Kevin P. Kilgore, M.D., FACEP. The process of wound care involves t evaluation t plan t action Overview Kevin P. Kilgore, M.D., FACEP.

Kevin P. Kilgore, M.D., FACEP

The process of wound care involves evaluation plan action

Overview


ObjectivesObjectives Discuss the process of wound evaluation Review the materials used for wound

repair Discuss “simple” wound closure Discuss wound aftercare items

Objectives


When did this happen? time

Where did this happen? location

How did this happen? mechanism

History


allergies current medications pre-existent medical conditions immunization status for tetanus

History


The “golden period”

A misnomer with: meticulous debridement copious irrigation antibiotic coverage

History


MechanismMechanism shear tension compression missile injuries a combination of shear,

tensile, and compressive

History


ShearShear

Sharp tissue division Little energy required Lower infection rate Cosmetics acceptable

History


TensionTension

Compression injury Less than 90o Triangular flap Increased infection Poor result

History


CompressionCompression

Crushing injury Significant injury Increased infection Poor results

History


Environment protective dressing gloves, gowns, goggles good lighting

goal - determine extent of injury

Examination


Extent of injuryExtent of injury amount of tissue loss tissue viability depth of the wound presence of any associated injuries

Examination


Depth of injuryDepth of injury Injury to underlying structures?

nerves tendons muscles bone

Examination


Lacerations over bonesLacerations over bones probe with a gloved finger to determine

whether or not there is a fracture. If a wound overlies a fracture site an open

fracture should be assumed present.

Examination


DeepDeep structurestructure injury injury puncture wounds of the head, neck and

torso must be managed on the premise that there has been penetration and damage to vital structures.

Examination


AnesthesiaAnesthesia Topical

TAC or XAP Local

1% buffered xylocaine bupivocaine

Regional (nerve block) 1% buffered xylocaine bupivocaine

Techniques


Irrigation & debridementIrrigation & debridement The single most important element of basic

wound care. Intent:

remove devitalized tissue remove potential nidus for infection

Techniques


PreparationPreparation Generally, an iodophor solution (e.g.,

Betadine 10%) Sterile draping is imperative

Techniques


InstrumentsInstruments four basic instruments

needle-holder forceps scissors towels

Techniques


Suture materialsSuture materials Absorbable Sutures

employed below the skin Polyglycolic acid (Dexon®)

Nonabsorbable Sutures nylon (dermalon®, ethilon®) surgelene® novifyl®

Techniques


Other closure materialsOther closure materials Steri-Strips® and Shur-strips® Surgical staples Dermabond

Techniques


Size SelectionSize Selection face, hands or feet - 5-0 and 6-0 trunk and extremity - 4-0 and 5-0

Techniques


Suture techniquesSuture techniques Subcuticular Closure

Dexon® or Vicryl®, are used for this deep layer closure.

Cuticular Closure

Techniques


Subcuticular ClosureSubcuticular Closure

Techniques


Simple SutureSimple Suture

easiest to learn safest & most effective more time needed

Techniques


Wound Edge EversionWound Edge Eversion

Techniques


Instrument TieInstrument Tie

Techniques


Dressings Immobilization Medications Antibiotics Tetanus Prophylaxis Rabies Prophylaxis Discharge Instructions

Completing Care


Suture RemovalSuture Removal face 3 to 5 days ear 4 to 6 days scalp 7 to 12 days trunk 7 to 12 days arms 10 to 12 days legs 10-12 days hand 10 to 12 days feet 10 to 14 days

Completing Care


Discuss the process of wound evaluation Review the materials used for wound repair Discuss “simple” wound closure Discuss wound aftercare items

Remember to remove your sharps from the tray

Objective Review


Now to the LabNow to the Lab

Kevin P. Kilgore, M.D., FACEP. The process of wound care involves t evaluation t plan t action Overview Kevin P. Kilgore, M.D., FACEP.

Documents

instruments t

objectives t

preparation t

t intent

time t

location t

injury t significant

tension t compression