Surgical Wound care Tarja Bergfors RN for surgical nursing M.Ed.Sc Turku University of Applied Science

Postoperative wound management

Classification of wounds Wound's age acute wound =vulnus, chronic wound =ulcus - fresh wound vulnus recens < 6 h - outdated wound vulnus inveteratum > 6 h - chronic wound 2-3kk Wound's depth - a simple wound =vulnus simplex - Complicated wound = vulnus complicatum - the body cavity extending wound =vulnus penetrans - penetrating wound =vulnus perforans

Stages of wound healing 1. phase of inflammatory= Phase von entzündlichen 2. phase of proliferative = Phase der proliferativen 3. phase of remodeling= Phase der Umgestaltung

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

Proliferative Phase A) 2 days to 3 weeks B) Granulation Fibroblasts lay bed of collagen Fills defect and produces new capillaries C) Contraction Wound edges pull together to reduce defect D) Epithelialization Crosses moist surface Cell travel about 3 cm from point of origin in all directions

Remodeling Phase A) 3 weeks to 2 years B) New collagen forms which increases tensile strength to wounds C) Scar tissue is only 80% as strong as original tissue

Factors affecting wound healing… The principles of correct wound care 1. The patient (age, health status, lifestyle ) 2. Aseptic 3. Instruments Tissue oxygenation Wound location (crook=Falte) Type and amount of missing tissue (mucous=Schleimhaut)

Factors affecting wound healing Temperature Classification of purity (how clean the wound is)= Klassifizierung der Reinheit Technical issues (hematoma, surgical technique, stitches ) Decreased immune response (=Verminderte Immunabwehr?) Nutritional factors = Ernährungsfehler

Postoperative wound management

Traumatic wound

Postoperative 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 redness, pain, heat and swelling of the wound and periwound area. These signs are also seen in the normal inflammatory response, but usually decrease after the first few days. Tight suturing can tear the skin. Verenkierto (ihon väri, lämpö, tunto) Verenvuoto (kuulto, läpi), hematooma, serooma Turvotus, ompeleiden kiristyminen Kudoseritteen määrä, laatu, väri Dreenin eli laskuputken tarkkailu Paikallisinfektion oireet Kipu KIRJAAMINEN!

Wound management after surgery Aseptic principles Fresh wound < 24 hours: if it’s needed to open because of bleeding, use sterile equipments and materials Possible to remove dressings > 24 hours: use factory clean gloves or an instrument Insert dressing or tape or can be without any dressing

Infected surgical wound redness, pain, heat and swelling of the wound and periwound area

Complications Rupture of wound Infections Hematoma - sometimes develops into wound, usually heals by itself - where appropriate, puncture Rupture of wound - either before or after removal of the sutures - cause deterioration of tissue resistance, Infections

Infected surgical wound Surgical site infections are general (4 – 10% ) Superficial wound infections Deep wound infections Body infections Wound infections depends on the presence of surgery and purity(clean) classes Antibiotics by mouth

Infected surgical wound

Identification of an infected wound Redness,flushes,swelling,pain Bad secretion Leak sensitivity is increasing The wound surface is broadened and deepened improvement/healing process slows

Surgical drain a drain removes blood and other fluids from a surgical wound Monitor that: the drain is on it’s place it’s open the vacum is working

Surgical drain Monitor that: skin area is clean (disinfection solution if it’s not clean) cover with dressing measure the bleeding document!

Removing a drain Inform the patient Pain medication Remove the suture or tape Close the drain and draw it out in line with the drain tube New dressing

Thank you! Děkuji vám! Kiitos!

References Lewis, Collier and Heitkemper.1996. Medical –Surgical Nursing. Assessment and management of clinical problems. Worley C. 2005. So, what do I put on this wound? Dermatology Nursing 17(4), 299-300. Kozier, Erb; Berman & Snyder. 2009. Fundalmentals of Nursing. Wound care. Prentice Hall. Hietanen H, Iivanainen A, Seppänen S & Juutilainen V. 2009. Haava. WS Bookwell, Porvoo. Iivanainen A, Jauhiainen M & Pikkarainen P. 2011. Sairauksien hoitaminen terveyttä edistäen. Helsinki, Tammi.