Wound Healing Lecture 2

What is the wound healing continuum

Nectrotic —> epithelisiation

Sloughy = (yellow + puss, simple way too look at wounds and depcet them

What is the progression model

dIfferent stages of wound healing requires different levels of moisture (wound exudate..)

See on the graph an ideal amount of fluid

early stages of healing often too much fluid, at the end of the process may have too little as dries out

OVERALL PURPOSE = use dressings to have the optimum amount of moisture for healing

what is an example of a wound diagram…

can identify what areas are yellow slough, ref granulation and balck slough.

VERYu important too have images which you can compare too…

What 8 factors can influence the rate of wound healing + _ideal wound healing..

• Moist enviroment, not macerated

• leaving new tissue undisturbed

• free of infection + excessive debris

• allow for adequete gas exchange

• free of toxic chemical

• dressings = painless

• Warm at optimum healing temperature

• dressings should minimise contamination too and from the wound

What are the 3 types of wound dressing you can choose

• Debridement dressings too take away moisture

• Neutral dressings - maintain moistire

• Moisture dressings - ADD moistire

Development of wound care dressings (do NOT learn textbook.. - referance onu

• Often is about protecting the wound so that is can heal…

What are some examples of moistire absorbing dressings..

• wet - dry gauze

• alginates

• foam dressings

• hydrocolloid dressing

Moisture maintain dresssings..

REatiain moistrie = Hydrogels to maintain moisture

Contact layer - woven or perforated material + requires secondary layer

What is a specialist dressing for highly necrotic wounds..

_ live mnedical maggots 0 highly specifict debride necrotic materiall…

What do you use silver dressings for…

• ANtimicrobial

• silver dressing - acute silver ions formed on contact with fluod, effective agaisnt MRSA , psuedomona + unknown toxicity

What is the purpose of Manuka honey..

Medical grade honey

antibacterial + draws fluid up via osmosis….

What are the 7 options in order too close wounds..

• Skin graft

• PRimary closure

• delayed primary closure

• secondary intention closure

• walking sutures

• local flaps

• axial pattern flaps..

4 principles of wound closure…

• anatomy

• have many plans

• pre warn of complications

• clip and prepare a larger area than anticipated

What is the key problem with closing wounds…

can produce too much tension, ciircularatory compromise, reduced wound healing _ infection, dehiscense and skin necrosis…

What are 6 methods to minimise wound tension…

• PAtient positioning

• undermining

• suture patterns

• relaxing incisions

• advancement flaps

Greater wound tension…

• techniques that provide add. skin

What are tension lines

area of the skin which it will naturally bounce bac too when stretche.d.

too check you are on the tension lines

• pinch the skin, check it comes to a straight line so it is over the same tension line..

HOw do you maximise skin availibility

• elavatin the limbs + bodie too maximise the skin available

• release leg ties in the inguinal regiion..

What is skin undermining…

seperating the cutaneous trunci muscle from the muscle below + undermine it below via blunt dissection…

undermine in deep fascia..

what must you be careful of when skin underingin

avoud the direct cutaneous artery…

whata is walking sutures

• after skin has been undermined

• distruvutes skin tension…

• skin pulled forwards in increments..

asymetic placemet

What are relaxing insicions…

*{ single or mulsiple insiciones to reduce tension… relaxinsig insictions heal by secondary i ntensino, removes tension from the key place. Sacrificing one area to allow for the wound closure..

whar aer rthe uses of relaxing incisions…

• chronic non healing wounds..

• * wounds exposing tendons

• protecting surgical implants

• areas suspectible to external traima…

• Can use 2 large incisions..

mutliple reling insiciongs OR single relacing insicions..

Secondary intentiosn healing..

• lead a normallife

• takes a long time

• 
  

What is a skin flap

8 secction of elebated skin

skin flp retains its own blood supply

skin flap can be used anwyere iis there is available skin

2 types of skin flap

• subdermal plexus flap

• axial pattern flap

4 classifcation of subdermal flaos..

if you advance a flap puch forward and creat available skin

If you dont want too put too much tension on the skin what should you doo…

Whide base to under mine flap + the larger undermining too m=pull skin, can do the same skin via rotation flap.. little skin too adance soo inside freeing up skin below and advancing it upwards

What are the 3 types..

• advancement = pull up

• rotation = incision futre down and rotate upwards as there is excess skin.

• transpositoin = incision and fully move pr rotate..

What are some complications..

• necrosis

• secondary traima. csecatonry tumour

What are axial pattern flaps..

flap supplied by a direct cutanoeus veirn and caudal superficial gastirci , all supplying it..

free skin graft

• keep animals still

• full moving skin onto the area

• make wells into granulation tissue to speed up process and epitherlise too each other..