Classification of wounds :
1. Simple v/s Complex
* Simple - Only skin is involved
* Complex - Underlying structures like nerves, vessles, tendons etc are also involved.
2. Closed v/s Open
* Closed - Contusion, hematoma etc.
* Open - Abrasion, Lacerated wound, Incised wound, Stab injury, Degloving injury etc.
3. Acute vs Chronic
* Acute - Lacerated wound, Incised wound etc.
* Chronic - Pressure sore, Venous ulcer etc
4. Tidy vs Untidy
* Tidy - e.g. Incised wound (by sharp object)
* Untidy - e.g. Lacerated wound (by blunt object)
5. Clean/ Clean contaminated/ Contaminated/ Dirty
Class I - Clean wound :
- Wounds of elective surgery with aseptic technique
- No hollow viscus, which normally contains bacteria, is opened (e.g.Gastrointestinal, Genitourinary or Respiratory tract)
Examples : Vascular surgery, Mastectomy, Herniorrhaphy, Total hip replacement, Exploratory laparotomy (with no bowel involvement) etc.
[Infection rate : 2%]
Class II - Clean contaminated wound :
- Gastrointestinal, Genitourinary or Respiratory tract is opened, but there is no spillage (minimum contamination)
Examples : Appendectomy, Cholecystectomy etc.
[Infection rate : 10 %]
Class III - Contaminated wound :
- Gross spillage from an unprepared organ
- Fresh, traumatic wounds
Examples : Resection of unprepared bowel, Ruptured appendix
[Infection rate : 20 %]
Class IV - Dirty wound :
- Pus in operative field
- Traumatic perforation of viscus
- Dirty, traumatic wounds
Examples : Debridement, Incision & drainage of abscess, Fecal peritonitis etc.
[Infection rate : 30-70%]
Phases of wound healing :-
1. Inflammatory phase (lag phase)
2. Proliferative phase (collagen phase)
3. Remodelling phase (maturation)
Factors affecting wound healing :
🅰) General factors -
Age (faster in children), Nutritional status (specially hypoproteinemia, Vitamin C and Zinc deficiency), Diabetes, Jaundice, Uremia, Drugs (steroids, cytotoxic drugs).
🅱) Local factors -
Infection, Vascularity (heals better on face & scalp), Hematoma, Radiation, Faulty technique.
Types of wound healing :
(a) Healing by primary intention (aka Primary wound healing)~
* Occurs when wound edges are cleaned & approximated towards each other by suturing.
* Best choice for a clean, fresh wound.
* Healing is comparatively faster & scar is cosmetically better.
(b) Healing by secondary intention (aka Secondary wound healing)~
* Occurs when wound edges are not approximated and wound heals by granulation tissue & epithelization.
* Commonly done in cases with contaminated & infected wounds.
* Comparatively a slower procedure & results in an uglier scar.
(c) Healing by tertiary intention (aka Delayed primary closure)~
If a wound is heavily contaminated at presentation, it may not be wise to do a primary closure.
In such cases, it is initially cleaned & debrided, but not sutured.
Regular dressing is performed and after few days, wound is reassessed for infection & vascularity.
If there is an improvement, edges are approximated by suturing.
Primary v/s Secondary suturing :
1.Primary suturing
Within few hours after injury (Ideal time - within 6 hours)
2. Secondary suturing
If sutured wound gets reopened because of poor healing (due to infection etc.)
--->Control the infection, and suture it again after refreshing its edges. This is known as secondary suturing.
Hypertrophic scar v/s Keloid
♻ Hypertrophic scar :
Occurs due to prolonged 'inflammatory phase' of wound healing. Hypertrophy of mature fibroblasts.
Non-tender, Not vascular, No itching
Does not extend beyond the boundary of original incision
Rx - Conservative, Stockings, Excision etc
♻ Keloid :
Proliferation of immature fibroblasts & immature blood vessels.
Tender, Vascular, Severe itching
Extends beyond the boundary of original incision in normal tissue (Claw-like projections)
Familial
More common in Negros
Common sites - Sternum, ear lobe, shoulder etc
Recurrence is common after excision.
Rx - Intralesional steroid injection
1. Simple v/s Complex
* Simple - Only skin is involved
* Complex - Underlying structures like nerves, vessles, tendons etc are also involved.
2. Closed v/s Open
* Closed - Contusion, hematoma etc.
* Open - Abrasion, Lacerated wound, Incised wound, Stab injury, Degloving injury etc.
3. Acute vs Chronic
* Acute - Lacerated wound, Incised wound etc.
* Chronic - Pressure sore, Venous ulcer etc
4. Tidy vs Untidy
* Tidy - e.g. Incised wound (by sharp object)
* Untidy - e.g. Lacerated wound (by blunt object)
5. Clean/ Clean contaminated/ Contaminated/ Dirty
Class I - Clean wound :
- Wounds of elective surgery with aseptic technique
- No hollow viscus, which normally contains bacteria, is opened (e.g.Gastrointestinal, Genitourinary or Respiratory tract)
Examples : Vascular surgery, Mastectomy, Herniorrhaphy, Total hip replacement, Exploratory laparotomy (with no bowel involvement) etc.
[Infection rate : 2%]
Class II - Clean contaminated wound :
- Gastrointestinal, Genitourinary or Respiratory tract is opened, but there is no spillage (minimum contamination)
Examples : Appendectomy, Cholecystectomy etc.
[Infection rate : 10 %]
Class III - Contaminated wound :
- Gross spillage from an unprepared organ
- Fresh, traumatic wounds
Examples : Resection of unprepared bowel, Ruptured appendix
[Infection rate : 20 %]
Class IV - Dirty wound :
- Pus in operative field
- Traumatic perforation of viscus
- Dirty, traumatic wounds
Examples : Debridement, Incision & drainage of abscess, Fecal peritonitis etc.
[Infection rate : 30-70%]
Phases of wound healing :-
1. Inflammatory phase (lag phase)
2. Proliferative phase (collagen phase)
3. Remodelling phase (maturation)
Factors affecting wound healing :
🅰) General factors -
Age (faster in children), Nutritional status (specially hypoproteinemia, Vitamin C and Zinc deficiency), Diabetes, Jaundice, Uremia, Drugs (steroids, cytotoxic drugs).
🅱) Local factors -
Infection, Vascularity (heals better on face & scalp), Hematoma, Radiation, Faulty technique.
Types of wound healing :
(a) Healing by primary intention (aka Primary wound healing)~
* Occurs when wound edges are cleaned & approximated towards each other by suturing.
* Best choice for a clean, fresh wound.
* Healing is comparatively faster & scar is cosmetically better.
(b) Healing by secondary intention (aka Secondary wound healing)~
* Occurs when wound edges are not approximated and wound heals by granulation tissue & epithelization.
* Commonly done in cases with contaminated & infected wounds.
* Comparatively a slower procedure & results in an uglier scar.
(c) Healing by tertiary intention (aka Delayed primary closure)~
If a wound is heavily contaminated at presentation, it may not be wise to do a primary closure.
In such cases, it is initially cleaned & debrided, but not sutured.
Regular dressing is performed and after few days, wound is reassessed for infection & vascularity.
If there is an improvement, edges are approximated by suturing.
Primary v/s Secondary suturing :
1.Primary suturing
Within few hours after injury (Ideal time - within 6 hours)
2. Secondary suturing
If sutured wound gets reopened because of poor healing (due to infection etc.)
--->Control the infection, and suture it again after refreshing its edges. This is known as secondary suturing.
Hypertrophic scar v/s Keloid
♻ Hypertrophic scar :
Occurs due to prolonged 'inflammatory phase' of wound healing. Hypertrophy of mature fibroblasts.
Non-tender, Not vascular, No itching
Does not extend beyond the boundary of original incision
Rx - Conservative, Stockings, Excision etc
♻ Keloid :
Proliferation of immature fibroblasts & immature blood vessels.
Tender, Vascular, Severe itching
Extends beyond the boundary of original incision in normal tissue (Claw-like projections)
Familial
More common in Negros
Common sites - Sternum, ear lobe, shoulder etc
Recurrence is common after excision.
Rx - Intralesional steroid injection
