1. Principles of Wound Management
define aetiology
control factors influencing healing
select appropriate dressing or device
plan for maintenance.

2. Wounds seen in General Practice
trauma: abrasions and cuts
superficial partial thickness burns
venous leg ulcers
arterial leg ulcers
foot wounds often associated with neuropathy and neuro-ischaemia
skin cancers.
Generally do not see: pressure injuries or dehisced surgical wounds

3. Factors Influencing Healing
poor nutrition
Infection/inflammation
ongoing trauma
incorrect cleansing and dressing
underlying disease processes.

4. Other Factors Related to Delayed Wound Healing
age
debris and foreign bodies in the wound
smoking
wound tissue too dry or too wet
pain
psychological issues.

5. Decision Making Tools
Select the most appropriate dressing according to:
Tissue colour
Wound depth
Exudate level
Periwound skin condition
Predicted weartime
Skill of carer
Availability/cost of product

6. Same thing mostly yellow: discuss percentages for documentinh and what does it need?6

7. What does this wound need? Debridement or cleaning?7

8. Discuss infected wounds and what do infected wounds need? Systemic antibiotics according to biopsy and safe topical agents
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10. World of Wounds 10

11. What does this wound need? Protection and possibly some hydration.
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12. Ideal Dressing provide mechanical protection
protect against secondary infection
non adherent and easily removed without trauma
leave no foreign particles in the wound
remove excess exudates
cost effective
offer effective pain relief.

13. Generic Names calcium alginates hydrofibre hypertonic salt
cadexomer iodine
silver
medicated honey
zinc bandages

14. Case Studies
skin tear
burn
venous ulcer
arterial ulcer
foot wound.

19. Skin Tear: 3

20. Burns: First Contact Assessment site depth surface area involved
age of patient
other influencing factors

21. What is reasonable to care for in general practice?
small superficial partial burns not involving face, feet, hands, perineum, genitalia on the very young or the elderly
further guidelines and very good advice may be found on the NSW DoH Website for Severe Burn Injury or ringing Concord Burns Unit

22. Superficial Burn Characteristics
epidermis only
erythema (vasodilatation)
tenderness (nerve irritability)
oedema.

23. Superficial Partial Burn Characteristics
epidermis and outer dermis
blisters (fluid shift)
shedding of skin
painful exposed (nerve endings to kinins)
bleeds when pricked with needle
hair present (hard to pull out)
full sensation
blanches on pressure.

24. Burn Surface Area Wallace’s rule of nines Lund and Browder chart
closed palmar hand of victim = 1% of body surface area.

25. Anatomical Site Considerations
hands
feet
face
perineum
genitalia
joints
circumferential burns
All these areas require special consideration to prevent cosmetic and functional problems secondary to hypertrophic scaring. 25

26. Other Considerations
extremes of age: very young or very old will need special care
co-morbidities
medications.

27. Lower Leg Ulceration Statistics venous 70% arterial 10% mixed 10%
skin cancers 2%
others 8%

28. World of Wounds 28

29. Arterial Ulcer Characteristics
usually located between ankles and toes or high up on leg or posterior leg
deep, punched out regular shape, often dry
thin, shiny, non hair bearing skin
thickened toenails
diminished or absent foot pulses
elevation pallor, dependant rubor
necrotic tissue, infection
pain, especially at night or when elevated.

30. World of Wounds