Introduction to Wounds

Wounds are injuries that break the skin or other body tissues, leading to a disruption in the body's
normal structure. They are commonly caused by accidents, cuts, punctures, scrapes, or surgical
incisions.
Classification of Wounds
Wounds can be classified based on various factors, including their cause, depth, and appearance. Here
are some common classifications of wounds:

Open Wounds:

Incised Wounds: These are clean, straight cuts caused by sharp objects, such as knives or glass.
Lacerations: Lacerations are irregular, jagged wounds caused by blunt force trauma or tearing
of the skin.
Puncture Wounds: Puncture wounds are deep, narrow wounds caused by sharp, pointed
objects, such as nails or needles.
Abrasions: Abrasions are superficial wounds that occur when the skin rubs against a rough
surface, resulting in a scrape or graze.
Avulsions: Avulsions are wounds where a portion of the skin or tissue is torn away, often due to
a traumatic injury.

Closed Wounds:
Contusions: Contusions, also known as bruises, are caused by blunt force trauma that damages
blood vessels under the skin.

Hematoma: A hematoma is a collection of blood outside of blood vessels, usually resulting from
a significant impact or injury.

Crush Injuries: Crush injuries occur when a body part is subjected to high pressure or
compression, causing damage to the underlying tissues.
Acute vs Chronic Wounds: Wounds can also be classified based on their duration. Acute wounds
are typically caused by a sudden injury and progress through the normal stages of healing. Chronic
wounds, on the other hand, fail to progress through the healing process in a timely manner and
may be associated with underlying health conditions or impaired healing mechanism.
OPEN WOUNDS

Abrasion Wounds Puncture Wounds Laceration Wounds

Abrasions occur when the skin These wounds are caused by a Lacerations result from a
is scraped or rubbed away pointed object piercing the tearing of the skin, often
through friction, such as a skid skin, leading to a small, deep caused by sharp objects like
mark or rug burn. hole. knives or broken glass.
Causes of Wounds

1 Accidents
Common causes include falls, automobile crashes, workplace mishaps, and domestic
injuries.

2 Violence
Wounds may result from assault, abuse, or unintentional injuries caused by others.

3 Surgical Procedures
Intentional incisions or cuts made during operations lead to surgical wounds.
The Wound Healing Process
Wound healing is a complex process that involves several stages:

1. Hemostasis: The body responds to the injury by constricting the blood vessels and forming a
blood clot to stop bleeding.

2. Inflammation: In this stage, the body's immune system activates to fight off any potential
infections. The area becomes red, swollen, and warm.

3. Proliferation: New blood vessels form, and the wound begins to fill in with granulation tissue. The
body produces collagen, a protein that helps strengthen the wound.

4. Remodeling: In this final stage, the wound continues to heal as the collagen fibers reorganize and
mature. The scar tissue gradually becomes stronger and less visible over time.

It's important to follow proper wound care during each stage of the healing process to promote
optimal healing and minimize complications.
Hemostasis Phase
The hemostasis phase is the initial stage of wound healing that occurs
immediately after the injury. It involves the following processes:

1. Vasoconstriction: When a wound occurs, the blood vessels in the

area constrict to reduce blood flow and minimize bleeding.
2. Platelet aggregation: Platelets in the blood adhere to the injured site
and form a platelet plug to stop bleeding.

3. Coagulation: The coagulation cascade is activated, leading to the

formation of a blood clot. This involves a series of chemical reactions
that result in the conversion of fibrinogen to fibrin, forming a mesh-like
structure that reinforces the platelet plug.
4. Clot retraction: The blood clot undergoes retraction, which helps to
bring the wound edges closer together and facilitate the subsequent
phases of wound healing.

The hemostasis phase is essential for controlling bleeding and creating a

foundation for the subsequent phases of wound healing.
Inflammation Phase
The inflammation phase is the second stage of the wound healing process. It is characterized by a
series of events that occur in response to tissue injury and aim to remove any potential pathogens
and foreign substances, and initiate the repair process. The inflammation phase involves the following
key processes:

Vasodilation: Blood vessels in the injured area widen, allowing increased blood flow to the site of
injury. This results in redness and warmth.
Increase in Vascular Permeability: The blood vessels become more permeable, allowing fluid and
immune cells to migrate from the bloodstream into the surrounding tissue.

Migration of Immune Cells: White blood cells, such as neutrophils and macrophages, are recruited
to the site of injury to eliminate bacteria, debris, and foreign substances.
Release of Chemical Mediators: Various chemical mediators, including histamine, cytokines, and
growth factors, are released to promote vasodilation, increase vascular permeability, and attract
immune cells to the site of injury.
Phagocytosis: Neutrophils and macrophages engulf and digest bacteria, dead cells, and debris to
clear the wound of potential contaminants.

The inflammation phase is crucial for initiating the wound healing process and preparing the wound for
the subsequent stages of repair.
Proliferation Phase
The proliferation phase is the third stage of the wound he

aling process. It is characterized by the formation of new tissue and the

restoration of the wound bed. The proliferation phase involves the
following key processes:

Granulation Tissue Formation: Granulation tissue, which is

composed of new blood vessels, fibroblasts, and extracellular matrix,
fills the wound bed. This tissue provides a framework for the migration
of epithelial cells and supports wound healing.

Epithelialization: Epithelial cells at the wound edges start to migrate

and proliferate, eventually covering the wound surface. This process is
essential for wound closure and the formation of a new epidermis.
Collagen Production: Fibroblasts in the wound bed synthesize and
deposit collagen, which provides strength and structural support to
the healing wound.
Contraction: Myofibroblasts, specialized contractile cells, exert forces
on the wound edges, leading to wound contraction. This helps reduce
the wound size and bring the wound edges closer together.

The proliferation phase is vital for the formation of new tissue, wound
closure, and the reestablishment of tissue integrity.
Remodeling/Maturation Phase
The remodeling/maturation phase is the final stage of the wound healing process. It involves the
remodeling and strengthening of the newly formed tissue. The key processes during this phase
include:

Collagen Remodeling: The collagen fibers formed during the earlier phases of wound healing
undergo remodeling and reorganization. This helps improve the strength and structure of the
healed wound.
Scar Formation: During the remodeling phase, the scar tissue continues to mature and undergo
changes in appearance and texture. The scar gradually becomes less prominent and more similar
to the surrounding skin.

Wound Contraction: The wound may continue to undergo contraction during the remodeling
phase, further reducing its size. This process helps to close the wound and improve its cosmetic
appearance.

The remodeling/maturation phase can take several months to years, and the final outcome of the
healed wound depends on various factors, including the individual's overall health, wound location, and
the extent of the initial injury.
Factors Affecting the Healing Process
The healing process of wounds can be influenced by various factors, including:

Age: Younger individuals tend to heal faster than older individuals due to better cell regeneration
and immune function.
Nutrition: A balanced diet with adequate protein, vitamins, and minerals is essential for proper
wound healing.

Chronic Conditions: Pre-existing chronic conditions such as diabetes, obesity, and autoimmune
disorders can impair the healing process.
Infection: Infections can significantly delay wound healing. Prompt treatment and prevention of
infections are crucial.
Smoking: Smoking can impair blood flow and decrease oxygen supply to the wound, hindering the
healing process.

Medications: Certain medications, such as corticosteroids and immunosuppressants, can

interfere with the healing process.
Wound Care: Proper wound care, including cleaning, dressing, and protecting the wound, is
essential for optimal healing.

Understanding these factors can help healthcare professionals and individuals take necessary steps to
promote effective wound healing.
Treatment Options for Wounds
When it comes to the treatment of wounds, there are several options available, depending on the type
and severity of the wound. The following are common treatment options:

Cleaning and Disinfection: Proper cleaning of the wound is essential to remove debris and reduce
the risk of infection. This can be done using mild soap and water or a wound cleanser. Disinfection
with an antiseptic solution may also be recommended.
Wound Dressings: Applying an appropriate wound dressing helps create an optimal healing
environment. There are various types of wound dressings available, such as gauze, films,
hydrocolloids, and foams. The choice of dressing depends on factors like wound type, exudate
level, and desired moisture balance.

Topical Medications: In some cases, topical medications may be prescribed or recommended to

facilitate wound healing. This may include antibiotic ointments, antimicrobial dressings, or growth
factors.
Debridement: Debridement involves the removal of dead or unhealthy tissue from the wound. It
can be done through various methods, such as surgical debridement, enzymatic debridement,
mechanical debridement, or autolytic debridement.

Wound Closure: Depending on the nature of the wound, it may require closure through sutures,
staples, adhesive strips, or tissue adhesives. This helps bring the wound edges together and
promotes healing.

Supportive Measures: Along with the direct treatment of the wound, certain supportive measures
can aid in the healing process. This includes proper nutrition, hydration, pain management, and
addressing underlying health conditions.

It's important to consult with a healthcare professional to determine the most appropriate treatment
plan for a specific wound.
Complications
While most wounds heal without any issues, there can be complications that may hinder the healing
process. Some common complications include:

Infection: Wounds that are not properly cleaned or protected can become infected, leading to
delayed healing and potential systemic infections.
Delayed Healing: Certain factors, such as poor nutrition, chronic illnesses, or certain medications,
can slow down the healing process.

Excessive Scar Tissue Formation: Some individuals may develop excessive scar tissue, also
known as keloids or hypertrophic scars, which can cause discomfort or affect the appearance of
the healed wound.
Dehiscence: Dehiscence refers to the reopening of a previously closed wound. This can occur due
to factors such as infection, poor wound care, or excessive strain on the wound site.
Chronic Wounds: Some wounds may become chronic, meaning they fail to heal within the
expected timeframe. Chronic wounds may require specialized treatment and ongoing care.

It's important to monitor wounds closely for any signs of complications and seek medical attention if
necessary. Early intervention can help prevent further complications and promote proper healing.
 Wound Dressing

Wound dressing refers to the materials and techniques used to cover and protect a wound during the
healing process. It involves the application of various types of dressings, such as bandages, gauze,
adhesive strips, hydrogels, foams, or films, depending on the type and severity of the wound.

The primary goals of wound dressing are:

Protection: Dressings provide a physical barrier that shields the wound from external
contaminants, such as dirt, bacteria, and other microorganisms.
Promotion of Healing: Dressings create an optimal environment for wound healing by maintaining
moisture balance, supporting autolytic debridement, and facilitating the growth of healthy tissue.

Management of Exudate: Proper wound dressings help manage wound drainage and excess fluid,
preventing complications such as maceration or infection.
Pain Relief: Some dressings contain analgesic properties or provide a cushioning effect, which can
help alleviate pain or discomfort associated with the wound.
Patient Comfort: Dressings should be comfortable and non-irritating to promote patient
compliance and overall well-being.

The choice of wound dressing depends on factors such as the type of wound, the stage of healing, the
amount of exudate, and the individual's specific needs. Healthcare professionals assess the wound
and select an appropriate dressing to optimize the healing process and prevent complications.
Types of Wound Dressings
There are several types of wound dressings available, each with its own properties and benefits. The
choice of dressing depends on factors such as the type of wound, the stage of healing, and the
individual's specific needs. Here are some common types of wound dressings:

1. Gauze Dressings
Gauze dressings are made of woven or non-woven material and are available in various forms, such as
pads, rolls, or strips. They are highly absorbent and can be used for different types of wounds,
including surgical wounds and moderate to heavy exudating wounds.

2. Hydrocolloid Dressings
Hydrocolloid dressings are made of a gel-forming material and have a self-adhesive backing. They
create a moist environment that promotes healing and can be used for low to moderately exudating
wounds, such as pressure ulcers or shallow wounds.

3. Foam Dressings
Foam dressings are soft and absorbent, providing cushioning and protection for the wound. They can
be used for wounds with moderate to heavy exudate, such as leg ulcers or post-operative wounds.

4. Alginate Dressings
Alginate dressings are made of seaweed-derived fibers and are highly absorbent. They are suitable for
heavily exudating wounds, such as diabetic ulcers or venous leg ulcers.

5. Transparent Film Dressings

Transparent film dressings are thin, flexible, and adhesive. They provide a barrier against bacteria and
promote a moist wound environment. They can be used for superficial wounds or as a secondary
dressing.

6. Hydrogel Dressings
Hydrogel dressings contain a high percentage of water and provide moisture to the wound. They are
suitable for dry or necrotic wounds and can help facilitate autolytic debridement.

It's important to consult with a healthcare professional to determine the most appropriate type of
dressing for your specific wound and to receive proper instructions on application and changing
frequencies.
Principles Involved in Wound
Dressings
When it comes to wound dressings, there are several key principles to keep in mind. These principles
guide healthcare professionals in selecting and applying the most appropriate dressings for optimal
wound healing. Here are some important principles involved in wound dressings:

1. Cleanliness and Sterility

Wound dressings should be applied in a clean and sterile manner to minimize the risk of infection.
Healthcare professionals follow proper hand hygiene and use sterile techniques when handling
dressings to prevent contamination.

2. Moisture Balance
Maintaining an optimal moisture balance in the wound is crucial for successful healing. Some wounds
require a moist environment to support cellular migration and tissue regeneration, while others may
benefit from a drier environment to prevent maceration. Dressings are chosen accordingly to promote
the appropriate moisture balance.

3. Wound Protection
Dressings serve as a protective barrier, shielding the wound from external contaminants and
mechanical trauma. They should be able to withstand the stresses of daily activities and provide a
barrier against bacteria and other microorganisms.

4. Absorption and Exudate Management

Proper management of wound exudate is essential for wound healing. Dressings should have the ability
to absorb excess exudate while maintaining a moist environment. This helps prevent complications
such as maceration or infection.

5. Facilitation of Healing
Wound dressings can help facilitate the healing process by providing a favorable environment for
cellular growth and tissue regeneration. Some dressings have properties that support autolytic
debridement, promote angiogenesis, or enhance granulation tissue formation.

6. Patient Comfort
Patient comfort is an important consideration when selecting wound dressings. Dressings should be
comfortable, non-irritating, and minimize pain or discomfort associated with the wound. They should
also be easy to apply and remove without causing additional trauma.

By following these principles, healthcare professionals can ensure that wound dressings are applied
effectively to promote optimal healing and minimize complications.
Equipments Required for Dressings

Gloves
Antiseptic solution

Cotton balls or swabs

Gauze pads

Tape or adhesive strips

Scissors

Forceps

Disposable bags

Waste container
Top shelf dressing kit
Equipment Preparation
Before starting the dressing process, it's important to prepare the necessary equipment. Here are the
steps for equipment preparation:

1. Gather all the required equipment listed in the previous card "Equipments Required for Dressings".

2. Ensure that the equipment is clean and sterile.

3. Organize the equipment in a clean and accessible area.

4. Check the expiration dates of any disposable items and discard them if expired.
Method/Procedure of Dressings
Follow these steps for performing wound dressings:

1. Wash your hands thoroughly with soap and water, or use hand sanitizer.
2. Put on gloves and other personal protective equipment, if necessary.
3. Cleanse the wound using an antiseptic solution and sterile cotton balls or swabs.
4. Apply the appropriate type of wound dressing, considering the type and severity of the wound.
5. Secure the dressing in place using tape or adhesive strips.
6. Dispose of used materials properly in disposable bags and discard them in a waste container.
7. Document the dressing procedure and any observations or changes in the wound.
8. Wash your hands again after removing gloves and disposing of waste.
Sterile Tray Containing Wound
Dressing Equipment
Item Quantity Notes

Gloves 2 pairs Non-sterile gloves for initial

setup and sterile gloves for
dressing change

Gauze pads 10-20 For cleaning and padding

Adhesive tape 1 roll For securing the dressing in

place

Scissors 1 pair For cutting gauze and tape to

size

Forceps/tweezers 1 pair For handling sterile dressings

Antiseptic solution 1 bottle For cleaning the wound

Sterile saline solution 1-2 bottles For moistening gauze and

irrigating the wound

Non-adherent dressing 1-2 For covering the wound and

preventing adherence to the
dressing

Transparent film dressing 1-2 For wounds with minimal

exudate or as a secondary
dressing for securing the
primary dressing

Hydrocolloid dressing 1-2 For wounds with moderate

exudate and as a primary
dressing for partial thickness
wounds

Foam dressing 1-2 For wounds with heavy

exudate and as a primary
dressing for full thickness
wounds
Topical agents for Cleaning wounds
Mercurochrome 1 to 2.5% = Skin Antiseptic.
Tr. Iodine 1 to 2% = Non-Irritating antiseptics used for cleaning of wounds.

Savlon 5%
Cetavlon 1%

Normal saline/Eusol solution 0.5 to 1%

Acetone, ether, turpentine = Used for removing adhesive marks from the skin.
After care of the patient and articles
Help the patient to dress up and to take comfortable position in the bed. Change the garments if
soiled with drainage.

Replace the bed linen.

Remove the mackintosh and towel.

Take all articles to the utility room. Discard the soiled dressing into a covered container and send
for incineration. Remove the instruments and other articles from the disinfectant solution and
clean them thoroughly. Dry them. Re-set the tray and send them for autoclaving. Replace all other
articles to their proper places. Send the soiled linen to the laundary bag for the washing.
Wash hands.
Record the procedure on nurse's record with date and time. Record the condition of the wound,
type and amount of drainage, condition of the sutures etc. on the nurses record. Report to the
surgeon if any abnormality found.

Return to the bedside to assess the comfort of the patient. Special instruction in the care of the
wound are to be communicated to the patient.
Tidy up the bed and unit of the patient.
THANK YOU….