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Woundcare
- 1. WOUND CARE “ the primary goal of wound care is not the technical repair of the wound; it is providing optimal conditions for the natural reparative processes of the wound to proceed” – Richard L. Lammers (Roberts and Hedges)
- 3. INTRODUCTION
- 18. Mechanism of injury FORCE OBJECT DAMAGE WOUND shear Sharp Minimal Linear compression Blunt Right angle Moderate (+) Stellate Jagged tensile Blunt Oblique angle Moderate (+) Triangular Flap
- 26. Local anesthetic Drug Max Dose Onset Duration Cocaine 6.6 mg/kg Rapid 1 hour Procaine 10-15 mg/kg Rapid 30min-1hr Tetracaine 1.5 mg/kg Moderate 2 hours Lidocaine 5 mg/kg 5-30 min 2 hours (with Epi) 7 mg/kg 5-30 min 2-3 hours Bupivacaine 2 mg/kg 7-30 min > 6 hours
- 55. Practice Time!
Notas del editor
- D = Diabetes: The long-term effects of diabetes impair wound healing by diminishing sensation and arterial inflow. In addition, even acute loss of diabetic control can affect wound healing by causing diminished cardiac output, poor peripheral perfusion, and impaired polymorphonuclear leukocyte phagocytosis. I = Infection: Infection potentiates collagen lysis. Bacterial contamination is a necessary condition but is not sufficient for wound infection. A susceptible host and wound environment are also required. Foreign bodies (including sutures) potentiate wound infection. D = Drugs: Steroids and antimetabolites impede proliferation of fibroblasts and collagen synthesis. N = Nutritional problems: Protein-calorie malnutrition and deficiencies of vitamins A, C, and zinc impair normal wound-healing mechanisms. T = Tissue necrosis, resulting from local or systemic ischemia or radiation injury, impairs wound healing. Wounds in characteristically well-perfused areas, such the face and neck, may heal surprisingly well despite unfavorable circumstances. Conversely, even a minor wound involving the foot, which has a borderline blood supply, may mark the onset of a long-term, nonhealing ulcer. Hypoxia and excessive tension on the wound edges also interfere with wound healing because of local oxygen deficits. (See image below and Image 4 .) Pressure ulcers of the lateral aspect of the right foot. H = Hypoxia: Inadequate tissue oxygenation due to local vasoconstriction resulting from sympathetic overactivity may occur because of blood volume deficit, unrelieved pain, or hypothermia, especially involving the distal extent of the extremities. E = Excessive tension on wound edges: This leads to local tissue ischemia and necrosis. A = Another wound: Competition between several healing areas for the substrates required for wound healing impairs wound healing at all sites. L = Low temperature: The relatively low tissue temperature in the distal aspects of the upper and lower extremities (a reduction of 1-1.5°C [2-3°F] from normal core body temperature) is responsible for slower healing of wounds at these sites.
- Minimal energy -> minimal tissue damage -> minimal devitalised tissue -> low risk of infection
- Most important prevention adequate irrigation & debridement
- The major role of these sutures is to reduce tension. They are also used to close dead spaces. Placement of deep dermal sutures. The needle is inserted at the depth of the dermis and directed upward, exiting beneath the dermal-epidermal junction. Then the needle is inserted across the wound and directed downward, exiting at the wound base. The suture knot is then placed deep in the wound.
- Individual sutures: -If one loosens, remainder unaffected -If wound becomes infected, may remove individuallyUse
- Quick technique-Only two knots are tied (one at each end) Best for wounds that are linear May accommodate wound swelling Sutures are not independent sutures: -If one breaks or one end unties, all are affected -If wound becomes infected, must remove all -May invert wound margins
- useful alternative to two-layer closure in a patient who is at high risk for developing a wound infection. Quicker to place than vertical mattress sutures -Covers more distance with each suture Generally allow for better wound margin eversion -Result 2 –3 months later is often more cosmetic Helpful for wounds that are under tension-especially around joints
- Enhances skin eversion -Maximizes precise skin-to-skin coaptation Helpful for wounds that are deeper, in areas of lax skin, or when the skin margins tend to invert Scarring may be inferior to other techniques May be used as an “all-in-one” suture -Deep and superficial –at the same time