Concept of Wounds

CONCEPT OF WOUNDS A. Wound Damage to the normal anatomical structure and function of the skin, including damage to the continuity of the skin, mucous membranes and bones or organs due to pathological processes originating internally and externally which will cause loss of all or part of organ function, sympathetic stress response, bleeding and blood clotting, bacterial contamination, and cell death. B. Classification 1. Based on the length of healing time, wounds are divided into 2 types, namely: a. Acute Wounds Acute wounds are traumatic wounds that usually receive immediate treatment and usually heal well if there are no complications. The criteria for an acute wound are a new, sudden wound and healing within the estimated time. Examples are cuts, burns, stab wounds b. Chronic Wounds Acute wounds are wounds that last a long time or often recur or there is interference with the healing process which is usually caused by multi-factorial problems in the sufferer. In chronic wounds, wounds fail to heal in the expected time, do not respond well to therapy and have a tendency to recur. Examples are leg ulcers, venous ulcers, arterial ulcers (ischemia), peripheral vascular disease decubitus ulcers, peripheral neuropathy decubitus ulcers 2. According to the degree of contamination of the wound: a.Clean Wounds(clean wound) Namely an uninfected surgical wound where there is no inflammatory process (inflammation) and infection (closed wound). b.Clean - contaminated Wounds(Clean wound contaminated) is a surgical wound. c.Contaminated Wounds(contaminated wound) Including open, fresh wounds, wounds resulting from accidents and operations with major damage. d.Dirty or Infected Wounds(Dirty or infected wound) namely the presence of microorganisms in the wound. 3. Based on its nature: a. Acute Wounds. Acute wounds are wounds that heal within the expected time period or in other words according to the concept of healing. Acute wounds can be categorized as: a. Acute surgical wounds, for example: incision, excision and skin graft. b. Acute non-surgical wounds, for example: Burns. c. Acute wounds due to other factors, for example: abrasion, laceration, or injury to the superficial skin layers. b. Chronic Wounds. Chronic wounds healing is delayed or even fails. Examples: Decubitus wounds, diabetic wounds, and leg ulcers.is wound Which process 4. Based on Network Loss. a. Superficial; The wound is only limited to the epidermis layer. b. Partial (partial-thickness); The wound includes the epidermis and dermis layers. c. Full (full-thickness); Wounds include the epidermis, dermis and subcutaneous tissue material and can also involve muscles, tendons and bones. 5. Based on Stadium. a. Stage I The epidermis layer is intact, but there is erythema or discoloration. b. Stage II. Superficial skin loss with damage to the epidermis and dermis layers. Erythema in the surrounding tissue that is painful, hot and edematous. Slight to moderate exudate. c. Stage III. Loss of tissue up to sub-cutaneous tissue, with the formation of cavities, moderate to large exudate. d. Stage IV. Loss of subcutaneous tissue with the formation of a cavity involving muscles, tendons and/or bones. Moderate to heavy exudate. C. Wound assessment (Wound Assessment) 1.Exudate(quantity and type) 2.Odor(smell) 3.Wound edges(edge of the wound) 4. Periwound skin 1. Color (erythema, white, bluish) 2. Texture (moist, dry, induration, maceration) 3. Skin temperature (warm, cold) 4. Integrity of the wound area 5.Presence or absence of local signs of infection (signs of infection) 6.Wound pain(pain in wounds) D. Type of tissue in the wound 1. Necrotic (black dead tissue around the wound) 2. Escar (dry, thick and hard black tissue) 3. Callus (hard tissue around the wound) 4. Slough (necrotic tissue, fibrinous, yellow) 5. Granulation tissue E. Wound Healing Phase 1. Coagulation and Inflammation Phase (0-3 days).Coagulation is the first response that occurs shortly after injury occurs and involves platelets. The release of platelets will cause vasoconstriction. This process aims at homeostasis thereby preventing further bleeding. The release of platelets will cause vasoconstriction. The next inflammatory phase occurs a few minutes after the injury occurs and continues for about 3 days. The inflammatory phase allows the movement of leukocytes (mainly neutrophils). Neutrophils then phagocytose and kill bacteria and enter the fibrin matrix in preparation for the formation of new tissue. 2. Proliferation or Reconstruction Phase (2-24 days). If there is no infection or contamination in the inflammatory phase, then the healing process then enters the proliferation or reconstruction stage. The main objectives of this phase are: a. Granulation process (to fill empty space in the wound). b. Angiogenesis (growth of new capillaries). Clinically, redness will appear on the wound. Angiogenesis occurs simultaneously with fibroplasia. Without the process of angiogenesis healing cells cannot migrate, replicate, fight infection and form or deposit new matrix components. c. Contraction process (to pull the two edges of the wound close to each other). According to Hunt (2003) contractions are physiological events that cause closure of open wounds. Contractions occur simultaneously with collagen synthesis. The results of the contraction will be visible where the size of the wound will appear to be getting smaller or merging. 3. Remodeling or Maturation Phase (24 days-1 year). This phase is the last and longest phase in the wound healing process. Collagen synthesis and degradation activities are in balance. Collagen fibers gradually increase and become thicker and are then supported by proteinase for repair along the wound line. Collagen is the main element in the matrix. Collagen fibers spread by bonding and uniting and gradually support tissue recovery. F. Wound Care Aseptic technique which aims to clean the wound from debris to speed up the wound healing process. The treatment provided is to provide warmth and a moist environment to the wound. Moist conditions on the wound surface can improve the process of developing wound repair, preventing tissue dehydration and cell death. This condition can also increase interactions between cells and growth factors. 1. Goals of Wound Care a) Increase the wound healing process b) Prevent infection 2. Types of Wound Treatment a) Conventional Wound Treatment Conventional dressing is a wound dressing that uses gauze as the main dressing. This bandage is a passive material with its main function as protection, maintaining warmth and covering an unpleasant appearance. Apart from that, gauze dressings are also used to protect wounds from trauma, protect the wound area, or to pressure the wound and the area around the wound and prevent bacterial contamination. Conventional dressings are changed twice a day. b) Modern Wound Treatment Modern dressings work by maintaining moisture and warmth in the wound area. This condition can increase the process of angiogenesis, cell proliferation, granulation and epithelialization. The types of dressings used in modern wound care are Calcium Alginate, Hydrogel, Hydrocolloid, Foam, Transparent film, etc. Wound dressing is adjusted to the condition and results of exudation in the wound. Modern dressings are changed every 2-3 days.Modern wound care uses semi occlusive, full occlusive and impermeable dressings based on considerations of cost, comfort and safety. Benefits of Modern Wound Care a) Prevent wounds from becoming dry and hard. b) Reduce pain when changing bandages. c) Increases the rate of epithelialization. d) Prevents the formation of scar tissue e) Can reduce the incidence of infection. f) The dressing does not need to be changed every day (Cost effective). g) Provides psychological benefits. h) Easy to use and safe