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Principles of Wound Management

Principles of Wound Management. Abdelrahman S-E Imbabi, FRCSEd Assistant Professor of Surgery University of Khartoum. Traumatic Wounds. Usually untidy Damage to tissues is extensive, and extent unclear – such as gunshot or blast injuries, crush injuries, lacerations or burns And contaminated

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Principles of Wound Management

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  1. Principles of Wound Management Abdelrahman S-E Imbabi, FRCSEd Assistant Professor of SurgeryUniversity of Khartoum

  2. Traumatic Wounds • Usually untidy • Damage to tissues is extensive, and extent unclear – such as gunshot or blast injuries, crush injuries, lacerations or burns • And contaminated • Most traumatic wounds are potentially contaminated, and hence likely to be infected

  3. Aim of managing wounds • To obtain healing by primary intention • Quick and easy • Smaller scars • Less contracture and deformity • Better looking

  4. Healing of untidy wounds • With untidy or infected wounds, loss of tissue is extended, and primary healing cannot be achieved • Such wounds heal by secondary intention • Prolonged and complicated healing process • Involves much fibrous tissue and scarring • Gross contractures and deformity • Ugly appearance

  5. Dealing with untidy wounds • The prime aim is to convert untidy and contaminated or infected wounds to tidy clean wounds which can heal by primary intention

  6. How can this be achieved • All dead and devitalized tissues MUST BE REMOVED • All dirt and gross contamination should be physically washed out, or picked up by forceps • Avoid further injury to surrounding healthy tissues

  7. How can this be achieved

  8. Wounds less than 6 hours • Generally, wounds less than 6 hours old may be closed primarily (preferably with drain), however, it is safer practice to leave the wound open, and re-evaluate after 3-5 days, whence if the wound is clean perform a delayed primary closure. • Broad spectrum antibiotic cover • Anti-tetanus prophylaxis

  9. Wounds more than 6 hours • For wounds older than 6 hours, or there is evidence of gross infection, or vitality of surrounding tissues is in doubt: • Keep the wound open • Take culture swabs and start broad spectrum antibiotics, modified later according to culture and sensitivity • Anti-tetanus prophylaxis • Re-evaluate the wound daily and debride as necessary (may require more frequent dressings)

  10. Then what ? • If loss of tissues prevents non-tense primary closure, then preferably resort to either: • Skin grafting • Local or distant flaps, with or without muscle • Combination of muscle flap with skin grafting

  11. What else ? • For proper wound healing: • Surrounding tissues must be well vascularized, hence good debridement down to bleeding tissues • Adequate oxygenation, hence improve tissue perfusion and oxygen-carrying capacity • Moisture; dehydration kills cells and tissues • Balanced nutrition with positive nitrogen balance and calories • Non-compromised immune system

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