08/10/2026
NURSES βοΈ HOME ββοΈββοΈ
BY MUTALE FREDRICK CHILESHE MWINE
COURSE MEDI SURGE
TARGET COURSE SURGERY
TOPIC WOUND
Definition
A Wound is a cut or a break in the continuity of the skin or tissue caused by an injury or an operation.
Classification of wounds
Wounds are classified as follows;
1.Open wounds
2.Closed wounds
3.Surgical wounds
1.Open wounds
Open wounds can be classified according to the object that caused the wound. The types of open wound are:
1)Incisions or incised wounds, caused by a clean, sharp-edged object such as a knife, a razor or a glass splinter.
2)Lacerations, irregular tear-like wounds caused by some blunt trauma. Lacerations and incisions may appear linear (regular) or stellate (irregular). The term laceration is commonly misused in reference to incisions.
3)Abrasions (grazes), superficial wounds in which the topmost layer of the skin (the epidermis) is scraped off. Abrasions are often caused by a sliding fall onto a rough surface.
4)Puncture wounds, caused by an object puncturing the skin, such as a nail or needle.
5)Penetration wounds, caused by an object such as a knife entering and coming out from the skin.
6)Gunshot wounds, caused by a bullet or similar projectile driving into or through the body. There may be two wounds, one at the site of entry and one at the site of exit, generally referred to as a "through-and-through."
2.Closed Wounds
Closed wounds have fewer categories, but are just as dangerous as open wounds. The types of closed wounds are:
1)Contusions, more commonly known as bruises, caused by a blunt force trauma that damage tissue under the skin.
2)Hematomas, also called a blood tumor, caused by damage to a blood vessel that in turn causes blood to collect under the skin.
3)Crush injury, caused by a great or extreme amount of force applied over a long period of time.
3.Surgical wounds
A surgical wound results from an incision "cut" purposefully through the skin usually made during surgery. Some incisions are small, and others are very long. The size of the incision will depend on the kind of surgery.
Wound Healing
To heal a wound, the body undertakes a series of actions collectively known as the wound healing process.
Whether wounds are closed by primary intention, subject to delayed primary closure or left to heal by secondary intention, the wound healing process is a dynamic one which can be divided into three phases. It is critical to remember that wound healing is not linear and often wounds can progress both forwards and back through the phases depending upon intrinsic and extrinsic forces at work within the patient.
The phases of wound healing are:
ο·Inflammatory phase
ο·Proliferation phase
ο·Maturation phase
a)The inflammatory phase
This is the bodyβs natural response to injury. After initial wounding, the blood vessels in the wound bed contract and a clot is formed. Once haemostasis has been achieved, blood vessels then dilate to allow essential cells; antibodies, white blood cells, growth factors, enzymes and nutrients to reach the wounded area. This leads to a rise in exudate levels so the surrounding skin needs to be monitored for signs of maceration. It is at this stage that the characteristic signs of inflammation can be seen; erythema, heat, oedema, pain and functional disturbance. The predominant cells at work here are the phagocytic cells; βneutrophils and macrophagesβ; mounting a host response and autolysing any devitalised βnecrotic / sloughyβ tissue.
b)Proliferation / Regeneration phase
The ability of cells to regenerate depends on the cell type. Some cells such as labile cells of the skin, bone marrow and mucus membranes of the GIT, urinary and reproductive tract divide constantly and regenerate fast following injury. Permanent cells do not regenerate e.g Neurons in the CNS and cardiac cells where as stable cells regenerate only if the organ is injured such as the Liver, Kidney, bones and the pancrease.
The wound is βrebuiltβ with new granulation tissue which is comprised of collagen and extracellular matrix and into which a new network of blood vessels develop, a process known as βangiogenesisβ. Healthy granulation tissue is dependent upon the fibroblast receiving sufficient levels of oxygen and nutrients supplied by the blood vessels.
c)Maturation/ Repair
It is the final phase and occurs once the wound has closed. This phase involves remodelling of collagen from type III to type I. Cellular activity reduces and the number of blood vessels in the wounded area regress and decrease. Repair occurs by primary, secondary and tertiary intention.
1)Primary Intention
This takes involves epidermis and dermis without total pe*******on of dermis.
ο·When wound edges are brought together so that they are adjacent to each other (re-approximated)
ο·Minimizes scarring
ο·Examples are most surgical wounds heal by primary intention
Wound closure is performed with sutures (stitches), staples, or adhesive tape.
2)Secondary intention
Wounds that occur from trauma, ulceration and infection with large amounts of exudates with wide irregular wound margins and extensive tissue loss.
ο·The wound is allowed to granulate
ο·Surgeon may pack the wound with a gauze or use a drainage system
ο·Granulation results in a broader scar
ο·Healing process can be slow due to presence of drainage from infection
ο·Wound care must be performed daily to encourage wound debris removal to allow for granulation tissue formation
ο·Examples: gingivectomy, tooth extraction sockets, poorly reduced fractures.
3)Tertiary intention
(Delayed primary intention or healing by delayed closure or secondary suture)
ο·Occurs when the primary wound becomes infected
ο·The wound is initially cleaned, debrided and observed, typically 4 or 5 days before closure.
ο·Opened and allowed to granulate and then sutured.
ο·Tertiary intention usually results in a larger and deeper scar than primary and secondary intention.
ο·Examples: healing of wounds by use of tissue grafts.
Factors that enhance healing of wounds
ο·Adequate nutrition, a diet of proteins vitamin C help in the repair and building up new cells hence promote healing.
ο·Cleanliness, especially on the wound to avoid infections setting. Patient also has to have good personal hygiene to prevent contamination of the wound.
ο·Good oxygen supply- well ventilated room with plenty of oxygen helps the wound to heal, the cells needs oxygen to multiply and hence the repair.
ο·Rest is very vital for repair; it promotes blood supply easily to the affected area and hence helps in quick repair and healing.
ο·Position good positioning of the affected area, will encourage good flow of blood to the area and also allows free circulation of oxygen, and promotes quick healing.
Management
I.Investigations
ο·History from the client is important to understand because the circumstances and mechanism of the injury determines the care and management to be provided. Animal bite, burn, diabetic wound, open or closed all require specific type of management.
ο·Pus swab for MCS to determine the causative organism and the drug the organisms will be sensitive to.
ο·
Treatment
ο·Tetanus Toxoid Immunisation 0.5mg start.
ο·Drugs are used to decrease inflammatory response and combat infection e.g. Penicillins according to culture and sensitivity. These include Cloxacillin, ampicillin, ampicillin in combination with cloxacillin- Ampiclox.
ο·Antipyretics to reduce fever e.g. Salicylates like asprin, Ibuprofen.
ο·Vitamines such as Vitamine A to accelerates epithelialisation and vitamin C assists in synthesis of collagen and new capillaries.
ο·Clean open wounds at least twice daily and dress with sterile gauze followed by a bandage. Sometimes they may be exposed after cleaning with a disinfectant depending on Doctors orders.
ο·Open clean wounds require suturing if they are 6 to 12 hours old after injury.
Nursing care
The aim is to restore the physical integrity and function of the injured tissue with minimum or no scarring.
Observations
TPR and BP 4- hourly. A rise in temperature may signify infection.
Observe and record wound characteristics such as consistency, colour, odor of any drainage. Observe if the wound is improving or not.
Wound care
Aseptic or the use of sterile technique is very important in prevention of infection and promoting quick wound healing. Frequency will depend on the type of wound and prescription. Septic wounds may be cleaned twice or more times.
Diet
High protein, carbohydrates and vitamins with moderate fat intake is necessary to promote healing. Proteins are necessary for synthesis of immune factors such as WBCs, collagen. Carbohydrates are needed for increased metabolic energy. Vitamin C is needed for capillary synthesis. Vitamin A aids in the process of epithelialisation.
Fluids
A high fluid intake is important to replace fluid loss from perspiration and exudates formation.
Hygien
Client with wounds should ensure good personal hygien to prevent infecting the wound and delaying the process of healing.
Complications
a.Scars and Keloid formation
These occur when the body produces excess collagen tissue. This is connective tissue into which blood vessels develop in the process of wound healing.
b.Contracture
Wound contraction is necessary for healing. When the process becomes abnormal, there is excessive contraction resulting in deformity/ contracture.
c.Dehiscence
It is the separation and disruption of previously joined wound edges. Usually occurs when a primary healing site burst open due to e.g. infection, obesity, etc. When wound edges separate to an extent that intestines protrude, it is called Evisceration.
d.Adhesions
They are bands of scar tissue between or around organs e.g in the abdominal cavity following laparatomy.
e.Chronic ulcers
Non- healing wounds occur most frequently in the elderly and in people with diabetes. These ulcers are associated with inadequate circulation, poorly functioning veins and immobility.
THE END
IS POWER
ASANTE SANAββοΈββοΈββοΈββοΈββοΈ
TOPIC WOUND
BY NTS MUTALE FREDRICK CHILESHE MWINE
A_TRUSTEE
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