Acute Wound Management - hsmedlife

 

From the Latin word plaga, the wound is a skin lesion that manifests itself by an opening in the skin. It can be the consequence of a trauma, minor or severe, or of a pathological process.   

There are two categories of wounds

 

Acute wounds.

They can be defined as sores of sudden onset and of short duration. They include burns, post-operative wounds   linked to a surgical intervention. Or traumatic wounds following an accident, such as cuts, lacerations, but also bites / scratches, frostbite and insect bites. For acute wounds, the physiological healing process lasts between 2 and 4 weeks.   

Chronic wounds

They include leg ulcers, diabetic foot ulcers or bedsores. Their chronic nature is explained by the presence of an associated pathology which is at the origin and which slows down the healing process. This then requires medical treatment of the cause and the wound. Venous and / or arterial insufficiency, diabetes, prolonged immobility associated with undernutrition, deterioration of the general condition, incontinence. Can thus be at the origin of these wounds which take longer to heal (up to 210 days on average). Age is also a risk factor in the appearance of these wounds and for slowing down healing (read our article on “Risk factors”). 



Regardless of the level of damage to the different layers of the skin, each wound - acute or chronic - requires appropriate attention and care. Indeed, the slightest opening of the skin - which is a protective barrier for the human body - exposes it to bacterial contamination and, therefore, to the risk of infection. Examples of acute wounds or abrasions, cuts, blisters, burns, as well as nosebleeds and surgical wounds belong to acute wounds. Acute wounds are difficult to heal on their own, and sometimes, despite treatment, have difficulty healing or recur. They are then called chronic wounds.  

HOW TO OBSERVE A WOUND

Care must be taken to observe the wound to determine the appropriate prescription to allow it to heal / heal. Here are the steps for diagnosis:  
1- LOCATION:
The anatomical area of   the wound is decisive, it must be taken into account and communicated with colleagues in the patient's care path.  
2-SIZE:
The size of his wound is actually its area. It is expressed in centimetres or millimetres on the model: length x width x depth. These parameters must be measured precisely to obtain comparative data.   An illustrated photo: observation  
 3- CLINICAL ASPECT (GRANULATION, NECROSIS, ETC.):
This involves determining the appearance and viability of the tissue to make a first inventory and then follow the healing process qualitatively and quantitatively in order, ultimately, to assess the effectiveness of the treatment.  
4- OUTLINE (INFLAMMATORY, MACERATED, IRRITATED, ETC.):
The condition of the surrounding area of   the wound provides key information on the dressings to be prescribed as well as being able to anticipate the potential for complications (local infection, dermatitis, etc.) and the level of protection of this fragile skin area.  
5- SECRETIONS:
It is the volume of secretions as well as their color and consistency that must be provided. The category of primary or secondary dressings that will be chosen for treatment will depend on this. One should also pay attention to the smell of the exudate.  
6- SCALABILITY AND CHANGE IN APPEARANCE:
Remember to take pictures of the evolution of each phase of the healing process!  
7-UNDERMINING OR CREVICES:
When deep, the wound should be inspected gently with forceps or a buttoned probe. This inspection must be done regularly because crevices can occur after the trauma. A peeling under the skin or a dead space that would not have been noticed can quickly lead to an infection. Warning!   
8- PAIN:
The patient's pain must be taken into consideration for a better quality of care, but also for a better quality of diagnosis! Pain related to the wound should be listed. Pain can be a sign of infection.   


Warning! If you experience any of the following, you should call for a specialist diagnosis:


  • Very extensive superficial wound (15 cm² or more in adults). This is the size threshold that should alert you. 


  • Very deep wound (appearance of bone, cartilage or tendons). It is the observation of crevices that should alert you. 
  • Wound located on the friction surfaces. Location criterion.
  • Wound on an old scar with radiotherapy sequel (Location).
  • Stagnant wound (observing scalability).
  • Infected wound with secretions of pus and symptoms of inflammation around the wound (observation of the perimeter + secretions).
  • Blood flow disturbance (clinical aspect)

Monitoring of the dressing:

The healthcare professional must regularly monitor the patient's pain but also the mobility that he retains with the dressing and the general comfort of his situation. It is also necessary to observe the good behaviour of the dressing and its tightness.  

Wound Treatment

Acute wound refers to the tissue damage or defect caused by the body after creation, often forming wounds or wounds. Properly handled, the repaired tissues are mostly the original cells, the re-repairing process is rapid and the function is repaired well. 

If not handled properly, it may lead to wound infection and incision dehiscence, which will eventually turn into scar healing, hyperpigmentation or chronic wounds. Our usual traditional method of acute wound treatment is dry treatment, which usually uses ethanol gauze, mercuromethalin or Vaseline gauze. 

In the past, it was generally believed that wound healing requires a dry environment and oxygen, but research and practice have shown that dry healing is not only easy to dehydrate and scab the wound due to a poor healing environment, but is not conducive to epithelial cell crawling, and biologically active substances are lost, resulting in the speed of healing. Slow.

In addition, the adhesion between the wound and the dressing causes pain and granulation tissue damage when changing the dressing, which is not conducive to the normal healing of the wound.

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