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wound healing

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CLASSIFICATION OF WOUNDS:

CLASSIFICATION OF WOUNDS By DR.M.RAVICHANDRA,M.S ASST PROFESSOR OF SURGERY RIMS ,SRIKAKULAM

RANK & WAKEFIELD CLASSIFICATION:

RANK & WAKEFIELD CLASSIFICATION TIDY WOUND NO DEVITALISED TISSUE SHARP INSTRUMENTS PRIMARY CLOSURE EX:SURGICAL INCISIONS,CUTS FROM GLASS&KNIFE SINGLE SKIN WOUND NO FRACTURES UNTIDY WOUND DEVITALISED TISSUE MULTIPLE SKIN WOUNDS CAUSED BY CRUSHING . AVULSION,TEARING&BURNS TENDONS,NERVES &VESSELS ARE INJURED NOT DEVIDED FRACTURES NO PRIMARY CLOSURE WOUND DEHISCENCE INFECTION,DELAYED HEALING,GAS GANGRENE

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*Image via Bing TIDY WOUND

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*Image via Bing UNTIDY WOUND

Treatment of Wounds:

Treatment of Wounds

MANAGEMENT:

MANAGEMENT TIDY WOUND UNTIDY WOUND REPAIR OF NERVES,TENDONS &VESSELS PRIMARY CLOSURE WOUND EXCISION / DEBRIDEMENT/WOUND TOILET FOLLOWED BY DELAYED PRIMARY CLOSURE OR ALLOWED TO HEAL BY SECONDARY INTENTION

PRIMARY CLOSURE OF A TIDY WOUND:

PRIMARY CLOSURE OF A TIDY WOUND *Image via Bing Incised wound

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*Image via Bing

Vs wound debridement:

Vs wound debridement WOUND EXCISION

WOUND EXCISION:

WOUND EXCISION DEFINITION CAREFULLY PLANNED OPERATION TO REMOVE ALL DEVITALISED & CONTAMINATED TISSUES WHICH MIGHT PREDISPOSE TO INFECTION

PROS AND CONS:

PROS AND CONS TREATMENT OF CHOICE IN ALL RECENT WOUNDS IMPORTANT IN PREVENTING WOND INFECTION INTENT IS TO REMOVE DEAD &INANIMATE MATTER DONE IN HIGH ENERGY SHEARING WOUNDS,BULLET &BOMB WOUNDS WITHIN FIRST EIGHTEEN HOURS

OPERATIVE PROCEDURE:

OPERATIVE PROCEDURE TOURNIQUE – NO ROLE (EXCEPT IN HAND) WHY? OBSCURES BLEEDING POINTS RECOGNITION OF DEVITALISED TISSUE MORE DIFFICULT REDUCES RESISTANCE OF THE PART TO INFECTION

SKIN PREPARATION:

SKIN PREPARATION PRELIMINARY CLEANING – SOAP AND WATER POVIDONE IODINE /CETAVLON PACK THE WOUND WITH GAUGE SKIN DRIED WITH SPIRIT & PREPARED WITH AN ANTISEPTIC

PROCEDURE:

PROCEDURE EXCISION OF SKIN EDGES SUB CUTANEOUS TISSUE DEEP FASCIA MUSCLE ISCHAEMIC MUSCLE – DARKER, DOES NOT CONTRACT, DOES NOT BLEED EXCISE UNTIL CLEAR BLEEDING

WOUND DEBRIDEMENT:

WOUND DEBRIDEMENT DEFINITION REMOVAL OF ANY DEVITALISED SKIN TAGS AND NECROTIC TISSUE ALONG WITH FOREIGN BODIES AND DEBRIS

PROS AND CONS:

PROS AND CONS UNDER TAKEN WHEN SIGNIFICANT PERIOD OF TIME ELAPSED AFTER INJURY FOR TREAMENT OF FACE WOUNDS MANAGEMENT OF WOUND INFECTION

PROCEDURE:

PROCEDURE SIMILAR TO WOUND EXCISION NO FORMAL EXCISION OF WOUND EDGES ABRADED /INJURED TISSUES ARE REMOVED WITH FOREIGN MATERIAL & DIRT HEALTHY TISSUES NOT DISTURBED

DEPENDING ON MECHANISM OF INJURY:

DEPENDING ON MECHANISM OF INJURY INCISED WOUND LACERATION ABRASION PUNCTURE WOUNDS PENETRATING WOUND/STAB WOUND GUN SHOT WOUND AVULSION INJURY DEGLOVING INJURY BITE WOUND

INCISED WOUND:

INCISED WOUND CAUSED BY SHARP OBJECT OR INSTRUMENT (GLASS PIECE,RAJOR,SHARP METAL) SKIN EDGES ARE REGULAR PAINFUL BLEEDING PRESENT SKIN AND TISSUE LOSS IS MINIMAL

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*Image via Bing INCISED WOUND OF FACE

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*Image via Bing INCISED WOUND OF NECK

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*Image via Bing INCISED WOUND FLANK

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*Image via Bing INCISED WOUND NECK

LACERATION LITERAL MEANING CUT SKIN JAGGEDLY :

LACERATION LITERAL MEANING CUT SKIN JAGGEDLY BLUNT OBJECT IRREGULAR TEAR IN SKIN SKIN EDGES ARE IRREGULAR DEEP/SHALLOW

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*Image via Bing FORE HEAD LACERATION

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*Image via Bing DEEP LACERATION

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*Image via Bing ELBOW LACERATION

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*Image via Bing THIGH LACERATION

ABRASIONS:

ABRASIONS A SHEARING INJURY OF SKIN DUE TO HORIZONTAL FORCE SURFACE RUBBED OFF MOST ARE SUPERFICIAL SOME FULL THICK NESS SKIN LOSS NUMEROUS PARELLEL SCRATCH LINES DIRT PRESENT

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*Image via Bing ABRASION

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*Image via Bing ABRASION

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*Image via Bing TOE ABRASIONS

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*Image by [email protected] via Flickr ABRASIONS ELBOW

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*Image by [email protected] via Flickr KNEE ABRASION

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*Image by [email protected] via Flickr ABRASION ELBOW

PUNCTURE WOUND:

PUNCTURE WOUND CAUSED BY OBJECTS PUNCTURING SKIN NAIL/NEEDLE/THORN FOREIGN MATERIAL AND ORGANISMS CARRIED DEEP LITTLE TO SEE ON SURFACE X-RAY MAY REVEAL METAL FRAGMENT / GLASS

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*Image by [email protected] via Flickr PUNCTURE WOUND

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*Image by [email protected] via Flickr TATTOOS MULTIPLE PUNCTURE WOUNDS

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*Image by [email protected] via Flickr PUNCTURE WOUNDS

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*Image by [email protected] via Flickr PUNCTURE WOUNDS

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*Image by [email protected] via Flickr PUNCTURE WOOUND

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*Image by [email protected] via Flickr PUNCTURE WOUND

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*Image via Bing IMPALED OBJECT

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*Image via Bing FOOT ABOUT TO STEP ON A RUSTY NAIL

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*Image via Bing FIRST DAY

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*Image via Bing X-RAY OF PUNCTURE WOUND SHOWING FOREIGN BODY

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*Image by [email protected] via Flickr TATTOO

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*Image by [email protected] via Flickr

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*Image by [email protected] via Flickr ART OF OF BLEEDING

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*Image by [email protected] via Flickr PUNCTURE WOUND BY NEEDLE

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*Image by [email protected] via Flickr THORN PUNCTURE CROWN OF A THORN

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*Image by [email protected] via Flickr STICK CAME OUT OF A NECK PUNCTURE WOUND

NEEDLE STICK INJURIES:

NEEDLE STICK INJURIES INJURY CAUSED BY NEEDLE OF A SYRINGE / NEEDLES USED DURING SURGERY / ANY SHARP INSTRUMENT PARTICULAR HAZARD FOR MEDICAL , NURSING & ANCILLARY STAFF H.I.V & HEPATITIS

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*Image by [email protected] via Flickr SIMPLE IDEA?

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*Image by [email protected] via Flickr HYPODERMIC SYRINGE

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*Image by [email protected] via Flickr HAPPY DOCTOR UNHAPPY CHILD VACCINATION

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*Image via Bing SAFETY I.V CATHETER

BITE WOUNDS:

BITE WOUNDS TYPE OF PUNCTURE WOUNDS MAY BE ANIMAL / HUMAN HIGH INCIDENCE OF INFECTION FROM MOUTH ORGANISMS SMALL SHARP INCISED WOUND / CRUSHING WOUND SEVERE DOG BITE – TISSUE AVULSION, PUNCTURE WOUNDS & CONTUSION ATTACKER STRICKING THE VICTIMS INCISOR TEETH – INJURY TO FIRST MP JOINT

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*Image via Bing HUMAN BITE CAUSES AVULSION OF PART OF EAR

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*Image via Bing SPIDER BITE

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*Image via Bing SHARK BITE AMAZING

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MOST POISINOUS BITE?

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*Image by [email protected] via Flickr DOG BITE

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*Image by [email protected] via Flickr DOG BITE

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*Image by [email protected] via Flickr DOG BITE

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*Image by [email protected] via Flickr AVULSION DUE TO DOG BITE

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*Image by [email protected] via Flickr HUMAN BITE

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*Image by [email protected] via Flickr

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*Image by [email protected] via Flickr

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PENETRATING INJURY:

PENETRATING INJURY CAUSED BY SHARP OBJECTS LIKE KNIFE ENTERING & COMING OUT THROUGH SKIN ALSO KNOWN AS STAB INJURY

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*Image via Bing STAB INJURY NECK

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*Image via Bing STAB INJURY NECK

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*Image via Bing CARDIC STAB

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*Image via Bing PSEUDOANEURYSM OF POPLITEAL ARTERY

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GUNSHOT WOUND:

GUNSHOT WOUND CAUSED BY BULLET OR A SIMILAR PROJECTILE OBJECT HAS AN ENTRY WOUND AND AN EXIT WOUND SEVERITY OF TISSUE DAMAGE DEPENDS ON VELOCITY LOW VEL-EXIT&ENTRANCE - EXIT WOUND BIGGER HIGH VEL-EXPLOSIVE PRESSURE & WIDE SPREAD TISSUE DAMAGE

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AVULSION OR DEGLOVING INJURY:

AVULSION OR DEGLOVING INJURY WHEN HANDS OR LIMBS ARE TRAPPED IN MOVING MACHINERY (ROLLERS) IN RUN OVER R.T.A WHERE FRICTION FROM RUBBER TYRES AVULSE SKIN & SUBCUTANEOUS TISSUE FROM DEEP FASCIA USUALLY OPEN BUT ON OCCASION CLOSED WHERE SKIN REMAINS CLOSED PRESENTS WITH SEVERE BRUISING AND SENSORY DISTURBANCE DEVASCULARISATION OF TISSUE & SKIN NECROSIS

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*Image via Bing DEGLOVING INJURY OF HAND

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*Image via Bing CONTAMINATED DEGLOVING INJURY CAR RUNOVER

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CLOSED WOUNDS:

CLOSED WOUNDS CONTUSION / BRUISE HAEMATOMA CRUSH INJURY

CONTUSION / BRUISE:

CONTUSION / BRUISE CAUSEDBY BLUNT FORCE TRAUMA DAMAGE TO TISSUES UNDER SKIN COMMON CAUSES ARE FALLS , SPORTS INJURIES & ASSAULT WITH A BLUNT WEAPON INITIALLY BLUISH IN COLOUR LATTER BROWNISH BLACK / GREENISH COLOUR OF BRUISE – USE IN FORENSIC PRACTICE CAUSED BY CAPILLARY RUPTURE

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*Image via Bing CONTUSION OR BRUISE

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*Image via Bing MULTIPLE CONTUSIONS OF THIGH

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*Image via Bing ILLUSTRTION OF SKIN CONTUSION

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*Image via Bing CONTUSION & LACERATION

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*Image via Bing CONTUSION LEG

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*Image via Bing FOOT CONTUSION DUE TO BIKE FALL

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*Image by [email protected] via Flickr

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*Image by [email protected] via Flickr BILATERAL CONTUSIONS OF EYE

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*Image by [email protected] via Flickr ECCHYMOSIS IN A CHILD

HAEMATOMA:

HAEMATOMA DUE RUPTURE OF A LARGE SUB CUTANEOUS VEIN THE AMOUNT OF BLOOD LOSS IS SUFFICIENT TO CRETE ACOLLECTION INITIALLY FLUID , CLOTTS IN MINUTES TO HOURS AFTER AFEW DAYS LIQUIFIES AGAIN DANGER OF INFECTION

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*Image by [email protected] via Flickr

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*Image by [email protected] via Flickr HAEMATOMA

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*Image by [email protected] via Flickr HAEMATOMA

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*Image by [email protected] via Flickr HAEMATOMA

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*Image by [email protected] via Flickr HAEMATOMA

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*Image by [email protected] via Flickr

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*Image by [email protected] via Flickr HAEMATOMA

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*Image by [email protected] via Flickr HAEMATOMA

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*Image via Bing DELAYED EXTENSIVE SUB GALEAL HAEMATOMA

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*Image via Bing SUBDURAL HAEMATOMA

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*Image via Bing RESULT OF LIPOSUCTION

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*Image via Bing COBRA PUNCH

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*Image via Bing LARGE FACIAL HAEMATOMA

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*Image via Bing FACIAL HAEMATOMA

CRUSH INJURY:

CRUSH INJURY CAUSED BY EXTREME AMOUNT OF FORCE APPLIED FOR APROLONGED PERIOD VARIANT OF BLUNT INJURY ACCOMPANIED BY DEGLOVING & COMPARTMENT SYNDROME SKIN,NERVES & MUSCLES ARE INVOLVED IN COMPARTMENT SYNDROME

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*Image via Bing SEVERE CRUSH INJURY OF ANTERIOR ABDOMINAL WALL

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*Image via Bing CRUSH INJURY OF HAND AFTER SURGICAL INTERVENTION

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*Image via Bing SEVERE CRUSH INJURY ARM

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*Image by [email protected] via Flickr

COMPARTMENT SYNDROME:

COMPARTMENT SYNDROME DEFINITION LIMB OR LIFE THRETENING CONDITION DEFINED AS THE COMRESSION OF NERVES , VESSELS & MUSCLE INSIDE A CLOSED SPACE OR COMPARTMENT WITH IN BODY RANKINS DEFINITION – PRESSURE WITH IN A CLOSED SPACE COMPRAMISING THE CIRCULATION & FUNCTION OF TISSUES IN THAT SPACE

PATHOLOGY OF COMPARTMENT SYNDROME:

PATHOLOGY OF COMPARTMENT SYNDROME

CLINICAL FEATURES OF COMPARTMENT SYNDROME:

CLINICAL FEATURES OF COMPARTMENT SYNDROME FIVE P ’S P AIN P ARESTHESIA P ALLOR P ARALYSIS P ULSELESSNESS SOME TIMES SIXTH P - POIKILOTHERMIA (FAILURE TO THERMOREGULATE) RELIABLE CLINICAL SIGN- PAIN WORSENED BY PASSIVE STRECHING

CRUSH SYNDROME:

CRUSH SYNDROME SEEN IN CRUSH INJURIES ACUTE RENAL FAILURE CAUSED BY MYOGLOBIN RELEASED WHEN MUSCLE UNDER GOES NECROSIS A FATAL COMPLICATION OF CRUSH INJURY

PATHOPHYSIOLOGY OF CRUSH INJURY:

PATHOPHYSIOLOGY OF CRUSH INJURY

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*Image via Bing BILATERAL COMPARTMENT AL SYNDROME OF LEGS DUE TO LITHOTOMY POSITION

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*Image via Bing DR.M.RAVICHANDRA

ME TO UNDERSTAND AND MANAGE:

ME TO UNDERSTAND AND MANAGE TWO MOST IMPORTANT THINGS FOR

AND WOUNDS:

AND WOUNDS WOMEN

ALGORITHOM FOR WOUND MANAGEMENT:

ALGORITHOM FOR WOUND MANAGEMENT INITIAL ASSESSMENT (WOUND & PATIENT) SURGICAL INTERVENTIONS (TO DEAL WITH DEVITALISED TISSUE , INFECTION & FOREIGN MATERIALS) TYPES OF WOUND CLOSURE WOUND CLOSURE TECHNIQUES DRESSINGS DRAINS NEW TECHNIQUES IN WOUND MANAGEMENT

INITIAL ASSESSMENT:

INITIAL ASSESSMENT OF THE PATIENT OF THE WOUND AGE HAEMODYNAMIC STABILITY CO-MORBID STATES NUTRITIONAL STATUS MECHANISM LOCATION EXTENT/SEVERITY TYPES OF TISSUES INVOLVED

SURGICAL INTERVENTION:

SURGICAL INTERVENTION WOUND EXCISION WOUND DEBRIDEMENT OR

TYPES OF WOUND CLOSURE:

TYPES OF WOUND CLOSURE PRIMARY SUTURING PARTIAL PRIMARY SUTURING GAUZE PACKING OF THE WOUND DELAYED PRIMARY SUTURING SECONDARY SUTURING

PRIMARY SUTURING:

PRIMARY SUTURING CLEAN INCISED WOUND NO INFECTION NO CAVITY NO TENSION

PARTIAL PRIMARY SUTURING:

PARTIAL PRIMARY SUTURING CENTRE OF WOUND LEFT OPEN OPEN WHERE SKIN DEVELOPES TENSION LIGHT GAUZE DRESSING / A DRAIN

GAUZE PACKING:

GAUZE PACKING HEAVY CONTAMINATION DEVITALIZED TISSUE A LARGE CAVITY DUE TO HEAVY TISSUE LOSS LIGHT PACKING SECONDARY SUTURE OR PLASTIC PROCEDURE

DELAYED PRIMARY SUTURING :

DELAYED PRIMARY SUTURING WOUND LEFT OPEN & PACKED WITH GAUZE NOT ALWAYS POSSIBLE(SKIN LOSS) PLASTIC SURGICAL PROCEDURE AFTER FIVE DAYS CLEAN & NO INFECTION

SECONDARY SUTURING:

SECONDARY SUTURING CARRIED OUT AFTER CONTROLLING INFECTION SKIN EDGES SHOULD BE HEALTHY NO SLOUGH NO INFECTED CREVICES HEALTHY GRANULATION TISSUE MINIMAL DISCHARGE(NONPURULENT)

WOUND CLOSURE TECHNIQUES:

WOUND CLOSURE TECHNIQUES Overview SUTURES STAPLES ADHESIVE TAPES GLUES / ADHESIVE COMPOUNDS ULTIMATE AIM IS AESTHETIC CLOSURE

HISTORY OF SUTURES:

HISTORY OF SUTURES DATES BACK TO TWO THOSAND YEARS AGO SUSRUTA – USED HEMP &HAIR AS SUTURE MATERIAL JAWS OF BLACK ANT – USED AS BOWEL CLIPS GALEN USED SILK & CATGUT 1950 FIRST SYNTHETIC SUTURE

SUTURE MATERIALS:

SUTURE MATERIALS ABSORBABLE SUTURES NONABSORBABLESUTURE MONOFILAMENT MONOCRYL(polyglecarpone) P.D.S(POLYDIAXONE) MAXONE BRAIDED ABSORBABLE VICRYL(POLYGLACTIN) DEXON CATGUT(polyglycolic acid) NYLON POLYPROPELENE (PROLENE) PTFE STEEL POLYESTER

ADHESIVES/GLUES:

ADHESIVES/GLUES SIMPPLIFIES SKIN CLOSURE NO SUTURE RELATED PROBLEMS NOINFLAMMATION LOCAL ANAESTHETIC NOT NEEDED USED IN FACIAL LACERATIONS & CHILDREN ACTS AS BARRIER AGAINST MICROBES DERMABOND (OCTYL-2-CYANOACRYLATE) APPROVED BY US FDA

FIBRIN BASED TISSUE ADHESIVES:

FIBRIN BASED TISSUE ADHESIVES ACHIEVE HAEMOSTASIS SEALS THE TISSUES FIXATE SKIN GRAFTS ARREST C.S.F LEAK TISSEEL & HEMASEEL

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*Image via Bing TISSUE ADHESIVES

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*Image via Bing CYANO ACRYLATE GLUE AVAILABLE IN MARKET

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*Image via Bing APPLICATION OF TISSUE ADHESIVES

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*Image via Bing USFDA APPROVED TISSUE ADHESIVES

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SKIN STAPLES:

SKIN STAPLES FAST METHOD STAINLESS STEEL STAPLES LESS REACTIVE FEW MICRO ORGANISMS ARE CARRIED INTO TISSUES EXPENSIVE APPLIED WITH GREAT CARE TO ENSURE EVERSION

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*Image by [email protected] via Flickr SKIN STAPLER SKIN STAPLER

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*Image by [email protected] via Flickr SKIN STAPLE REMOVER

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*Image by [email protected] via Flickr THE SKIN STAPLING

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*Image by [email protected] via Flickr REMOVER

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*Image via Bing DISPOSABLE SKIN STAPLER

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*Image via Bing REMOVAL OF SKIN STAPLES

ADHESIVE TAPES OR STRIPS:

ADHESIVE TAPES OR STRIPS FIRST USED IN FRANCE IN 1500 A.D CHEAPER STERISTRIPS USED TODAY ARE POROUS PAPER TAPES EG : CLOZEX

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*Image via Bing WOUND CLOSURE STRIPS

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*Image by [email protected] via Flickr CUT HAND

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*Image by [email protected] via Flickr LEG STERISTRIPS

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*Image by [email protected] via Flickr SURGICAL WOUND

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*Image by [email protected] via Flickr IDIOCY?

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*Image by [email protected] via Flickr NECK

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*Image by [email protected] via Flickr STERISTRIPS AFTER MASTOIDECTOMY

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*Image by [email protected] via Flickr NO MORE BANDAGES

HAT?:

HAT?

HAIR APPOSITION TECHNIQUE:

HAIR APPOSITION TECHNIQUE

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NOVEL NEW TECHNIQUE FOR SELECTED SCALP LESIONS NO ANESTHESIA NOBLEEDING NO PAIN NO SPECIAL TOOLS NO DOCTOR NOSUTURES NO HAIR – NOT POSSIBLE INFECTION & CONTUSION NOT POSSIBLE WOUND LENGTH <10 CM ,HAIR LENGTH>3CM HAT

WOUND CLOSURE TECHNIQUES WITH SKIN LOSS:

WOUND CLOSURE TECHNIQUES WITH SKIN LOSS

DRESSINGS:

DRESSINGS MATERIAL APPLIED TO WOUND WITH OR WITH OUT MEDICATION TO GIVE PROTECTION &ASSIST HEALING

BEST DRESSING?:

BEST DRESSING?

LISTER:

LISTER SKIN!

Treatment of Wounds:

Treatment of Wounds Dressings The main purpose of wound dressings is to provide the ideal environment for wound healing. The dressing should facilitate the major changes taking place during healing to produce an optimally healed wound. Desired Characteristics of Wound Dressings to - Promote wound healing (maintain moist environment) -Conformability -Pain control -Odor control - Nonallergenic and nonirritating -Permeability to gas Safety - Nontraumatic removal -Cost-effectiveness -Convenience

Treatment of Wounds:

Treatment of Wounds Dressings Covering a wound with a dressing mimics the barrier role of epithelium and prevents further damage. Application of compression provides hemostasis and limits edema. Occlusion of a wound with dressing material helps healing by controlling the level of hydration and oxygen tension within the wound. It also allows transfer of gases and water vapor from the wound surface to the atmosphere. Occlusion affects both the dermis and epidermis, and it has been shown that exposed wounds are more inflamed and develop more necrosis than covered wounds.

Treatment of Wounds:

Treatment of Wounds Occlusion also helps in dermal collagen synthesis and epithelial cell migration and limits tissue desiccation. As it may enhance bacterial growth, occlusion is contraindicated in infected and highly exudative wounds. Dressings can be classified as primary or secondary. A primary dressing is placed directly on the wound and may provide absorption of fluids and prevent desiccation, infection, and adhesion of a secondary dressing. A secondary dressing is one that is placed on the primary dressing for further protection, absorption, compression and occlusion

Treatment of Wounds:

Treatment of Wounds Absorbent Dressings Accumulation of wound fluid can lead to maceration and bacterial overgrowth. The Dressing should absorb without getting soaked through, as this would permit bacteria from the outside to enter the wound. The dressing must be designed to match the exudative properties of the wound and may include cotton, wool, and sponge.

Treatment of Wounds:

Treatment of Wounds Nonadherent Dressings Nonadherent dressings are impregnated with paraffin, petroleum jelly, or water-soluble jelly for use as nonadherent coverage. A secondary dressing must be placed on top to seal the edges and prevent desiccation and infection. Occlusive and Semiocclusive Dressings Occlusive and semiocclusive dressings provide a good environment for clean, minimally exudative wounds. These film dressings are waterproof and impervious to microbes, but permeable to water vapor and oxygen.

Treatment of Wounds:

Treatment of Wounds Hydrophilic and Hydrophobic Dressings Hydrophilic and hydrophobic dressings are components of a composite dressing. Hydrophilic dressing aids in absorption , whereas a hydrophobic dressing is waterproof and prevents absorption . Hydrocolloid and Hydrogel Dressings Attempt to combine the benefits of occlusion and absorbency. Form complex structures with water, and fluid absorption occurs with particle swelling, which aids in atraumatic removal of the dressing. Absorption of exudates by the hydrocolloid dressing leaves a yellowish-brown gelatinous mass after dressing removal that can be washed off. Hydrogel is a cross-linked polymer that has high water content. Hydrogels allow a high rate of evaporation without compromising wound hydration, which makes them useful in burn treatment .

Treatment of Wounds:

Treatment of Wounds Absorbable Materials Are mainly used within wounds as hemostats and include collagen, gelatin, oxidized cellulose, and oxidized regenerated cellulose Medicated Dressings Used as a drug-delivery system. Agents include benzoyl peroxide, zinc oxide, neomycin, and bacitracin-zinc. These agents have been shown to increase epithelialization by 28%.

NO NONSENSE POINTS ABOUT DRESSINGS:

NO NONSENSE POINTS ABOUT DRESSINGS DRESSINGS ON UNDRAINED/UNTREATED WOUNDS SERVE ONLY TO HIDE THE WOUND ,INTERFERE WITH EXAMINATION AND TO INVITE ADHESIVE TAPE DERMATITIS EXPENSIVE FORMS OF WOUND COVERAGE ARE A GIMMICK .SIMPLE IS BEAUTIFUL.

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Treatment of Wounds:

Treatment of Wounds Mechanical Devices Augments and improves on certain functions of dressings, in particular the absorption of exudates and control of odor. The vacuum-assisted closure system assists in wound closure by applying localized negative pressure to the surface and margins of the wound. The negative pressure therapy is applied to a special foam dressing cut to the dimensions of the wound and positioned in the wound cavity or over a flap or graft. This form of therapy has been found to be effective for chronic open wounds (diabetic ulcers and stages 3 and 4 pressure ulcers), acute and traumatic wounds, flaps and grafts.

VACCUM ASSISTED CLOSURE SYSTEM:

VACCUM ASSISTED CLOSURE SYSTEM VAC - SYSTEM

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Treatment of Wounds:

Treatment of Wounds Skin Replacements Conventional Skin Grafts : Skin grafts have long been used to treat both acute and chronic wounds. Split- or partial-thickness grafts consist of the epidermis plus part of the dermis, whereas full-thickness grafts retain the entire epidermis and dermis. Split-thickness grafts require less blood supply to restore skin function. The dermal component of full-thickness grafts lends mechanical strength and resists wound contraction better, resulting in improved cosmesis

Treatment of Wounds:

Treatment of Wounds Skin Replacements Skin Substitutes Manufactured by tissue engineering , they combine novel materials with living cells to provide functional skin substitutes, providing a bridge between dressings and skin grafts. Have advantages of being readily available , not requiring painful harvest, and they may be applied freely or with surgical suturing. They promote healing, either by stimulating host e cytokin generation or by providing cells that may also produce growth factors locally. Disadvantages include limited survival, high cost, and the need for multiple applications . Allografting , albeit with a very thin graft, may at times be required to accomplish complete coverage.

Treatment of Wounds:

Treatment of Wounds Skin Replacements Skin Substitutes The acellular (e.g., native collagen or synthetic material) component acts as a scaffold, promotes cell migration and growth, and activates tissue regeneration and remodeling. The cellular elements re-establish lost tissue and associated function, synthesize extracellular matrix components, produce essential mediators such as cytokines and growth factors, and promote proliferation and migration. Bioengineered skin substitutes have evolved from keratinocyte monolayers to dermal equivalents to split-thickness products with a pseudoepidermis and, most recently, to products containing both epidermal and dermal components that resemble the three-dimensional structure and function of normal skin .

Treatment of Wounds:

Treatment of Wounds Growth Factor Therapy Growth factors for clinical use may be either recombinant or homologous/ autologous . Autologous growth factors are harvested from the patient's own platelets, yielding an unpredictable combination and concentration of factors, which are then applied to the wound. Recombinant molecular biologic means permit the purification of high concentrations of individual growth factors. At present, only platelet-derived growth factor BB ( PDGF-BB) is currently approved by the Food and Drug Administration for treatment of diabetic foot ulcers. A great deal more needs to be discovered about the concentration, temporal release, and receptor cell population before growth factor therapy is to make a consistent impact on wound healing.

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REMEMBER TREAT THE WHOLE PATIENT AND NOT JUST THE HOLE IN THE PATIENT

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