Published on September 27, 2014
Wound Management SEPEHR ROOZDAR M.D.
Wound Types 1. Clean : Primary Intention 2. Clean-Contaminated : Tertiary Intention 3. Contaminated : Secondary Intention 4. Dirty ( Infected ) : Secondary Intention
Intentions View slide
Steps 1. Hemorrhage Management ( Hemostasis ) 2. Cleansing and Irrigation 3. Conservative Debridiment 4. Closure 5. Dressing 6. Follow Up View slide
1. Hemostasis Firm Pressure Tourniquet Vasoconstrictors ( Epinephrine )
2. Cleansing and Irrigation Cleansing the Skin ( NOT the Wound ) by Anti-Septics High Pressure Normal Saline Irrigation ( By 30-60 cc Syringes ) Hydrogen Peroxide and Povidine should NOT be used for Irrigation
3. Conservative Debridiment Excision of Devitalised Skin and Subcutaneous Tissue Conserving Viable Tissue ( Specially in Face and Hands )
4. Closure Local Anaesthetics ( LET : Lidocaine , Epinephrine , Tetracaine ) Chosing Suturing Material Chosing Suturing Technique Skin Adhesives ( As Needed )
5. Dressing Goal : Optimal Hydration of Wound Margins ( Moisture Improves Epithelization )
6. Follow Up Patient Home Care Suture Removal
Optimal Time for Suture Removal Location Number of Days Face 3-5 Scalp 7 Chest and Extremities 8-10 High Tension ( Joints , Hands ) 10-14 Back 10-14
Factors Affecting Wound Healing Systemic Local Age Mechanical Injury Nutrition Infection Trauma Edema Metabolic Diseases Ischemia Immunosuppression Topical Agents Connective Tissue Disorders Ionizing Radiation Smoking Low Oxygen Tension
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