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འབྲུག་རྒྱལ་འཛིན་གཙུག་ལག་སློབ་སྡེ།
རང་འབྱུང་འཐློན་བསྡེད་མཐློ་རིམ་སློབ་ྲྭ།
སྤུ་ན་ཁ་རློང་ཁག།
ལློད་སྦུད་ས།
དློག་ཏྲར་་་འཇིགས་འབྡེལ་རློ་རྡེ།
རང་འབྱུང་འཐློན་བསྡེད་མཐློ་རིམ་སློབ་ྲྭ། སྤུ་ན་ཁ་རློང་ཁག།
ལློད་སྦུད་ས།
Wound
W O U N D
1
2
W O U N D
Learning Outcome
After the completion of this lesson, each student should
be able to;
1. Define Wound.
2. Classification of Wound
3. Process of Wound Healing
4. Treatment
3
W O U N D
Definition of Wound
A wound is defined as;
 Separation or Discontinuity of the Skin, Mucus
Membrane or Tissue Surface caused by
Physical, Chemical or Biological Insult.
4
W O U N D
Causes of Wound
 Trauma or external violence,
 Sharp objects
5
W O U N D
Classification of Wound
Open
Closed
Incised
Lacerated
Penetrating
Gunshot
Poisoned
Bite
Virulent
Ulcerative
Erosive
Punctured
Abrasion
Contusion
6
W O U N D
1. Incised Wound:
 Caused by sharp cutting instrument such as knives , Scalpels,
fragments of glass etc. with minimum loss of tissues, regular
edges, bleeds freely and Painful.
2. Lacerated Wound:
 Caused by tearing of tissues with torn and uneven edges.
Wounds have irregular jagged borders and loss of tissue is
limited skin and subcutaneous tissue. Eg. Barbed wire.
Open Wound
Open Wound: Discontinuity in the skin and other
covering tissues to a varying depth.
7
W O U N D
4. Perforating wound:
 One having two openings, entrance and exit.
5. Punctured Wound:
 Caused by sharp pointed objects like nails relatively
with small opening. Infection/foreign particles may
be present deep into the wound with inadequate
drainage Eg. Stab wound.
6. Gunshot wound:
 Produced by various forms of firearms. Eg Bullet
8
W O U N D
7. Bite Wound:
• Caused by bites of the animals.eg Dog bite, Snake bite.
8. Virulent Wound:
• Caused by Virus or bacteria leading to formation of pustules,
or vesicles. Eg. FMD, Anthrax
9. Granulating Wound:
that has tendency to heal within expected time.
10. Aseptic Wound:
• Surgical wound made under aseptic conditions where
chances of bacterial contamination is negligible.
9
W O U N D
11. Contaminated Wound:
 Wound where there is bacterial contamination.
12. Infected/Septic Wound
 A contaminated wound may become infected after a period of
6-8 hours where bacterial multiplication may occur and
liberation of their toxins.
3. Penetrating wound:
 Type of deep wounds communicating with cavities like
abdomen, thorax and joints etc. e.g. Stab wound.
10
W O U N D
Closed Wound/Internal Wound
Only deeper tissues, muscles, nerves, barring the skin or mucus
membrane are damaged.
1. Contusion/Bruises:
 Injury to the skin without any break in the continuity of the
tissue surface. Usually caused by blunt objects and the SC
tissues, muscles and nerves are damaged to a varying degree.
2. Abrasions:
Area of body denuded of skin or mucus membrane. Only
superficial tissues are involved.
11
W O U N D
Wound Healing
May be achieved by :
1. First Intension healing
2. Second Intension healing
3. Mixed Intension healing
4. Third Intension healing
5. Healing under scab
12
W O U N D
First Intension Healing (primary union)
Condition required
- clean and fresh,
- free from infection,
- no foreign body,
- good blood supply
- and properly immobilised
Healing process
-Space between the wound edges is first filled with blood clot.
- Capillaries and fibroblast cells grow into the space
- and unite the wound edges.
- Healing normally completes by five to fourteen days.
13
W O U N D
Second Intension healing (healing by
replacement)
- takes place in wound with extensive loss of tissue
- or when the wound edges are widely separated
Process
 The gap gets filled with capillaries and fibroblast cells growing
from the sides and bottom of the wound.
 At the end of the healing fibrous tissue contracts and closes
most of the capillaries causing paleness of scar tissue.
 The healing completes by fifteen to twenty days
 but large wound with extensive loss of tissue may take six
weeks or more.
14
W O U N D
Mixed Intension Healing:
 Healing partly by first intension and partly by second
intension noticed when a sutured wound has partially
disrupted area where the suture remains intact heals by first
intension healing in the suture disrupted area healing by
second intension healing
Third Intension Healing
 Is also called healing by secondary suture noticed in wound
with extensive loss of tissue, which other wise will heal by
second intension healing.
 Gap between the wound edges is narrowed by suturing to
promote faster healing.
15
W O U N D
Healing under scab:
 This healing takes place in superficial wound where inner
tissue is not damaged but only the skin is damaged. Example
superficial wound like abrasion exudates dries up on the
surface forming a crust / scab
 The healing takes place beneath the scab.
 Do not remove the scab - hemorrhage
16
W O U N D
Management of Wound
Basic Principles of Infected Wound Treatment Strategies
are as follows.
1. Debridement: The procedure will help manage septic wound
by providing access to the depth of the wound.
 All necrotic tissue debris and foreign materials should be
removed until clean healthy tissue margin is achieved.
2.Lavage: After removal of necrotic debris, healthy exposed
tissues should be adequately irrigated with NSS or 2% H2o2
17
W O U N D
 If the wound has accumulated exudate using catheters, or rubber
tubes. Incision for drainage should be on the direct route
possibly away from tendons and major blood vessels.
 Drainage of large volume of fluid from wounds should be done
slowly.
 The wound space should be filled with sterile bandages dipped
in betadine or Povidone iodine and removed after 24-48 hrs.
 Regular dressing is advised daily to prevent infection.
3. Wound Drainage:
18
W O U N D
4. Antimicrobial Therapy:
 Infected wound should be treated with antibiotics based on
CST.
 Intravenous loading dose of antibiotics should be continued
for 10-14 days.
5. Sterile Protective Bandaging: is a good practice to avoid
infection with opportunistic organisms and to prevent
environmental contamination.
19
W O U N D
1.Control of hemorrhage
- Tourniquet
- Thermocautery
- Crushing with forceps
- Torsion of vessel
- Ligation/ligature
- Injection
- Vitamin K
SA @0. 5 – 1 ml im
LA @ 10 –20 ml im
- calcium
5 – 10 ml in DNS
General Line of Wound Treatment
20
W O U N D
TRASHI DELEK

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Wound

  • 2. 2 W O U N D Learning Outcome After the completion of this lesson, each student should be able to; 1. Define Wound. 2. Classification of Wound 3. Process of Wound Healing 4. Treatment
  • 3. 3 W O U N D Definition of Wound A wound is defined as;  Separation or Discontinuity of the Skin, Mucus Membrane or Tissue Surface caused by Physical, Chemical or Biological Insult.
  • 4. 4 W O U N D Causes of Wound  Trauma or external violence,  Sharp objects
  • 5. 5 W O U N D Classification of Wound Open Closed Incised Lacerated Penetrating Gunshot Poisoned Bite Virulent Ulcerative Erosive Punctured Abrasion Contusion
  • 6. 6 W O U N D 1. Incised Wound:  Caused by sharp cutting instrument such as knives , Scalpels, fragments of glass etc. with minimum loss of tissues, regular edges, bleeds freely and Painful. 2. Lacerated Wound:  Caused by tearing of tissues with torn and uneven edges. Wounds have irregular jagged borders and loss of tissue is limited skin and subcutaneous tissue. Eg. Barbed wire. Open Wound Open Wound: Discontinuity in the skin and other covering tissues to a varying depth.
  • 7. 7 W O U N D 4. Perforating wound:  One having two openings, entrance and exit. 5. Punctured Wound:  Caused by sharp pointed objects like nails relatively with small opening. Infection/foreign particles may be present deep into the wound with inadequate drainage Eg. Stab wound. 6. Gunshot wound:  Produced by various forms of firearms. Eg Bullet
  • 8. 8 W O U N D 7. Bite Wound: • Caused by bites of the animals.eg Dog bite, Snake bite. 8. Virulent Wound: • Caused by Virus or bacteria leading to formation of pustules, or vesicles. Eg. FMD, Anthrax 9. Granulating Wound: that has tendency to heal within expected time. 10. Aseptic Wound: • Surgical wound made under aseptic conditions where chances of bacterial contamination is negligible.
  • 9. 9 W O U N D 11. Contaminated Wound:  Wound where there is bacterial contamination. 12. Infected/Septic Wound  A contaminated wound may become infected after a period of 6-8 hours where bacterial multiplication may occur and liberation of their toxins. 3. Penetrating wound:  Type of deep wounds communicating with cavities like abdomen, thorax and joints etc. e.g. Stab wound.
  • 10. 10 W O U N D Closed Wound/Internal Wound Only deeper tissues, muscles, nerves, barring the skin or mucus membrane are damaged. 1. Contusion/Bruises:  Injury to the skin without any break in the continuity of the tissue surface. Usually caused by blunt objects and the SC tissues, muscles and nerves are damaged to a varying degree. 2. Abrasions: Area of body denuded of skin or mucus membrane. Only superficial tissues are involved.
  • 11. 11 W O U N D Wound Healing May be achieved by : 1. First Intension healing 2. Second Intension healing 3. Mixed Intension healing 4. Third Intension healing 5. Healing under scab
  • 12. 12 W O U N D First Intension Healing (primary union) Condition required - clean and fresh, - free from infection, - no foreign body, - good blood supply - and properly immobilised Healing process -Space between the wound edges is first filled with blood clot. - Capillaries and fibroblast cells grow into the space - and unite the wound edges. - Healing normally completes by five to fourteen days.
  • 13. 13 W O U N D Second Intension healing (healing by replacement) - takes place in wound with extensive loss of tissue - or when the wound edges are widely separated Process  The gap gets filled with capillaries and fibroblast cells growing from the sides and bottom of the wound.  At the end of the healing fibrous tissue contracts and closes most of the capillaries causing paleness of scar tissue.  The healing completes by fifteen to twenty days  but large wound with extensive loss of tissue may take six weeks or more.
  • 14. 14 W O U N D Mixed Intension Healing:  Healing partly by first intension and partly by second intension noticed when a sutured wound has partially disrupted area where the suture remains intact heals by first intension healing in the suture disrupted area healing by second intension healing Third Intension Healing  Is also called healing by secondary suture noticed in wound with extensive loss of tissue, which other wise will heal by second intension healing.  Gap between the wound edges is narrowed by suturing to promote faster healing.
  • 15. 15 W O U N D Healing under scab:  This healing takes place in superficial wound where inner tissue is not damaged but only the skin is damaged. Example superficial wound like abrasion exudates dries up on the surface forming a crust / scab  The healing takes place beneath the scab.  Do not remove the scab - hemorrhage
  • 16. 16 W O U N D Management of Wound Basic Principles of Infected Wound Treatment Strategies are as follows. 1. Debridement: The procedure will help manage septic wound by providing access to the depth of the wound.  All necrotic tissue debris and foreign materials should be removed until clean healthy tissue margin is achieved. 2.Lavage: After removal of necrotic debris, healthy exposed tissues should be adequately irrigated with NSS or 2% H2o2
  • 17. 17 W O U N D  If the wound has accumulated exudate using catheters, or rubber tubes. Incision for drainage should be on the direct route possibly away from tendons and major blood vessels.  Drainage of large volume of fluid from wounds should be done slowly.  The wound space should be filled with sterile bandages dipped in betadine or Povidone iodine and removed after 24-48 hrs.  Regular dressing is advised daily to prevent infection. 3. Wound Drainage:
  • 18. 18 W O U N D 4. Antimicrobial Therapy:  Infected wound should be treated with antibiotics based on CST.  Intravenous loading dose of antibiotics should be continued for 10-14 days. 5. Sterile Protective Bandaging: is a good practice to avoid infection with opportunistic organisms and to prevent environmental contamination.
  • 19. 19 W O U N D 1.Control of hemorrhage - Tourniquet - Thermocautery - Crushing with forceps - Torsion of vessel - Ligation/ligature - Injection - Vitamin K SA @0. 5 – 1 ml im LA @ 10 –20 ml im - calcium 5 – 10 ml in DNS General Line of Wound Treatment
  • 20. 20 W O U N D TRASHI DELEK