What is Wound Defination ,Wound Classification-Clean wounds,Clean-contaminated wounds,Contaminated wounds,Dirty wounds,Acute and Chronic Wounds,Primary and Secondary Intention All these topic covered in this artical.
What is Wound Defination ?
Wound is a break in the continuity of any bodily tissue due to violence, where violence is understood to encompass any action of external agency, including, for example, surgery. Within this general definition many subdivisions are possible, taking into account and grouping together the various forms of violence or tissue damage.
“The most important distinction is between open and closed wounds. Open wounds are those in which the protective body surface (the skin or mucous membranes) has been broken, permitting the entry of foreign material into the tissues. In closed wounds, by contrast, the damaged tissues are not exposed to the exterior, and the process of repair can take place without the interference that contamination brings, in greater or lesser degree. Further divisions may be made on the basis of the mode of production of the wound.Now be discussed about Wound Classification.
There are several ways for Wound Classification. In the hospital setting, surgeons often do Wound Classification according to their degree of apparent contamination and infection risk:
Clean wounds are generally surgical wounds in which no inflammation or infection are encountered.
Clean-contaminated wounds, also typically surgical wounds, are those in which the gastrointestinal, respiratory, genital, or urinary tract are entered without resulting in unusual contamination.
Contaminated wounds include fresh accidental wounds as well as surgical wounds in which acute inflammation is encountered or sterile procedure is not properly followed.
Dirty wounds include accidental wounds that retain dead tissue or are infected, and surgical wounds complicated by existing infection or organ perforation.
Difference between Acute and Chronic Wounds
Acute wounds can result from surgery or accidental trauma. Examples include clean incisions and common uncomplicated traumatic lacerations, abrasions, and punctures that heal with standard care. An acute injury can become a chronic wound.
Chronic wounds are defined by their persistence, often failing to heal for weeks or months. Chronic wounds often fail to progress through the normal healing stages because of an underlying disease process. Common causes include reduced oxygen supply to the wound site due to poor blood flow, prolonged inflammation, poor cellular response to reparative stimuli, and infection. Infections from chronic wounds can spread to surrounding tissues or enter the bloodstream and become widespread.
Mitochondrial dysfunction may also impair wound healing. Because they provide energy for all cellular metabolic processes, including cell division, mitochondria play a critical role in the healing process. They also produce reactive oxygen species, which kill bacteria and participate in cell signaling during wound healing.
Common types of chronic wounds
Common types of chronic wounds include:
- Diabetic foot ulcers
- Venous ulcers (such as from venous insufficiency)
- Arterial ulcers (such as from atherosclerosis)
- Bedsores (pressure ulcers)
Primary and Secondary Intention
Wound Classification can also be classified by the way they are managed:
Primary intention involves closure of the wound or surgical incision such that the edges of the wound are in direct contact and can reconnect with minimal need for new tissue synthesis. Primary intention best preserves the integrity of tissues surrounding the wound and reduces scarring, but can only be performed on surgical and some limited other wounds soon after they are inflicted.
Secondary intention is used for wounds with edges that cannot be brought together because of extensive tissue loss. This is a longer process in which the open wound heals through the formation of new connective tissue and small blood vessels (granulation tissue) and the laying down of new superficial (epithelial) cells. Healing by secondary intention results in more inflammation and susceptibility to infection than healing by primary intention. Examples of wounds generally left to heal by secondary intention include pressure ulcers and diabetic ulcers. Secondary intention healing leads to more scar formation.
Delayed primary intention
Delayed primary intention (sometimes called tertiary intention) is a technique used for contaminated wounds, in which the wound edges are not brought together right away. This allows time for the cells of the immune system to remove dead and contaminated tissue from the wound before it is closed. Delayed primary intention involves aspects of both primary and secondary wound management.