Transcript Wound Healing, Dressing, and Drains - An

Wound Healing, Dressing, and
Drains
Dr. Aidah Abu Elsoud Alkaissi
Wound healing
• Etiology of wounds:
– Surgical: caused by an incision or excision
– Traumatic: caused by an injury (mechanical,
thermal, or chemical)
– Chronic:caused by an underlying
pathophysiology, such as pressure sores, or
venous leg ulcers, over time
Exact biologic process that takes place in
orderly sequence
• An exudate containing blood, lymph, and fibrin
begins clotting and loosely binds the cut edges
together
• Blood supply to the area is increased, and the basic
process of inflammation is set in motion
• Leukocytes increase in number to fight bacteria in
the wound area and by phagocytosis help to remove
damaged tissues
• The served tissue is quickly glued together by
strands of fibrin and a thin layer of clotted blood,
forming a scab
Wound Healing
• Plasma seeps to the surface to form a dry
protective crust
• This seal helps to prevent fluid loss and bacterial
invasion
• During the first few days of wound healing, the
seal has little tensile (The resistance of a
material to a force tending to tear it apart)
strength
• After 3-4 days , connective tissue cells
(fibroblasts)rapidly proliferate and give strength
to the wound by producing collagen, a tough
fibrous protein responsible for the structural
integrity of the skin
Wound Healing
• At the same time small blood vessels regenerate
and build new blood channels, granulation tissue
(fibrous connective tissue) includes blood vessels
and lymphatics that proliferate from the base of
the wound
• Rapidly growing and multiple epithelial cells
begin to restore the epithelial continuity of the
skin
• At this stage the wound appears healed, healing is
not complete until the granulation tissue
organizes into scar tissue
Wound Healing
• By the ninth or tenth day, the wound is
moderately well healed and then becomes
progressively stronger
• The whole process of repair takes 2 weeks or
more depending on factors such as physical
condition of the patient, size and location of the
wound, and stresses put on the incisional area
• During this time the scar (cicatrix) strengthens as
the connective tissue shrinks
Wound Healing
• The amount of tissue loss, the existence of
contamination or infection and damage to tissue
are all factors that determine the type of wound
healing that will occur
• Process of healing takes place in one of three
ways
– Healing by primary (first) intention
– Healing by secondary infection (granulation)
– Healing by delayed primary closure (third intention)
Healing by primary (first)
intention
• Edges of an incised wound in a healthy person are
promptly and accurately approximated
• Contmination is held to a minimum by impeccable
(without fault or error) aseptic technique
• Trauma to the wound is minimal
• After suturing , no dead space is left to become
site of infection
• Drainage is minimal
Healing by secondary intention
(granulation)
• When surgical wounds are characterized by tissue loss with
inability to approximate wound edges, healing occurs through
secondary intention
• This type of wound is left open and allowed to heal from the
inside towared the outer surface
• In infected wound this process allows the proper cleansing and
dressing of the wound as healthy tissue builds up from the inside
Healing by secondary intention
(granulation)
• The area of tissue loss gradually fills with
granulation tissue (fibroblasts and capillaries)
• Scar tissue is extensive because of the size of the
tissue gap that must be closed. Contraction of
surrounding tissue also takes place
• Consequently this healing process takes longer
than primary intention healing
Healing by delayed primary
closure (third intention)
• This healing process takes place when approximation of
wound edges is delayed by 3-5 days or more after injury
or surgery
• The condition contribute to a decision for a delayed
closure are:
– 1. Removal of an inflamed organ
– 2. Heavy contamination of wound
Factors influencing wound
healing
• The patient´s nutritional status and overall
reoperative (To return to health or strength;
recover) power
• Especially significant is an adequate supply of
protein, which is necessary for the growth of new
tissues, the regulation of the osmotic pressure of
blood and other body fluids and the formation of
prothrombin, enzymes, hormones and antibodies
• Vit C which aids connective tissue production
and strong scar formation
• Scrupulous (extreme care and great effort)
aseptic technique must be used to prevent any
wound infection-the most common cause of
delayed wound healing
Factors influencing wound
healing
• Theories abound as to the genesis of wound
infection. Cross – contamination from operating
room, post anesthesia care unit and unit personel
is believed to be a primary source
• Aseptic principles and maintenance of operating
room environmental conditions are significant
factors
• Length of time that the wound is open in the
operating room has also been mentioned
• The pat own endogenous flora
• Rough handling of tissue causes trauma that can
lead to bleeding and other conditions conducive
to the infection
Factors influencing wound
healing
• Other factors pat age, stress level,
presxisting condition as diabetes, anemia,
malnutrition, cancer , obesity, advanced
age, cardiovascular, respiratory
impairments. Overall physiacal and
psychological condition
Terms
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Keloid
Proud flesh
Gangrene
Adhesions
Dehiscence
Evisceration
Please read page 142
Wound Classification
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Clean wound
Clean contaminated wound
Contaminated wound
Dirty or infected wound
Please read Page 143
Dressing
• After surgery the dressing may be applied
to the wound please read page 143, 144
145