Wound Healing, Wound Types, Wound Dressings, & Drainage Devices

Name: Wound Healing, Wound Types, Wound Dressings, & Drainage Devices
Uploaded: 2017-07-16T07:24:48+00:00
Duration: PTM25S51
Channel: Charity Gordon
Description: Wound Healing, Wound Types, Wound Dressings, & Drainage Devices

Wound Healing, Wound Types, Wound Dressings, & Drainage Devices
ST230 Concorde Career College

Wound Types & Wound Healing
Objectives: List and define the four types of wound classifications and provide examples of wound types for each category. List and describe the types of wounds and provide examples of each. List and describe the types of wound healing and explain the mechanism for each type.

Objectives: Identify the factors that influence wound healing and understand how to implement techniques that promote optimal wound healing. Describe Halsted’s principles of tissue handling and explain the relationship of those principles to today’s methods of suturing. List and describe the techniques used for suturing and provide examples of when each may be utilized.

Objectives: Outline the dressing application process and identify the optimal time for dressing placement. Identify basic abdominal incisions and identify the tissue layers of the abdominal wall.

Wound Classifications

Surgical Wound Classifications Type I Clean Wound Type II Clean-contaminated Wound Type III Contaminated Type IV Dirty/Infected

Type I - Clean Wound (Potential infection rate 1%- 5%) No inflammation No break in sterile technique Wound primarily closed/Not drained Aerodigestive and genitourinary tract not entered

Type II - Clean-contaminated Wound (Potential infection rate 8% - 11%) No inflammation/Infection present Minor break in technique Wound primarily closed/Not drained Aerodigestive or genitourinary tract entered under controlled circumstances

Type III - Contaminated Wound (Potential infection rate 15% - 20%) Traumatic wound (less than 4 hours old) Acute inflammation present Major break in technique Gross spillage/contamination from respiratory, gastrointestinal, biliary, or genitourinary tracts

Type IV - Dirty/Infected Wound (Potential infection rate 27% - 40%) Traumatic wound (more than 4 hours old) Organisms present at surgical site prior to procedure/Existing infection Perforation (Gastrointestinal, biliary, respiratory, genitourinary tract)

Types of Wounds

Types of Wounds Intentional (Surgical) Accidental (Traumatic) Chronic

Intentional (Surgical) Incision Purposeful cut through intact tissue for the purpose of exposure or excision Wounds Excisional Removal of tissue

Six Types of Accidental Closed Simple Clean (Traumatic) Wounds Open Complicated Contaminated

Closed Traumatic Wound Skin Intact / Underlying tissue damaged Examples: Blister Simple Fracture

Open Traumatic Wound Skin Disrupted Examples: Laceration Compound Fracture

Simple Traumatic Wound Skin Disrupted/No loss or destruction of tissue/No foreign body implanted Examples: Minor penetration Cut with sharp object

Complicated Traumatic Wound Skin disrupted/Underlying tissue lost or destroyed/Foreign body implanted Examples: Severe burn Stab or bullet wound

Clean Traumatic Wound Simple wound caused by a sharp edged object Expected to be sutured and heal by first intention without infection Example: Laceration

Contaminated Traumatic Wound Complicated wound caused by a dirty object May need debridement and has a high potential for becoming infected Examples: Crush Type Injury Foreign Body Implantation

A SINGLE WOUND MAY BE CLASSIFIED IN MORE THAN ONE CATEGORY

Chronic Wound - Wound that fails to heal over an extended period of time Examples: Decubitus ulcer (Pressure sore) Wound caused by inadequate circulation or in which healing is delayed as a result of vascular compromise Infected wounds

Types of Wound Healing First Intention (Primary Union) Second Intention (Granulation) Third Intention (Delayed Primary Closure)

First Intention (Primary Closure) Wound is sutured closed Healing occurs from side-to-side Healing occurs rapidly with little inflammation and minimal scarring Wound heals in three phases

Phases of Wound Healing by First Intention Phase I - Lag Phase or Inflammatory Response Phase Phase II - Proliferation Phase Phase III - Maturation or Differentiation Phase

Phase I - Lag Phase or Inflammatory Response Phase Begins within minutes of the injury and lasts 3-5 days Inflammation is present (manifested by heat, redness, swelling, pain, loss of function) Inflammation is a result of increased blood flow to the area caused by arterial dilation

Phase I (continued) Bleeding controlled by platelet aggregation Oxygenated blood delivered to the site Epithelial cells for repair formed Scab formed Phagocytosis occurs

Phase I (continued) Basal cells seal wound surface Fibroblasts begin reconstruction of nonepithelial tissue

Phase II - Proliferation Phase Begins about the 3rd postoperative day and continues up to 20 days Fibroblasts multiply (proliferate) and bridge wound edges Collagen secreted from fibroblasts

Phase II (continued) Collagen fibers begin to restore tensile strength of tissue Capillary networks established and lymphatic networks reformed

Phase II (continued) Definition: Tensile Strength: Ability to resist rupture During the proliferation phase (phase II) of wound healing by first intention the wound regains 25%-30% of its original tensile strength

Phase III - Maturation or Differentiation Phase Begins on the 14th postoperative day and lasts until the wound is completely healed, (may take up to 12 months) Tensile strength increased by interweaving of collagen fibers

Phase III (continued) Collagen density increases and formation of new blood vessels decreases Cicatrix is formed

Second Intention (Granulation) Wound is intentionally left open Healing occurs from the bottom - up High risk of infection (if not already present) Union is weak and scar formation extensive Pg. 282

Second Intention (Granulation) (continued) Granulation tissue containing myofibroblasts forms in the wound Gaps in tissue fill from bottom upward closing the wound by contraction Epithelial growth is secondary

Third Intention (Delayed Primary Closure) Two granulated surfaces are approximated Wound is left open to heal by second intention for 4-6 days Then, wound is closed Equation 2+1=3 (Second Intention plus First Intention equals Third Intention)

Factors Affecting Wound Healing Three main factors influence wound healing: Physical condition of the patient Intraoperative tissue handling Application of the principles of asepsis

Physical Condition Age Nutritional Status Disease (Chronic or Acute) of the Patient Smoking Radiation Exposure Immunocompromised or Immunosuppressed Patients

Intraoperative Length and direction of the incision Dissection technique (sharp or blunt) Length of surgery Hemostasis Tissue Handling Minimal and gentle tissue handling Precise tissue approximation Elimination of dead space Secure wound closure

Halsted's Methods of Tissue Handling Strict aseptic technique Gentle handling of tissue Use of the finest suture material Small stitches and low tension on the tissue Complete closure of wounds whenever possible Refer to chapter diagrams for suturing types – interrupted sutures

These basic procedures had a far-reaching effect on the practice of surgery, making it safer and more effective than it had been previously. William S. Halsted

Dead Space Dead space is a separation of wound edges, which have not been closely approximated or air that has become trapped between tissue layers. This space may allow for serum or blood to collect and provide a medium for microbial growth that may result in infection.

Dead Space Reduce or eliminate dead space with the use of: Proper suturing techniques Wound drains Pressure dressings

Application of the Principles of Asepsis Through the Use of Sterile Technique A sterile field is created for each surgical procedure Sterile team members must be appropriately attired prior to entering the sterile field Movement in and around the sterile field must not compromise the sterile field

Complications of Dehiscence Evisceration Hemorrhage Infection Adhesions Wound Healing Herniation Fistula Sinus tract Suture complications Keloid scar formation Pg tables 11-2 & 11-3

Knot Tying Basics Knot Security Knot Tying Principles Square Knot (Two Hand Technique) Surgeon’s Knot See Ethicon wound closure manual

Knot Security Knot security is of utmost importance in preventing wound complications Use the most simple; secure knot possible

Knot Tying Principles Knot must be firm Tie knot as small as possible and trim ends as close as possible When tying, avoid “sawing” motion or excessive tension, which may damage the integrity of the suture

Two Simple Knots (Over 1,000 types of knots available) Square Knot - Easiest and most reliable Surgeon’s Knot - Provides extra security

NO GRANNIES!!!! A Granny knot is a slip knot and is NOT acceptable as a surgical knot!

Square Knot (Two Hand Technique) Right over left (first throw) Left over right (second throw)

Surgeon’s Knot First step Right over left Repeat right over left Then tighten

Surgeon’s Knot Second Step Left over right Tighten DONE!! It should look like this...

Tissue Approximation Pg

Suturing Techniques Primary Suture Line Holds wound edges together Heals by first intention May be continuous or interrupted

Suturing Techniques Secondary Suture Line Supports and reinforces primary suture line Also called retention sutures Usually interrupted

Primary and Secondary Suture Lines

Continuous Suture Line Also called “running” stitch Series of stitches placed with one continuous suture

Continuous PROS Quick placement Less foreign body in wound Tension evenly distributed Suture Line CONS Over tensioning can cause suture failure leading to wound disruption Can allow fluid to travel along suture line - may spread infection

Interrupted Suture Each suture strand is placed individually Individual suture strands are tied and cut Key concept in Halsted’s suturing principles - still employed today

Interrupted PROS Secure closure Remaining sutures should hold wound edges together if one stitch fails Microbes less likely to move along interrupted suture line Suture Line CONS Time consuming More foreign body in wound

Continuous Suturing Techniques Over and Over Running Stitch

Continuous Suturing Techniques Interlocking Stitch

Interrupted Sutures Simple Interrupted Evenly spaced Equal depth Ends uniformly cut

Interrupted Sutures Vertical Mattress

Interrupted Sutures Horizontal Mattress

Dressing Application

Dressing Application Last step of the sterile procedure

Basic Abdominal Incisions

Basic Abdominal Incisions ST4ST table 14-3 fig

Layers of the Abdominal Wall

Wound Healing, Wound Types, Wound Dressings, & Drainage Devices
ST230 Concorde Career College

Sponges Laparotomy Ray-Tec Cottonoids Tonsil Kittner Peanut
Tapes, packs, laps Ray-Tec ray Cottonoids Patties Tonsil Kittner Peanut ** must be counted**

Sponges Peanut Lap sponge Ray-Tec Tonsil 78

Sponges Have a radiopaque strip so they can be located by X-ray

Discarded Dirty sponges are placed in kick bucket or sponge tree

Dressing Choice determined by several factors:
Type, size, and location of the wound Amount of drainage expected Surgeon preference Age and size of the patient Underlying medical conditions Condition of the surrounding skin Comfort of the patient 81

Dressing One-layer Three-layer Pressure Bulky Rigid Specialty Packing
82

Dressing One-layer dressing Cover small incisions
Frequently used to cover IV access Transparent polyurethane film/adhesive backing 83

Dressing One-layer dressing OP-site Collodion
Aerosol adhesive sprays, foams, gels Skin closure tapes 84

Dressing Three-layer dressing Inner (contact) layer
Intermediate (absorbent) layer Absorbs drainage 4X4, kerlix, fluffs Outer ( securing) layer Tape, stockinette 85

3 layer dressing/ Contact Layer
Nonpermeable Occlusive xeroform Semipermeable Semi-occlusive Exu-derm, aqua-gel Permeable Nonocclusive Telfa, adaptic Wicking action

Dressing Pressure dressing Immobilization of an area Support
Absorption of excessive drainage Even pressure distribution Elimination of dead space Reduced edema Reduced hematoma formation 87

Dressing Bulky dressing Three-layer dressing
Additional material is added to the intermediate layer Used to immobilize an area Provide support Absorb excessive drainage 88

Dressing Rigid dressing Casts Splints Encircles Provide support
Prevent movement Often incorporates the joint Splints Applied to one side of a structure Support Prevent unidirectional movement 89

Specialty Dressing Bolster Wet-to-dry Wet-to-wet Drain Ostomy Peri-pad

Dressing Packing Assist with hemostasis Provide pressure
Provide support Eliminate dead space

Catheters Used to remove fluid or other objects
Used to monitor body functions Insert fluids 92

Catheters Remove air and fluids Decompression Maintain patency
Administration of oxygen, anesthetic, medications, fluids 93

Cystostomy catheter

Drains Passive Drains air or fluid moves from an area of high pressure to one of lower pressure. Penrose Cigarette T-tube Gastrostomy Cystostomy Nephrostomy

Penrose Drain

Drains Active Drains Negative pressure
Connected to a collection device Hemovac Jackson-Pratt Stryker

Jackson Pratt(JP) drain

Hemovac Drain with trocar

Tubes Used to remove air and fluids Decompression
Maintain patency of a lumen Administer oxygen, anesthetics, and other gases Administer medications

Gastrostomy tube

Nephrostomy tube

Non-suture Needles Hypodermic Arterial Intravenous Biopsy
Used to withdraw fluid from medication or tissue 12g-30g; ½-4 inches long Arterial Used to place plastic indwelling catheter Intravenous Biopsy

Non-suture needles Insufflation Heparin Spinal Irrigate vessels
3-4 inches Beveled stylet within the cannula

Syringes Luer lock Luer slip ( slip tip) 3-60 cc
Three ring or control syringe Bulb Asepto

Wound Healing, Wound Types, Wound Dressings, & Drainage Devices

Similar presentations

Presentation on theme: "Wound Healing, Wound Types, Wound Dressings, & Drainage Devices"— Presentation transcript:

Similar presentations

About project

Feedback

Log in

Auth with social network:

Wound Healing, Wound Types, Wound Dressings, & Drainage Devices

Similar presentations

Presentation on theme: "Wound Healing, Wound Types, Wound Dressings, & Drainage Devices"— Presentation transcript:

Similar presentations

About project

Feedback