SURGICAL WOUNDS & WOUND INFECTION

By Dr.xyz

SURGICAL WOUNDS

A break in continuity of tissues is called wound.A Wound can be caused by almost any injurious agent and can involve almost any tissue or structure.

CLASSIFICATION OF WOUNDS

RANK AND WAKEFIELD CLASSIFICATION

●Tidy wounds

●Untidy wounds

TIDY WOUNDS:

●inflicted by sharp instruments

●contain devitalized tissue

●can be closed immediately with expectation of quiet primary healing

●e.g. surgical incisions

Cuts from glass or knives

●skin wounds― single or clean cut

●tendons, nerves, arteries― frequently injured but repair is usually possible

●fractures are not common

UNTIDY WOUNDS:

●Result from crushing,avulsions,tearing,vascular injury or burns

●Contain devitalized tissue

●Skin wounds―multiple or irregular

●Tendons,nerves,arteries―exposed

●fractures are common.may be multifragmentary

●untidy wounds need conversion to tidy wounds by wound excision and then can be closed or allowed to heal by second intention

WOUND CLOSURE

Direct closurePartial thickness skin graftFull thickness skin graftComposite graftSkin flapFascicutaneous graftMusculocutaneous graftFree tissue transfer

TYPES OF WOUND

BRUISE, CONTUSION AND HAEMATOMA

Resulting from closed blunt injury

Bleeding into the tissues and visible discoloration

Require no specific management.pt shoud be advised that time required to clear bruise is variable

Localized collection of blood in the tissues is called haematoma

These usually resolve spontaneously

They can be drained or aspirated if necessary(pressure effects,cosmetically sensitive site)

PUNCTURE WOUNDSAn open injury in which foreign material and organisms are likely to be carried deeply into underlying tissues

e.g. standing on nail or other sharp object

Rx.Wound irrigationAntibiotic treatmentTetanus prophylaxisLarge foreign bodies should be removed but small ones requiring tissue dissection cause tissue damage and are better left undisturbed.

If there is abcess formation it should be drained

ABRASIONS & FRICTION BURNS

An abrasion is a shearing injury of skin in which surface is rubbed off

Most are superficial and heal by epithelialisation

If ingrained with dirt, treatment is by cleaning with a scrubbing brush

Friction burn―abrasion+thermal damage

LACERATIONLaceration or cut is the result of contact with a sharp object

Management :

Inspection Cleaning Closure

Haemostasis is important.

Drains may be needed to prevent fluid collection

TRACTION & AVULSION

Open injuries with severe degree of tissue damage

e.g. ●hands or limbs trapped in moving machinery like rollers producing degloving injury●runover road traffic accident injuries

Degloving is caused by shearing forces that separate tissue planes ,rupturing vascular interconnections and causing tissue ischemia

RxIdentify the area of devitalized skin & to remove it,defat it & then reapply it as a full

thickness skin graft

CRUSH

Crush injuries are a variant of blunt injury often accompanied by degloving and compartment syndrome

Injury to tissues within closed fascial compartment

Bleeding,exudate,swelling Increased interstitial pressure Decreased blood flow Muscle ischaemia,nerve ischaemia Muscle necrosis,skin necrosis &limb

lossMuscle necrosis may result in renal failure

Clinical sign:Pain worsened by passive stretching of affected muscle

Process can be arrested by early recognition and decompression of affected compartment(s) by FASCIOTOMY

CHRONIC WOUNDS

o ULCERS Any breach in epithelial surface

Wound healing is delayed by infection,mechanical irritation,ischaemia or other metabolic factors Common in diabetes & rheumatoid arthritis

Rx●Specific management of underlying cause●Ulcer is managed either by dressings to allow healing by second intention or by surgical excision of granulation tissue and split skin grafting.

o PRESSURE SORESAre chronic wounds following tissue necrosis from pressure

Occur over bony prominences

Common in paraplegics,unconscious or confused,hypotensives and patients with peripheral vascular disease

PREVENTIONRegular turning,skin care,protection of pressure areas

Rx● Identify and treat underlying cause● Nutritional support● Incontinence should be managed appropriately● Surgical treatment accelerates healing.sore is excised and closed using a flap