L29: wound management

what are the degrees of contaminations for surgical wounds?

1. clean

2. clean-contaminated

what are the degrees of contamination for surgical and traumatic wounds?

1. contaminated

2. infected

what are examples of clean surgical wound?

1. skin incision

2. mass removal

3. exploratory laporotomy

4. spay/neuter

what is a clean-contaminated surgical wound?

1. surgery involving non-sterile luminal organs with no contamination

2. minor break in sterility during a clean procedure (glove break)

what are examples of clean-contaminated wounds?

1. enterotomy

2. cholecystectomy

3. placement of a drain in an otherwise clean wound

what is considered a contaminated wound?

1. surgery involving luminal organs and leakage of content

2. serious break in sterility

when is a traumatic wound considered contaminated?

<12 hours post-wounding

what action do we take if we have a contaminated wound?

1. antibiotics

2. lavage

3. +/- debridement

when is a traumatic wound considered dirty?

>12 hours post-injury or overtly infected

what are examples of infected (dirty) wounds?

1. perforated viscera

2. abscess

3. peritonitis

4. fecal contamination

what action do we take for infected wounds?

1. antibiotics

2. lavage

3. debridement

4. drainage

5. + / - wet dry bandages

what is the “golden period” for wound assessment?

first 6-8 hours between contamination at injury and bacterial infection → HIGH amounts of bacteria present

what impacts the decision to close a wound?

golden period

what is the ideal type of solution to lavage a wound?

isotonic solutions

what can be used to lavage a wound?

1. saline

2. lactated ringers solution

3. tap water

4. dilute antiseptic solutions

which anti-septic would we use if we were worried about possible exposure to clostridium spores?

hydrogen peroxide

when do we use chlorhexidine as an antiseptic for wound cleaning?

1. purulent or necrotic wound

2. abscess

when do we use povidone-iodine as an antiseptic for wound cleaning?

1. periorbital wounds or surgical procedures

2. orthopedic procedures

which antiseptic is deactivated in organic material?

povidone iodine

when do we use hydrogen peroxide as an antiseptic for wound cleaning?

1. purulent or necrotic wound

2. abscess

3. exposure to clostridium

what are some of the benefits of moist wound healing?

1. reduced risk of infection

2. decreased pain

3. production of growth factors

4. faster re-epithelialization

what are the layers of the modified robert jones bandage?

1. contact (primary)

2. intermediate (secondary)

3. outer (tertiary)

what are the functions of the contact layer of wound dressing?

1. debride

2. deliver topical medication

3. absorb wound exudate

4. protect granulation tissue (NON-ADHERENT ONLY)

what are the two types of contact layers in wound dressing?

1. adherent

2. non-adherent

what is the indication for absorbent wound dressing?

open contaminated and infected wounds

what is an example of an absorbent wound dressing?

hydrocolloid

what is the indication for an adherent wound dressing?

necrotic wounds

what is an example of an adherent wound dressing?

gauze

what are the indications for non-adherent wound dressings?

1. all non-necrotic wounds

2. surgical wounds

what is an example of a non-adherent wound dressing?

tefla pad

what do we never use adherent bandage in?

when we have granulation tissue

what is the benefit of adherent wound dressings?

debridement

what is benefit of non-adherent wound dressings?

1. protects wound

2. retain moisture at wound site

what wound dressing is for short-term use only?

adherent

what wound dressing can be used for both short and long term use?

non-adherent

what are the functions of the intermediate layer (padding)?

1. absorbent

2. provides padding

3. holds contact layer in place

what are materials for the intermediate layer?

1. cotton wool roll

2. cast padding

what are the functions of the outer layer (holding)?

1. protection

2. stability

3. holds other layers

what are the materials for the inner layer of the holding layer for a wound?

conforming bandage

what are the materials for the outer layer of the holding layer for a wound?

elastic adhesive tapes

what phase of wound healing is occurring with primary closure?

inflammatory phase

what phase of wound healing is occurring with secondary closure?

repair phase

primary closure wound healing

wound repair within 24 hours of injury

what are the indications for primary closure wound healing?

1. clean surgical wound

2. contaminated traumatic wounds that are rendered clean

delayed primary closure wound healing

wound repair within 5 days of injury BEFORE granulation tissue forms

what is the indication for delayed primary closure wound healing?

mild to moderately infected wounds → want to control infection before closing wound

second intention wound healing

allow body to heal the wound

what are the indications for second intention wound healing?

1. wound to large to surgically close

2. area cannot have surgery

3. heavily infected wound

4. surgical repair not an option

what are the potential complications of second intention wound healing?

1. contracture

2. proud flesh (horses)

3. delayed wound healing

what are indications for drains?

1. infection

2. dead space

3. body cavity effusions

what drain is used as a preventitive against dead space?

flat (penrose) drain

which drain type has passive flow with gravity?

penrose drain

when do you remove a penrose drain?

2-5 days

what do we never do to a penrose drain?

NEVER fenestrate

what is the function of the penrose drain?

to drain subcutaneous spaces

what is the function of the tubular drain (jackson-pratt)?

to drain subcutaneous or deeper tissue spaces

which drain has the ability to measure fluid?

tubular drain

what is the most common complication for drains?

ascending infection

what type of drains do we use for intracavitary drains?

radiopaque