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Kevin P. Kilgore, M.D., FACEP. The process of wound care involves t evaluation t plan t action Overview Kevin P. Kilgore, M.D., FACEP.

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Presentation on theme: "Kevin P. Kilgore, M.D., FACEP. The process of wound care involves t evaluation t plan t action Overview Kevin P. Kilgore, M.D., FACEP."— Presentation transcript:

1 Kevin P. Kilgore, M.D., FACEP

2 The process of wound care involves t evaluation t plan t action Overview Kevin P. Kilgore, M.D., FACEP

3 Objectives t Discuss the process of wound evaluation t Review the materials used for wound repair t Discuss “simple” wound closure t Discuss wound aftercare items Objectives Kevin P. Kilgore, M.D., FACEP

4 t When did this happen? l time t Where did this happen? l location t How did this happen? l mechanism History Kevin P. Kilgore, M.D., FACEP

5 t allergies t current medications t pre-existent medical conditions t immunization status for tetanus History Kevin P. Kilgore, M.D., FACEP

6 The “golden period” A misnomer with: l meticulous debridement l copious irrigation l antibiotic coverage History Kevin P. Kilgore, M.D., FACEP

7 Mechanism t shear t tension t compression t missile injuries a combination of shear, tensile, and compressive History Kevin P. Kilgore, M.D., FACEP

8 Shear t Sharp tissue division t Little energy required t Lower infection rate t Cosmetics acceptable History Kevin P. Kilgore, M.D., FACEP

9 Tension t Compression injury t Less than 90 o t Triangular flap t Increased infection t Poor result History Kevin P. Kilgore, M.D., FACEP

10 Compression t Crushing injury t Significant injury t Increased infection t Poor results History Kevin P. Kilgore, M.D., FACEP

11 Environment t protective dressing t gloves, gowns, goggles t good lighting t goal - determine extent of injury Examination Kevin P. Kilgore, M.D., FACEP

12 Extent of injury t amount of tissue loss t tissue viability t depth of the wound t presence of any associated injuries Examination Kevin P. Kilgore, M.D., FACEP

13 Depth of injury Injury to underlying structures? t nerves t tendons t muscles t bone Examination Kevin P. Kilgore, M.D., FACEP

14 Lacerations over bones t probe with a gloved finger to determine whether or not there is a fracture. t If a wound overlies a fracture site an open fracture should be assumed present. Examination Kevin P. Kilgore, M.D., FACEP

15 Deep structure injury t puncture wounds of the head, neck and torso must be managed on the premise that there has been penetration and damage to vital structures. Examination Kevin P. Kilgore, M.D., FACEP

16 Anesthesia t Topical l TAC or XAP t Local l 1% buffered xylocaine l bupivocaine t Regional (nerve block) l 1% buffered xylocaine l bupivocaine Techniques Kevin P. Kilgore, M.D., FACEP

17 Irrigation & debridement t The single most important element of basic wound care. t Intent: l remove devitalized tissue l remove potential nidus for infection Techniques Kevin P. Kilgore, M.D., FACEP

18 Preparation t Generally, an iodophor solution (e.g., Betadine 10%) t Sterile draping is imperative Techniques Kevin P. Kilgore, M.D., FACEP

19 Instruments t four basic instruments l needle-holder l forceps l scissors l towels Techniques Kevin P. Kilgore, M.D., FACEP

20 Suture materials t Absorbable Sutures l employed below the skin l Polyglycolic acid (Dexon®) t Nonabsorbable Sutures l nylon (dermalon®, ethilon®) l surgelene® l novifyl® Techniques Kevin P. Kilgore, M.D., FACEP

21 Other closure materials t Steri-Strips® and Shur-strips® t Surgical staples t Dermabond Techniques Kevin P. Kilgore, M.D., FACEP

22 Size Selection t face, hands or feet - 5-0 and 6-0 t trunk and extremity - 4-0 and 5-0 Techniques Kevin P. Kilgore, M.D., FACEP

23 Suture techniques t Subcuticular Closure l Dexon® or Vicryl®, are used for this deep layer closure. t Cuticular Closure Techniques Kevin P. Kilgore, M.D., FACEP

24 Subcuticular Closure Techniques Kevin P. Kilgore, M.D., FACEP

25 Simple Suture t easiest to learn t safest & most effective t more time needed Techniques Kevin P. Kilgore, M.D., FACEP

26 Wound Edge Eversion Techniques Kevin P. Kilgore, M.D., FACEP

27 Instrument Tie Techniques Kevin P. Kilgore, M.D., FACEP

28 t Dressings t Immobilization t Medications t Antibiotics t Tetanus Prophylaxis t Rabies Prophylaxis t Discharge Instructions Completing Care Kevin P. Kilgore, M.D., FACEP

29 Suture Removal t face 3 to 5 days t ear 4 to 6 days t scalp 7 to 12 days t trunk 7 to 12 days t arms10 to 12 days t legs 10-12 days t hand 10 to 12 days t feet 10 to 14 days Completing Care Kevin P. Kilgore, M.D., FACEP

30 t Discuss the process of wound evaluation t Review the materials used for wound repair t Discuss “simple” wound closure t Discuss wound aftercare items H Remember to remove your sharps from the tray Objective Review Kevin P. Kilgore, M.D., FACEP

31 Now to the Lab

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