remove necrotic tissue, employ lavage with saline.
Apply anti-septic agents; chlorohexidine is preferred; avoid hydrogen peroxide for ulcerated wounds.

Studying That Suits You

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Description

Explore the various types of wounds, their definitions, and classifications through this flashcard quiz. Perfect for students and professionals in medical fields, this quiz will help you understand wounds like abrasions, lacerations, and more.