Surgical Wound care

Tarja BergforsRN for surgical nursing

M.Ed.ScTurku University of Applied Science

Postoperative wound managementPostoperative wound management

Classification of woundsClassification of wounds

Wound's ageWound's age- acute woundacute wound =vulnusvulnus, chronic wound, chronic wound

=ulcusulcus - fresh wound - fresh wound vulnus recens vulnus recens < 6 h< 6 h

- outdated wound- outdated wound vulnus inveteratumvulnus inveteratum > 6 > 6 hh

- chronic wound- chronic wound 2-3kk2-3kk

Wound's depthWound's depth- - a simple wounda simple wound =vulnus simplexvulnus simplex- - Complicated wound =Complicated wound = vulnus complicatumvulnus complicatum- - the body cavity extending woundthe body cavity extending wound =vulnus vulnus

penetranspenetrans- - penetrating woundpenetrating wound =vulnus perforansvulnus perforans

Stages of wound healingStages of wound healing

1.1. phase ofphase of inflammatory=inflammatory= Phase von entzündlichen

2. phase of proliferative2. phase of proliferative = = Phase der proliferativen

3. phase of remodeling=3. phase of remodeling= Phase der Umgestaltung

Inflammatory PhaseInflammatory Phase

A) Immediate to 2-5 daysA) Immediate to 2-5 days B) Hemostasis B) Hemostasis Vasoconstriction Vasoconstriction Platelet aggregation Platelet aggregation Thromboplastin makes clot Thromboplastin makes clot C) InflammationC) Inflammation Vasodilation Vasodilation Phagocytosis Phagocytosis

Proliferative Phase Proliferative Phase A) 2 days to 3 weeksA) 2 days to 3 weeks

B) Granulation B) Granulation Fibroblasts lay bed of collagen Fibroblasts lay bed of collagen Fills defect and produces new capillaries Fills defect and produces new capillaries

C) Contraction C) Contraction Wound edges pull together to reduce defect Wound edges pull together to reduce defect

D) Epithelialization D) Epithelialization Crosses moist surface Crosses moist surface Cell travel about 3 cm from point of origin in all Cell travel about 3 cm from point of origin in all directionsdirections

Remodeling PhaseRemodeling Phase

A) 3 weeks to 2 years A) 3 weeks to 2 years

B) New collagen forms which B) New collagen forms which increases tensile strength to wounds increases tensile strength to wounds

C) Scar tissue is only 80% as strong C) Scar tissue is only 80% as strong as original tissueas original tissue

Factors affecting wound Factors affecting wound healinghealing……

The principles of correct wound careThe principles of correct wound care 1. 1. The patient (age, health status, The patient (age, health status, lifestylelifestyle ))

22. Aseptic. Aseptic

3. Instruments3. Instruments Tissue oxygenationTissue oxygenation Wound locationWound location (crook=Falte) Type and amount ofType and amount of missing tissue missing tissue (mucous=(mucous=Schleimhaut)

Factors affecting wound Factors affecting wound healinghealing

TemperatureTemperature Classification of purity (how clean the Classification of purity (how clean the

wound is)=wound is)= Klassifizierung der Reinheit Technical issuesTechnical issues (hematoma, surgical (hematoma, surgical

technique, stitchestechnique, stitches )) Decreased immune responseDecreased immune response

(=Verminderte Immunabwehr?) Nutritional factorsNutritional factors = Ernährungsfehler

Postoperative wound managementPostoperative wound management

Traumatic wound

Postoperative wound managementPostoperative wound management

Circulation = Blutzirkulation Bleeding and haematoma Tight suturing = Enge Naht Swelling of the wound=Schwellung der

Wunde Monitoring the drain The signs of wound infections=die

Anzeichen von Wundinfektionen Pain= Schmerz

Wound management after surgeryWound management after surgery

Aseptic principlesAseptic principles Fresh wound < 24 hours: if it’s Fresh wound < 24 hours: if it’s

needed to open because of bleeding, needed to open because of bleeding, use sterile equipments and materialsuse sterile equipments and materials

Possible to remove dressings > 24 Possible to remove dressings > 24 hours: use factory clean gloves or an hours: use factory clean gloves or an instrumentinstrument

Insert dressing or tape or can be Insert dressing or tape or can be without any dressingwithout any dressing

Infected surgical wound

ComplicationsComplications

Hematoma Hematoma

- - sometimes develops into wound, usually sometimes develops into wound, usually heals by itselfheals by itself

- - where appropriate, puncturewhere appropriate, puncture Rupture ofRupture of wound

- - either before or after removal of the either before or after removal of the suturessutures

- - cause deterioration of tissue resistance,cause deterioration of tissue resistance, InfectionsInfections

Infected surgical woundInfected surgical wound Surgical site infections are generalSurgical site infections are general (4 (4

– 10% )– 10% ) Superficial wound infectionsSuperficial wound infections Deep wound infectionsDeep wound infections Body infectionsBody infections Wound infections depends on the Wound infections depends on the

presence of surgery and purity(clean) presence of surgery and purity(clean) classesclasses

Antibiotics by mouth

Infected surgical wound

Identification of an infected Identification of an infected woundwound

Redness,flushes,swelling,painRedness,flushes,swelling,pain Bad secretionBad secretion

Leak sensitivity is increasingLeak sensitivity is increasing

The wound surface is broadened and The wound surface is broadened and deepeneddeepenedimprovement/healing process slowsimprovement/healing process slows

Surgical drainSurgical drain

a drain removes a drain removes blood and other blood and other fluids from a fluids from a surgical woundsurgical wound

Monitor that:Monitor that: the drain is on it’s the drain is on it’s

placeplace it’s openit’s open the vacum is the vacum is

workingworking

Surgical drainSurgical drain

Monitor that: skin area is

clean (disinfection solution if it’s not clean)

cover with dressing

measure the bleeding

document!

Removing a drainRemoving a drain

Inform the patientInform the patient Pain medicationPain medication Remove the suture or tapeRemove the suture or tape Close the drain and draw it out in line Close the drain and draw it out in line

with the drain tubewith the drain tube New dressingNew dressing

Thank you! Děkuji vám! Kiitos!

ReferencesReferences

Lewis, Collier and Heitkemper.1996. Medical –Lewis, Collier and Heitkemper.1996. Medical –Surgical Nursing. Assessment and management Surgical Nursing. Assessment and management of clinical problemsof clinical problems..

Worley C. 2005. So, what do I put on this wound? Worley C. 2005. So, what do I put on this wound? Dermatology Nursing 17(4), 299-300.Dermatology Nursing 17(4), 299-300.

Kozier, Erb; Berman & Snyder. 2009. Kozier, Erb; Berman & Snyder. 2009. Fundalmentals of Nursing. Wound care. Prentice Fundalmentals of Nursing. Wound care. Prentice Hall.Hall.

Hietanen H, Iivanainen A, Seppänen S & Hietanen H, Iivanainen A, Seppänen S & Juutilainen V. 2009. Haava. WS Bookwell, Porvoo. Juutilainen V. 2009. Haava. WS Bookwell, Porvoo.

Iivanainen A, Jauhiainen M & Pikkarainen P. 2011. Iivanainen A, Jauhiainen M & Pikkarainen P. 2011. Sairauksien hoitaminen terveyttä edistäen. Sairauksien hoitaminen terveyttä edistäen. Helsinki, Tammi.Helsinki, Tammi.