PRINCIPLES OF WOUND PRINCIPLES OF WOUND CLOSURECLOSURE

SHARON HARVEYSHARON HARVEY

NORMAL WOUND HEALINGNORMAL WOUND HEALING

3 MAJOR PHASES OF WOUND HEALING3 MAJOR PHASES OF WOUND HEALING INFLAMMATORY PHASE LASTS 4-6 INFLAMMATORY PHASE LASTS 4-6

DAYSDAYS PROLIFERATIVE PHASE BEGINS PROLIFERATIVE PHASE BEGINS

BETWEEN 1 AND 4 DAYS AFTER BETWEEN 1 AND 4 DAYS AFTER INJURY AND ENDS 14-21 DAYS LATERINJURY AND ENDS 14-21 DAYS LATER

MATURATION PHASE BEGINS 14-21 MATURATION PHASE BEGINS 14-21 DAYS AFTER INJURY AND CAN LAST UP DAYS AFTER INJURY AND CAN LAST UP TO 2 YEARS.TO 2 YEARS.

TYPES OF WOUND HEALINGTYPES OF WOUND HEALING

PRIMARY INTENTIONPRIMARY INTENTION THIS IS THE SIMPLEST THIS IS THE SIMPLEST

FORM OF HEALING. FORM OF HEALING. THE SKIN IS CLEANLY THE SKIN IS CLEANLY

INCISED THROUGH A INCISED THROUGH A SURGICAL INCISION OR SURGICAL INCISION OR TRAUMATIC LACERATIONTRAUMATIC LACERATION

THIS TYPE OF WOUND THIS TYPE OF WOUND CAN BE CLOSED BY CAN BE CLOSED BY SUTURES OR STAPLESSUTURES OR STAPLES

TYPES OF WOUND HEALINGTYPES OF WOUND HEALING

SECONDARY INTENTIONSECONDARY INTENTION BURNS, PRESSURE ULCERS BURNS, PRESSURE ULCERS

AND WOUNDS WITH LARGE AND WOUNDS WITH LARGE PIECES OF SKIN MISSING HEAL PIECES OF SKIN MISSING HEAL THIS WAYTHIS WAY

NO EDGES ARE AVAILABLE FOR NO EDGES ARE AVAILABLE FOR SUTURINGSUTURING

SKIN CELLS EPITHELIZE FROM SKIN CELLS EPITHELIZE FROM THE EDGE OF THE WOUNDTHE EDGE OF THE WOUND

INCREASED TIME FOR HEALINGINCREASED TIME FOR HEALING AT RISK OF LOCAL AND AT RISK OF LOCAL AND

SYSTEMIC INFECTIONSYSTEMIC INFECTION

TYPES OF WOUND HEALINGTYPES OF WOUND HEALING

TETIARY INTENTIONTETIARY INTENTION THE WOUND IS LEFT OPEN TO HEALTHE WOUND IS LEFT OPEN TO HEAL THESE WOUNDS ARE INFECTED AND THESE WOUNDS ARE INFECTED AND

NEED FREQUENT IRRIGATION AND NEED FREQUENT IRRIGATION AND DRESSING CHANGESDRESSING CHANGES

PATIENTS WITH PERITONITIS OR PATIENTS WITH PERITONITIS OR RUPTURED APPENDIX MAY REQUIRE RUPTURED APPENDIX MAY REQUIRE THISTHIS

FACTORS AFFECTING WOUND FACTORS AFFECTING WOUND HEALINGHEALING

NUTRITIONNUTRITION GENERAL PHYSICAL HEALTHGENERAL PHYSICAL HEALTH MEDICATIONSMEDICATIONS

GOALS OF WOUND CAREGOALS OF WOUND CARE

REMOVE NECROTIC TISSUEREMOVE NECROTIC TISSUE PREVENT, ELIMINATE OR CONTROL PREVENT, ELIMINATE OR CONTROL

INFECTIONINFECTION ABSORB DRAINAGE (EXUDATE)ABSORB DRAINAGE (EXUDATE) MAINTAIN A MOIST WOUND ENVIRONMENTMAINTAIN A MOIST WOUND ENVIRONMENT PROTECT THE WOUND FROM FURTHER PROTECT THE WOUND FROM FURTHER

INJURYINJURY PROTECT THE SURROUNDING SKIN FROM PROTECT THE SURROUNDING SKIN FROM

INFECTION AND TRAUMAINFECTION AND TRAUMA

METHODS OF WOUND METHODS OF WOUND CLOSURECLOSURE

STERISTRIPSSTERISTRIPS TOPICAL GLUE (DERMABOND)TOPICAL GLUE (DERMABOND) SUTURESSUTURES STAPLESSTAPLES

SUTURESSUTURES

ARE AVAILABLE IN A WIDE VARIETY OF ARE AVAILABLE IN A WIDE VARIETY OF MATERIALS INCLUDING SILK, NYLON, STEEL, MATERIALS INCLUDING SILK, NYLON, STEEL, LINENLINEN

SUTURE MATERIALS ARE EITHER NATURAL OR SUTURE MATERIALS ARE EITHER NATURAL OR SYNTHETICSYNTHETIC

TWO MAIN CATEGORIES OF SUTURE MATERIAL TWO MAIN CATEGORIES OF SUTURE MATERIAL – ABSORBABLE AND NON ABSORBABLE– ABSORBABLE AND NON ABSORBABLE

SUTURES ARE AVAILABLE WITH OR WITHOUT A SUTURES ARE AVAILABLE WITH OR WITHOUT A NEEDLE ATTACHEDNEEDLE ATTACHED

WITH NEEDLE ATTACHED – CALLED AN WITH NEEDLE ATTACHED – CALLED AN ATRAUMATIC SUTUREATRAUMATIC SUTURE

SUTURESSUTURES

ARE USED TO:ARE USED TO: HOLD TOGETHER INTERNAL HOLD TOGETHER INTERNAL

STRUCTURESSTRUCTURES CLOSE INTERNAL STRUCTURESCLOSE INTERNAL STRUCTURES CLOSE THE WOUND IN LAYERSCLOSE THE WOUND IN LAYERS CLOSE THE SKIN INCISIONCLOSE THE SKIN INCISION SECURE DRAINAGE TUBESSECURE DRAINAGE TUBES

SURGICAL SKIN STAPLESSURGICAL SKIN STAPLES

OFTEN USED AS THE METHOD OF OFTEN USED AS THE METHOD OF CHOISE FOR CLOSING SKIN INCISIONSCHOISE FOR CLOSING SKIN INCISIONS

VERY POPULAR IN NEUROSURGERY, VERY POPULAR IN NEUROSURGERY, GYNAECOLOGY, ORTHOPAEDICS, GYNAECOLOGY, ORTHOPAEDICS, GENERAL AND VASCULAR SURGERYGENERAL AND VASCULAR SURGERY

PROVIDE MORE STRENGTH THAN PROVIDE MORE STRENGTH THAN MANY OTHER SUTURE MATERIALS AND MANY OTHER SUTURE MATERIALS AND TEND TO CAUSE LESS IRRITATIONTEND TO CAUSE LESS IRRITATION

ADVANTAGES OF SKIN ADVANTAGES OF SKIN STAPLESSTAPLES

GRASP ONLY THE SUPERFICIAL SKIN LAYER GRASP ONLY THE SUPERFICIAL SKIN LAYER (ESSENTIAL THAT UNDELYING TISSUE HAS (ESSENTIAL THAT UNDELYING TISSUE HAS BEEN APPROXIMATED CORRECTLY)BEEN APPROXIMATED CORRECTLY)

PROVIDES A SECURE HOLD PROVIDES A SECURE HOLD LESS UNDERLYING TISSUE TRAUMA THAN LESS UNDERLYING TISSUE TRAUMA THAN

WITH SUTURESWITH SUTURES BAR OF THE STAPLE DOES NOT COME IN BAR OF THE STAPLE DOES NOT COME IN

CONTACT WITH SKIN SO LESS LIKELIHOOD CONTACT WITH SKIN SO LESS LIKELIHOOD OF CROSS HATCHING EFFECT AS WITH OF CROSS HATCHING EFFECT AS WITH SUTURESSUTURES

REMOVAL OF SUTURESREMOVAL OF SUTURES

SUTURE REMOVAL IS DETERMINED BY SUTURE REMOVAL IS DETERMINED BY THE RATE OF EXPECTED TISSUE THE RATE OF EXPECTED TISSUE HEALING, TYPE OF TISSUE SECURED HEALING, TYPE OF TISSUE SECURED AND LOCATION OF WOUNDAND LOCATION OF WOUND

THEREFORE – WOUND ASSESSMENT THEREFORE – WOUND ASSESSMENT VITAL, BUT PLANS NEED TO BE FLEXIBLE VITAL, BUT PLANS NEED TO BE FLEXIBLE TO TAKE ACCOUNT OF THE PATIENT TO TAKE ACCOUNT OF THE PATIENT AND THE RATE OF TISSUE REPAIRAND THE RATE OF TISSUE REPAIR

ANY QUESTIONS??????ANY QUESTIONS??????