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Wound Mnagement

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Submitted By paulbaalham
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Wound Management

1 What is a wound?
A wound is defined as the disruption of the normal anatomical structure and function of tissue. Or it could be described more simply as any physical injury involving a break in the skin.

A partial thickness injury would be one that is limited to the epidermis and superficially the dermis. There is no damage to the dermal blood vessels.

A full thickness injury incorporates damage to the epidermis and dermis, with damage to the dermal blood vessels and deep tissue layers.

Wounds can be acute or chronic.
An acute wound can be an injury from surgery or trauma and would expect to heal in a month.
A chronic wound would be one that shows no sign of healing after a month. This may be due to underlying disease such as diabetes mellitus or circulatory disorders.
Some biomechanical abnormalities can slow the healing process.

2 What are the basics of wound care?
Wounds should be kept 1, clean 2, moist 3, well nourished (pressure needs to be kept off the wound)

Careful observation is needed on removal of any dressings, and notes should be taken recording any the appearance, drainage, granulation and location of the wound.
Records need to be made of any cleansing agents and debridement agents used. Also all dressings that are applied need to be listed.

Wound cleaning and irrigation, The aims are to facilitate the removal of foreign bodies. debridement To reduce pathogen numbers. To remove blood and necrotic tissue.

Irrigants are used to cleanse the wound and removes debris with as little irritation as possible. The safest and most natural irrigant is Saline Solution, There are also a range of antiseptics available, but care needs to be taken as some can slow the healing process whilst some may even be toxic to tissue. Chlorhexedine at 0.05% is possibly the safest and widest antiseptic used.
After cleansing, the wound needs to be dressed. The function of the dressing is to stop bleeding (hemostasis), protect, support and absorb. Ideally dressings should be easy to apply and easy to remove.

A wound will heal better in a moist environment, so hydrocolloid and hydrogel dressings can be useful, however, hydrocolloids have a limited absorption capacity, and, as they are occlusive they should not be used badly infected wounds that excrete large amounts of exudate.
For wounds with large amounts of exudate, absorption dressings should be used. Dressings such as foam, gauze, hydrofibers and alginates may be useful.
Partial thickness wounds can be dressed with semipermeable transparent adhesive films which will help maintain a moist healing environment.

A good blood supply is also needed to aid healing, so dressings should not be applied to tightly and as little pressure as possible applied to the wound.

3 What is ABPI and why is it important?
ABPI is the Ankle Brachial Pressure Index, also known as the ankle to arm systolic pressure index. It is the most common non invasive diagnostic test used on a suspect lower limb.
The index is calculated by measuring the maximum systolic pressure at the ankle by taking the highest of either the dorsalis or posterior tibial with a hand held Doppler then dividing by the systolic pressure in the brachial artery.
ABPI is important as it measures blood flow pressure (circulation) to the lower limb. It can indicate if there problems such as atherosclerosis or any other peripheral arterial disease.

4 Describe the Wagner Classification
The Wagner classification enables you to grade foot lesions in order of severity. Grade 0 skin intact but bony deformities produce a 'foot at risk.' Grade 1 localised, superficial ulcer. Grade 2 deep ulcer to tendon, bone, ligament, or joint Grade 3 deep abscess, osteomyelitus Grade 4 gangrene of the toes or forefoot Grade 5 gangrene of entire foot

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