Basic principles of surgical wound care for nursing students.

1. Wound care (3 Hrs.)

2. Wound care (3 Hrs.)
• Wound healing process
• Dressing wounds
• Wound irrigation
• Suturing and removal of stiches
By Ame M.

3. Wound healing and methods of hemostasis
• Types of wound:
– Open wounds
1. Surgical Incision
2. Lacerations wounds
3. Abrasions wound
4. Avulsions wound
5. Ulceration wound
6. Puncture wound
– Closed wound
• Contusion wound
By Ame M.

4. Mechanism of wound healing
• Wound healing differs according to how much tissue has
been damaged.
• Wound healing occurs by first, second, and third intention.
• Types of wound healing:
A. First intention:
B. Second intention:
C. Third intention:
By Ame M.

5. Mechanism of wound healing
• Types of wound healing:
1. First intention (most surgical incisions):
– Healing occurs directly, without formation of granulation tissue
with minimal scar formation.
– Clean incision, early suturing, hairline scar.
• First-intention healing (healing by primary intention)
– occurs in wounds with minimal tissue loss, such as
• surgical incisions or
• wounds sutured (stitched) soon after injury.
– Edges are approximated (close to each other); thus,
– they seal together rapidly.
– Scarring and infection rates are low.
By Ame M.

6. Mechanism of wound healing
1. Second intention (tissue must granulate in):
–Healing occurs with granulation tissue.
–Scar formation is excessive.
–Irregular wound, granulation, skin grows over scar.

7. WOUND HEALING
• Second-intention healing (healing by secondary intention)
– occurs with tissue loss; the wound edges are widely separated.
– Secondary intention healing occurs in injuries such as deep lacerations, burns,
and pressure ulcers.
– Because edges do not approximate (come together), openings fill with
granulation tissue that is soft and pinkish.
– The granulation tissue grows in slowly and must grow in from the inside out-
ward, to prevent abscess.
– When the granulation tissue is in place, epithelial cells grow over the top.
– (Drainage or other wound debris slows the healing process.)
– Scarring often occurs, and the risk of infection is greater than that for first-
intention healing.
– New technologies have been developed to treat such wounds more
successfully.

8. Mechanism of wound healing
1. Third intention(wound edges brought together some time
after wound occurs):
–A deeper and wider Scar usually result.
–Open wound, increased granulation, late suturing, wide
scar.

9. WOUND HEALING
• Third-intention healing (healing by tertiary intention)
– occurs when there is a delay in the time between the injury and the closure of
the wound.
– For example, a wound may be left open temporarily to allow for drainage or
removal of infectious materials.
– This type of healing sometimes occurs after surgery when there is an infection,
or in a large open wound when the wound is closed later.
– In the meantime, wound surfaces start to granulate in.
– Deep scarring almost always occurs.
– Hundreds of products and procedures are in use today to assist in the healing
of wounds.
– These include procedures such as electrical stimulation, diathermy, and
hyperbaric chamber treatment; discussion of many of these is beyond the
scope of this book.

10. WOUND HEALING
• Medications
– Some of the available wound care products are medications, such
as antibiotics and antiseptics.
– Usually, the wound is cleaned and then patted dry with sterile
gauze or other dressing.
– Follow the provider’s orders carefully; in addition, read the
instructions packaged with the medication.
– Apply the medication to the wound itself, but not to the skin’s
edges unless ordered otherwise.

11. WOUND HEALING
– Rationale:
• The medication may be damaging to surrounding tissues.
• In many cases, an open wound will be filled in with a prescribed cream or
ointment.
• In the case of a large wound, this application is most often performed with
a tongue blade.
• For smaller wounds or sinus tracts, a cotton-tipped applicator is used.
• (Oral or intravenous antibiotics and other medications are often given as
well, to speed the healing process.)
– Table 58-3 presents wound care product categories, and Table 58-4
outlines the objectives of wound care and the products used.

12. Factors influencing wound healing:
Age
Weight
Nutritional status
Fluid and electrolyte imbalance
General health
Drug therapy
Post-operative complication.
Physical Activity
By Ame M.

13. Hemostasis:
• is the arrest of a flow of blood or hemorrhage.
• The mechanism is coagulation (clot formation)
– When there is incision or traumatic injury, a blood vessel
constricted and platelets rapidly clump and adhere to connective
tissue at the cut end of constricted vessel.
– In some cases, blood disease, or operation on blood vessel.
– They use anticoagulant agent as heparin to depress blood
prothrombin and tendency of blood platelets to cling together.
By Ame M.

14. Methods of hemostasis:
1.Chemical Method
2.Mechanical methods
3.Thermal methods
By Ame M.

15. Methods of hemostasis……
1. Chemical Method
A. Biological dressing:
• It is covering an open surface defect of skin to, and promote the production
of granulation.
• The biological dressing is a graft and has the following types:
1. Auto graft: Skin grafted from one part of pt. body to another part.
2. Homograft: Skin taken from one person to another.
3. Heterograft: Skin grafted between two different species(e.g. an
animal)
B. Oxytocin: used to get uterine contraction after delivery to control bleeding.
C. Epinephrine (Adrenaline): vasoconstriction which decrease bleeding.
D. Tannic acid: is used on mucous membranes of the nose and throat.
By Ame M.

16. Methods of hemostasis……
2. Mechanical methods
1. Bone wax: It is used to control bleeding from bone in some orthopedic
surgery
2. Drain: As prophylactically or therapeutic during operation to evacuate
fluids.
3. NG tube: To measure blood loss during gastric surgery
4. Urinary drainage (Urethral catheter).
5. Heamovac drain.
6. Chest tub.
7. Dressing over incision.
8. Hemostatic clamps
9. Ligature
10.Pressure
By Ame M.

17. Methods of hemostasis……
3. Thermal methods
Diathermy
Production of heat in the body tissue by a high frequency of
electric current.
Types of diathermy
Medical diathermy:- sufficient heat is used to warm the tissues
but not harm them.
Short–wave diathermy:- used in physiotherapy to relieve pain
or heat infection.
Surgical diathermy:- of very high frequency, used to coagulate
blood in vessels, cut & desiccation of tissues.
By Ame M.

18. Diathermy…..
Functions
Electrotomy/cutting (generation of
heat destroys tissue cell)
Blend (cutting & coagulation)
Fulguration (cell walls destroyed
through dehydration)
Coagulation/Desiccation (dryness
of tissues)
Physiology of coagulation of
diathermy
Retraction of blood vessels
Contraction of the muscle
The dryness of tissue cell
Minimum out put of power
By Ame M.

19. Diathermy…..
• Advantages
– Relief pain
– Prevention of infection
– Shortens the duration of surgery
– Controls minute bleedings
• Disadvantages
– Delayed wound healing
– Channeling (thrombosis
formation)
– Explosions/sparking
– Burn/ignition
– Organ perforation
– Gas embolism
By Ame M.

20. Diathermy…..
ways of delivering currents
Monopolar Vs Bipolar delivery
Monopolar
The current is passed
through a large volume of
tissue.
Large surface area of the
body contact.
A very low current density
passed through most of
the body.
 Bipolar
Involves the current being passed b/n two
point electrodes.
A very high current density.
High heating effect, is produced over a
very small volume of tissue.
Virtually no heat generated else where in
the body.
be used with relatively low currents
For coagulation of small blood vessels.
Its greatest application is in
microsurgery(the hand & in neurosurgery.
By Ame M.

21. Diathermy…..
Diathermy burn occurs b/c
of:-
Faulty applications of
different electrodes
Failure to insulate/protect
the pt
Failure to insulate the cable
Inadvertent actions/activity
Proper applications of
Pads/plates
Place the diathermy plate
near to operation site
If the site is below the heart-
Put on the gluteus muscle
portion
If the site is above the heart-
Put on the shoulder muscle
portion
By Ame M.

22. Wound Closure Material
Suture: Is a material used to bring tissue together.
Ligature: Is a material tied around blood vessel to occlude lumen and
attached to needle.
Free tie: Is a single strand material handed to surgeon or assistant to
tie blood vessel.
Suture Material Must:
1. Be sterile when placed in tissue.
2. Be predictably uniform in tensile strength
3. Be small in diameter and safe to use
4. Have knot security, remain tied.
5. Cause as a little foreign body tissue reaction.
By Ame M.

23. Classification of suture material
I. Absorbable suture:
• Prepared form collagen or synthetic polymer they are
absorbed or digested by the body cells and tissue fluids.
II. Non absorbable suture:
• Effectively resist enzymatic digestion or absorption in living
tissue.
By Ame M.

24. Classification of suture material
• Subdivision of suture material:
A. Monofilament suture:
– Consisting of single thread that is non-capillary.
B. Multifilament suture:
– Made of more than one thread held together, it is considered capillary
By Ame M.

25. I. Absorbable suture:
1) Surgical Gut:
 Collagen derived from the sub mucosa or serosa of beef intestine
 Ranging from the heaviest size 3/0 to finest size 7/0
 Digested by body enzymes and absorbed by tissue.
– Types of Surgical Gut:
a) Plain Surgical Gut
b) Chromic Surgical Gut
By Ame M.

26. I. Absorbable suture:
a) Plain Surgical Gut:
 Digested quickly in 5-10 days and
is completely digested by 60 days.
 It is used to ligate small vessels
and to suture subcutaneous fat.
 It is available in size 3/0 through
6/0 .
 It has natural yellowish color.
By Ame M.

27. I. Absorbable suture:
b) Chromic surgical gut
From the sub mucosa of sheep
intestine or serosa of beef intestine
treated with chromium salts to
delay the rate of wound
absorption.
Maintains strength for 10-14 days
making it useful for mucosal
closures and absorbed completely
within 120 days.
Rang size 3/0 to 7/0.
By Ame M.

28. Reading the Suture Label
• Company
Needle
Size
Order Code
Name
Also:
LENGTH
NEEDLE
SYMBOL
COLOR
Absorbable or
Non
By Ame M.

29. The rate of absorption is influenced by:
1. Type of tissue: The surgical gut absorbed much more rapidly in
mucous membrane, and absorbed slowly in subcutaneous fat.
2. Condition of tissue: Absorption takes place more rapidly in absence
of infection.
3. General health status of patient: Surgical gut may be absorbed more
rapidly in well nourished tissue or healthy tissue, but in old pt. it may
remain for long time.
4. Type of surgical gut: Plain gut is untreated but chromic gut is treated
to provide greater resistance to absorption.
By Ame M.

30. Handling characteristic of surgical gut and
collagen suture:
1. Surgical gut and collagen suture are sealed
in packets that contain fluid to keep the
material pliable, this fluid is alcohol and
water, hold packet over basin and open it
carefully spilling fluid to your eyes.
2. Surgical gut and collagen suture should be
used immediately after removal of their
packets, you can put it into saline to soften
it but do not soak it.
3. Handle it as little as possible, never stretch
it that weakens it
By Ame M.

31. 2. Synthetic Absorbable polymers:
• Dyed or un dyed multifilament synthetic absorbable suture,
these sutures as absorbed by slow hydrolysis process in the
presence of tissue fluid.
• Example
a)VICRYLE
b)Monocryl
By Ame M.

32. 2. Synthetic Absorbable polymers:
a)VICRYLE®:
1.Absorbed rapidly within 90 days.
2.Multifilament braided, size range
2/0 through 7/0.
3.Monofilament, size rang 9/0
through 10-0 for ophthalmic
procedures.
By Ame M.

33. 2. Synthetic Absorbable polymers:
b) Monocryl®:
1.Monofilament maintaining 50-60%
strength at 7 days with complete
absorption by 3 months.
2.It offers better handling and knot security
than most other monofilament sutures.
3.Less tissue reaction than Vicryl® and is
therefore useful where minimal tissue
reaction is essential.
By Ame M.

34. II. Non absorbable suture
1.Surgical silk:
• An animal-product made from the fiber
spume.
• Fiber are braided or twisted together to
from Multifilament suture.
• It is also dyed most commonly black, size
range from 5/0 through 9/0.
By Ame M.

35. II. Non absorbable suture……
• Characteristics of silk suture:
– Silk is not a true non-absorbable material, it loses
much of it is tensile strength after about 1 year
and usually disappear after 2 or more years.
– Silk suture are dry, they also lose tensile strength
if wet, so do not moisture before use.
– If it is necessary to autoclave e silk suture, so at
121C for 15minutes, but some of it is tensile
strength is lost during sterilization.
– It is used frequently in serosa of GI tract and to
close fascia in the absence of infection and it may
be used in anastomosis of major vessels.
By Ame M.

36. Synthetic non-absorbable polymers
a) Surgical nylon:
– It is derived by chemical synthesis.
– Inexpensive monofilament and has high tensile
strength but lose it by hydrolysis in tissue.
– Has minimal tissue reactivity
– Size range from 2/0 through 11/0.
– It used to close skin and ophthalmology.
– Disadvantages
• are its handling and knot security, but it
remains one of the most popular non-
absorbable sutures in dermatological
surgery.
By Ame M.

37. Synthetic non-absorbable polymers
b) Prolene®
– A monofilament polymer with a very low
coefficient of friction making it the suture
of choice for running subcuticular stitches.
– It has good plasticity but
– limited elasticity,
– poor knot security, and
– it is relatively expensive.
– Flavored by some for facial repairs
By Ame M.

38. Factors that influence the choice of
suture materials
1. Biologic characteristics of the suture material
2. Healing characteristics of the tissue
3. Location and length of the incision
4. Presence or absence of contamination and/or infection
5. Patient problems such as obesity, debility, advanced age and
diseases
6. Physical characteristics of the material such as ease of
passing through tissue, knot tying and other
7. personal preference of the surgeon.
By Ame M.

39. Hand Hygiene Techniques
• Routine Hand washing
• The purpose of handwashing is to mechanically remove soil and debris
from skin and reduce the number of transient microorganisms.
• For appropriate handwashing:
– Thoroughly wet hands
– Apply a hand washing agent (plain soap or detergent)
– Vigorously rub all areas of hands and fingers for 10-15 seconds, paying close
attention to fingernails, and areas between the fingers
– Rinse hands thoroughly with clean running water from a tap or a bucket
– Dry hands with personal dry clean towel, paper towel or air dry (using shared
towel is not recommended as they quickly become contaminated)
By Ame M.