Healing Period
- 5d-1 wk Skin & Mucosa
- 1-2 wk Subcutanous & Peritoneum
- 14-28d Fascia
Y Cleaning is done after 24 hours appliance Hemistasis ⇒ Inflammatory ⇒ Profierative ⇒ Remodeling
Classification of wound healing
- Primary healing (Closure by suturing)
- Secondary healing - (Leaving wound to heal by it self) may cause contraction, scars
- Tertiary (Delayed primary healing)
Critical Wound Healing Period
Wound Healing Phases
(1) Hemostasis
(2) Inflammatory
(3) Proliferative
(4) Remodeling
Wound Evaluation
- wounds that are >24hr difficult for closure to possibility of bacterial infection - which needs different approach for therapy.
- Size of wound - never underestimate, may cause pneumothorax
- Depth of wound
- Tendon / Nerve involvement
- Bleeding site
When to referZ
- In sensitive areas, may be referred to specialized doctor
- Deep wounds - muscle, tendon, nerve
- Crush injuries - long term assessment is needed = worst type of injuries
- Bite injuries - worst type of injuries
- Markedly contaminated wound requiring drainage - assessed prior to closure
- Concern about cosmesis
Contraindications to suturing
- Signs of infection
- Animal Bites
- Complex injury (Tendon, nerve, vessel involvement)
- Wounds >12Hrs (body) & 24Hrs (Face)
- Stabbing wounds (stabbing wound are deep and need further evaluation)
Wound Preparation
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Most important step for reducing the risk of wound infection.
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Remove all contaminants and devitalized tissue before wound closure. -IRRIGATE w/ NS or TAP WATER (AVOID H2O2, POVIDONE-IODINE) -CUT OUT DEAD, FRAGMENTED TISSUE
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If not, the risk of infection and of a cosmetically poor scar are greatly increased
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Personal Precautions
Patient instructions and follow up care
Wound care
- Usually, patient can take off the dressing after first 48 hours.
- Patients can take shower and gently washing the wound with soap and water without rubbing the wound, dry it carefully, and replace the dressing/bandages.
- Give information about sign/symptoms of wound infection (redness, hotness, swelling, discharges).
- Inform the patient when he should remove the sutures.
- Antibiotics and Analgesia as needed