Download - 7-Wounds and Their Management
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WOUNDS AND THEIR WOUNDS AND THEIR MANAGEMENTMANAGEMENT
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Inflammation, epitheliallization, Inflammation, epitheliallization, granulation, fibroplasias, granulation, fibroplasias, contractioncontraction
Processes occur simultaneously Processes occur simultaneously rather than a series of discrete rather than a series of discrete steps steps
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WOUNDSWOUNDS
A DISRUPTION OF NORMAL A DISRUPTION OF NORMAL ANATOMIC RELATIONSHIPSANATOMIC RELATIONSHIPS
AS A RESULT OF AN INJURYAS A RESULT OF AN INJURY THE INJURY - INTENTIONALTHE INJURY - INTENTIONAL
- ACCIDENTAL- ACCIDENTAL
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WOUNDSWOUNDS
DISRUPTION OF TISSUE DISRUPTION OF TISSUE INTEGRITY INTEGRITY – SURGICALSURGICAL– TRAUMATICTRAUMATIC
STIMULATES A SERIES OF STIMULATES A SERIES OF CELLULAR AND MORPHOLOGIC CELLULAR AND MORPHOLOGIC EVENTS- SPONTANEOUS WOUND EVENTS- SPONTANEOUS WOUND CLOSURECLOSURE
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WOUNDSWOUNDS
IMPAIREMENT OF NORMAL IMPAIREMENT OF NORMAL HEALING, ESPECIALLY BY HEALING, ESPECIALLY BY INFECTION INFECTION
IS A MAJOR SOURCE OF SURGICAL IS A MAJOR SOURCE OF SURGICAL MORBIDITYMORBIDITY
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WOUND REPAIRWOUND REPAIRTHREE BASIC THREE BASIC PROCESSESPROCESSES
1. Epithelial coverage of the 1. Epithelial coverage of the woundwound
2. Collagen formation2. Collagen formation
3. Contraction in the tissues3. Contraction in the tissues
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WOUND REPAIRWOUND REPAIRTHREE BASIC PHASESTHREE BASIC PHASES
1. THE LAG PHASE1. THE LAG PHASE
2. THE PROLIFERATIVE PHASE2. THE PROLIFERATIVE PHASE
3. THE MATURATION PHASE3. THE MATURATION PHASE
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WOUND HEALINGWOUND HEALING
For 2-6 months the scar is For 2-6 months the scar is described immature or activedescribed immature or active
Scars become fully mature from Scars become fully mature from 1-3 years after the surgery or 1-3 years after the surgery or injuryinjury
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WOUND HEALINGWOUND HEALING
When a scar matures:When a scar matures:– The color fadesThe color fades– The scar softensThe scar softens– It becomes flatterIt becomes flatter– It is less itchy It is less itchy
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HEALING WOUNDSHEALING WOUNDSCLASSIFICATIONCLASSIFICATION
1. PRIMARY HEALING1. PRIMARY HEALING
2. SECONDARY HEALING2. SECONDARY HEALING
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NUTRITIONNUTRITION
PROTEIN DEPLETIONPROTEIN DEPLETION VIT. C – FIBROBLASTS PRODUCE VIT. C – FIBROBLASTS PRODUCE
LESS COLLAGENLESS COLLAGEN VIT A VIT A VIT B6 DEFICIENCY IMPAIRS VIT B6 DEFICIENCY IMPAIRS
COLLAGEN LINKINGCOLLAGEN LINKING VIT B1 – B2VIT B1 – B2 ZINC DEFICIENCYZINC DEFICIENCY
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WOUNDSWOUNDSTREATMENT OPTIONSTREATMENT OPTIONS Delayed primary closureDelayed primary closure
Healing by secondary intentionHealing by secondary intention
Skin graftingSkin grafting
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IMPAIRED WOUND IMPAIRED WOUND HEALINGHEALING Systemic risk factorsSystemic risk factors
Local risk factorsLocal risk factors
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Systemic risk factorsSystemic risk factors
1. Malnutrition1. Malnutrition 2. Diabetes mellitus2. Diabetes mellitus 3. Sepsis3. Sepsis 4. Chemotherapy4. Chemotherapy 5. Immunosuppressant5. Immunosuppressant
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Local risk factorsLocal risk factors
1. Local ischemia- PVD1. Local ischemia- PVD 2. Radiotherapy- ischemic vasculitis2. Radiotherapy- ischemic vasculitis 3. Obesity3. Obesity 4. Local edema4. Local edema 5. Tension suture on wound edges5. Tension suture on wound edges 6. Pressure over a bony prominence6. Pressure over a bony prominence 7. Dry environment7. Dry environment 8. Presence of necrotic tissue8. Presence of necrotic tissue
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WOUNDSWOUNDSCLASSIFICATIONCLASSIFICATION 1. Incised wound1. Incised wound 2. Punctured wound2. Punctured wound 3. Laceration3. Laceration 4. Shear wound4. Shear wound 5. Missile wound5. Missile wound
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LACERATIONLACERATION
A wound that is produced by the A wound that is produced by the tearing of soft body tissuetearing of soft body tissue
This type of wound is often This type of wound is often irregular and raggedirregular and ragged
Often contaminated with bacteria Often contaminated with bacteria and debris from whatever object and debris from whatever object caused the cutcaused the cut
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PUNCTURED WOUNDPUNCTURED WOUND
It is caused by a sharp pointy It is caused by a sharp pointy objectobject
This type of wound usually does This type of wound usually does not bleed excessivelynot bleed excessively
Can appear to close upCan appear to close up Also prone to infectionAlso prone to infection
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GUN SHOT WOUNDGUN SHOT WOUNDCLOSE RANGECLOSE RANGE
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GUN SHOT WOUNDGUN SHOT WOUNDINTERMEDIATE RANGEINTERMEDIATE RANGE
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MULTIPLE KNIFE STAB MULTIPLE KNIFE STAB WOUNDSWOUNDS
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EMERGENCY WOUND EMERGENCY WOUND CARECARE 1. Anesthesia & wound cleansing1. Anesthesia & wound cleansing 2. Hemostasis2. Hemostasis 3. Wound exploration3. Wound exploration 4. Debridement4. Debridement 5. Wound closure5. Wound closure 6. Antibiotics6. Antibiotics
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WOUND FAILUREWOUND FAILURE
1. Wound fibrosis1. Wound fibrosis 2. Wound infection2. Wound infection 3. Dehiscence3. Dehiscence
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HYPERTROPHIC SCARHYPERTROPHIC SCAR
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HYPERTROPHIC SCARHYPERTROPHIC SCAR
During the active phase the scar During the active phase the scar may:may:– become firm to the touch,become firm to the touch,– may rise from the surrounding may rise from the surrounding
unbroken skin,unbroken skin,– but remain within the boundaries of but remain within the boundaries of
the original woundthe original wound
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HYPERTROPHIC SCARHYPERTROPHIC SCAR
This type of scar generally This type of scar generally improves with timeimproves with time
Tends to occur more frequently in Tends to occur more frequently in people with darker skinpeople with darker skin
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HYPERTROPHIC SCARHYPERTROPHIC SCAR
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KELOIDSKELOIDS
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KELOIDSKELOIDS
An overgrowth of fibrous tissue on An overgrowth of fibrous tissue on the skinthe skin
Keloids occur due a defective or Keloids occur due a defective or overactive healing process in overactive healing process in which an excess of collagen forms which an excess of collagen forms at the site of healing scarat the site of healing scar
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KELOIDSKELOIDSSIGNS AND SYMPTOMS SIGNS AND SYMPTOMS Firm, raised, hard scars Firm, raised, hard scars Slightly pinkSlightly pink May itch, cause pain, are tender to the May itch, cause pain, are tender to the
touchtouch May continue to grow and develop May continue to grow and develop
“claw-like” projections over a period of “claw-like” projections over a period of timetime
It looks ugly and does not improve with It looks ugly and does not improve with time time
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KELOIDS- CAUSESKELOIDS- CAUSES
Skin injury:Skin injury:– Surgical incisionsSurgical incisions– Traumatic woundsTraumatic wounds– Vaccination sitesVaccination sites– BurnsBurns– ChickenpoxChickenpox
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KELOIDS AFTER KELOIDS AFTER THERMAL RADIATIONTHERMAL RADIATION
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SUTURE MATERIALSUTURE MATERIAL
1. Needles1. Needles– Straight or curvedStraight or curved– Cutting or circular tipsCutting or circular tips
2. Suture2. Suture– Absorbable or non absorbaleAbsorbable or non absorbale– Braided or monofilamentBraided or monofilament
3. Metal staples3. Metal staples 4. Skin tapes4. Skin tapes
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TYPES OF STITCHESTYPES OF STITCHES
1. Simple interrupted stitches1. Simple interrupted stitches 2. Running locked stitches2. Running locked stitches 3. Running sub cuticular stitches3. Running sub cuticular stitches 4. Vertical mattress sutures4. Vertical mattress sutures 5. Horizontal mattress stitches5. Horizontal mattress stitches
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KNOTSKNOTS
1. Granny knot1. Granny knot 2. Square knot2. Square knot 3. Surgeon’s knot3. Surgeon’s knot
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SUTURE REMOVALSUTURE REMOVAL
2 DAYS POSTOP.- HEAD, NECK2 DAYS POSTOP.- HEAD, NECK
7 DAYS POSTOP- ABDOMEN, 7 DAYS POSTOP- ABDOMEN, THORAXTHORAX
9 DAYS POSTOP- WHERE THERE IS 9 DAYS POSTOP- WHERE THERE IS ANY RISK OF SEPARATIONANY RISK OF SEPARATION