Surgery Book



Aka: Wound, Wound Healing, Skin Wound
  1. See Also
    1. Chronic Wound
    2. Laceration Repair
    3. Wound Closure with Staples
    4. Wound Infection
    5. Foot Wound
    6. Leg Ulcer Causes
    7. Decubitus Ulcer
  2. Types
    1. Acute wounds
      1. Surgical wound
      2. Penetrating wound (e.g. knife or Bullet Wound)
      3. Avulsion Injury (e.g. Finger Tip Amputation)
      4. Crushing or shearing Injury
      5. Burn Injury
      6. Laceration (See Laceration Repair)
      7. Bite wound (e.g. Dog Bite, Cat Bite, Human Bite)
    2. Chronic Wounds
      1. Arterial Ulcer (Peripheral Vascular Disease)
      2. Venous Ulcer (Venous Insufficiency)
      3. Pressure Ulcer (Decubitus Ulcer)
      4. Diabetic Foot Ulcer (Neuropathic Foot Ulcer)
      5. Lymphedema
  3. Physiology: Wound Healing Stages
    1. Hemostasis and Coagulation (days 0-3)
      1. Bleeding stops with Vasoconstriction and Clotting Factors
    2. Inflammation (days 1 to 25)
      1. Wound site is red, swollen, warm and painful as a result of influx of Cytokines, growth factors and white cells
      2. Chronic Wounds are typically stuck in this stage
    3. Proliferation (days 1 to 25)
      1. Type III Collagen is deposited, granulation and epithelialization, and Angiogenesis result in wound closure
    4. Maturation and Remodeling (days >20)
      1. Scar remodels with type 1 and 3 deposited, resulting in increased scar strength
  4. Classification
    1. Class 1 Wound
      1. Surgical incisions in a sterile environment, not involving gastrointestinal, genitourinary or respiratory tract
    2. Class 2 Wound
      1. Surgical incisions into normal tissue that is colonized with Bacteria
      2. Involves gastrointestinal, genitourinary or respiratory tract
    3. Class 3 Wound
      1. Wound contains foreign or potentially infectious matter (typical Laceration)
    4. Class 4 Wound
      1. Infected wounds
  5. Prognosis: Factors associated with impaired Wound Healing
    1. Chronic Disease
      1. Diabates Mellitus
      2. Peripheral Vascular Disease
      3. Chronic Renal Failure
    2. Malnutrition
      1. See Nutrition in Wound Healing
    3. Immunosuppression
      1. Topical Corticosteroids (e.g. Triamcinolone)
      2. Systemic Corticosteroids over 10 mg per day
      3. Chemotherepeutics (e.g. Methotrexate)
    4. Petrolatum or vaseline (however, good skin protectant)
    5. Topical Antiseptics
      1. Topical Alcohol
      2. Hexachlorophene
      3. Povidone-Iodine 1% (Betadine 1%)
      4. Hydrogen Peroxide 3%
      5. Chlorhexidine 0.5%
    6. Topical hemostatic preparation
      1. Monsel's Solution (Ferric Subsulfate)
      2. Aluminum Chloride 30%
      3. Silver Nitrate
  6. Prognosis: Factors associated with improved Wound Healing
    1. Skin Lubricants and ointments (e.g. Eucerin, Aquaphor)
    2. Silver sulfadiazine (Silvadene cream)
    3. Topical antibiotic (e.g. Bacitracin)
      1. Avoid neosporin due to Allergic Contact Dermatitis
      2. Bacitracin is also associated with Hypersensitivity Reactions
    4. Nonadherant Dressing (e.g. Telfa)
    5. Honey
      1. Partial thickness burns heal more rapidly
      2. Effective on C-Section surgical sites
      3. Effective on herpes and zoster lesions
      4. Decreases Diabetic Foot Ulcer odor
      5. Antimicrobial activity
        1. MRSA activity (Manuka honey)
        2. E. coli
        3. Pseudomonas
        4. Salmonella typhi
        5. Streptococcus Pneumoniae
        6. Vibrio species
        7. Candida
      6. References
        1. Jull (2015) Cochrane Database Syst Rev 6(3): CD005083 +PMID: 25742878 [PubMed]
  7. Management
    1. See specific wound types
    2. See Wound Cleansing
    3. See Wound Debridement
    4. See Wound Dressing
    5. Indications for hospital management (or emergent Consultation)
      1. Sepsis
      2. Critical Limb Ischemia
      3. Necrotizing Fasciitis
      4. At risk for Sepsis or Critical Limb Ischemia
        1. Progressive, refractory local infection
        2. Large area of involvement (e.g. Burn Injury)
        3. Insurmountable barrier to outpatient management (e.g. homeless, financial limitations)
        4. Osteomyelitis (esp. exposed bone, probe to bone positive)
    6. Indications for urgent wound clinic evaluation
      1. Wounds requiring significant Debridement (e.g. grossly infected wounds, necrotic material, deep wounds)
        1. Typically refer to general surgery
      2. Full thickness Burn Injury
        1. Refer to burn center if >9% involvement
    7. Indications for non-urgent wound clinic referral
      1. Stable, Chronic Wounds with barriers to healing
        1. Scars from prior wounds, radiation
        2. Higher risk locations (e.g. creases)
      2. Specialized equipment or advanced therapy needed
        1. Off-loading measures (e.g. full contact Casting, advanced Wound Dressings)
    8. Other referrals
      1. Vascular surgery
        1. Critical for ischemic limbs before Debridement, compression
      2. Dermatology (or biopsy)
        1. Atypical wounds suspicious for cancer, vascular lesions
      3. General surgery
        1. Extensive surgical Debridement
        2. Large Hematomas
        3. Hidradenitis Suppurativa
      4. Podiatry
        1. Diabetic Foot Ulceration
  8. Course: Wound Healing
    1. Epithelialization (Sealing of wound) by 48 hours
    2. Peak Collagen formation by 7 days
    3. Expect wound to be 30% smaller by 4 weeks, and healing by 12 weeks
      1. Wound tensile strength 20% of full by 3 weeks
      2. Wound tensile strength 60% of full by 4 months
      3. Wound tensile strength never exceeds 80% of full
    4. Mature scar forms by 6 to 12 months
    5. Factors suggesting increased Wound Healing time
      1. See impaired Wound Healing above
      2. Increased wound width
      3. Wounds created by destructive technique
        1. Cryosurgery
        2. Electrosurgery
        3. Laser surgery
  9. References
    1. Cole (2017) Wound Care Update, Park Nicollet Conference, St Louis Park, MN (attended 9/15/2017)
    2. Bello (2000) JAMA 283(6): 716-8 [PubMed]
    3. Degreef (1998) Dermatol Clin 16(2): 365-75 [PubMed]
    4. Findlay (1996) Am Fam Physician 54(5): 1519-28 [PubMed]
    5. Habif (1996) Clinical Derm, Mosby, p. 810-13
    6. Knapp (1999) Pediatr Clin North Am 46(6):1201-13 [PubMed]
    7. Krasner (1995) Prevention Management Pressure Ulcers
    8. Lewis (1996) Med-Surg Nursing, Mosby, p. 199-200
    9. Lueckenotte (1996) Gerontologic Nurs., Mosby, p. 800-7
    10. PUGP (1995) Am Fam Physician 51(5):1207-22 [PubMed]
    11. PUGP (1994) Pressure Ulcer Treatment, AHCPR 95-0653
    12. Way (1991) Current Surgical, Lange, p.95-108

Wound Healing (C0043240)

Definition (NCI) Restoration of diseased or damaged tissues naturally by healing processes.
Definition (CSP) restoration of integrity to traumatized tissue.
Definition (MSH) Restoration of integrity to traumatized tissue.
Definition (GO) The series of events that restore integrity to a damaged tissue, following an injury. [GOC:bf, PMID:15269788]
Concepts Organism Function (T040)
MSH D014945
SnomedCT 18867006, 271617006, 298005009
English Healing, Wound, Healings, Wound, Wound Healing, Wound Healings, Repair, NOS, Structure resulting from tissue repair process, heal, healing, repair tissue, wound heal, healing wounds, heals wounds, repairing tissues, repairs, wound healing, healed wounds, heals, healings, repairing, repair, tissue repair, Wound healing (finding), Wound healing, Healing, Observation of wound healing, Finding of wound healing (finding), Finding of wound healing, Healing following injury, Repair following injury, Structure resulting from tissue repair process (morphologic abnormality), Tissue repair, Healing following injury, NOS, Repair following injury, NOS, Tissue repair, NOS, Wound healing, NOS, Wound Repair
Swedish Sårläkning
Czech rány - hojení
Finnish Haavan paraneminen
French Guérison de blessure, Cicatrisation de blessure, Réparation de blessure, Cicatrisation
Spanish hallazgo relacionado con la curación de una herida, hallazgo relacionado con la curación de una herida (hallazgo), curación de una herida - hallazgo, curación de la herida - hallazgo (hallazgo), curación de la herida - hallazgo, curación de una herida, reparación hística, reparación tisular, cicatrización, cicatrización luego de una lesión, estructura originada en un proceso de reparación tisular, curación de herida, curación de herida (hallazgo), estructura originada en un proceso de reparación tisular (anomalía morfológica), Cicatrización de Heridas
Latvian Not Translated[Wound Healing]
Portuguese Cicatrização, Cicatrização de Ferimentos, Cicatrização de Feridas
Polish Gojenie się ran
Norwegian Not Translated[Wound Healing]
German Wundheilung
Italian Cicatrizzazione di ferita
Dutch Genezing, wond-, Wondgenezing
Derived from the NIH UMLS (Unified Medical Language System)

Wound of skin (C0564444)

Concepts Injury or Poisoning (T037)
SnomedCT 262526004
English skin wound (symptom), skin wound, surface wound, wound skin, Wound;skin, skin wounds, Skin wound, Wound of skin, Surface wound, Wound of skin (disorder)
Czech Kožní rána
Dutch huidwond
French Plaie cutanée
German Hautwunde
Hungarian Bőrön keletkezett seb
Italian Ferita cutanea
Spanish Herida cutánea, herida de piel (trastorno), herida de piel, herida de superficie
Japanese 皮膚創傷, ヒフソウショウ
Portuguese Ferida na pele
Derived from the NIH UMLS (Unified Medical Language System)

wound care (C0886052)

Definition (PNDS) Examines characteristics of wound sites and provides appropriate wound care
Definition (CCC) Actions performed to support open skin areas
Definition (NIC) Prevention of wound complications and promotion of wound healing
Definition (ALT) Caring for a patient's wound(s) by cleaning, applying dressing(s) and/or bandage(s) to his or her wound(s).
Definition (ALT) Managing and/or caring for a patient's wound(s).
Concepts Therapeutic or Preventive Procedure (T061)
SnomedCT 42149003, 225358003, 367070007, 367297009
English wound care (treatment), Wound care (regime/therapy), rnrx wound care (treatment), rnox wound care, rnrx wound care, rnox wound care (treatment), wound care procedure, caring wound, rnox perform wound care, rnox perform wound care (treatment), Wound Care, Wound care (procedure), Administers care to wound sites, Wound care, wound care, Wound management, wound mgmt
Spanish atención de herida, atención de herida (régimen/tratamiento), atención de una herida, atención de una herida (procedimiento)
Derived from the NIH UMLS (Unified Medical Language System)

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