Wound Care & Dressing

Third year DMS Team

and
Department of Surgery
2009

Types of Wound Healing

Primary intention
Surgical / incisional wound, reapproximated.
Absence of complication
Heal with scar; no special wound care needed

Secondary intention
Not reapproximated
Defect fill in with granulation tissue and later reepithelized
Delay healing; Require special dressing and
treatment
Gurtner GC. Wound Healing: Normal and Abnormal. In: Grabb and Smiths Plastic Surgery, 6 th edition.
Lippincot William and Wilkins. 2007;2:15-22

Anal injury, cleaned and reapproximated by suturing

Primary intention healing by suturing in surgical incision

Acute Infected Wound caused by insect bite in diabetic patient

Clean and Debridement; expect the wound to heal with secondary intention

Types of Wound Healing

Acute Wound
Occurred within 3-4 weeks

Chronic Wound
Persist beyond 4-6 weeks
Include wound that present for months or years

Nonhealing or delayed healing Wound

Term use interchangeably to describe chronic
wound
Gurtner GC. Wound Healing: Normal and Abnormal. In: Grabb and Smiths Plastic Surgery, 6 th edition.
Lippincot William and Wilkins. 2007;2:15-22

Chronic Wound caused by

Pressure Sores (decubitus) in
paraplegic patient

Chronic wound caused by

Chronic Venous Insufficiency

Phases of Normal Wound Healing

Following the injury:
Inflammatory phase
Proliferative phase
Remodelling phase

Gurtner GC. Wound Healing: Normal and Abnormal. In: Grabb and Smiths Plastic Surgery, 6 th edition.
Lippincot William and Wilkins. 2007;2:15-22

Inflammatory phase
Immediately following tissue injury
Functional priorities:
Hemostasis
Removal of dead and devitalized tissue
Prevention of colonization and invasive
infection by microbial pathogens

Provisional of Fibrin matrix

Inflammatory cells are recruited to the
wound site
Gurtner GC. Wound Healing: Normal and Abnormal. In: Grabb and Smiths Plastic Surgery, 6 th edition.
Lippincot William and Wilkins. 2007;2:15-22

Proliferative phase
Occurred 4-21 days following injury
Replace of fibrin matrix by granulation
tissue; composed of three cells:
Fibroblasts
Macrophages
Endothelial cells

Keratinocytes migration
Re-epithelialization
Gurtner GC. Wound Healing: Normal and Abnormal. In: Grabb and Smiths Plastic Surgery, 6 th edition.
Lippincot William and Wilkins. 2007;2:15-22

Remodeling phase
Last from 21 days and up to 1 years
Programmed regression of blood
vessels and granulation tissue
Wound contraction
Collagen remodeling

Gurtner GC. Wound Healing: Normal and Abnormal. In: Grabb and Smiths Plastic Surgery, 6 th edition.
Lippincot William and Wilkins. 2007;2:15-22

Basic wound care

The basics of wound care are the following:
1) Keep the wound clean
2) Keep the wound moist
3) Keep the wound well nourished

Keep the wound clean

The wound can simply be washed once or
twice daily with soap to help achieve and
maintain wound cleanliness
Wound irrigation with normal saline (NaCl
0.9%)
Wound debridement; to remove the necrotic
or death tissues, foreign material

 The only exception to immediate debridement

is a dry, chronic, arterial insufficiency eschar
without evidence of infection
It may promote further ischemia and lead to the
formation of larger ulcer
These type of wounds should be
revascularized before debridement

Lorentz HP. Longaker MT. Wounds: Biology, Pathology, and Management. In: Norton, Bollinger, Chang et
al. Surgery: Basic Science and Clinical Evidence. Springer-Verlag New York. 2001;12:233-235

Buergers disease

Atherosclerosis obliterans
Digital gangrene due to Raynauds disease

Dry, uninfected, chronic wound

Caused by arterial insufficiency.
Debridement should not be performed
Before revascularization

Keep the wound moist

Second principle is to keep the wound moist
Obviously, it has the dual function of helping
keep the wound clean
Moist Wound dressing:
To provide the ideal environtment for wound
healing
To mimics the barier role of epithelium and to
prevent further damage

Keep the wound well nourished

The third principle of wound care is to
ensure good nutrition
Which implies reducing or eliminating
edema and keeping pressure off the
wound
Particularly if the patient is immobilized
and can't move spontaneously to relieve
pressure on the wound

Wound culturing

Wound culturing using cotton swab

If the tissue around

the wound is red
and tender
suggesting
infection, then the
wound should be
cultured

Wound dressing

This shows a bulky dressing applied on top

of the non-adherent dressing to absorb the
bleeding that will occur over the next hour
or two after debridement

Wound dressing
The optimal open wound dressing:
Maintains a moist, clean environment that
prevents pressure and mechanical trauma,
reduces edema, stimulates repair, and
inexpensive.
Less frequent dressing changes and
prevention of skin irritation

No ideal dressing exists

Lorentz HP. Longaker MT. Wounds: Biology, Pathology, and Management. In: Norton, Bollinger, Chang et
al. Surgery: Basic Science and Clinical Evidence. Springer-Verlag New York. 2001;12:233-235

Wound dressing
Numerous dressing products
Plain gauze and normal saline (moist to dry
gauze) with or without antibiotic ointment remain
the simplest and least expensive dressing
Major disadvantages:
Frequent need for changes
Painful changes

Lorentz HP. Longaker MT. Wounds: Biology, Pathology, and Management. In: Norton, Bollinger, Chang et
al. Surgery: Basic Science and Clinical Evidence. Springer-Verlag New York. 2001;12:233-235

Infected wound after primary suture

Case

Second degree burn

Necrotomy and debridement in OR

(General anesthesia)

Application of Silver Sulfadiazine ointment

Dressing with Saline Moist Gauze

Case

Extending submandibular abscess;

The wound dressing had been removed
To clean and irrigate using normal saline

Application of saline moist gauze and dry gauze

July 8th 2008, day 0

Case

Diabetic foot abscess

Day 29

Secondary healing intention:

Granulation tissue and epithelialization

Day 4

Necrotomy and debridement,

abscess drainage
Day 50

Wound contraction; and the wound heal

Case

Severe tissue damage Diabetic wound

Repeated Necrotomy and debridement

Daily wound care is only application of saline moist gauze and dry gauze

Secondary healing intention:

Granulation tissue and epithelialization

Wound contraction; and the wound heal

Schwartzs Principles of Surgery

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