Transcript ASEPSIS AND PRINCIPLES OF WOUND CLOSURE

PRINCIPLES OF WOUND
CLOSURE
SHARON HARVEY
NORMAL WOUND HEALING
3 MAJOR PHASES OF WOUND HEALING
 INFLAMMATORY PHASE LASTS 4-6 DAYS
 PROLIFERATIVE PHASE BEGINS BETWEEN
1 AND 4 DAYS AFTER INJURY AND ENDS
14-21 DAYS LATER
 MATURATION PHASE BEGINS 14-21 DAYS
AFTER INJURY AND CAN LAST UP TO 2
YEARS.
TYPES OF WOUND HEALING
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PRIMARY INTENTION
THIS IS THE SIMPLEST
FORM OF HEALING.
THE SKIN IS CLEANLY
INCISED THROUGH A
SURGICAL INCISION OR
TRAUMATIC LACERATION
THIS TYPE OF WOUND
CAN BE CLOSED BY
SUTURES OR STAPLES
TYPES OF WOUND HEALING
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SECONDARY INTENTION
BURNS, PRESSURE ULCERS AND
WOUNDS WITH LARGE PIECES
OF SKIN MISSING HEAL THIS
WAY
NO EDGES ARE AVAILABLE FOR
SUTURING
SKIN CELLS EPITHELIZE FROM
THE EDGE OF THE WOUND
INCREASED TIME FOR HEALING
AT RISK OF LOCAL AND
SYSTEMIC INFECTION
TYPES OF WOUND HEALING
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TETIARY INTENTION
THE WOUND IS LEFT OPEN TO HEAL
THESE WOUNDS ARE INFECTED AND
NEED FREQUENT IRRIGATION AND
DRESSING CHANGES
PATIENTS WITH PERITONITIS OR
RUPTURED APPENDIX MAY REQUIRE
THIS
FACTORS AFFECTING WOUND
HEALING
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NUTRITION
GENERAL PHYSICAL HEALTH
MEDICATIONS
GOALS OF WOUND CARE
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REMOVE NECROTIC TISSUE
PREVENT, ELIMINATE OR CONTROL INFECTION
ABSORB DRAINAGE (EXUDATE)
MAINTAIN A MOIST WOUND ENVIRONMENT
PROTECT THE WOUND FROM FURTHER INJURY
PROTECT THE SURROUNDING SKIN FROM
INFECTION AND TRAUMA
METHODS OF WOUND CLOSURE
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STERISTRIPS
TOPICAL GLUE (DERMABOND)
SUTURES
STAPLES
SUTURES
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ARE AVAILABLE IN A WIDE VARIETY OF
MATERIALS INCLUDING SILK, NYLON, STEEL,
LINEN
SUTURE MATERIALS ARE EITHER NATURAL OR
SYNTHETIC
TWO MAIN CATEGORIES OF SUTURE MATERIAL
– ABSORBABLE AND NON ABSORBABLE
SUTURES ARE AVAILABLE WITH OR WITHOUT A
NEEDLE ATTACHED
WITH NEEDLE ATTACHED – CALLED AN
ATRAUMATIC SUTURE
SUTURES
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ARE USED TO:
HOLD TOGETHER INTERNAL
STRUCTURES
CLOSE INTERNAL STRUCTURES
CLOSE THE WOUND IN LAYERS
CLOSE THE SKIN INCISION
SECURE DRAINAGE TUBES
SURGICAL SKIN STAPLES
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OFTEN USED AS THE METHOD OF
CHOISE FOR CLOSING SKIN INCISIONS
VERY POPULAR IN NEUROSURGERY,
GYNAECOLOGY, ORTHOPAEDICS,
GENERAL AND VASCULAR SURGERY
PROVIDE MORE STRENGTH THAN MANY
OTHER SUTURE MATERIALS AND TEND
TO CAUSE LESS IRRITATION
ADVANTAGES OF SKIN STAPLES
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GRASP ONLY THE SUPERFICIAL SKIN LAYER
(ESSENTIAL THAT UNDELYING TISSUE HAS
BEEN APPROXIMATED CORRECTLY)
PROVIDES A SECURE HOLD
LESS UNDERLYING TISSUE TRAUMA THAN
WITH SUTURES
BAR OF THE STAPLE DOES NOT COME IN
CONTACT WITH SKIN SO LESS LIKELIHOOD OF
CROSS HATCHING EFFECT AS WITH SUTURES
REMOVAL OF SUTURES
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SUTURE REMOVAL IS DETERMINED BY
THE RATE OF EXPECTED TISSUE
HEALING, TYPE OF TISSUE SECURED AND
LOCATION OF WOUND
THEREFORE – WOUND ASSESSMENT
VITAL, BUT PLANS NEED TO BE FLEXIBLE
TO TAKE ACCOUNT OF THE PATIENT AND
THE RATE OF TISSUE REPAIR
ANY QUESTIONS??????