a puncture wound

is a stab wound made for a drainage system

Sterile Procedure

Free of Microorganisms

Sutures

Sew wound closed

staple

hook edges of skin together with staple, pull straight from the middle

Approximation

wound edges are healing together

what we want in surgery

Exudate

fluid consisting of plasma which is secreted during the inflammatory phase of healing

Decreases/resolves day 5

Epithelial tissue is

seen by day 4

Remove sutures/staples by when?

day 9 to 14

What diseases cause chronic wounds

chronic venous insufficiency, peripheral artery disease, diabetes

Diseases that expose individuals to lower extremity wounds

venous disease, arterial disease, neuropathic disease

Wound Classifications:

Class 1

not infected or inflamed

Wound Classifications:

Class 2

clean/contaminated; minimal bacteria and closed after procedure

Wound Classification:

Class 3

Contaminated; high bacterial count. May interfere with healing. If surgical might be left open and require long term management

Wound Classification:

Class 4

Dirty wound; high bacterial count. Gangrene, necrotic, purulent drainage

Stages of wound healing:

Inflammatory stage

begins immediately after surgery, lasts about 3-6 days

Stages of wound healing:

Proliferative stage

begins on day 3 or 4, Lasts 3 to 24 days

Stages of wound healing:

Maturation stage or remodeling stage

begins Day 21, can last months to 1-2 years

Phases of wound healing:

Hemostasis

Termination of bleeding starts as soon as the injury occurs platelets adhere to the walls of the injured vessels and a clot begins to form. The fibrin in the clot begins to hold the wound together and bleeding subsides...Example a scab(extra layer of protection

Usually happens in the first 2 hours after the injury

Phases of wound healing:

Inflammatory

initial increase in the flow of the blood elements and water out of the blood vessels into the vascular space

This process causes the cardinal signs of inflammation

redness, heat, edema, pain and tissue dysfunction. White blood cells appear and begin to engulf the pathogen, if infection is not present these will decrease

Reconstruction

collogen production appears during this phase, begins on the 3rd or 4th day after the injury and lasts 2 to 3 weeks

Maturation

healing begins when granulation tissue is visible, 3 weeks after surgery fibroblasts begin to exit the wound and the would continues to gain strength

Internal wounds heal faster than external wounds..Keyloid may form during this phase

Process of wound healing

Primary intention

wounds with skin tissue close together, little tissue is lost, minimal scaring result

Process of wound healing

Secondary intention

would edges are not close together, pus has formed, ad the would must granulate to heal, pus like drainage, would may be OPEN to drain, drain is placed or packed, with gauze to allow it to drain , the necrotic or dead tissue dissolves and the wound fills with granulation tissue

Process of wound healing

tertiary intention

a contaminated would is left open and closed later after the infection is under control, granulation tissue begins to grow and then that tissue is sutured together, results in larger deeper scar tissue

Wound closures

Sutures

Threads of wire, silk, steel, cotton, linen, or nylon are used to sew body tissue together.

Dissolvable, may be placed in deep tissue layers in deep wounds and superficially to close the wound.

Retention ones may be left in place for up to 3 weeks.

Staples

• Made of stainless-steel wire
• Primarily used in abdominal incisions and orthopedic surgery
• Remove every other suture or staple and place steri strips if the incision starts to
come apart leave the other in place.

General Suture and Staple policies

• Usually removed in 7 to 10 days after surgery.
  ▪ May be done all at once or in phases.
  ▪ Steri strips are usually used after the suture or staple is removed.

Steri-strips

Stringed tape which holds the skin together.

Butterfly strips

Tape which holds the skin together.

Transparent sprays and films

Sticky piece of clear material.

Low Hgb in men

Less than 14/100mL

Low Hgb in women

Less than 12/100 mL

Wound Assessment
Measurement

Length(measure head to foot), Width(measure side to side) and Depth (Use cotton
swab or wound measurement device)

Wound Assessment

Measurement

Tunneling

narrow channel or passageway extending any direction from the base
of the wound. Use clock face to describe location.

Exudate

leaking slowly from the wound

Drainage

accumulation of body fluid from a body cavity, wound or other source of discharge.

What amount of drainage should you notify the doctor about if it is more than this amount in 24 hours?

Greater than 300 mls

Sanguineous

bloody fluid, indicates active bleeding

Serosanguineous

pale, red, watery. It is a mixture of serous and
sanguineous fluid

serous

clear, watery plasma

Wound Color

Red

Healthy(cover wound), granulation tissue,

Yellow

Purulent drainage (Clean Wound)

Slough

Yellow/gray (Clean wound)

Black

Eschar (Debride wound)

Peri wound skin integrity

color, texture, temperature and description of any areas that
are open, stripped or have a rash.

Closed drainage

Airtight device that prevents environmental contaminants from
entering the wound

JP, Hemovac, Chest tube drainage, foley catheter

Open drainage

passes through and open-ended tube into a receptacle or onto a dressing. This kind of
drain is placed to help fluid escape the surgical site. Examples can be used post-op for
an anal fistula.

Examples of open drainage system

Penrose Drain

Suction drainage

uses a pump or some type of suction to extract the fluid. Gentle suction can be used to help gravity move the exudate. Ex. JP drain, Hemovac, Chest tube