Wound Closure And Healing - Study Guide PDF

**Page Title** **Content You Should Know** Module Outcome & Objectives **Outcome** On successful completion of the Wound Closure and Healing module, 80% of nurses will be able to demonstrate knowledge related to the processes of wound closure and wound healing, as evidenced by passing the post...

**Page Title** **Content You Should Know** Module Outcome & Objectives **Outcome** On successful completion of the Wound Closure and Healing module, 80% of nurses will be able to demonstrate knowledge related to the processes of wound closure and wound healing, as evidenced by passing the posttest with a score of 80% or higher.  **Objectives** 1. Identify suture elements such as suture material, characteristics, and packaging.  2. Describe the four different surgical wound classifications.   3. Identify skin closure options.  4. Explain wound healing influences and criteria for surgical site infection types.  Suture Material Classifications Suture classification system elements - Natural or synthetic material - Absorbable or non-absorbable suture strand - Monofilament or multifilament Suture Material Characteristics Suture material characteristics - Physical configuration - Handling ability - Potential for tissue reaction Stitch Types There are various suturing methods in different circumstances: Interrupted - Single sutures that are tied independently Continuous or running stitch - Uninterrupted suture line Retention suture - A heavy suture that reinforces the primary suture line Subcuticular stitch - A suture line under the epidermis Purse-string Suture placed around a circular wound Other Skin Closure Options Other skin closure options include: Staples - Advantages - Easy to use - Provides uniform incisional tension - Faster wound closure - Disadvantage - Require extraction, unless staples are absorbable Adhesives - Advantages - Reduced risk of infection - Less scarring - Eliminates skin closure device removal - Disadvantages - Limited to superficial wounds - Higher allergic reaction rate - Not optimal for slow-healing health conditions Wound closure/Adhesive strips - Advantage - Less expensive than other skin closure methods - Disadvantage - Can loosen with moisture, causing wound compromise Zipper - Advantages - Distributes skin stretching forces over a wide surface area and away from the wound edges - Faster application than suturing - Reduced costs related to surgeon's and operating room time - Eliminates the need for suture removal - Provides more patient comfort - Lower infection rate - Disadvantage - Cost of product Wound Healing Mechanisms Three types - Primary intention - Clean incision with no tissue loss, minimal wound trauma and drainage, and the edges of the wound are approximated, leaving no "dead" space - Secondary intention - Wound heals by granulation, leading to wound contracture - Tertiary Intention/Delayed primary closure - Delayed wound closure due to considerable tissue loss and/or gross infection - Wound is not devascularized - Deep sutures are not used to avoid granuloma formation Wound Classification Wound Class I -- Clean Wounds - Have no inflammation or infection present - The respiratory, alimentary, and genitourinary tracts are not entered - Examples: hernia surgery, breast surgery, and non-traumatic orthopedic, cardiac, or peripheral vascular surgery Wound Class II -- Clean Contaminated - The respiratory, alimentary, or genitourinary tract is entered under controlled conditions and without contamination of the surrounding tissue - There is no evidence of infection or no major break in aseptic technique - Examples: dilation and curettage (D&C), total abdominal hysterectomy (TAH), gastrectomy, cholecystectomy without spillage, elective appendectomy, and lung wedge resection Wound Class III -- Contaminated - Open, fresh, traumatic wounds - Major breaks in sterile technique - Gross spillage from the gastrointestinal tract - Incisions in which acute, nonpurulent inflammation is encountered - Examples: Laparotomy with significant spillage, traumatic wounds (eg, gunshot and stab wounds), acute inflammation of any organ without frank pus present (eg, acute appendicitis or cholecystitis) Wound Class IV -- Dirty, Infected - Old traumatic wounds with retained devitalized tissue - Wounds that involve existing clinical infection or perforated viscera - Wounds with a delayed primary closure - Examples: Incision and drainage, total evisceration, perforated viscera SSI Categories 1. Superficial incisional a. Epidermis, dermis, subcutaneous layers b. Within 30 days after surgery 2. Deep incisional c. Fascial, muscle layers d. Between 30 and 90 days after surgery 3. Organ/space e. Organ, space layer f. Between 30 and 90 days after surgery Wound Therapy-Difficult Wounds Negative-pressure wound therapy (NPWT) / Vacuum-assisted closure (VAC): - Wound therapy used for difficult wounds that have not responded to other care methods - A specialized device applies constant, controlled, negative pressure to a wound into which a drainage sponge has been placed Three components of NPWT / VAC - Reduces edema - Promotes granulation tissue perfusion and formation - Removes exudate and infectious materials Drains Drains are used to provide an exit for blood, serum, bile, air, intestinal secretions, and pus. Drains also create a portal of entry for pathogenic microorganisms. - Aseptic technique is necessary when emptying closed systems and changing a wound drain dressing. Open - Penrose drain Closed suction - Hemovac - Jackson-Pratt **PRACTICE QUESTIONS** **QUESTIONS** **YOUR ANSWER** -------------------------------------------------------------------- ----------------- What is the wound classification for a D&C procedure? A Jackson-Pratt drain is an example of what kind of drain? Where is a superficial incisional surgical site infection located?