CHAPTER 1 - WOUND/S (PART V) GUIDELINES IN WOUND MANAGEMENT

PRIMARY GOAL OF WOUND MANAGEMENT

Aid in the natural body process and to produce an optimally functional & cosmetic result

MANAGEMENT OF ACUTE WOUNDS

Begin with obtaining a careful history of the events surrounding the injury

After history taking, meticulous examination of the wound should include:

• assessment of its depth & configuration

• Extent of non-viable tissue

• Presence of foreign bodies or other contaminants

ANTIBIOTIC ADMINISTRATION

May be needed with consideration to the planning of the type & timing of the wound repair

ANTIBIOTICS

• Are given when there is an obvious infection commonly characterized with the presence of swelling, purulent discharge, erythema (redness caused by increased blood flow in superficial capillaries), and cellulitis (a spreading bacterial infection just below the skin surface)

• Most wound are contaminated or colonized with bacteria

• 0.5 - 2% lidocaine

• 0.25 - 0.5% bupivacaine with 1:100,000 - 200,000 epinephrine

Local anesthetic may be given

risk of tissue necrosis secondary to terminal arteriole vasospasm

but EPINEPHRINE should NOT be used for wounds of the finger, toes, ears, nose, or male genitalia due to the _____ in these structures

irrigation & debridement

Further examination of the wound may require _____ that is facilitated by the use of local anesthetics.

Further examination of the wound

______ may require irrigation & debridement that is facilitated by the use of local anesthetics.

use of local anesthetics

Further examination of the wound may require irrigation & debridement that is facilitated by the _______

normal saline solution (NSS)

Irrigation to visualize all areas of the wound & remove foreign material/s is best accomplished with _____

High-pressure wound irrigation

is more effective in achieving complete debridement of foreign material & non-viable tissues.

Initial debridement method

______ for acute & chronic wounds or ulcers should be surgical debridement over other non-surgical methods

surgical debridement

Initial debridement method for acute & chronic wounds or ulcers should be _____ over other non-surgical methods.

Iodine, povidone-iodine, & hydrogen peroxide

are organically based antibacterial solutions that (when used as irrigating & debriding agents) have all shown to impair wound healing due to injury to wound neutrophils & macrophages, and thereby should not be used.

Wound bed

The _____ needs to be moist, well vascularized, free of devitalized tissue, and clear of infection to ensure optimal wound healing.

Following wound preparation: acute wounds

can often be closed by primary intention

Following wound preparation: chronic wounds

can undergo delayed closure or coverage with skin grafts or human skin equivalents

antiseptics & antimicrobial agents

Topical agents such as ______ can be used to control locally heavy contamination.

Recombinant human growth factors

can be utilized to stimulate healing in impaired wounds

After the wound has been anesthetized, explored, irrigated, & debrided:

area/s encircling the wound must be cleaned, inspected, and the surrounding hair must be cut or clipped.

prepared with povidone-iodine & draped with sterile towels

The area surrounding the wound should be _________

When hemostasis is ensured with adequate debridement of the non-viable tissues & removal of any remaining foreign bodies:

irregular, macerated, & beveled wound edges must be debrided in order to provide a fresh edge for reapproximation.

Initial sutures that realign the edges of these different tissue types

will speed up and gently enhance the esthetic outcome of the wound repair.

smallest tissue suture

In general, the ________ required to hold the various layers of the wound in approximation should be selected in order to minimize suture-related inflammation.

split-thickness skin grafting

In areas with significant superficial tissue loss, ________ may be required to accelerate the formation of an intact epithelial barriers & avoid fluid loss or infection.

Wound dressing

must be chosen to eliminate dead space, control exudate, prevent bacterial overgrowth, ensure proper fluid balance, cost-efficiency, and be manageable for both the doctor as well as the patient.

After closing deep wounds & replacing significant tissue deficits:

skin edges should be reapproximated for esthetic concerns and aid in the rapid healing of the wound.

stainless steel staples or non-absorbable monofilament sutures

Skin edges may be quickly reapproximated with _________

Multifilament sutures

______ are prone to infection due to high capillarity of the suture material which is referred to as the wick effect.

wick effect

Multifilament sutures are prone to infection due to high capillarity of the suture material which is referred to as the _____

cosmetically inferior wound

Failure to remove sutures or stapes in 7-10 days after repair will result in a ______ that can be avoided by using absorbable sutures.

Negative pressure wound therapy (NPWT) for deep wounds

can be beneficial in protecting the wound and reducing the complexity & depth of the defect.

Adjunct therapies like hyperbaric oxygen therapy, therapeutic ultrasound, electromagnetic & electrical energy

have been tried for the purpose of enhancing wound healing, but no significant benefits have been identified.

TIME framework

is a practical guide for use when managing patients with wounds. It has assisted clinicians systematically in wound assessment & management

TIME

is an acronym from the Wound Health Society