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

2. Postoperative wound management

3. 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- outdated wound vulnus inveteratum 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

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

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

6. 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

7. 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

8. 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)

9. 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

10. Postoperative wound management

11. Traumatic wound

12. 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!

13. 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

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

15. 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

16. 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

17. Infected surgical wound

18. 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

19. 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

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

21. 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

22. Thank you!
Děkuji vám!
Kiitos!

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