1. Wound Healing Objectives:
Indicate terms relevant to wound healing
Summarize the possible complications of wound healing
Recognize the classifications of surgical wounds
Indicate and give examples of types of traumatic wounds
Analyze the factors that influence healing and recognize the manner in which
affect the healing process
6. Recognize the characteristics of inflammation

2. Wound
Any tissue that has been damaged by either intentional (surgical) or accidental (traumatic) means

3. Classification of Surgical Wounds
Class I - Clean
Incision made under ideal conditions
No break in sterile technique during procedure
Primary closure
No wound drain
No entry to aerodigestive tract or genitourinary tract

4. Class II – Clean Contaminated
Primary closure
Wound drained
Minor break in sterile technique occurred
Controlled entry to aerodigestive, biliary or genitourinary tract

5. Class III - Contaminated
Open traumatic wound (less than 4 hours old)
Major break in sterile technique
Acute inflammation present
Entry to aerodigestive tract or genitourinary tract with spillage

6. Class IV – Dirty/Infected 
Open traumatic wound (more than 4 hours old)
Microbial contamination prior to procedure
Perforated viscus

7. Surgical Wound classification is subject to change during the procedure according to the situation. The final wound classification is assigned at the end of the procedure and is included in the permanent documentation.

8. TRAUMATIC WOUNDS
Closed wound
Open wound

9. CLOSED WOUND
The skin remains intact, but underlying tissues suffer damage

10. OPEN WOUND The integrity of the skin is destroyed
Simple wound – The integrity of the skin is destroyed, there is no loss or destruction of tissue and there is no foreign body in the wound.
Complicated wound – Tissue is lost or destroyed, or a foreign body remains in the wound.
Clean wound – Wound edges can be approximated and secured. A clean wound is expected to heal by first intention.
Contaminated wound – Contamination occurs when a dirty object damages the integrity of the skin. Debridement of necrosed tissue may be necessary.

11. Mechanism of Injury: Abrasion Contusion Laceration Puncture Thermal
Another way of classifying traumatic wounds

12. Chronic Wounds
Those that persist for an extended period of time. A chronic wound may develop because of an underlying physical condition that the patient suffers from or it may be due to infection

13. Inflammatory Response
Inflammation is the body’s protective response to injury or tissue destruction, it serves to destroy, dilute, or wall off the injured tissue…
Classic local signs:
Pain
Heat
Redness
Swelling
Loss of function

14. Types of Wound Healing First intention Second intention
Third intention

15. Phase I Lag Phase/Inflammatory Response Phase
Phase II Proliferation Phase
Maturation or Differentiation phase
See page

16. Factors Influencing Wound Healing
Age
Nutritional Status
Disease (acute, Chronic)
Smoking
Radiation exposure
Immunocompromised

17. Second Considerations (Intraoperative)
Length and direction of incision
Dissection technique
Duration of Surgery
Amount of tissue handling
Achievement of hemostasis
Precise tissue approximation
Elimination of dead space
Secure wound closure

18. Third consideration (Aseptic Technique)
Microbial contamination, could lead to infection, increase in morbidity or mortality

19. Complications of the Healing Wound
Dehiscence
Friable
Evisceration
Hemorrhage
Infection
Adhesion
Herniation
Fistula
Sinus tract
Suture complications
Keloid scar Pg

20. Intraoperative Wound Care
Sterile Techniques
Proper suturing techniques
Wound drains
Different types of dressings

21. Postoperative Wound Care
Wound Drains
Dressings
Packing