NURSING & MIDWIFERY

TRAINING COLLEGE KORLE-BU

SURGERY AND SURGICAL NURSING 1
PRESENTATION BY GROUP TWO (2)
ON THE TOPIC WOUND
 COURSE OBJECTIVES
• Definition of wound
• Causes and classification of wound
• The phases of wound healing
• The types of wound healing
• Factors affecting and promoting wound healing
• Complications of wound
• Wound infection, treatment and prevention of wound
infection.
• Wound dressing, wound debridement and wound
drainage.
 WOUND
• A wound can be defined as a break in the continuity of
the mucous membrane or the skin. A term wound is
also used for injuries to an organ or tissue within the
body .Example lungs, kidney, liver, heart, spleen.
• In any wound, when blood vessels are damaged the cut
or torn end contract to reduce bleeding. Naturally, a
clot forms which stops further bleeding. If there is any
tissue loss, new connective tissues and blood vessels
grow in to fill the gap, but healing takes longer in torn
wounds than in cleanly cut (surgically incised) wounds.
 Causes of Wounds
• Accident or trauma
• Surgical incision
• Chemicals such as acids, alkalines
• Radiation
• Infections
• Temperature extremes, burns
 CLASSIFICATION OF WOUND
• Mechanism of injury
• Degree of contamination
• Visibility of the wound
Mechanism of Injury
• Abrasion: It is an open wound involving the
scraping off of the skin as a result of frictional
force. It involves only the superficial layer of
the skin.
Abrasion wound
 Mechanism of Injury cont’d
• Laceration: This is the type of wound in which
the edges are torn rather than a cut. The
edges are irregular and bruised. It occurs
under non-sterile conditions and commonly
following accidental wound.
Lacerated wound
 Mechanism of Injury cont’d
• Surgically incised wound: These are wounds
made under sterile conditions and therefore
there’s minimal tissue loss. Additionally, they
are caused by straight forward cut with sharp
instruments like blade, knife etc.
Surgical Incised Wound
 Mechanism of Injury cont’d
• Contusion: This is closed wound with skin
appearing ecchymotic (bruised) because of
damaged blood vessels. It is usually allows
bleeding into the tissues or the skin. Example
is hitting the hand with hammer or pestle.
 Mechanism of Injury cont’d
• Puncture wound: This is caused by sharp
pointed instrument like nail, pencil. There’s a
danger of internal organs being damaged and
it could be penetrated or perforated .
Punctured wounds have an increased risk for
infection because they are difficult to clean.
Punctured Wound
 Mechanism of Injury cont’d
• Avulsion: This occurs when a piece of the skin
has been partially ripped off. Depending on
how deep wound is, it is difficult to control
bleeding .
 Degree of Contamination
• Clean wound: They are uninfected wound
created under aseptic condition and does not
enter the respiratory tract, alimentary tract,
urinary tract. E.g mastectomy.
• Clean – contaminated wound: They are surgical
wound in which there’s entry into the alimentary
canal, respiratory tract, genitourinary tract and
show no sign of infection. Example is surgery on
the lungs, appendix or vaginal procedure.
 Degree of Contamination cont’d
• Contaminated wound: They include open, flesh, accidental
wounds and surgical wounds including a major break in
sterile technique. Contaminated wounds show evidence of
inflammation.
• Dirty or Infected wound: Include wounds containing dead
tissue and with evidence of clinical infection such as
purulent drainage. An incision undertaken during an
operation in which the viscera are perforated or when acute
inflammation with pus is encountered during the operation.
For example emergency surgery for faecal peritonitis and
for traumatic wounds where treatment is delayed.
 Visibility of the wound
This may be classified according to the color
and the tissue present in the wound.
• Granulating – Is when healthy red tissue is
observed and is deposited during the repair
process. It presents as pinkish/red colored
moist tissue and comprises of newly formed
collagen, elastin and capillary networks. The
tissue is well vascularised and bleed easily.
 Visibility of the wound cont’d
• Epithelialising – This begins when wound has
filled with granulation tissue. This tissue is pink,
almost white and occurs on top of healthy
granulation tissue.
• Sloughy – This may be liquid or semi-liquid with
exudates that may be creamy or yellow green.
• Necroctic – This describes a wound containing
dead tissues. It may appear hard, dry and black.
 The Phases Of Wound Healing
• Wound healing is an intricate process where
the body tissues repair itself after injury.
• Wound healing can be broken down into four
phases namely: Hemostasis, Inflammatory,
Proliferative, and Maturation or Remodelling.
 1. Hemostasis
• This is the cessation of bleeding, vaso-
constriction of large blood vessels in the affected
area. Firstly, blood vessel around the wound
narrow which help to stop bleeding and platelets
(clotting cells) in the blood clump together to
make a plug on the wound surface. This provides
initial wound closure, prevents excessive blood
loss and body fluids and inhibits contamination
of the wound by microorganisms.
 2. Inflammatory
• Immune cells such as neutrophils, macrophages are
attracted by factors released from the wound site and
begin to accumulate, travelling through the circulatory
system. These cells responsible for the removal of debris
and killing of bacteria that easily colonize the wound site
and prepare the wound for proliferative and remodelling
phase.
• Macrophages also secrete several factors including
Fibroblast Activating Factor (FAF) and Angiogenesis Factor
(AGF) stimulates the formation of new blood vessels to
support and sustain the wound for healing process.
 3. Proliferative/Reconstructive
This phase has four (4) stages;
• Re-vascularisation /Angiogenesis and granulation
i.e new blood vessels are formed around the
wound site in order to supply the cells and
nutrients required to remodel the wound.
• Re-epithelialization and contraction i.e where the
epithelial cells around the wound becomes more
motile and stretch to cover the wound site.
 4. Maturation or Remodelling
• At this stage, the epidermis proliferates and
returns to its normal character ; fibroblast and
immune cells were recruited to the site are
degraded. Finally, capillaries eventually
disappear leaving an avascular scar(a scar that
is white because it lacks a blood supply). The
scar tissue then becomes strong but not as the
original tissue.
 Types of wound healing
• Primary intention – healing occurs in wounds that have minimal
tissue loss and edges that are well approximated (closed). The
wound is clean and dry with minimal granulation tissue and
scarring within a week. Example is the closure of surgical wound.
• Secondary intention –healing is seen in wound with extensive
tissue loss and wound in which the edges are gaping. The wound
is left open, and granulation tissue gradually fills in the deficit.
The wound is susceptible to infection because of epidermal
barrier to microorganisms.
• Tertiary intention –healing is known as delayed primary closure .
Conditions in which healing by tertiary intention may include
poor circulation or infection.
Types of wound healing cont’d
 Factors affecting wound healing.
• Inadequate blood circulation and oxygen
• Underlying disease conditions like diabetes
mellitus
• Infection
• Inappropriate wound care/management
• Bleeding
• Medications such as steroids
• Obesity and smoking
• Debris and foreign bodies in the wound
 Factors that promotes wound healing
• Sufficient blood supply to the wound
• Adequate nutrition
• Proper wound management
• Proper use of drugs or medications such as
antibiotics
• Absence of disease condition
• Adequate rest and sleep
 Complications of wound
• Excessive scar formation
• Infection
• Keloid formation
• Dehiscence
• Contracture or deformity
• Fistula formation
• Evisceration
 Wound Infection
• Wound infection is defined as the presence of replicating
microorganisms within a wound leading to tissue injury and
delay its healing process.
Signs and Symptoms of infected wound
• Presence of purulent drainage
• Loss of function and movement
• Redness
• Swelling
• Pain and presence of sloughs
• Sometimes fever, chills
• Foul smell from wound
 Prevention and Treatment of wound
infection
Treatment of wound infection involves optimizing the
host immune system, wound cleansing, debridement
and applying antimicrobial dressings that lower the
bioburden in the wound bed.
• Taking of wound swab for culture and sensitivity test
• The use of antibiotic e.g penicillin, ampicillin
• Application of wound irrigation method and
debridement
• Wash your hands before and after you care for your
wound.
 Prevention cont’d
• Ensure aseptic technique during wound dressing
• Frequent changing of dressing
• Observe wound for any signs of infection
• Maintenance of personal hygiene
• Washing of the hands before and after every
procedure
• Administration of prescribed antibiotics
• Switching off fans during dressing
 Wound dressing
• Wound dressing refers to anything that is used in direct
contact with the wound to help it heal and prevent
further issues or complications.
Purpose of wound dressing
• To protect the wound from mechanical injury
• To protect wound from microbial contamination
• To promote thermal insulation of wound
• To maintain moist wound healing
• To absorb drainage from the wound
• To prevent hemorrhage or bleeding
 Wound Debridement
• Debridement is the removal of dead(necrotic) or
infected skin tissue to help a wound heal. Removal may
be surgical, mechanical, chemical, autolytic (self
digestion).
• Surgical debridement: This debridement can be
performed in the operating room under anesthesia
depending on the extent of necrotic material and the
patient’s ability to tolerate the procedure.
• Autolytic debridement: Autolysis uses the body’s own
enzymes and moisture it to re-hydrate, softens, and
finally liquefy hard eschar and slough.
 Wound debridement cont’d
• Mechanical debridement: When removal of tissue
is necessary for the treatment of wounds,
hydrotherapy which performs selective
mechanical debridement can be used. Example of
this include directed wound irrigation with
suction.
• Chemical debridement: This procedure is
performed by using certain enzymatic chemicals
on the wound to remove devitalized tissue by
digesting and dissolving the non-viable tissue.
 Wound drainage
• A surgical drain is a tube used to remove blood, pus and other fluids
from a wound.
Indications
• To help eliminate dead space
• To prevent potential accumulation of fluids
• To decrease the rate of infection
Complications of Drain
• Discomfort or pain
• Erosion into hollow organs
• Inefficient drainage
• Poor placement can results in the accumulation of fluids
• Infection
 Suturing
• Suturing refers to the joining of tissues with needle and
tread so that the tissues bind together and heal.
• The specific removal of sutures depends on the location of
the wound of the body but they need to be removed
within 3 – 14 days. If sutures are not removed on time it
will leave skin marks, excessive scar and even keloids as
seen on the waist, elbows, shoulders and the chest.
• Different part of the body require suture removal at
varying times.
• Face: 3-5 days, Scalp & Trunk: 7-10 days, Arms & Legs: 10 -
14 days, Joints : 14 days
• END OF PRESENTATION ON WOUND
PLEASE ANY QUESTIONS?
GROUP TWO(2) MEMBERS
NAMES INDEX NUMBER
• Essiaw Michael • KB/20/3891
• Charway Enoch • KB/20/3879
• Petra Araba Yorke • KB/20/3945
• Adoma Mary • KB/20/3834
• Twumasi Vida • KB/20/3942
• Oforiwaa Okai Jennifer • KB/20/3919
• • KB/20/3857
Arhin Nyaniba Mercy
• KB/20/3925
• Owusuaah Elizabeth
• KB/20/3884
• Darkwah Sarah
• BK/20/3909
• Mensah Linda
• KB/20/3917
• Odumang Atswei Bernice
• KB/20/3831
• Adams Magdaline