Wound Healing Objectives: Indicate terms relevant to wound healing Summarize the possible complications of wound healing Recognize the classifications of surgical wounds Indicate and give examples of types of traumatic wounds Analyze the factors that influence healing and recognize the manner in which affect the healing process 6. Recognize the characteristics of inflammation

Wound Any tissue that has been damaged by either intentional (surgical) or accidental (traumatic) means

Classification of Surgical Wounds Class I - Clean Incision made under ideal conditions No break in sterile technique during procedure Primary closure No wound drain No entry to aerodigestive tract or genitourinary tract

Class II – Clean Contaminated Primary closure Wound drained Minor break in sterile technique occurred Controlled entry to aerodigestive, biliary or genitourinary tract

Class III - Contaminated Open traumatic wound (less than 4 hours old) Major break in sterile technique Acute inflammation present Entry to aerodigestive tract or genitourinary tract with spillage

Class IV – Dirty/Infected  Open traumatic wound (more than 4 hours old) Microbial contamination prior to procedure Perforated viscus

Surgical Wound classification is subject to change during the procedure according to the situation. The final wound classification is assigned at the end of the procedure and is included in the permanent documentation.

TRAUMATIC WOUNDS Closed wound Open wound

CLOSED WOUND The skin remains intact, but underlying tissues suffer damage

OPEN WOUND The integrity of the skin is destroyed Simple wound – The integrity of the skin is destroyed, there is no loss or destruction of tissue and there is no foreign body in the wound. Complicated wound – Tissue is lost or destroyed, or a foreign body remains in the wound. Clean wound – Wound edges can be approximated and secured. A clean wound is expected to heal by first intention. Contaminated wound – Contamination occurs when a dirty object damages the integrity of the skin. Debridement of necrosed tissue may be necessary.

Mechanism of Injury: Abrasion Contusion Laceration Puncture Thermal Another way of classifying traumatic wounds

Chronic Wounds Those that persist for an extended period of time. A chronic wound may develop because of an underlying physical condition that the patient suffers from or it may be due to infection

Inflammatory Response Inflammation is the body’s protective response to injury or tissue destruction, it serves to destroy, dilute, or wall off the injured tissue… Classic local signs: Pain Heat Redness Swelling Loss of function

Types of Wound Healing First intention Second intention Third intention

Phase I Lag Phase/Inflammatory Response Phase Phase II Proliferation Phase Maturation or Differentiation phase See page 281- 282

Factors Influencing Wound Healing Age Nutritional Status Disease (acute, Chronic) Smoking Radiation exposure Immunocompromised

Second Considerations (Intraoperative) Length and direction of incision Dissection technique Duration of Surgery Amount of tissue handling Achievement of hemostasis Precise tissue approximation Elimination of dead space Secure wound closure

Third consideration (Aseptic Technique) Microbial contamination, could lead to infection, increase in morbidity or mortality

Complications of the Healing Wound Dehiscence Friable Evisceration Hemorrhage Infection Adhesion Herniation Fistula Sinus tract Suture complications Keloid scar Pg 282-283

Intraoperative Wound Care Sterile Techniques Proper suturing techniques Wound drains Different types of dressings

Postoperative Wound Care Wound Drains Dressings Packing